Vol 20, No 2 (2018)
- Year: 2018
- Articles: 51
- URL: https://bakhtiniada.ru/1682-7392/issue/view/777
- DOI: https://doi.org/10.17816/brmma.372
Articles
Influence of various degrees of normobaric hypoxia on the physical working capacity of a person
Abstract
Man’s performance of various tasks in mountainous terrain often involves a high-intensity physical load. The influence of an artificial gas medium depleted in oxygen content (corresponding to an altitude of 2500 m above sea level) on the physical working capacity of a person under normal atmospheric pressure was studied. It has been established that the exercise of the veloergometric load of the stepwise increasing power (PWC170 sample) under these conditions leads to the development of mild hypoxic hypoxia, manifested in a decrease in oxygen saturation and an increase in the heart rate with unchanged bloodpressure and working efficiency. Finding a person in conditions of an artificial gas medium corresponding to an oxygen content of 4500 m above sea level at a normal barometric pressure is accompanied by the development of a moderate degree of hypoxic hypoxia with a more pronounced decrease in oxygen saturation and an increase in the heart rate. During the performance of the veloergometric test under these conditions, the PWC170 sample index decreases 1,4 times compared to the background indicators. The received results testify that the development of acute normobaric hypoxia of mild degree does not render essential influenceon physical working capacity of the person, and moderate hypoxia - reduces it. The proposed method can be used to assess the influence of various degrees of hypoxia on the tolerance of physical activity by a person and serve as one of the criteria for the professional selection of specialists for special purposes (military personnel, climbers, geologists, etc.), and to determine the degree of man’s readiness to perform tasks associated with exercise in the mountainous terrain.
Bulletin of the Russian Military Medical Academy. 2018;20(2):7-9
7-9
New diagnostic criteria for assessing homeostasis in patients with respiratory tuberculosis
Abstract
The search for available informative criteria for diagnosing the state and dynamics of the homeostatic equilibrium of the organism, which began at the end of the XIXth century, continues to the present. Scientific research establishes the priorities for the study of homeostasis in the clinic and its control over the supra-segmental regulatory centers of the autonomic nervous system. The proposed functional, instrumental, immunological, biochemical and hormonal methods for evaluating it in phthisiology for various reasons, including economic ones, cannot be used fully. The modern clinic needs accessible and informative criteria for homeostasis. The theoretical basis for their development was the doctrine of the general adaptation syndrome, which revealed the reaction of «stress» to extreme irritants. The subsequent discovery of changes in the body’s homeostasis to the effect of strong, medium strength, and weak stimuli has made it possible to identify three more types of adaptation reactions: the training reaction, the activation reaction, and the re-activation reaction. At the Department of Phthisiopulmonology of the FirstSt. PetersburgStateMedicalUniversity named after Acad. I.P. Pavlov proposed and tested new diagnostic criteria for homeostasis. They were developed on the basis of quantitative and qualitative characteristics of the formed elements of peripheral blood. Among them, in addition to these types of adaptive reactions of the body, leukocyte- lymphocyte index, indices of monocytogram, degree of disturbance of homeostasis and types of reactivity of the organism were introduced. These criteria allowed us to determine not only the state of homeostatic equilibrium of the organism, but also to assess the depth of its disturbance and the types of reactivity of the organism. Their use in daily clinical work provides an opportunity to monitor the course of the disease and carry out a personified correction by means of pathogenetic therapy.
Bulletin of the Russian Military Medical Academy. 2018;20(2):10-15
10-15
Features of changes in physiological and psychophysiological indices, as well as of the physical efficiency of the heart, depending on the degree of neurotism in hypoxic conditions
Abstract
Features of hypoxia tolerability by persons with different levels of neurotism are presented. It was found that changes on physiological parameters such as heart rate, arterial pressure and saturation of arterial blood in persons with a high level of neurotism are more pronounced in conditions of hypoxia. In particular, to the 25-30th min. when they stay in altitude chamber, heart rate is enlarged by 38% (p<0,01) from initial. The persons with the low level of a neyrotizm, the augmentation of heart rate doesn’t exceed 28% (p<0,01). This compensatory physiological reaction helps maintain arterial blood saturation in people with high neurotism by 5,3% (p<0,05) more, at people with a low degree of neurotism. However, at the same time at examinees with a high level of neurotism, in comparison with persons with the low level of a neyrotizm more expressed decrease of working capacity of a myocardium on 23,4%. In addition, in persons with a high degree of neurotism, there is a more pronounced negative dynamics of an increase in the time of a complex sensomotorny reaction to 41,57 ms (p<0,05) from background level, while in persons with low neurotism only by 26,19 ms (p<0,05). Thus, at assessment of an acceptability of a hypoxia, it is necessary to take into account the dependence of changes physiological and psychophysiological indicators and also physical effeciency of heart from degree neyrotizm.
Bulletin of the Russian Military Medical Academy. 2018;20(2):16-20
16-20
Semantic differential of time among women affected with disease caused by the human immunodeficiency virus
Abstract
Аbstract. The possibility of using the semantic differential of time for revealing the prevailing, including the little-understood, tendencies in the actual mental state and the relation of the individual to reality is known, since it is known that the unity of the individual in the destiny of man is realized by the semantic unity of the past, present and future time in their subjective differentiated meaning. The differences in the perception of the past, present and future time by patients in the dynamics of their disease caused by the human immunodeficiency virus have been revealed depending on the receipt of antiretroviral therapy. The study of time factors allowed to differentiate the features of the mental state of these women in the dynamics of the disease. It is established that the ideas about the future of the time in healthy and sick persons in the period of relative remission of their disease are similar. It is characterized by them in a single semantic structure. However, the existing differences in comparing the perception of future factors by patients and practically healthy women suggest that patients have a higher motivational component for the future. The mechanisms of the formation of those components of self-awareness (knowledge and understanding of oneself) in women affected with disease caused by the human immunodeficiency virus, which are related to the concepts and properties of psychological time, are specified and concretized. The results obtained can be used to predict psycho-social adaptation of patients in the dynamics of the disease. This is a prerequisite for conducting preventive psychological measures to reduce the risk of negative clinical dynamics of the disease, primarily because the patient is not just a complex combination of various pathological and pathophysiological processes, but first of all a person is a person in need of a return to full biological and social activity.
Bulletin of the Russian Military Medical Academy. 2018;20(2):21-27
21-27
Features of a functional state and special working capacity, highly skilled athletes, taking into account type of the vegetative regulation of a cordial rhythm
Abstract
The results of research of high-speed, speed-strength abilities and special anaerobic endurance in highly skilled male and female athletes are presented. It is established, that the indices of physical working capacity depend on the type of vegetative regulation of the heart rhythm. Athletes (male and women), who have the same level of skill with moderate dominance of central mechanisms vegetative regulation of a cordial rhythm, significantly higher speed-strength indicators. In particular, for men, with moderate dominance of central mechanisms vegetative regulation of a cordial rhythm (1 type), during the work in the anaerobic mode, gather higher speed, which on 4,1% is statistically higher in comparison with athletes with moderate domination of the autonomous mechanism of regulation of a cordial rhythm (3 type). At the same time, the time of achievement of frequency of rotation of pedals of a veloergometer, equal 70% of the maximum size, they on 3% (р<0,05) less. The women, with the 1 type of a regulation of a cordial rhythm, indicators of absolute, average and relative power (р<0,05) on 1,6; 2,6 and 8,9 higher. With an increase in the duration of anaerobic work, the indices of special endurance are statistically reliably higher in athletes with moderate dominance of the autonomous regulatory mechanism. For example, for men, the indicator of total work power on 4,2% higher, and indicators of maximum, average and relative power by 2,4;2,9 and 1,9%, respectively (p<0,05). The women, with type III multiple scores, the rates were significantly higher by 3,2; 4,2;4,1; 3,6%, respectively (p<0,05).
Bulletin of the Russian Military Medical Academy. 2018;20(2):28-32
28-32
Experience in conducting aftercare for children with consequences of neuroinfections on the basis of the Science Research Institute of Сhildren Infections
Abstract
The experience of medical rehabilitation for children who have undergone neuroinfections and other disorders of the central and peripheral nervous systems on the basis of the Children’s Scientific and Clinical Center of Infectious Diseases is presented. The importance of this problem is determined by the high degree of disability of children with lesions of the nervous system. Based on this center, a two-stage system of medical rehabilitation of children was developed and organized, which transferred the neuroinfections. The first stage is carried out directly in the profile department intended for the treatment of neuroinfections. In this department, children with diseases of the nervous system prevail, infectious and parasitic diseases accounting for 70.2 and 17.6%, respectively. The second stage of medical rehabilitation is conducted in the profile 55-bed rehabilitation department of day and night stay. The department is equipped with robotic medical diagnostic devices. In this department, not only those children who have undergone neuroinfections can be treated, but also with a number of complications arising from other diseases. A two-stage system of medical rehabilitation of children, created on the basis of the Children’s Scientific and Clinical Center for Infectious Diseases, is an exemplary model of providing medical rehabilitation for children. Nevertheless, there was a significant excess of the load on this department for such indicators as: the average length of stay of the patient on the bed, and also the average annual employment of the bed both at the first stage of medical rehabilitation and at the second stage. The data obtained during the study indicate the need to develop and expand the network of these institutions.
Bulletin of the Russian Military Medical Academy. 2018;20(2):33-35
33-35
Experience of dermatological patients’ treatment in the psychosomatic unit
Abstract
The patients’ attitude to the possibility of combining the traditional treatment of the basic dermatological disease with psychotherapeutic methods, based on the results of medical and social research, is determined. A social portrait of a dermatological patient of a psychosomatic department has been drawn up, which requires an individual approach in the treatment process. Of all the examined patients, 38,5% of patients had a dermatologic diagnosis, included in the rubric«Dermatitis and eczema». In the structure of psychiatric pathology, the greatest contribution (30,6%) was made by disorders related to the International Classification of Diseases of the 10th revision to the heading «Organic, including symptomatic psychiatric disorders». The combination of anxious and depressive states have 23,9% of patients, depression - 19,6%, anxiety - 13,1% of the patients surveyed. Anxiety disorders are more common in women than in men - 22,7% versus4,2%. In addition, 13% assess their mood as poor, and 56,5% as satisfactory. It was found that 67,4% of patients consider treatment in the psychosomatic department more effective than in the usual dermatological department. 65,2% of patients note improvement of their psycho-emotional background from the moment of treatment start. It has also been established that patients understand the causes of their underlying illness and the importance of comprehensive treatment that is, both treating the dermatological disease and correcting the mental status with the help of various psychotherapeutic techniques. The compliance of patients with the use of methods of psychotherapeutic influence was revealed. 73,9% of patients note the importance of the psychotherapeutic approach during the inpatient phase of treatment, and 50% expressed a desire to continue receiving psychotherapeutic counseling after discharge from the hospital.
Bulletin of the Russian Military Medical Academy. 2018;20(2):36-39
36-39
The role of early prosthetic help in the system of rehabilitation of the military personnel with military trauma: organizational, legal and methodical aspects
Abstract
The role and the place of early use of technical means of rehabilitation in the system of complex rehabilitation of patients and disabled people owing to a military trauma is considered. Need of early providing the needing persons with technical means of rehabilitation is proved during recovery treatment, including before establishment by him of disability and formation of the individual program of rehabilitation and an abilitation of disabled people. The efficiency of the developed non-plaster technology of prosthetics manufacturing techniques of artificial limbs of the lower extremities is proved by express method, options of her execution are offered. The first option of production of products on this technology consists in use of polymeric silicone covers and the water-hardening polymeric bandage directly on the patient’s stump. The second option of prosthetics is applied at some defects and diseases of a stump excluding application of silicone covers and full contact individual reception sleeves. For this purpose at production of medical and training artificial limbs of a shin and hip adjustable demountable reception sleeves from thermolayers for right-and left-side amputating defects are used. These options of prosthetics by express method are innovative, are aimed at early rendering the prosthetic and orthopedic help to patients with amputating defects. At production of artificial limbs on these technology domestic materials, modular and not modular accessories are used. The modular complete set of medical and training artificial limbs provides fast and individual setting up the scheme of construction, the individual choice of combinations of functional elements taking into account group of physical activity of the patient, a possibility of replacement of a reception sleeve and any of product elements without withdrawal of an artificial limb at the user. In need of service of a product, for example repair, replacement of the module (artificial foot, a knee) there is no requirement of urgent production of a similar design. Adjustable reception sleeves for primary artificial limbs of a shin and hip in the form of a standard series and moisture-curing bandage can add the list of products of medical appointment in laying for expansion of medical institutions during the special period.
Bulletin of the Russian Military Medical Academy. 2018;20(2):40-47
40-47
Matrix metalloproteinase-9 blood level as a predictor of post-stroke cognitive impairment
Abstract
Ischemic stroke is one of the leading causes of disability of the population. Among the consequences of stroke besides motor, speech disorders, the most important cause of cognitive impairments, it’s frequency is variable between 25-40%. Post-stroke cognitive disorders are pathogenetically heterogeneous conditions. The nature, modality and severity are determined by the clinical subtype of it’s development. So, cognitive impairment most often can be a consequence of a strategic infarcts, multi-infarct damage, decompensation of chronic cerebrovascular pathology against the background of an acute condition or neurodegenerative process that existed earlier and diagnosed before the appearance of any signs of stroke. In addition, the subtype of ischemic stroke also matters. In stroke, a family of zinc-binding proteolytic enzymes, in particular matrix metalloproteinase-9, plays a significant role in the development of damage of the brain tissue, which is of great importance in the reconstruction of the extracellular matrix. A high serum concentration of metalloproteinase-9 increases the severity of ischemic damage, the severity of the stroke and worsens the functional outcome of the disease. In addition, metalloproteinase-9 is also considered as a biomarker for Alzheimer’s disease, since it acts as a proteolytic enzyme, which, along with neprilizine, cleaves the amyloid protein. The results of a survey of 135 patients in the acute and early recovery period of ischemic stroke are presented. The level of metalloproteinase-9 and cognitive impairment have been studied on 1-2 and 21-22 days of the disease. It was found that a higher level of metalloproteinase-9 in blood plasma reflects a high probability of post-stroke cognitive impairment at the end of an acute period of ischemic stroke. The increase in metalloproteinase-9 did not depend on the localization of the focus of the stroke and its volume. Thus, metalloproteinase-9 investigation in the acute period of the ischemic stroke can predict the development of post-stroke cognitive decline.
Bulletin of the Russian Military Medical Academy. 2018;20(2):48-54
48-54
T2*-magnetic resonance relaxometry of the liver in the quantitative assessment of iron overload
Abstract
For objective quantitative assessment of iron overload in 60 patients with hemochromatosis of different genesis, T2*-magnetic resonance relaxometry of the liver was performed. The results of the latter were compared with the concentration of serum ferritin, which is by far the most common marker of iron overload. It has been established that T2*-magnetic-resonance relaxometry is a non-invasive, highly effective method of objective quantitative assessment of iron overload in patients of the hematological profile, in comparison with the serum ferritin concentration, which is not specific, since its change can be influenced by inflammatory and neoplastic processes in The organism, often found in patients with oncohematological profile. Thus, according to T2*-magnetic resonance relaxometry of the liver, all patients were divided into two groups: with iron overload and with no overload, the latter among the total number of subjects was 13,3%. The explanation of the increase in serum ferritin concentration in these patients was the presence of identified inflammatory foci in the body. In most patients (86,6%), iron overload was confirmed by T2*-magnetic resonance relaxometry measurements. However, at each degree of overload, there was no clear regularity in the proportional increase in serum ferritin concentration of the intensity of pathological changes revealed by T2*-magnetic resonance relaxometry. Thus, ferritin cannot remain a reliable marker for iron overload. In general, magnetic resonance T2 *-relaxometry provides the most accurate estimate of the degree of iron overload in the liver. T2*-magnetic resonance relaxometry should be included in the protocol of examination of patients with suspicion of the presence of iron overload.
Bulletin of the Russian Military Medical Academy. 2018;20(2):55-58
55-58
State of the lipid spectrum and coagulation system of blood in patients with obliterating atherosclerosis of vessels of the lower extremities living in mountain conditions near uranium tailings
Abstract
In Kirgizstan, radionuclides enter the environment from rock dumps and uranium tailings. Therefore, the problem of adaptation, life, preservation, working capacity of the population in these conditions is of great scientific and practical important. Тhe prevalence of diseases associated with disorders of endothelial disfunction and the hemostasis system. In the pathogenesis of these diseases the activation of the blood coagulation and thrombosis play the main role. We investigated the relationship of lipid metabolism and coagulation system of blood of patients with obliterating atherosclerosis of vessels of lower extremities, with concomitant arterial hypertension, who live in the mountains in close proximity to uranium tailings. It was found that this category has changes in the lipid profile, manifested by a high level of both atherogenic (total cholesterol, low density lipoprotein cholesterol) and high-density lipoprotein cholesterol fractions. These patients have revealed trends in hyper coagulation of the plasma mechanism of hemostasis, in the form of shortening of prothrombin, thrombin and activated thromboplastin time with hypefibrinogenemia amid a downward trend in fibrinolytic activity. Complex, statistically significant correlation between lipid profile and coagulation components of homeostasis. According to the results of the study, it is recommended to conduct an annual dispensary observation of the population living in mountainous conditions near uranium tailings for early detection and timely treatment of endothelial dysfunction and homeostasis system.
Bulletin of the Russian Military Medical Academy. 2018;20(2):59-62
59-62
Features of the hormone-receptor interaction in the endometrium during ovulatory menstrual cycle in women with reproductive failure
Abstract
A comparative analysis of the levels of estradiol and progesterone in the blood, immunohistochemical parameters of estrogen receptors and progesterone in endometrium in women with a history of reproductive disorders is presented. It was found that all women had an ovulatory ovarian cycle, levels of estradiol and progesterone in the blood were within the reference values. In women with reproductive failures in the history (n=107), four types of hormone-receptor response in the endometrium were identified. In 46 (43%) women, the first (normoreceptor) type of endometrial response was detected, without significant differences from the control group (n=15) corresponding to the middle stage of the secretion phase. Hyperreceptor (hyper-estrogen-progesterone-receptor, hyper-estrogen-receptor, hyper-progesterone-receptor) types have been identified in 61 patients (57%) with reproductive dysfunctions. The endometrium corresponded to the mid secretory phase was detected in 47 (44%), inadequate secretory phase of the endometrium - in 60 (56%) women with reproductive failures in the anamnesis. All women in the control group had a full secretory change in the endometrium. In general, more than half (61 (57%)) of women with reproductive failures in the history with the ovulatory menstrual cycle with normal values of the level of progesterone in the blood showed signs of a decreased endometrial receptivity status. This indicates that the ovulatory level of progesterone in the blood is not an unconditional predictor of full secretory transformations of the endometrium.
Bulletin of the Russian Military Medical Academy. 2018;20(2):63-67
63-67
Case of surgical treatment of the heavy nonspecific ulcer colitis complicated by massive bleeding
Abstract
Complex treatment of patients with nonspecific ulcerative colitis is one of the most difficult problems of modern gastroenterology and is characterized by ulcerative-destructive changes of its mucous membrane. The main indications for surgical treatment of patients with nonspecific ulcer colitis are its complications, as well as the inefficiency of multi-component conservative therapy. The case of treatment of a young patient suffering from ulcerative colitis complicated by bleeding is considered. The possibility of performing radical surgical interventions for complications of ulcerative colitis is shown. One of the most dangerous, life-threatening complications of ulcerative colitis is bleeding. Most operations in patients with bleeding are performed urgently in extremely adverse conditions, due not only to the severity of bleeding, posthemorrhagic anemia and significant violations of hemostasis, but also the presence of concomitant complications of nonspecific ulcerative colitis, as well as associated multiple organ dysfunction. Thus, during the hospitalization of the patient, which amounted to 48 days, the patient underwent 11 open surgical interventions. For proper treatment it took more than 25 liters of blood products. Attention is paid to the favorable long-term result of treatment of patients with this pathology. In the treatment of this category of patients should be aware of the possibility of using minimally invasive technologies. The urgency of the problem under consideration is increased due to the steady increase in the incidence of nonspecific ulcerative colitis, which is naturally accompanied by an increase in the frequency of complications and disability of patients, a significant part of whom are the most efficient and socially active patients aged 20-40 years, with the causes and mechanisms of their development are not fully known.
Bulletin of the Russian Military Medical Academy. 2018;20(2):68-71
68-71
Forensic medical characteristic of the stromal component of myocardial tissue in cases of death from alcoholic cardiomyopathy
Abstract
A histological examination of the stromal component of myocardial tissue, which is one of the main components of the histohematological barrier, in cases of alcoholic cardiomyopathy, revealed a set of morphological changes, the development of which is caused by a cascade of pathological processes which were resulted from prolonged toxic effects on the cardiac muscle of ethanol and its metabolites. Morphological changes of the stromal component of the histohematological barrier of the myocardium in the form of metabolic and replaceable sclerosis have been revealed. The immediate role in the processes of the formation of metabolic sclerosis, manifested as perimuscular cardiosclerosis and perivascular cardiosclerosis, is played by hypoxia, caused by the toxic effect of ethanol and its metabolites on the main structural components of the vascular walls of the microcirculatory bed with the development of their increased permeability. Sclerosis processes during the formation of pleximorphic cardiosclerosis in alcoholic cardiomyopathy are of a substitutionary nature, the development of which is associated with the alteration of cardiomyocytes, caused both by direct toxic effects on the myocytes of ethanol and its metabolites, and by progressive hypoxia phenomena. The revealed features of the spread of pleximorphic cardiosclerosis in the myocardium testify to the mosaic damage of the cardiac muscle in alcoholic cardiomyopathy. It is established that the relative area of the stroma of the myocardium does not depend on the age and sex belonging to those who died from alcoholic cardiomyopathy. The relative area of the stroma was almost the same in all the dead and did not have significant differences.
Bulletin of the Russian Military Medical Academy. 2018;20(2):72-75
72-75
Analysis of decreased bioelectric activity of a brain with pharmacoresistant epilepsy
Abstract
High-frequency bioelectrical activity in pharmacoresistant epilepsy is analyzed. It has been established that pathologic high-frequency oscillations are a potential marker of the epileptogenic zone. We propose a classification of pathological high-frequency oscillations: 1) continuous high-frequency oscillations; 2) modulated pathological high-frequency oscillations, associated with slow waves; 3) modulated pathological high-frequency oscillations, associated with spikes. An example illustrating the application of the analysis of high-frequency bioelectrical activity for the localization of the epileptogenic zone in the widespread irritative zone is given. Variants of interrelation of the regions generating pathological high-frequency activity and epileptic activity in the range up to 70 Hz are demonstrated. Recording of epileptic activity in the frequency range up to 70 Hz is not an exclusive criterion of the epileptogenesis. Recording of modulated pathological high- frequency oscillations associated with spikes allows the differentiation of two spike types. We can assume that the mechanism for generating spikes containing high-frequency component differs from the one for plain spikes. The generators of the pathological high-frequency oscillations are characterized by a smaller size, which should allow more precise localization of the focus of pathological activity. In some cases, the analysis of the high-frequency component of the electrocorticogram makes it possible to differentiate the secondary irritative zone. It has been demonstrated that in patients with extratemporal, especially frontal, epileptogenic zone localization pathological high-frequency oscillations provide additional information about the location of the generator of abnormal activity.
Bulletin of the Russian Military Medical Academy. 2018;20(2):76-80
76-80
Influence of arterial hypertension on intrauterine development of the fetus
Abstract
The results of monitoring the course of pregnancy in women suffering from arterial hypertension and preventive measures focused on problems associated with hypertension are analyzed. It is shown that hypertension does not occur in pregnant women under 18 years old, but with the increasing of age of pregnant women, its occurrence is sharply increased. It was revealed that arterial hypertension during pregnancy creates not only a threat of preeclampsia and eclampsia development, but also a threat of defective development of the fetus. It was found that 26 (46%) parturient women undergone cesarean section. In this case, in 12 (21%) pregnant pre-natal development of the fetus was abnormal. After giving birth, the women in childbirth were under the supervision of a cardiologist and received appropriate treatment. 25 (45%) of women had another pregnancy after the treatment. Among the re-pregnant women, who before the onset of pregnancy received treatment in a specialized cardiological clinic, only 5 (20%) were prescribed to caesarean section. The remaining 80% of parturients gave birth naturally. Stillbirth and spontaneous miscarriages were not observed. Out of 25 newborns, only 3 (12%) children were found to have congenital malformations. Thus, in women with arterial hypertension and receiving appropriate treatment in cardiology hospitals, the indications for cesarean section were 26% less, also there were 10% perinatal development defects less than in women who did not receive such a treatment. Consequently, pregnant women suffering from hypertension should be monitored not only by an obstetrician-gynecologist, but also by cardiologist, nephrologist, ophthalmologist and endocrinologist.
Bulletin of the Russian Military Medical Academy. 2018;20(2):81-85
81-85
Characteristics of imported malaria in the Astrakhan region
Abstract
Epidemiological situation of imported malaria in the Astrakhan region for 2000-2016 is characterized. It is established that during this period, 90 cases of malaria were registered in the Astrakhan region, including 70 (77,8%) cases of imported malaria. Imported malaria was registered in both adults and children (53 (75,7%) and 17 (24,3%) cases, respectively). 65,7% of cases of imported malaria in the Astrakhan region falls on the urban area. Most cases (25,6%) of cases of malaria were registered in persons living in the Leninsky district, 2 times less often - in the Soviet and Kirov districts (17,1 and 15,7%, respectively) and in 1 (1,4%) cases - from the city of Astrakhan, who lived in the Trusovsky District. In rural areas of the Astrakhan region, imported malaria was recorded in 34,3% of cases, 10% in Narimanov, Krasnoyarsk -8,6%, Akhtuba - 5.7%, Kharabalin - 4,3%, Chernoyarsk - 2,9% , Liman and Kamyzyzk regions - 1,4% each. In 2 (2,9%) cases, imported malaria was registered in persons who do not have a permanent residence permit in Astrakhan and who are passing through it. Cases of imported malaria were recorded from January to October. Most often, 58 (82,9%) cases were recorded in the spring-summer period from April to August. In other months malaria cases were noted, but in rare and isolated cases: March and September - by 5,7%, October - 2,9%, January and February - 1,4%. In 92,9% of cases, the import of malaria to the Astrakhan region was carried out from the countries of the Commonwealth of Independent States in 7,1% of cases - from Africa. Thus, from countries of the Commonwealth of Independent States, in 50% of cases malaria was imported from Azerbaijan, in 37,2% - from Tajikistan. In isolated cases (2,9%), malaria was imported from Armenia and Uzbekistan. In general, in the territory of the Astrakhan region over the past 10 years, there has been a reduction in imported cases of malaria from the Commonwealth and the African contingent. In most cases, cases of three-day malaria were registered on the territory of the Astrakhan region. The importation of malaria into the Astrakhan region was mainly carried out from countries that were not well-off for malaria - Azerbaijan, Tajikistan and Africa.
Bulletin of the Russian Military Medical Academy. 2018;20(2):86-89
86-89
Problems of rendering primary prosthetic and orthopedic help in the megapolis
Abstract
On the basis of studying of statistical data, medical documents, results of the carried-out questioning in 2012-2015 the specific weight of the patients who have transferred amputation of the lower extremity owing to complications of diabetes and the obliterating diseases of vessels of the lower extremities, their distribution for the reason and level of amputating defects is estimated. Circulation periods of citizens on primary prosthetics of the lower extremities are studied and analysed. The problems of primary prosthetics connected with presence at patients of the accompanying pathology of the blood circulatory system, breath and the musculoskeletal device are designated. The prevalence of elderly people with amputating defects of the lower extremities is revealed. Features of prosthetics for elderly people, which have decreasing of weight-bearing on safe lower extremity, physical weakness, decreasing of the cognitive functions leading to difficulty of use of technical means of rehabilitation, decrease in learning ability to skills of use of artificial limbs is characteristic are specified. Problems of early rendering the prosthetic and orthopedic help and primary prosthetics of patients after amputation of the lower extremities in the megalopolis are considered. The new technology of early primary prosthetics of the lower extremities developed by specialists of Federal Scientific Center Rehabilitation of the Disabled named after G.A. Albrecht is presented by express method. Results of introduction of modern techniques of prosthetics by express method and their value for rendering primary parotezno-ortopedicheskoyy the help in the megalopolis are discussed. This type of the help can be rendered before formation of the individual program of rehabilitation and an abilitation of disabled people in the conditions of the medical organizations when rendering out-patient and stationary medical care. Rendering early primary prosthetic and orthopedic help is feasible when healing a wound of a stump after amputation, lack of contraindications to prosthetics, high motivation of the patient. Advantages of this technology of early primary prosthetics by express method is restoration of ability of the patient to movement and self-service, decrease in dependence on assistance and leaving, prevention of emergence of some defects and diseases of a stump at uluchsheny the general condition of an organism.
Bulletin of the Russian Military Medical Academy. 2018;20(2):90-98
90-98
Influence of different types of loads on quality of spatial orientation and operator activity of operators of an aviation profile
Abstract
The positive experience of using modern aviation complexes is repeatedly confirmed by their increasing participation in the solution of many combat and transport tasks. The aircraft equipment in system «pilot - plane - environment», continues to be improved, and possibilities of operators of an aviation profile remain at the same level. This discrepancy requires the experts of aviation medicine to search for new approaches to rising of fastness of a human body to the impact of aggressive air flight factors. It is known that the violation of spatial orientation continues to remain a current problem of flight safety and it accounts for 5 to 14% of all aviation incidents. The preventive events held within the last several decades do not lead to a qualitative solution to this problem. The process of spatial orientation is a complex multi-sensory type of perception, the main input channels of information for which are vestibular and visual analyzers. Research is quality of a training of spatial orientation lasting 10 days at the statokinetic, optokinetic and combined types of influence is investigated. It is established that the most effective type of a training is the combined stato-optokinetic influence, leading to the greatest improvement, as qualities of spatial orientation, so and qualities of performance of operator activity. To achieve sustainable improvement of these qualities it is necessary to conduct training for at least 9 days.
Bulletin of the Russian Military Medical Academy. 2018;20(2):99-104
99-104
Effects of platelet-rich plasma in the complex therapy of patients with androgenic alopecia
Abstract
Features of platelet-rich plasma in the complex therapy in patients with androgenic alopecia are analyzed. A comparative evaluation of the clinical efficacy of the three treatment methods was carried out: topical applications of a5% solution of minoxidil, intradermal injection of platelet-rich plasma, and combination of these techniques. A solution of minoxidil was applied to the dry skin of the scalp 1 ml twice a day without washing throughout the observation period. The course of treatment consisted of 4 procedures with an interval of 4 weeks. Clinical efficacy was assessed by the dynamics of morphometric indices of hair growth. It was established that after complex therapy in the form of minoxidil applications and injections of plasma rich plasma, the hair density increased by 32% (p=0,00004), the diameter of the hair shafts by 26% (p=0,00004). At the same time, the share of vellus hair decreased by 30% (p=0,00082), and the proportion of telogen hair decreased by 39% (p=0,00008). The results of using complex therapy significantly exceeded the clinical effect of platelet-rich plasma and topical applications of a 5% solution of minoxidil. The data obtained allows to suggest that plasma enriched with platelets and minoxidil potentiate each other’s effects, and their complex application seems promising for the treatment of androgenetic alopecia.
Bulletin of the Russian Military Medical Academy. 2018;20(2):105-109
105-109
Changes in the composition of proteins in the blood during the period of ischemia-reperfusion syndrome, modeled by a violation of blood flow in the liver
Abstract
On the experimental model of liver ischemia-reperfusion, quantitative changes in protein composition in the blood of white outbred rats were investigated. It was found that against the background of a 10-minute ischemia, the total protein content decreased by 0,9%, albumins by 1,5% (p<0,05). The content of globulins practically did not change, and the content of fibrinogen increased by 33,3% (p<0,05). In the corresponding periods of reperfusion compared with intact values, the content of total protein and albumins decreased, and globulins and fibrinogen increased. The intensity of changes in the quantitative and qualitative content of proteins in the blood of animals depended on both the duration of the ischemia period and the duration of reperfusion. At the same time, the increase in the level of globulins in the blood occurred more intensively during reperfusion after 20 minutes of ischemia. Thus, against the background of ischemia, there are changes in the quantitative composition of plasma proteins (total protein, albumins, globulins, fibrinogen). As the duration of ischemia increases, pathological changes increase. With reperfusion, the process continues unidirectionally, but against the background of a deeper ischemia lasting 20 minutes, some parameters of the pathological changes in the blood composition are less pronounced than against a background of reperfusion after a 10-minute ischemia. This phenomenon is explained by the activation of the protective and adaptive functions of the body.
Bulletin of the Russian Military Medical Academy. 2018;20(2):110-114
110-114
The experience of using cascade plasmofiltration in combined treatment with systemic lupus erythematosus on the background of programmed hemodialysis
Abstract
The results of combined treatment of systemic lupus erythematosus with the use of extracorporeal hemocorrection on the background of replacement therapy for kidney function are presented. The dynamics of the activity of the disease, assessed on the scales recommended by the European League against rheumatism, is presented. The analysis of humoral immunity indices and markers of inflammation before and after the application of efferent therapy methods is carried out. Thus, after applying the first operation cascade plasma filtration using fractionator plasma «Cascadeflo EC40», was a decrease in disease activity with a very high to a high degree, also decreased the activity of systemic lupus erythematosus with high to low degrees of activity after application of the second operation of systemic lupus erythematosus using plasma fractionator «Cascadeflo EC20». The results of combined treatment testify to the high effectiveness of therapeutic apheresis in the complex treatment of systemic lupus erythematosus. Operations cascade plasma filtration as part of combination immunosuppressive therapy allows to correct the main factors of the pathogenesis of systemic lupus erythematosus (antinuclear factor, antibodies to double-deoxyribonucleic acid, antibodies to histones, total immunoglobulins of classes G, M, A, circulating immune complexes, inflammation markers) selectively removing them from the vascular bed. Thus, the inclusion cascade plasmafiltration operation in the combined treatment of systemic lupus erythematosus, allows to quickly remove the main factors of the pathogenesis, which leads to a rapid decrease in the disease activity and reduces the dosages of cytostatic and glucocorticoid therapy.
Bulletin of the Russian Military Medical Academy. 2018;20(2):115-119
115-119
Clinical and pathogenic features of entrapment neuropathy in patient’s hands with acromegaly
Abstract
For specification of entrapment neuropathies pathogenesis in patients with acromegaly clinical and electroneurophysiological trial of the nerveswere conducted. It was determined that motor disorders in patients with incomplete remission of an acromegalia were more often than in patients with full remission. A significant difference between the frequency of occurrence of sensitive disturbances in patients with incomplete and full remission of acromegalia was not revealed. Expression of disturbances of the majority of electroneurophysiological indicators was more appreciable in patients with incomplete remission. In patients with incomplete remission the moderated and expressed disturbances prevailed, and patients from full remission had mild disturbances. The neurologic symptomatology of tunnel neuropathies and electroneuromyography disturbances were more expressed in group with incomplete remission. Conservative therapy of tunnel neuropathies was more effective in patients with full remission of acromegaly. It was revealed that the durability of acromegalia and accompanying pathology of a patient also influences expression of neurologic symptomatology and effect of the treatment. The lesser the durability of acromegalia, the better treatment results of neuropathies. The data obtained with a magnetic and resonant tomography on growth existence round a tendon of a flexor, regional growth of a bone trapeze and augmentation of transversal section of a median nerve and as signal strength change from it allow to specify a pathophysiology of tunnel neuropathies in acromegalia. The combined use of an electroneuromyography and a magnetic and resonant tomography possesses high informational content in diagnostics of tunnel neuropathies. These methods allow giving an objective assessment of changes of neuromuscular changes in patients with a syndrome of the carpal channel with acromegalia. Specification of a pathogenesis of tunnel neuropathies allows carrying out correction of agents and treatment methods in patients with acromegalia, thus reaching good results of treatment in short terms.
Bulletin of the Russian Military Medical Academy. 2018;20(2):120-123
120-123
Alternative anatomy of a gastrolic trunk of Genle and her applied value in surgery
Abstract
Are submitted the data about typical and atypical options of a trunk Genle, to his arhitectonics, topography, existing classifications, morphometric characteristics and cclinical value of anatomic features. It shown, that the anatomy of a trunk of Genle and his inflows has the expressed variability, and practically it isn’t described in Russian-speaking literature. Appreciable number of various options of formation of a trunk of Genle, various frequency of occurrence of these options, morphometric indicators, apparently, depends on the size of selection of the studied objects, a sex and other reasons. Classification is created, reflecting results of a research, and presenting data in foreign literature. It reveal, that, despite a large number of the described versions of the description of this anatomical structure, there is no uniform idea of the veins forming this trunk. Nosological examples are analyzed, showing need of control of options of formation of a trunk of Genle and his morphometric features at expeditious and diagnostic manipulations on organs and vessels of a peritoneal cavity. Without comprehension arhitectonics of roots and inflows of a portal vein, there is a great risk of a surgical mistake which can lead to lethal complications. In general, cases in point are important for surgical practice, in particular, for abdominal surgery and an onkokhirurgiya.
Bulletin of the Russian Military Medical Academy. 2018;20(2):124-129
124-129
Stastical methods in studies on the status of nutrition of military personnel
Abstract
The possibility of applying the nonparametric statistical methods to solve the tasks of investigating and appraising the index status of nutrition of military servicemen is considered. The experience to use in parallel several statistical algorithms for testing hypotheses is shown. An approach was worked out to test a sequence of hypotheses going one after another when testing the previous hypothesis influences the choice of subsequent hypothesis to test. This approach is formalized as a scheme to incrementally estimate the status of nutrition of military servicemen. The proposed model of status of nutrition exploration is used to obtain the quality and quantity digital estimation of the expected trend of a certain controllable parameter or a group of parameters of status of nutrition. It is established that among the considered indicators of the status of nutrition, the prevailing number of them has undergone a regular change in different periods of a prolonged sea voyage, depending on the balance of the main food components (proteins, fats and carbohydrates) with other nutrients and on the energy costs of the body of servicemen. The algorithm for studying the status of nutrition of servicemen with the use of nonparametric methods of statistical analysis made it possible to reveal a number of changes in metabolic processes occurring at the prenosological level and conditioned by the peculiarities of nutrition and the nature of military professional activity. On the basis of the research results obtained, requirements for the content of vitamins and minerals in the diet, as well as vitamin-mineral complexes, necessary for strengthening the body’s protective functions and preventing various diseases, can be formulated. Applying this model enlarges greatly the exploration possibilities when the methodical recommendations and normative documents to regulate the nutrition of military servicemen are developed.
Bulletin of the Russian Military Medical Academy. 2018;20(2):130-138
130-138
Physiological and hygienic assessment of nutrition for crew members of surface ships of the Navy in a long maritime campaign
Abstract
The nutrition of food for the crews of surface ships (vessels) of the Navy in a long sea cruise was studied to assess the energy and plastic adequacy of the current diet. The indicators of the chemical composition and energy value of the average daily diet are determined taking into account natural technological losses. Standard data on incomplete digestibility of nutrients are taken into account. It has been established that the full compliance of the composition of the consumed food with the norm of sea rations is not ensured. Some mineral elements and vitamins are contained in the food prepared in insufficient quantities. Consequently, in a long maritime campaign, actually consumed food for energy value does not fully ensure the daily energy expenditure of this category of specialists. However, this is not confirmed by the anthropometric and component indices of the body composition revealed before and after the long hike: an increase in the waist-hip index (medians of 0,85 and 0,91 eu, respectively, p=0.008); an increase in the percentage of adipose tissue in the body (medians 15,3 and 18,5%, respectively, p=0,044). Established in the course of work, the dynamics of the body composition of servicemen in a long sea cruise testifies to the non-observance of the principle of energy adequacy of feeding the crew in the direction of exceeding its calorific value. Thus, the current diet (sea ration) does not need to increase its energy content, but it requires improving its composition and compensating for the deficiency of vitamins and certain trace elements by introducing modern vitamin-mineral complexes into the diet.
Bulletin of the Russian Military Medical Academy. 2018;20(2):139-143
139-143
Experimental simulation in the modern wound ballistics
Abstract
The main medical and biological aspects of conducting experiments in wound ballistics are considered. It is established, that currently in the studies devoted to the study of wound ballistics of firearms ammunition, the method of experimental modeling using simulators of various origins is widely used. A detailed description of the main simulators used by the leading domestic researchers is given now with a reflection of their positive and negative properties. The question of choice of an optimal laboratory animal for the solution of certain problems of ballistic experiment is considered. The world practice of studying the problems of wound ballistics has shown that the organs and tissues of a pig are the closest, of all known animals, to organs and tissues of man in a whole series of morphofunctional properties. The similarity in the structure of organs with a human can in some respects be quite striking, which is used in experimental surgery, especially for studying cardiovascular diseases and in organ transplantation studies. To transfer experimental data from a model (simulator) to a human, it is necessary to observe the main condition of modeling, namely, the principle of similarity of the experimental model to the process that should be reproduced. The problem of use of human corpses and corpse material is reflected, and also attention is paid to a need of observance of ethical rules and norms at carrying out this kind of experiments. It is concluded that despite the extensive list of available materials of non-biological origin, it is not possible to completely abandon the use of laboratory animals and corpse material at this stage of development of science, and their use should be carried out with mandatory compliance with certain norms of ethical and legal nature.
Bulletin of the Russian Military Medical Academy. 2018;20(2):144-149
144-149
Justification for the initial medical data for the development of an anthropomorphic test dummy
Abstract
To protect against the adverse impact of shock acceleration, technical protection equipment is being developed, the effectiveness of which is verified during the tests. Special place among these tests belongs to physical analogue of human body- anthropomorphic testing dummy. The experiments with the participation of volunteers allowed to develop anthropometric, biomechanical and consumers requirements to anthropoid testing dummy, which are corresponded to small (5 percentile), medium (50 percentile) and big Russian servicemen (95 percentile). There were also established demands to body weight, stature - body height, sitting height, height of shoulders over the seat, chest circumference, mass of the main segments of anthropoid testing dummy (head and neck, upper, middle and lower parts of a trunk, shoulder, forearm, hand, leg, foot). An anthropoid testing dummy, modeling servicemen with small sizes, must have 58 kg weight, 165,6 cm body height, 86 cm sitting height and 88,8 cm chest circumference; a dummy, modeling middle servicemen, must have 68 kg weight, 173 cm body height, 92,2 cm sitting height and 98,5 cm chest circumference; a dummy, modeling big servicemen, must have 101,2 kg weight, 190 cm body height,96,5 cm sitting height and 101,2 cm chest circumference. During the experiments with the participation of volunteers, pliability of soft tissues of human, being in connection with restraint system, was studied. It allows modeling mechanical characteristics of anthropoid testing dummy’s torso and ensure adequate reaction to inertial load of a body. There are given demands to dynamical firmness of anthropoid testing dummy and to its qualities, ensuring peculiarities of its use during natural and semi-natural testing.
Bulletin of the Russian Military Medical Academy. 2018;20(2):150-153
150-153
Correlation matrix for revealing informative indicators of functional state estimation, anaerobic working capacity and physical readiness of highly qualified athletes
Abstract
The possibility of revealing informative markers for assessing the functional state and special working capacity of highly skilled multihorts by means of correlation analysis is considered. It is established that the values of the relative and explosive strength of most muscle groups have prognostic significance as a criterion for their physical fitness. The priority of extensor musculature for achieving high sports results in athletics decathlon is proved. It was found that the parameters of the anaerobic threshold, determined by the heart rate, are more related to the athletic result than the anaerobic threshold values determined by the amount of oxygen consumed. Five groups of indicators were distinguished, which had a strong relationship with the athletic result in the decathlon. The first group included markers that characterize the aerobic capacity of the body: the relative level of maximum oxygen consumption, anaerobic threshold, pulmonary ventilation, respiratory coefficient and vital capacity of the lungs. The second group consisted of parameters reflecting the rate of recovery of aerobic capacity of the body within 2 minutes after the end of physical activity: heart rate, respiratory, oxygen consumption and pulmonary ventilation. The third group included the values of energy metabolism in the central, right and left temporal regions of the brain, where the higher centers of the motor and sensory systems are located, as well as the centers of the descending pyramidal tract responsible for performing arbitrary movements. The fourth group included indicators characterizing the background mental state, speed and accuracy of the attentional set-shifting, psycho-emotional stability. The fifth group consisted of parameters of the analysis of the heart rate, which reliably correlated with the sum of points in the decathlon.
Bulletin of the Russian Military Medical Academy. 2018;20(2):154-159
154-159
Experimental substantiation of the possibility of using the cytochemical parameters of peripheral blood to assess the functional state of the organism of the pilot
Abstract
The activity of succinate (mitochondrial), lactate, α-glycerophosphate, glucose-6-phosphate peripheral blood lymphocytes in rats under the conditions of modeling acute and chronic gravitational stress was studied by quantitative spectrophotometry of cytochemical reaction products to reveal the localization of oxidative enzymes. The dynamics of morphofunctional transformations is determined, the severity of which depends on the duration of the effect (the rotation time of the animals on the centrifuge). For acute gravitational stress, changes in the activity of mitochondrial succinate dehydrogenase are characteristic, and in the various stages of chronic gravitational stress, glycolysis (increase in lactate dehydrogenase and α-glycerophosphate dehydrogenase activity) and plastic metabolism (increase in glucose-6-fosfata dehydrogenase activity) are characteristic. These changes are explained by the inclusion of neurohumoral regulatory mechanisms that ensure synchronization of oxidative metabolic processes in the cells of organs of various body systems under unfavorable conditions of their functioning. Significant correlation links between the activity of lymphocyte enzymes with the same indices of neurons of the celiac sympathetic node, adenocytes of the cortical and medulla of the adrenal glands have been established. This suggests that the activity of lymphocyte enzymes can be used as indirect indicators of the processes occurring in the organs of the sipato-adrenomedular and pituitary-adrenocortical systems under conditions of acute and chronic gravitational stress.
Bulletin of the Russian Military Medical Academy. 2018;20(2):160-165
160-165
Characteristics of psychophysiological indicators of students with different interhemispheric asymmetry
Abstract
Abstact. Psychophysiological parameters (short-term visual memory, speed of successive addition of numbers in visual perception, indicators in the Raven progressive matrices test and the Stroop test) were investigated among left-handed and right- handed men (aged 19-25 years). It was found that the verbal stimuli perception in competition with the corresponding sensory perception of right-handers are more pronounced. At the same time, sense perception of the image and its indicating verbal stimuli associated to a greater extent for left-handed persons. The advantage of the left-handers in the test of the Raven progressive matrices test and the advantage of the right-handers in the sequential addition of single-valued numbers were noticed. All indicators of short-term visual memory demonstrated the advantage of left-handers. The use of factor analysis showed that right-handers have greater productivity in performing the proposed tests. This is mainly due to the functions of the left hemisphere - verbal thinking and consistent processing of information. The second important factor is visual spatial thinking. Productivity of left-handers is largely determined by the function of the right hemisphere: sensory perception and spatial thinking. The third most important factor is the interaction between figurative and verbal thinking and the attentional set-shifting. Thus, right-handers in a greater extent than left-handed people, have more success in intellectual activity because of the development of the functions of the dominant hemisphere.
Bulletin of the Russian Military Medical Academy. 2018;20(2):166-170
166-170
Possibilities of use of arc-type discharge low-temperature air plasma of atmospheric pressure for burn wound treatment
Abstract
Results of experimental assessment of efficiency of use of low-temperature air plasma of the arc category of atmospheric pressure at treatment of burns of skin of the III degree in small laboratory animals are given. It is established that use of low-temperature air plasma of the arc-type discharge of atmospheric pressure allows to accelerate terms of final healing of wounds for 49% (p<0,05), to reduce development frequency in them purulent inflammation by 45,5% (p<0,01). Positive influence of air and plasma processing on dynamics of the area of a hem which after single influence by 35 days is reduced for 67% is revealed (p<0,01). The analysis of a histologic picture confirms acceleration of formation of an extracellular matrix and epitelization against the background of impact of an air and plasma stream on wounds. Processing of a wound of low-temperature air plasma of the arc category of atmospheric pressure after an early surgical escharotomy allows to form on a wound surface a so-called nanofilm of a layer the coagulated proteins of wound exudate and cellular fragments which has selective vapor permeability, reduces an rate of wounds pathogenic infection, prevents drying and as a result, allows to reduce the frequency of development of purulent complications and extent of zones of a secondary necrosis. Influence of a stream of low-temperature air plasma of the arc-type discharge of atmospheric pressure allows to optimize significantly processes of reparative regeneration in a zone of a deep burn of skin at a stage of preparation for their surgical treatment.
Bulletin of the Russian Military Medical Academy. 2018;20(2):171-176
171-176
Comparative chemical composition analysis of femoral condyles bone tissue in health and in deforming arthrosis
Abstract
A comparative analysis of the chemical composition of the medial and lateral condyles of the femur in norm and with deforming arthrosis of the third degree is presented. It was found that when the bone tissue of the femur is degraded from the surface, a decrease in crystallinity is observed in depth, quantitative and qualitative changes in the organic bone matrix, in particular, a decrease in the proportion of the protein component, a change in the phase inorganic composition, and an increased degree of substitution of calcium in hydroxyapatite for ions of other metals. And the most dramatic changes are observed in bone tissue located near the pathologically deformed areas. It is shown that the data for normal bone tissue of the lateral and medial condyle of one specimen differ, which can be caused by different degrees of stress on the condyles themselves in the process of vital activity of the organism caused by asymmetry and a different shape of their articular surfaces. With deforming arthrosis in the surface layer of bone tissue, the concentration of calcium and a number of other metals increases, while the proportion of the protein component decreases. It was revealed that in the affected bone replacement of phosphate tetrahedra with carbonate ions occurs, as well as substitution of cations of divalent calcium with ions of other metals such as copper and manganese, and especially ferric cations. This breaks the overall structure of the crystal lattice of hydroxyapatite and affects the biomechanical properties of the surface, in particular, the reduction of trophism and the elasticity of the surface. In osteophyte tests, partial replacement of phosphate groups with carbonate groups occurs. Isomorphic structural substitutions caused by deposition of crystalline impurities lead to a change in the ratio of calcium and phosphorus concentrations. Excessive deposition of calcium salts leads to the formation of osteophytes.
Bulletin of the Russian Military Medical Academy. 2018;20(2):177-181
177-181
Possibilities of bioimpedance analysis in the diagnosis of obesity
Abstract
The use of additional parameters obtained with the help of bioimpedance analysis allows correctly to establish or exclude the diagnosis of obesity when conducting a survey of men. We proposed the «fat mass index» index, which has the greatest sensitivity and specificity in the diagnosis of obesity. The use of ROC-analysis allowed setting threshold values (cut-off points) in samples of a number of bioimpedanceometry indicators for diagnosing obesity according to known grades of body mass index according to the classification of the World Health Organization. Thus, for the visceral fat area, this boundary corresponds to 103,95 cm2, the fat mass index is 7,33 kg / m2, the fat mass is 22,45 kg, the percentage of body fat is 24,55% and the degree of abdominal obesity is0, 94%. Exceeding the above thresholds can be used as additional criteria for diagnosing obesity. The existence of phenotypic and metabolic heterogeneity of persons with normal body weight and obese patients is shown. It was confirmed that 93,3% of patients are metabolically unwell, and 6,7% are metabolically healthy. A similar pattern is also observed with normal body weight: a larger pool (92,4%) is metabolically healthy, and a small proportion of people (7,6%) are metabolically unwell. At present, normative values do not exist for all parameters obtained with the help of bioimpedance analysis; therefore, in the complex survey of men, the use of the optimal cut-off threshold for the studied indicators will help to identify individuals with true obesity. The results obtained should increase the diagnostic value of biomedance analysis of body composition and help to conduct an effective evaluation of curative and preventive measures for obesity by comparing the considered indicators in dynamics.
Bulletin of the Russian Military Medical Academy. 2018;20(2):182-186
182-186
Substantiation and development of the economic-mathematical model of rational drug provision for certain categories of citizens attached to military medical organizations
Abstract
In modern socio-economic conditions, the maximum efficiency of the use of funds allocated from budgets of different levels to finance federal, regional and departmental programs for providing medicines is required. In connection with it, there is a need to justify and develop a model of rational drug supply for certain categories of citizens attached to military medical organizations that will visually reflect the functioning of military and civilian health in a single organizational and legal space, with the elimination of duplication of functions and powers of government. Approaches to the development of a model of rational drug provision are substantiated, while modeling the mathematical apparatus of Petri nets. A characteristic of the existing model of drug supply based on Petri nets for certain categories of citizens attached to military medical organizations is presented. The irrationality of the existing order of drug provision is proved, which results in an increase in the resource burden on public health in general. The model of rational drug supply of patients attached to military medical organizations that excludes duplication of provision of medicines by citizens within the framework of military and civil health is substantiated and developed; optimizes the distribution of rights, powers and responsibilities between military and civil health; ensures the coherence of military and civil health activities in the provision of medicines on the basis of information interaction; contributes to the preservation of financial, information and material resources in public health, as well as their balanced and rational use.
Bulletin of the Russian Military Medical Academy. 2018;20(2):187-194
187-194
«Off-label» use of botulinic toxin type A preparations in neurological practice
Abstract
The modern view on the application of botulinum toxin type A for the off-label use in neurology and foreign experience analysis are presented. The «off-label» category referred to any prescription of a medication in case of using it for unregistered indications, with product instruction violation or in the presence of contraindications including age restrictions. The sources of information about medicines were the leaflets of manufacturers of medicines and the State Register of Medicines. It is well known that Botulinum toxin type A is a good therapeutic option for treating children with cerebral palsy. Increased efficacy of regularly repeated cycles with Onabotulinumtoxin A in medication-overuse headache patients beyond the first year of treatment. Botulinum toxin type A is effective in the management of sialorrhea. Botulinum toxin type A is a safe and effective treatment for primary axillary hyperhidrosis and produces high levels of patient satisfaction. Facing depression with botulinum toxin: positive effects on mood have been observed in subjects who underwent treatment of glabellar frown lines with botulinum toxin and, in an open case series, depression remitted or improved after such a treatment. Botox injection significantly improved foot dystonia, pain and lower limb functional outcomes in patients with Parkinson’s disease with deep brain stimulation. The paper describes the problems associated with the lack of clinical data about the possibility of using botulinum toxin type A in different conditions, emphasizes the need to organize clinical trials and educational programs for neurologists as well as more active implementation of protocols for the treatment of patients.
Bulletin of the Russian Military Medical Academy. 2018;20(2):195-201
195-201
Modern methods of the functional state assessing of the body and the physical performance of a serviceman in solving scientific research problems of biomedical direction
Abstract
The main issues related to the assessment of the functional state of the body and the physical performance of the serviceman are considered. The review of modern methods for assessing the functional state and physical working capacity of a person in sports medicine and the physiology of military labor both in Russia and abroad is presented. The choice of the methods allowing to unify approaches to an estimation of military-professional working capacity in stationary and field conditions is proved. It is established that in the scientific research practice of military medical specialists, it is expedient to evaluate the functional state of the serviceman’s organism and its physical working capacity under loads associated with both dynamic and static muscle work. It is determined that ergospirometry is the most acceptable method of assessing the functional state of the body and the physical performance of servicemen in the process of performing dynamic work. It is noted that with the help of ergospirometric testing, it is possible to predict the physical performance of a serviceman and the duration of its preservation at a given level, replacing or supplementing most standard load tests, which is a weighty argument in favor of its choice as a «gold standard». It has been established that to evaluate the functional state of the body and the physical performance of servicemen in the process of performing static work, the main method is stabilometry. A significant number of available stabilometric techniques, including those using biofeedback, significantly expands the possibilities of diagnosing the functional state of the body of a military specialist. It is determined that the most acceptable method for assessing the impact of dynamic loads on the locomotor system of a serviceman is the use of the “motion capture” technology. The main advantages and disadvantages of modern means and methods of studying the functional state and physical working capacity of a person are revealed. The modern hardware and software complexes used to solve scientific research problems of biomedical orientation are listed.
Bulletin of the Russian Military Medical Academy. 2018;20(2):202-208
202-208
Вiological effects of viroids
Abstract
Possible potential microbial agents of a human which represent by ring highly complementary one-chained ribonucleic acid with an absent of protein coating, as for viruses containing a ribonucleic acid, are characterized. Pathogenic effects of viroids in comparison with viruses and defective viruses are considered. Intimate viroid’s mechanisms on a host cell are described. So viroids do not code any proteins, their action on a plant should be consequence of direct interaction of viroid’s ribonucleic acid and host cell’s contents. However the molecular mechanism by which viroids causes plants’ diseases still remains not completely determined. It is considered, that the first targets of viroid are the nucleic acids and proteins of the host cell. Genomes of some viroids contain areas complementary to some cellular RNA. In connection with it supposed, that disease begins because of inhibition of functions of these cellular ribonucleic acids or their cutting directed viroids by a ribonucleic acid. Pathogenicity of viroids can be also a result of mimicry at a molecular level. Because of features of structure or sequence nucleotides the viroid’s ribonucleic acid can replace by itself some cellular ribonucleic acids. In viroid’s pathogenesis also can be involved and an interference of ribonucleic acids. All this allows to assume, that viroids can become the reason of infectious diseases of the human.
Bulletin of the Russian Military Medical Academy. 2018;20(2):209-214
209-214
Circulation and resorption of cerebrospinal fluid: historic and up-to-date presentation
Abstract
It is analyzed historical development and current apprehension about cerebrospinal fluid. We are interested in all about liquor however the huge our attention concentrates on resorption of fluid. It is caused by many cases with expiration of liquor after operation but there isn’t answer about arrangement of this complication. It is notably but now the question about resorption of cerebrospinal fluid is still controversial. The part of scientists stands by classic speculation. They think that resorption of liquor arises by Pachioni’s granulations. Another part keeps to theory that the main role performs glymphatic system by the resorption of liquor. That’s why we make a decision that we need to make an investigation of nowadays literature about dynamic of cerebrospinal fluid and resorption of liquor.We think after neurosurgical operations cerebrospinal fluid’s resorpting ability decreases. We make these conclusion, because there are lots of science experiments. These experiments simulate real surgical procedures. That’s why intracranial pressure raises and then liquor runs out. We made a conclusion lots of scientists adhere to mind that after neurosurgical operations resorption of liquor decreases that’s why it starts hyporesorption. However even presently this problem is actually. There is a little bit experiments but there isn’t any clinical research.
Bulletin of the Russian Military Medical Academy. 2018;20(2):215-220
215-220
Possibilities of pharmacological correction of pathologies of gepatobiliarny system
Abstract
Diseases of the hepatobiliary system increase from year to year. Etiopathogenetic factors of liver lesion development are different, but in all cases of hepatopathies, despite a polietiologichnost of lesions, the treatment of a disease in general is referred on improvement of hepatocytes, and rather close pathogenetic therapy is for this purpose applied. Numerous researches reveal the leading role of an oxidative stress and, provoked by it, the perekisny oxidation of lipids of phospholipid membranes of hepatocytes provoked, by it in development of hepatopathies of any etiology. Taking into account a pathogenesis, of hepatopathies treatment of pathologies assumes an integrated approach. A specific place in the treatment of hepatopathies is held by gepatoprotektor - the means, which rise fastness of hepatocytes to the damaging factors. Today, n medical practice a series of gepatoprotektors of animals, plant and animal origin is used. By present time, are developed and studied a series of drugs of a plant origin, among which, the most often used, and well learned, are drugs of the sum of the flavonoids, received from a spotty thistle. Phytocomplexes for the purpose of their use for treatment and prophylaxis of development of the hepatopathies including caused by use of the medicinal preparations prescribed on vital indicators are framed and are investigated. The review of available literature showed, that despite the sufficient range of hepatoprotective drugs, today, the drugs conforming to clinical requirements no. In this regard search of new and modern highly effective medicines for treatment of the lesions of a liver of various etiology taking into account a development pathogenesis and which aren’t rendering undesirable side effects remains a current problem of medical science and practice. The leading direction is search of these means in group of substances with antioxidatic and antigipoksantny activity.
Bulletin of the Russian Military Medical Academy. 2018;20(2):221-225
221-225
Organization of the treatment of the wounded and sick in medical institutions in Saratov during The Great Patriotic War. Deployment of evacuation hospitals in the initial period of the war (June 1941 - June 1942)
Abstract
The issues of the deployment of hospitals in the city of Saratov in the initial period of the Great Patriotic War are considered. The article briefly describes the decisions of the State Defense Committee, which initiated the reorganization of the civil health of our country for the solution of the tasks of wartime. The medical-geographical factors that determined the expediency of deploying evacuation hospitals in Saratov and the region are indicated. The great role of leading specialists in clinics and departments of the Saratov Medical Institute in the deployment and specialization of evacuation hospitals was underscored. Their management of day-to-day clinical work and advice helped not only to maintain the high quality of medical care provided to the wounded and sick, but also contributed to the growth of the professional skills of physicians who do not have sufficient experience in treating a variety of combat pathologies. The statistics on the number of hospital beds in Saratov hospitals is given. Data on the structure of the wounded in the first year of the war for treatment in medical institutions of the city and the region are presented. The efforts made by party and city authorities to increase the capacity of the Office of the45th local evacuation center are highlighted. The importance of the problem of retraining, additional specialization, training of new medical personnel is shown. Using a variety of time and content of training programs allowed to significantly staff the deployed evacuation hospitals at the expense of residents of the city and the region.
Bulletin of the Russian Military Medical Academy. 2018;20(2):226-233
226-233
Etiopathogenesis of internal and external genital endometriosis (evolution of views)
Abstract
The etiology and pathogenesis of endometriosis and adenomyosis, as well as their interrelations, are not fully understood and are the subject of discussions and research. The question remains whether the endometriosis and adenomyosis are different diseases, or they represent different phenotypes of the same pathology. Considerations are given about the etiopathogenesis of these diseases, which existed in different years. It is now recognized that endometrioid heterotopias in adenomyosis and endometriosis are derivatives of the basal layer of the endometrium - endometrial stem cell. There are three possible ways of spreading the stem cells of the basal layer of the endometrium, leading to the formation of foci of endometriosis and adenomyosis: retrograde cast into the abdominal cavity with menstrual blood, invasive growth in myometrium due to the mechanism of epithelial-mesenchymal transformation and disruption of the endometrium and myometrium connection zone, and neonatal bleeding. Thus, the mechanisms of the appearance of foci of endometriosis in various organs and tissues are quite diverse and are associated with the primary dysfunction of the endometrium itself, retrograde menstruation, pathological regeneration accompanied by epithelial-mesenchymal transformation, as well as pathological changes in the endometrium and myometrium connection zone, neonatal bleeding. The severity of the clinical course of endometriosis, the frequency of relapse after surgical treatment, the effectiveness of conservative therapy, and the overcoming of infertility are probably due to the mechanism of development of this pathology in each specific case.
Bulletin of the Russian Military Medical Academy. 2018;20(2):234-239
234-239
Techniques for dental implants positioning
Abstract
The modern techniques for dental implants positioning are analyzed. It is established that the duration of dental implants functioning depends on the accuracy of their positioning. The peculiarities of the influence of the human factor on the results of the installation of dental implants are revealed. It is shown that the «free hand» technique is the most inaccurate method. The accuracy of mechanical devices leaves an imprint on the results of dental implantation. Overall, the improvement of implant positioning techniques went along the way of eliminating the negative influence of the human factor on the results of the operation. For this purpose, a few mechanical devices and methods were proposed to approximate the result of the operation to the preoperative plan. Thus, the development of methods for positioning dental implants has gone from the«free hand» technique to robotic systems. Dental navigation platforms evolved along the path of improving the design and increasing the accuracy of implant positioning. In recent years there has been a sharp slowdown in the development of dental navigation systems and an increasing number of applications of robotic systems for the installation of dental implants. At the same time, the role of the implantologist gradually fades into the background, giving way to the dominant role for robotic systems that exceed the accuracy of the positioning of dental implants. In general, the use of mechanical and robotic devices in dental implantation makes it possible to achieve the best result in comparison with the «free hand» technique.
Bulletin of the Russian Military Medical Academy. 2018;20(2):240-243
240-243
Functional state of the autonomic nervous system, adaptation, homeostasis and reactivity of the organism in the clinic of tuberculosis and sarcoidosis
Abstract
In recent decades, the shift in priority in the treatment of patients with pulmonary granulomatosis in the direction of etiotropic therapy and reduced attention to the state of the macroorganism led to a decrease in the effectiveness of treatment. In modern conditions, when carrying out complex therapy for patients with tuberculosis and sarcoidosis, insufficient attention is paid to the state and dynamics of adaptation, resistance, homeostasis and reactivity of the organism. At the same time, the dynamics of these processes in patients is insignificant, the homeostatic balance of the organism is not restored, and the reactivity of the organism remains at the pathological level, with the predominance of paradoxical, hyporeactive and areactive types. This is due to the continuing influence on the regulatory centers of the vegetative system of not diagnosed, latent, ongoing tuberculosis intoxication. Undetected specific intoxication causes in patients activation of the sympathetic department, suppression of parasympathetic and development of dysfunction of the autonomic nervous system. Its dysfunction leads to a decrease in vascular supply of the organism, a high tension of anabolic processes, and a further change in the functional activity of both parts of this system when pathology develops. In addition, the emergence of vegetative dysfunction leads to a high consumption of plastic materials, energy resources, a decrease in the functional reserves of the body, a decrease and depletion of the body’s defense systems, its anti-inflammatory potential and the reactivity of the organism as a whole. These changes lead to an extension of the main course of treatment and the formation of expressed residual tubercular and sarcoidosis in the respiratory organs. To restore these disorders, it is necessary to carry out complex therapy with the inclusion of a personified appointment of activators of protective systems under the control of monitoring their effectiveness.
Bulletin of the Russian Military Medical Academy. 2018;20(2):244-248
244-248
Modern ideas about the methods of surgical organ-preserving treatment of kidney cancer
Abstract
Renal cell carcinomas account for about 3% of all cancers in adults. The annual increase in the detection of this disease is 2,9%, which is due both to a true increase in the number of cases and to the widespread introduction of modern research methods (ultrasounds examination, computerized tomography, magnetic resonance imaging) that allow us to detect small asymptomatic lesions. This, in turn, makes it possible to perform organ-preserving surgical interventions. Comparative analysis of long-term results of treatment in patients after kidney resection does not differ from those after radical nephrectomy, at the same time, the functional results of organ-preserving surgical interventions are more attractive, especially in patients with an initially present renal dysfunction. Currently, there are three methods of performing organ-preserving operations: open, laparoscopic and robot-assisted kidney resection. Contrary to the general interest in the problem of nephron-preserving surgery of renal cell carcinomas, the choice of operative access while performing kidney resection remains the subject of discussion. In this light, the use of intermuscular mini-lumbotomy access can act as an optimal replacement for laparoscopic access or resection from traditional lumbotomy. This technique of operative intervention allows to combine the positive properties of both minimally invasive procedure (laparoscopic resection) and open surgical intervention: reduction of the volume of blood loss and duration of the operation, reduction of hospitalization time, fewer late complications, good cosmetic result. Also, the issues of processing the resected surface of the organ, the time of ischemia, and the choice of the vascular clamp when clamping the renal artery, the distance from the tumor edge to the line of resection are also disputable. In addition, the functional results of organ-preserving resections of the kidney are not sufficiently studied in the long term after surgical interventions.
Bulletin of the Russian Military Medical Academy. 2018;20(2):249-253
249-253
Organization of rendered surgical assistance in extreme conditions of autonomous navigation
Abstract
The problem related to the need to improve the effectiveness of providing emergency surgical care in extreme conditions of autonomous navigation is discussed. The principle of organization of medical support cannot be effectively implemented in the realities of the present time, due to the lack of sufficient naval bases. Modern medical technologies seem to be a strategic reserve that can solve the emerging problems before the medical service of the Navy. The most priority and promising technique with a high level of quality of urgent surgical care is the use of laparoscopic techniques by the personnel of the medical service directly at the ship’s medical station. Presented data on the results of the application of this technique indicate its prospects. In addition, in order to optimize the provision of emergency medical care to seamen in conditions of autonomous navigation, it is expedient to actively use telemedicine. The historical and systematic review of modern literature confirms the high potential of these methods provided that the surgeons’ competence and scientific and practical solution of technical aspects are sufficient. Important is the development of professional standards for specialized medical care in emergency conditions in the sea and active implementation in clinical practice.
Bulletin of the Russian Military Medical Academy. 2018;20(2):254-258
254-258
Tissue engineering for compensating short bowel syndrome
Abstract
Short bowel syndrome is an important clinical problem characterized by a high incidence of serious complications, deaths and socioeconomic consequences. Parenteral nutrition provides only a temporary solution without reducing the risk of complications. This applies equally to surgical treatment, in particular to small intestine transplantation and related concomitant interventions, which only facilitate the adaptation of the intestine to new conditions. Potential approaches have been analyzed in the treatment of the syndrome of the small intestine, which can be offered by dynamically developing tissue engineering. Various types of carriers and cell types that are used in experiments for obtaining tissue engineering designs of the intestine are discussed. A wide range of variants of such constructions is analyzed that can lead to obtaining an organ prosthesis with a cellular organization and mechanical stability similar to those of the native small intestine, which will ensure the necessary biocompatibility. It is established that one of the optimal carriers for today are extracellular matrices obtained by decellularization of the native small intestine. This process allows to preserve the microarchitecture of the small intestine, which greatly facilitates the process of filling the matrix with cells both in vitro and in vivo. It has also been established that mesenchymal stromal multipotent cells and organoid units obtained from the tissue of the native small intestine are particularly prominent among the most promising participants in the cellular ensemble.
Bulletin of the Russian Military Medical Academy. 2018;20(2):259-264
259-264
At the origins of the native medical aviation accidents study (to the 110th anniversary of the birth of A.G. Shishov)
Abstract
The life and scientific path of Shishov Anatoly Grigoryevich - the founder of aviation medical avariology, the first chief of the Department of Aviation Medicine of the Military Medical Academy named after S.M. Kirov (1958-1965). A.G. Shishov is known for his work in the field of the study of causes, investigation and prevention of aviation accidents, professional selection of flight crew, medical and flight expertise, flight training simulators. A.G. Shishov justified the leading role of the «personal factor» in the development of aviation accidents. He introduced the practice of studying the psychophysiological state and individual characteristics of the personality of the pilot and increased the role of the aviation doctor in the investigation of aviation accidents to the status of a mandatory expert. A.G. Shishov developed an algorithm for the medical study of aviation accidents, incidents and erroneous actions of the flight crew, as well as a complex of medical measures for the prevention of accidents.
Bulletin of the Russian Military Medical Academy. 2018;20(2):265-267
265-267
The contribution of A. Gref to clinical ophthalmology (to the 190th anniversary of the birth)
Abstract
The first scientific and practices works in ophthalmology of Professor Albreht Grephe are possibilities. Notes, that in 1850 Hermann Helmholtz introduced the ophthalmoscope into clinical practice, this tool allowed Albrecht Gref to make a number of discoveries and scientific proposals concerning the pathology of the fundus. He described the embolism of the retinal artery, differentiated central recurrent syphilitic retinitis from diffuse, described optic neuritis and much more. Seven years of his scientific work, A. Gref has devoted to the study of the functioning of the eye muscles, strabismus and its correction by surgery, the study of amblyopia. Later, he described in detail the symptoms of ocular muscle paralysis and the clinical manifestations of diphtheria and benign renal conjunctivitis, outlined the ways of drug treatment of these diseases. Gref considered eye pressure the main cause of glaucoma. In his opinion, reducing pressure, it was possible to save the patient from glaucoma. During the treatment of the patient with complete infection of the pupil, A. Grefe made iridectomy (excision of the iris part) and noticed that the eye after the operation became softer. This prompted the doctor to think about the possibility of using such an operation for glaucoma. It is important to note that at the first International Ophthalmological Congress in Brussels in 1857 Gref made a report «On the nature and treatment of glaucoma by iridectomy». This operation brought him world fame and saved many glaucoma patients from blindness. Iridectomy is used in ophthalmic practice and at the present time. In 1859 Grefe proposed a method for peripheral linear extraction of cataracts. He made a peripheral linear cut, thanks to which the divergence of the edges of the wound of the patch cut was eliminated. For such a cut Grefe invented a special long and narrow scalpel, behind which the name Grefevsky was preserved. As time has shown, the basic theoretical and practical provisions and discoveries of Grefe still form the foundation of our knowledge in ophthalmology.
Bulletin of the Russian Military Medical Academy. 2018;20(2):268-271
268-271
History of military hygiene studies in the russian army
Abstract
The issue of teaching in military schools the discipline «military hygiene» is being considered. The experience of the Russian army shows that from the fourth quarter of the 19th century, and until 1917 military hygiene was an academic discipline in the training of cadets and officers. At the same time, programs and textbooks were created, even for training at the accelerated courses of cadets and officers during the First World War. The textbooks contained sections on the basics of international military law, human anatomy and physiology, food hygiene, water supply, placement of military personnel in stationary and field conditions, hygiene uniforms, bath and laundry services, personal hygiene, rules for maintaining the territory and cleaning battlefields. Separate chapters presented the issues of urgent illnesses for the troops and their prevention. At the same time, comparative statistics are provided on the irrecoverable losses of troops from weapons and mainly from diseases. In addition, the textbooks contained information on the organization of the army’s sanitary service, the rules for the arrangement of premises for the sick and wounded were considered. In the applications, even the «highest approved» Instruction for protecting the health of the military ranks of the active army, various methods and tools for hygienic analysis, methods, disinfectants and others were presented. Here you can find a list of control questions on the sections of the discipline and the answers to them, which indicates the control over the assimilation of the material.
Bulletin of the Russian Military Medical Academy. 2018;20(2):272-278
272-278
Pravila dlya avtorov
Bulletin of the Russian Military Medical Academy. 2018;20(2):279-280
279-280