Bulletin of the Russian Military Medical Academy
ISSN (print): 1682-7392, ISSN (online): 2687-1424 Founders: Kirov Military medical academy, Eco-Vector Editor-in-Chief: Evgeniy V. Kryukov, academician RAS, Doctor of Sc., Full Professor Frequency / Access: 4 issues per year / Open Included in: White list (4th level), Higher Attestation Commission List, RISC
Authors who publish with this journal agree to the following terms: Authors retain copyright and grant the journal exclusive license to first publication. Authors are able to distribute the manuscript and/or the article in accordance with Self-Archiving policy of the journal (see details). The manuscript can be accepted for publication only by decision of the Editor-in-Chief and the Editorial board of the journal in accordance with the Manuscript stelection policy of the journal (see details). Published Article will be distributed in print and electronic version an will be available under subscription with Delayed Open Access or in Immediate Open Access under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License (CC BY-NC-ND 4.0). The access model depends on the publisher's decision or is determined by a separate Open Access publishing agreement with the authors. An exclusive license for publication granted by authors allows the publisher to use the article in the following ways: Reproduction of the Article or its sections or parts, as well as the metadata of the Article in any languages, in any material form, including on paper and electronic media, as a separate work in the journal and/or databases (local or in the Internet) of the publisher and/or other persons, at the discretion of the publisher; Distribution of the Article or its sections or parts, as well as the metadata of the Article in any languages, on any medium as part of the journal and/or databases of the publisher or other persons, at the discretion of the publisher, or as an independent work around the world whether on Open-Access terms or for a fee without remuneration to the Author; Making the Article or any of its sections or parts, as well as the Article’s metadata in any languages, publicly available in such a way that any person can access the Article from any place, including via the Internet, and at any time of their own choosing; Granting permission/s for the use of the Article or its sections or parts, as well as its metadata in any languages, to third parties with notice to the Author made by posting relevant information on the journal’s website, without paying remuneration to the Author; Processing the Article (i.e., editing, correcting, annotating, tagging, translating to any languages, typesetting) and using the revised (translated) Article in the aforementioned ways. Other rights not directly transferred to the publisher under this License Agreement, including patent rights to any process, method etc., described by the Authors in the manuscript, as well as trademark rights, are reserved for the Authors. All the Copyright statements for authors are present in the standart Publishing Agreement (Public Offer) to Publish an Article in an Academic Periodical 'Bulletin of the Russian Military Medical Academy'. - DOWNLOAD the print-version of the License Agreement. READ the details online (tap to see in details) Author’s license agreement (public offer) on the publication of an article in a scholarly journal “Bulletin of the Russian Military Medical Academy” Eco-Vector, represented by its CEO Evgeniy Schepin and acting on the basis of the Charter (hereinafter referred to as the Publisher), on the one hand, offers an indefinite circle of persons (hereinafter referred to as the Author), and on the other hand, hereinafter jointly referred to as the Parties, to execute this agreement (hereinafter referred to as the Agreement) on the publication of scientific article (hereinafter referred to as the Article) in a scholarly journal “Bulletin of the Russian Military Medical Academy” (further-the Journal) in accordance with the conditions stated below. I. General Provisions This Agreement, in accordance with clause 2 of Article 437 of the Civil Code of the Russian Federation, is a public offer (hereinafter referred to as the Offer) requiring full and unconditional acceptance (Acceptance), which, in accordance with Article 438 of the Civil Code of the Russian Federation, means the sending by the Author of his/her materials by way of uploading the same to the online electronic system designed to accept manuscripts for consideration, and subsequently posted in the corresponding section of the Journal’s website on the Internet information and telecommunications network (hereinafter referred to as the Internet). In accordance with the current legislation of the Russian Federation regarding the observance of copyright on electronic information resources, all materials found in a website, including submitted and published in electronic journals, may not be reproduced in whole or in part in any form (electronic or printed) without the prior written permission of the Publisher. Prior permission can be given by publishing an article in the open access with Creative Commons license. The journal requires license users to reference the original source, i.e., the publication, if the Author permits use of the public materials in the context of other documents. II. Terms used in the Agreement “Author” refers to an individual (or individuals) whose creative work has led to the creation of the manuscript of a scientific Article, or to a representative of these persons. “Manuscript” is the result of intellectual activity in the form of a scientific work containing text, graphic and numerical data, audiovisual information, program code and other elements submitted by the Author for publication in the Journal; it is also the mean “a draft of an Article submitted by the Author to be published in the Journal”. “Offer” is the current agreement (an offer to the author for the publication of an Article in the Journal). “Publication” is the process of placement of an Article in the Journal. “Article” is the manuscript that has been published in the Journal (after successful selection, editing, type-setting, copyediting, proofreading, translation). “Acceptance of the offer” refers to the full and unconditional acceptance of the offer on the terms specified in paragraph 3 of this agreement (the Author accepts offer by submitting a Manuscript to the Publisher via the online electronic submission system on the Journal’s Internet website). “Journal” is a scientific peer-reviewed periodical registered as a mass media entity in the Roskomnadzor register of the Russian Federation and ISSN-center. “Submission” is an electronic appeal of the Author to the Publisher for the publication of an Article in the Journal by uploading the manuscript and accompanying materials to the online electronic submission system on the Journal’s Internet website). “Publisher” refers to Eco-Vector, which is the Publisher of the journal. Article metadata includes the information that are intended for inclusion in International Scientific Databases and search engines, namely the following: title of the Article; information about each of the Authors (surname and first name; patronymic; place of work with the postal address indicated, contact information (e-mail)); abstract; keywords; thematic rubricator: UDC (Universal Decimal Classification) or other library and bibliographic classification and subject indexes; list of references. “Editorial board” is the creative team that prepares the journal for publication. “Parties” refers to the Author and the Publisher. “Author Guidelines” are the requirements for Articles published in the Journal, posted in the “For authors” section of the Journal’s Internet website. III. Subject of the Agreement (Offer) Under this agreement, the Author grants the Publisher, free of charge for the entire period of validity in accordance with the legislation of the Russian Federation, an exclusive license to use the Article created by the former for publication in the Journal, as well as the rights to use the article in the following ways: Reproduction of the Article or its sections or parts, as well as the metadata of the Article in any languages, in any material form, including on paper and electronic media, as a separate work in Journals and/or databases (local or in the Internet) of the Publisher and/or other persons, at the discretion of the Publisher; Distribution of the Article or its sections or parts, as well as the metadata of the Article in any languages, on any medium as part of the Journal and/or databases of the Publisher or other persons, at the discretion of the Publisher, or as an independent work around the world whether on Open-Access terms or for a fee without remuneration to the Author; Making the Article or any of its sections or parts, as well as the Article’s metadata in any languages, publicly available in such a way that any person can access the Article from any place, including via the Internet, and at any time of their own choosing; Granting permission/s for the use of the Article or its sections or parts, as well as its metadata in any languages, to third parties with notice to the Author made by posting relevant information on the Journal’s website, without paying remuneration to the Author; Processing the Article (i.e., editing, correcting, annotating, tagging, translating to any languages, typesetting) and using the revised (translated) Article in the aforementioned ways. Other rights not directly transferred to the Publisher under this Agreement, including patent rights to any process, method etc., described by the Author in the Article, as well as trademark rights, are reserved for the Author. The territory where the rights to the Article are allowed to be used is the whole world. The validity of this Agreement commences only if the manuscript of the Article is accepted for publication in the Journal and only from the moment of sending a notification of acceptance of the Article for publication to the Author from the official e-mail of the Journal. The rights are granted by the Author to the Publisher free of charge; the publication of the Article in the Journal does not entail any financial deductions to the Author. If the Publisher decides to reject the Submission or refuse to publish the Article in the Journal (i.e., retraction of the published Article), this Agreement becomes invalid. The decision to refuse publication will be sent to the Author at the e-mail address specified in the Submission. IV. Rights and Duties of the Parties The Author guarantees that: s/he holds the copyright the exclusive rights to the materials submitted to the Publisher as part of the manuscript of the Article; the rights granted to the Publisher under this agreement have not been previously transferred and will not be transferred to third parties in the future during the duration of the Agreement; the manuscript contains all references to the cited authors and/or publications (materials) provided for under the current copyright legislation; the Author has obtained all the necessary permissions for all information and other materials s/he holds no copyright to and that are used in the manuscript of the Article; the Article manuscript contains only materials permitted to be published in the open press in accordance with the current legislative acts of the Russian Federation, and its publication and distribution will not lead to the disclosure of secret (confidential) information (including state secrets); the Author has informed co-authors about the terms of this Agreement and has received their consent to execute this Agreement under the terms provided for in the Agreement. The Author carries certain obligations under the terms of the Agreement: s/he should prepare and submit the manuscript of the Article in accordance with the Author Guidelines posted on the Journal’s website; the Author should not use an electronic copy of the Article for commercial purposes and in other journal publications without the consent of the Publisher; in the process of preparing a manuscript for publication, the Author is obligated to undertake the following: make corrections to the text of the manuscript that have been marked by the peer-reviewers and accepted by the editorial board, and/or as necessary, upon the request of the Publisher and the editorial board, finalize the manuscript of the Article; revising and proofreading the manuscript of the Article in accordance with the editorial recommendations; suggest only the minimum of corrections to the type-setted (layout) Article. The Author has the following rights and duties: Use preprint or prior-to publication versions of an unpublished Article in the form and content accepted by the Publisher for publication in the Journal. Such prior-to-publish versions can be placed as electronic files on the personal websites of the Author (co-authors) or on the protected external websites of the employers of the Author; however, the Author cannot use the unpublished version(s) for commercial sale or for systematic external distribution by a third party (i.e., post on social media). The author or co-authors must, in turn, carry out certain duties, namely: include the following warning in the prior-to-publish version: “This is prior-to-publish version of the article accepted for publication in (Journal’s name), © Eco-Vector (year)”; provide the corresponding electronic link to the Publisher’s website at https://journals.eco-vector.com/ and/or via the DOI. Copy or transfer a copy of the published Article in whole or in part to colleagues free of charge for their personal or professional use, for the promotion of academic or scientific research, or for informational purposes of the Author’s employer. Use materials from a published Article in a book written by one of the co-authors. Use figures, tables and text excerpts from the Article for his or her (or co-authors’) own training purposes, or to include them in other published works in printed or electronic format by a third party, or to submit them in electronic format on an internal computer network, or on the public website of the Author (co-authors) or his/her employer. Include the Article in educational collections for use in the classroom, either for free distribution to the Author’s (co-authors’) students or in electronic format on a local server for access by students as part of the training course, as well as for internal training programs at the institution of the Author’s employer. The Publisher, for its part, is obliged to: publish the Author’s article in the Journal in printed and electronic form in accordance with the terms of this Agreement; if necessary, as so decided by the Journal’s editorial board, provide the Author with the proofreading of the manuscript and make a reasonable editing; provide to the Author the unlimited access to the final electronic version of the published Article (Version of Record) through the online electronic submission system on the Journal’s Internet website; comply with the Author’s rights as provided for by the current legislation, as well as protect them and take all necessary measures to prevent copyright infringement by third parties. The Publisher has a right to: conduct an expert evaluation of the manuscript (peer-reviewing and editorial evaluation) and invite the Author to make the necessary changes (revisions) to the manuscript; provide editing, copyediting, type-setting, proofreading, tagging, indexation and translation of the Article’s manuscript without altering the main content; in any subsequent authorized use by the Author (and/or other persons) of the Journal and/or Article (including any separate part or fragment thereof), require that a link to the Journal, Publisher, Author or other copyright holders, the title of the Article, the Journal’s volume/issue, and the year of publication be specified in the Journal; post preliminary and/or advertising information about the upcoming publication of the Article in the media and other information sources; make changes to the offer in accordance with the procedure established by the offer. The editorial board of the Journal, headed by the editor-in-chief, has the exclusive rights to select and/or reject materials sent to the Journal editorial office for publications purposes. The manuscript sent by the Author to the Journal editorial office is not subject to return. The editorial board of the Journal does not enter into correspondence about rejection of submissions. In all cases not stipulated and not provided for in this agreement, the parties are obliged to be guided by the relevant current laws of the Russian Federation. V. Acceptance of the Offer and Execution of the Agreement. Terms of the Agreement The Author accepts the Offer by submitting the manuscript on the Article to the Publisher through the electronic manuscript submission system on the Journal's Internet website. Acceptance of the offer by the author creates an Agreement in writing (Articles 438 and 1286.1 of the Civil Code of the Russian Federation) on the terms of the offer. This Agreement is valid for the duration of the exclusive rights to the Article. When transferring (alienating) the exclusive right to the Article by the Author to a third party, this Agreement does not terminate. VI. Procedure for changing and terminating the Agreement The Publisher has the right to unilaterally change the terms of this Agreement, in advance, at least 10 (ten) calendar days before the entry into force of the intended relevant changes, but with notice to the Author through the Journal’s website or by e-mail to the Author’s e-mail address specified in the Author’s Submission. The changes will take effect from the date specified in the relevant notification. If the Author rejects the changes to the terms of this Agreement, s/he has the right to notify the Publisher by sending a written notification through the online manuscripts submission system, making sure that the same is sent to the official e-mail address of the editorial office. This Agreement may be terminated prematurely, either by agreement of the parties at any time, or on other grounds provided for in this Agreement. The Author has the right to unilaterally withdraw from the execution of this Agreement by sending the Publisher a corresponding notification in writing at least 60 (sixty) calendar days in advance before the expected date of publication of the Article in the Journal. Termination of the Agreement for any reason does not release the parties from liability for any violation of the terms of the Agreement that occurred during the validity period. VII. Responsibility The parties are responsible for non-fulfillment or improper fulfillment of their obligations under the Agreement in accordance with the current relevant legislation of the Russian Federation. All information provided by the Author must be reliable. The Author is expected to provide accurate and complete the information to the Publisher. When using false information received from the Author, the Publisher is not responsible for the negative consequences caused by his actions on the basis of the false information provided. With regard to the content of the Article, the Author is solely responsible for compliance with the requirements of the laws of the Russian Federation pertaining to advertising, copyright and related rights’ protection, protection of trademarks and service marks, and the protection of consumer rights. The Publisher does not bear any responsibility under the agreement: for any actions that are a direct or indirect result of Author’s illegal actions; for any loss incurred by the Author, regardless of whether the Publisher could have foreseen the possibility of such losses or not. The Publisher is released from liability for violation of the terms of the Agreement if such violation is caused by force majeure, including actions of state authorities (including the adoption of legal acts), fire, flood, earthquake, other natural disasters, lack of electricity and/or computer network failures, strikes, civil unrest, riots, etc. VIII. Dispute resolution Disputes and disagreements will be resolved by the parties through negotiations, and in case of failure to reach an Agreement they will strive to seek resolution in accordance with the current legislation of the Russian Federation. If there are unresolved disagreements, the parties agree to resolve the disputes in court at the jurisdiction covered by the Publisher’s location in accordance with the current legislation of the Russian Federation. IX. Miscellaneous All notifications, messages, requests, etc. (with the exception of documents that must be sent as originals in accordance with the laws of the Russian Federation) are considered received by the Author if they were transmitted (sent) by the Publisher through the Journal’s website (including by publication), fax, e-mail based on the address specified in the Submission, and other communication channels. The parties recognize the legal force of notifications, messages, requests, etc., transmitted (sent) by the above methods. In the event of claims against the Publisher related to the violation of the exclusive copyright and other intellectual property rights of third parties when creating an article or in connection with the execution of this Agreement by the Author, as well as in connection with the use of the Article by the Publisher in accordance with the Agreement, the author undertakes: To immediately take measures to resolve disputes with third parties soon after receiving Publisher’s notification, and if necessary, enter into legal proceedings on the Publisher’s side and take all appropriate actions needed to exclude the Publisher from the list of defendants; To reimburse the publisher for the legal costs incurred and expenses and losses caused by the application of measures to secure the claim and execute a court decision, and the money paid to a third party for the violation of exclusive copyright and other intellectual property rights, as well as other losses incurred by the Publisher in connection with the Author’s non-compliance with the guarantees provided by them under this Agreement. X. Legal address and details of the Publisher Eco-Vector Address: 191186, St. Petersburg, Aptekarsky Pereulok, 3 letter A, room 1N TIN: 7806423692; KPP: 784101001; OGRN: 1099847039907.
Cystatin C as a biomarker of acute kidney injury in patients with combat injury
BACKGROUND: An analysis of the nature of casualties in the context of modern armed conflicts revealed the need to improve the diagnosis of combat injury complications. Acute kidney injury is a multifactorial condition resulting both from injury and systemic dysfunction. Current methods of diagnosing acute kidney injury are inadequate and time-consuming, which results in worse clinical outcomes. Developing innovative systems that can predict acute kidney injury at an early stage will optimize the timing of emergency and intensive care, thereby improving the quality of care provided. AIM: This study aimed to evaluate the diagnostic value of the proposed immunochromatographic test system in semi-quantitative determination of urine cystatin C levels for the prediction of acute kidney injury in patients with combat injuries. METHODS: This was a prospective analysis of the assessment results of 168 patients with combat injury who were admitted to a specialized medical care facility. Urine samples were collected at admission. The obtained material was used determine the threshold urine concentrations of cystatin C with a semi-quantitative method using innovative immunochromatographic test strips. The results were compared to those of the standard diagnosis technique for acute kidney injury, which involved monitoring serum creatinine levels and diuresis rates over time. RESULTS: The innovative test system revealed a high (91.6%) diagnostic value of urine concentrations of cystatin C in predicting acute kidney injury in patients with combat injuries. The sensitivity and specificity of the test was 83.3% and 92.8%, respectively. CONCLUSION: The proposed test for early acute kidney injury prediction should be implemented at the initial stage of medical care to establish evacuation procedures, initiate emergency preventive measures, and select treatment options for acute kidney injury in patients with combat injuries.
Copyright (c) 2025 Eco-Vector https://eco-vector.com/for_authors.php#07
Sex- and age-related changes in saliva levels of nitric oxide metabolites in healthy volunteers and patients with cancer
BACKGROUND: Nitric oxide is a multifunctional signaling molecule that regulates processes such as vasodilation, platelet aggregation, immunotoxicity, and carcinogenesis. Currently, nitric oxide is believed to be involved in the development and progression of tumor lesions. Depending on the concentration, nitric oxide can affect tumor cell apoptosis, metastasis, and angiogenesis intensity. It also demonstrates anti-tumor and cytotoxic properties. Additionally, being the end products of nitric oxide, the total concentration of nitrites and nitrates can be considered diagnostic and prognostic markers for subclinical forms and recurrent cancer. AIM: This study aimed to compare total nitrite and nitrate concentrations in the saliva of healthy volunteers and patients with tumors localized at different sites, depending on sex and age. METHODS: The study included 106 patients, with 74 in the comparison group (healthy volunteers) and 32 in the cancer group. The study participants provided fasting saliva samples (5.0 ± 0.5 mL) in the morning. The samples were collected in plastic test tubes. The total concentration of nitrites and nitrates was determined by spectrophotometry using the colorimetric nitrite diazotization reaction with sulfanilamide and 1-naphthylamine. Nitrates were reduced to nitrites using zinc powder in an alkaline medium containing a copper sulfate-ammonia complex. Next, nitrite ions were quantified. RESULTS: The total concentration of nitrites and nitrates in the saliva samples of healthy volunteers was 129 [59; 261] μM, with nitrites at 109 [36.4; 254.0] μM and nitrates at 6.4 [2.1; 20.9] μM. Nitrate and nitrite concentrations in saliva did not differ statistically between men and women. Nitrate and nitrite concentrations also increased with age. The total concentration of nitrites and nitrates in the saliva samples of patients with tumors at different sites was 14.5 [6.5; 80.1] μM, with nitrites at 9.2 [3.0; 79.4] μM and nitrates at 3.9 [1.5; 7.7] μM. The concentrations were statistically significantly lower compared with those in healthy volunteers. Additionally, patients with cancer aged 40 to 69 years demonstrated the most significant decrease in the total concentration of nitrites and nitrates. CONCLUSION: The results suggest significant differences in nitrite and nitrate concentrations in saliva between healthy volunteers and patients with cancer. Further research could lead to new approaches for diagnosing cancer by using nitrite and nitrate concentrations in saliva as signal markers.
Optimization of drug provision for patients with rheumatoid arthritis based on a pharmacoeconomic analysis in the Republic of Kazakhstan
BACKGROUND: Providing the least costly, safe, and highly effective pharmacotherapy to patients with rheumatoid arthritis remains an urgent issue. AIM: This work aimed to develop approaches for optimizing drug provision for patients with rheumatoid arthritis (using the city of Almaty as an example). METHODS: This work used the information resources of the Ministry of Health of the Republic of Kazakhstan; reports from the Almaty City Rheumatology Center, the State Register of Medicinal Products of the Republic of Kazakhstan, the Clinical Protocol for the Diagnosis and Treatment of Rheumatoid Arthritis No. 12 dated September 29, 2016; wholesale prices for medicinal products, antineoplastic agents, and immunomodulators (anatomical therapeutic chemical groups L01, L04) provided by the City Rheumatology Center; and statistical indicators accumulated based on data from the World Health Organization and the Bureau of National Statistics of the Agency for Strategic Planning and Reforms of the Republic of Kazakhstan. RESULTS: The highest disease prevalence (60%) was observed among working-age patients aged 35–55 years, whereas only 0.36% of the medicinal products used belonged to biologic agents. The cost ranking (ascending order) of adverse drug reaction therapy was as follows: adalimumab, etanercept, rituximab, tocilizumab, golimumab, and infliximab. With regard to additional cost expenditures, the leading agents (based on the lowest cost of the treatment course) were golimumab, rituximab, and infliximab. The lowest total treatment cost across all treatment stages (in ascending order) was identified for etanercept, adalimumab, and infliximab. CONCLUSION: Strengthening physician-led patient education regarding treatment strategies is necessary to improve adherence among patients with rheumatoid arthritis. To expand therapy options, the inclusion of etanercept in the guaranteed free medical care list must be considered. To reduce expenditures for medicinal provision, producing biologic agents in the Republic of Kazakhstan is required.
Contemporary approaches to early detection of asymptomatic heart disease in patients with hypertension
BACKGROUND: The onset and progression of hypertension may damage target organs, particularly the heart. This disease is asymptomatic during its early stages. According to Russian guidelines for the treatment of hypertension, left ventricular myocardial hypertrophy is the primary marker of asymptomatic heart disease. Earlier signs may include functional changes in the left atrium, which is detected by speckle tracking echocardiography with longitudinal strain assessment. AIM: This study aimed to assess the efficacy of speckle tracking echocardiography with longitudinal strain assessment in detecting early signs of left myocardial dysfunction in patients with hypertension. METHODS: Segmental and global left atrial and ventricular longitudinal strain was evaluated in patients with hypertension with or without left ventricular hypertrophy and a control group. The longitudinal strain was assessed by analyzing curves of segmental longitudinal strain peaks and rates. Following echocardiography in three standard apical views, software was used to convert data into bull’s eye diagrams. This enabled a comprehensive assessment of global and regional left ventricular contractility using numeric and color parameters. Segmental left ventricular and left atrial longitudinal strain was evaluated using 17 and 6 segments, respectively. RESULTS: No significant differences were found in global left ventricular longitudinal strain parameters between patients with hypertension without echocardiographic signs of left ventricular hypertrophy and healthy individuals. Patients with hypertension (both with and without left ventricular hypertrophy) showed a significant decrease in left atrial longitudinal strain compared to healthy individuals. CONCLUSION: Decreased left atrial longitudinal strain may be the earliest sign of asymptomatic heart disease in hypertension. Impaired longitudinal strain in the left ventricular basal segments is associated with left ventricular hypertrophy in patients with hypertension.
Early diagnosis of upper gastrointestinal disorders in military personnel
BACKGROUND: Subclinical conditions are a primary focus of military medicine because military personnel are routinely exposed to adverse conditions. AIM: This study aimed to evaluate the actual significance of risk factors for esophageal, gastric, and duodenal disorders in National Guard of Russia personnel in order to develop a screening model for upper gastrointestinal diseases. METHODS: A survey included 504 personnel of National Guard of Russia aged 21 to 65 years, who had participated in combat operations. Of these, 197 were officers and 307 were contract servicemen. Their combat tours ranged from 3 to 6 months. Esophagogastroduodenoscopy was performed in 55 respondents (22 officers and 33 contract servicemen). The rank dependence of the risk factors on endoscopic changes was calculated using paired linear correlations. The data were then extrapolated to the entire population (n = 504). RESULTS: The effects of risk factors on disease onset differed among officers and contract servicemen for seven parameters: combat tour duration (p < 0.0001), history of periodic alcohol consumption (p = 0.0153), rushed food intake (p = 0.0020), smoking (p = 0.0116), physical exertion (p = 0.0011), consumption of chemically contaminated products (p = 0.0098), and asthenic body habitus (p = 0.0031). Using Kendall’s tau rank correlation, the relative risk, and the odds ratio, five key risk factors were identified from seven risk factors involved in the development of upper gastrointestinal disorders in the group of officers. These factors included consumption of chemically contaminated products, periodic alcohol consumption, smoking, physical exertion, and asthenic body habitus. CONCLUSION: The evidence has been collected to support the role of certain risk factors in the early diagnosis of upper gastrointestinal diseases. It may be used to generate a screening model for National Guard of Russia servicemen.
Copyright (c) 2025 Eco-Vector https://creativecommons.org/licenses/by-nc-nd/4.0/
Multicenter analysis of long-term clinical outcomes of an algorithmic approach to selecting ventral decompressive-stabilizing procedures in two-level degenerative cervical spine disease
BACKGROUND: Currently, the scientific data lack well-substantiated clinical and radiologic indications for the differentiated use of anterior cervical discectomy with two-level interbody fusion versus anterior cervical corpectomy with single-level transbody fusion in patients with two-level degenerative cervical spine disease. AIM: This work aimed to prospectively assess the long-term clinical outcomes of an algorithmic approach for the selection of anterior interbody cervical fusion versus anterior transbody cervical fusion in patients with two-level degenerative cervical spine disease. METHODS: The treatment of patients with two-segment degenerative cervical spine disease was compared between a prospective cohort (n = 97), operated according to a preoperative clinico-morphologic algorithm in neurosurgical departments in Irkutsk and Krasnoyarsk during 2021–2023, and a retrospective control group (n = 186), operated at the Irkutsk Neurosurgery Center in 2009–2020 using the same surgical techniques according to surgeon preference. RESULTS: After undergoing anterior interbody cervical fusion, the prospective group demonstrated significantly better trends in improvement as compared with the retrospective group, including neurologic function recovery (p < 0.05), regression of pseudoradicular symptoms (p < 0.05), improvement in cervical disability scale indices (p = 0.03) and modified Japanese Orthopaedic Association scores (p = 0.04), improvement in both physical (p = 0.01) and psychological (p = 0.01) SF-36 health components, and better MacNab scale outcomes (p = 0.006). After anterior transbody cervical fusion, the prospective group demonstrated significantly better trends in improvement than the retrospective group did, including neurologic function recovery (p < 0.05), regression of pseudoradicular symptoms (p < 0.05), improvement in cervical disability scale indices (p = 0.03) and modified Japanese Orthopaedic Association scores (p = 0.01), as well as better physical (p = 0.02) and psychological (p = 0.01) health components of the SF-36. Complication rates in the prospective subgroups were significantly lower than those in the retrospective subgroups. CONCLUSION: In two-level degenerative cervical spine disease, an algorithm-based anterior approach to the differentiated selection of anterior interbody versus anterior transbody cervical fusion led to a significant improvement in clinical outcomes and a reduction in postoperative complications at a minimum 2-year postoperative follow-up.
Impact of combat conditions on casualties and surgical care
BACKGROUND: Modern armed conflicts evolve rapidly, resulting in changes in combat scenarios, tactical settings, and military medicine. This, in turn, influences the prevalence of combat-related surgical injuries, with a significant effect on the scope and type of surgical care provided during the early stages of casualty evacuation. The medical evacuation support system established at the beginning of the military operation is currently facing new challenges. These include providing medical care throughout a lengthy prehospital phase as well as the need for specialty care and military medical examination for the increasing number of light casualties in the active army. AIM: This work aimed to assess the prevalence of combat-related surgical injuries as well as the type and scope of surgical care in various combat scenarios of a modern regional conflict. METHODS: Data on casualties that required surgical treatment were pooled and analyzed for several forward medical facilities of individual medical battalions, including those of reinforced combat teams, during a modern armed conflict. RESULTS: Modern warfare is evolving rapidly, as evidenced by the fact that three-fourths of patients admitted to tertiary care were injured as a result of unmanned aerial vehicle attacks. Changes in combat conditions have significantly altered the prevalence of combat-related surgical injuries and the type of surgical care provided. The longer time to casualty evacuation for specialty surgical care is the most significant change influencing the current medical evacuation support system. Other changes, including the decreased proportion of severe and extremely severe wounds (by 15.4%), the increased proportion of minor wounds (by 49.9%), the decreased incidence of penetrating wounds (by 45.2%), and the increased incidence of isolated wounds (by 53.2%), facilitate secondary and tertiary casualty evacuation. CONCLUSION: The changes discussed above are primarily associated with a longer time to casualty evacuation for specialty surgical care. These changes signify a new, significant challenge for tactical medicine during a lengthy prehospital phase. Specialized military hospitals for light casualties deployed in a combat area and its immediate vicinity have reduced the need for casualty evacuation to rear military medical facilities.
A risk-based approach to sanitary and hygienic measures for improving compounding performance in pharmacies
BAKGRAUND: Risk management and effective sanitary and anti-epidemic measures are crucial for improving the efficiency of pharmaceutical compounding. Most pharmacies lack a comprehensive and well-defined algorithm for developing sanitary and anti-epidemic requirements or sanitary and hygienic measures in their standard operating procedures or other local policies. AIM: This work aimed to provide a risk-based, research- and practice-oriented approach to developing standard operating procedures and local regulations to improve sanitary and hygienic measures in pharmacies, including those with the right to aseptic pharmaceutical compounding. The work also aimed to propose an algorithm for implementing these measures into routine practice. METHODS: The work was based on laws and regulations on drug circulation and pharmaceutical activities, research into drug provision and sanitary and anti-epidemic measures in pharmacies, as well as other scientific publications and reference materials on the subject. Latent semantic, historical, structural logical, and content analyses were used. RESULTS: Due to the lack of clear requirements for the implementation of sanitary and hygienic measures, the following risks have been identified: reduced quality and safety of pharmaceutical products; contamination of pharmacy facilities (e.g., process equipment) with various agents, including microorganisms. The fundamental principles of sanitary, hygienic, and anti-epidemic measures in pharmacies were justified. The key sanitary requirements for pharmacies were specified, including interior finishing, ventilation, and lighting, as well as receipt, storage, and transportation of purified water and water for injection. Specific sanitary and anti-epidemic measures were defined for pharmaceutical compounding, including aseptic compounding. A recommended schedule for junior pharmacy staff during sanitary and hygienic measures was provided. CONCLUSION: Pharmacies should make the development and implementation of standard operating procedures and local regulations a priority to improve their sanitary and hygienic practices. This will significantly improve the effectiveness of pharmaceutical compounding. A risk-based approach to sanitary and hygienic measures in pharmacies is essential for ensuring the high quality and safety of compounded drug products. Any deviations in this approach can have a detrimental impact on public health.
Potential biomedical use of nanosized cerium phosphate compounds in wound healing
BACKGROUND: Skin wound healing is a global public health concern that has a significant effect on quality of life. Ongoing exploratory studies demonstrate the consistently expanding potential of nanoparticles in wound healing. However, although there has been extensive biomedical research of nanoparticles, nanocerium has yet to find use in real-world practice. AIM: This work aimed to examine the biological properties of nanosized cerium phosphate compounds and assess the effect of various concentrations of colloidal solution on the proliferative activity of cells involved in regeneration and skin wound healing. METHODS: Multivalent cerium compounds were manufactured in the form of nanosized cerium phosphate powder, containing both Се3+ and Се4+, as well as methyl cellulose–based nanocomposites. Human fibroblasts were co-cultured with various colloidal solutions of cerium phosphate nanoparticles. The proliferative activity was evaluated using a thiazolyl blue tetrazolium bromide (MTT) assay and direct cell counting with live/dead quantification 72 hours after co-incubation with samples. RESULTS: Cerium phosphate nanoparticles significantly increase the metabolic activity of cells while having no noticeable effect on cell numbers. The most significant effect was reported for cerium phosphate (Ce3+/4+) + methyl cellulose 0.5 g/L as well as cerium(III) phosphate (CePO4-I, CePO4-II) at a maximum concentration of 10−3 M. No samples showed a cytotoxic effect. CONCLUSION: Nanosized cerium phosphate compounds, including methyl cellulose–based nanocomposites, exhibited a significant stimulating biological effect in cell cultures involved in regeneration. This highlights their potential in the development of effective medical devices that contain cerium phosphate particles for healing wounds of various origins. However, the findings do not explain the mechanisms behind this stimulatory effect.
Features of collateral portal circulation in the formation of gastric varices in patients with portal hypertension
BACKGROUND: Bleeding from esophageal varices and gastric varices is the most frequent and life-threatening complication of portal hypertension is. In 20% to 30% of cases, gastric varices are the source of hemorrhage. Bleeding from gastric varices is more dangerous than bleeding from esophageal varices, due to its greater bleeding volume and persistence as well as the lower therapeutic effectiveness of conventional hemostatic methods. Preventing the development and progression of gastric varices is therefore a key element in managing and preventing portal hypertensive bleeding. AIM: This study aimed to improve algorithms for preventing and treating portal hypertensive gastric bleeding by characterizing the features of collateral circulation within the gastroesophageal region of the portal system in the context of gastric varix formation. METHODS: A total of 137 patients with portal hypertension were examined. The main group included 67 patients with gastroesophageal varices type 1 or type 2 or isolated fundal varices. The etiologic factor of portal hypertension was liver cirrhosis of various etiologies in 37 cases and extrahepatic portal hypertension in 30 cases. Left-sided portal hypertension resulting from isolated splenic vein thrombosis was established in 13 (43.3%) patients with extrahepatic portal hypertension. Subcompensated liver function was identified in 22 cirrhotic patients and decompensated in 15 according to the C. Child – D. Turcotte – R. Pugh classification. The control group comprised 70 patients with portal hypertension and esophageal varices without extension of varices across the gastroesophageal junction. Cirrhosis was the etiologic factor of portal hypertension in 44 patients, whereas the elevated portal venous pressure in 26 patients was due to extrahepatic portal hypertension resulting from portal vein thrombosis. Based on the C. Child – D. Turcotte – R. Pugh classification, subcompensated liver function was noted in 25 cirrhotic patients and decompensated in 19. RESULTS: Hepatofugal flow through the left gastric vein was the major factor resulting in the formation of esophageal varices and gastroesophageal varices type 1, which was characteristic for patients with cirrhosis. When an afferent inflow via the posterior gastric vein was present in addition to the left gastric vein, gastroesophageal varices type 2 developed more frequently. Concurrent retrograde flow through all three afferent vessels (left gastric vein, posterior gastric vein, and short gastric veins) resulted in a twofold higher likelihood of the development of isolated fundal varices or combined gastroesophageal varices type 1/type 2 patterns and occurred with similar frequency in both intrahepatic and extrahepatic portal hypertension (p = 0.0014). Retrograde flow through the posterior gastric vein and short gastric veins led to the development of isolated fundal varices type 1 and was typically associated with left-sided portal hypertension. CONCLUSION: When making a differentiated selection of treatment and prevention methods for gastric variceal bleeding, the identified characteristics of collateral circulation in the gastroesophageal portal system must be considered.
Review of diagnostic approaches for mental and cognitive impairment in post-traumatic stress disorder
Post-traumatic stress disorder (PTSD) is becoming increasingly common among military personnel who have participated in combat operations, posing a significant challenge to their normal social functioning. Without effective rehabilitation programs, maladaptive behaviors can become habitual, hindering social integration. Therefore, it is crucial to start the mental recovery process as early as possible. This work evaluated the validity of the diagnostic approaches recommended by the Research Domain Criteria (RDoC) project in evaluating the PTSD severity. We used the RDoC and International Classification of Functioning, Disability, and Health (ICF) domains to evaluate PTSD-associated functional impairment. The work reviewed the syndromic heterogeneity of PTSD, the challenges of differential diagnosis, and the impact of etiological factors on the clinical presentation. We identified three main categories of functional impairment: stress-related behaviors, interpersonal interactions, and cognitive abilities. Diagnostic approaches and research paradigms were proposed to assess and standardize these categories. The RDoC and ICF concepts provide a new perspective on the pathogenesis of PTSD and development of personalized management strategies. It appears promising to enhance specialized diagnostic approaches for this patient population, considering their cultural and mental background.
A personalized approach to current antiplatelet therapy strategies
Antiplatelet therapy, which consists primarily of aspirin (acetylsalicylic acid) and P2Y12 receptor antagonists, is one of the most commonly prescribed treatments in current clinical practice, because of the steadily increasing incidence of cardiovascular disease and the related high mortality rates. Antiplatelet agents are valuable tools for physicians because they can prevent atherothrombotic events, improve clinical outcomes, and reduce cardiovascular mortality rates in primary and secondary prevention. However, secondary bleeding remains a concern with antiplatelet therapy. The current goal of medical science is to minimize bleeding risk in patients at high risk for hemorrhagic events. This review presents data on antiplatelet drugs used in real-world clinical practice. It provides detailed, comprehensive descriptions of their use in various situations and highlights strategies for switching between them. The review also discusses the consequences of high residual platelet reactivity after treatment and summarizes current trends in patient-centered medicine. Additionally, the work revealed the high potential for developing effective and safe agents to counteract the effects of antiplatelet agents. New antiplatelet agents are being developed, such as selatogrel, revacept, and glenzocimab. Further research is required to understand how these potential new agents will integrate into the current antiplatelet therapy paradigm and whether they will promote safer clinical practices. Although significant advances in optimizing antiplatelet therapy have been made through clinical studies, more work is yet to be done. Most genetic intervention studies focus on CYP2C19 polymorphisms in order to personalize antiplatelet treatment strategies.
Contemporary diagnosis and surgical treatment of acute traumatic pancreatitis
This review examined Russian and international publications on the diagnosis, classification, surgical treatment, and drug therapy of acute traumatic pancreatitis, a condition caused by pancreatic injury. Pancreatic injuries, although uncommon, typically have an unfavorable prognosis. Timely diagnosis and optimal surgical treatment are essential for the prognosis. Diagnosing pancreatic injury is made challenging by the anatomical position of the pancreas, resulting in delayed treatment. Because of its subclinical course, acute traumatic pancreatitis is frequently difficult to diagnose, especially early after injury. The lack of typical clinical signs is the main cause of diagnostic errors in acute traumatic pancreatitis. This review discusses the contemporary diagnostic techniques for pancreatic injury. Furthermore, it addresses the clinical course of acute traumatic pancreatitis and measures to prevent complications. The American Association for the Surgery of Trauma pancreatic organ injury scale is the primary generally accepted classification for traumatic pancreatic injuries. The main aspects of medical care in modern armed conflicts are highlighted in this review. The surgical treatment of acute traumatic pancreatitis combines conservative management, minimally invasive and conventional open surgeries, and the early prevention of complications. Further research is warranted to develop unified diagnosis and surgical treatment protocols and to assess the long-term treatment outcomes in acute traumatic pancreatitis. The review of published research suggests that this subject is insufficiently studied, highlighting the relevance of this work.
Professor Pavel P. Goncharov, researcher and manager: to his 125th birthday
Examining the lives of prominent military physicians is one way to honor our nation’s heroes. Instilling national spiritual and moral values in future generations is vital. This article honors the life and research of Professor Pavel P. Goncharov, a well-known Soviet pathophysiologist who made significant contributions to military medicine. Throughout his lengthy academic career, Professor Goncharov contributed substantially to the establishment and evolution of interoception, a unique branch of science. He demonstrated the efficacy of sulfonamides in the treatment of combat injuries and promoted significant changes in military medicine research, emphasizing the practical applicability of discoveries. Professor Goncharov’s leadership had a significant impact on the S.M. Kirov Military Medical Academy, one of Russia’s oldest and most unique educational institutions. He made an invaluable contribution to the Academy’s history as a researcher, educator, and manager, helping to reform its academic programs and elevate the status of military medical education. Professor Goncharov published more than 80 research works, with the most notable being the monographs “On Cardiac Tamponade” and “On Intestinal Visceral Reflexes.” His work and research are inseparable from the traditions of the Military Medical Academy and its renowned scientific schools. Professor Goncharov is a true example of a military physician who valued service to his country and its people the most. Learning about the lives and work of outstanding scientists shapes the attitudes and motivations of young people who choose to pursue a career in military medicine.
An example of professional and military devotion
This article highlights the life, teaching activities, and research work of Professor Anatoly M. Shelepov, Doctor of Sciences in Medicine, retired Major General of Medical Service. It examines the milestones in his career as a researcher and the head of one of the leading theoretical departments of the S.M. Kirov Military Medical Academy. Anatoly M. Shelepov, a Suvorov Military School alumnus, has always followed Suvorov’s credo, “Never give up!” In his 18 years as department head, he has reached his full potential as a researcher, educator, and academic team leader. Professor Shelepov has consistently expanded the department’s scientific capacity. Approximately 80 doctoral and candidate theses were defended under his supervision. Many of Shelepov’s former students now hold managerial positions in various military and civilian organizations, lead medical services of military districts and branches of the Russian Armed Forces, or work at the Military Medical Academy. In 1998, Professor Shelepov founded the scientific school for military medicine management. In 2003, the federal government recognized the school’s leading scientific status. Shelepov’s fellow researchers proposed theories and concepts for the development of the Russian Armed Forces Medical Service, addressed practical issues of military medicine during armed conflicts and peacetime emergencies, worked on standardization in medical care, and explored the history of military medicine. Since 1993, Professor Shelepov has been a member of the medical geography department of the Russian Geographical Society. Under his supervision, a territorial medical support system was developed; the scope of military medical care during local wars, armed conflicts, and peacekeeping efforts was proposed; and a plan for the Russian Armed Forces Medical Service development until 2030 was established.