Russian Military Medical Academy Reports
ISSN (print): 2713-2315, ISSN (online): 2713-2323 Founders: Military Medical Academy; "Eco-Vector" LLC Editor-in-Chief: Kryukov Evgeniy Vladimirovich, Academician of the Russian Academy of Sciences, Doctor of Medicine. sciences Frequency / Access: 4 issues per year / Subscription Included in: RISC
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Diagnosis of Impaired Brain Perfusion in Children with Craniosynostosis by Magnetic Resonance Imaging
BACKGROUND: Craniosynostosis is a medical condition characterized by the premature fusion or absence of cranial sutures, leading to an abnormal head shape and a potential risk of neurological disorders. There is a growing interest in the early diagnosis of craniosynostosis. Delayed treatment of synostoses can impede normal cranial bone growth, resulting in cranial deformities, craniocerebral disproportion, and microcephaly. The abnormal head shape may result in the compression of brain tissue, meninges, and vascular structures in the affected regions. Noninvasive imaging techniques are currently available for assessing cerebral hemodynamics. Dynamic susceptibility contrast magnetic resonance perfusion facilitates the evaluation of relative cerebral blood flow in regions suspected of brain compression in pediatric patients with craniosynostoses. AIM: To evaluate cerebral blood flow in children with craniosynostoses using dynamic susceptibility contrast magnetic resonance perfusion to determine relative hemodynamic parameters, such as cerebral blood flow and cerebral blood volume. METHODS: The study included a total of 52 children diagnosed with different types of craniosynostosis. The age of the participants ranged from 3 to 38 months. They were assessed using a 1.5T magnetic resonance imaging scanner with an intravenous paramagnetic contrast agent (0.1 mmol/kg of body weight) administered during drug-induced sleep. The standard brain examination protocol was augmented with dynamic susceptibility contrast magnetic resonance perfusion pulse sequences. RESULTS: A comprehensive analysis of the findings demonstrated that metopic, mono- and bicoronal synostosis were associated with reduced cerebral blood flow and blood volume in the compressed region when compared with the contralateral intact region. In contrast, no significant differences in magnetic resonance perfusion findings were identified between the affected and intact regions for the patients with sagittal craniosynostosis. CONCLUSION: This study found that dynamic susceptibility contrast magnetic resonance perfusion can be a useful tool for assessing changes in cerebral perfusion. This finding offers novel prospects for planning treatment strategies. The proposed approach has the potential to serve as a valuable tool for patient assessments during both the early and late postoperative periods.
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Background: Primary health care is a basic component of the Russian healthcare system. All relevant national projects and programs are focused on improving primary health care both in outpatient and day stay settings. Furthermore, a strategy to reduce hospital bed capacity by increasing day hospitalizations is considered a promising area for further advancements in healthcare services. The continuous evaluation of the performance of the healthcare system components is necessary to ensure its effective operation. AIM: To review the scientific publications and propose a new terminology for better organizing and evaluating primary health care activities. METHODS: Laws and regulations from the Russian Ministry of Health were thoroughly analyzed, and scientific medical publications regarding the system of primary health care were also reviewed. RESULTS: We have developed and proposed the new concept of “simultaneous day stay interventions” to increase the functional capacity of day hospitals and improve patient satisfaction. This concept facilitated the integration of multiple therapeutic and preventive interventions in day stay settings, which had not been previously performed in combination, thereby increasing the functional capacity of day hospitals and improving patient satisfaction. CONCLUSION: The practical implementation of this concept will contribute to the enhanced effectiveness of day hospitals and treatment outcomes, ensuring a more optimal use of healthcare resources and improved patient satisfaction.
Magnetic Resonance Imaging-Based Frontal Lobe Morphometry in Pediatric Patients
Background: Magnetic resonance imaging-based morphometry is a highly informative, noninvasive method for early diagnosis of structural brain changes, which facilitates their quantitative and qualitative evaluation. The frontal lobes increase significantly in size during brain development, which is associated with their important role in cognitive functions and environmental adaptations. Frontal lobe morphometry in pediatric patients can be used to identify abnormalities and understand normal developmental processes in early childhood. AIM: To identify any changes in the morphometry of the frontal lobes in neurologically healthy children and to analyze how these changes may vary across sex and age groups. METHODS: The study included 49 children aged 6 months to 18 years. The observations were categorized into two age groups: from 0 to 7 years (17 children) and from 7 to 18 years (32 children). Automatic magnetic resonance imaging-based morphometry was performed with FreeSurfer software used to determine morphometric parameters, including frontal lobe volume, surface area, and cortical thickness. RESULTS: The findings showed age-related variations in the frontal lobe volume, area, and thickness. There were no significant sex-specific differences in the morphometric parameters between the age groups. However, relative values of the morphometric parameters calculated as a percentage of intracranial volume were higher in boys than in girls. The obtained results demonstrate both symmetrical and asymmetrical changes, thereby underscoring the multidirectional nature of the frontal lobe development during human growth. CONCLUSION: Magnetic resonance imaging-based morphometry is a highly effective method for identifying the developmental patterns of the frontal lobes in neurologically healthy children. The morphometric parameters outlined in this study may serve as reference values in the assessment of pediatric populations diagnosed with neurodegenerative diseases.
Experience with Telemedicine Technologies in Providing Medical Care to the Population of the Republic of Bashkortostan
BACKGROUND: Contemporary medicine has experienced a significant expansion in its capabilities and scope through the integration of telemedicine technologies across various disciplines, an advancement that has garnered favorable reviews from both healthcare professionals and patients. An annual increase in telemedicine visits has been observed, contributing to an improvement in patient satisfaction. AIM: To analyze the structure and development of telemedicine visits facilitated by the Telemedicine Center of the Bashkortostan Healthcare Information System, and to assess the use and implementation of telemedicine technologies in the context of Russian compulsory medical insurance. METHODS: This was a retrospective analytical study based on the annual statistical reports published by the Bashkortostan Medical Information and Analytics Center and the annual reports of the Bashkortostan Regional Compulsory Medical Insurance Fund for 2019–2023 that were submitted through the Unified Data Collection and Processing System of the Federal Compulsory Medical Insurance Fund. RESULTS: Between 2019 and 2023, the number of telemedicine visits increased 8.3-fold in Bashkortostan. Oncology is the most frequently consulted discipline. In 2023, the proportion of this category increased by 2.5 times compared with 2020, which can be attributed to the approval of the Procedure for Providing Medical Care to the Adult Patients with Cancer, including the use of telemedicine technologies. This involved facilitating patient visits and/or online case conferences to decide on treatment strategies, including choosing a chemotherapy regimen. In 2023, 100% of Bashkortostan healthcare facilities were providing medical care using telemedicine technologies. CONCLUSION: The future challenges for the medical community can be addressed by improving the methods used in digital systems; establishing units within healthcare facilities that provide assistance using telemedicine technologies; setting standards for procuring the necessary equipment and software; and regularly offering special training to medical personnel to improve their IT skills.
Comparison of Primary Disease Incidence Among Students of Pre-University Educational Schools of the Russian Ministry of Defence and Russian Adolescents
Background: In 33 educational schools of the Russian Ministry of Defense, approximately 18,000 students are enrolled in programs preparing them for military or other public service functions. These programs are focused on the development of an active personality, innovative thinking, physical training, and the improvement of the body’s functional reserves. AIM: of this study was to compare the primary incidence trends and patterns categorized by the International Classification of Diseases, 10th revision, among students of pre-university educational schools of the Russian Ministry of Defense and general population of Russian adolescents over a 12-year period (2010–2022). METHODS: The analysis included primary disease incidence data submitted with 13K/MED reports. Primary disease codes were matched with classes of the 10th revision of the International Statistical Classification of Diseases and Related Health Problems. The incidence rates were calculated per 1000 students (%). The primary disease incidence rates were compared between students and general population of adolescents aged 15–17 years. The long-term average annual rate was determined based on total absolute values over the 12-year period. The annual average rates alongside with arithmetic means and their standard errors (M ± m) were calculated for the analysis of similarities (differences). The trends were assessed by analyzing time series and calculating a second-order polynomial trendline. RESULTS: Among students, the long-term average annual and average annual rates were 2694.3% and 2709.0 ± 77.1%, respectively, in 2010–2022. For Russian adolescents, lower values were observed, i.e. 1361.2% and 1380.0 ± 19.9%, respectively (p < 0.001). We assume that higher rates of primary disease incidence among students were attributed to higher rates of disease detection, more accessible qualified and high-tech medical care, and personalized accountability of all cases, including those of mild or moderate severity, which are associated with home treatment and are not reported by regional healthcare facilities of the Russian Ministry of Health. Primary incidence rates were calculated for main classes of diseases reported in students and Russian adolescents. CONCLUSION: The early detection, prevention, timely treatment and rehabilitation of main classes of diseases can significantly reduce the primary disease incidence among students of pre-university educational schools of the Russian Ministry of Defense and Russian adolescents aged 15–17 years.
Corrosion Resistance of Dental Alloys in Aqueous Hydrogen Peroxide Solutions
Background: Hydrogen peroxide is widely used as a hemostatic and antiseptic agent. Anecdotal reports also highlight the potential benefits of oral administration of hydrogen peroxide solutions, extending their use beyond oral disinfection. However, the contact with peroxides often overlooks the risk of corrosion damage to artificial dentures, particularly those manufactured 20–30 years ago. At that time, steel alloys were commonly used in denture manufacturing, especially in developing countries such as Vietnam. AIM: To assess the corrosion risk of dental metals when exposed to medical hydrogen peroxide agents recommended for mouth rinsing and oral administration. METHODS: The study investigated the corrosion behavior of two dental alloys, an iron alloy and a filling material, in an antiseptic oral solution with 3% w/w hydrogen peroxide (Н2О2) as an active component. The mass corrosion rate was gravimetrically measured for three samples of metal alloys and a filling material in a dental solution. The oxygen release kinetics and solution pH were determined. RESULTS: In an open-air environment, the hydrogen peroxide solution decomposes intensively to yield oxygen. The time for intensive decomposition of hydrogen peroxide in the test concentration was approximately 500 s, and therefore the chemical and corrosive activity was limited by this interval. Titanium, cobalt and chromium alloys showed high corrosion resistance in the hydrogen peroxide solution. Non-metallic glass-ionomer cements were resistant to the hydrogen peroxide solution. In contrast, iron alloys have high corrosion rates in the hydrogen peroxide medium. Iron alloys corrosion rates and hydrogen peroxide decomposition rates were demonstrated to follow similar temporal patterns. This suggested that oxygen released during hydrogen peroxide decomposition plays a leading role in the corrosion process. CONCLUSION: Based on the study findings, titanium, cobalt, and chromium alloys and non-metallic glass-ionomer cements demonstrate high corrosion resistance in hydrogen peroxide solutions. The study also highlights that regular use of antiseptic medical solutions containing 3% hydrogen peroxide requires careful consideration of the potential risks posed by their corrosive effects on denture alloys that contain iron components.
Current Challenges in Evaluating National Health Systems’ Response to Technogenic Emergencies
The industrial development is associated not only with economic growth but also by technogenic risks that threaten human health and the environment. Historical incidents such as the Bhopal Disaster (1984), Chernobyl Accident (1986), Fukushima Daiichi Accident (2011), Flint Water Crisis (2014), and many other technogenic accidents and disasters dramatically demonstrate the impact of existing threats to society and healthcare systems. The aim of the study was to identify key challenges and current approaches to evaluate national health systems’ responses to technogenic emergencies. The study analyzed scientific publications from the NCBI, PubMed, and Elibrary databases published between 2000 and 2024. These publications underwent terminological analysis using the VOSviewer software and were peer-reviewed. Based on an analysis of the most relevant publications concerning healthcare system responses to technogenic emergencies, five key areas were identified. These areas integrate resources from healthcare facilities, management systems, and technological innovations. The study highlights the significance of an integrated approach in preparing healthcare systems for technogenic emergencies. It provides a systematiс review of measures focused on improving the effectiveness of response, including simulating disaster scenarios, conducting surveys among staff and victims, raising public awareness, establishing psychological support systems, developing volunteer services, and promoting cooperation with public organizations.
Single- and Dual-Energy Computed Tomography for Brachiocephalic Atherosclerosis Imaging: Review
Brachiocephalic atherosclerosis remain the primary cause of acute cerebral ischemic events, such as ischemic stroke and transient ischemic attack. As reported by the World Health Organization, the ischemic stroke mortality has declined, however remains high at 117.9 per 100,000 population. Recent studies increasingly demonstrate that ischemic stroke and transient ischemic attack are associated with signs of unstable atherosclerotic plaques. Advances in structural vascular imaging techniques, particularly in radiation-based techniques, now enable not only the assessment of stenosis severity but also the detailed evaluation of plaque composition and instability signs, such as intraplaque hemorrhages, lipid-rich necrotic cores with thin fibrous caps, calcifications, and neovascularization. Precise imaging of the extracranial carotid arteries is essential for accurate risk stratification. This review summarizes recent data on the imaging capabilities of computed tomography, including dual-energy computed tomography, in visualizing brachiocephalic atherosclerosis. The review is based on the scientific articles published over the past decade and retrieved from PubMed and eLibrary databases. The analysis includes the scientific articles, Russian and international clinical guidelines on carotid artery disease management that incorporate evidence-based experimental and clinical findings. Computed tomography has been established as a standard diagnostic tool for assessing brachiocephalic atherosclerosis; it is considered the gold standard for assessing stenosis severity and also provides valuable information on plaque morphology, ulceration, etc. Although dual-energy computed tomography broadens the scope to detect signs of unstable plaques, further research and standardization are required.
BACKGROUND: Preeclampsia is a specific pregnancy complication associated with a high cardiovascular risk in both mothers and neonates. Recent research has focused on understanding its underlying mechanisms, which involve differential methylation of cytosine-phosphate-guanine islands and alterations in microRNA expression, genetic and epigenetic factors, and various biomolecules involved in inflammation, oxidative stress, and angiogenesis, etc. Through all these mechanisms, preeclampsia-induced vascular abnormalities may be linked with the pathogenesis of potential cardiovascular diseases. This review explores the diverse mechanisms underlying preeclampsia and the associated cardiovascular changes in pregnant women. The review findings may inform potential strategies for early diagnosis and targeted treatment of preeclampsia. AIM: to analyze published data on the risks and pathophysiological mechanisms of preeclampsia. The review was conducted in 2024 using the eLibrary and PubMed databases. The following search queries were used: риски развития преэклампсии (risks of preeclampsia), механизмы развития преэклампсии (mechanisms of preeclampsia), осложнения при преэклампсии (complications of preeclampsia), and сердечно-сосудистые заболевания как осложнение преэклампсии (cardiovascular diseases as a complication of preeclampsia). Currently, there is no consensus regarding the true etiology of preeclampsia. It is often referred to as a disease of theories, which may reflect the fact that the primary biological mechanisms connecting clinical and epidemiological data with organ dysfunction, remain elusive. Despite the lack of definitive evidence, many experts favor the hypothesis that preeclampsia is a primary placental disease. Ongoing efforts are focused on developing effective strategies for screening, diagnosis, treatment, and improving maternal postpartum cardiovascular outcomes. CONCLUSION: Preeclampsia is a pregnancy-specific complication with a multifactorial etiology, involving abnormal placentation, endothelial dysfunction, systemic inflammation, and oxidative stress. Despite advancements in understanding its underlying mechanisms, effective prevention and treatment options remain limited. The increased risk of cardiovascular diseases in women with preeclampsia may be associated with genetic predisposition, epigenetic modifications during pregnancy, and placental abnormalities.
Uremic Toxin Indoxyl Sulfate and Progression of Chronic Kidney Disease
Chronic kidney disease is a progressive disease, which is characterized by a decline in renal function due to various underlying causes. A frequent outcome shared by nearly all chronic and progressive nephropathies is renal fibrosis. Current evidence highlights multiple mechanisms involved in renal fibrosis, including natural aging processes, glomerular hyperperfusion, intratubular hypertension and hyperfiltration, alterations in the expression of mediators responsible for cellular and structural damage, etc. The progression of fibrosis is accompanied by the decline in the renal function, resulting in uremic syndrome characterized by the accumulation of various substances known as uremic toxins. They include low-molecular water-soluble compounds, protein-bound molecules, and medium-molecular compounds. Recent studies suggest that uremic toxins can contribute to the progression of fibrosis. This review summarizes data from retrospective, prospective, and experimental studies, and systematic reviews regarding the impact of uremic toxins on the progression of renal fibrosis. The data were retrieved from bibliographic databases such as MedLine, PubMed, Google Scholar, Scopus, and eLibrary. Only articles published in peer-reviewed scientific journals were included. The search strategy was based on the key terms including хроническая болезнь почек (chronic kidney disease), уремические токсины (uremic toxins), индоксил сульфат (indoxyl sulfate), фиброз почек (renal fibrosis), and эпителиально-мезенхимальный переход (epithelial-mesenchymal transition). Lists of all relevant articles and systematic reviews were manually examined. A total of 114 full-text articles were reviewed, with 60 selected for this review. The review highlights the role of indoxyl sulfate as an active contributor to renal fibrosis, rather than a consequence of chronic kidney disease.
Dengue virus and its interactions with Aedes mosquito vectors and human hosts have garnered significant scientific interest over the past decade. Despite extensive research, many aspects of these interactions remain poorly understood, highlighting the need for further investigation to develop effective therapeutic and preventive strategies to reduce the spread of dengue virus and the prevalence of the disease. The key challenges underpinning the relevance of dengue virus studies include the insufficient current preventive measures, the limited efficacy of approved vaccines, the absence of antiviral therapies with proven clinical efficacy, the risk of complications, and other factors. The review provides a characterization of dengue virus virions, highlighting the four virus serotypes, mutation rates and genome evolution. Genotypic and serotypic variations, which are regularly identified through the study of regional viral circulation, have the potential to give rise to new dengue strains, which can cause subsequent epidemics. The review details the stages of the viral life cycle in vertebrate and invertebrate hosts. Viral replication, transcription, and translation within cells of vertebrate and invertebrate hosts are examined, along with both typical and atypical routes of infection transmission. The ecology of A. aegypti and A. albopictus vectors, vector competence and the factors that reduce vector competence under natural conditions are discussed. Strategies for targeted intervention in the interactions between the pathogen, vector, and vertebrate host are examined. The most probable driver for the global expansion of the virus is the active migration of infected individuals. Research focused on identifying critical points in the protein interactions of the pathogen, vertebrate and invertebrate hosts, and exploring mechanisms to inhibit these interactions, appears promising for reducing the risk of dengue infection. The detection of imported cases of dengue fever in Russia underscores the need to implement measures for increasing public awareness regarding transmissible diseases and to minimize contact with potentially infected individuals when visiting tropical and subtropical regions.
Diagnosis of Primary Omental Infarction and Epiploic Appendagitis Using Computed Tomography
Omental infarction and epiploic appendagitis are rare conditions characterized by fat tissue necrosis and clinically presenting with acute abdominal pain. Omental infarction and epiploic appendagitis can mimic various acute urological, surgical, and obstetric-gynecological diseases depending on pain localization. These conditions can be classified as primary or secondary, i.e. those of unknown origin or those resulting from a definite cause. It is generally believed that primary appendagitis is more common than primary omental infarction. Currently, there is no evidence-based consensus on the most optimal treatment approach for omental infarction and epiploic appendagitis. However, most experts agree that these conditions are self-limiting and tend to resolve spontaneously. Consequently, accurate detection and differentiation from other acute abdominal conditions requiring urgent surgery are crucial. For omental infarction and epiploic appendagitis, computed tomography remains the primary imaging modality in emergency diagnostics, as it is superior to clinical examination and blood chemistry in terms of sensitivity and specificity. The article reviews predisposing factors and anatomical prerequisites for primary omental infarction and epiploic appendagitis. It also details characteristic computed tomography signs that may be used to differentiate omental infarction and epiploic appendagitis between each other and from other acute abdominal conditions. Although computed tomography may identify typical signs of these conditions, the differentiation between primary omental infarction and epiploic appendagitis can sometimes be challenging. Therefore, the term “intra-abdominal focal fat infarction” is recommended.