Extreme Medicine

ISSN Print 2713-2757 ISSN Online 2713-2765

Extreme Medicine

SCIENTIFIC AND PRACTICAL REVIEWED JOURNAL OF FMBA OF RUSSIA

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Kolomiitsev VG, Gornov SV, Gornov VV, Burova IV, Eselevich RV, Litvinenko EA, Krupa RA, Karpenko DV

Retrocerebellar cysts of the brain represent the aspect that is important for determination of fitness for flight. The study was aimed to assess their impact on the pilot performance by conducting comparative analysis of MRI data of the first-year cadets and experienced pilots. We assessed the prevalence of retrocerebellar cysts among cadets and pilots, conducted non-contrast brain MRI, and compared the major academic and physical performance indicators, along with the results of professional psychological screen. The prevalence of retrocerebellar cysts among first-year cadets was 8.2%. High prevalence of asymptomatic retrocerebellar cysts among experienced pilots was revealed (two cases out of five). The intergroup comparison of indicators makes it possible to draw a conclusion about probable minor impact of such changes on fitness for flight. Further research is required to clarify the mechanisms underlying the impact of retrocerebellar cysts on the pilot performance and develop appropriate guidelines for medical boards.

Received: 2024-02-05

Published online: 2024-03-31

DOI: 10.47183/mes.2024.017

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VIEWS 109

Tolstoguzov SN, Fisher TA, Naida YuV, Lepunova ON

The study was focused on the features of spectral characteristics of the EEG alpha and theta ranges in the military academy cadets undergoing specific training to improve cold resistance (cold exposure training). The study was aimed to assess the impact of the military academy cadets’ incremental exposure to the graduated cold stress (cold exposure training) on spectral characteristics of the EEG alpha and theta rhythms. Students of the civil higher educational institution and military academy cadets were assessed (58 individuals in total). Cadets underwent a specific program focused on improving cold resistance (cold exposure training). Background EEG in the alpha and theta frequency ranges was recorded. Statistical data processing involved nonparametric comparison using the Mann–Whitney U test. The results were obtained suggesting that there were significant differences in spectral characteristics of alpha and theta rhythms between the group of foreign cadets and the controls. The cold exposure training program was effective in the group of Russian cadets, which had an effect on the cerebral homeostasis stability with some degree of instability of neurodynamic processes in the CNS. In foreign cadets, regular cold exposure training resulted in the pronounced disintegration of cortical-subcortical and intracortical interactions, as well as in the formation of binary alpha-theta structure of background EEG.

Received: 2024-02-20

Published online: 2024-03-31

DOI: 10.47183/mes.2024.016

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VIEWS 110

Katunina EA, Gryaznev RA, Shipilova NN, Katunin DA, Malykhina EA

The review is focused on essential tremor (ET), the most common extrapyramidal system disorder. Current understanding of the disease pathogenesis is provided; issues of classification and differential diagnosis are discussed. Modern ET treatment methods include therapeutic approaches and surgical interventions. The benefits of the new ET treatment method, the magnetic resonance-guided focused ultrasound treatment (MRgFUS), are described; the world’s experience of using the method, indications and contraindications are summarized.

Received: 2024-02-28

Published online: 2024-03-31

DOI: 10.47183/mes.2024.015

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VIEWS 136

Mitryashov KV, Mitryashov IV

Hip dysplasia (HD) represents the congenital underdevelopment of the hip joint (HJ) being the most common orthopedic problem of newborns having the prevalence of 5–20%. Late HD detection is the main cause of coxarthrosis in young adulthood. The study was aimed to assess the results of ultrasound screening for HD in infants. The study involved 860 full-term infants aged 1–3 months (446 boys (51.9%) and 414 girls (48.1%)). All newborns underwent ultrasound imaging of the hip joint at the age of 1 month and the follow-up examination at the age of 3 months (Graf method). The χ2 test and p < 0.05 were used to compare the data. In their first year of life, 685 newborns (79.7%) had joints of normal or transitory shape, 161 (18.7%) showed physiological immaturity and 14 (1.6%) showed the HJ abnormality; the HJ immaturity and abnormality were more prevalent in girls (113 cases (26.3%)) than in boys (62 cases (13.9%)). The relationship between the breech presentation and the likelihood of developing HD was revealed (p < 0.001). Spontaneous improvement by the age of 3 months took place in the majority of infants having the ultrasound signs of HD, the rate of normal HJ increased from 79.8 to 94.5%. Ultrasound screening is an effective method allowing one to detect HD starting from the first days of the child’s life. The risk factors of HD are still female sex and breech presentation, regardless of the number of births. Spontaneous improvement following prescription of relaxing massage occurs in the majority of children.

Received: 2024-02-15

Published online: 2024-03-31

DOI: 10.47183/mes.2024.013

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VIEWS 107

Misharin VM, Kochubey AV

Shortcomings of the categorization system include weakness of the normative regulation oriented towards the outdated ideas about the qualification and formal features of professional development. It is often proposed to objectify measuring the professional competence of the subjects evaluated in order to improve the categorization system. The study was aimed to test the qualification requirements of physicians for the relationship with their qualification and the possibility of accurate full-fledged measurement of those in the evaluated subjects. We performed expert assessment of 22 requirements for grades approved by the Order of the Ministry of Health of the Russian Federation dated 31 August 2023 No. 458n relative to four items: their relationship with the physician’s qualification, feasibility of measurement (usability), relationship with the competence of the evaluation commission member (objectivity), possibility of determining the extent of the knowledge, abilities, skills required for each professional grade. Assessment involving the use of the Stapel rating scale (“–5” to “+5”) was performed by seven experts. The sums of scores by items were as follows: relationship with qualification — 477, usability — 316, objectivity — ‒662, grade — –699. There are significant differences between the scores reported for all the requirements and pairs of all items (р ≤ 0.0001), except the objectivity–grade pair (р = 0.103). The total of the scores reported for the majority of requirements is negative due to the lowest possible scores of objectivity and grade. The experts believe that none of the qualification requirements approved by the Order enables accurate full-fledged determination of physician’s qualification during evaluation.

Received: 2024-02-24

Published online: 2024-03-30

DOI: 10.47183/mes.2024.014

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VIEWS 122

Eichler OV, Miroliubov AA, Nechaev DN, Titova AG, Trusov GA, Garbuz VV, Lomov AN, Yudin VS, Keskinov AA, Kraevoy SA

The paper provides the summary of foreign literature data on the organizational and methodological aspects of functioning of the bone marrow and hematopoietic stem cell donor registries, the issues of HLA typing, the technical algorithms for compatibility degree ranking. The changes in the citizens’ motivations in response to the bone marrow donating program popularization are described, along with the features of arranging recruitment, approaches to determining the requirements for the registry population considering the multinationality and heterogeneity of ethnic composition, and the statistical approximation algorithms. Furthermore, attention is paid to the so-called specific aspects of the functioning of bone marrow and hematopoietic stem cell registries and biobanks. The latter is important in terms of ensuring national security, adaptation of the population to the effects of the disasters, emergencies, and terrorist attacks associated with the development of bone marrow syndrome in a large number of victims.

Received: 2023-12-18

Published online: 2024-03-28

DOI: 10.47183/mes.2024.011

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VIEWS 121

Kostyushok NYa, Gornov SV, Sizov AV

Introduction of point genetic associations into clinical and laboratory diagnosis will allow the physician to determine the risk of severe diabetes mellitus and its complications with a focus on detection of the genetically determined disorder. The study was aimed to identify the molecular genetic markers of severe diabetic nephropathy in patients with type 1 and 2 diabetes mellitus (DM) based on the GSTP1 (I105V) gene assessment. Genotyping of the GSTP1 gene I105V locus was performed in patients with type 1 and 2 DM. Then we identified the features of oxidative status, free radical oxidation, and renal function in patients with various polymorphic variants of the studied gene. Patients with type 1 DM, who were carriers of the GSTP1 heterozygous polymorphic variant (Ile/Val), showed higher activity of the oxidative stress enzymes (glutathione-S-transferase, catalase) and malondialdehyde compared to homozygous carriers (р < 0.001, р < 0.001, р < 0.05). They also showed a significant increase in the levels of triglycerides (1.6-fold) and the glycated hemoglobin levels (1.1-fold) (p < 0.05). Patients with type 2 DM, who were carriers of the GSTP1 polymorphism homozygous for allele 2 (Val\Val), had a higher level of malondialdehyde (100.5 µmol/L, (р < 0.001)), which was associated with the more severe diabetic nephropathy (average glomerular filtration rate — 48 mL/min/1.73 m2, 24-h urinary albumin excretion — 0.9 g/L; р < 0.01). It has been proposed to assess the GSTP1 (I105V) gene in individuals with type 1 and 2 DM. This polymorphism that is heterozygous in individuals with type 1 DM and homozygous for allele 2 in individuals with type 2 DM is unfavorable in terms of the DM course and complications.

Received: 2024-01-25

Published online: 2024-03-28

DOI: 10.47183/mes.2024.012

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VIEWS 117

Semigolovskii NYu, Balluzek MF, Guslev AB, Mazurenko SO, Kozaev AV, Semenova IG, Nikolskaya EM, Scheglov AN

The main causes of postoperative mortality associated with percutaneous coronary interventions involving the coronary artery stent insertion are perioperative myocardial infarction and acute heart failure due to inadequate protection of the myocardium against ischemia/reperfusion. The standard therapy includes beta blockers, anticoagulants, antiplatelet drugs. Two clinical cases of successful use of intravenous levocarnitine for cardioprotection in senile patients with acute forms of coronary heart disease with multivessel lesions are reported. The postoperative period went well, smooth dynamics of biomarker levels (troponin I, creatine phosphokinase, MB fraction of creatine phosphokinase) was observed, and ischemic ECG changes were relatively small. The expected results of the technique application include reduction of intraoperative and postoperative complications of ischemia/reperfusion and the increase in effectiveness of the stent insertion clinical outcomes in high-risk patients.

Received: 2024-01-29

Published online: 2024-03-25

DOI: 10.47183/mes.2024.010

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VIEWS 123