Medicine of Extreme Situations
Scientific and Practical reviewed Journal
of FMBA of Russia

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№2, 2018 (June)

FORECASTING AND RISKS MINIMIZATION OF FATAL ADVERSE OUTCOMES OF ELECTIVE SURGICAL TREATMENT OF ONCOLOGICAL PATIENTS WITH COMORBID SOMATIC PATHOLOGY

Year: 2018 (June) Number: №2 Pages: 8-18

Article type: Scientific article.

Authors: Udalov Yu.D., Gordienko A.V., Samoilov A.S., Bakharev S.A.

Organization:

State Research Center - A.I. Burnazyan Federal Medical Biophysical Centre of the Federal Medical Biological Agency of the Russian Federation, Moscow, 123182, Russian Federation
S.M. Kirov Military Medical Academy, St. Petersburg, 194044, Russian Federation

Annotation:

In the article the characteristics of the examined patients are given, the early outcomes of the surgical treatment of tumors of different localization are analyzed depending on the severity of the general somatic state and the nature of the existing comorbid pathology. There is shown a high importance of preoperative examination with a substantiation of a choice of methods and technologies of an assessment of a condition of patients, including the dynamics, the application of methods of modeling of risks of fatal complications. The efficacy of preoperative preparation in the minimization of lethal outcomes in early terms after operation is proved.

Keywords:

oncological patients of advanced age; comorbid pathology; causes and mechanisms of lethal outcomes of surgical treatment; forecasting and fatal risks minimization of elective surgical treatment

EXPERIENCE OF THE CENTER FOR EXTRACORPOREAL MEMBRANE OXYGENATION (ECMO CENTER) OF THE FEDERAL MEDICAL BIOLOGICAL AGENCY OF THE RUSSIAN FEDERATION FOR TRANSPORTATION OF PATIENTS WITH RESPIRATORY DISTRESS SYNDROME

Year: 2018 (June) Number: №2 Pages: 19-25

Article type: Scientific article.

Authors: Popugaev K.A., Gubarev K.K., Kruglyakov N.M., Belousova K.A., Lobanova I.N., Abudeev S.A., Bagzhanov G.I., Bakharev S.A., Voloshin E.V., Zakhlevnyy A.I., Shmarova D.G., Savostyanov M.Yu., Udalov Yu.D., Zabelin M.V., Samoylov A.S.

Organization:

State Research Center - A.I. Burnazyan Federal Medical Biophysical Centre of the Federal Medical Biological Agency of the Russian Federation, Moscow, 123182, Russian Federation

Annotation:

Introduction. Over the past decade, the frequency of the application of extracorporeal membrane oxygenation (ECMO) has increased significantly in patients with refractory respiratory distress syndrome (RDS). Being life-saving, ECMO is fraught with a lot of complications and financial costs. Healthcare systems in many countries have come to realize the need to create specialized ECMO centers. In 2016, in the system of the Federal Medical and Biological Agency (FMBA) of Russia, the ECMO Center was created on the basis of the State Research Center - A.I. Burnazyan Federal Medical Biophysical Centre of the Federal Medical Biological Agency (FMBA) of the
Russian Federation  Aim of the study. To analyze the experience of the ECMO-center of FMBA of Russia in the transportation of RDS patients. Materials and methods. The apparatuses RotoFlow, Cardiohelp, and cannula Maquet (Rastatt, Germany) were used. A peripheral connection was made either in the primary hospital, followed by transportation to the ventilator and ECMO, or at the Center after the patient’s admission. During the ECMO, special attention was paid to the developing disorders of homeostasis. Results. Over 12 months of the operation of the Center, ECMO was performed in 20 patients. 7 RDS patients were transported. These patients included in the study. The average age was 42.6 years, there were 3 women, 4 men. There were no complications due to cannulation of vessels and transportation of patients. The duration of ECMO amounted 13 ± 11.6 days, mechanical ventilation – 18.9 ± 10.7 days, patients stayed in the intensive care unit for 22.1 ± 11.6 days, hospitalization – 32.9 ± 18.7 days. The lethality rate accounted for 42.8%, the immediate cause of death was sepsis and/or massive bleeding. Conclusion. Automobile and air transportation of patients receiving ECMO seem to be safe with sufficient experience of the ECMO team. With an oxygenation index below 80, ECMO should obligatorily begin at the primary hospital. With an oxygenation index of 80 to 100, such factors as transportation distance, hemodynamic stability, and carbon dioxide level in the arterial blood are likely to influence the decision on the conditions of transportation of RDS patients.

Keywords:

extracorporeal membrane oxygenation; respiratory distress syndrome; communityacquired pneumonia; transportation of patients; Center for Extracorporeal Membrane Oxygenation (ECMO Center)

PERSPECTIVES OF APPLICATION OF SUPERCONDUCTED NON-NICKEL TITANIUM ALLOYS IN DENTAL IMPLANTOLOGY ON THE RESULTS OF EXPERIMENTAL INVESTIGATIONS

Year: 2018 (June) Number: №2 Pages: 25-31

Article type: Scientific article.

Authors: Olesova V.N., Lerner A.Ya., Zaslavsky R.S., Olesov E.E., Shmatov K.V., Lobanov S.A.

Organization:

Clinical Center for Dentistry of the Federal Medical and Biological Agency, Moscow, 123098, Russian Federation

Annotation:

Superelastic titanium alloys (titanium-niobium-zirconium and titanium-niobium-tantalum) are more favorable in comparison with titanium for dental implants because of their physicomechanical properties seem to be more similar to bone tissue characteristics. Morphological animal studies on biocompatibility of these alloys in comparison with titanium have been executed. The control of the interaction of titanium alloy samples with bone tissue was followed up for 30 and 90 days. The method of investigation is scanning electron microscopy and microprobe element analysis of the tissue along the boundary with titanium alloys. The proximity of the morphological pattern and elemental composition of bone tissue along the border of titanium and superelastic alloys of titanium is shown both during observation period of 30 days (in contact with alloys, poorly mineralized connective tissue is detected) and of 90 days (the border with titanium alloys is covered with mineralized bone tissue, similar in composition to the surrounding bone tissue).

Keywords:

implant; titanium; titanium-niobium-zirconium; titanium-niobium-tantalum; bone tissue; morphology; osseointegration; elemental composition.

EVACUATION OF HEAVILY BURNED CASES AS A STAGE OF ACTIVE TACTICS OF RENDERING SPECIALIZED COMBUSTIOLOGICAL AID. EXPERIENCE OF THE FEDERAL STATE BUDGET HEALTHCARE INSTITUTION “THE FAR EASTERN REGIONAL MEDICAL CENTER” OF THE FEDERAL MEDICAL AND BIOLOGICAL AGENCY OF RUSSIA

Year: 2018 (June) Number: №2 Pages: 31-38

Article type: Scientific article.

Authors: Griban P.А., Sotnichenko S.A., Terekhov S.M., Usov V.V., Maistrovsky K.V., Partin A.P., Bondarchuk D.V., Popov M.D.

Organization:

Far-Eastern Regional Medical Center of the Federal Medical-Biological Agency, Vladivostok, 690000, Russian Federation;
Territorial Center for Disaster Medicine, 690000, Vladivostok

Annotation:

An analysis of the organization of specialized medical care for victims of severe thermal trauma in Primorsky Krai was carried out. In the conditions of a vast territory in Primorsky Krai, the problem of evacuation of severe burned cases from remote areas to the combustiological department of the Far-Eastern Regional Medical Center of the Federal Medical-Biological Agency of Russia remains urgent. This problem is successfully solved by introducing a step-by-step system of providing surgical and resuscitation assistance to the victims. The scheme of the evacuation of severe burned cases in Primorsky Krai allows early initiating of specialized care, active surgical treatment of burn wounds, and the improvement of treatment outcomes.

Keywords:

thermal burn; Emergency Medicine; evacuation; active treatment tactics.

RATIONALE FOR THE NECESSITY OF CREATION OF MONITORING SYSTEM FOR PREPARATION OF STUDENTS TRAINING ON TARGET DIRECTION AS A COMPONENT OF PERSONNEL PLANNING OF MEDICAL ORGANIZATION OF FMBA SYSTEM OF RUSSIA

Year: 2018 (June) Number: №2 Pages: 38-44

Article type: Scientific article.

Authors: Romanov S.V., Rodina A.A., Abaeva O.P.

Organization:

Privolzhsky Regional Medical Center of the Federal Medical and Biological Agency, Nizhny Novgorod, 603001, Russian Federation

Annotation:

The problem of the need for training of doctors for the intended appointment has been widely discussed in the medical community on many different levels. The feature of the presented article is the description of the experience for the work with this category of students obtained at the level of medical organization of the Federal Medical Biological Agency. The authors substantiate the need to create a system of monitoring of training and extracurricular work of each student in modern organizational and legal conditions, which will allow the future employer to make objective decisions about the need and the profile of further training of the graduate. The article describes the experience
of such a system, which is based on a systematic assessment of the academic performance of the student, his success in obtaining practical skills in practical training, scientific and educational achievements, active participation in scientific, educational and social activities of the future employer and the presence of other competencies (sports, linguistic, information, creative, etc.). The authors note the need for the systematic participation of the organization that sent the student to study, in its professional development, taking into account the characteristics. The training itself should take into account the specifics of the future employer. The main direction of such work, according to the
authors, is the organization of practical training on the basis of the structural units of the medical organization and the involvement of students to participate in scientific, educational, social, sports activities as volunteers. Students’ work is evaluated by the original system of key indices using a five-point scale. As a result, at the end of medical School, the student objectively occupies a certain place in the ranking of graduates of the given year, which were sent to study at the target reception. In addition, the success and dignity of the future employee are made in the form of a portfolio, creativity which is also evaluated by the Commission. Such a system, according to the authors, will help to reduce the number of conflict situations with graduates when deciding on further training or employment and will be a good tool for the administration of a medical organization in the implementation of the strategic and operational planning of the work with personnel.

Keywords:

targeting; workforce planning; medical staff.

MEDICAL INSPECTIONS OF NORTHERN FLEET PERSONNEL: RESULTS, ANALYSIS, PROBLEMS

Year: 2018 (June) Number: №2 Pages: 44-51

Article type: Scientific article.

Authors: Kazakevich E.V., Arkhipovsky V.L., Doronin I.A.

Organization:

N.A. Semashko Northern Medical Clinical Center named of the Federal Medical and Biological Agency, Arkhangelsk, 163000, Russian Federation

Annotation:

The article presents an analysis of medical examinations of the Northern Fleet personnel over the period from 2015 to 2017. The incidence and reasons for the professional unfitness of the crew, the effect of harmful occupational factors on the health of navy men were studied. During three years the total and primary morbidity was shown to decline, and the proportion of people on dispensary records with chronic diseases decreased. At medical examinations in the structure of the morbidity in terms of common and diagnosed diseases, the first place is occupied by the disease of the eye and its adnexa, which requires the development of a set of measures to reduce this pathology in the
crew. In the structure of the limitations of the professional suitability of the crew, cardiovascular pathology predominates. The leading professional pathology in seamen is a sensorineural hearing loss. Audiologic screening aimed at early detection of patients with the tonal hearing loss was introduced. Treatment-and-prophylactic measures aimed at improving the state of health of the crew are given. The article also reflects the problems of the regulatory legal regulation of the medical inspections of the crew.

Keywords:

medical examination; navy personnel; northern region; harmful occupational factor; morbidity.

TEMPORALY DISADILITY OF SEAFARERS AND EMPLOYEES OF COASTAL MARINE SERVICES

Year: 2018 (June) Number: №2 Pages: 52-59

Article type: Scientific article.

Authors: Vagin V.A.

Organization:

Kholmskaya Hospital of the Far-Eastern Regional Medical Center of the Federal Medical-Biological Agency, Kholmsk, 694620, Russian Federation

Annotation:

The aim of the study: the study of features of the morbidity and temporary disability (MTD) in various groups of workers in the navy personnel (sailors and shore services). Materials and methods. Over period of 2014-2017 peculiarities of the MTD in different groups of workers of the Sakhalin Shipping Company (floating crew - 599 people and shore services - 793 people) were investigated accordingly to the form No. 16-VN “Information on the causes of temporary incapacity for work (VN)”. Results. The average number of recorded cases for seafarers per year was 12.1 ± 0.7 MBD cases per 100 workers (11.1 ± 0.8 for men, 18.7 ± 2.4 cases for women, with a total duration of 166.1 ± 0.23 days per 100 workers (153.6 ± 0.3 days for men, 248.5 ± 1.0 days for women), while the number of temporal disability (TD) cases among shore workers at the same time was 29.4 ± 1.6 TD cases per 100 workers (in men - 27.6 ± 2.3 cases, in women - 31.0 ± 2.2 cases), the number of days - 590.9 ± 0.9 (for men – 507.8 ± 1.2 day, in women – 663.6 ± 1.3 day). The low level of MTD in the crew can be explained by a younger age, professorship, possibility of the complete registration of TD in flights, difficulty in detecting pathology during medical examinations, since seamen hide their complaints and illnesses due to the possibility of writing off the fleet for health reasons, etc. The crew of the seafarers revealed significant gender differences in the TD per 100 workers, the number of TD cases in women is 1.68 times, and the number of days of TD is 1.62 times greater than that of men). The number of days of TD
per 100 working men was more than for women only for severe, long-term classes of illnesses: injuries, poisonings and other external causes by 48.1% and tumors by 49.2%. For the rest of the groups of diseases, the performance losses for women are much greater. The number of cases and days of TD per 100 men and women working on the shore of men and women is almost the same - gender differences among workers in coastal services are insignificant.
Conclusions. In the various groups of workers in the marine fleet, there is a considerable difference in the frequency of sound. Workers on the shore have significantly more TD indices than seamen: TD frequency rate by 2.4 times, duration of one TD case - 1.5 times, number of TD days - 3.6 times.

Keywords:

sailors; employees of coastal services; morbidity with a temporary disability (MTD); structure of sound; frequency of sound signals; duration of sound; gender differences.

DIAGNOSIS OF MINOR INJURIES OF THE MUSCULOSKELETAL SYSTEM OF QUALIFIED ATHLETES BY THE METHOD OF LEVEL-BY-LEVEL ANALYSIS OF THE CONSTRUCTION OF THE MOVEMENT

Year: 2018 (June) Number: №2 Pages: 69-74

Article type: Scientific article.

Authors: Samoylov A.S., Vasiliev O.S., Levushkin S.P.

Organization:

State Research Center A.I. Burnazyan Federal Medical Biophysical Centre of the Federal Medical Biological Agency of the Russian Federation, Moscow, 123182, Russian Federation;
Russian State University of Physical Education, Sport, Youth and Tourism, Moscow, 105122, Russian Federation

Annotation:

Minor injuries to the musculoskeletal system (MSS) are the most frequent conditions that arise in sports practice. The primary clinical diagnosis of such disorders in some cases is not very informative. Under the guise of minor injuries, often the initial manifestations of more significant pathological conditions are concealed, which, in the absence of the timely started treatment, can lead to serious problems with the health of the athlete. With the help of the method of level-by-level analysis, the construction of the movement can be distinguished from the contingent of “observables” with nonspecific symptomatology of MSS disorders in need of urgent additional types of examination.

Keywords:

minor injuries; musculoskeletal system; sports medicine; traumatology; diagnostics; motion building; N.A. Bernstein.

TOWARDS TECHNICAL CONDITIONS FOR MODELING THE EFFECTS OF LUNAR AND MARTIAN GRAVITY ON CELL CULTURES

Year: 2018 (June) Number: №2 Pages: 75-82

Article type: Scientific article.

Authors: Artamonov A.A., Alchinova I.B.

Organization:

Research Institute of Space Medicine of the Federal Scientific-Clinical Center of the Federal Medical-Biological Agency of Russia, 115682, Moscow

Annotation:

The paper deals with issues related to modeling various operating modes on a 2D clinostat. It is revealed that for the qualitative implementation of experiments on 2D clinorotation, it is necessary to take into account the peculiarities of the physical processes occurring in the culture liquid. The shape and size of the culture flasks and the radius of rotation were shown to play an important role in modeling the conditions of different gravity. The theoretical calculations presented in the article indicate to the use of smaller culture dishes (as much as the experimental conditions permit) and a more streamlined form to reduce the stochastic flows causing shear stress. Theoretically, the most optimal dimensions of the radius of the 2D clinostat were found - from 10 to 20 cm for the most correct modeling of the conditions of the attraction of the Moon and Mars. In using a 2D clinostat, stochastic flows in a culture liquid occur less likely than in 3D clinostat, as evidenced by simulations conducted by other authors. For assessing the damaging effect of shear stress on cells, authors recommend conducting dynamic control studies with the same rotational parameters, as in the case of a 2D clinostat. We found that it is important to take into account the layout of the vial with the culture attached to it relative to the axis of rotation in the clinostat. It is important to orient the vial in such a way that the resulting acceleration is directed at the culture of cells, but not from it. Application of the above calculations in direct experiments will significantly improve the quality and reproducibility of the results, expand the possibilities for modeling the combined effect of weightlessness and other factors of space flight.

Keywords:

3D clinostat; 2D clinostat; modeling of weightlessness; lunar gravity; Martian gravity; cell culture; vials; rotation; calculations of gravity force; gravitational physiologу.

MEASUREMENTS OF THE CONTENT OF RADON IN THE SPACES OF RESIDENTIAL AND PUBLIC BUILDINGS OF THE CITY OF LESNOY

Year: 2018 (June) Number: №2 Pages: 83-87

Article type: Scientific article.

Authors: Kiseleva M.E., Nefedov N.A., Sutyagina G.I.

Organization:

Center of Hygiene and Epidemiology No. 91 of the Federal Medical-Biological Agency of Russia, Lesnoy, 624200, Russian Federation;

Scientific and Technical Center for Radiation-Chemical Safety and Hygiene of the Federal Medical-Biological Agency of Russia, Moscow, 123182, Russian Federation

Annotation:

Natural sources of ionizing radiation (NSIR) - radon, gamma radiation of the ground, cosmic radiation and, mainly, radon make the main contribution to the radiation dose of the population - up to 70%. At least 10% of the annually recorded cases of lung cancer in the world are caused by radon. It is second to a smoking risk factor for the onset of pulmonary oncopathology. The main part of the dose of irradiation from radon is received by a person who is in the room, whereby the control of radiation doses from the daughter products of the decay of radon acquires special significance. In 2012, the Federal State Budgetary Healthcare Institution “Center of Hygiene and Epidemiology No. 91” of the Federal Medical-Biological Agency of Russia in cooperation with the head executor - the Federal State Unitary Enterprise “Scientific and Technical Center for Radiation and Chemical Safety and Hygiene of the Federal Medical and Biological Agency” took part in the implementation of selective radiation examinations of buildings and structures in the framework of the activities of the Federal Target Program “Ensuring Nuclear and Radiation Safety for the Period from 2008 until 2015”. There was executed the examination of residential and public buildings in the town of Lesnoy of the Sverdlovsk region on the radon content in premises. Measurements of the volumetric activity of radon were carried out by an integrated method with the help of track exposure meters REI-4. 17 kindergartens, 7 schools, 20 dwelling houses, 22 medical institutions and 3 buildings of public organizations were examined. The radon exposure meters for measurements were placed mainly in the premises with the longest stay of the inhabitants. In kindergartens - there are playrooms, study rooms, etc., in schools - classes, in medical and other institutions, working classrooms, in residential buildings - bedrooms and living rooms. There were obtained values of the equivalent equilibrium volumetric radon activity in the rooms. The situation with irradiation of the city of Lesnoy with radon generally was shown to meet the requirements of the Norms of Radiation Safety.

Keywords:

Federal target program; natural sources of ionizing radiation; radon; population; integral measurements; instantaneous measurements; track exposure; volumetric activity (OA) and equivalent equilibrium volumetric activity (ERAA) of radon.

COMPARATIVE CHARACTERISTIC OF TOXICITY AND RISK OF MIXTURES OF LIMITED HYDROCARBONS C1-C5 AND C6-C10

Year: 2018 (June) Number: №2 Pages: 89-94

Article type: Scientific article.

Authors: Radilov A.S., Solntseva S.A., Shkayeva I.E., Zemlyanoy A.V., Dulov S.A.

Organization:

Scientific Research Institute of Hygiene, Occupational Pathology and Human Ecology of the Federal Medical and Biological Agency, Kuzmolovsky, 188663, Russian Federation

Annotation:

Aim of the study. A comparative assessment of the toxicity and danger of a mixture of saturated hydrocarbons С1-С5 and С6-С10 with a single and chronic intake into the body. Results. Significant differences between the quantitative mixtures (indices of toxicometry) and the qualitative characteristics of the effect on the organism were revealed. It is shown that the according to parameters of the acute toxicity (CL50) and a single inhalation action threshold (Limac), a mixture of hydrocarbons C6 -C10 was shown to be 4-5 times more toxic than mixtures C1-C5. According to indices of toxicometry (Limch, MNC) the most significant, 8-10 fold differences were found with long-term intake in the organism in a chronic experiment. The impact of C1-C5 mixture on the body was mainly characterized by signs of narcotic effect, whereas in the clinical picture of acute poisoning with a mixture of C6-C10, in addition to signs of drug action there was observed embryotoxic effect and irritating action on the skin and mucous membranes of the eyes, chronic poisoning was manifested with neurotoxic, hepatotoxic and embryotoxic effects.
Conclusions. Based on the conducted studies, it was made a draw that the mixture of saturated hydrocarbons with C6-C10 is a danger under the prolonged intake, especially for offspring of mother’s exposed during pregnancy. The revealed significant differences in the toxic effect of mixtures determine the need for their separate regulation in the ambient air and in the air of the working area.

Keywords:

saturated hydrocarbons; toxicity; danger; mixtures.

BALLOON STUDIES AS A METHOD OF MODELING THE EFFECTS OF SPACE RADIATION

Year: 2018 (June) Number: №2 Pages: 104-111

Article type: Scientific article.

Authors: Zemnov K.E., Chashchin E.D., Artamonov A.A., Golubenko K.S., Onuchina M.Р.

Organization:

Moscow Polytechnical University, Moscow, 107023, Russian Federation;
Research Institute of Space Medicine, Moscow, 115682, Russian Federation;
St. Petersburg State University, St. Petersburg, 198504, Rusian Federation;
Institute of Medical and Biological Problems of Russian Academy of Sciences, Moscow, 123007, Russian Federation;
National Research Technological University, Moscow, 119049, Russian Federation;

Annotation:

Theoretical analysis of the effectiveness of the application of balloon studies for modeling cosmic radiation is presented. For the analysis, a numerical model was used for the calculation the ambient dose, obtained with allowance for the secondary particles of cosmic rays of galactic and solar origin at two significant heights: 10.5 km and 15.2 km. These heights are significant, since they are in the range of both military and civil airplanes fly. The model is based on new numerically calculated response functions and the realistic propagation of cosmic rays in the Earth’s magnetosphere (realistic propagation means recording magnetospheric effects, cascading in the atmosphere). The response functions allow establishing the efficiency function, which is the product of the spectrum of galactic cosmic rays with a response function. Both the spectrum of galactic protons and a modified spectrum of alpha particles are considered. The model used made it possible to simulate the atmospheric cascade induced by primary protons and alpha particles and secondary particles (neutrons, protons, gamma quanta, electrons, positrons, muons and charged pions). The influence of solar activity on the spectrum of galactic cosmic rays is considered in the article. The solar activity has the strongest effect on alpha particles. The efficiency function is calculated. The authors have identified the energies of galactic protons and alpha particles, which contribute the most to the ambient dose of radiation. Thus, with minimal solar activity, when the spectrum of galactic protons and alpha particles is maximal, protons with energy from 1 GeV/nucleon to 30GeV/ nucleon, and alpha particles with energy of 5-50 GeV/ nucleon make the largest contribution to the radiation situation. The review of experiments on various particle accelerators is presented. The accelerators are shown to be greatly limited in the ability to model the spectrum of galactic cosmic rays. First of all, the limitation is due to the fact that the accelerators give beams of particles in a narrow range of energy. Another limitation is the small values of the particle energies. Experiments on accelerators can be considered quite complex and expensive. Based on the results of the study, the application of ballons or airplanes for the purpose of simulating the effects of cosmic rays on biological objects was concluded to be quite effective. When comparing experiments on balloons and accelerators, the spectra in balloon experiments were considered to be the
better model for the effect of cosmic radiation.

Keywords:

atmospheric cascade modeling; response function; function of efficiency; ambient dose rate.

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