Vol 25, No 3 (2023)

The study analyzed the results of an experimental study on the influence of optokinetic, statokinetic, and combined optostatokinetic types on the spatial orientation of aviation profile operators. Three series of experiments were conducted, with the participation of 32 men aged 22–23 years, who had previously been assessed for vestibular stability using the intermittent cumulation of Coriolis accelerations. In the first series, the statokinetic effect was analyzed by performing a vestibular test “Otolith reaction-10” on an electric rotating chair “Nydiag.” In the second series, the condition of being inside an optokinetic drum was imitated, for which virtual reality glasses “VRBoxVR 2.0” were used. In the third series, the combined static–optokinetic effect was analyzed. If all the participants took part in the first two series, then only 27 people took part in the third because five participants, who experienced a significant deterioration in well-being and exhibited pronounced vegetative reactions after combined stato-optokinetic exposure, could not complete the vestibular test on an aviation simulator in full and were forced to refuse further participation. The combined optostatokinetic effect has the most pronounced negative effect on the quality of spatial orientation, in which the generalized piloting error and the time of bringing the aircraft simulator to the specified parameters were greatly affected than with isolated types of exposure. Thus, the assessment of only statokinetic stability does not allow us to fully assess high-quality aerobatic ability with high indicators of qualitative characteristics of spatial orientation. Moreover, the quality of a pilot’s spatial orientation is one of the most important parameters of piloting, which directly affects flight safety. However, only the degree of vestibular stability is assessed in the initial selection to educational institutions for the training of flight personnel, without predicting the effect of this characteristic on the quality of spatial orientation. Considering these results, at the stage of medical selection to higher educational institutions for the training of flight personnel, we propose evaluating not only isolated statokinetic resistance but also resistance to combined optostatokinetic effects.

The study presents the results of an epidemiological prospective field cohort study on a comparative assessment of the epidemiological effectiveness of domestic inactivated influenza vaccines and vaccines against new coronavirus infection during immunization of adults aged >18 years. Statistically significant differences were found in the incidence of influenza, acute upper respiratory infections, and new coronavirus infection between the vaccinated and unvaccinated groups. The etiologies of cases of acute upper respiratory infections registered in the study participants during the epidemic season of influenza in 2022–2023 were verified. The clinical symptoms of influenza in the vaccinated group were significantly less severe than those in the unvaccinated group. No significant differences were found in the clinical picture of acute upper respiratory infections between the compared groups. Influenza immunoprophylaxis is an urgent problem, which consists of the ability of viruses to change their antigenic structure and avoid immunity, remaining in constant circulation. Thus, the antigenic composition of influenza vaccines must be systematically updated to ensure the formation of effective population immunity. More studies on the etiological spectrum of respiratory pathogens and assessment of the epidemiological effectiveness of vaccination against vaccine-controlled infections in the analyzed groups are needed. Therefore, to assess immunological protection, including the assessment of the epidemiological effectiveness of seasonal vaccines used against influenza and new coronavirus infection, the priority age group includes individuals aged 18–25 years (especially those belonging to organized collectives) and adults with an unfavorable premorbid background. The use of domestic vaccines against influenza and the new coronavirus infection for specific immunoprophylaxis is generally recognized as the most effective sanitary and anti-epidemic (preventive) measure in the morbidity management of several infectious diseases.

The study estimated the prevalence of human immunodeficiency virus infection and viral hepatitis in patients admitted to the tuberculosis hospital in 2018–2020. Among patients admitted for the treatment of tuberculosis, 36.8% had human immunodeficiency virus infection. Markers of viral hepatitis were also detected in 78.8% of patients with human immunodeficiency virus infection associated with tuberculosis. The most common coinfection was tuberculosis — human immunodeficiency virus–hepatitis C, which was confirmed in 28.2% of the admitted patients. Clinical, X-ray, laboratory, and sonographic indicators were analyzed in 43 patients with tuberculosis having human immunodeficiency virus infection and viral hepatitis in various combinations. All patients were divided into three groups: group 1 included patients with tuberculosis, human immunodeficiency virus infection, and viral hepatitis, group 2 included patients with tuberculosis and human immunodeficiency virus infection, and group 3 included patients with tuberculosis and viral hepatitis. Anti-tuberculosis therapy was prescribed to all patients based on the spectrum of drug sensitivity of Mycobacterium tuberculosis, and when a human immunodeficiency virus infection was detected, antiretroviral therapy was prescribed during the first 2 weeks. Patients with viral hepatitis, if indicated, were prescribed hepatoprotective drugs. Control laboratory tests were conducted once every 2 months or more often in the presence of indications. Groups 1 and 2 were more likely to have multiple organ involvement and generalized forms, which determined the severity of the clinical course. In group 1, the activity of alanine aminotransferase and aspartate aminotransferase exceeded the normal limits upon hospital admission. Bilirubin levels were significantly higher in group 3 than in groups 1 and 2. The analysis of sonographic characteristics revealed increased size of the right liver lobe in all groups, without statistically significant differences between the groups. Adverse hepatotoxic reactions were reported in 5 (33.3%) patients of group 1, 4 (26.6%) of group 2, and 4 (30.7%) of group 3. The main manifestations of these reactions were pain in the right hypochondrium and increased activities of alanine aminotransferase and asparate aminotransferase. Patients with hepatotoxic reactions were prescribed hepatoprotective drugs, which made it possible to avoid the cancellation of complex etiotropic therapy

The study investigated the possibilities and effectiveness of surgical navigation in the installation of external ventricular drainage in patients with severe combined traumatic brain injury. In total, 41 patients were examined, and in those with urgent indications during the first period of traumatic illness, external ventricular drainage was installed (up to 2 days). All patients were divided into the main group (n = 14) and control group (n = 27). In the main group, external ventricular drainage was installed using surgical navigation. The control group underwent surgery without surgical navigation. According to the treatment results of the main group, the use of surgical navigation during the introduction of ventricular drainage significantly increased the accuracy of its installation and reduced the number of complications and rechecks. The accuracy of ventricular drainage installation was improved by 35%. Thus, out of 13 drainage installations, 12 (92.3%) had an optimal position, and 1 had a satisfactory position because its tip had a deviation of 2 mm; however, this drainage did not require re-examination, performing its function. Moreover, in the control group using the classical “free hand” technique, out of 21 cases with drainage installed, only 12 (57.1%) had an optimal position, 9 (42.9%) drains were rechecked because of deviation from the specified trajectory over 3 mm, and 4 (19%) required repeated rechecking (p = 0.039). The main causes of errors and complications of the surgical treatment of patients with craniocerebral injuries are related to the difficulties in installing ventricular drainage, namely, inaccurate positioning of the drainage tip, placement of the drainage in the brain substance at a distance from the planned point (28.6%), the drainage is going beyond the ventricular system of the brain (14.3%), re-drainage during the operation (44.4%), which often (42.9%) leads to incorrect introduction of the drainage into the ventricular system of the brain. Thus, the application of the navigation technology technique when installing drains into the ventricular system of the brain is very effective in the treatment of patients with severe combined traumatic brain injury. This innovative technique for ventricular drainage in severe combined traumatic brain injury will reduce the frequency of errors and complications associated with repeated drains, which is fundamentally important in unstable patients with multiple traumas. The navigation system allows for accurate installation of the drainage to the planned location from the first attempt.

The study compared the long-term results of thymectomy from traditional “open” thoracic/sternotomic and endovideosurgical access in 98 patients with thymus tumors. All patients were divided into two groups depending on the thymectomies performed from various surgical approaches. The control group consisted of 34 patients in whom surgical interventions were performed via the traditional “open” access, and the main group consisted of 29 patients in whom surgical interventions were performed via the endovideosurgical access. Both groups were comparable by sex, age, concomitant pathology, presence, and severity of clinical signs of myasthenia gravis, tumor size, morphological structure, and progression stage according to the classifications by Masaoka-Koga (1997) and TNM-8 2017. According to the frequency of tumor recurrence and regression of myasthenic disorders within 3 years after surgery, no significant differences were found between the groups (2 (5.9%) and 0, p = 0.27;

9 (69.2%) and 10 (71.4%), p = 0.52, respectively). Moreover, no significantly significant differences were found in the long-term survival (so-called Kaplan–Meier survival function) between the two groups. The annual, 3-, 5- and 10-year survival rates in the control group were 100%, 90.3% ± 2%, 87% ± 4%, and 87% ± 4%, and in the video-assisted thymectomy group, the survival rates were 100%, 100%, 100%, and 92.3% ± 3%, respectively (p = 0.71). In general, the long-term results of endovideosurgical thymectomy with small tumors and the absence of invasion into neighboring anatomical structures do not differ from those of traditional “open” surgical interventions in terms of the main oncological indicators, namely, long-term survival and frequency of tumor recurrence. The obtained results are consistent with world literature data, according to which the most significant prognostic factor of long-term survival is the stage of tumor progression by TNM. The average 5-year survival rates following radical thymectomy were 90%, 90%, 60%, and 25%, respectively, for TNM stages I, II, III, and IV.

The study evaluated the effectiveness of interval hypoxia in patients with chronic obstructive pulmonary disease receiving basic therapy. The study employed double-blind randomization with placebo control in two parallel groups of patients with chronic obstructive pulmonary disease. Course interval hypoxic therapy (10 sessions) and screening laboratory and instrumental evaluation of its effectiveness were conducted initially and before discharge of the patient who received treatment, which included stress hypoxic-stress testing, computer spirography, general and biochemical blood tests. The study involved 22 patients with grade 2–3 chronic obstructive pulmonary disease in the phase of drug control, who had similar cardiovascular comorbid backgrounds and were randomly divided into equal groups. Ten sessions of interval hypoxic therapy in the main study group significantly reduced laboratory markers of inflammation, promote high-speed ventilation, and increased desaturation–reoxygenation indicators in patients with chronic obstructive pulmonary disease in comparison with the control group. During hypoxic training, an increase in the functional capabilities of the respiratory system indicated the probable sanogenic effects of hypoxia on the elasticity, extensibility, and resistance of the bronchopulmonary continuum, which can positively affect gas exchange by improving the diffusion–perfusion capabilities of the lungs. In general, the results correspond to modern concepts about the relationship between hypoxia and inflammation. The results can be used as a reference for the development of a promising approach, in addition to basic therapy, to prevent exacerbations of chronic obstructive pulmonary disease.

The treatment of chronic paralytic laryngeal stenosis remains a relevant issue. It ranks second and accounts for 29.9% of chronic diseases of the laryngeal plexus. The number of affected patients has increased 10-fold over the past 10 years (2010–2020). Surgical treatment of chronic paralytic laryngeal stenosis is aimed at respiratory function restoration and the possibility of decanulation of the patient while maintaining vocal function. In the literature, the effectiveness of surgical treatment of patients with laryngeal stenosis varies greatly, ranging from 22% to 94%. We have proposed a technique for performing laryngoplasty in a patient with chronic paralytic laryngeal stenosis using a laser with a wavelength of 445 nm with a supply of inert gas (helium) in the operating field. When helium was injected into the operating field, the oxygen content at the laser exposure site decreased; thus, the effect of tissue carbonation was minimized, and thermal damage to surrounding tissues was reduced. Owing to the presence of gas, the smoke generated during the operation was quickly removed from the operating field, which provided good visualization. The properties of the aforementioned laser ensure a “bloodless” operating field, increasing the accuracy of surgical intervention. When using this laser, thermal damage to the surrounding tissues is no more than 0.6 cm in depth. This minimizes inflammatory reactions in the larynx in the postoperative period and promotes faster patient rehabilitation. The proposed volume of resection of the anatomical structures of the larynx was as follows: the posterior two-thirds of the vocal muscle and the anterior two-thirds of the body of the arytenoid cartilage, with the preservation of the mucous membrane to close the surgical wound, which ensures healing by primary tension and creates the necessary lumen of the glottis for sufficient breathing and allows for the maintenance acceptable voice function for patient communication. A laser with a 445-nm wavelength and a flap for closing the surgical wound used during the operation can speed up the recovery process and reduce the risk of relapse. This technique can be a method of choice for the treatment of patients with paralytic laryngeal stenosis.

The study highlighted the most significant scientific works that examined the influence of androgen deficiency and its drug correction in coronary heart disease. The effects of androgens on metabolic parameters, development of atherosclerosis, inflammation, coagulation and thromboembolism, blood pressure, and development of cardiovascular complications were also evaluated. The importance of conducting long-term randomized international studies evaluating the effects of testosterone in men with androgen deficiency and cardiovascular diseases, a cautious approach to androgen replacement therapy, and the need for individualization of therapy were discussed. Cardiovascular diseases are the leading cause of mortality. Thus, the study of the role of sex steroids in the development of atherosclerosis and coronary heart disease is of great interest. Testosterone is the main sex hormone that determines a man’s health. With age, testosterone levels gradually decrease, and mortality from cardiovascular complications increases. Low testosterone levels are associated with erectile dysfunction, decreased libido, decreased skeletal muscle mass, metabolic disorders, osteoporosis, and depression, and the importance of androgens for the circulatory system remains insufficiently studied. Many men receive testosterone replacement therapy, which leads to the improvement of well-being, sexual function, surge of strength, and favorable metabolic changes. The scientific literature describes the possible cardioprotective effect of testosterone, and it is believed to have vasodilating properties, shorten the Q–T interval, and normalize the ratio of fat and muscle mass. However, the expediency and safety of prescribing testosterone drugs to patients with hypogonadism and high cardiovascular risk is debatable because only several studies have described an increase in the number of cardiovascular complications in the androgen therapy group relative to the placebo group. Most studies on testosterone replacement therapy did not assess cardiovascular risks and excluded people with a recent stroke, heart attack, or severe heart failure. In addition, data interpretation is complicated by the lack of generally accepted international standards of testosterone for men of different ages, and most studies do not consider the change in androgen status relative to peak values at a young age and features of the receptor apparatus.

Currently, surgical intervention is the “gold standard” treatment of thymus tumors. Radical removal of the thymus gland in a single block, including the tumor, adjacent lymph nodes, and surrounding tissue of the anterior mediastinum, is a prerequisite for achieving satisfactory immediate and long-term results. The need for “maximum” thymectomy together with anterior mediastinal fiber is attributed to the fact that, along with other long-term survival factors (stage of tumor progression and histological subtype of the tumor), 45–50% of deaths in the long-term follow-up period are due to the recurrence of thymoma and 15–20% are caused by a progressive course of myasthenia gravis. The results of domestic and foreign studies on the implementation of thymectomy from various surgical approaches are analyzed. These include traditional thoracotomy and sternotomy, video-assisted and robot-assisted interventions, and combined operative accesses. The data presented are based on systematic reviews, retrospective cohort studies, clinical cases, and experimental studies using text databases PubMed, Google Scholar, and eLibrary.ru. The clinical characteristics of each operative access are given with an emphasis on technical features and advantages and disadvantages of thymectomy. The immediate results of surgical treatment of patients with thymus gland neoplasms are presented. Additional methods of visualization and physical preparation of anterior mediastinal tissues are described separately, which help increase the safety and effectiveness of surgical intervention. Currently, low-traumatic video-assisted surgical interventions are widely used in thoracic surgery, gradually replacing traditional “open” operations. Nevertheless, the variety of proposed options for surgical access, lack of clear indications and contraindications to various interventions on the thymus gland, and discrepancies in the use of various terms determine the need to develop a modern classification of surgical accesses for performing thymectomy. Taking into account world literature data and our own experience, a classification of operative accesses for performing thymectomy is proposed.

The study presents the main milestones in the history of the surgical scientific school of I.F. Bush, the founder and first head of the Department of Theoretical and Practical Surgery of the Medical Surgical Academy, who led it from 1800 to 1833. Being the head of one of the first departments of the academy, I.F. Bush can rightfully be considered the founder of the pedagogical school. The Guide to Teaching Surgery, which he published in 1807, became the first textbook in the specialty in Russian, which was taught for 40 years. The textbook also contained sections devoted to narrow surgical specialties–desmurgy and mechanurgy, thermal lesions, otorhinolaryngology, ophthalmology, maxillofacial surgery and dentistry, gynecology, urology, skin, and venereal diseases; accordingly, I.F. Bush can be considered the founder of these academic disciplines in our country. During the period of his leadership of the department, I.F. Bush had trained 15 professors who had led many of the nation’s surgical teams, as well as more than 2000 practicing surgeons. Many university and professional communities have chosen I.F. Bush as an honorary member. In Saint Petersburg and Moscow, the Bush Prizes were established for distinguished students. The first scientific academic schools served as the bases for the formation of subsequent scientific directions in surgery under the guidance of N.I. Pirogov, N.V. Sklifosovsky, S.P. Fedorov, V.N. Shamov, S.S. Lytkin, P.N. Zubarev, and others. The scientific school created by I.F. Bush was a Russian school, different from Western surgical schools in its basis, style, and organization of teaching. He put forward a galaxy of major surgical scientists who glorified Russian science. Representatives of this school have done important research in the field of surgery, anatomy, forensic medicine, eye diseases, gynecology, epidemiology, oncology, transfusiology, etc. Their works were translated into foreign languages, and many of them became classics. As clinicians, representatives of the first surgical scientific school were in no way inferior to the best surgeons in Europe. The article contains historical, practical, and professional interests for a wide range of readers: surgeons, historians of medicine and science, and general practitioners who are not indifferent to the history of domestic surgery.