[Mechanism of formation and morphological features of a gunshot injury to the chest and abdomen arising from the use of body armor]. / Mekhanizm obrazovaniya i morfologicheskie osobennosti ognestrel'noi travmy grudi i zhivota, voznikayushchei pri ispol'zovanii bronezhileta.

The features of a gunshot injury arising in the presence of body armor on the injured person are considered. The purpose of the work is to reveal the mechanisms of damage formation during non-penetration of an armored composition, during its penetration, as well as during external or internal rebound. The characteristic of damages arising with this is given. It was shown that injuries due to non-penetration of body armor are characterized mainly by local closed injuries, not only of integumentary soft tissues, but also of internal organs in the projection of impact of a wounding projectile. With through penetration of body armor, the severity and volume of gunshot damage increase due to the introduction of fragments of bullets, fragments of armored panels and pieces of equipment into the wound channel. Rebounding of elements of dismantled bullets from the outer or inner surface of the body armor can cause severe gunshot damage to both the wearer of body armor and other persons. Knowledge of the mechanisms of formation and morphological features of injuries that occur when using body armor are prerequisites for a full forensic medical assessment of the investigated incident.

[Features of an explosive lower extremities injury protected by sapper shoes]. / Osobennosti vzryvnoi travmy nizhnikh konechnostei, zashchishchennykh obuv'yu sapera.

The purpose of the work is to conduct experimental studies that reveal the characteristic features of explosive injuries of the lower extremities using various samples of sapper protective shoes of domestic and foreign production. The subjects of experiment were the amputated by medical reasons lower extremities of a person. The severity of explosive damage during contact blasting and the parameters of shock accelerations acting on the lower extremities, as well as approximate periods of disability and the forecast of possible disability, are determined. The results of the study can serve as initial data when testing safety shoes. In addition, using the proposed modeling technique, it is possible to compare the protective properties of various samples of anti-mine shoes, assess the presence (or absence) of signs of aggravation of damage during an anti-personnel mine detonation, and carry out a forensic medical assessment of an explosive injury.

Resuscitative endovascular balloon occlusion of the aorta: what is the optimum occlusion time in an ovine model of hemorrhagic shock?

PURPOSE: The aim of this study is to evaluate the early survival and organ damage following 30 and 60 min of thoracic resuscitative endovascular balloon occlusion of the aorta (REBOA) in an ovine model of severe hemorrhagic shock. METHODS: Eighteen sheep were induced into shock by undergoing a 35 % controlled exsanguination over 30 min. Animals were randomized into three groups: 60-min REBOA 30 min after the bleeding (60-REBOA), 30-min REBOA 60 min after the bleeding (30-REBOA) and no-REBOA control (n-REBOA). Resuscitation with crystalloids and whole blood was initiated 20 and 80 min after the induction of shock. Animals were observed for 24 h with serial potassium and lactate measurements. Autopsy was performed to evaluate organ damage. RESULTS: Two animals of the n-REBOA group died within 90 min of shock induction; no hemorrhagic deaths were observed in the REBOA groups. Twenty-four-hour survival for the 60-, 30-, and n-REBOA groups was 0/6, 5/6, and 4/6 (P = 0.002). In 60-REBOA, potassium and lactate were increased at 270-min time point: from 4.3 to 5.1 mEq/l and from 3.7 to 5.1 mmol/L, respectively. Both these values were significantly higher than in the n-REBOA group (P = 0.029 for potassium and P = 0.039 for lactate). Autopsy revealed acute tubular necrosis in all died REBOA group animals. CONCLUSIONS: In this ovine model of severe hemorrhagic shock, REBOA can be used to prevent early death from hemorrhage; however, 60 min of occlusion results in significant metabolic derangement and organ damage that offsets this gain.

[Comparative evaluation of effectiveness and safety of the local hemostatic agents in the experiment].

Comparative evaluation of effectivennes and safety of the local hemostatic agents in the experiment. On the model side damage the femoral artery of pigs we performed a comperative test of modern local hemostatic agents (LHA): bandages on the basis of chitosan <> (TG), eGemofleks Combat> (GC), (GB) bandages on kaolin-based <> (CG), and the usual bandage 10 cm x 3 m (control group). 25 animals were divided equally into 5 groups. After 45 seconds of bleeding from 6-mm side wound of femoral artery was used LHA with a three-minute external compression and wound edges approximation. In the case of the continuation-bleeding wounds performed re-tamponade with the second package of the LHA. Hemostasis after applying the first packet never recorded in the CG group, occurred in I out of 5 animals in the groups TG and GC, 2 of 5 animals in the group GB and the control group (p>0,05). Application of two packages LHA in the TG group, GB and the control group was effective in 3 of 5 animals and in groups CG and GC - in 2 of 5 animals (p>0,05). Mortality did not differ significantly between the groups. Thus, the conventional bandage wound with ordinary tamponade in this model is not less effective than current LHA.

[A NATURAL PLAGUE FOCUS. IN GORNYI ALTAI: FORMATION, DEVELOPMENT, AND FUNCTIONING].

The paper gives the results of analyzing the data of long-term studies of the natural focal pattern of plague in the Gornyi Altai natural focus. It describes a wide range of biological processes occurring in the focus and shows the most important patterns of its functioning as a complex multilevel ecological system. The key features of the formation of the focus have been revealed. The plague focus in South-Western Altai has formed relatively, recently, about half a century ago, then it has intensively developed and its enzootic area and the activity of epizootic manifestations have considerably increased. This process is due to the space-time transformations of the basic ecological and population characteristics of Pallas' pika (Ochotoma pallasi), the principal vector of the pathogen of plague and fleas parasitizing the mammal, which is in turn related to the aridization of mountain steppes in South-Western Altai.

[An improvement of experimental model for a study of local hemostatic agents' effectiveness].

With the help of tests on 10 big biological objects (sheep) was studied a modern model of severe lateral damage (6 mm diameter) of femoral artery. Within 45 seconds blood loss was 432.5 +/- 258.2 ml. The usage of domestic local hemostatic agent--"Gemostop" based on zeolite and "Gemofleks" based on chitosan. The total three-hour mortality was 50%. Primary hemostasis was recorded only in 20% of biological objects, the final hemostasis in 60%. Thus, the model of standard 6-mm lateral damage of femoral artery with a free primary hemmorage during 45 seconds should be considered as. optimal for evaluating the effectiveness of modern hemostatic agents.

[First experience of a polyurethane foam composition "Locus" use to stop intra-abdominal hemorrhage as a result of liver damage of V degree. (An experimental study)].

Today self-expanding polymers are considered as the most promising as means for intracavitary hemostasis in case of continuing bleeding after trauma. Testing of domestic open-cell polyurethane foam composition "Locus" was carried out on the developed experimental model simulating liver trauma of V degree. After damaging 6 experimental rabbits were injected intraperitoneally with 80 ml of the composition. 5 experimental rabbits were included into to control group (haemostatic agent was not given). Estimated blood loss was 111-124 ml. The two-hour survival rate didn't differ significantly: 3 animals survived in the experimental group; 2 animal survived in the control. Despite the 3-4-fold widening of the foam, due to open cells it absorbed 72.6 +/- 8.3 g of blood. Thus, open-cell polyurethane foam intraperitoneal administration of the composition didn't provide a temporary intra-abdominal hemostasis in liver. In order to enhance the hemostatic effect it requires changing the formulation of the polyurethane composition. For a more accurate assessment of the results it is neccessary to perform additional researches on larger animals.

[Surgical peculiarities of gunshot injuries to arteries of the extremities caused by modern small arms and light weapons].

The aim of the given study was development of surgical tactics in case of femoral artery injury, caused by medium-calibre bullet, on the basis acute experiment on large biological objects. Experimental animals were shot into mid third of the femora by a rifle cartridge in 7,62-mm calibre (AK-47 made in 1943). The analysis of microstructure, made in 5 cross-sections performed every 1-centimetre way from the wound canal, showed that there were no any damages of arterial wall. Authors came to conclusion that the surgical debridement of the gunshot wound, made by a rifle cartridge in 7,62-mm calibre of AK-47, should consist of exsection of devitalized section of artery.

[Membranes structure and physical and mechanical erythrocytes properties in the early period of traumatic brain injury caused by less-lethal firearms].

The dynamics of erythrocytes properties in the acute phase of traumatic brain injury caused by less-lethal firearms has been studied by the methods of atomic force and morphometry. The experiments have been performed on sheep by a Makarych pistol single shot at the parietooccipital area. It has been established that under the influence of the shock waves the erythrocyte disks and transmembrane liquid oscillatory fluctuations (flicker) are increased. The fluctuations are rapidly attenuated and the shock waves energy is accepted by cytoplasmic membranes lipoproteids. As a result the interface tlipid-protein, phase transitions are hastened. The membranes undergo heterogeneous structural, physical and mechanical transformations the character of which is determined by the phase transitions direction. In the spots of phospolipid liquid clusters accumulation the fluidity is increased and marks caused by membranes lamination and spreading appear. In the spots of phospholipids solid phase the surfaces become hydrophobic and marks caused by membranes local embrittlement and fragility appear. The transmembrane fluid hydrodynamic flows heterogeneity is increased due to deformation processes irregular spreading. The flows acceleration causes the hydrodynamic ruptures-like defects. The flows deceleration results in depressions evolving through the mechanism of creeping erosions.

[Safety criteria for blood refusion in military field surgery and trauma surgery].

Massive intracavitary hemorrhage in case if severe concomitant injury is the most frequent cause of death. Necessity of blood loss replacement requires effective and safe methods. One of them is blood reinfusion - technically less complicated method. The article shows advantages of using the hardware and filtration methods of blood sampling and reinfusion, developed scale rapid diagnosis of the level of hemolysis of autologous blood. Using of the method of filtration blood sampling provides 2X minimal amount of free hemoglobin than using an aspirator and reinfusion of blood with the contents therein to free hemoglobin 2.0g/ L prevents the risk of developing the syndrome and massive blood transfusion reduces the incidence of deaths at 11%. In patients with massive intracavitary hemorrhage it is advisable to use the method of semi-quantitative rapid analysis of free hemoglobin color scale.

[The involvement of some flea species in the epizootic process in the Gorno-Altai natural plague focus: spatial and temporary characteristics].

The relative number of plague pathogen strains isolated from some flea species in different Gorno-Altai natural plague foci substantially varies; this indicator also varies with time. These patterns are due to the difference in the structure of multispecies communities of ectoparasites in these areas and their long-term transformation. As of now, the three species Paradoxopsyllus scorodumovi, Ctenophyllus hirticrus, and Amphalius runatus are widely involved in pathogen transmission in all three foci. These ectoparasites should be referred to as main plague vectors. In each focus, they are joined by other flea species, such as Rhadinopsylla dahurica and Amphipsylla primaris in the Ulandryk focus, Frontopsylla hetera, R. dahurica, Paradoxopsyllus kalabukhovi, and Paramonopsyllus scalodae in the Tarkhatin focus, and P. scalonae and P. kalabukhovi in the Kurai focus, which should be classified as an additional vector.

[Change in the habitat of Yersinia pestis in the Gorno-Altaisk natural focus of plague].

The paper analyzes the change that occurred in the habitat of the causative agent of plague in its Gorno-Altaisk natural focus in 1961 to 2012. Since 1961 when the plague microbe was found to come from the southern slopes of the Saylyugem mountain range, which are located in Mongolia, to the northern slopes situated in Russia, a gradual expansion of the habitat of Yersenia pestis subsp. altaica had commenced in South-Eastern Altai. During the considered period, the area where epizootic manifestations were registered showed an 11-fold increase. In most cases, the spread of the plague pathogen within the focus was natural and occurred in the successive and closely related settlements of Mongolian pikas (Ochotona pallasi). By now, the plague microbe has been widely distributed in three populations of this small animal, which inhabit the territory of South-Eastern Altai.

[Pathogenesis and early diagnosis of deep vein thrombosis in case of polytrauma].

Pathogenesis and early diagnosis characteristics of acute deep vein thrombosis (advt) have been studied in 323 polytrauma patients (iss: 29.4 +/- 2.0 score). Acute vein thrombosis, confirmed by us examination, was determined in 22.3% of patients (in the case of severe craniocerebral trauma--scct--12.6%, extremity trauma--60.5%, spinal trauma 75%, severe sepsis--25%). Despite the complex diagnosis and prophylaxis (thrombus removal, thrombosed veins ligation, external iliac vein and inferior vena cava clipping, permanent and removable cava-filters positioning) pulmonary artery thromboembolism (pate) developed in 3.1%. ADVT in patients with polytrauma developed as a pathogenic basis of systemic inflammatory response syndrome (sirs), which was observed to be associated with endothelium damage and thrombophilia. Hence, thrombophilia values (high levels of crp, f.viiia, D-dimer, low levels of antithrombin iii--at-iii), which are characteristic of sirs, lose their informativeness in the early diagnosis of advt and pate risks identification. In this regard, early advt diagnosis in polytrauma should be based on doppler study results, and the adequacy of anticoagulant and antiplatelet therapy should be determined by the levels of crp, f.viiia, D-dimer, activated partial thromboplastin time--aptt, anti- xa heparin activity, international normalized ratio--inr, platelet aggregation, thrombodynamic potential, at-iii.

[The development and implementation of polymerase chain reaction to detect in real-time operation mode yersinia pestis in field material].

The article presents the results of development and practical implementation of system of polymerase chain reaction testing in real-time operation mode to detect agent of plague infield material. In laboratory conditions the system demonstrated good results and hence it was applied in conditions of field laboratory of epidemiologic team during planned epizootologic examination of Gorno-Altaisk hot spot of plague. The sampling consisted of more than 1400 objects. It was demonstrated that high sensitivity and specificity is immanent to proposed system. The adaptation of the system to the real time amplifier "Smart Cycler" (Cephid, USA) having some specific technical characteristics makes it possible to consider the proposed test-system as an effective sensitive and precise instrument for screening studies in the process of regular epizootologic examinations of hot spots of plague.

[The forensic medical aspects of mechanogenesis of the blast injury].

This experimental study had the objective to elucidate the injurious action of various traumatic factors associated with explosions with special reference to the objective registration of the related high-speed processes. Most attention was given to aerial and surface bursts. Mechanogenesis and pathological morphology of the blast injuries have been most thoroughly investigated.

[Peculiarities of forensic medical expertise of gunshot wounds inflicted through a bulletproof vest].

A series of experimental studies was conducted with the object of elucidating the mechanisms of the bullet after-penetration effect produced by a handgun shot into the armoured vest with special reference to the changes developing in the space behind the barrier. The application of the pulsed radiographic technique revealed a transient cavity the presence of which accounts for the injuries to soft tissues, bones, and internal organs in the projection of the bullet impact without damage to the armour plates.

[The use of local hemostatic agent "Celox" in experimental model of grade IV liver injury].

Ongoing intra-abdominal bleeding is the main life-threatening sequence of blunt abdominal trauma. The use of local hemostatic agents allows achieving fast and reliable hemorrhage control in case of parenchymatous organs injury. We investigated the efficacy of a dressing "Celox Gauze" in an experimental model of grade IV liver injury in large animals in the setting of coagulopathy. We used the following experimental model: 30-35% of blood volume was withdrawn followed by severe liver injury and hemostatic agent application. Laboratory tests were controlled in three endpoints. Hemostasis was evaluated in 2 days. "Celox Gauze" was effective for hemorrhage control in 100% of cases. All animals survived until the end of the experiment. Perihepatic packing with "Celox Gauze" applied is more effective to control hemorrhage than packing only. It has been noted lower volume of blood loss, lower decrease of red blood cells in animals of "Celox Gauze" group. We noted no adverse effects. Histological analysis showed the absence of any significant local hepatic damage. In whole the local hemostatic agent "Celox Gauze" has been shown highly effective in the model of parenchymatous bleeding. Additional studies with more number of animals are warranted to confirm our results.

[Mechanisms of damage of internal ear capsules labyrinths at head injury, caused by non-lethal kinetic weapon].

Structural, physical, chemical and micromechanical properties capsules labyrinths of an internal ear are studied at influence of the shock wave caused by wound of a head by not lethal kinetic weapon. It is established, that under the influence of a shock wave in bone plates capsules labyrinths processes remodeling, and accompanied osteolysis amplify. Hydroxyapatites capsules labyrinths tests polymorphic phase transitions and depending on an initial condition is exposed amorphizationor increases the crystallinity. As a result of change of micromechanical properties in capsules labyrinths there are cracks, ruptures matrix and bone cavities.

[New data on morphogenesis of gunshot bone injuries].

Studies with the use of atomic-force and scanning electron microscopy yielded new data that extend our knowledge of the complicated process underlying bone tissue degeneration as a result of its interaction with a high-speed injurious projectile. These data open up good prospects for the study of gunshot wounds and provide novel opportunities for forensic medical examination and diagnostics including confirmation of gunshot origin of the injury, elucidation of the properties (in the first place, energetic characteristics) of the injurious projectile, and determination of the wound size.

Frequency doubling of a broadband Raman fiber laser to 655 nm.

655 nm laser radiation with power of >60 mW is generated by frequency doubling of a broadband randomly-polarized 1.31-microm Raman fiber laser (RFL). The red power appears to grow linearly with increasing RFL power up to 7 W at efficiency comparable with that for single-frequency lasers. It has been shown that multiple sum-frequency mixing processes involving different RFL modes provide the main contribution to the output, which is enhanced by 2 times due to the modes stochasticity.