Vol 10, No 2 (2024)

INTRODUCTION. Numerous studies in the field of hyperbaric physiology and diving medicine note changes in the water-electrolyte metabolism as well as renal function of men and animals in conditions of high pressure of gas and water environments. Despite undeniable water part in the process of body saturation-desaturation from indifferent gas as well as in processes of maintaining osmotic homeostasis, the role of water-electrolyte metabolism and renal functions in adaptation processes to hyperbaric conditions remains under-researched.

OBJECTIVE. To determine mechanisms and patterns of changes in the water-electrolyte metabolism and renal functions under the action of hyperbaric factors.

MATERIALS AND METHODS. Review work of scientometric databases was conducted: eLibrary.ru, RSCI, Scopus, PubMed, Cochrane, Google Scholar, www.academickeys.com, Ulrichsweb, www.research4life.org, www.lens.org, www.cabi.org, rucont.ru, www.ebsco.com, www.mendeley.com, OpenCitations.net, unpaywall.org, xueshu.baidu.com, www.wikidata.org, na.neicon.ru, keepers.issn.org. the search was done by keywords and phrases in Russian and English: a diver, water-electrolyte metabolism, excretory system, renal functions, diuresis, kidney, nitrogen toxic effect, hyperoxia, hypoxia, decompression sickness, oxygen toxic effect. 155 literary sources of 1975–2023 were analyzed, 53 works of which were included in the review, met the criteria for inclusion and exclusion. In this case, at least 80 % of works, included in the review, have been published for the past 10 years.

RESULTS. Most analyzed works contain information on an increase in diuresis in most subjects in the course of diving. Apart from it, there is an increase in the excretion of sodium and potassium in the urine, correlated with the amount of urine produced. Hypernatremia and an increase in tissue hydration are often revealed in the hyperbaric conditions, cause by oxygen toxic effect, supersaturation of body tissues with indifferent gases and nitrogen toxic effect. Renin-angiotensin-aldosterone system (RAAS) and its main component aldosterone play a key role in changes of the water-electrolyte metabolism in the hyperbaric conditions. The role of antidiuretic hormone is interesting because a lot of “non-classical” effects are uncovered in it that could be manifested in hyperbaric conditions and have never been associated with the action of high pressure on the regulation of the water-electrolyte metabolism.

DISCUSSION. Staying in conditions of increased pressure of the gas and water environment is subject to numerous and sometimes divergent changes in the water-electrolyte metabolism and renal functions. The loss of water and electrolytes by the body, recorded by bioimpendance methods in the course of hyperbaric factors, might result in dehydration. This, in turn, can increase the risk of developing specific divers’ disease, primarily such as decompression sickness. The studied literature does not provide clear guidelines on water-electrolyte balance correction in divers. Some works present data showing the possibility and usefulness of liquid intake (drinks) or pharmacological drugs, affecting divers’ water-electrolyte metabolism.

CONCLUSION. Analysis of literature data shows that specific changes of water-electrolyte metabolism and functions of excretory system emerge in the conditions of hyperbaric factors. In most subjects, these changes involve increased diuresis, hypernatremia and reduced tissue hydration. In cases where the effect of the adverse hyperbaric factor led to the development of pathological changes, tissue hyperhydration and increasing concentration of potassium in the blood as well as reduction of sodium in the urine were observed. This could indicate the possibility of forming the specific phenomenon “pressure diuresis” in hyperbaric conditions. All changes, occurring in the body under the action of hyperbaric factors, should be considered in terms of individual resistance to these factors and primarily to decompression sickness. Studies of divers’ water-electrolyte metabolism and renal function in the conditions of adverse hyperbaric factors are relevant with a view to developing the system of correction measures and prevention of the revealed violations.

INTRODUCTION. A person’s tendency to deviant behavior is to a large extent genetically determined and persists through life. Aggressive, suicidal and addictive behavior forms the basis of social and criminal tension in the society that justifies the need for further study of their genetic etiology.

OBJECTIVE. Virtual screening of most likely genes and their polymorphisms with a systemic impact on forming aggressiveness, suicidality and a person’s inclination to chemical addictions.

MATERIALS AND METHODS. NCBI, PubMed Central (National Institutes of Health’s National Library of Medicine, USA), PDB (Program database), KEGG (Kyoto Encyclopedia of Genes and Genomes), dbSNP (National Center for Biotechnology Information, USA), eLIBRARY open databases were used. The following search queries were applied: genetics of aggressive behavior; genetics of suicidal behavior; genetics of addictive behavior; genetic basis of risk-taking behavior. 834 publications were analyzed. There was virtual screening of genes and their polymorphisms, associated with phenotypic traits of the aggressive, suicidal and addictive behavior.

RESULTS. The bioinformatic analysis revealed a number of polymorphisms, systemically related to a person’s predisposition to form aggressive, suicidal and addictive behavior: rs1800497 (DRD2), rs6280 (DRD3), rs1851048 (CACNAD3-1), rs 6777055 (CACNA2D3-2), rs4680 (COMT), rs2562456 (ZNF-LD).

DISCUSSION. According to the analysis of the potential role of the selected single nucleotide polymorphisms in forming phenotypic prerequisites of a person’s systemic inclination to aggressive, suicidal and addictive behavior, genotypes of the studied SNP were characterized by the presence and nature of their effect on the studied vectors of deviant behavior.

CONCLUSION. There are systemized characteristics of genes, polymorphisms and relevant genotypes, associated with phenotypic and behavioral risks of aggressive, suicidal and addictive behavior. There is a developed look-up table, reflecting in detail the connection between genotypes of the selected polymorphisms, the presence and their effect on the studied vectors of deviant behavior.

OBJECTIVE. To shift the focus of practitioners’ attention to pathogenetic role of intravascular gas bubbles, which likelihood is high with wounded kidney, hollow veins and venous sinuses of the brain as well as with pressure drops, occurring in case of shockwaves, exposed to the body.

MATERIALS AND METHODS. There was analysis of literature, published from 1957 to the present and being in the public domain in the State Central Scientific Medical Library, Scientific Electronic Library “CyberLeninka”, Scientific Library of IMBP RAS, electronic databases of RSCI and PubMed. Search keywords: air embolism, mine-blast trauma. 58 articles have been analyzed.

RESULTS. Air embolism is often associated with diving medicine only. Nevertheless, there are severe (and fatal) manifestations of gas bubbles in the vascular bed in surgical practice, military medicine and clinic of internal diseases, and this cannot be ignored. Given that in blast trauma, in a number of neurosurgical, trauma operations, in anesthetic practice, in the use of AVL, and in other areas of medicine there are often situations, creating conditions for the emergence of free gas in the systemic circulation, methods of barotherapy may be demanded much more frequently than in decompression sickness. Hyperbaric physiology and diving medicine are engaged in ensuring functions of the body in a changed gaseous medium and in providing a set of measures to prevent critical states while leaving it. Also, the prerogative in this field is to use the physical properties of a changed respiratory gaseous medium under different pressure, temperature and combination of components in the treatment process.

DISCUSSION. According to the authors of the review, it is essential to work towards developing practitioners’ knowledge (especially, surgeons, anesthesiologists and resuscitators) of gas embolism and methods of barotherapy, expanding the area of surgery, anesthesiology and resuscitation, hyperbaric physiology and diving medicine to treat gas embolism of various etiologies.

INTRODUCTION. Contrast seasonal changes of the North exogenous natural factors cause significant restructuring in the human body despite the fact that the effect of social factors may greatly modify adaptation processes.

OBJECTIVE. To determine features of seasonal changes in physiological parameters in 2 groups of young men (military personnel and students) in the European North.

МАТЕРИАЛЫ И МЕТОДЫ. The study involved 2 groups of men-northerners, living in Syktyvkar during the survey period (62^о N latitude): conscripts (n = 19) and university students (n = 16). The study was conducted for over a year: in January, April, July and October: anthropometric measures, arterial pressure and heart rate variability (RV) were recorded.

RESULTS. All the examined experienced an increase in body weight and body mass index in the cold season, more pronounced in October. An increase in diastolic pressure was also noted in autumn. Heart rate variability in the examined had different seasonal dynamics.

DISCUSSION. The study found that if regarding mass index, fat mass and body mass index, the examined young men had similar dynamics, however, arterial pressure and heart rate variability differ between groups both at a basic level and in seasonal dynamics.

CONCLUSION. In the European North young men experience seasonal rate changes, which dynamics have been different in the studied groups. Long daily exposure to the open air cause mor pronounced signs of vagotonia in conscripts.

OBJECTIVE. Evaluate thoroughness of diagnostic methods of identifying damage in patients with severe traumatic shock and determine the time of their admission to the operating room since the moment they have been taken to hospital.

MATERIALS AND METHODS. There was an open prospective cohort clinical study of 183 affected, taken to the budgetary health care institution of the Omsk region since 2016 to 2022 and divided into three groups, depending on the severity of traumatic shock. Each group was split into two subgroups based on the method of identifying damage. In all the affected of subgroups 1 damage was recognized, using a combination of abdominal ultrasound examination and polypositional X-ray of body segments. Current damage of all the affected of subgroup 2 was diagnosed by multispiral computed tomography (MSCT). Thoroughness of applied diagnostic methods of identifying damage was checked by sensitivity, specificity, method value, positive predictive value as well as negative results.

RESULTS. The findings show that MSCT is the key diagnostic method of identifying damage in patients with traumatic shock of different. This method of diagnosing damage in patients with traumatic shock of different severity seems not only to be highly sensitive, but also to have low incidence of false positives with a significant predictive value of positive and a low one of negative results regarding an alternative way of recognition.

DISCUSSION. MSCT plays a crucial role in expediting the decision-making process on strategies and tactics of surgical treatment in patients with traumatic shock. It reduces the risk of developing multiple organ failure and deaths due to rapid and accurate diagnosis of internal injuries. The technical characteristics of this research method allow to obtain detailed images of organs and systems in a short time, which greatly increases the chance of successful treatment. This diagnostic method is especially valuable for its ability to estimate the amount of blood loss non-invasively and informatively and to accurately localize damage, which is critical for determining an optimal strategy for surgical intervention and intensive therapy.

CONCLUSIONS. The use of MSCT method for the diagnosis of identifying damage in patients with severe traumatic shock is crucial and justified due to its high informative relevance for a logical implementation of strategies and tactics of surgical treatment. The use of MSCT method in patients with severe traumatic shock contributes to a significantly more rapid start of patients’ treatment in comparison with the diagnostic method of identifying damage, based on data X-ray and ultrasound scan.

OBJECTIVE. Study objective and subjective indicators of the auditory and vestibular functions of patients with mixed cochleovestibular syndrome before, during and after therapy. Based on the data obtained, optimize approaches to treat patients with this pathology.

MATERIALS AND METHODS. 842 patients were examined with the diagnosis: mixed cochleovestibular syndrome, the mean age of the examined group is 52. The duration of the disease was from 1 to 4 years. A comprehensive examination of patients was carried out проводили at key points of the study (inpatient: before initiation of drug therapy, in the middle and at the end of treatment course, and also outpatient monthly for 6 months.

RESULTS. Computer videonystagmography measures were the most sensitive and objective diagnostic method in this category of patients. Based on computer videonystagmography, data evaluation reveals the following patterns: by the main values, most changes are determined before therapy (point 1); during drug therapy (point 2, 3) videonystagmography values are almost unchanged, coinciding at point1; reduced imbalance in the vestibular system response is observed at points 4, 5 (the 3^rd and 4^th months of monitoring); at point 6 (the 6^th month) there are recorded changes in some values, which speak of onset of the disease exacerbation. When assessing other values (tonal threshold audiometry, vestibular passport, etc.) the findings of study methods were not sensitive to changes.

DISCUSSION. The evaluation of clinical guidelines did not find the optimal scheme of treating this pathology. We recommend treatment, which includes a comprehensive approach, consisting of a two-week course of parenteral drug injections (based on etiological reasons for the development of the pathological process) with physiotherapeutic procedures and vestibular rehabilitation measures, included in the treatment regimen. The repeated course of supportive therapy is recommended 6 months after the course of primary treatment.

CONCLUSION. The study has given and proven the optimal scheme of therapeutic measures and periods of preventive treatment. The recommended algorithm of guiding patients with mixed cochleovestibular syndrome will help to avoid the progression of the disease, achieve stable remission, to prevent complications and disability of patients. This strategy is also more economically beneficial.

Ocean management takes place in research, experimental and industrial directions, which define the basic principles of training specialist, working as divers in the underwater environmental condition. There are problems of enrolment in educational institutions, which provide training in the diving specialty, associated with a small number of applicants and their poor health status, that poses new challenges for maritime medicine. Taking into account modern realities, there is need to optimize models of divers’ selection.