Modern weapons cause severe damage, accompanied by high rates of complications and mortality. The investigation of such kinds of weapons is in high demand considering the ongoing active phase of ...russia's war against Ukraine since February 2022. In order to understand the pathological processes that occur in and outside the gunshot wound, we conducted an experimental study using mathematical simulation. The results presented in the article will help to choose the appropriate surgical management and improve the results of treatment. The aim of this study was to investigate and evaluate the damaging effect of a 5.45 mm 7N6M bullet and a 5.45 mm V-max expansive bullet using numerical modeling of wound canals in ballistic plasticine. The Ansys Explicit Dynamics engineering complex was used to simulate the dynamics of the bullet’s motion. The basic equations, solved by the explicit dynamic analysis, express the conservation of mass, momentum, and energy in Lagrange coordinates. Together with the material model and the set of initial and boundary conditions, they determine the complete solution to the problem. Taking into account that the initial velocity of the bullet is 1185 m/s at a mass of 3.9 g, we obtain energy 2740 J. All this energy acts at the area of the wound canal with a depth of 150 mm. Injury with a conventional 7N6M bullet is characterized by the fact that it passes through the block and loses only part of the kinetic energy. The simulation results showed that the velocity of the bullet at the outlet is 220 m/s. Taking into account the initial velocity of the bullet 918 m/s with a mass of 3.4 g, we obtain the kinetic energy acting on the walls of the wound canal with a depth of 200 mm of about 830 J. Mathematic analyses showed that the expansive bullet has a soft core that deforms and transfers all the kinetic energy to the tissues immediately after penetration into the tissues. The loss of kinetic energy of the bullet (ΔE, J) is defined as the difference between the kinetic energy at the time of injury (Ec, J) and the residual energy of the bullet when leaving the material (Er, J). Numerical modeling of wound ballistics in biological tissue simulators allows us to determine with high accuracy the features of wound canal formation and tissue response to damage of bullets having different kinetic energy, which contributes to the choice of adequate surgical management during surgery for gunshot wounds.
Artificial intelligence (AI) encompasses the advancement of computers and robots, enabling them to surpass human capabilities in various aspects. By utilizing AI, programs have the ability to ...autonomously analyze and interpret data, offering information and executing actions without any human involvement. The ongoing war in Ukraine showed various aspects of severe gunshot injuries because of previously unknown course of wounds after application of ballistic missiles, drones, etc., which is frequently applied by russians. In such conditions, decision-making process by military medical doctors must be quick and rational, however in case of massive casualties, combined trauma (e.g. thoracoabdominal gunshot injury) MDs might have permanent challenges to apply appropriate care options and individualized approach. The aim of this study is to start the discussion about role and possible application of AI in management of gunshot injuries in combat patients or other individuals who received wounds relating to high-energy weapon. Conclusions. Gunshot wound is a clinical challenge in many cases among patients who were injured by high-energy weapons, requiring complex and quick decisions. AI might be applied as an additional tool for the decision-making process in case of severe trauma in deployed field hospitals, or in hospitals of higher Roles (3-4). This study is to start the research discussion about the utility of AI application for the management of the injured in the war associated with high-energy weapons.
In this study were included 37 patients with diabetic peripheral neuropathy, which, along with standard glucose-lowering therapy received thioctic (α-lipoic acid) «Berlition», initially 600 mg — ...infusion over 12–16 days, followed by an oral form of the drug up to 40 days. The control group included of 14 patients with compensated diabetes who were outpatients and received only glucoselowering therapy. In all three patients transdermally determined level of partial pressure of oxygen on the rear side of the foot. After the end of the injection of «Berlition» in a dose of 600 mg mean partial pressure of oxygen increased from 33,11 ± 7,21 to 34,20 ± 6,54 mm Hg (p = 0.054). At allotment of patients with NSS index > 6 in a special subgroup was obtained the increase of partial pressure of oxygen from 30,93 ± 5,92 to 34,48 ± 5,26 mm Hg (P < 0,05). After ending of drug administration the mean value of partial pressure of oxygen (37,65 ± 5,54 mm Hg) statistically significantly different from both the entry-level, and from the control group. At the same time significantly reduces the degree of diabetic neuropathy. The author makes the assumption that the resulting effect may be due to the fact that on the background of severe diabetic neuropathy develops the arteriolo-venular shunting, and in the condition of improving innervation of small diameter vessels (arterioles, venules) of lower limbs under the influence of thioctic acid «open» capillaries and stop functioning pathological shunts.
Retrospective analysis of efficacy of complex treatment, including surgical intervention, radioiodine therapy (RITH), suppressive hormonotherapy of differentiated forms of the thyroid gland cancer ...(DFTHGC) was done in 281 patients with positive effect of postoperative distant radiation therapy (PDRTH) application as a component of the treatment. Positive effect of therapy was estimated basing on the dynamic scintigraphy data with 131I and determination of thyroglobulin level in blood serum. The PDRTH conduction does not improve prognosis of the disease, does not lower the tumor metastasizing frequency to regional lymph nodes and remote organs and does not replace RITH. To achieve positive result in 12.8% of patients with PDRTH more than two courses of RITH were performed, enhancing so the total radiation dosage on the organism. To provide protracted nonrecurrent survival of patients with DFTHGC the radical approach is necessary, envisaging performance of thyroidectomy, the timely conduction of RITH with subsequent suppressive therapy using L-thyroxin.
Vascular injuries to extremities are common in armed conflicts. Such kind of injury is associated with a high risk of critical ischemia, limb amputation, and high morbidity. There is a clinical ...challenge for the management of vascular injuries to extremities in ongoing warfare due to limited medical resources.
A 34 years old male received a gunshot injury to both low extremities on March, 23rd 2022 in a battlefield area 30 km away from Kyiv city. CAT tourniquet was applied to stop the bleeding and the patient was transported to Level II by ambulance 40 min after the injury. The patient was diagnosed with a gunshot injury to the left superficial femoral artery (SFA) followed by primary surgical debridement and temporary arterial shunting at Level II hospital. Then the patient was evacuated to Level IV hospital, diagnosed with an injury to the right popliteal artery, and underwent vascular reconstruction.
Arterial shunting is a well-known approach to prevent critical ischemia and limb amputations of injured extremities in both combat and civilian patients. This case report provides evidence for the utility of temporary arterial shunting in combat conditions, which is supported by data from the larger cohorts. We consider temporary vascular shunting as a damage control measure to be associated with high chances of limb salvage in ongoing warfare.
Our study demonstrated the utility of temporary arterial shunting in combat patients with gunshot wounds in ongoing warfare, which could be performed even in case of limited medical resources.
•Gunshot wound to the major vessels is associated with high risk of lethal outcome.•Temporary arterial shunting could be performed in combat settings even in limited medical resources.•Damage control surgery is useful approach in case of severe vascular injury.
