OBJECTIVE. Analyze Russian and foreign scientific literature reflecting the mechanisms of CD8⁺ Т -lymphocyte activation, lysis of infected cells, and the formation of possible immune dysfunctions.

MATERIALS AND METHODS. Recent Russian and international scientific literature from 1998 to 2025 on the biological features of CD8⁺ Т -lymphocyte activation was studied and analyzed. The primary sources were searched in the RINC, PubMed, Scopus, and Web of Science databases. The following combinations of keywords were used: T-lymphocyte subpopulations, cytotoxic T-lymphocytes, cytokines, granulins, perforin proteins, transcription factors, and hereditary mutations. A total of 49 articles were analyzed.

RESULTS. The differentiation of CD8⁺ Т cells depends on many factors, including CD4⁺ T lymphocytes, without which the formation of effector CD8+ T cells and memory T cells does not occur. Interleukins -2, -12, and IFN type I ensure the proliferation of CD8⁺ Т cells and their differentiation into cytotoxic lymphocytes. They stimulate the expression of transcription factors T-BET and BLIMP-1, which ensure the expression of perforin and granzymes. In chronic viral infections, T-cell differentiation is blocked by programmed cell death protein-1, as well as CTLA-4, TIM-3, LAG-3, and others. KIR receptors transmit inhibitory signals that prevent the destruction of uninfected cells by cytotoxic T lymphocytes. Thanks to the expression of NKG2D receptors, which recognize MHC-like class I molecules—MICA, MICB, and ULBP—that are expressed only by infected or transformed cells, “normal” cells and tissues are not damaged, activating nucleases in target cells. DISCUSSION. Cytotoxic T lymphocytes initiate the destruction of microbial DNA, as well as the genome of the target cell, thereby eliminating potentially infectious DNA. The functioning of cytotoxic T lymphocytes is affected by hereditary mutations associated with perforin and occurring in genes encoding proteins involved in exocytosis.

CONCLUSION. CD8⁺ Т lymphocytes proliferate and differentiate into CTLs containing cytotoxic granules, which enable them to lyse infected cells. Differentiation into CTLs is accompanied by the acquisition of mechanisms for destroying target cells and controlling various transcription factors. In the case of chronic antigen exposure (tumors, chronic viral infections), CD8⁺ Т cells initiate a response and begin to express inhibitory receptors that suppress the immune response.

INTRODUCTION. This review article is devoted to the topical issue of studying the relationship between irritable bowel syndrome (IBS) and post-traumatic stress disorder (PTSD). Over the past decade, there has been an increase in the number of patients with a combination of adaptation disorders and functional gastrointestinal tract (GIT) diseases, which requires an in-depth analysis of both the mechanisms underlying this association and an assessment of its impact on patients’ quality of life, as well as the development of preventive and corrective-rehabilitative approaches. This study is a literature review of relevant sources on the epidemiology, pathogenesis, and treatment approaches for this group of pathologies, with an emphasis on finding points of application for antihypoxants/antioxidants and cognitive-behavioral therapy (CBT).

OBJECTIVE. Analysis of pathophysiological mechanisms linking IBS and PTSD and evaluation of promising approaches to comprehensive therapy.

MATERIALS AND METHODS. An analytical review of literary sources in PubMed, Google Scholar, eLibrary, Scopus, Web of Science, Cochrane Library, and CyberLeninka databases for the last 10 years was conducted using the keywords: “CBD,” “PTSD,” “comorbidity,” and “brain-gut axis.” Forty-six articles that met the search criteria were selected. RESULTS. A high prevalence of comorbidity between IBS and PTSD (OR = 4.54; 95% CI: 4.07–5.06) was established, with a predominance of the diarrhea variant of IBS (71%) and more severe symptoms. Key pathophysiological mechanisms were identified: dysregulation of the autonomic nervous system (sympathicotonia), hyperactivation of the hypothalamic-pituitary-adrenal axis and hypercortisolemia, hypoxic changes and oxidative stress in the microbiota, and dysfunction of the brain-gut axis (dysbiosis, systemic inflammation).

DISCUSSION. The comorbidity of IBS and PTSD is a clinically significant condition with common pathogenetic mechanisms. The most promising approach to treatment is an integrative one, combining the use of several main groups: pharmacotherapy (antihypoxants, cytoflavin), psychotherapy (cognitive-behavioral therapy (CBT)).

CONCLUSION. The pathogenesis of comorbidity of IBS and PTSD integrates disturbances in neurovegetative regulation, hypoxia, and dysfunction of the brain-gut axis. The priority direction is the development of combined treatment regimens (antihypoxants + CBT + diet) to influence various links in the pathogenesis.

INTRODUCTION. Timely diagnosis of mental disorders in conscripts is essential for national security. An important task is to predict the risk of personality disorders (PD), which account for up to two-thirds of mental disorders in conscripts.

OBJECTIVE. Evaluate the efficacy of a model for predicting the risk of personality disorders in individuals of draft age based on biopsychosocial markers.

MATERIALS AND METHODS. A total of 239 conscripts were examined at the V. M. Bekhterev Center for Psychiatry and Mental Health in 2022–2024. The median age was 18.0 [18.0; 19.0] years. The experimental group (EG) consisted of 140 (58.6%) conscripts with a confirmed diagnosis of PD, and the comparison group (CG) consisted of 99 (41.4%) mentally healthy conscripts. Clinical (questionnaire, analysis of complaints and anamnestic data, clinical examination) and experimental psychological methods were used. The experimental psychological study (EPS) was conducted using a proprietary questionnaire to identify markers of mental disorders in conscripts. Based on the results of comparing the frequency of occurrence of biopsychosocial markers of mental disorders in the EG and CG, a predictive-analytical mathematical model was created to assess the risk of PD in conscripts.

RESULTS. The following markers of mental disorders were significantly more common (p ≤ 0.01) in the EG: lack of academic activity, frequent family quarrels, poor relationships with peers, bullying by peers, lack of friends in the past and present, quarrels at school, committing sudden rash acts, quick temper, ability to strike when offended, observation/treatment by a psychiatrist, signs of Internet addiction, bad mood, mood swings, anxiety, suicidal thoughts, negative attitude towards military service. Based on the identified markers, a predictive analytical mathematical model was constructed to assess the risk of PD in persons of draft age. Testing on experimental data with a cutoff threshold of 0.5001 showed that the accuracy of the prediction is 84.1%.

DISCUSSION. The biopsychosocial markers of PD included in the mathematical model for conscripts meet the criteria for PD and reflect persistent manifestations of social maladjustment. Among the variables specific to the conscript contingent that have the greatest influence on the outcome of the risk equation is the item “attitude toward military service”; the other markers correlate with the most common types of PD in conscripts (emotionally unstable, dependent, dissocial), as well as with data from the literature.

CONCLUSION. Thus, the identification of PD biopsychosocial markers allows to have the successful prediction of the likelihood of mental disorders from this group in individuals of draft age in 84.1% of cases. The information obtained can be used to improve the quality of PD diagnosis when examining individuals of draft age in a psychiatric hospital.

INTRODUCTION. Injuries sustained by employees of the internal affairs agencies (IAAs) of the Russian Federation remain a significant medical and social problem that directly affects their professional fitness, staff stability, and the amount of disability-related payments. According to a number of studies, occupational injuries in high-risk environments require systematic recording and analysis. However, the dynamics of changes in the consequences of injuries in the structure of military medical examinations (MME) at the federal level have not previously been studied retrospectively over a long period of time.

OBJECTIVE. Assess the level of injury, the structure of professional fitness, and the dynamics of its changes among employees of the internal affairs agencies of the Russian Federation based on official statistics from the military medical commissions of the Ministry of Internal Affairs for 2008–2024.

MATERIALS AND METHODS. The study uses summary statistical data at the federal level reflecting the results of medical examinations of injured law enforcement officers. A comprehensive retrospective analysis of annual MME reports for 17 years was conducted. Standardized indicators per 1,000 employees (‰), absolute risk (AR), relative risk (RR), odds ratio (OR), the proportion of injuries among unfit and limited-fit employees, as well as epidemiological significance coefficients were calculated. Descriptive statistics and dynamic analysis methods were used.

RESUTLS. During the observation period, there was a significant decrease in the overall injury rate from 7.095‰ in 2008 to 1.354‰ in 2024. The AR, RR, and OR indicators also decreased for employees with less than 20 years of service and who had not reached the age limit. The proportion of injured persons among all those recognized as unfit and limited fit for service decreased from 11.98% to 3.62%. Against the backdrop of a decrease in serious injuries, minor domestic and work-related injuries consistently dominated the structure of medical examinations, while the proportion of persons recognized as limited fit for service remains significant, especially in the group with up to 20 years of service.

DISCUSSION. The results obtained reflect a general trend toward a decrease in the medical and social burden associated with injuries among law enforcement officers. The dynamics are consistent with the literature, which emphasizes the role of systematic prevention, the development of medical and psychological support services, and the modernization of approaches to assessing professional suitability. At the same time, the continuing proportion of employees with limited fitness and unfitness, especially among junior staff, indicates the need for an in-depth analysis of the causes of chronic trauma consequences and the improvement of secondary prevention programs.

CONCLUSION. A retrospective analysis of summary statistics from the military medical commissions of the Russian Ministry of Internal Affairs for 2008–2024 demonstrated a steady decline in the level of injuries and their epidemiological significance. The data obtained can serve as a basis for improving the regulatory framework, preventive measures, and assessment of professional suitability of employees. The use of AR, RR, OR indicators and injury significance coefficients can be recommended for monitoring the effectiveness of measures in the medical care system of the Ministry of Internal Affairs.

OBJECTIVE. To determine the peculiarities of the severity of the victims’ condition with shockogenic traumas received in road traffic accidents (RTA) on federal, regional and local highways in the seaside region of the Arctic zone of the Arkhangelsk region.

MATERIALS AND METHODS. There was the analysis of medical documents of 71 victims of road accidents on the roads of the Arkhangelsk region who had received severe mechanical trauma accompanied by shock. The severity of the victims’ condition at admission to the trauma center was assessed according to the CAP-SP scale. Three categories of victims were distinguished: with severe combined injuries, polytraumas and extremely severe polytraumas. RESULTS. The severity of the victims’ condition who suffered shock trauma on a federal highway is higher than those injured on regional and local roads. Victims of federal highway accidents are more likely to suffer polytrauma and extremely severe polytrauma compared to those injured on regional and local roads. High severity shock is more common in victims injured on the federal highway than in victims injured on regional and local roads.

DISCUSSION. The most severe condition of the victims who received shockogenic trauma on the federal highway is probably related to the peculiarities of traffic on this road, which is caused by higher speed, higher load capacity, higher density of the vehicle flow compared to the regional and local roads.

CONCLUSION. The severity of the victims’ condition in road accidents and severe mechanical trauma accompanied by shock on federal, regional or local roads is related to the place of injury. The most severe condition of victims, which is manifested by clinical picture of polytrauma, including extremely severe, occurs on the federal highway. At the same time, shock of III-IV degree also occurs more often in victims of road traffic accidents on the federal highway. In order to provide timely emergency medical care to victims of road accidents on the federal highway, it is necessary to create mobile highway stations.

INTRODUCTION. The new coronavirus infection (NCI) COVID-19 has brought significant changes in the structure of morbidity and mortality of the whole mankind, especially it affected people of middle, old and elderly age, which is associated both with the peculiarities of age-related changes in the human body and onset of many comorbidities in patients of older age group. That is why timely vaccination and regular revaccination against NCI play a particularly important role in the course of the disease and prevention of complications in this category. Due to the inclusion of COVID-19 in the list of sea-sonal diseases, the abolition of mandatory revaccination against SARS-CoV-2 coronavirus is currently being discussed, but it should most likely remain mandatory for certain high-risk groups, including those over 50 years of age. In this study, we evaluated the impact of vaccination on the course of COVID-19 in patients exactly at this age, taking into account all the main indicators of the clinical course of the disease. Comparison of the results and determination of their statistical significance indicate that vaccination, indeed, reduces the risks of moderate and severe course, decreases the average duration of hospitalization and positively affects a number of indicators of the course of COVID-19 in people over 50 years of age.

OBJECTIVE. To evaluate the course of NСI in vaccinated and unvaccinated patients over 50 years of age.

MATERIALS AND METHODS. In the course of the study, a retrospective evaluation of the COVID-19 course in vaccinated and unvaccinated patients over 50 years of age was carried out. A homogeneous sample of 56 people (age median of both samples - 63 years, from 50 to 83 years) from the patients treated at the Clinic of Naval Therapy of the Kirov Military Medical Academy in the period from April 2020 to February 2021 was determined for the study. The total sample was divided into two subgroups: homogeneous according to the criterion of vaccine receipt. Thus, a group of vaccinated (group 1) of 27 people and unvaccinated (group 2) of 29 people was distinguished. The groups were compared according to the main significant indicators of the disease course, including period of hospitalization, main complaints, clinical and biochemical blood tests, results of instrumental investigations and treatment outcomes.

RESULTS. The data obtained in the course of the study indicate the ambiguity of the problem of the vaccination effect on the course of NCI in patients over 50 years of age, since at this age the disease inevitably enters the synergy with concomitant somatic pathology and general age-related changes. Despite this, statistically significant differences were found between the course of the disease in the studied groups, indicating a beneficial effect of vaccination on the rate of patients’ recovery from the infection and on its development in general.

CONCLUSION. Vaccination against NCI in people over 50 years of age facilitates recovery from the disease and reduces the risks of complications, making it essential for this age group. Making vaccination mandatory for people over 50 years of age will help reduce the burden on health care and the economic costs of medical support.

INTRODUCTION. In the context of modern threats and dangers, health remains one of the most important values of the population. Health is the basis of human potential, a guarantee of well-being and sustainable society development. Today, one of the most important problems is the search for ways and means of effective training of private first aid competencies. Problematic issues, despite the experience of SWE, are still simple human emotions: fear of blood and injuries, squeamishness of another person’s body, shyness, etc. The article describes the process of selecting the optimal method of teaching first aid and the basics of tactical medicine, based on an array of data after conducting classes in training groups with military cadets, students of St. Petersburg State University, workers and employees undergoing retraining and participating in various government programs of professional retraining. Various teaching methods were used during the classes, in the final part of which a written survey of each student, as well as teachers was conducted to determine the best, from their point of view, teaching method based on a person-centered approach. Using game theory methods, the approach to processing the results of the survey to find the most optimal method (ways, techniques) of teaching first aid and the basics of tactical medicine is shown.

OBJECTIVE. To investigate statistical results from a survey of class participants to select the optimal method of teaching first aid and basic tactical medicine.

MATERIALS AND METHODS. The chosen methodology is based on the creation of a model that allows processing the results of questionnaire by simplex method of game theory, considering the psychological characteristics of the personality of the teacher, learner, forms and resources of teaching. As a result, we obtained a mathematical model that allows us to determine the most optimal way of teaching, with regard to the psychological portrait of the group of students and the personal characteristics of the teacher.

RESUTLS. With the help of the developed model, it is possible to assess the influence degree of the forms of classes offered on the learner’s choice of how to obtain the required private competencies.

DISCUSSION. The proposed model for selecting the optimal method of teaching first aid and basic tactical medicine allows to add private probabilistic characteristics of teams of trainees beyond the constraints and assumptions given below.

CONCLUSION. The considered mathematical model allows to choose a teaching method that takes into account the psychological characteristics of the student and the teacher, as well as the resources spent on the implementation of each lesson type.

OBJECTIVE. Compare the psychophysiological parameters of nurses in military medical institutions under normal conditions and during the COVID-19 pandemic.

MATERIALS AND METHODS. The object of the study is the working capacity of medical nurses with a therapeutic profile in military medical institutions belonging to the Saratov garrison’s area of responsibility. A total of 200 people were examined. The study included specialists with secondary or higher medical education who worked in inpatient military medical institutions in Saratov and the Saratov region. All nurses were divided into two groups of 100 people. The first group (group A) included nurses who worked under normal conditions without exposure to extreme factors, while the second group (group B) included nurses who worked under extreme conditions caused by the new COVID-19 coronavirus infection. The participants’ main psychophysiological parameters were examined.

RESULTS. The study found that increased stress caused by the intensity of work during the COVID-19 pandemic leads to changes in key psychophysiological parameters. The severity of these changes depends on age group: they have the least impact on young people and the greatest impact on the elderly, which may affect the nurses’ health.

DISCUSSION. Thus, the study shows that during the pandemic caused by the new coronavirus infection COVID-19, there is an increased psychophysiological load on nurses in military medical institutions. At the same time, there is not enough time allocated for rest between shifts during periods of increased stress, and the body does not have time to recover, which undoubtedly affects both physical and psychological health. The resulting overload leads to the accelerated development of emotional burnout, which also reduces the performance of nurses.

COLCUSION. Studies show that the stress and intensity of work experienced by nurses in military medical organizations undoubtedly affect their psychophysiological parameters. These parameters change significantly under conditions of increased stress caused by the extreme circumstances of working during the COVID-19 pandemic.

INTRODUCTION. Leukocytes provide resistance, leukocyte indices allow analysis of the body’s adaptive capabilities. OBJECTIVE. To assess the body’s reactions in working people in the Arctic zone of Russia based on blood leukocyte count indicators for different lengths of professional activity.

MATERIALS AND METHODS. The leukocyte formulas of blood were analyzed in military personnel with up to 5 and up to 10 years of service in the Arctic (n = 51) and Subarctic (n = 60). Leukocyte indices were calculated. The characteristics of everyday life and the ecological and hygienic conditions of living in the Subarctic were assessed.

RESULTS. Leukocytes, except for band neutrophils, were normal. In the subarctic, the number of leukocytes was 1.19– 1.31 times lower (p = 0.001), the proportion of segmented neutrophils was 1.19–1.2 times higher (p = 0.01); and monocytes exceeded normal limits by 11.1–12.7%. Leukocyte indices in groups living in the Arctic zone for up to 5 years showed differences in 5 out of 8 calculated indices, and for up to 10 years — in 7 indices. In studies up to 5 years, there were no signs of inflammation, normal immunoreactivity, sufficient reserves for adaptation, high level of immune protection, balanced immune system, high reactivity, adaptive immunity, and phagocytic activity of cells; in the Subarctic, there was an immediate hypersensitivity reaction. During work lasting up to 10 years in the Arctic, a negative effect on the humoral and cellular components of immunity and phagocytic activity of cells was revealed, as well as an increase in the body’s adaptability to conditions; in the Subarctic, there was a decrease in immunoresistance and immune protection of the body.

DISCUSSION. A negative impact of work in the North on lymphocytes has been established, with working conditions playing a more significant role than the duration of work. Our data differ from these results: we have established a multifactorial impact, determined by the type of work, its duration, environmental and hygienic conditions, and, possibly, nutrition.

CONCLUSION. Harmful mental and physical labor in the Arctic had a negative impact on the humoral and cellular components of immunity, but contributed to an increase in the body’s adaptability. Harmful mental labor in the Subarctic, with an increase in its duration, reduced the body’s adaptive capabilities and nonspecific resistance.

INTRODUCTION. Maritime terrorism poses a multi-level threat, affecting not only international security but also the healthcare system and the units responsible for dealing with the aftermath of terrorist acts. Despite the existence of isolated studies, there is no comprehensive scientific picture based on statistical data on the methods, means, and targets of maritime terrorist attacks.

OBJECTIVE. Identify structural features and dynamic patterns of maritime terrorist acts in terms of methods, means, and targets, as well as assess irreparable and sanitary losses, followed by a discussion of predictive models up to 2030.

MATERIALS AND METHODS. The study was conducted using data from the Global Terrorism Database (GTD), which includes 209,707 terrorist acts (1970–2020). Using text analysis with keywords, 69,772 events potentially related to the marine environment were selected. Frequency analysis, normalization, dynamic series construction, and visualization methods were used for the analysis. The results were aggregated by the number of people killed and injured and classified by the method, means, and target of the attack.

RESULTS. The highest number of injuries (34.5%) and deaths (31.1%) are associated with attacks on private individuals. Explosions are the most common method (68.9% of those injured, 47.6% of those killed), with the use of explosives being the most common means. The key targets are military facilities, police, and government officials. The dynamics show a peak in activity in 2014–2016, followed by a decline.

DISCUSSION. The results obtained confirm the hypothesis about the targeted nature of maritime terrorism directed against infrastructure and politically significant objects. The methodological novelty lies in combining structural and dynamic analysis with the use of universal approaches to visualization and maintaining the accuracy of data representation.

CONCLUSION. The proposed approach not only allows identifying the characteristic features of maritime terrorist acts, but also provides a practical basis for planning preventive measures, medical response, and updating the regulatory framework in the field of maritime security.

INTRODUCTION. The demand for lower limb prostheses is growing every year, and improving the technological processes involved in their manufacture is an important technical challenge that could solve the medical and social problem of providing prosthetic and orthopedic devices to those in need.

OBJECTIVE. Develop the architecture of a neural network model for processing 3D scans of limb stumps for the digital automated design of individual prosthetic socket shells for the lower leg using artificial intelligence (AI) technologies.

MATERIALS AND METHODS. 3D scans of lower leg stumps and the inner surfaces of prosthetic sockets. Software for analyzing and processing data using neural networks. Python programming language (Netherlands, Opensource) and MeshLab modeling environment (Italy, Opensource). Identification of key features and creation of a dataset for the design of individual lower leg prosthesis modules. Development of a neural network model architecture for the digital automated design of individual lower leg prosthesis sockets based on a scan of the patient’s stump and prediction of load and unload areas when using the prosthesis.

RESULTS. The architecture of a neural network model for processing 3D scans of stumps has been developed for the digital automated design of prosthetic lower leg socket receptacles. Data sets have been formed, including 3D scans of stumps and characteristics of the inner surfaces of sleeves. The prototype system allows predicting areas of load and unload inside the sleeve, taking into account the individual characteristics of the patient, based on a three-dimensional scan of their amputated limb.

DISCUSSION. The use of artificial intelligence (AI) technologies for processing 3D scans of the stump offers significant advantages: reduction in the manufacturing time of individual modules (receiving sleeves) for prosthetic limbs without compromising quality; automation of manual labor, reduction of human error, and increased accuracy in the design of prosthetic sockets; increased efficiency in providing prosthetic limbs to people with disabilities and ensuring comfort when using the product. However, the implementation of such systems requires further research, including model validation on a large volume of data and integration with existing technological processes.

CONCLUSION. The developed architecture of the neural network model for processing 3D scans of stumps significantly reduces the duration of the design process for individual prosthetic socket designs without compromising quality. The use of artificial neural networks accelerates manufacturing and reduces human error. The implementation of the developed model contributes to improving the quality of life of people with amputations, as well as the effectiveness of rehabilitation and prosthetic-orthopedic measures and services.

OBJECTIVE. Justification for the need to create a unified register of medical organizations for conducting preliminary and periodic medical examinations of water transport workers in the context of ensuring transport safety and compliance with international standards.

MATERIALS AND METHODS. An analysis was conducted of the current Russian and foreign regulatory framework and systemic problems in conducting preliminary and periodic medical examinations of water transport workers in the Russian Federation. The functions and powers of the FMBA of Russia and the newly created National Center for the Health Protection of Seafarers and Divers were examined. Approaches for including medical organizations in the register were proposed.

RESULTS. Systemic problems have been identified in the existing medical examination system: insufficient standardization of requirements for medical organizations, fragmented data, and poor quality of implementation. The key role of preliminary and periodic medical examinations as elements of transport safety affecting the health of crew, passengers, the safety of ships, cargo, and the environment is noted. The relevance of creating a register to solve these problems and achieving the goals of the Transport Strategy and Maritime Doctrine of the Russian Federation is justified.

DISCUSSION. It has been proposed that the registry operator should be the National Center for the Protection of Seafarers’ and Divers’ Health, established by the FMBA of Russia, which has already implemented an effective model of a departmental registry that can be scaled up to the federal level. The main criteria for including medical organizations in the registry have been defined: specialization in providing services in the field of maritime medicine, the availability of appropriately qualified medical personnel and material and technical resources, document management and reporting systems, internal quality control, the ability to provide medical services in a timely manner, and compliance with ethical and legal aspects. The need for active participation of seafarers’ professional unions in quality control of registered organizations’ services and conflict resolution is justified. The risks of bureaucratization are noted, but the positive experience of centralized systems (basin hospitals) and the strategic importance of the register for the restoration of the maritime medicine system in accordance with the concept of its development until 2030 are emphasized.

CONCLUSION. The creation of a centralized register of medical organizations for the examination of water transport workers is a strategically important and urgent task, the solution of which will contribute to improving the quality of medical examinations, compliance with international requirements, strengthening transport safety in water transport, and digitizing the medical support system for maritime activities.

INTRODUCTION. Armed conflict has a serious impact on the mental health of combatants. Cognitive and sensorimotor impairments in this patient group are being studied because they significantly affect combat effectiveness. The study opens up new opportunities for understanding the pathophysiological mechanisms of mental disorders, developing objective diagnostic criteria, and creating personalized approaches to therapy.

OBJECTIVE. To study the peculiarities of the functioning of individual cognitive and sensorimotor systems in combatants with combat-related mental disorders.

MATERIALS AND METHODS. The study involved 94 male military personnel divided into two groups: a group with combat-related mental disorders (CRMD) (n=53) and a comparison group (n=41) of healthy military personnel. Validated psychometric scales were used for additional diagnosis of the severity of mental disorder symptoms: the Hospital Anxiety and Depression Scale (HADS), the subjective Asthenia Rating Scale (MFI), which includes subscales for general asthenia, decreased activity, decreased motivation, and physical and mental asthenia; the Clinical Assessment of Posttraumatic Stress Disorder Scale (CAPS), the Hamilton Anxiety Rating Scale (HAMA), and the Impact of Event Scale-Revised (IES-R). To identify neurophysiological correlates of sensorimotor and cognitive functions, the Dexterity and Pursuit Rotor techniques were used, presented using the Psychology Experiment Building Language (PEBL version 2.0) software. The functional state of the central nervous system was assessed using the Encephalan-NEXT hardware and software complex. The data were processed using StatSoft Statistica 12.0 software. The Mann-Whitney U test was used to determine intergroup and intragroup differences, with differences considered statistically significant at p<0.05. Correlations were calculated using Spearman’s criterion.

RESULTS. An analysis of cognitive-motor functions in individuals with combat-related mental disorders (CRMD) revealed complex impairments in higher mental functions, including motor dysfunction and reduced learning ability. The data obtained confirm the hypothesis of impaired movement accuracy and cognitive control of motor activity in the study group. The analysis of the results of the Dexterity test showed that subjects with CRMD took significantly longer to complete the task than the control group, indicating a marked decrease in the speed of sensorimotor reactions. In addition, the CRMD group showed a statistically significant increase in the number of corrective movements relative to the control indicators, reflecting impairments in the accuracy of motor acts. Correlation analysis showed that the test time and the number of corrective movements were directly related to the severity of reduced activity on the subjective asthenia assessment scale (MFI), impaired movement accuracy was associated with physical asthenia on the same scale, as well as with symptoms of increased excitability on the CAPS scale and the severity of anxiety symptoms on the Hamilton Anxiety Scale.

DISCUSSION. Research shows that the normal functioning of sensorimotor systems and cognitive control is ensured by the complex interaction of cortical and subcortical structures. In particular, the initiation of movements depends on the activity of the supplementary motor area (SMA) and the pre-SMA zone, while their inhibition is regulated by the right inferior frontal gyrus (rIFG) and the subthalamic nucleus (STN) via the “hyperdirect” pathway of the basal ganglia. Cognitive aspects of control, including suppression of unwanted responses and monitoring of action effectiveness, are performed by the anterior cingulate cortex (ACC) and dorsomedial prefrontal cortex (dlPFC). In patients with BPR, the identified impairments in movement accuracy and reduced learning ability may be associated with dysfunction of these neural networks. In particular, deficits in inhibitory control may reflect disturbances in the functioning of the rIFG and STN, while difficulties in learning motor skills may reflect possible dysfunction of the SMA and associated basal ganglia. Neurochemical imbalances, particularly in the GABAergic and noradrenergic systems, may also contribute to the observed impairments, explaining both motor and cognitive deficits. Individuals with combat-related mental disorders spent significantly more time on the tests than healthy individuals and also performed a greater number of both target and corrective movements. The data obtained on the decrease in motor coordination in patients with CRMD are consistent with the results of previous studies, where similar disorders were explained by dysfunction of the prefrontal cortex and amygdala. It can be assumed that the impairments in motor tests identified in the CRMD group are associated not only with psychological factors (e.g., increased anxiety) but also with neurobiological changes affecting cortical-subcortical interactions.

CONCLUSION. Individuals with combat-related mental disorders (CRMD) have been found to have reduced movement accuracy and slowed sensorimotor reactions associated with increased fatigue and reduced cognitive control over movements, which is critically important for survival in combat conditions. The objective markers identified allow the use of the Pursuit Rotor (assessment of visual-motor coordination) and Dexterity (testing of agility and reaction speed) methods in the comprehensive diagnosis of combat mental disorders, and also indicate new targets for the development of medical and psychological rehabilitation measures.

INTRODUCTION. In modern conditions, one of the pressing issues in flight crew training is assessing the level of professional preparedness of future flight specialists given existing resource constraints. When solving practical problems related to assessing the success of flight training, one has to deal with a large number of criteria for evaluating training success. There is a need to identify the leading criterion for the success of pilot training.

OBJECTIVE. Justify the relevance and significance of the proposed method of expert assessments as a component of professionally significant qualities of future flight specialists, aimed at identifying problem areas in the process of flight and students’ simulator training.

MATERIALS AND METHODS. The study analyzed data from 2,363 people studying aviation specialties in their third and fourth years. The experts were specialists with 20-35 years of flight and teaching experience who provide flight and simulator training. There were 70 experts participating in the study. Expert assessments of training success were based on evaluations of professionally important qualities that ensure successful completion of simulator and flight training, developed on the basis of professional profiles for specialties and compiled by expert groups.

RESULTS. In the group of the best students, expert assessments increase by the fourth year. In the group with average performance, it was found that some of the expert assessment indicators increase, but some indicators decrease. In the group of the worst performers in the 4th year, expert assessments of learning indicators do not change. Identifying changes in the dynamics of expert assessments of trainees allows us to identify problems in the mastery of ground training and flight programs among trainees.

DISCUSSION. An analysis of descriptive statistics on the success of flight training showed that fourth-year students had higher scores than the average external criterion score for third-year students. The training process also revealed an increase in the importance of qualities related to preparation for simulator and flight activities. This, in turn, reflects the specifics of training in each of the courses and allows for a comprehensive assessment of the level of flight skills development. Accordingly, in the 4th year, there is a higher level of development of pilot’s professionally important qualities and the formation of flight skills.

CONCLUSION. The proposed approach allows expert assessments to be used as a generalized indicator that solves the following tasks: assessing the quality of professional training of flight specialists during flight and simulator training; identifying problems in students’ mastery of ground training and flight programs; determining factors that influence student assessments; forecasting and correcting the success of the training program based on the results obtained.

The article considers a clinical case of planned specialized medical care of a patient with complete rupture of the calcaneal tendon, obtained as a result of trauma during the performance of assigned tasks in navigation on a surface ship. The surgical intervention was performed under conductive anesthesia of the femoral and sciatic nerves under ultrasound navigation, which makes anesthesia support of surgical operations not only safer, but also the preferred method of analgesia in conditions of sea excitement and rockiness.