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Objective: To present a case of reconstruction of a full-thickness lower eyelid defect.Case report: Male patient Y. aged 71 years was admitted to the Scientific Research Institute – Ochapovsky Regional Clinical Hospital No. 1 (Krasnodar, Russian Federation) with the diagnosis: cancer of skin of the lateral canthus of the left eye, T1N0M0, stage I, clinical group II. According to the medical history, the neoplasm was self-detected 5 years ago. Histology findings revealed micronodular basal cell carcinoma.After a general clinical examination, the patient underwent surgery to remove the neoplasm of the lower eyelid skin and lateral canthus and reconstruct the defect using a lateral infraorbital fat pad flap, local tissues, and a free autologous cartilage graft. The configuration of the soft tissues of the eyelid was restored. Soft tissue edema was not observed. The functional state of the lacrimal apparatus was fully preserved. The esthetics of the soft tissue was rehabilitated.Conclusions: Reconstruction in such esthetically significant area as the middle third of the face is associated with special requirements for graft formation and positioning. A gentle and functionally justified method for restoring the parameters of the tarsal plate, conjunctival sac, and lower eyelid skin ensures complete rehabilitation of patients and improves their quality of life.

Calcification of the lower extremities arteries is an unfavorable factor for vascular surgery. Extensive lesions of the femoral segment are an indication for femoropopliteal bypass surgery. Calcification of the femoral arteries complicates the construction of a proximal anastomosis because it precludes clamping the arteries. In addition to technical difficulties in the construction of an anastomosis, significant calcification increases the risks of bleeding and embolic complications and the duration of surgery. In cases of total calcification of the femoral and iliac arteries, balloon occlusion during the construction of an anastomosis makes it possible to occlude the arteries without clamping, which reduces the risks of perioperative complications. We report a case of femoropopliteal bypass surgery in a patient with total calcification of the iliofemoral segment and occlusion of the superficial femoral artery.

Background: One-lung ventilation is used to improve surgical visualization and facilitate thoracoscopic manipulations; however, it induces ventilation/perfusion mismatch, exacerbating the inflammatory response that causes hypoxemia in the perioperative period. Opioid analgesics are the main analgesic drugs used during video-assisted thoracoscopic surgery (VATS), but their use is associated with adverse effects and higher risk of respiratory complications. Corrective measures to eliminate hypoxemia, reduce the inflammatory response, control pain, and minimize opioid-induced adverse effects are crucial in thoracic surgery.Objective: To study the efficacy of dexmedetomidine in reducing lung damage and postoperative complications after VATS.Materials and methods: We examined 100 patients who underwent lobectomy via a thoracoscopic approach. The patients were grouped based on anesthetic management: group 1 (n = 50) with intraoperative dexmedetomidine and group 2 (n = 50) without it. We determined the level of pro-inflammatory cytokines IL-6, IL-8, and TNF and calculated PaO2/FiO2 and A-aDO2. We also assessed the postoperative pain intensity, need for trimeperidin promedol and tramadol, and incidence of postoperative complications.Results: During one-lung ventilation, patients from group 1 had higher PaO2/FiO2 values (P = .025). The A-aDO2 value was higher in group 2 (P = .006). After surgery, we found differences in the content of TNF and IL-8 (P < .001). Twenty-four hours after surgery, we recorded a more significant prevalence of the studied cytokines in group 2 (P < .001). There were no significant differences in the pain dynamics on the first postoperative day (P > .05). Opioid analgesics were less needed in group 1 than in group 2 (P < .001). The incidence of postoperative complications did not differ significantly.Conclusions: Dexmedetomidine in thoracic surgery improves the oxygenation and reduces the percentage of intrapulmonary shunting by inhibiting the release of pro-inflammatory cytokines. In the postoperative period, dexmedetomidine reduces the need for opioid analgesics, but does not affect the pain level or incidence of complications.

Introduction: The main disadvantage of bioprosthetic valves is the susceptibility of their leaflets to structural changes, leading to bioprosthetic valve dysfunction requiring a repeated surgical intervention. This group of patients is characterized by high comorbidity, which increases the risk of hospital mortality during repeated interventions. At the same time, low left ventricular ejection fraction (LVEF) is the main independent predictor of adverse outcomes. Transcatheter valve-in-valve implantation can be an alternative to an open intervention in patients with high surgical risk. However, this technique is often associated with prosthesis-patient mismatch due to a smaller effective orifice area of a bioprosthetic valve, as well as with the high incidence of intraventricular conduction disorders and/or the need for a pacemaker, preventing the LVEF recovery even in the late period after the procedure.Objective: To demonstrate the role of transluminal balloon valvuloplasty in staged surgical treatment of bioprosthetic aortic valve dysfunction. Case report: We present our experience of successful staged surgical treatment of biodegenerative dysfunction of a biological prosthetic aortic valve using balloon valvuloplasty followed by “open” repeated valve replacement in a patient at very high cardiovascular risk.Conclusions: This staged approach may be justified in patients with extremely low LVEF to minimize risks and improve surgical outcomes.

Objective: To demonstrate the effectiveness of a supraciliary approach in zygomaticomaxillary complex fractures treatment.Case report: Patient A. (33-year-old man) was admitted to the Scientific Research Institute – Ochapovsky Regional Clinical Hospital No. 1 (Krasnodar, Russian Federation) with a diagnosis of traumatic fractures of the right and left zygomaticomaxillary complexes. According to the medical history, the injury was caused by a car accident. The patient underwent computed tomography of the facial skeleton. Computed tomography findings: fractures of lateral and medial orbital walls, supraorbital and infraorbital rims, glabella, and nasal septum. The patient underwent repositioning of the bone fragments and internal fixation with metal implants. The glabella fracture was reduced through a supraciliary approach. The function of the mimic muscles was fully preserved. The configuration of the face and soft tissues was restored. No soft tissue edema was observed. The postoperative scar is visualized after the unfolding of the orbito-palpebral fold of the upper eyelid.Conclusions: The systematic use of esthetic approaches by surgeons completely changes the rooted traditional way of managing patients with various maxillofacial pathologies. In addition to outstanding esthetic results, it increases the surgeons’ expertise level and the range of tasks a comprehensively developed specialist is capable of dealing with. One of the most crucial aspects is improvement of patients’ quality of life.

Background: Patients with gastric cancer (GC) are at high risk of nutrient deficiencies (ND) that can negatively affect the postoperative period and long-term treatment outcomes.Objective: To assess the nutritional status (NS) and skeletal muscle condition in patients with resectable stage I-III GC.Materials and methods: Our study included 102 GC patients: 64 men (62.7%) and 38 women (37.3%) aged 31 to 77 years. During the assessment we used the NRS-2002 system, determined laboratory markers of the NS, calculated the Nutritional Risk Index (NRI), and evaluated the condition of adipose tissue and skeletal muscles using computed tomography.Results: We found that 70.6% of the patients had ND: NRS-2002 score < 3 points (52%) and NRS-2002 score ≥ 3 points (18.6%). Risk factors for ND were tumor localization in the cardia and stage III GC. Laboratory markers of ND were transferrin and NRI. Among the examined patients (n = 80) sarcopenia was detected in 10 (12.5%) patients: 1 patient (1/25; 4.0%) from the group without ND, 6 patients (6/42; 14.3%) from the group with NRS-2002 score < 3 points, and 3 patients (3/13; 23.1%) from the group with NRS2002 score ≥ 3 points, (P = .212). In multivariate logistic regression analysis, independent factors associated with sarcopenia were age, body mass index, and total protein.Conclusions: All GC patients selected for radical surgery should undergo nutritional assessment using special tools (NRS-2002, NRI) and evaluation of the skeletal muscle condition. Sarcopenia may occur in patients with no clinical or laboratory evidence of ND. In GC patients at nutritional risk, preand postoperative nutritional support should be considered to reduce the ND-related risks.

Introduction: Lung cancer is one of the most common cancers in the world. Approximately 40% of all metastases make up brain metastases that occur in 3% of patients at early stages of lung cancer. Early diagnosis of brain metastases directly affects patients’ survival and quality of life.Objective: To study the role of contrast-­enhanced magnetic resonance imaging (MRI) in detecting brain metastases at the outpatient stage in patients with newly diagnosed and histologically confirmed lung cancer and to compare the findings to that of computed tomography (CT).Materials and methods: Our study was conducted at the premises of the Scientific Research Institute – Ochapovsky Regional Clinical Hospital No. 1 (Krasnodar, Russian Federation) between November 2022 and January 2023. Seventy­five patients with histologically confirmed lung cancer underwent brain MRI on a Philips Panorama 1.0T MRI scanner and intravenous administration of Clariscan to detect metastatic lesions. As a diagnostic method, we used a “short” scanning protocol in T1­-WI (TR: 450, TE: 15, slice thickness 5 mm), T2­-WI (TR: 4533, TE: 100, slice thickness 5 mm) and DWI (TR: 3712, TE: 97, slice thickness 5 mm) modes in the axial plane, then the Clariscan contrast agent was injected intravenously at the rate of 0.2 ml per 1 kg of the patient's weight, after which the scan was repeated using 3D T1 (TR: 450, TE: 15, slice thickness 1 mm).Results: The average age of the patients was 60 years. The majority of the participants were male. Of all the patients, the majority had central lung cancer (57.3%). During contrast-­enhanced brain MRI, brain metastases that accumulated a contrast agent in 100% of cases were detected in 30 patients (40%) of the total number of patients. In 7% of the patients, there were non-­metastatic findings undetected by prior contrast­-enhanced CT, such as pontine cavernoma and venous malformations. After MRI for brain metastases, management strategies changed in 30 (40%) patients.Discussion: Contrast-­enhanced MRI is one of the most effective methods for diagnosing metastatic lesions. It allows to localize brain metastases and helps the clinician choose the most effective management strategy. The introduction of contrast­-enhanced brain MRI into routine medical practice could improve the accuracy and quality of brain metastasis detection in patients with lung cancer.

Introduction: The article discusses formation and development of the Kuban school of thought in thoracic surgery. We reviewed the main aspects of the accumulation of knowledge and experience in thoracic surgery and formation of a scientific association of thoracic surgeons that further developed into a school of thought first regionally, then internationally.Objective: To analyze the main stages of the development of the Kuban school of thought in thoracic surgery through the prism of scholars who made major contributions to the formation of the school’s research concept, as well as through succession (transfer of scientific and medical experience).Materials and methods: Our methodology involved a comparative historical analysis of the most important stages of the development of the school of thought in thoracic surgery, a retrospective evaluation of the contributions made by the surgeons who transformed the surgical community, and a comprehensive analysis of research materials on this subject. We used retrospective, biographical, analytical, and comparative research methods.Results: We identified the fundamental trends in the development of the Kuban school of thought in thoracic surgery, key directions for improving the methods of chest pathology diagnosis and surgical treatment that have been forming in the Kuban over the past 100 years.The education and training of staff, as well as formation of a scientific medical community and its international integration clearly demonstrated the transformation dynamics of the Krasnodar Krai’s research potential in thoracic surgery.

Introduction. Bronchial fistula often occurs after lung surgery. This is an extremely severe complication with high mortality. Despite the variety methods for the treatment of bronchial fistula, the results are not always effective. In our paper, we presented a method of preventing the development of bronchial fistula based on the cell therapy. The objective of the study was to evaluate the effects of the cell therapy on the regeneration of damaged bronchial tissue in an experiment on non-human primates. Methods and materials. The study was performed on 6 non-human primates. Laboratory animals were divided into 2 groups: experimental and control. The left pneumonectomy with the formation of a stump of the main bronchus was done in each primate. In the experimental group, a regenerative product was introduced into the stump; in the control group, 0.9 % NaCl solution was used. The regenerative product consisted of autologous platelet-rich plasma activated by thermal lysis and the suspension of the xenogeneic fibroblast’s culture. The primates were observed for 7, 14 and 21 days, the peripheral blood was taken to study the dynamics of biologically active substances. A histological examination of the autopsy material was performed at the end of the follow-up time. Results. On the early postoperative period, a typical inflammatory reaction was observed and resulted by the intraoperative tissue damage. Then the morphological changes were different in both group. The inflammatory were mild, the restoration of the natural function of the mucous membrane and the formation of scar tissue were earlier in the experimental group than in the control group. An analysis of the dynamics of plasma mediators in the postoperative period revealed an earlier dominance of regenerative processes in the experimental group. Conclusion. The results of the study showed that the cell therapy stimulates the tissue regeneration, thereby preventing the failure of the bronchial stump suture.

Fistulas of various etiologies are one of the severe and life-threatening diseases of the upper respiratory tract. The most common cause is bronchial stump failure after pulmonary resection, usually pneumonectomy. The incidence and mortality of this complication is 3 %-4 % and 12.5 %-71.2 %, respectively. Despite the fact that many devices and methods have been described to date, it is usually treated with surgical closure. Standard surgical approaches are associated with significant morbidity and mortality and are not reliably successful. In recent years, cell therapies aimed to stimulate tissue healing rose to prominence and can be considered a potential treatment method. We review current trends in bronchopleural fistula treatment using cell therapy and report cases of the bronchopleural fistula treatment according to the research protocol developed in our clinic. Although clinical experience is quite limited owing to a small number of patients in the most studies, the information on safety and tolerance can help plan future larger trials with innovative methods to further improve clinical results.

Objective: To describe an improved technique for dilatational tracheostomy. Clinical case: We report a case of severe community-acquired polysegmental viral pneumonia, grade 2 respiratory failure. After the start of antiviral therapy and staged respiratory support, the female patient was placed on mechanical ventilation 12 hours following hospital admission due to an increasing systemic inflammatory response and cytokine storm. In 20 hours, a dilatational tracheostomy using a modified technique was performed. Advantages of the modified technique are low trauma, short duration (5-10 minutes), significantly rarer wound infection (important benefit due to the COVID-19 features), significantly rarer postoperative scarring and cicatricial stenosis of the trachea. Technical improvement of dilatational tracheostomy allows for optimal management of critically ill patients (multiple organ failure, severe sepsis, considerable total body surface area burns with concomitant inhalation injury), which will significantly increase treatment efficiency, reduce the number of complications, and speed up the hospital discharge.

Background: Computed tomography angiography (CTA) is the primary and minimally invasive imaging modality currently used for diagnosis and monitoring of intracranial aneurysms as well as preoperative planning of their treatment. However, its interpretation is time-consuming even for specially trained neuroradiologists. Nowadays little is known whether trained neural networks contribute to analyzing medical images and reduce the time to diagnosis, and how effective they are in detecting intracranial aneurysms according to the CTA findings.Objective: To assess the diagnostic value of a convolutional neural network prototype in the intracranial aneurysm detection according to the brachiocephalic arteries CTA findings.Materials and methods: We analyzed the 3D convolutional neural network prototype based at Kuban State University (Krasnodar, Russian Federation).This prototype was to determine the probability of intracranial aneurysms according to the brachiocephalic arteries CTA findings, obtained in the Radiology Department of Scientific Research Institute – Ochapovsky Regional Clinical Hospital No. 1. The study included 451 CTA scans of 205 patients with confirmed intracranial aneurysms and 246 patients without aneurysms.Results: The sensitivity of the 3D convolutional neural network prototype in the aneurysms detection according to the brachiocephalic arteries CTA findings was 85.1%, the specificity was 95.1%, and the overall accuracy was 91%.Conclusions: The 3D convolutional systems may predict aneurysms with a high accuracy as well as localize them with an accuracy of more than 90%. Such results require a larger dataset.

Introduction: Computed tomography (CT) and CT angiography are standard imaging modalities for suspected acute intracerebral hemorrhage due to ruptured intracranial aneurysms. In this clinical setting, several protocols of computed tomography and CT angiography may be implemented. The standard CT angiography protocol is limited to intracranial vessels. The extended protocol may also include carotid and vertebral arteries and the aortic arch.Objective: To define the CT angiography role in detection of extracranial carotid and vertebral artery disease and clinical significance of this method for patients with suspected acute intracerebral hemorrhages due to ruptured intracranial aneurysms.Materials and methods: The study included 275 neurosurgical patients with acute nontraumatic intracranial hemorrhages due to ruptured intracranial aneurysms who were treated in Scientific Research Institute – Ochapovsky Regional Clinical Hospital No. 1 (Krasnodar, Russian Federation) from September 2017 to August 2020. Computed tomography and CT angiography were performed in all patients. The scanned area included both intracranial and extracranial arteries (an arch-to-vertex angiogram) to detect extracranial carotid and vertebral artery diseases such as stenoses, occlusions, tortuosity, and hypoplasia.Results: Atherosclerosis of internal carotid and vertebral arteries was diagnosed in 95 patients (34.5% of the total number of patients included in the study). In 13 (4.7%) patients these stenoses were hemodynamically significant. We identified a high frequency of tortuous carotid and vertebral arteries (122 cases, 44.3%) and vertebral artery hypoplasia (59 cases, 21.5%). The carotid and vertebral artery stenoses and congenital anomalies of vertebral arteries (however, not of carotid arteries) were associated with a higher incidence of unfavorable outcomes after endovascular treatment of intracranial aneurysms.Conclusions: The optimal CT angiography protocol for acute nontraumatic intracranial hemorrhage should focus on the arteries of the head and neck (up to the aortic arch). This protocol shows higher detection rate of concomitant anomalies of carotid and vertebral arteries. These findings are important for planning and successful performance of endovascular treatment for intracranial aneurysms.

Abstract Background Gastropleural fistula is an exceptionally rare condition, the incidence of which is currently unknown (Kunieda et al. in Intern Med 51(3):331, 2012, https://doi.org/10.2169/internalmedicine.51.6823 , Iqbal et al. in Cureus 11(2):e4136, 2019, https://doi.org/10.7759/cureus.4136 , Kathayanatt et al. in Lung India 37(2):174–175, 2020, https://doi.org/10.4103/lungindia.lungindia_242_17 ). The etiology varies from traumatic or iatrogenic injury to perforation in a herniated stomach due to ischemia, ulceration, or malignancy. Case presentation A 27-year-old European male presented to our hospital with complaints of general weakness and shortness of breath. The patient had a single episode of hemoptysis before admission. A computed tomography scan demonstrated a left-sided pyopneumothorax, a defect in the left main bronchus, and signs of pneumonia in the lower sections of the right lung. Therefore, a rare complication of perforation of a gastric fundus ulcer with the formation of a subdiaphragmatic abscess, gastropleural fistula, gangrene of the left lung with circular necrosis of the left main bronchus and diastasis of its edges, and pleural empyema on the left is presented in this report. Conclusions Although, a radical surgery may be preferable for this suspected malignancy; it should be weighed carefully against the risk of sepsis and the morbidity associated with a prolonged procedure in a sick patient. Damage-control surgery may be a viable option for a very sick patient, with more extensive resection reserved for later, provided the risk of infection and bleeding has been mitigated.

Background: Today protective ventilation is the predominant ventilation methodology. It includes the use of low tidal volume, inspiratory pressure limitation, and the application of positive end-expiratory pressure. However, several retrospective studies have shown that tidal volume, inspiratory pressure, and Positive End-Expiratory Pressure (PEEP) are not associated with patients’ treatment outcomes, but could be associated only when they influence driving pressure.Objective: Optimization of the strategy of protective one-lung ventilation under the control of driving pressure, to reduce early postoperative respiratory complications in patients operated for lung cancer.Material and methods: A prospective controlled study was conducted on 110 patients undergoing extended anatomical lung resections with subsequent comparison of clinical results depending on the level of driving pressure during one-lung ventilation. Postoperative pulmonary complications based on the Melbourne scale that appeared within 3 days after surgery became the endpoint.Results: A correlation was established between the level of driving pressure and the level of PaO2 in the intraoperative period – high inverse (r = – 0.901). The greatest value in the development of postoperative respiratory failure is driving pressure, exceeding 15 cm of water (Odds ratio = 18.25). In the first 3 days, postoperative pulmonary complications, determined by the Melbourne group scale, occurred in 9 (8.2%) patients in whom the driving pressure exceeded 15 cm of water, and in 3 patients (2.7%) with a driving pressure level less than 15 cm of water (p = 0.016).Conclusion: Driving pressure excess with values of more than 15 cm of water significantly increases the incidence of postoperative pulmonary complications. Fixed PEEP will be inappropriate both high and low, and individualized PEEP titrated by CStat may reduce driving pressure and become the next step in protective one-lung ventilation.

Currently, there are limited data supporting the use of parathyroid hormone-related protein for the purposes of breast cancer detection and disease prognosis. This literature review covers research results on diagnostic potential of parathyroid hormone-related protein as a biomarker for breast cancer, as well as the information available in the scientific literature, reflecting obvious contradictions regarding clinical and prognostic importance of this protein in the primary breast cancer, correlation of its expression with the risk of bone metastasis and survival of patients. Results of preclinical and clinical research show, that parathyroid hormone-related protein inhibits tumor progression and decreases its metastasis at early stages of the disease, which improves the survival rate, but it has an opposite effect at the advanced stages of cancer, as it increases tumor development and metastasis, and reduces survival rates. Altogether, these studies prove an idea that parathyroid hormone-related protein plays a double role in breast cancer. Use of parathyroid hormone-related protein for breast cancer early detection and disease prognosis is currently becoming a subject of detailed scientific research studies, which is confirmed by the facts presented in this literature review.

The epithelial‑to‑mesenchymal transition (EMT) is a cellular biological process, that occurs in a wide range of cells and tissues and is triggered by complex regulatory networks involving transcriptional control with SNAIL, ZEB1, ZEB2, Twist, SLUG, E‑cadherin, vimentin, tumor microenvironment and genetic characteristics. EMT is represented by the multi‑stage development and transformation of cells of the epithelial phenotype into cells that acquire mesenchymal features of various severity. These quasi‑mesenchymal cells are characterized by stemness, tumor heterogeneity, increasing invasiveness, drug resistance and a tendency to distant metastasis, which leads to the proliferation of neoplastic cells, tumor dissemination and initiation of metastasis, which induces the therapy resistance and the oncological recurrence.This review is based on the latest scientific publications about the EMT phenomenon, indexed in PubMed. The aim of the study was to evaluate the biochemical and molecular pathogenetic mechanisms of EMT and the effect of EMT markers on the progression of neoplastic processes and the effectiveness of the treatment. Nowadays the proper EMT scheme that combines all the molecular transformations of sells with quasi‑mesenchymal phenotype doesn’t exist. But analyzing the features of this cellular program, we can find the proper therapy, that could be able to suppress the plasticity of cancer cells, prevent EMT induction by blocking contextual signals, and induce mesenchymal‑epithelial transition. All these aspects will lead to the reduction of the risk of tumor dissemination and the increase of the effectiveness of cancer treatment.

This review focuses on the biological aspects of the use of cord blood as a valuable source of cells. The distinctive features of hematopoietic stem cells, cells of the immune system, mesenchymal stem cells are described. The analysis of the results of clinical research and development of therapeutic approaches using cord blood cells and umbilical cord for the treatment of various diseases has been carried out.Currently, the target area of cord blood research is hematopoietic stem cell transplantation, as well as cellular immunotherapy of tumor diseases, treatment of neurological diseases and regenerative medicine.

Objective: To study the features of the coronavirus infection course in cardiosurgical and thoracic patients to determine the factors potentially affecting the possibility of lethal outcome. To identify the predictors of fatal outcome based on the analyses of the features of the coronavirus infection course in this category of patients.Material and methods: During the analyzed period 80 patients from the departments of thoracic surgery and cardiac surgery were transferred to the infectious diseases department: 20 patients from the cardiac surgery department (CSD) – group 1; 60 patients from the thoracic surgery departments (TSD) – group 2. A control group number 3 consisting of 59 non-thoracic and non-cardiosurgical patients was also formed. According to the disease outcome the patients were divided into two groups: group 1 – fatal outcome, group 2 – recovery.Results: Out of 80 patients, lethal outcome was recorded in 25 cases: 22 patients of the thoracic profile (36% of the total number of transferred from this department) and 3 patients of the cardiosurgical profile (15% of the total number of those transferred from the cardiac surgery department). 20 out of 20 cardiac patients had been operated on the day before, 49 out of 60 thoracic patients also underwent surgery. 3 people from the group of non-operated patients transferred from departments of thoracic surgery died. Moreover, after pneumonectomy, fatal outcome was recorded in 7 out of 8 cases (87.5%).Conclusion: During the analyses of indicators it was revealed that the number of fatal outcomes in patients of the thoracic profile with COVID-19 infection is higher than of the cardiosurgical profile and in the infectious diseases department. Presumably, this is due to the fact that coronavirus infection affects the lungs to a greater extent, and in patients with a thoracic profile (in particular, those who have undergone resection interventions), the volume of the lung parenchyma is initially reduced. This is confirmed particularly by the highest percentage of fatal outcomes after pneumonectomy. Cardiosurgical patients after surgical interventions do not have a reduction in the functioning lung parenchyma, which creates an additional “reserve” for recovery. Moreover, men predominate among patients of the thoracic profile, with the survival rate lower in all groups compared to women. Patients transferred from thoracic departments showed higher rates of systemic inflammation, which indicates a more severe course of the viral infection and the possible development of complications.When analyzing the predictors of lethal outcome, the following factors were identified: male gender and, in general, a more severe course of a viral infection (low saturation, a high percentage of lung lesions on CT, more pronounced changes in laboratory screening). The studied factors are associated with a large number of fatal outcomes in thoracic and cardiac surgery patients. Among the factors that do not affect the prognosis are diabetes mellitus, stroke and myocardial infarction in history.Thus, patients diagnosed with coronavirus infection that developed after thoracic surgery had the most unfavorable prognosis. The revealed patterns are of interest for optimizing the routing of this category of patients in order to prevent coronavirus infection.

The presented literature review shows up-to-date information about the possibilities and new methods of magnetic resonance angiography in patients with cerebral aneurysms who have undergone surgical treatment. The articles for analyses have been taken from the PubMed database. The most important aspects of the implementation and the possibilities of improving magnetic resonance angiography protocols for visualization and postoperative control of treated cerebral aneurysm have been considered.

Objective To determine the ratio of the main growth factors when using various methods of local stimulation of reparative osteogenesis.Material and methods The study consisted of two parts: in the first part a comparative analysis of the content of growth factors by ELISA was carried out (PDGF – platelet derived growth factor, TGF – transforming growth factor, VEGF – vascular endothelial growth factor, IGF – insulin-like growth factor, BMP6 and BMP7 – morphogenetic proteins 6 and 7), capable of stimulating reparative osteogenesis in blood plasma, plateletrich plasma, red bone marrow and bone autoregenerate. The second part presented the results of approbation of the autoregenerate obtained according to the original method in the framework of an acute experiment on animals.Results The most important cytokines affecting the process of reparative osteogenesis are fibroblast growth factor – FGF1 and bone morphogenetic protein 7 – BMP7. Based on the results of a comparative enzymelinked immunosorbent assay, it has been established that the autoregenerate, obtained by the original method, and a bone marrow aspirate concentrate have the highest osteogenic potential.Conclusion Autoregenerate is an effective and promising means of local stimulation of reparative osteogenesis, and its transplantation is a simple and highly effective procedure.

The search for the optimal approach in the treatment of brachiocephalic arteriovenous fistulas is one of the current problems of neurosurgery and vascular surgery. It is important to note that the best prognosis requires timely diagnosis and the earliest possible dissection of the fistula. Also, the method of treatment should have the least negative consequences and a good clinical effect. Previously, surgeons used open surgical vessel ligation with great technical difficulties due to anatomical difficulties of access as well as bleeding. In recent decades, the endovascular approach to treatment has demonstrated advantages over open interventions. Despite the low traumaticity, there is a risk of complications such as untargeted vascular embolization, perioperative stroke, etc. In this article we demonstrate the experience of arterio-venous vertebral artery fistula dissection using an occluder.

Extracorporeal membrane oxygenation (ECMO) has been used for more than 20 years in the treatment of severe respiratory distress syndrome. However, ECMO in some categories of patients is not sufficiently covered in the literature, due to a small number of registered cases. This group includes pregnant women and women in labor. During the intensive care of such patients, the entire available range of therapeutic manipulations and measures that can favorably affect the outcome of the disease should be used. We have describe a clinical case of successful ECMO in a patient with novel coronavirus disease (COVID-19) and obstetric sepsis developed in the early postpartum period.

Background There are scanty data of right ventricular dysfunction markers after major pulmonary resection.Objective To study the changes of plasma level of N-terminal pro-brain natriuretic peptide (NT-proBNP) and its association with pulmonary artery pressure (PAP) as markers of right ventricular dysfunction in patients who underwent bronchoplastic lobectomy or pneumonectomy.Material and Methods The study population consisted of 36 patients aged 40–65 who underwent major pulmonary resection for lung cancer in 2016–2018. Patients were stratified into two groups according to the type of surgical procedure: bronchoplastic lobectomy, the main group (n = 19), and pneumonectomy, control group (n = 17). They were then analyzed for plasma NT-proBNP concentration, operative time, blood loss, intraoperative fluid administration, intraoperative urine output, and mean PAP level before and after an operation.Results The mean PAP level correlated positively with the plasma NT-proBNP concentration in the pneumonectomy group (Pearson r = 0.916754; p < 0.001). This correlation was no evident in the subset of patients undergoing bronchoplastic lobectomy at the same determination point (Pearson r = 0.234741; p = 0.330).Conclusion The mean PAP increased significantly after pneumonectomy and is closely correlated with plasma NTproBNP concentration. These findings support the conclusion that bronchoplasty is preferable over pneumonectomy for lung cancer patients.

Background Intracranial hemorrhage is the most serious manifestation of a ruptured cerebral aneurysm, and subarachnoid hemorrhage (SAH) is the most common clinical and anatomical form. The treatment strategy for SAH varies from conservative to emergency surgical treatment and depends on the source of the hemorrhage. Currently, the search for sources is carried out using various methods of diagnostic radiology.Objective To compare the images of intracranial arteries obtained by computed tomography (CT) angiography with the data of cerebral angiography in the acute period of hemorrhage in the subarachnoid space.Material and Methods We retrospectively analyzed the medical records of 242 patients with acute SAHs from September 2017 to September 2019, examined in the emergency room of the Research Institute – Ochapovsky Regional Hospital no. 1.Results According to CT angiography, the initially occult vascular lesion was verified in 212 patients (87%), of which in 84.0% of cases (205 patients) the cause of SAH was ruptured cerebral aneurysms. In 3 patients, ruptures of arteriovenous malformations were detected (1.2%). In 4 patients, the “cerebral aneurysms” diagnosis was excluded due to the establishment of a hypertensive nature of intracranial hemorrhage (1.7%). In 30 patients, CT angiography revealed no vascular pathology. According to the results of CT angiography only, 225 patients (93%) were microsurgically operated on, and 12 patients (5%) were operated on using intravascular access. Among 30 patients whose vascular pathology was not detected by CT angiography, 6 patients were found to have single aneurysms according to cerebral angiography: the internal carotid artery – in 3 patients, the middle cerebral artery – in 2, and the pericallous artery – in 1 patient.Conclusion CT angiography is a key tool of non-invasive diagnosis of the source of SAH in emergency departments. The absence of vascular pathology on CT angiography in the presence of massive basal SAH, the detection of multiple and “complex” aneurysms, as well as cerebral arteriovenous malformations of the brain during CT angiography remain indications for cerebral angiography.

Purpose: tо evaluate effectiveness of cataractogenesis prophylaxis in patients with epiretinal membrane (ERM) after vitrectomy based on the pirenoxin use.Patients and мethods. The study included 72 patients (64.5 ± 6.4 years old; 31 men, 41 women) with ERM before and after 25G microinvasive vitrectomy with removal of ERM. The 1-st group patients (36 eyes) received pirenoxin instillation (Catalin®; 3 times a day, 6 months) in addition to the standard pharmacological support. The 2-nd group patients received only standard therapy. All patients underwent: standard ophthalmologic examination; lens state photoregistration with an assessment of lens opacities intensity (LOCS-III classification) with the calculation of the cataract development index (CDI). These were control points: examination before vitrectomy and 5 months after surgery. At control points, the incidence of lens opacities in the observation groups was also evaluated. Statistical analysis included: calculation of the mean and its standard deviation (M ± s); assessment of the significance of differences in control points with each group (Wilcoxon's T-test) and between groups (Mann—Whitney U-test); Pearson xi-square test.Results: In the 1-st group (pirenoxin instillation), 6 months after vitrectomy and ERM removal, the following indicators were noted: the initial cataract incidence was 5.6 %; CDI — 0.36 ± 0.03 points, increasing the maximum corrected visual acuity (MCVA) from 0.31 ± 0.03 to 0.6 ± 0.05. In the 2-nd group similar indicators significantly differed from the 1-st group data: the initial cataract incidence was 36.1 % (Pearson xi-square test > 3; p < 0.05); CDI — 3.1 ± 0.3 points (p < 0.01); the MCVA increase from 0.3 ± 0.05 to 0.43 ± 0.1 (p < 0.05).Conclusion. Pirenoxin (Catalin®) has demonstrated quite high efficacy in the cataract prevention in patients after vitrectomy with ERM removal.

Objective. This study evaluated the long-term clinical and angiographic outcomes of coronary artery reconstruction for a diffusely diseased coronary artery without endarterectomy.Material and Methods. We retrospectively reviewed 660 consecutive patients (mostly men (89.5%), mean age 68.3 ± 7.4 years) who underwent coronary artery bypass grafting in combination with coronary artery reconstruction between 2003 and 2016. 558 operated on patients (84.5%) were followed up for a mean of 94.3 ± 31.2 months.Results. Long-term survival was 83.2% (95% confidence interval: 74.5–89.3); freedom from cardiac death was 97.4 ± 1.2%; and freedom from major adverse cardiac and cerebrovascular events was 64.7 ± 4.1%. Independent predictors of long-term mortality were age at surgery (< 70 years, p < 0.001), chronic obstructive pulmonary disease (p = 0.007), peripheral arterial disease (p = 0.002), diabetes mellitus (p = 0.013) and chronic kidney disease (p = 0.034). The arterial graft patency rate was 95.2%, and the vein graft patency rate was 75.4%.Conclusion. Coronary artery bypass grafting in conjunction with coronary artery reconstruction without endarterectomy confers satisfactory long-term clinical outcomes with high probability of freedom from cardiac death and angina pectoris, good rates of angiographic patency of arterial grafts and favorable rates of vein graft patency.

Reimplantation of a bicuspid aortic valve is relatively rare, and in combination with a the correction of aortic ductus diverticulum is a casuistic case. We present the experience of simultaneous reimplantation of bicuspid aortic valve with the correction of aortic ductus diverticulum. A 53-year-old male with a diagnosis of ascending aortic aneurysm, bicuspid aortic valve type 0 by Sievers with failure, aortic ductus diverticulum. The patient underwent an aortic valve reimplantation operation using the vascular prosthesis UniGraft № 36 and exoprosthetics of the descending aorta in the area of diverticulum. In the postoperative period, satisfactory aortic valve function was observed on ultrasound of the heart. The patient was discharged on the 15th day.

The treatment of pulmonary valve disease is one of the urgent problems of modern cardiology and cardiac surgery. In most cases, pulmonary valve abnormalities are congenital. Synthetic conduits (homografts) and bioprosphetic valves are currently used in the surgical treatment of patients with the diseases mentioned above. Pulmonary valve surgical prosthetics allows one to normalize the circulatory dynamics and condition of the patient, however, time-dependent degradation results in conduit and valve dysfunction. The abnormal circulatory dynamics caused by valve and conduit dysfunction is linked to exercise intolerance, arrhythmia, right ventricular failure, and sudden death. Starting in childhood, affected patients undergo repeated openheart surgeries to restore valve function and potentially reduce morbidity and mortality. Percutaneous transcatheter treatment of the pulmonary valve stenosis with the Melody® valve (Medtronic Inc.) has been performed in a large number of patients worldwide. Despite minimal invasiveness, this procedure restores pulmonary valve function and reduces repeated open-heart interventions. Recent clinical trials have shown excellent and durable results in terms of both restoring valve function and decreasing right ventricular outflow tract obstruction. In this study, we want to reflect the relevance of the Melody transcatheter valve and present our first experience of its usage.

This report presents a clinical case of treatment of Salmonella coxitis, developed as a result of bacteremia, which is a fairly rare complication. We performed head resection of both femurs and, after long-term antibiotic therapy, total hip replacement within six months from the onset of the disease. Given the lack of publications on the tactics of treating patients with this pathology in the accessible medical literature, we believe that our experience will be useful to specialists engaged in the treatment of patients with diseases of large joints.

Background. Postoperative delirium is one of the most severe and common complications of thoracic surgery in elderly patients.Objective. To establish a simple and accurate method for predicting the development of postoperative delirium in patients after thoracic surgery.Material and Methods. We performed an observational cohort study of 303 patients who underwent lobectomy for oncological diseases. The nature of anesthesia and surgical intervention, features of the volume status and hemodynamic changes during the perioperative period were analyzed, laboratory indicators of this period were evaluated.Results. Of 303 patients, 43 (14.2%) developed postoperative delirium. Non-modifiable factors for the development of postoperative delirium included age, history of cerebrovascular accident, alcohol misuse disorder, chronic heart failure, more severe physical status according to the ASA (American Society of Anesthesiologists) Physical Status Classification System. Modifiable factors are the following: the duration of one-lung ventilation, episodes of perioperative hypotension and hypoxemia, the use of opioids, the intensity of the pain syndrome in the postoperative period, and reduced oxygen transport function of the blood. A number of laboratory parameters (blood albumin, blood glucose, leukocytosis), reflecting the degree of surgical stress, may also be useful in postoperative delirium predicting.Conclusion. A prognostic coefficient was compiled with a concordance of 99.9 and Somers' D 0.998. It is equal to the sum of the products: (–3.5367) multiplied by pain intensity on a 10 cm Visual Analogue Scale an hour after surgery; 2.2037 multiplied by the blood albumin level the morning after surgery; (–4.8151) multiplied by the blood glucose level the morning after surgery.

Acute respiratory disease COVID-19 caused by the SARS-CoV-2 coronavirus demonstrate weak clinical manifestation in most patients. However, pneumonia and acute respiratory distress syndrome in some cases may cause serious problems due to the lack of effective etiotropic and pathogenetic therapy. Presumably, SARS-CoV-2 leads to the delayed type I interferon activation and loss of control over virus replication in the early stages of infection, which is why the adaptive CD8+T-cell response must be controlled to avoid the development of pulmonary pathology. These data should be taken into account when developing strategies for COVID-19 therapy. Mesenchymal stem cells therapy serves as possible treatment opportunity for severe forms of the disease due to their homing, pronounced anti-inflammatory and antifibrotic properties. It was found that in viral infections, including COVID-19, mesenchymal stem cells can synthesize antiviral defense mediators under the influence of interferon causing resistance to viruses. Thus, mesenchymal stem cells are able to provide comprehensive anti-inflammatory protection, which leads to clinical improvement in patients with COVID-19.

Bland - White - Garland syndrome (BWGS) is a clinical symptom complex, which is based on the congenital anomalous discharge of the left coronary artery of the heart from the pulmonary trunk. This article presents a case report of successful surgical treatment of BWGS in an adult patient (25 years). The patient after childbirth began to note fatigue, angina pectoris, dyspnea, heartbeat with rapid walking up to 100 meters. The patient underwent coronary angiography, echocardiography, multispiral computed tomography. As a result of researches, it was established abnormal discharge of the left coronary artery from the pulmonary trunk. Surgical treatment was performed - reimplantation of the main left coronary artery into the aorta with repair of the pulmonary trunk with xenopericardium. Discharged on the 16th day after surgery.

Coronary artery perforation is a rare (0.1–3.0%) but rather severe complication that occurs during the coronary interventions. Treating the perforation caused by the coronary conductor is extremely complicated, as it could be caused quite unexpectedly and may be accompanied by catastrophic consequences if misdirected. Choosing effective treatment techniques is not easy, as evidenced by hospital and remote clinical outcomes with high mortality rates.

Aim. Creating a mathematically based scale of risk stratification of thromboembolic complications in patients with acute abdominal organs pathology requiring urgent surgical treatment.Material and Methods. This work is based on data from 185 case reports of patients with acute surgical diseases of the abdominal organs that had undergone emergency operations. Clinical and statistical analyses were carried out and the most significant risk factors for venous thromboembolic complications were identified. By digitally estimating the specific gravity of each of the factors, the method of sequential probability ratio criterion was applied to the obtained data.Results and Discussion. Based on a retrospective analysis of clinical records, 13 most informative prognostic criteria for thromboembolic complications formed in the prognostic table were identified. Each sign, depending on its value, had a specific gravity. For the convenient using of the prognostic scale in practice, the indicators of natural logarithms are translated into arbitrary units (points). The results are checked on available archival records. The overall forecast reliability was 97%.Conclusion. The proposed prognostic scale made it possible to optimize the likelihood of a feasibility study in patients with acute diseases of the abdominal organs.

Despite advancements in modern surgery in the treatment of cutaneous injuries, the search for new methods of ensuring faster and more effective wound healing appears especially urgent today. Tissue engineering is undoubtedly of interest when it comes to developing such technologies. Objective: to determine the optimal protocol for obtaining a decellularized dermal matrix scaffold for subsequent development of tissue-engineered skin. Materials and methods. One Landrace piglet was used as the experimental animal. After preliminary skin treatment with dermatome, 0.3 cm thick samples were taken. Two decellularization protocols were considered: protocol No. 1 was based on the use of Triton X-100 and deoxycholate, protocol No. 2 was only based on deoxycholate. There were 5 processing cycles in total for the 2 protocols. After treatment, acellular matrix scaffolds were examined through histological analysis and quantitative determination of DNA concentration. Next, static recellarization of the matrix scaffolds was carried out with porcine dermal fibroblasts. After that, the matrix scaffolds were tested for cytotoxicity using XTT test and differential staining test to differentiate between live and dead cells. Results. Comparative analysis of the two protocols for porcine dermis decellularization showed that both protocols effectively remove cells and nuclear material, while maintaining the architectonics of the intercellular substance intact, since fibrous structures are not destroyed. But when assessing the biocompatibility of matrix scaffolds based on analysis of cell viability according to data obtained from XTT test and cell–matrix adhesion, the matrix scaffold processed under protocol No. 1, shows advantages. Conclusion. In this study, a decellularization protocol based on Triton X-100 and deoxycholate was noted. The results obtained mark the first stage towards developing a tissue-engineered skin.

To date, the incidence of penetrating aortic ulcers is from 2 to 7 % of all cases of acute aortic syndrome, localization of this pathology in the ascending aorta are casuistic. We present the case of an intraoperative finding of a penetrating ulcer of the ascending aorta. The patient underwent separate prosthetics of the ascending aorta with the vascular prosthesis Uni-Graft No. 28 and the aortic valve prosthesis with the mechanical prosthesis Medtronic No. 23. The patient was discharged on the 8th day in a satisfactory condition. Penetrating atherosclerotic ulcer is a potentially life-threatening condition, the detection of which requires aggressive tactics of surgical treatment.

It is known at the present time that immunological biomarkers may become more sensitive, non-invasive methods of graft rejection diagnosis than those currently used. A growing amount of studies in animal models shows that chemokines, as active participants in the immune process, may be used to this purpose. Our earlier studies have shown an important prognostic significance of IL-6, IL-2, 17A and IL-1RA increase in pre-operative period as markers of acute kidney allograft rejection. When assessing changes in studied peripheral blood growth factors, we concluded that a sharp decrease in BDNF content is a diagnostically significant early sign of kidney allograft rejection. The aim of this study was to identify the prognostic role of serum chemokine levels at the preoperative stage, taking into account the production of anti-HLA antibodies during the post-transplant period as a risk factor of kidney allograft rejection. A comparative analysis of chemokine serum concentrations was performed in the patients with terminal-stage chronic kidney disease (CKD). In the patients from main clinical groups, the blood cytokine levels were measured 6 hours before transplantation, i.e., Eotaxin (CCL11), GRO-α (CXCL1), IL-8 (CXCL8), IP-10 (CXCL10), MCP-1 (CCL2), MIP-1α (CCL3), MIP-1β (CCL4), SDF-1α (CXCL12), RANTES (CCL5), MIG (CXCL9) by means of multiplex immunological assays, using appropriate test systems. The studies have shown significant changes in several chemokines in the CKD patients compared to age-matched controls. However, the following diagnostically significant biomarkers associated with early rejection of transplanted kidney should be considered: increased concentration of CCL2 and CCL4 chemokines, as well as an acute decrease in CCL11. Significantly decreased CXCL12 concentration in peripheral blood could be considered a marker of favorable posttransplant clinical course. Occurence of HLA antibodies in recipients is also associated with elevated serum levels of CXCL8, CXCL10, CCL4, and CCL5.

Introduction. Arterial hypotension is the reasonable cause for intravenous injections of crystalloid solutions. However, as far as this statement is fair in the patients that underwent extensive scheduled thoracic operations at that moment is not defined.Aim. To reduce the number of complications in patients following thoracic operations by definition of optimum strategy for correction of postoperative hypotension.Methods. The retrospective analysis of 154 patients who were divided into 2 groups was conducted. In 58 patients, for correction of arterial blood pressure we used noradrenaline, in other cases (96 patients) noradrenaline in combination with infusion therapy was administered. The comparative analysis of the perioperative volemic status, levels of hemoglobin, urea, creatinine, a lactate, glucose, paO2 , paCO2 , ScvO2 , SaO2 , pvCO2 -paCO2 , duration of noradrenaline application and also a range of the postoperative complications was carried out.Results and conclusions. It is revealed that correction of hypotension with crystalloid solutions in thoracic patients results at and conclusions increased risk of pneumonia development. At the same time, infusion therapy in the early postoperative period in thoracic patients did not reduce the risk of intense kidney failure development. Severity of postoperative complications according to Clavien-Dindo classification was higher in patients who had infusion therapy. At the same time, duration of vasopressor support showed no change.

This report presents a clinical case of endovascular treatment of a rare complication – a spurious aneurysm from a linear aorto-femoral shunt. We performed implantation of a self-expandable stent graft directly into the vascular prosthesis in the projection of the defect of its wall. We tried to foresee possible procedural complications, and in this regard to justify the choice of tactics of treatment and selection of the applied tools. Given the lack of available literature data on the methods and techniques of interventions in this pathology, we believe that our experience will be interesting and useful for professionals involved in the treatment of patients with vascular diseases.

Background. Assessment of endovascular methods possibilities in the treatment for carotid-cavernous fistulas.Material and methods. The results of endovascular treatment in 22 patients with carotid-cavernous fistulas in the period from 2008 to 2018 were evaluated. The number of male patients was 13 (59%), female patients – 9 (41%). Fifteen patients (68%) had traumatic damage, 7 patients developed a spontaneous disease. All patients had a specific clinical features of carotid-cavernous fistula, confirmed by anamnesis and angiographic study. After verification of the diagnosis, all patients underwent permanent transcatheter embolization of the pathological connection using detachable balloons, microspirals and adhesive composition. Results. Twenty-one patients (95.5%) underwent one-stage embolization of carotid-cavernous fistulas. One patient (4.5%) required three procedures: two embolization with detachable balloons, final embolization with detachable spirals, due to deflation of the balloons in the early postoperative period. Destructive embolization of carotid-cavernous fistulas was performed in 2 cases (9%), reconstructive interventions were performed in 20 cases (91%). The angiographic success of the procedure was 100%. All treated patients had regression of symptoms during their hospital stay. During this period, one complication was identified in the form of post puncture hematoma, which required conservative treatment.Conclusion. Endovascular treatment is a modern, effective and safe method for treating carotid-cavernous fistulas. Destructive occlusion (if there is no possibility of performing reconstructive intervention) is also a safe and clinically justified method for treating this pathology.

Justification. The most methods of extensive skin and soft tissue defects are aimed at accelerating wound healing and preventing infectious complications. To improve the effectiveness of such defects treatment, a method of dosed tissue distraction (MDTD) is used, consisting in the application of a continuously acting load to the area of healthy soft tissue in close proximity to the wound defect.Purpose. It performed the evaluation of the medico-social effectiveness of the introduction into clinical practice of developed methods and devices for implementing MDTD in the treatment of skin and soft tissue defects of the extremities.Methods. 407 patients were treated with wound defects of the extremities, which were divided into two groups: the main group – 198 patients in whose treatment MDTD was applied using original methods and devices; comparison group – 209 patients, in whose treatment standard treatment methods were applied. Comparison of the long-term results of treatment according to the frequency of repeated operations, complications, indicators of quality of life, frequency of disability.Results. The use of MDTD is characterized by better performance compared with the use of standard approaches. There is a decrease in the frequency of performing reconstructive plastic surgery after inpatient treatment (9–10 times), remote complications by 2.6 times, a reduced value of the Vancouver scale (by 28.8%), quality of life indicators higher levels. The use of the proposed approach is characterized by a shorter duration of treatment (by 26.0%), duration of disability (1.4 times), cases of disability (2.2 times).Conclusion. The use of MDTD is characterized by high medical and social efficiency, allows to reduce the cost of treating extensive skin and soft tissue defects by reducing the length of hospitalization, the frequency of repeated rehabilitation and reconstructive operations, accelerated recovery of patients, improving the quality of life and reducing the incidence of disability.

Background. Myocardial infarction (MI) without obstructive lesion of coronary arteries (MINOCA) has incidence to 14%. Despite its high prevalence, MINOCA is paid not enough attention, therefore some patients can not receive appropriate treatment.Aim. Evaluating the long-term results of clinical observation in patients with MINOCA in comparison with patients with obstructive damage and the subsequent revascularization of myocardium.Material and methods. On the basis of Scientific Research Institute RCH – 1 the multicenter cohort observation was organized. Patients from the register CROCS (the register of acute coronary syndrome in Krasnodar region) with the diagnosis MI were divided into two groups: MINOCA including patients without obstructive damage of coronary arteries and MINOCA including patients with obstructive injury and the subsequent stenting a heart attack connected artery. All patients in 12 months would have control assessment during which they had objective survey; electrocardiography; daily monitoring; test of six-minute walking, echocardiography. Results. In the MINOCA group in 12 months after the acute coronary event in 21.5% cases there were tension stenocardia, in 16.2% – a painless form of myocardial ischemia was revealed, in a group of patients with MINOCA stenocardia of tension was revealed at 12.5% and 8.4% – with painless ischemia. The group of patients with MINOCA is characterized by more reliable decrease in both parameters of heart rate variability, and turbulence of heart rate. MINOCA is followed by statistically significant increase in risk of ACS development and death within 12 months. All indicators had reliable difference.Conclusion. Patients with MINOCA are a special group, their differential characteristics demand definite diagnostic efforts.

Correction of the patent ductus arteriosus (PDA) takes an important place in management of congenital heart defects (CHD). Untreated PDA can lead to heart failure due to left ventricular myocardial hypertrophy (LVH), pulmonary hypertension, bacterial endocarditis, pulmonary infection, and rarely the development of ductal wall aneurysm, its calcification and further rupture.It is believed that the closure of PDA is indicated in any child or adult who develops pathognomonic symptoms: expansion of the left heart; the presence of signs of pulmonary hypertension with left-right blood discharge; prior endocarditis. In asymptomatic patients with PDA accompanied by left ventricular hypertrophy closure of the duct is indicated to reduce the risk of further complications.There were various surgical methods of PDA treatment discovered in the period of the development of medical industry. Previously the most common intervention was ligation of the duct, accompanied by thoracotomy. However, in the present days the ligation of PDA is extremely rare. Endovascular occlusion has taken the lead in the modern practice. Its purpose is to close the duct with intravascular access with help of specialised tools.In this article we present a case of PDA management in a patient with clinical manifestation of PDA at the age of 35 years.

Background. Generalize modern data on the current opportunities and the perspective application directions of stem/stromal cells of fat tissue in regenerative surgery.Results. Preclinical and clinical developments of cellular transplantology techniques and tissue engineering with use of the cultivated multipotent mesenchymal stromal cells of fat tissue and freshly isolated stromal vascular fraction of fat tissue in plastic surgery, maxillofacial surgery, orthopedics, neurosurgery, coloproctology, urology, thoracic surgery, cardiac surgery are presented.Conclusion. Transplantation of stromal vascular fraction of fat tissue for which releasing we do not perform cultivation of cells out of a human body is a safe and effective regenerative technology with an application potential in the wide range of surgical areas.

Aim. To evaluate patients with acute coronary syndrome (ACS) in combination with atrial fibrillation (AF) according to the total register of ACS in the Krasnodar region of echocardiographic (EchoCG) parameters (left atrial dimension (LAD), left ventricular wall thickness (LVWT), left ventricle end-diastolic diameter (LVEDD), left ventricular ejection fraction (LVEF), pulmonary artery systolic pressure (PASP), as well as coronary substrate assessment according to coronary angiography (CAG) and determination of the relationship between the value of LVEF and the coronary substrate.Material and methods. From the register of the ACS in the Krasnodar region, patients were successively taken to the cardiology departments of Krasnodar regional clinical hospital № 1 for the period from November 20, 2015 to November 20, 2017 with a diagnosis of ACS, accompanied by one of the types of atrial fibrillation. This group of patients was designated as a group of ACS + AF and amounted to 119 patients. The comparison group was selected with the help of a random number generator from patients admitted to the hospital with ACS and intact sinus rhythm (SR) for the period of time from November 20, 2015 to November 20, 2017 (120). We analyzed the ECHO-CG parameters, the coronary substrate — according to the CAG.Results. When comparing the cohort of patients with ACS + AF with the cohort of patients with ACS + SR, we determined a significant (p40% and ACS + SR we determined a significantly more frequent (p

Gastric cancer keeps its position among the top five leaders of oncological mortality. Extended lymph node dissection D2 allows to achieve good long-term results after surgical treatment, however process extension and specific features of a tumor have significant impact on the result.Background. Study influence of various tumor characteristics, volume of LN dissection and operation on recurrence probability in patients with locally-advanced gastric cancer.Material and methods.We performed analysis of long-term results of treatment in 662 patients with gastric cancer with application of minimum admissible lymph node dissection D1 and extended lymphodissection D2 operated by one group of surgeons and also 10 various characteristics of tumor process which had an impact on survival rate.Results. Improved survival in patients with extended LN dissection was observed beginning from stage II disease and was the best in cases with stage III. Main group of patients treated with extended LN dissection showed better results compring to the control group with minimally accepted lymphodissection regarding overall and recurrence-free lifespan. Own effect of an extended LN dissection is shown against the background of any other factor of variability. Effects of tumor characteristics (first of all, its prevalence, i.e. stage of disease, metastatic invasion of regional lymph nodes and histologic structure of tumor) and combined surgical volume have always more effect than extended LN dissection.Conclusions.The observed additional effect of an extended lymph node dissection is universal, that is shown on any clinical background of the disease – histologic structure, gastric localization, form of tumor growth, invasion depth in a gastric wall, invasion of regional lymph nodes and stage of cancer (except stage I). The most significant negative impact on life expectancy in patients after treatment had low differentiated tumors, metastatic invasion of regional lymph nodes, stages of disease, on duration of recurrence-free period – stage of cancer and the combined nature of surgical intervention.

In donor organ recipients we observe sufficiently high risk of invasive mycotic infection development and most of them are caused by Candida spp and Aspergillus spp. Clinical evidence of invasive candidiasis are diverse and this fact makes early diagnosis complicated. At the same time, despite relative frequency of invasive mycoses at transplantation, there are no definite recommendations for diagnosis, treatment and prevention of mycotic infections. In most cases physicians should rely on their own clinical experience. In the present study we demonstrated modern approaches to diagnosis and treatment for invasive candidiasis in donor organ recipients.

In donor organ recipients development of invasive fungous infections, the majority of which is caused by Candida spp and Aspergillus spp, significantly increases. Invasive candidiasis clinical signs are diverse and this fact complicates early diagnostics. At the same time, despite the relative frequency of invasive mycoses at transplantation, there are no certain accurate references on diagnostics, treatment and prophylaxis of invasive fungous infections. In most cases clinicians should rely generally on their own clinical experience. Modern approaches to diagnostics and treatment for invasive candidiasis in recipients with donor organs are shown in the submitted review.

In the present article we described a systemic approach to aortic valve reimplantation in patients with aneurysm and/or ascending aorta dissection and with aortic insufficiency. We highlighted several surgical aspects of reimplantation with so called Kuban Cuff.