In recent decades, the number of patients with coronary artery disease and diffuse coronary artery disease has increased, the results of revascularization of which remain unsatisfactory, and the risk of repeated interventions and postoperative complications is high. In some cases, such patients are classified as inoperable, and drug therapy is ineffective for them. It is for such patients that the method of stimulation of extracardial neoangiogenesis has been developed and introduced into clinical practice, which allows increasing the effectiveness of surgical treatment. In our article, a comparative assessment of the results of surgery in patients with diffuse coronary lesion after various methods of myocardial revascularization was carried out.
Aim: to compare the efficacy and safety of standard surgical and endovascular correction of coronary artery lesions, as well as complex myocardial revascularization (bypass surgery and percutaneous coronary intervention, supplemented by the “YurLeon” technique) in patients with diffuse coronary atherosclerosis.
Materials and methods. The study included 133 patients with coronary artery disease and diffuse coronary artery disease who were treated at the St. George Clinic of Thoracic and Cardiovascular Surgery named after N.I. Pirogov NMHC from 2011 to 2024. I – patients who underwent coronary bypass surgery (n = 35); II – endovascular correction of coronary blood flow disorders (n = 33); III – patients who underwent coronary bypass surgery supplemented by stimulation of extracardial neoangiogenesis (n = 37); IV – patients to whom percutaneous coronary intervention was supplemented with a minimally invasive procedure “Yurleon” (n = 28). According to the clinical and angiographic characteristics, the patients did not differ statistically significantly from each other. Clinical data, echocardiography parameters, the degree of damage to the coronary bed, complications after surgery, cases of major adverse cardiovascular and cerebrovascular events (MACCE), and overall survival were evaluated.
Results. The average follow-up period was 41.8±25.9 months. The groups differed in the frequency of repeated endovascular revascularization (repeated coronary bypass surgery was not performed) (p = 0.013): in group I (34.3%) it was observed more often than in group III (13.5%) (p = 0.04); it was the highest in group II (42.4%) of patients, which is statistically significantly higher, than in IV (17.9%) (p = 0.041). The study showed that the number of MACCE cases was statistically significantly different in different patient groups. After complex revascularization, the number of such observations decreased compared to isolated CABG or PCI (p = 0.0004), in group II the indicator was the highest (84.8%). At the same time, there was a tendency to a higher survival rate of patients in groups III and IV.
Conclusion. Complex myocardial revascularization in patients with coronary artery disease and diffuse coronary artery disease is an effective and safe procedure. A new hybrid approach combining percutaneous coronary intervention under the control of intravascular research methods and minimally invasive implementation of the “YurLeon” technique makes it possible to expand the possibilities of treating patients who were previously considered inoperable

Heart failure is usually based on damage to cardiomyocytes. At the same time, the most common cause of myocardial dysfunction is coronary heart disease (CHD), various inflammatory processes, excessive physical overload, including acquired and congenital heart defects, and so on. However, it is not uncommon to meet patients with heart failure, in whom the listed causes are absent and are not confirmed by either instrumental or laboratory studies, and the treatment of such patients is ineffective. Long-term clinical practice, numerous scientific and experimental studies by Academician of the Russian Academy of Sciences Shevchenko Y.L. allowed us to establish that the cause of such myocardial dysfunction is immobilizing interstitial fibrosis of the heart. which is based on direct compression of cardiomyocytes (immobilization) by sharply compacted connective tissue (diploma for discovery No. 536 dated August 23, 2023).
Immobilizing interstitial fibrosis of the heart, which occurs as a result of excessive deposition of physically altered collagen fibers and structural and functional transformations of the myocardium, can be primary or secondary (induced) and occurs in many chronic cardiac diseases, including coronary heart disease. The available data indicate that an increase in the number of collagen fibers, metamorphoses of their composition and physico-chemical properties play a leading role in impaired microcirculation, extravasal compression of coronary arteries, remodeling of the left ventricle and a decrease in heart contractility, which may explain the unsatisfactory results of treatment of various groups of patients with heart failure, including patients after coronary bypass surgery. The results of the study indicate a fairly frequent detection of interstitial immobilizing fibrosis in patients with coronary heart disease with a reduced left ventricular ejection fraction.
The recognition of immobilizing interstitial fibrosis of the heart presents serious difficulties. However, a comprehensive assessment of general clinical, instrumental and laboratory studies makes it possible to diagnose this insidious disease with greater certainty, the most severe stage of which is determined by compression of the peripheral coronary arteries (coronary stage). The article describes the main pathophysiological mechanisms of the formation of immobilizing interstitial fibrosis of the heart and the most important angiographic signs of its most severe stage of extravasal compression of the coronary arteries – the Shevchenko-Brado symptom complex.
Materials and methods. The prospective study included the results of observations of 82 patients who were treated at the St. George Thoracic and Cardiovascular Surgery Clinic of the Federal State Budgetary Institution “NMHC named after N.I. Pirogov” of the Ministry of Health of the Russian Federation from 2020 to 2024. Group I (n = 33) – patients with coronary heart disease and immobilizing interstitial fibrosis (IFS). Group II (n = 40) – patients with coronary heart disease without IFS. To assess the manifestations of the Shevchenko-Brado angiographic symptom complex, an additional group of patients was considered separately – group III (n = 9) with a coronary stage of primary IFS without coronary artery disease.
The average age of patients was 63.26±5.7 years (group I), 64.9±6.6 years (group II), 55.9±5.9 years (group III). Clinical data, magnetic resonance imaging, echocardiography were evaluated. Selective coronary angiography was performed at a frequency of 15 frames per second. Myocardial biopsy, histological examination of biopsies were performed, the percentage of fibrosis sites to the total area of the tissue fragment under study, the volume of collagen fibers of types I and III were calculated.
Results. According to clinical, morphological and instrumental data, five stages of IFS have been identified. In all patients with primary IFS without coronary artery disease (group III), the Shevchenko-Brado symptom complex was detected, the duration of the passage of contrast agent from the trunk of the left coronary artery to the coronary sinus was 6.4 [5.8; 6.9] seconds. This symptom complex is specific for the coronary stage of IFS, however, it can manifest itself in different ways in its other forms: in the group I the angiographic picture of diffuse thinning of the distal sections of the coronary arteries by the type of “mouse tails” was determined in 63.64% (n = 21), in the group II – 22.5% (n = 9), OR 6.03 (95% CI 2.16-16.83) p = 0.0004. When comparing these observations with histological examination data, it turned out that in cases of severe and extremely severe stage of immobilizing IFS, extravasal compression of the coronary arteries was detected. Statistically significant differences were found in the studied groups: lengthening of the time of “native” T1, according to MRI data: 1128.0 [1059;1181] ms (group I), 952.0[914;993] ms (group II) p<0.0001, an increase in the volume of intercellular space: 39.0[34;50]% (group I), 24,5[21;28]% (group II), at p<0.0001. According to a special histological study, the average area of fibrosis zones in the group I was 18.7[11;27]%, type I collagen – 4795[3992;6157] per 1 mm2 and type III collagen – 3531[2350;4905] per 1 mm2.
Conclusion. The formation of interstitial immobilizing fibrosis is almost always an integral part of the pathological process of heart remodeling. There are specific signs of IFS that can help in diagnosis, including the described angiographic Shevchenko-Brado symptom complex, which is detected in patients with severe immobilization of the peripheral coronary bed.

Purpose of the study: to study the effect of perioperative use of levosimendan on the restoration of viable myocardium in patients with coronary artery disease with a significantly reduced left ventricular ejection fraction during myocardial revascularization. An open, prospective, randomized study was conducted, including 98 patients.
The patients were divided into two groups. In group I (n = 55), levosimendan infusion was used perioperatively. Administration of the drug (loading dose of 12 mcg/kg/min for 10 minutes) began after induction of anesthesia and continued infusion at all stages of the operation and in the immediate postoperative period. The total time of drug administration was 24 hours. In group II (n = 43), standard drugs were used to correct the circulatory system. It was found that the inclusion of levosimendan in a comprehensive program of cardioprotection caused a more rapid recovery of hibernated myocardium. This assumption is based on the fact that in patients of group I, the use of levosimendan led to a decrease in the volume of hibernation after surgery, in comparison with the preoperative level, by 42%. At the same time, in group II of patients operated on without the use of the drug, the percentage reduction in the volume of viable myocardium was 13%. In addition, a clear dependence of the state of the pumping function of the heart on the hemodynamic effects of levosimendan was discovered. Thus, in patients of group I, an increase in cardiac index was detected from 2.23±0.49 to 2.96±0.52 l./min./m2 (p<0.05), an increase in minute blood volume from 4.51± 0.99 to 6.04±1.1 l./min. (p<0.05), decrease in pulmonary valve wedge pressure from 13.3±4.6 to 9.8±3.07 mmHg. (p<0.05). In addition, levosimendan had a clear anti-ischemic effect. This was expressed in a lower concentration of troponin I in patients of group I, in comparison with patients of group II, at the stage of the study after surgery (I group – 2.78 ± 2.31 ng./ml., II group – 3.45 ±4.9 ng./ml., p<0.05). It should be noted that, simultaneously with a decrease in the volume of hibernated myocardium, in patients of group I there was an increase in the ejection fraction of the left ventricle from 40% to 49% (p<0.05). The data presented indicate an improvement in the functional state of the myocardium against the background of the prevention of ischemic and reperfusion disorders with levosimendan. It was noted that the preoperative volume of hibernated myocardium and the usefulness of reperfusion could have an additional influence on the implementation of the protective effects of levosimendan. Thus, there is some reason to believe that myocardial conditioning with levosimendan improved contractility in the reperfusion zones of hibernated myocardium during coronary artery bypass surgery in patients with ischemic left ventricular dysfunction

Objective. To evaluate and compare the immediate results of surgical treatment of aneurysms and dissection of the ascending aorta by the classic Bentall technique with anastomosis according to Cabrol and as modified by N. Kouchoukos
Material and Methods. We analyzed 189 patients who underwent aortic valve and ascending aorta prosthesis by Bentall-de Bono technique (n = 135) and in Kouchoukos modification (n = 49). Exclusion criteria: repeated operations, one-stage interventions on the aortic arch, heart valves, coronary bypass surgery. The mean age of patients in the first group (Bentall – de Bono technique) was 46±14.5 (14L – 73g); in the second group (Kouchoukos modification) – 50.18±12.8 (23-72 years). Both groups were predominantly male, 110 (84.6%) in the first group and 40 (81.6%) in the second group. Patients with ascending aortic aneurysm, 110 (81.4%) / 41 (83.6%); acute aortic dissection, 10 (7.6%) / 5 (10.2%); and chronic aortic dissection, 15 (11.1%) / 3 (6.1%), predominated in both groups. Etiology – CHD (bicuspid aortic valve) predominated in both groups, 53 (40.45%) / 28 (57.1%); atherosclerosis, 45 (33.3%) / 11 (22.4%); connective tissue dysplasias, 34 (17.7%) / 9 (11.4%); syphilitic aortitis, 2 (1.48%)/ 1 (2%). Both groups had severe circulatory insufficiency (NYHA FC III to IV) – 109 (83.2%) / 39 (79.5%). Mean diameter of the ascending aorta was 58.6±13.2 mm / 54.4±9.84 mm. Mean EuroScore- 6.5±4.1 (0.96–23.8) / 6.14±4.01 (1.28–14.95). The groups were not statistically significantly different on these factors (p>0.05)
Results: Hospital mortality was not statistically significantly different between the groups, with 4 patients (3%) in group 1, mean Euroscore among those who died was 8.2±4.14, and 1 (2.8%) in group 2. IR time was statistically significantly higher in group 1 and amounted to 188.8±44.3 /161.1±60.2 min, respectively; aortic constriction in both groups was not statistically different – 115.27±33.9 / 117.2±54.8 min. Rethoracotomy due to bleeding in the first group was performed in 5 patients (3.8%). In all cases during revision the source of bleeding was not determined. The reason for rethoracotomy in two patients in the second group was bleeding from the left coronary anastomosis area and bleeding from soft tissues. Intraoperative blood loss in group 1 was 745.8 ml, in group 2 – 822±452 ml. The average stay in ORIT was 1.6±2.48 / 1.13±2.44 days. Duration of hospitalization – 10.9±4.28/11.5±3.3 days. The groups were not statistically different according to these parameters.
Conclusions: Both techniques are optimal and have comparable immediate results of surgical treatment of aneurysms and dissection of the ascending aorta.

Objective. To identify differences between the cardiovascular – renal – metabolic syndrome and separately cardiorenal syndrome on the course of coronary heart disease.
Methods. The study included 111 patients – 71 (59.5%) men and 40 (40.5%)
women who were treated at the RCH Hospital No. 2 from 2022 to 2023. The patients were divided into two groups, group 1 included n = 52 with cardiovascular – renal – metabolic syndrome, group 2 included n = 59 with cardiorenal syndrome. The duration of the study is 18 months. Statistical processing of the obtained data was carried out using Excel and Statistica 7.0 programs.
Results. Thus, the primary indicators of LDL cholesterol in the 1st group were 2.9±3.6, in the 2nd group 2.2±3.7 (p = 0.08), and upon re – examination, the ratio of values was as follows – 3 .2±2.8 to 32.7±3.9 (p = 0.06). There was an increase in total cholesterol and triglycerides, and indicators of good HDL cholesterol remained virtually unchanged p<0.05. Patients with stage 2 diabetes mellitus increased by the end of the examination in both groups, but so significantly in relation to the total weight of 2.7% to 1.8%, p = 0.01. During the repeated examination, the indicators of arterial hypertension of the 2nd degree prevailed in the group with cardiovascular – renal – metabolic syndrome 34.6 to 23.7 p = 0.01. But, both upon admission and during re – examination, the increase in arterial hypertension of the 3rd degree exceeded in patients with cardiorenal syndrome 25.0 to 27.1 p = 0.04. The development of acute myocardial infarction predominated in the group with cardiovascular – renal – metabolic syndrome, and the number of repeated events of coronary heart disease, the ratio was 33.6 to 23.4 p = 0.05.
Conclusion. Our study showed that patients with cardiovascular – renal – metabolic syndrome are hospitalized faster and have recurrent development of coronary heart disease. As for deaths, they were equal in patients with cardiovascular – renal – metabolic and cardiorenal syndrome

Rationale: The use of various efferent methods has proven positive in the complex treatment of patients with cardiac surgical pathology. The article presents a method for performing filtration plasmapheresis during during cardiopulmonary bypass surgery in patients with infective endocarditis.
Objective: To evaluate the effectiveness of the developed method of intraoperative plasmapheresis during cardiopulmonary bypass in patients with infective endocarditis.
Methods: The study materials describe a method for integrating a plasma filter directly into the circuit of a heart – lung machine without the use of additional equipment for plasmapheresis. The study of this method was carried out on the basis of the Department of Cardio – and X – ray Vascular Surgery of the State Budgetary Institution of the DPR “Republic Clinical Hospital named after M.I. Kalinin”, Donetsk in the period from 2014 to 2024. The study involved 96 patients who were divided into two groups (52 and 44 patients, respectively). In Group I, the procedure of intraoperative plasmapheresis was performed. In Group II, the plasmapheresis procedure was not performed. Patients underwent the following surgical interventions: aortic valve replacement (AVR) – 28 (29.17%), mitral valve replacement (MVR) – 30 (31.25%), tricuspid valve replacement (TVR) – 33 (34.38%), replacement of aortic and mitral valves – 5 (5.2%).
Conclusion: Intraoperative plasmapheresis helps improve exit from cardiopulmonary bypass by independently restoring the rhythm without the use of defibrillation and reducing the need for the use of adrenergic agonists to normalize blood pressure.
The use of the method demonstrates an improvement in the course of the postoperative period, manifested in a decrease in cardiotonic support, early normalization of body temperature and laboratory parameters, namely: the absolute number of leukocytes, relative to the content of band and segmented leukocytes, erythrocyte sedimentation rate, C – reactive protein and leukocyte intoxication index

Purpose of the study. Comparison of the results of coronary stenting and coronary bypass surgery in patients with hereditary hypercholesterolemia and angina pectoris. Materials and methods. An analysis of the results of treatment of 100 patients
with hereditary hypercholesterolemia and exertional angina was carried out. As part of the preoperative preparation, all patients were classified according to the SYNTAX Score – in all cases, moderate severity of the lesion was revealed. Based on this, before the 2nd stage of surgical treatment, all patients were randomly divided into 2 equal groups: Group 1 included patients who underwent endovascular revascularization of the affected coronary artery as the 2nd stage of surgery treatment; Group 2 included patients who underwent coronary artery bypass grafting (CABG) as the 2nd stage of revascularization.
Results. The results of endovascular stenting and cardiac bypass surgery demonstrate almost identical results 12 months after surgical treatment and in patients with moderate severity of lesions according to the SYNTAX Score. The quality of life of patients who have undergone coronary artery stenting is much higher than that of patients who have undergone open cardiac surgery

Rationale: Echocardiographic changes are observed in more than 50% of patients with acute pancreatitis. Studying the phenomenon of cardiodepression in patients with acute pancreatitis will make it possible to predict the development of moderate and severe pancreatitis.
Purpose of the study: to identify the characteristic echocardiographic signs of cardiac dysfunction and their relationship with the severity of acute pancreatitis.
Material and methods of research: 81 people participated in the research. Of these, there were 21 healthy volunteers and 60 patients with acute pancreatitis. There were 36 men and 24 women.
The results of their own research: having studied the end diastolic volume of the left ventricle (EDV), the authors came to the conclusion that a very large spread of values even in healthy individuals does not allow using this indicator to assess the state of the myocardium. And even more so forecasting.
It became obvious that for greater objectification it is necessary to take into account, first of all, the size of the heart. To simplify the calculations, as an indicator indirectly characterizing the size of the heart, the authors decided to use the thickness of the interventricular septum in diastole (IVD).
Thus, having EDV and IVS, the authors proposed to use the diastolic coefficient (DK) = EDV / IVS.
After analyzing the value of this indicator, the authors found that most often in moderate and severe pancreatitis, established for a completed case, DC was below 9.
The diastolic coefficient of DC proposed by the authors, calculated on the first day of treatment, also showed a clear relationship with the severity of pancreatitis, established by the completed case.
Conclusions: if, in the absence of hypovolemia and signs of heart failure in patients with acute pancreatitis on the first day of adequate treatment, the value of the diastolic ratio is less than 9, the relative risk of developing moderate and severe pancreatitis is 5.991 at S - 0.359. The diastolic ratio proposed by the authors is a prognostically significant indicator for the development of moderate and severe pancreatitis. The sensitivity of the proposed prediction method is 0.788, the specificity is 0.896.

Peripheral artery bypass surgery can be performed both in patients at the stage of claudication or in those who is suffering from critical limb ischemia (CLI). Patients with CLI have more severe stages of atherosclerosis and comorbidities as compared with patients at the stage of claudication, and tend to have a higher risk of amputation and death following revascularization of the lower limb. No comparison of primary surgery outcomes performed at the stages of claudication and CLI has been conducted so far. This study was based on different approaches to timing and techniques of peripheral artery bypass surgery and aimed at studying the results of revascularization procedures performed in patients with various stages of chronic lower limb ischemia.
Materials and methods. The study included 88 patients who had undergone surgical revascularization. In 44 cases, the surgical procedures were performed at the CLI stage and 44 cases – at the stage of claudication. Similar techniques of revascularization were used in both groups, including conventional (bypass surgery, endarterectomy) and endovascular procedures (angioplasty or stenting). The outcomes of revascularization procedures were evaluated within the first 30 days after the surgery.
Results. Clinical improvement after the surgery was more commonly observed in the claudication group (93%) compared with the CLI group (75%). The rate of complications in the CLI group (59%) was in 5 times more that in the claudication group (9%).
Conclusions. Timely performed surgical revascularization for limb ischemia in patients with rapidly progressing peripheral arterial disease can contribute to lower rate of complications and amputations and better clinical outcomes

Fractures of the distal humerus account for about 0.5-2.5% of all fractures of the bones of the skeleton, 15% of all fractures of the humerus, about 30% of fractures of the elbow joint and 7.8-24% of all fractures of the upper limb. At the same time, intraarticular fractures of the distal humerus (DPK) account for 10-24% of all intraarticular fractures. The difficulties in treating patients with fractures of this localization are due to the complex anatomy and biomechanics of this area, the predisposition of the elbow joint to the development of post-traumatic contractures and heterotopic ossifications, as well as the high demands of patients on the results of rehabilitation treatment. Subcutaneous subfascial osteosynthesis is one of the methods of surgical treatment of fractures of the distal humerus, which allows to restore the anatomy of this segment and provides a good functional result. An important advantage of this method is that when using it, traumatization of neurovascular structures is minimized, since access is carried out through anatomical safe zones.
Aims: based on our experience in the surgical treatment of patients with fractures of the distal humerus, to show the advantages of subcutaneous subfascial osteosynthesis to improve the quality of treatment results in this category of patients.
Materials and methods: we observed 74 patients with fractures of the periarticular distal humerus. Surgical treatment was carried out in the conditions of the Tula Regional Clinical Hospital. The age of the patients ranged from 18 to 73 years. The operations were performed within 1-3 weeks after the injury. The method of subcutaneous subfascial osteosynthesis was used in 10 patients.
Results and conclusions: subcutaneous-subfascial osteosynthesis refers to minimally invasive methods of surgical treatment of fractures and corresponds to modern trends in traumatology and orthopedics, as it provides stable fixation of fragments in fractures of the lower third of the shoulder and minimizes traumatization of soft tissues and neurovascular structures

Rationale: three methods are used for surgical correction of femoroacetabular impingement (FAI): surgical dislocation of the femoral head (Dann-Ganz operation), minimally invasive technique with direct anterior access (mini-open operation) and arthroscopic intervention.
The aim of the study was to evaluate the results of treatment of FAI with open surgical dislocation within 12 months after surgery.
Material and methods: a single-center, prospective, controlled, non-comparative study was conducted. From 2019 to 2021, 30 patients with FAI underwent open surgical dislocation. The results of treatment were evaluated using radiation research methods, magnetic resonance diagnostics and patient questionnaires using the iHOT12, HOOS, and VAS scales. Statistical data analysis was carried out using Microsoft Office Excel 2010 and Statistica 12 STATSOFT programs. To assess the normality of the data distribution, the Q–Q Plot and the Shapiro-Wilk criterion were used. Quantitative data are presented in the form of M±SD (where M is the average value, SD is the standard deviation). Qualitative data are presented in the form of P±σp (where P is the percentage, σp is the standard deviation of the percentage). Qualitative indicators were analyzed using conjugacy tables and the Pearson Chi-square criterion with the Yates correction. The data were considered statistically significant at p≤0.05.
Results: it was possible to achieve the angle-alpha indicators close to the target values. Analysis of gait biomechanics and scores on the iHOT12 and HOOS scales before and after surgery revealed no statistically significant differences. During the follow–up period, complications were revealed: avascular necrosis of the femoral head – 3 (10%), non–fusion of the osteotomy zone of the great trochanter - 1 (3,3%), heterotopic ossification of the abductor muscles – 1 (3,3%), persistent postoperative pain syndrome – 4 (13,3%).
Conclusion: performing an open surgical dislocation with FAI makes it possible to achieve complete correction of deformity. However, a significant number of complications indicates the need to consider minimally invasive techniques, such as arthroscopic correction and mini-open surgery

Objective. o improve the diagnostic capabilities and treatment results of patients with diverticular colon disease (DBTK) complicated by the development of colorectal cancer. Materials and methods. A study was conducted with the participation of 72 patients treated at the State Clinical Hospital of the NSR of Vladimir from 2013–2023 with DBTC complicated by the presence of acute colonic obstruction. There were 56 men (77.7%) and 16 women (22.2%). The average age of the patients was 56.2±11.3 years. All patients had a history of clinical manifestations of DBTC. In 98% of the cases of the studied patients, with a disease duration of more than three years, there were at least three exacerbations of acute diverticulitis of the colon during the year. The mandatory diagnostic program included: general clinical examinations, ultrasound and CT of the abdominal cavity and pelvis, Cnott irrigoscopy, fibrocolonoscopy (FCS) with histological verification. All patients, upon admission, underwent a complex of therapeutic measures aimed at resolving intestinal obstruction. In 54 (75%) patients, the obstruction was of an obstructive nature. 18 (25%) had partial colonic obstruction, which resolved after conservative treatment.
Results: The main complaints of the subjects were pain in the left half of the abdomen, periodic rises in body temperature, weight loss, stool disorders such as constipation or diarrhea, blood admixture in feces. In 45 (62.5%) cases, against the background of ultrasound signs of acute diverticulitis, a tumor-like formation in the intestinal wall with signs of colonic obstruction was determined. Irrigoscopy was performed in 54 (75%) cases. In 26 (36.1%), the tumor was localized in the sigmoid colon, 9 (12.5%) – in the splenic bend of the colon, 9 (12.5%) – in the descending intestine, 10 (13.8%) – in the recto-sigmoid colon. Fibrocolonoscopy with biopsy was performed in 18 (25%) cases. Against the background of DBTC, a tumor of the sigmoid colon was detected in 10 (13.8%) patients, a tumor of the recto-sigmoid department in 3 (4.1%) cases, cancer of the descending intestine in 2 (2.7%) patients and a tumor of the splenic bend of the colon in 3 (4.1%) cases. 72 (100%) patients were operated on. The main types of surgical treatment were: obstructive resection of the sigmoid colon in 25 (34.7%) cases, resection of the sigmoid colon with the imposition of primary anastomosis in 20 (27.7%) patients, resection of the sigmoid colon with the imposition of preventive loop transversostomy in 6 (8.3%) cases, in 15 (20.8%) left-sided hemicolectomy with the imposition of primary anastomosis, left-sided hemicolectomy with Thornball preventive ileostomy was performed in 6 (8.3%) patients. Complications occurred in 6 (8.3%) cases. There were no fatalities.
Conclusion: the only radical method of treatment for this category of patients is only surgical intervention. The use of modern methods of instrumental diagnostics allows you to choose the most optimal amount of surgical intervention. When detecting a combined lesion of the colon of DBTC and cancer, an intervention should be performed in compliance with oncological principles and the expansion of the boundaries of colon resection with the removal of the zone of spread of diverticulosis

Backgraund: for the purpose of navigation during laparoscopic cholecystectomy, intraoperative laparoscopic ultrasound (IUS, LUS) has been actively used. This technique is non-invasive, non-irradiating and can be performed repeatedly. LUS has high sensitivity and specificity of 93% and 96%, respectively, and is also characterized by the high quality of intraoperative diagnostics of choledocholithiasis in real time, the absence of invasiveness, short imaging time, the ability to repeat imaging at any stage of the operation, and the absence of ionizing radiation.
Aims: improve the results of laparoscopic cholecystectomy using laparoscopic ultrasound.
Materials and methods: a review of the results of 455 LUS performed during laparoscopic cholecystectomy for cholelithiasis and its complicated forms since 2013 is presented. Patients range in age from 28 to 75 years. Aloka Prosound 6 device and UST-5550 linear laparoscopic high-frequency ultrasound transducer were used to perform LUS, with a movable distal working area, the possibility of using color and pulse Doppler examination.
Results: LUS allows you to assess the condition of gallbladder walls, its lumen, condition of nearby organs, to obtain information about the topographic anatomy of bile ducts, as well as the structure of walls and contents of the bile ducts. The study allows to prevent vascular injury around the Calo triangle, to assess the condition of the lymph nodes of hepatoduodenal ligament. By means of a LUZI, visualization of instruments inserted into the lumen of the bile ducts is possible, which allows you to perform an operational manual under control.
Conclusions: in all cases, the ultrasound was performed without complications, and no contraindications to the study were revealed. The average study time was about 4 minutes. Ultrasound allows you to identify in real time the anatomical features of the structure of the biliary tract and blood supply of a particular patient, assess the condition of the lumen of the biliary tract, assess the condition of the walls of the gallbladder and bile ducts, and the surrounding tissues. The ability to visualize instruments in the lumen of the bile ducts, as well as calculi and sludge, allows simultaneous intervention to be performed under LUS control

Justification. Surgical infection is an urgent medical problem, as up to 40% of patients in surgical hospitals are hospitalized for purulent-septic complications of various diseases. At the end of the 20th century, low-temperature argon plasma or low-temperature plasma became widely used in medicine.
The purpose of this publication is to evaluate the effectiveness and safety of using the PlazmoRan plasma arc installation (manufactured by PlazmoProm (Russia)) in the complex treatment of chronic infected wounds, including postoperative wounds.
Methods. A study was presented in which 41 patients were included. The main group consisted of 20 patients in whom, in addition to complex therapy, therapy using the PlazmoRan installation was applied. The control group included 21 patients who received standard treatment. The clinical criteria for assessing the condition of patients were an assessment based on the comorbidity index and the severity of surgical complications. The criteria for evaluating the wound process were cytological examination of wound exudate, bacteriological examination, and visual assessment of the timing of the appearance of granulation tissue in the wound. The dynamics of the systemic inflammatory response syndrome was assessed according to clinical blood analysis, biochemical blood analysis (C-reactive protein), thermometry monitoring, respiratory rate and heart rate.
Results. The use of the plasma arc PlazmoRan installation in the complex treatment of infected wounds helps to reduce the duration of the wound process, the early onset of the regeneration phase, reduces the manifestations of the systemic inflammatory response syndrome, which in this study made it possible to shorten the treatment time of patients.
Conclusion. The use of low–temperature plasma is a safe, painless, easy-to-use and well-tolerated method in the complex treatment of infected wounds, which does not interfere with early activation. It helps to quickly clean wounds, heal them, and reduce the severity of local and general symptoms of the infectious process

Background: On August 14, 2023, as a result of an explosion at a service station in the Kumtorkalinsky district of the Republic of Dagestan, 119 people were injured, 35 of them died, including 3 children.
Purpose: To assesse the transfusion of blood components to the victims, the adequacy of the stocks and actions of the blood service, as well as donor practices before and after the disaster.
Methods: We studied the work of the blood service and transfusion care in medical organizations of the Republic of Dagestan after an explosion at a service station in the Kumtorkala region.
Results: 74 patients were hospitalized, there were no deaths. Blood components were received by 14 (17.7%) patients. The ratio of transfused units of erythrocytes and plasma was 0.37 or 1:2.7. On the first day, 56.3% of erythrocyte units and 65.1% of plasma units were transfused. On average, 1 recipient received 1.1 units of erythrocytes and 3.1 units of plasma. Similar indicators per 1 hospitalized patient were 0.2 and 0.5 doses, respectively. The transfusion therapy of the victims of the tragedy required the use of 2.6% of the stock of erythrocytes and 1.9% of the stock of plasma. During the working week, the number of donations at the Republican Blood Transfusion Station (RSPK) increased by 128%, and at the Kuraev Children’s Republican Clinical Hospital – by 73%.
Conclusion: The work of the RSPK and the blood services of the hospitals of the Republic of Dagestan made it possible to provide adequate transfusion assistance to the victims of the explosion

Unfortunately, the problem of traumatic abdominal injuries does not lose its relevance. According to the data presented in the scientific literature, injuries to this anatomical area in the structure of combat wounds occur in 4-7% of observations. At the same time, the most severe injuries occur with wounds in the pelvic region.
Goal. To study changes in the hormonal background in dynamics in women with penetrating gunshot wounds of the pelvis in the immediate postoperative period. Materials and methods. 40 patients from among the civilian population who were treated for penetrating gunshot wounds of the pelvis received as a result of local hostilities were selected for scientific work. All patients were female, the average age was 36±4 years (M±m). It is proved that the immediate postoperative period depends on the time factor that occupies the interval from the moment of injury to the surgical intervention. Based on this, we have formed two clinical groups. In the first (A), the wounded were selected in the number of 20 (50%) people, whose time interval did not exceed 60 minutes, in the second (B) – 20 (50%) wounded, whose time interval exceeded 60 minutes. In the course of the study, hormones related to stress were studied: thyroid-stimulating hormone, cortisol, insulin-like growth factor, leptin, adrenaline, serotonin, histamine.
Results. The study shows that gunshot wounds of the pelvis in women lead to changes in the hormonal background, which depend on the time elapsed from the moment of injury to the start of surgical treatment and vary depending on the day that has passed since the surgical intervention. Starting from the first day after surgery, an increase in hormones was registered, the regulation of which is by the hypothalamicpituitary system, as well as hormones produced by the adrenal cortex. First of all, it is an insulin-like growth factor and adrenaline. At the same time, the increase in hormones in the two groups was different, in group A, where help was provided faster, respectively, the traumatic factor was less, the amount of hormones increased compared to normal indicators, however, it was less compared to group B, where the traumatic factor was significantly longer. At the same time, hormonal recovery in group A was also faster compared to group B. During the study, it was found that in group B, starting from 5-7 days after the surgical intervention, there was an increase in the amount of glucose in the blood serum, and this was noted against the background of an increased content of hormones involved in metabolic processes. The restoration of the serum glucose index occurred on the 17th-19th day after the surgical treatment, when there was a complete restoration of the hormonal background in the operated patients.
Conclusion. Based on the conducted research, it can be concluded that gunshot wounds of the pelvis in women lead to changes in the hormonal background, which depend on the time elapsed from the moment of injury to the start of surgical treatment and vary depending on the day that has passed since the surgical intervention

Backgraund: The treatment of patients with wound defects of soft tissues is a difficult task for the healthcare system. Despite the variety of methods, it is not always possible to achieve positive results. The development of new technologies aimed at stimulating of regeneration can help improve the results of skin plastic in the complex treatment of wounds.
Aims: To study the clinical efficacy of the wounds plastics using autologous red bone marrow aspirates.
Materials and methods: A prospective simple controlled randomized clinical trial was conducted on two parallel groups of patients.
The study involved 84 patients with wounds that arose after surgical treatment of abscesses and phlegmons, surgical site infections and injuries.
The main group consisted of 42 patients who used the technique of the wounds plastics using autologous red bone marrow aspirates. Indication for use of the method – wounds with the signs of chronicity of wound healing. The area of wounds defects was 24 (12; 32,5) cm2.
The comparison group consisted of 42 patients who were treated using traditional methods. The area of wounds defects was 23,8 (11,98; 31,6) cm2.
The planimetry was performed using ImageJ software. Statistical data processing was performed using Microsoft Excel 2018, Statistica 7.0 and IBM SPSS Statistics 22 programs. The differences between the groups were considered significant at p<0,05.
Results: Among 42 patients in the main group, in 33 (78,57%) wounds healed, in 6 (14,29%) – partial lysis was noted, in 3 (7,14%) – lysis of the skin flap. Among 42 patients in the comparison group, wound healing was observed in the 26 (61,9%) patients, partial flap lysis – in the 7 (16,67%) patients, and lysis – in 9 (21,43%) (p<0,05).
Conclusion: The wounds plastics using autologous red bone marrow aspirates is characterized by a fairly high clinical efficacy. This approach significantly improved the results of autodermoplasty by 16,67%.

The modern scientific literature overwhelmingly pays attention to the arterial and, to a lesser extent, the venous link of the myocardial blood supply. However, the lymphatic drainage system from the structures of the heart remains practically unlit. This literature review is devoted to the lymphatic bed of the heart. The historical aspects of his discovery are shown, modern data concerning embryonic development, anatomical structure and function of the lymphatic structures of the heart, and features of lymph outflow from the myocardium are presented. Modern methods of assessing the development, structure and function of the lymphatic structures of the heart based on the use of specific markers of lymphoid structures are demonstrated. Special attention is paid to the possibilities of stimulating the lymphatic system of the heart in order to prevent the development of interstitial fibrosis, as well as heart failure in acute circulatory disorders and inflammatory changes of the myocardium

Coronary artery bypass grafting remains a widespread and vital treatment for patients with multivessel coronary artery disease, especially diabetics. Despite the success of the surgery, the long-term outcome of coronary bypass grafting is influenced by the choice of used grafts. Currently, the internal thoracic artery, radial artery, and saphenous vein graft are used as grafts in coronary bypass grafting. The long-term benefit of the anastomosis between the left internal thoracic artery and the anterior interventricular branch of the left coronary artery is well established and remains the gold standard for revascularization of severe coronary artery disease. The radial artery and saphenous vein are grafts of the second order. Presently, there are discussions about which of the grafts is more effective and more durable, since the long-term functioning of the grafts makes it possible to protect patients from the risk of recurrent symptoms of coronary heart disease and the development of life-threatening complications. Each conduit has its own pathophysiological, anatomical and histological features, in our opinion, the combination of the radial and internal thoracic arteries under the term «autoarterial bypass surgery» and the analysis of these conduits in a single group can lead to incorrect interpretation of the data and the formation of unreliable conclusions

The paper highlights the evolution of mitral valve prosthetics, from the first developments to modern innovative technologies. The history of development of prosthetic methods both in Russia and in the world, their effectiveness, advantages and disadvantages, as well as the latest developments in the practice and technology of mitral valve prosthesis are considered. The article also provides an overview of the results of clinical trials conducted using different types of prostheses and their impact on survival and quality of life of patients. The problems faced by physicians and researchers in this field are analyzed, and the prospects for the development of mitral valve prosthetics are discussed

Objective. To perform a meta-analysis of publications to assess the safety and effectiveness of epicardial thoracoscopic ablation.
Material and methods. The research was searched for and selected by two independent researchers. Any disagreements were resolved by involving a third party. When summarizing the data from individual studies, taking into account the significant statistical heterogeneity of the indicators, a random effects model was used.
Results. In total, 13 articles are included in the analysis. The number of patients presented in the publications ranged from 10 to 475, with an average age of 54 to 62 years. A meta-analysis of the development of all complications; major cardiac and cerebral complications; freedom from atrial fibrillation after 12 months was performed. The analysis of the number of complications by different authors revealed that the average frequency of the complicated postoperative period was 11.0% (95% CI 1.0–1.5%). The indicator had high heterogeneity (I2 = 85.5%, p<0.001), taking values from 1.0% (van Laar, 2019) to 39.0% (Adiyaman, 2018). A meta-analysis of the incidence of major cardiac and cerebral complications showed that the average result was 2%. The indicator had moderate heterogeneity (I2 = 35.5%, p = 0.01). The results of a meta-analysis of the frequency of freedom from atrial fibrillation 12 months after epicardial thoracoscopic ablation surgery showed that, on average, the sinus rhythm was maintained in 79% of patients (95% CI 73.0–85%). The indicator had high heterogeneity (I2 = 87.4%, p<0.001), taking values from 35.0% (Adiyaman, 2018) to 95.0% (Sindby, 2018). Conclusion. This study showed the high effectiveness of the operation under study for the treatment of atrial fibrillation with a low risk of major cardiac and cerebral complications

Varicose veins of the lower extremities are quite common in the elderly population. The severity of venous disease is determined by the individual tolerance of the symptoms of varicose veins, taking into account the natural aging of the body and the existing comorbid status. This article provides an overview of the problem of varicose veins and chronic venous insufficiency in general and through the prism of patients of the older age group. The advantages and limitations of various approaches to the diagnostics and treatment of varicose veins in the gerontological patients are discussed and presented. Endovenous treatment modalities, specifically glue ablation, open new horizons of pain-free and radical treatment of varicose veins in the elderly patients

Introduction: Degenerative and dystrophic diseases of the lumbar spine in Russia rank 5th among the causes of hospitalization and 3rd among the causes of surgical treatment. Herniated discs are the most common degenerative disease of the lumbar spine causing low back pain and radicular symptoms in the lower extremities. Lumbar microdiscectomy has become one of the most common spinal surgeries. Various worldwide studies cite a postoperative recurrence rate ranging from 1.1% to 27.3%. Recurrences of herniated discs are one of the main reasons for revision surgeries in spinal surgery. Also in a number of cases, radicular pain syndrome persists after microdiscectomy, which may be associated with biochemical changes in the intervertebral disc. Through the annular defect inflammatory mediators (interleukins), cytokines and chemical agents are released from the pulposus nucleus, which cause irritation of the spinal ganglion and nerve root. Purpose of the study: to analyze the frequency and causes of recurrence of herniated discs after microdiscectomy and sequestrectomy according to the literature, which will allow us to develop a device to reduce the number of recurrences
Materials and methods: we searched available literature sources, including PubMed and eLibrary databases, for the following keywords: «recurrence of disc herniation», «annulus fibrosus defect», «annulus fibrosus prosthesis», «lumbar disc reoperation», «annulus fibrosus defects», «annulus fibrosus prosthesis». The depth of the search was more than 20 years (2002–2023). As a result of the search, 108 articles were found and analyzed.
Results: In our opinion and according to the literature, the most complete reduction in the number of disease recurrences is possible only with the help of mechanical obstruction of regenerate or intervertebral disc substance exit into the spinal canal by covering the intraoperative defect of the annulus fibrosus. We analyzed the devices, methods that were used earlier or are used now, formulated the requirements that, in our opinion, the implant should possess. Based on this, we came to the conclusion that at present there is no device that meets all the requirements. The time of implant degradation should coincide with the process of fibrous ring regeneration to ensure proper tissue remodeling. The change in the mechanical properties of the implant as a result of degradation must remain compatible with the repair and regeneration process. Finally, the implant should contribute to the restoration of normal spine biomechanics: restoration of IVD height; correct distribution of load on all areas of the IVD; restoration of physiologic volume of movement, lordosis; achievement of sagittal balance.
Conclusion: Based on the analysis of the world literature data, we started to develop a biocompatible biodegradable device for filling the intervertebral disc cavity and closing the defect in the area of the annulus fibrosus after sequestrum and microdiscectomy to restore the biomechanics of the vertebral-motor segment in the lumbar spine and to eliminate postoperative recurrences. At present, the FGBNU «Petrovsky RRCS» together with SIC «Kurchatov Institute» are conducting laboratory tests of prototypes to study the static properties of materials and select the most suitable one

Predicting and preventing the development of death and chronic thromboembolic hypertension in patients with pulmonary embolism is one of the urgent problems of modern medicine. The introduction into clinical practice of stratification of the risk of early death from pulmonary embolism has made it possible to optimize the treatment of these patients in many ways. However, uncertainty remains in the choice of the volume of therapy in patients with moderate risk of early death. What underlies the often incorrect choice of treatment tactics and, as a result, the development of chronic thromboembolic pulmonary hypertension in these patients, more often than in other patients. Many researchers see ways to solve this problem in establishing new echocardiographic criteria for the severity of pulmonary embolism. This article analyzes modern literary data and the results of their own research. The superiority of determining the pressure gradient on the pulmonary artery valve, calculated on the basis of measuring the volume of the heart ejected into the aorta in one systole during echocardiography, over most widely used parameters is shown

A 59-year-old man with a multivessel lesion of the coronary artery. Initially, the patient was scheduled to undergo minimally invasive coronary bypass surgery. Intraoperatively, such a nature of damage to the coronary arteries was revealed, which required the conversion of the original operation plan. Hybrid extracardial myocardial vascularization was performed

Two clinical cases of surgical tactics options for Burhaаve syndrome (spontaneous perforation of the esophagus) are presented. The assessment of the status of patients, the nature of interventions, the results of histological examination and the outcomes of the disease was carried out.
In both cases, the reason for hospitalization in the thoracic department was a spontaneous rupture of the esophagus, complicated by mediastinitis and pleural empyema.
The first patient, 59 years old, underwent esophageal extirpation with the imposition of gastro- and esophagostomy. Сlinical recovery has been achieved with the reconstructive surgery was performed. The second patient, 69 years old, underwent conservative treatment. On the 7th day, there was an arrosive bleeding. A thoracolaparotomy and suturing of the esophageal defect were urgently performed. In the postoperative period, there was a progressive deterioration with the death for the esophageal sutures leak and coronary syndrome.

Intraocular tuberculosis is a great mystifier of various forms of uveitis, and it should be put in the first row in the differential diagnosis of any type of intraocular inflammation, as well as clearly differentiate it from other etiologies of choroidal lesions, which presents certain difficulties due to the diversity, mosaic, and often atypical clinic of the tuberculosis process. The article presents a clinical observation of tuberculous uveitis in a 61-year-old patient D., which was well stopped by nonspecific anti-inflammatory therapy and antibacterial drugs. When conducting and evaluating the results of additional studies, such as computed tomography of the chest and a highly specific TSPOT.TB test, the patient was suspected to have a latent tuberculosis infection in the patient. As a result, a test with recombinant tuberculosis allergen (ATR) was performed, as a result of which the authors received a pronounced focal reaction from the eye. Thus, for the first time in the world scientific community, a clinical picture of a pronounced reaction of the eye to an ATR test is presented, since at the moment there is no information among the available sources of domestic and foreign literature that describes the same reaction to an ATR test as in the presented clinical example. The authors note that the eccentricity of the course of tuberculosis of the visual analyzer obliges the doctor to correctly collect an anamnesis, choose current diagnostic methods, correctly evaluate their results and evaluate the effectiveness of anti-tuberculosis therapy.

Liver cirrhosis is one of the factors in the development of portal hypertension. Portal hypertension leads to dilation of collateral portosystemic veins along the gastrointestinal tract. The most common and serious complication of portal hypertension is varicose veins of the esophagus and bleeding from them. Less known, but no less dangerous, is bleeding from varicose veins of the lower gastrointestinal tract. The incidence of varicose veins occurs in 38–56% of patients with liver cirrhosis. Confirming the diagnosis is often difficult, and bleeding is sometimes massive. It can be life-threatening if not clearly diagnosed and treated promptly. Unlike the treatment of gastric and esophageal varices, there is currently no definitive recomended treatment due to insufficient data and rarity. In this article, we report the case of a 78-year-old woman with liver cirrhosis and rectal variceal bleeding which was refractory to medical and endoscopic therapy and successfully treated with transjugular intrahepatic portosystemic shunting (TIPS).

In this article a clinical case of a patient with locally advanced colon cancer is presented. The necessity and expediency of performing multivisceral colon resection are discussed. In colon cancer involving neighboring organs and soft tissues, secondary lesions are limited in nature, which makes it possible to consider the possibility of performing organ-preserving surgical interventions. A patient with a tumor of the splenic bend of the colon with signs of extraorgan spread underwent a combined left-sided hemicolectomy with longitudinal resection of the stomach, resection of the left dome of the diaphragm with an atypical resection S4. 5 of the left lung, splenectomy. The postoperative period was uneventful. He satisfactorily underwent 4 courses of adjuvant chemotherapy according to the XELOX regimen. With dynamic observation, no data for recurrence was obtained, and stabilization of the process was achieved. The patient currently feels satisfactory and leads an active lifestyle

Rationale. Os acromiale is a variant of nonunion of the apophysis of the acromial process, occurring in 6–8% of cases in the adult population. Symptomatic os acromiale may be accompanied by pain and decreased muscle strength during active sports.
Target. The main goal is to develop an effective method for of treatment of symptomatic os acromiale in athletes.
Materials and methods. A technique for surgical treatment of unstable os acromiale in athletes has been proposed, including mobilization of a free bone fragment of the acromion, formation of bone tunnels using a double-barreled guide for parallel drilling of bone canals and osteosynthesis using two cannulated screws.
Conclusion. Thus, our proposed technique allows us to achieve reliable fixation of an unstable fragment of the acromial process without the use of additional grafts with simultaneous correction of the shape of the acromial process of the scapula to prevent the subsequent development of impingement syndrome and disruption of the congruence of the acromioclavicular joint

A clinical case of colorectal cancer complicated by acute intestinal obstruction, combined with acute violation of mesenteric circulation, is presented. The patient was admitted to a multidisciplinary hospital in St. Petersburg in extremely serious condition. The examination revealed widespread peritonitis complicated by abdominal sepsis and septic shock. After the patient was brought out of critical condition, an operation was performed. The operation revealed cancer of the hepatic bend of the colon, complicated by acute intestinal obstruction and acute violation of mesenteric circulation. An extended hemicolectomy with resection of 1.5 m necrotically altered ileum was performed. In the postoperative period, the patient underwent program rehabilitation of the abdominal cavity. However, it was not possible to achieve successful treatment. The cause of death was massive bilateral thromboembolism of the pulmonary artery and its branches

Biography of academician Anatoly Panteleimonovich Kolesov, a student and follower of the Kupriyanov Surgical School, his contribution to the development of thoracic and cardiovascular surgery, military field surgery, surgical infection, anesthesiology and intensive care, teaching surgical disciplines is presente

А brief biography of Academician Donat Semenovich Sarkisov and his contribution to the development of medical and biological sciences is presented

Rationale: 2024 marks the 175th anniversary of the birth of the great Russian scientistphysiologist, academician I.P. Pavlov. This year marks the 120th anniversary of his Nobel Prize award. In our difficult times, there is a need not only to develop his rich scientific heritage, but also to preserve for future generations the memorable places associated with his life, including in his small homeland, in Ryazan, where he was born, where his childhood and youth were spent, and the ideological basis of his life was formed.
Purpose: To present the main stages of the life of academician I.P. Pavlov and how the Ryazan region is preserved.
Materials and methods: Analysis of literary data, work with archival materials of the Ryazan State Medical University named after Academician I.P. Pavlov and the Memorial Museum-estate of Academician I.P. Pavlov, located in Ryazan. Results: The authors of the article reflect the main stages of the great scientist’s life and how the memory of him is preserved on the Ryazan land. The article presents a large amount of illustrative material confirming the presented data.
Conclusion: According to the general recognition of scientists around the world, academician I.P. Pavlov is a personality of a planetary scale. Therefore, the memory of this outstanding scientist should be preserved not only in the development of his rich scientific heritage, but also in the preservation for future generations of memorable places associated with his life, including in his homeland, in Ryazan, where he was born, where his childhood and youth were spent and the ideological basis of his life was formed