The biography of the outstanding organizer of national healthcare N.A.
Semashko, his contribution to the development of practical healthcare,  preventive medicine, social hygiene, science, education, organizational and public-state activities is presented. 

Purpose of the study: to evaluate the results of using a protocol for the prevention of bleeding in cardiac surgical patients with pathology of the aortic valve and aortic root to optimize tactics for preventing bleeding.
Materials and methods: the first group included 185 cardiac surgical patients with pathology of the aortic valve and aortic root, who underwent surgery on the aortic valve, during the treatment of which a bleeding prevention protocol was applied. The second group consisted of 237 cardiac surgical patients with pathology of the aortic valve and aortic root who underwent surgery on the aortic valve, during whose treatment a bleeding prevention protocol was not used. Data were collected on the management tactics of the preoperative, intraoperative and postoperative periods, such as:
– anamnestic data, results of echocardiographic examination, laboratory data: preoperative level of hemoglobin, fibrinogen;
– intraoperative level of hemoglobin, fibrinogen, dose of transfused cryoprecipitate, thromboelastometry data, intraoperative blood loss;
– drainage discharge during 1 day of the postoperative period, frequency of bleeding, resternotomy, and deaths.
Study results: In the second group of patients, the number of cases of intraoperative hypofibrinogenemia was almost 5 times greater than in group 1; out of 237 patients, 62 (26.2%) had a critically low level of fibrinogen. Fibrinogen hemodilution coagulopathy (intraoperative hypofibrinogenemia) was associated with resternotomy: Х² = 63.375, p = 0, df = 1, HR = 11.686, 95% CI: 5.61-24.33. Complications associated with bleeding were more common in the second group of patients – 44 (18,6%) cases out of 237 operated patients, Х² = 10,6; р = 0,001, Х²_Yates = 9,693; р = 0,002, RR = 2,453, 95% CI: 1,39-4,34. In the first group, there were only 14 (7,6%) cases of complications associated with bleeding out of 185 operated patients. Significant differences were also found in the frequency of resternotomies: in group 1 – 3 (1.6%) cases, in group 2 – 28 (11.8%) Х² = 15,859; р = 0 (Х²_Yates = 14,397, р = 0; р (F) = 0; RR = 7,286, 95% CI: 2,25-23,59). Of 185 operations in group 1, only 3 cases of resternotomy were observed, which corresponds to 1.6% of all patients in group 1. Upon repeated inspection of the surgical wound, surgical sources of bleeding were identified in all 3 cases. Of the 237 operations in group 2, there were 28 cases of repeated revision of the surgical wound. Of the 28 resternotomies, only in 15 cases a surgical source of bleeding was identified, therefore, the remaining 13 cases of bleeding occurred due to coagulopathy. In group 1, there were no cases of resternotomy performed due to hypocoagulable bleeding. A statistically significant association was found between preoperative anemia and resternotomy (x², p = 0.039, RR = 2.03, 95% CI: 1-4).
Conclusions:
1) intraoperative hypofibrinogenemia increases the risk of resternotomy 11 times (x² = 63.375, p = 0, df = 1, RR = 11.686, 95% CI: 5.61-24.33);
2) preoperative anemia doubles the risk of resternotomy (p = 0,039, ОR = 2.03, 95% CI: 1-4);
3) when using the bleeding prevention protocol, intraoperative hypofibrinogenemia occurs 5 times less often;
4) when using the bleeding prevention protocol, complications associated with bleeding are 2.5 times less common: Х² = 10,6; р = 0,001, Х²_Yates = 9,693; р = 0,002, RR = 2,453, 95% CI: 1,39-4,34;
5) when using a bleeding prevention protocol, the risk of resternotomy is reduced by 7 times: Х² = 15,859; р = 0 (Х²_Yates = 14,397, р = 0; р (F) = 0; RR = 7,286, 95% CI: 2,25-23,59).

Objective. To compare the results of surgical and conservative treatment of patients with acute myocardial infarction admitted to a medical institution 48 hours after the occurrence of a coronary event.
Materials and methods. The analysis of surgical treatment and postoperative observation of 43 patients with acute coronary syndrome admitted to hospital treatment within 72 to 120 hours from the onset of acute myocardial infarction was performed. All patients were divided into 2 groups: Group 1 (n = 17) included patients who underwent PCI for vital indications due to the presence of one or more emergency conditions in patients. Group 2 (n = 26) included patients who were hospitalized in a stable condition: they had no pain syndrome, life-threatening cardiac arrhythmias; hemodynamic parameters were within normal limits. The patients underwent complex conservative therapy, PCI was recommended on a delayed basis.
Results. Two months after the treatment, higher myocardial functioning indices, and, as a result, better quality of life, were recorded in patients in the surgical treatment group. A greater number of fatal complications were recorded in patients after myocardial revascularization (which is explained, in all likelihood, by the extensive area and depth of damage to the heart muscle), and the number of non-fatal complications prevails in the conservative treatment group.

Background. Incidental durotomy is a common complication in degenerative spine surgery and according to the literature occurs in 1 to 17%. Different clinical cases with severe complications are described and which are resulted in wrong tactics for dural lesion treatment.
Objective. To evaluate frequency, treatment methods and possible complications of incidental durotomy in spinal degenerative disease surgery.
Material and Methods. A retrospective analysis of the data of 859 patients who underwent surgery in spinal department since 2018 till 2021.
Results. 22 cases of incidental durotomies were found. One during anterior cervical discectomy (ACD), one during lumbar laminectomy with posterior instrumentation, six during microdiscectomy and fourteen during lumbar minimally invasive unilateral decompression. Three patients repeated revision surgery due to complication: liquorrhea, wound infection. Maximum follow-up period was 24 months. Positive results were achieved in all cases. The frequency of incidental durotomies depends on whether the operation is revision: 18.8% (9 injuries out of 48 revision operations) vs. 1.6% (13 injuries out of 811 primary operations). p<0.001. The risk of durotomy during revision surgery is 10 times higher (RR = 10,0; 95%, CI: 4,5–22,4).
Conclusion. A statistically significant relationship was revealed between the incidence of durotomy and the type of surgery. During minimally invasive unilateral decompression for bilateral stenosis the risk of incidental durotomy is significantly higher. Primary repair of the incidental durotomy is recommended to prevent complications. If wound liquorrhea is detected, lumbar drainage system is recommended. The liquorrhea lasting more than 48 hours is an indication for revision surgery. In our study the VAS back and limb score and ODI did not differ from similar data of patients without incidental durotomy. If primary repair of durotomy is performed and liquorrhea is eliminated, the results of treatment of this patients are good. No consequences are noted when primarily dural repair is performed.

Rationale: Endovascular intervention is often the first-line treatment for patients with intracranial artery pathology. Specialists performing therapeutic interventions on cerebral vessels must have practical training, since the cost of error is extremely high. For this reason, these interventions are performed by residents and interns less often than other endovascular surgeries. Printing of 3D models is a unique educational tool that can improve the effectiveness of training in endovascular techniques. However, to date, the role of this new technology in training specialists, as well as the features of its application, have not been sufficiently covered.
Objective: to analyze the effect of 3D printing of an individually recreated digital model of vascular structures of the brain on the results of training and education in the technical aspects of endovascular neurointerventions.
Materials and methods: At the first stage of the study, an analysis of the fundamental possibility of 3D printing was carried out, based on an individually recreated digital threedimensional model of vessels (using the carotid artery bifurcation as an example). Silicone was selected as the raw material for 3D printing. It was found that when printing with one-component silicone, there is significant ribbing of the model. Two-component silicone compounds were tested; their compliance with the required characteristics of the vascular model in terms of optical transparency and strength was demonstrated. 20 variants of carotid artery bifurcation models were manufactured. The task of the second stage was to create 3D models of vascular structures of a more complex shape and a smaller internal diameter than at the first stage. As a result, 3D models were designed and samples of cerebral arteries (2-5 mm) were created on their basis. At the third stage, the arterial vascular models were used for training in endovascular neurointerventions.
Results: Five endovascular surgeons (with conditional numbers 1-5) took part in the simulation training. None of them managed to successfully complete all 10 attempts, while at least one success was recorded for all of them. Number of successful attempts: 8, 7, 7, 1, 3 respectively. Number of attempts to the first success: 1, 2, 1, 7, 6. Time spent on a successful attempt (M±σ): 25±8, 30±12, 45±15, 45, 65/60 min. Overall assessment of the effectiveness and feasibility of the simulation training by the surgeon on a 5-point scale: 3, 4, 5, 5, 3. Most of the training participants noted the low realism of the models
and the discrepancy between the characteristics of the inner wall of the model and the real endothelium of the vessel: the silicone was too rigid, which limits its use as a training prototype.
Conclusion: 3D printing of vascular structures for the purpose of practicing in neurovascular intervention seems to be a promising technique. The first experience demonstrated that its implementation is accompanied by significant difficulties associated with both the initial experience the new method and with the existing limitations of the technology itself.

Rationale: Ankle injuries involving the tibiofibular syndesmosis often require surgical treatment and selection of the optimal fixation method to restore joint stability. Recent studies in adults have shown that tibiofibular fixation using the TightRope syndesmosis system results in a better functional outcome than screw fixation [1; 2]. There is little evidence to support the preferred design in children and adolescents [3]. This study reviewed the surgical outcomes of two different tibiofibular fixation techniques for ankle syndesmosis injuries in adolescents.
Objective: To compare two methods of fixation of the tibiofibular syndesmosis in adolescents to improve treatment outcomes.
Methods: A prospective study of patients with a closed growth plate was performed. The age of the patients ranged from 15 to 17 years, the total number of children was 62 people. This cohort of patients was divided into two groups: the main and the control. In the main group, the tibiofibular syndesmosis was fixed using the TightRope system, in the control group, the tibiofibular fixation was performed using a 3.5 mm cortical screw. To assess the recovery of the ankle and foot function, the international FAAM scale (adl subscale) was used at 8–10 weeks and 6 months from the injury. Statistical analysis of the data was performed with the calculation of Student’s t-test at a significance level of p≤0.05.
Results: In the main group, the number of excellent results increased by 9.8% compared to the control group at 10-12 weeks, and satisfactory results by 51.3% at p≤0.05 at 10–12 weeks based on statistical analysis of the results of ankle and foot function recovery according to the FAAM scale (adl subscale). The number of excellent and good results increased by 7.2% six months after the injury.
Conclusions: The use of the TightRope system allowed for earlier loading of the limb, which led to a significant improvement in ankle and foot function at all stages of recovery.

Backgraund: Proximal femur fractures are a serious medical problem, especially among elderly patients.
Aims: This study aims to compare the effectiveness of various rehabilitative treatments among elderly patients with proximal femur fractures.
Materials and methods: The research was conducted between 2022 and 2023 at the state autonomous healthcare institution “City Clinical Hospital No. 7 named after M.N. Sadykov” (Kazan, Russia). The study included 150 patients randomised to four groups. Group 1: patients after osteosynthesis with restorative treatment (n = 37), Group 2: patients after osteosynthesis without restorative treatment (n = 38), Group 3: patients after endoprosthesis with restorative treatment (n = 38), Group 4: patients after endoprosthesis without restorative treatment (n = 37). Rehabilitation treatment included physical therapy (PT) and physiotherapy. All patients received basic medical therapy, including non-steroidal anti-inflammatory drugs (NSAIDs) and analgesics. Statistical analysis: Descriptive statistics, analysis of variance (ANOVA) to compare groups, and regression analysis were used to identify factors influencing treatment outcomes. Assessments were made pre-operatively, post-discharge and 3 months later using visual analogue scale (VAS), Harris pain scale, SF-36 quality of life scale and Rivermead pain scale.
Results: The mean pain scores (VAS) at baseline were 8.0±0.5 (group 1), 7.9±0.4 (group 2), 7.8±0.3 (group 3) and 7.7±0.4 (group 4). After one month of treatment, the values decreased to 3.9±0.3, 5.4±0.4, 4.1±0.3 and 5.8±0.5, respectively. After three months, the values were 1.5±0.2, 3.7±0.3, 1.8±0.2 and 4.2±0.4, respectively. The analysis showed a significant improvement in patients who received restorative treatment compared to those who did not receive restorative treatment (p < 0.001).
Conclusions: Our study confirmed a significant improvement in outcome in patients with proximal femoral fractures treated with surgery combined with physiotherapy and exercise. These data are important for developing clinical recommendations and optimizing standards of care for this group of patients.

This paper summarizes the experience of treating 59 patients with adhesive capsulitis of the shoulder joint. The observation period was 2 years. Rationale of choosing a method of treatment and a methodology of conservative treatment of adhesive capsulitis of the shoulder joint by intra-articular injection of corticosteroids in the projection of the anteriorupper arthroscopic access and subsequent exercise therapy and physical rehabilitation are described. As a result of the study, it was found that in 94% of patients treated for adhesive capsulitis there was a complete relief of adhesive capsulitis symptoms after 3 months from the start of the treatment, a full range of motion was achieved.

Background: Controlled generation of active forms of oxygen and nitrogen stimulates wound healing processes. One of the sources of controlled generation of active forms of oxygen and nitrogen is low-temperature argon plasma. Low-temperature plasma activates various forms of cellular activity. However, the subtle mechanisms of such stimulation remain unclear. Thus, there is a need for a detailed study of the biological effect of low-temperature argon plasma on human cells.
Objective: to evaluate the effect of low-temperature argon plasma on the structure and proliferative activity of human fibroblasts in vitro.
Materials and methods. Human fibroblast culture (line M-21, passage 25, Chumakov Institute of Poliomyelitis and Viral Encephalitis) was used in the work. After exposure to low-temperature argon plasma, the cells were cultured for 3 days in DMEM/F12 medium supplemented with 10% Gibco bovine embryo serum, then morphofunctional analysis of the cells was performed using vital staining. After 3 days, the cells were passaged (reseeded in other Petri dishes with a 1:2 dilution), then the cells were cultured for 3 days, and a repeated morphofunctional analysis was performed. All work with cell cultures was carried out in accordance with the international GMP standard.
Results. Stimulation of the proliferative activity of fibroblasts was noted in the second passage after treatment with low-temperature argon plasma from a distance of 10 cm for 30 and 45 seconds and 15 cm for 45 seconds.The use of a collagen bandage screen significantly increases cell survival when exposed to plasma from a distance of 10 cm for 15 seconds. With screening, the decrease in the integrity of cell membranes after plasma exposure is less pronounced than with exposure without screening. When reseeding, cells treated in the presence of a collagen screen exhibit high proliferative activity and restore membrane integrity.

Rationale: Chronic radiation proctitis is a complication of remote radiation therapy used to treat malignant neoplasms of the pelvis, and is often complicated by the development of rectal bleeding. Argonoplasmic coagulation is one of the available endoscopic methods of their treatment, but the effectiveness of its use needs to be studied.
Objective: To evaluate the effectiveness of endoscopic argonoplasmic coagulation to eliminate telangiectasias of the rectal mucosa in patients with chronic radiation proctitis complicated by bleeding, and to present a sectoral classification of lesions of the rectal mucosa with telangiectasias.
Methods: The article presents the results of treatment of 18 patients with chronic radiation proctitis who underwent argonoplasmic coagulation of telangiectasias of the mucous membrane of the rectum in order to stop bleeding and prevent their occurrence. To assess the effectiveness of treatment, a sectoral classification of the rectal lesion was applied.
Results: After argonoplasmic coagulation of telangiectasia of the rectal mucosa, all patients had no rectal bleeding for 6 months. In 13 (72%) patients, there was a sharp decrease in the frequency of blood excretion during defecation, in the remaining 5 (28%) patients there was no blood excretion from the rectum. In the postoperative period, two recurrence of bleeding from the treatment site was observed on the second and seventh days of the postoperative period, which required repeated application of argonoplasmic coagulation.
Conclusion: Endoscopic argonoplasmic coagulation is effective in eliminating telangiectasia in patients with chronic radiation proctitis complicated by bleeding. The presented sectoral classification of rectal lesions in chronic radiation proctitis is convenient to use and contributes to the assessment of changes in the mucous membrane of the rectum in dynamics.

The article details the history of the development of surgical proctology, from the moment the colostomy appeared, the imposition of anastomoses, the stages of surgical treatment of stoma patients. Methods and results of rehabilitation of  stoma patients, principles of application and closure of single-double-barreled  colostomy, treatment after surgical complications. Influence of this or that method of surgical treatment on social adaptation and quality of life of patients. 

Rationale: Albumin is one of the most important proteins, playing a significant role in maintaining colloid osmotic pressure, wound healing, reducing oxidative damage, transport of drugs and endogenous substances, and coagulation.
Objective: To identify patterns of albumin infusions in a multidisciplinary hospital, to assess the compliance of albumin use with the standards of medical care.
Methods: Retrospectively, based on materials from 43,710 electronic medical records, the infusion of albumin solution to hospital patients at the Pirogov Center in 2023 was studied. Infusions of 25% albumin solution in 50 ml bottles (Kedrion, Italy) were performed. The data were studied using descriptive and inductive statistics, analysis of variance ANOVA at a significance level of 0.05.
Results: 146 people (0.3%) received albumin infusions. In total, patients received 2466 vials of albumin, or an average of approximately 211 grams of albumin per patient. There were 5 groups of albumin recipients: 1) cardiac surgery (n = 45); 2) oncohematology (n = 14); 3) oncology (n = 35); 4) trauma/orthopedics (n = 16); 5) other (n = 36). There were no gender differences in albumin recipients in terms of age, duration of treatment, mortality, volume or regimen of albumin administration. In the selected groups of patients, significant differences in age were revealed. Minimum age – in the oncohematology group: median (quartiles) – 43 (35; 52) years, maximum age – in the oncology group: 67 (59; 73) years (p<0.001). The groups also differed in terms of hospital treatment: minimum – in the cardiac surgery group: median (quartiles) – 13 (9; 17) days, maximum – in the group of other diseases: 22 (15; 35) days (p<0.001) and in intensive care: minimum – in the cardiac surgery group: median (quartiles) – 4 (3; 7) days, maximum – in the group of other diseases: 6.5 (4; 20) days (p<0.001). Body weight is known in 7 patients of the Pirogov Center with a minimum albumin concentration in 2023 (from 11.6 g/l to 18.4 g/l). If we apply a target albumin concentration of 30 g/l, then the prescribed dose of the drug will range from 35.4 g to 91.7 g.
Conclusion: At the Pirogov Center, a 25% albumin solution is administered for replacement purposes, focusing on the target concentration of albumin in the patient’s serum of about 30 g/l. The dosage and duration of albumin administration differs in different groups of patients: the minimum amount of albumin was received by patients in the cardiac surgery group: median (quartiles) – 75 (37.5; 122.5) grams for 2 (1; 3) days, the maximum – by patients in the other group diseases: 110 (62.5; 337.5) grams for 3 (1; 6) days (p = 0.009 and p = 0.012, respectively).
It is advisable:
a) make changes to 11 standards of medical care regulating the dose of albumin in milliliters, without indicating the concentration of the solution;
b) to clarify the possibly overestimated average daily dose of albumin of 100 grams, determined by 4 standards of medical care for cardiac surgery patients.

It is known that coronary artery bypass grafting is still one of the main method of treatments from the point of increasing survival rates and avoidinig resergions and the risk of repeated interventions for most patients, in particular, in patients with multivessel coronary disease and diabetics. More than 45 years have passed since the first operation of coronary artery bypass grafting, and currently coronary artery bypass grafting is not only the most common operation in cardiovascular surgery, but also the “gold standard” for the treatment of the coronary heart disease. Currently, the internal thoracic artery, radial artery, and saphenous vein graft are used as grafts in coronary bypass grafting. And the question of which grafts are more efficient and durable is becoming more and more urgent. The long-term benefit of the internal thoracic artery has long been proven and 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. It is not always possible to achieve complete revascularization with arterial grafts, which requires the use of venous grafts. Unfortunately, the saphenous vein graft does not have the same duration of functioning, which leads to the occurrence of dysfunctions and the development of repeated ischemic events. On the other hand, the radial and internal arteries are exposed to spasm and vulnerable to competitive blood flow In this paper, a detailed analysis of the main types of grafts in coronary surgery is carried out.

Global mortality statistics give coronary heart disease a leading role. Surgical treatment remains the gold standard for improving prognosis and quality of life in these patients. Comorbid pathology, such as type 2 diabetes mellitus and chronic kidney disease, significantly increases the severity of ischemic heart disease, as well as the incidence of perioperative complications and the duration of the rehabilitation period. There are several methods of coronary artery atherosclerosis surgical treatment, such as: percutaneous coronary intervention, coronary artery bypass grafting, as well as a relatively new method of hybrid myocardial revascularization. The decision on the choice of surgical treatment method is made by the Heart Team, which should also include a specialist in the relevant comorbid pathology. Percutaneous coronary interventions are statistically more likely to result in the need for repeat myocardial revascularization than coronary artery bypass grafting. However, open major intervention is accompanied with a great number of postoperative complications and prolonged patient rehabilitation period. Hybrid myocardial revascularization is an alternative method that reduces the risks of adverse complications of multivessel coronary bypass and balloon angioplasty with coronary artery stenting and combines the advantages of both procedures. The choice of the optimal strategy of surgical treatment in patients with comorbid pathology requires special attention.

Coronary heart disease (CHD) is associated with oxidative stress (OS), in which this balance is disrupted, and the production of ROS outweighs their elimination. The oxidative reaction leads to impaired cell function and may increase the likelihood of complications during or after coronary artery bypass surgery (CABG). In pathophysiological conditions associated with OS, there is a general increase in the need for glutathione in antioxidant reactions, conjugation reactions and reduction of protein disulfides. Data on the effect of CABG on plasma aminothiols are incomplete and contradictory.
The plasma pool of aminothiols, on the one hand, has a significant effect on the metabolism of glutathione in the tissues of blood vessels and the heart, and on the other hand, may reflect its disorders. CABG, in turn, can be considered as a procedure that triggers stress and adaptive mechanisms that can have a significant effect on the metabolism of aminothiols. However, to date, data on this effect of CABG are fragmentary. To understand the processes occurring in the aminothiol system in coronary heart disease and CABG, it is important to detect not only shifts in the concentrations of these markers, but also.

Trauma remains a leading global cause of mortality, particularly in the young population. Cardiac damage is a predictor for poor outcome after multiple traumas, with a poor prognosis and prolonged in-hospitalization. Cardiac injury encompasses a spectrum of pathologies ranging from clinically silent, transient arrhythmias to deadly cardiac wall rupture. Of diagnosed cardiac injuries cardiac contusion (blunt cardiac injury) and commotio cordis are most common. Timely diagnosis of this category of victims is a key aspect of successful treatment and emergency care both at the pre-hospital stage and in a specialized medical institution. This narrative review focuses on the main types, etiopathology, as well as classification of cardiac trauma. It explains the main histopathological difference between blunt cardiac injury and myocardial infarction.

Carotid endarterectomy was introduced into clinical practice only in the middle of the last century. However, this intervention has gained a very strong position in the arsenal of vascular surgeons, which is performed in every third case among all operations performed on arterial vessels. This literature review examines the history of the development of carotid endarterectomy methods, technical features and advantages of performing its classical and eversion methods, the relevance and effectiveness of this method of surgical treatment. Particular attention is paid to the analysis of the results associated with perioperative and postoperative complications.

In recent years, due to the accumulation of long-term results of various types of surgical interventions in the pancreaticoduodenal region, the question of the correct tactics of management of patients with primary unresectable periampullary tumors has been raised more often in the medical community. Such patients need palliative treatment consisting in biliary tract decompression, which can improve the patient’s condition by reducing mechanical jaundice and pruritus, as well as increase the probability of survival by reducing the level of total bilirubin. Thus, together with the widespread introduction of minimally invasive interventions, endoscopic biliary stent placement during ERCPG is now recognized as the gold standard for the treatment of these patients. However, due to the development of modern polychemotherapy schemes, accumulation of distant results regarding complications and survival of patients after different methods of biliary tract decompression, the statement about the greatest efficacy of endoscopic methods is questionable. Indeed, due to the increase of patients’ life expectancy the number of complications has also increased. As a result recurrent jaundice and cholangitis requiring repeated hospitalizations with subsequent reconstructive interventions develop.
Having analyzed the available data published in recent years in different countries, we can conclude that in some cases bypass operations are not inferior to minimally invasive interventions, and sometimes, on the contrary, have a number of advantages. In this review, we have extensively collected data comparing the efficacy of endoscopic and bypass surgeries for the treatment of inoperable patients diagnosed with periampullary cancer.

Intraduction. In orthopedic practice, modern surgical treatment of popliteal Baker’s cysts is carried out using arthroscopic methods. Surgical treatment of Baker’s cysts is variable, there is no consensus on the technique and extent of surgical intervention. To date, the search for optimal solutions for arthroscopic intervention remains relevant, which would reduce the cost of patient recovery.
The aim of the work is to evaluate the effectiveness of surgical treatment of Baker’s cyst using arthroscopic technologies according to scientific publications.
Methods. An analysis of 47 literature sources was performed and a comparative evaluation of the effectiveness of surgical treatment of Baker’s cyst, including the use of arthroscopic posteromedial access, was carried out.

Flexible ureterorenoscopy (URS) is the surgery of choice in the treatment of patients with nephrolithiasis. Currently, this technique is successfully used in the treatment of patients with stones not only less than 2 cm, but also in some cases more than 2 cm, with any localization in the kidney with a high frequency of complete stone removal, significantly reducing the time spent in the hospital. However, despite the high manufacturability and safety, flexible URS has its possible complications, which are considered in this literature review.

Rationale: chronic pain syndrome in patients with combined mine-explosive injuries, traumatic limb amputations, extensive burns, etc., is currently especially relevant. The presented analysis of modern literature data on electrophysiotherapy of chronic pain in this category of patients.
Objective: to study the literature data and conduct a comparative analysis of the currently used methods of transcranial electrophysiotherapy of pain syndrome, which will improve the results of treatment of patients with chronic pain syndrome.
Materials and methods: the analysis of articles, reviews, and studies in the modern scientific medical literature on the voiced problem is carried out. The collection of materials was carried out in the electronic libraries of the kirov university, the first sechenov Moscow state medical university, articles from information resources were used: ncbi, pcm; springer; elsevier, embase, web of science and psychinfo, elibrary, etc.
Results: a wide variety of transcranial electrophysiotherapy methods used in clinical practice in the treatment of chronic pain syndrome has been revealed in the literature. The methods are systematized based on: the nature of the intervention (invasive, non-invasive), the parameters of the electric current (direct, alternating, continuous or pulsed).
Conclusion: methods of noninvasive transcranial electrophysiotherapy may be more effective and preferable for the treatment of chronic pain syndrome compared to other methods for a number of reasons: noninvasiveness, safety, simplicity, pain reduction due to regulation of neuroplasticity, regulation of emotional state.

The widespread of ferrum deficiency in the population of age-related patients significantly worsens the distance prognosis of major cardiovascular diseases and requires timely diagnosis and correction. The currently accepted routine approach to the diagnosis of latent and apparent ferrum deficiency does not correlate with tissue metabolic changes in cardiomyocytes and needs to be revised. The process of the aggravating effect of anemic syndrome on the course of somatic pathology, including at the tissue level, continue to be actively researched.
Many experimental researches have confirmed that in order to verify ferrum deficiency in cardiomyocytes, in addition to ferritin and ferrum levels in blood serum, it is necessary to calculate the transferrin saturation coefficient with ferrum, assess the level of soluble transferrin receptors and determine the level of hepcidin.

Rationale: Chronic respiratory failure is becoming an increasingly serious problem for patients with incurable diseases, the progression of which dictates the need for respiratory therapy. Many specialists face the problem of identifying early symptoms of respiratory failure progression, diagnosing its degree, prescribing respiratory therapy and organizing continuous monitoring of vital functions at home. Both infants and adults of various age groups need such treatment. The list of diseases that require respiratory therapy for a long time or for life is quite large. In young children, this may include bronchopulmonary dysplasia, consequences of hypoxic-hemorrhagic damage to brain structures, congenital malformations and genetic diseases. At an older age, neurodegenerative and neuromuscular diseases may manifest, as well as other problems associated with the severe course of acute neuroinfections and hypoxic-traumatic damage to the central nervous system, oncological diseases, consequences of acute cerebrovascular accident, injuries, critical blood loss, cardiopulmonary resuscitation. The most promising method is non-invasive ventilation of the lungs, which allows achieving the set therapeutic goals and reducing the frequency of complications. The appointment of this type of treatment requires a different approach to these patients. The doctor should daily assess the patient’s condition, the degree of synchronization with the device, the presence of signs of obstruction of the upper respiratory tract and air leakage. Continuous telemonitoring of body functions is important for such patients. The article discusses the organization of respiratory therapy, options for its use in patients with various diseases.

 This article presents a clinical observation of the use of the YurLeon technique in the surgical treatment of a patient with IHD and diffuse coronary disease, the purpose of which is to stimulate extracardiac myocardial perfusion. 

A clinical observation of a 42-year-old female patient suffering from post-thrombotic syndrome and obstructive lesions of the iliocaval segment in combination with a previously implanted cava filter after a tibial fracture complicated by deep vein thrombosis of the lower extremities in 2011 is presented. Despite prolonged treatment, no positive result in the patient’s condition was achieved. The prolonged lack of effect from conservative therapy gradually led to the progression of disease severity and a decrease in the patient’s quality of life. In January 2021, bifurcational venous stenting using the “double-barrel” technique was performed at the N.I. Pirogov National Medical and Surgical Center. Follow-up examinations at 6 and 12 months confirmed stent patency with significant clinical improvement in the patient.

Cyanoacrylate adhesive closure (CAC) of varicose veins of the lower limbs has been in practical use for more than a decade. The main advantages of CAC are avoidance of tumescent anesthesia and post-interventional compression. In this clinical report we illustrate a case of glue ablation in a patient receiving life-long antithrombotic therapy (warfarin). The follow-up on 1, 3, 6 and 12 months post-procedure has shown occlusion of the target saphenous veins. However, following 36 months post intervention, recanalization of one of the two previously occluded veins has been detected.

The article presents a clinical observation of a 41-year-old patient with multiple large uterine fibroids. Given the patient’s persistent desire to preserve the uterus in view of planning a future pregnancy, surgical treatment in the form of laparotomy and removal of myomatous nodes was proposed. Underlying disease: grade 1 anemia (hemoglobin concentration 110 g/l). A hemostatic tourniquet was used for temporary occlusion of the uterine arteries. The mass of the removed nodes ranged from 5 g to 1500 g. In total – 3500 g. Blood loss – 200 ml. Serous-serous discharge through the drainage – 400 ml. Blood transfusions were not performed. The postoperative period was uneventful. The patient was discharged home in a satisfactory condition on the 5th day after the operation. The hemoglobin concentration at discharge was 92 g / l. It was concluded that a temporary uterine tourniquet can be an effective method for reducing perioperative blood loss in patients with multiple large fibroids.

The risk of developing Hodgkin Lymphoma (HL) is 5 to 26 times higher in HIV-infected patients compared to the general population. HL can develop even with moderate immune suppression and treatment with antiretroviral medicines. This article reviews the current treatment strategy for HL in HIV-infected patients and describes the first successful experience of high-dose chemotherapy following autologous hematopoietic stem cell transplantation (autoHSCT) in an HIV-infected patient at the Hematology Department of the Pirogov National Medical and Surgical Center. This clinical case demonstrates the efficacy and safety of autoHSCT for treatment of relapsed and refractory HL in patients with HIV infection.

The article presents a clinical observation of a case of echinococcosis of the lungs, liver and pancreas in a 33-year-old patient. The clinical manifestations, instrumental studies of echinococcosis, diagnostics of its complications are described and the issues of surgical and drug treatment methods are considered. The use of a spiral computed tomograph and a serological diagnostic method made it possible to verify the prevalence of the parasitic disease, which made it possible to determine a staged treatment strategy that led to the patient’s recovery with a generalized form of echinococcosis.

The article presents a clinical observation of the successful treatment of a patient with a combat trauma of the chest, pelvis, and lower extremities, complicated by a severe course of the wound process, the development of a traumatic disease due to explosive damage by high-energy cluster ammunition. 

The article presents a successful clinical observation of the consequences of a  mine-explosive injury with the avulsion of the lower limbs at the stage of formation of a short stump of the lower leg using various means for wound closure and their combinations. 

This article examines the evolution of face protection products, starting from combat drawings and masks in ancient times and ending with modern helmets using advanced technologies such as artificial intelligence. Various historical stages are analyzed, including ancient civilizations, antiquity, the Middle Ages, as well as the XX and XXI centuries, when new threats such as firearms and mine explosive devices appeared. The key stages of the development of military helmets and masks are described, as well as their impact on the safety of soldiers and the improvement of tactical mobility. Attention is also paid to technical innovations in helmet design and their use in modern conflicts.