Currently, the problem of repeat in-stent restenosis (ISR) of coronary arteries (CA) remains the main limiting factor for PCI in the long-term follow-up period.

Objective. To develop a comprehensive clinical and morphofunctional classification and evaluate the frequency, structure, and clinically significant types of repeat in-stent restenoses.

Materials and Methods. This retrospective study included 168 patients with recurrent coronary restenosis who underwent endovascular revascularization at the St. George Thoracic and Cardiovascular Surgery Clinic of the N. I. Pirogov National Medical Surgical Center of the Ministry of Health of the Russian Federation.

Results. Based on the obtained data, restenoses were classified as follows:

1. Clinical stratification: asymptomatic (43.5%), stable (47.6%), ACS-associated (8.9%);
2. Chronological: early (25.6%), late (36.3%), distant (38.1%); 3. Anatomical: local (35.5%), diffuse (27.3%), proliferative (27.1%), occlusive (10.1%); 4. Etiologic: malposition (74.4%), no malposition (25.6%); 5. Anamnestic: recurrence after BLP (42.3%), after stent implantation (33.3%), residual restenosis (24.4%).

Conclusion. The developed clinical and morphofunctional classification of repeated in-stent restenoses allows for an objective description of the structure, frequency and characteristics of the clinical course.

Background: Bioprosthetic aortic valves (AV) are widely used in cardiac surgery due to the absence of lifelong anticoagulation requirements and a lower risk of thromboembolic complications. However, their durability is limited by structural valve deterioration (SVD), which may lead to prosthetic dysfunction, reoperations, and increased mortality. Despite numerous reports, the predictors of accelerated valve degeneration remain insufficiently understood, particularly in the context of multifactorial analysis and machine learning applications. Aims: To determine the frequency and timing of bioprosthetic AV degeneration and to identify clinical and echocardiographic predictors of structural deterioration using statistical modeling, machine learning, and propensity score matching (PSM).

Materials and methods: A retrospective cohort study included 259 patients who underwent surgical aortic valve replacement with a bioprosthesis between 2012 and 2022. Criteria for SVD were morphological leaflet changes (fibrosis, calcification), increased transvalvular gradients (peak >40 mmHg or mean >30 mmHg), aortic regurgitation ≥ grade 2, reoperation, or death due to prosthetic dysfunction. The primary endpoint was time to valve degeneration. Statistical methods included logistic regression, random forest modeling, Kaplan–Meier survival analysis, and PSM.

Results: Structural valve deterioration was detected in 62 patients (23.9%) during a median follow-up of 48 months. Logistic regression demonstrated significant associations with body mass index (OR 3.39; 95% CI: 2.54–4.53; p<0.001), reduced left ventricular ejection fraction (p<0.001), coronary artery disease (p = 0.010), chronic heart failure class III or higher (p = 0.020), and serum creatinine (p = 0.048). The random forest model achieved an AUC of 0.72, with the most relevant predictors being ejection fraction, body mass index, creatinine, and age. PSM analysis confirmed significantly shorter prosthesis durability in the SVD group compared with matched controls (median 38 vs. 48 months; log-rank p = 0.010).

Conclusions: Bioprosthetic AV deterioration occurs in nearly one-quarter of patients within 4–5 years after surgery. A multilevel approach using machine learning and PSM improves risk stratification and may support personalized follow-up and surgical decision-making.

Background. Mitral valve disease is one of the main diagnoses operated on in cardiac surgery at the present time. There are a number of etiological causes of mitral valve disease that require correction. The distribution of etiologies, methods of valve correction, and the results of operations change with the growth of surgical practice.

Purpose. To study all cases of surgical treatment of mitral valve disease in the cardiac surgery department of Belgorod for the period of 2015-2024. To identify the main pathologies, their distribution, and changes in surgical techniques over the selected period.

Methods. In the cardiac surgery department of the St. Joasaph Regional Hospital, an average of 490 heart surgeries were performed per year over the selected 10-year period. Of these, 51–84 cases involved surgical correction of mitral valve defects. In total, 582 cases of mitral valve defects were treated during the period from January 1, 2015 to December 31, 2024. The etiology of the defect is diverse: degenerative mitral valve insufficiency (DMI), chronic rheumatic disease, secondary damage in coronary artery disease (CAD), infectious endocarditis (IE), hypertrophic obstructive cardiomyopathy (HOKM). The method of correction was taken into account: valve prosthesis or reconstruction.

Results. The first place in the etiology of the defect was occupied by degenerative insufficiency of the MK, the second – CRBS, the third – secondary damage of the valve in CAD, the fourth – IE, the fifth – HOKM. During the selected period, the proportion of degenerative mitral insufficiency (DMI) was 40.5% to 64.5% per year, with an average of 50.86%. The proportion of operated CHF was 6.3% to 23.6%, with an average of 17.52%. Ischemic mitral insufficiency occurred in 30.8% to 5.7%, with an average of 13.92%. Operations for infectious endocarditis were performed in 3.2% to 13.6% of cases, with an average of 9.62%. Corrections of the mitral valve defect in HCMF were performed in 1.9% to 13.4% of cases, with an average of 8.06%. During the follow-up period, there was a decrease in the frequency of correction of mitral valve insufficiency in IHD and an increase in the frequency of correction in CRBS. The share and variety of reconstructive techniques used have increased significantly.

Conclusion. During the selected period of time 2015–2024, the number and proportion of cases of surgical correction of mitral valve disease remain relatively constant. The proportions of the frequency of etiologies of operations on the MK obtained by us correspond to the global practice. The expansion of the frequency of use and complexity of the valve reconstructions used did not lead to a decrease in the quality of the results.

Objective: To evaluate the impact of preoperative pulmonary function tests (PFTs) on clinical outcomes in patients undergoing surgery for ascending aortic aneurysm.

Methods: 321 patients undergoing surgery for ascending aortic aneurysm were included into the study. All patients underwent PFTs before the surgery. By analysing pulmonary function, the types of respiratory dysfunction were determined based on forced expiratory volume (FEV1) in one second and forced vital capacity (FVC), according to the recommendations of the American and European Respiratory Societies. The criterion for obstructive pattern was a FEV1/FVC ratio <70%, restrictive pattern was defined as reduced VC (vital capacity), FVC <80% while maintaining normal FEV1/FVC ratios, and mixed pattern was characterized by reduced FEV1, FVC <80% and a FEV1/FVC ratio ≤70%. An analysis of the relationship between PFTs and early clinical outcomes of surgical treatment was performed.

Results: PFTs were abnormal not only in 74 patients with a diagnosed chronic obstructive pulmonary disease (COPD) but also in patients without COPD (64 patients). In this group, the obstructive pattern was most frequently observed in 14.2% patients, while restrictive and mixed patterns were detected in 6.5% and 5.3% of cases, respectively. According to multifactorial regression analysis, decreased forced vital capacity, restrictive and mixed patterns, duration of cardiopulmonary bypass, aortic clamping time, obesity, type I aortic dissection, and Marfan syndrome significantly increased the duration of mechanical ventilation, stay in the intensive care unit (ICU), and hospital length of stay. Concomitant COPD increased the frequency of respiratory failure after surgery (p = 0.02) and the rate of mortality (p = 0.036).

Conclusions: Assessment of preoperative PFTs prior to surgery allows to predict the complicated outcomes, thus facilitating perioperative planning.

Background. Following infection with coronavirus-2 (SARS-CoV-2), the risk of both acute non-ischemic myocardial injury and acute myocardial infarction may increase, particularly type 2 myocardial infarction. Timely interventional coronary revascularization after thrombosis does not always result in restoration of coronary artery patency due to re-thrombosis and inflammatory processes. A number of studies conducted in Europe and the United States involving coronary angiography and percutaneous coronary intervention (PCI) in patients with acute coronary syndrome (ACS) and COVID-19 confirm the validity of pathophysiological concepts regarding the inflammatory and thrombotic nature of coronary and myocardial injury.

Objective. To compare the frequency of use of coronary stents with different drugeluting coatings in selected groups of patients with acute myocardial infarction, COVID-19 infection, and viral pneumonia depending on in-hospital outcomes: discharge or death due to disease complications.

Materials and Methods. The study included 83 patients aged 45–85 years admitted on an emergency basis with a diagnosis of acute myocardial infarction (AMI) or unstable angina combined with viral pneumonia (or acute gas exchange disorders) and COVID-19. All patients with AMI underwent pulse oximetry, complete blood count, biochemical blood analysis, urinalysis, coagulation profile, multislice computed tomography (MSCT) of the lungs, and COVID-19 diagnosis using polymerase chain reaction (PCR) testing of oropharyngeal and nasopharyngeal swabs. Renal excretory function was dynamically assessed by changes in serum creatinine levels. Clinical, electrocardiographic, angiographic (coronary angiography), and biochemical (enzymatic) criteria were used to diagnose acute coronary syndrome and myocardial infarction with and without ST-segment elevation. Contrast coronary angiography (CAG) was performed using Artis Zee (Siemens Healthineers, Germany) and Azurion 3 (Philips, Netherlands) angiographic systems. CAG and transluminal balloon coronary angioplasty (TBCA) were performed according to the method of Elchaninoff et al. via radial access, less frequently via femoral arterial access. Mechanical recanalization, balloon angioplasty, and coronary artery stenting using balloon dilation were performed in 59 patients.

Results. Contrast coronary angiography revealed more severe atherosclerotic involvement of the coronary bed in deceased patients with ACS and COVID-19, predominantly affecting the left anterior descending coronary artery. The frequency of coronary occlusion was generally similar in deceased and surviving patients, averaging 58% and 46%, respectively, with acute forms predominating (83–92% of all cases). Implantation of coronary stents coated with sirolimus during PCI was associated with a significantly higher incidence of fatal outcomes in the group of deceased patients (by an average of 25.3%). In contrast, the use of zotarolimus-eluting stents demonstrated a significant positive trend toward improved survival in patients with AMI and COVID-19 following coronary intervention.

Conclusions. Analysis of the use of coronary stents with different antiproliferative drug-eluting coatings in patients with AMI complicated by COVID-19 and viral pneumonia during primary PCI revealed an association between sirolimus-eluting stents and unfavorable in-hospital outcomes. Conversely, a positive survival trend was observed following coronary revascularization with zotarolimus-eluting stents.

Backgraund: In the late periods after reconstructive operations on the abdominal aorta patients are under the observation of vascular surgeons at the place of residence. The majority of such patients are representatives of older age groups. The ability to recognize and correct significant risk factors for complications during long-term dynamic observation of operated patients in time ultimately affects the quality and duration of their life.

Aims: To evaluate the long-term results of open reconstructive surgeries on the abdominal aorta and to determine the factors that change the quality of life and survival of operated patients in the long term.

Materials and methods: a non-randomized comparative retrospective continuous study of the quality of life and survival for up to 5 years after surgery was conducted. Depending on the type of pathology, patients were divided into 2 groups – with aortoiliac aneurysm (n = 166) and occlusive pathology of the terminal aorta and iliac arteries (n = 73). The assessment of remote results was carried out during an outpatient appointment.

Results: In the remote periods after open surgery, the quality of life was expressed by an improvement in the indicators (p < 0.05) of mental and physical condition and general health. Negative dynamics were noted on the emotional scale. By the end of the 5-year observation period, the difference in mortality between those operated on for abdominal aortic aneurysm and Leriche syndrome was 7.9% (AAA – 13.67%, Leriche syndrome – 21.60%) with statistically significant differences in the two survival curves (logrank<0.01). Significant factors worsening survival were identified: emergency surgery (p<0.01), chronic lung diseases (p<0.01), kidney diseases (p<0.01), progression of chronic lower extremity ischemia (p<0.01).

Conclusions: The following factors have an adverse effect on 5-year survival in the remote period: emergency surgery, length of hospital postoperative period, chronic lung and kidney diseases, decompensation of chronic lower limb ischaemia with followed amputation. The statistical significance of cerebrovascular disease, heart rhythm disturbances and hypertension has not been confirmed. The impact of ischemic heart disease was not assessed due to the need for its surgical treatment.

Background: minimally invasive treatment methods for varicose veins are aesthetically pleasing and minimally invasive. However, many aspects of the patient’s psychological and physical adaptation accompanying surgical treatment remain insufficiently studied. A comprehensive assessment of the impact of various surgical treatment methods on patients’ quality of life (QOL) is needed.

Aims: comparative assessment of QOL after various minimally invasive methods of treatment of varicose veins – miniphlebectomy and sclerotherapy – in patients with varicose veins using the CIVIQ-20 (The ChronIc Venous Insuficiency quality of life Questionnaire) and SF-36 (The Short Form-36) questionnaires.

Materials and methods: a prospective single-center study included 84 patients with CEAP C1-C4 varicose veins. Patients were divided into two comparable groups: in group 1 (n = 43), patients underwent endovascular laser coagulation (EVLC) and miniphlebectomy of dilated tributaries; in group 2 (n = 41), EVLC and sclerotherapy of dilated tributaries were performed. QOL was assessed using the CIVIQ-20 and SF-36 questionnaires before surgery, on days 3 and 7, and 1 and 6 months after the intervention.

Results: The study demonstrated similar long-term QOL dynamics in patients with varicose veins according to the CIVIQ-20 and SF-36 questionnaires: QOL improved 6 months after surgery. According to the intergroup analysis, the physical health component decreased more significantly on the third day after surgery in patients undergoing miniphlebectomy (Group 1), while the psychological health component overall decreased on the third and seventh days after surgery, compared to patients who underwent sclerotherapy of the dilated tributaries (Group 2).

Conclusions: miniphlebectomy and sclerotherapy of varicose veins in patients with varicose veins demonstrate comparable efficacy in improving quality of life at long-term follow-up. Furthermore, sclerotherapy of varicose veins is associated with better physical and psychological health outcomes in the early postoperative period, which can be considered when choosing a treatment method for some patients.

Abstract. Objectives. The aim of the study was to determine the degree of influence of retrograde blood flow in the deep veins of various segments of the lower extremities on the formation of pathological segmental hypervolemia of the lower leg in patients with chronic venous diseases (CVD) of various clinical classes according to the CEAR classification.

Methods. 380 healthy individuals and 896 patients with CVD were examined using ultrasound scanning (USDS) and pneumoplethysmography (PPG). Retrograde blood flow was detected in the ilio-femoral, femoral-popliteal and popliteal-suric venous segments. The extent of reflux was classified into three degrees. To assess the intensity of venous outflow, the following values were calculated: the maximum capacity of the lower leg veins, the volume of their emptying, the maximum venous outflow, and the ratio of these values on both extremities.

Results. It was found that retrograde blood flow in deep veins lasting more than 3 seconds is important for the progression of chronic venous insufficiency (CVI) in patients with CVD. The most noticeable effect of retrograde blood flow on the progression of CVI is when they are localized at the level of the popliteal and intramuscular veins of the lower leg. At the same time, the pneumoplethysmographic venous capacity index (VCI) has statistically significant differences as CVD progresses, which may indicate that patients develop pathological segmental venous hypervolemia of the lower leg as the disease progresses.

Conclusion. The presence of prolonged popliteal-sural reflux in patients with CVD affects the formation of pathological segmental hypervolemia of the lower leg and is a hemodynamic factor in the development of CVI.

Background: Acute postoperative perforating ulcers of the small intestine (APPSUI) are an understudied but dangerous complication of abdominal and pelvic surgeries. The absence of national clinical guidelines for APPSUI management makes it difficult to choose the optimal surgical approach and postoperative patient management in case of this complication.

Aim: To determine the optimal surgical approach for managing APPSUI following abdominal and pelvic surgeries.

Methods: Analysis of medical records of patients who underwent emergency and elective surgeries on abdominal and pelvic organs at the I.I. Mechnikov North-Western State Medical University, City Hospital No. 40, and Toksovo Clinical Interdistrict Hospital between 2012 and 2025, followed by the development of APPSUI.

Inclusion criteria:

1. Age over 18 years;
2. History of surgery on abdominal or pelvic organs;
3. Development of acute perforating ulcers of the small intestine during the postoperative period within the current hospitalization.

Exclusion criteria:

1. Age under 18 years;
2. Development of small intestine perforation in close proximity to anastomoses or intestinal stomas (0.5-1 cm);
3. Inability to exclude small intestine perforation due to mechanical or thermal injury
4. Generalized oncological process. Results: The study analyzed medical records of 98 patients with diagnosed APPSUI.

The age range of the study sample was 28 to 88 years (mean 55.5±14.1). Gender distribution: female (n = 62; 63.3%) of the total number of patients. Analysis of hospitalization type: 76.5% of patients (n = 75) were admitted to the hospital as emergencies.

The main finding: upon initial detection of APPSUI, suturing should be applied as it shows the lowest mortality rate (25%; p = 0.045). Resection of the affected area is recommended for repeated perforation and/or failure of previously sutured defect.

Conclusion: Differences in mortality rates depending on the chosen surgical approach for APPSUI were identified. The lowest mortality rate is observed with the suturing method, while the highest rate is characteristic of ileostomy formation when used at initial APPSUI detection. In 29 (29.5%) patients, the first relaparotomy was scheduled, of which 13 (13.2%) had a favorable outcome. In other cases, relaparotomy was performed on demand (n = 69 (70.4%)), of which 8 (11.5%) were discharged. The statistically significant difference (p<0.001) between the groups confirms lower mortality in the scheduled relaparotomy group.

Colostomy is one of the most common life-saving surgeries performed worldwide to decompress colon obstruction. A comparative analysis of late colostomy complications was performed in patients after emergency open and endovideosurgical obstructive resections of the left half of the colon.

The aim of the study. To assess the nature of late complications of colostomies after open and endovideosurgical obstructive resections of the colon.

Materials and methods. The study included 609 patients with left colon cancer of stages I–III, who underwent temporary single-barrel colostomies after emergency obstructive resections. Resection of the colon with a tumor from laparotomy was performed in 426 (70.0%) cases, using endovideosurgical method – in 183 (30.0%). In the late period, various surgical complications arose: parastomal hernia, combination of parastomal hernia with ventral hernia, colostomy stricture, colostomy retraction, intestinal prolapse. Complications in the group of patients after open interventions arose in 289 (67.8%) patients, in the group of endovideosurgical interventions – in 98 (53.6%).

Results of the study. During the statistical analysis in the group of patients after open and endovideosurgical operations, statistically significant differences were found in complications such as parastomal hernias, a combination of parastomal and ventral hernias, colostomy stricture, and colostomy retraction. Late complications of colostomies were more common in patients after open surgeries. In the group of patients after open operations, 29 (10.1%) patients developed complications that required emergency surgery: strangulated parastomal hernia – 15 (5.2%), acute intestinal obstruction caused by stricture or retraction of the colostomy – 8 (2.8%), strangulation of the prolapsed intestine – 6 (2.1%). When performing laparoscopically assisted colostomy formation, such complications occurred in 4 (4.1%) patients.

Background: the problem of treatment of diseases of the musculoskeletal system is one of the most urgent in modern science. The main focus for our regenerative medicine is the treatment of degenerative-dystrophic diseases of the musculoskeletal system in children. This study examined the effects of liquid nitrogen vapor on osteogenesis in the rabbit femur. Cryotweezers made of porous nickel titanium alloy (nitinol or NiTi) obtained by self-propagating high temperature synthesis were used in this experiment.

Aims: evaluation of the effectiveness of subdestructive cryotherapy on the focus of osteonecrosis of the femoral head in an experimental model as close as possible to LeggCalve-Perthes Disease and enhance osteogenesis in rabbit bones through cryotherapy using porous NiTi cryotweezers.

Materials and methods: the study was conducted on 24 rabbits. The animals underwent of a surgical interventions against the background of aseptic necrosis of the femoral head by tunneling and cryotherapy with an applicator made of porous titanium nickelide on the osteonecrosis site to optimize osteoreparative processes of bone tissue. The control group consisted of 8 animals that did not undergo surgery.

Results: It was found that a 3 s exposure time stimulates osteogenesis, which was manifested in a greater number of osteoblasts in the regenerate compared to the control sample without liquid nitrogen. It was observed that increasing the exposure to 6, 9 or 12 s had a destructive effect, to varying degrees. The most severe damage was exerted by a 12 s exposure, which resulted in the formation of osteonecrosis areas. In the samples exposed to 6 and 9 s of cryotherapy, destruction of the cytoplasm of osteocytes and osteoclasts was observed.

Conclusions: The NiTi alloy produced through the SHS method offers a novel approach to the manufacture and use of cryoinstruments due to its high heat capacity and ductility, which provide rapid local cooling and its ability to prevent sticking to moist mucous tissues. The experimental results obtained make it possible to apply the proposed developed cryotherapy method to pathologically altered bone tissue.

Background: Arthroscopic stabilization of the shoulder joint in anterior labral injuries requires precise positioning of anchor fixation devices. Traditionally, anchors are placed from inferior to superior, starting at the 6 o’clock position on the glenoid. However, in the beach-chair position, access to the inferior pole is limited. There is a knowledge gap in the evaluation of alternative fixation strategies while maintaining biomechanical effectiveness, which is especially important for athletes, given the high risk of anterior shoulder instability and the frequency of relapses after stabilization.

Aims: to optimize and theoretically substantiate the positioning of anchor fixators in the treatment of glenoid labrum injuries in the beach-chair position.

Methods: this study is based on vector modeling analysis of the capsulolabral complex tension under different anchor positions and sequences of fixation. The primary endpoint was the magnitude of the resulting tension force achieved by the fixation.

Results: the analysis showed that initiating fixation at the superior anchor followed by tensioning and attachment to the inferior anchor produces a resulting force comparable in direction and magnitude to the traditional inferior-to-superior fixation. Additionally, fixation of the inferior portion of the capsulolabral complex using two anchors at the 5 and 7 o’clock positions generated a greater force than fixation with a single anchor at the 6 o’clock position.

Conclusions: superior-to-inferior fixation of the capsulolabral complex, as well as fixation of its inferior portion using two anchors at the 5 and 7 o’clock positions, may be considered a biomechanically equivalent alternative to the traditional inferior-to-superior approach (with the inferior anchor at 6 o’clock), particularly when access to the lower glenoid pole is limited, as in the beach-chair position.

Introduction. Knee arthroplasty is the method of choice in the treatment of late stages of gonarthrosis. A new stage in the development of technologies in orthopedics is associated with the introduction of robotic systems into the practice of orthopedic surgeons.

The aim of the study: to evaluate the learning curve and compare early outcomes of knee replacement using the CORI robotic system with manual joint replacement.

Materials and methods. The prospective study involved 30 patients (11 men, 19 women), who were randomized into two groups using a random number generator: Group 1 (n = 15), patients underwent robotic knee arthroplasty using the CORI system from Smith&nephew; Group 2 (n = 15), patients underwent manual knee arthroplasty. Evaluation of the functional state of the knee joint in the postoperative period was also carried out using the KSS questionnaire.

Results. Analysis of the learning curve of a surgeon with experience in using other robotic systems showed that starting from the 3rd case, the duration of the operation began to decrease and reached a plateau from the 6th case of using the CORI robotic system. In group №1, the duration of the operation was statistically significantly longer compared to group №2. The volume of intraoperative blood loss was comparable in both groups. The KSS values were statistically significantly higher in group №1.

Discussion. The authors suggest that the main reason for the higher KSS scores in group №1 is the minimal soft tissue release, which in this study was achieved using the functional alignment approach.

Conclusion. The data obtained during the study indicate that the existing experience in using robotic systems contributes to a faster mastery of the robot-assisted CORI system. In our opinion, a surgeon with experience in working with a robotic system can overcome the learning curve and reach a plateau already at the 6th case of knee arthroplasty. Moreover, the duration of the operation using the robotic system after overcoming the learning curve was longer, compared to the manual technique.

In modern armed conflicts, various complications occur in 78.6% of patients with abdominal injuries. From the first minutes after a gunshot wound, one of the most severe syndromes of peritonitis begins to develop – enteral insufficiency, which manifests as the spontaneous and often asymptomatic occurrence of acute perforating ulcers in various parts of the small intestine. The relevance of this issue is associated with a significant increase in their incidence and the poorly studied psychophysiological reasons for their formation.

Objective: To study the frequency of development, possible predisposing factors, and morphological characteristics of acute perforating ulcers of the small intestine that arise in the postoperative period after surgical interventions on the abdominal and pelvic organs due to gunshot wounds.

Materials and Methods. A retrospective analysis was conducted on the treatment of 264 patients with abdominal firearm injuries. Among them, 27 (10.2%) patients were diagnosed with acute perforations appearing as ‘punch-like’ holes in various sections of the small intestine against the backdrop of widespread peritonitis at the stage of specialized medical care. The most optimal method for diagnosing this complication was contrastenhanced spiral CT. Endoscopic examinations (EGD, colonoscopy, double-balloon and capsule enteroscopy) were performed in 19.4% of the patients, among whom manifestations of ischemic and erosive-ulcerative enteritis were diagnosed. The time range for the occurrence of acute small bowel perforations was 2 to 26 days. All injured patients underwent emergency surgery for this complication.

Results. During relaparotomies, 24.7% of the wounded were found to have both foci of ischemia and necrosis of the small intestine, as well as perforation holes measuring 0.1–0.3 cm. Morphological studies confirmed a severe disruption of microcirculation in areas where acute perforating ulcers had formed. To assess the overall condition of patients with widespread gunshot peritonitis, the Mannheim Peritonitis Index was used alongside an evaluation of functional organ-system dysfunction according to the SOFA scale. Marked hemostatic changes were detected in 72.4% of the victims, leading to significant suppression of regional blood flow, impaired regeneration, and biological integrity of the small intestine. The risk group for the development of this severe complication includes victims with multiple and combined abdominal gunshot injuries, prolonged nasointestinal drainage, prolonged mechanical ventilation, and those requiring frequent scheduled relaparotomies. The incidence of abdominal sepsis and multiple organ failure in the study group was 64.3%, with a mortality rate of 3.7%. The main therapeutic measures for this category of wounded were carried out in the intensive care unit using extracorporeal detoxification methods aimed at eliminating circulatory hypoxia, endogenous microbial intoxication, and intestinal paresis.

Conclusion. The occurrence of acute perforations of small intestine ulcers in the postoperative period in patients with gunshot wounds to the abdomen is a highly unfavorable complication, indicating a decompensation of enteral insufficiency, which serves as an integral indicator in the progression of widespread gunshot peritonitis and the formation of small bowel fistulas.

Introduction: The instability of the residual limb circumference makes it difficult for the patient to fabricate and master the prosthesis. Compression therapy is the main method for controlling residual limb swelling to stabilise the circumference of the residual limb. Patients with hip stumps have polytylological reflex spasms of the muscles of the lumbosacral spine, the sacroiliac joint and the gluteal group. These, due to compression of the vascular and lymphatic channels, can lead to local microcirculation disorders, further increasing the severity of residual limb oedema. The use of postisometric relaxation technique (PIR), which allows to reduce the reflexive muscle spasm, may increase the effectiveness of compression therapy.

Objective: To evaluate the effect of using the PIR technique of the muscles of the lumbosacral spine, sacroiliac joint and gluteal group in the rehabilitation of patients with hip stump on the effectiveness of compression therapy.

Methods: The materials presented in this paper are based on the observations of men who underwent mid-third femoral amputation divided into two clinical groups depending on the application of the PIR technique.

Results and their discussion: The data on changes in the girth dimensions of the preserved lower limb and femoral stump in dynamics depending on the application of PIR and the type of constitution were obtained. The decrease in the circumferential dimensions of the residual limb after 6 months of PIR application is mainly due to the reduction of soft tissue oedema. Further in the dynamics they remain stable, indicating a positive effect of PIR on the effectiveness of compression therapy.

Conclusion: The use of the PIR technique of the muscles of the lumbosacral spine, sacroiliac joint and gluteal group in rehabilitation increases the effectiveness of compression therapy of the femoral stump in men.

A comparative study of the effectiveness of treatment of 342 patients with surgical hand infection and type 1 diabetes mellitus after surgery using traditional methods and kinesio taping was conducted. The results showed that the use of kinesio taping promotes rapid wound healing, reduces the period of hospitalization and improves the general condition of patients. The kinesiotaping technique in the early postoperative period effectively copes with swelling, pain, improves microcirculation and lymph outflow, which has a beneficial effect on the course of the wound process. The use of kinesiotapes makes it possible to create “soft” immobilization, early initiation of rehabilitation, and reduce trauma to the postoperative wound during dressings. There is a reduction in the average time patients spend in a medical facility (from 16 to 9 days) and an acceleration in their adaptation to everyday activities.

Wound healing is a single active dynamic process that begins at the moment of injury and ends with the restoration of tissue integrity. Based on the improvement of scientific knowledge and the process of the pharmacological industry, it is possible to introduce surgical techniques and therapeutic measures that will provide significant support to the body’s own capabilities of this severe category of patients to prevent the development and treatment of long-term non-healing chronic post-traumatic wounds.

Objective: to optimize diagnostic approaches and treatment algorithm in patients with chronic soft tissue wounds with an assessment of their compliance with the standards of medical care in a multidisciplinary hospital.

Materials and methods: the clinical study is based on a retrospective analysis of the results of surgical and medical treatment of 82 patients with chronic wounds of the trunk and limbs. The patients were divided into two representative groups. In the first research group (n = 32), local wound treatment in phase II of the wound process was carried out with the use of Velstic-PRO cream, which contains silver preparations and epithelial growth regenerators. The second control group (n = 50) was divided into two subgroups (subgroup I (n = 20) was treated with traditional antiseptics, in subgroup II (n = 30) dressings were changed using Ebermin ointment). The results of treatment in the study groups were evaluated by quantitative (visual screening, planometry and histomorphology) and qualitative (bacterial culture, saturation in the wound, pulse filling index, rate of change in capillary blood filling), characteristics of the course of the wound process on days 3, 7, 15, 20.

Result: the inflammatory reaction of tissues in the first group was stopped much faster by the 3rd day, and by the 7th day, the process of epithelialization of chronic wounds began. In the second group, this period was much longer (2.5 times). By the 15th day, the largest number of patients in the first group (82.4%) were characterized by complete epithelialization of wounds or their preparedness for plastic surgery aimed at closing the skin defect. In the second group (especially in the first subgroup) this period lasted more than 20 days, and the possibility of performing plastic surgery appeared only after 27 days in 43.5% of patients.

Conclusion: topical application of the cream (Velstic-PRO) allows you to optimize the reparative processes in the wound 2 times faster compared to traditional medications, which makes it possible to recommend it in the therapeutic algorithm of chronic posttraumatic wounds after their thorough surgical debridement in the II and III phases of the wound process.

Periarticular tissues have traditionally been regarded as a collection of discrete peri-articular structures surrounding the joint – tendons, ligaments, joint capsule, fasciae, synovial bursae, entheses and muscles. Emerging evidence indicates that in chronic pathology these structures function as a unified neurovascular–connective tissue “organ”, in which mechanical injury, disturbed innervation, impaired vascular regulation and persistent inflammation, including infection-associated inflammation, converge into a common pathogenetic trajectory leading to enthesopathy. This review summarizes current data on the structure and pathophysiology of periarticular tissues, the role of the peripheral nervous system and the microvascular bed, as well as the contribution of infectious triggers to the development of the pathological process. We discuss the concept of a pathogenetic cascade: “mechanical loading – neural dysregulation – vascular remodelling and pathological angiogenesis – infection-driven and autoimmune inflammation – chronicity and structural remodelling of the enthesis organ”. Particular attention is paid to clinical and imaging features of lesions of the synovio-entheseal complex and their relationship to cellular, structural and metabolic disturbances. Potential therapeutic targets in enthesopathy are outlined, including modulation of angiogenesis, neurovascular complexes and immune pathways. The proposed model provides a framework for unifying approaches to diagnosis and treatment of periarticular pathology.

Rationale: Meniscectomy is one of the most common surgical procedures for meniscal injuries. Depending on the clinical situation, either partial meniscectomy (PM) or total meniscectomy (TM) is performed, each having its own long-term consequences, which remain the subject of active scientific discussions.

Objective: The aim of this study is to analyze the clinical outcomes of PM and to assess its impact on the long-term health of the knee joint based on existing literature data.

Methods: A review of scientific publications was conducted, including randomized controlled trials and cohort studies published since 2019. Studies providing data on long-term clinical outcomes, such as osteoarthritis progression, pain syndrome, knee joint functional activity, and patient quality of life after surgery, were included. Articles with low evidence quality and small sample sizes were excluded.

Results: The analysis revealed that PM is associated with slower progression of osteoarthritis and reduced pain syndrome. In contrast, TM leads to more pronounced degenerative changes in the knee joint, chronic pain, and functional deterioration.

Conclusion: The long-term outcomes of PM are more favorable than those of TM, particularly in terms of preserving knee joint functionality and reducing the risk of osteoarthritis development.

The rapid development of artificial intelligence (AI) technologies in the healthcare sector has attracted widespread attention from the global medical community. The potential of AI applications in the field of traumatology, which is a race against time, is particularly noticeable. Trauma is the leading cause of death among people under the age of 40 worldwide, and the effectiveness and quality of treatment are directly related to survival and prognosis for patients. The traditional trauma treatment model is limited by factors such as uneven distribution of medical resources, differences in professional experience, and delayed diagnostic solutions, and there are many challenges that need to be addressed urgently. The intervention of artificial intelligence has opened up the possibility of revolutionary changes in traumatology. The purpose of this study is to provide a comprehensive overview of the current state of artificial intelligence in all aspects of traumatology, an in-depth analysis of its clinical value and limitations, as well as to offer practical recommendations based on the latest data. Through a systematic review of existing research, we hope to provide doctors, researchers, and policy makers with authoritative background information on the use of AI in traumatology.

Parenchymatous organ injuries affected highly vascularized organs such as liver, spleen or kidneys, become a major challenge in surgical practice, mainly because of tendency to life-threatening bleeding, complex tissue architecture and susceptibility to infections. Using biological polymers as hemostatic agents is important both for stopping bleeding and improving tissue regeneration. Medicines based on such substances are in high demand, they integrated into military medicine, civilian emergency care, surgical interventions and treatment of chronic wounds. Cross-linked chitosan-collagen systems have become a breakthrough solution for hemostasis in parenchymatous organ injuries. In this article we will demonstrate the latest innovations based on interaction of biological polymers such as chitosan and collagen. We will uncover modern processes of their production, purification and transformation, present a full analysis of pharmacodynamic and pharmacokinetic differences between hydrogel and spongy collagen-chitosan systems, compare the preclinical data and clinical studies to understand the use of a specific medical form.

Rationale: Autoimmune diseases (AIDs) are characterized by immune response dysregulation, in which pro-inflammatory cytokines contribute to chronic inflammation and tissue damage. Anti-cytokine therapy represents a promising method for targeted intervention in the immunopathological mechanisms of AIDs, necessitating an analysis of its efficacy and safety.

Objective: To assess the clinical efficacy and safety of anti-cytokine therapy in patients with various AIDs based on data from recent clinical studies.

Methods: A review of literature sources published in peer-reviewed international scientific journals from 2019 to the present was conducted. Studies with small sample sizes and low-quality evidence were excluded.

Results: Tumor necrosis factor-alpha (TNF-α) inhibitors demonstrate high efficacy in rheumatoid arthritis, Crohn’s disease, and psoriatic arthritis, but their use is associated with an increased risk of infectious complications. Interleukin (IL)-6 inhibitors reduce inflammatory activity and improve clinical outcomes in patients with rheumatic diseases but may increase the risk of hypercoagulation. IL-17 inhibitors are effective in ankylosing spondylitis, but their use is linked to a higher frequency of infectious complications. Janus kinase (JAK) inhibitors selectively modulate immune responses and have shown clinical efficacy in inflammatory bowel diseases, though they may cause metabolic and hematological disturbances.

Conclusion: Anti-cytokine therapy is an essential approach in the treatment of AIDs, leading to reduced inflammatory activity, remission achievement, and improved patient quality of life. Further research is required to assess the long-term safety of anti-cytokine therapy and to identify predictors of therapeutic response.

Rationale: With the pandemic caused by SARS-CoV-2, accurate identification of patients at high risk for complications has become a key factor in ensuring positive treatment outcomes. A promising technique to facilitate such identification is the use of biomarkers that can predict complications and severity of COVID-19 course.

Objective: The purpose is to evaluate the prognostic significance of various biomarkers in individuals with COVID-19 and to determine the value of developing standardized protocols for monitoring these indicators under pandemic conditions.

Methods: For the analysis, we reviewed studies on the role of biomarkers such as C-reactive protein, D-dimer, ferritin, lactate dehydrogenase and troponins in predicting complications in patients with COVID-19. Sources used were international peer-reviewed journal publications, clinical trial results, and meta-analyses available in scientific databases.

Results: Elevated levels of biomarkers such as C-reactive protein, D-dimer, ferritin, lactate dehydrogenase and troponins correlate with a high risk of acute complications, making them useful tools for monitoring. The common thresholds for assessing severity of illness will reduce data variability and improve comparability of results between healthcare providers.

Conclusion: The data highlights the importance of biomarkers for monitoring patients with COVID-19 and the need to develop standardized protocols to improve prognostic accuracy. Prospects for the use of biomarkers in adaptive critical care and resuscitation are important means to optimize patient outcomes and further research.

This article presents a case of a mine blow shrapnel wound to the chest with shell fragment fixation in the interventricular septum. The patient underwent several evacuation stages in stable condition and then underwent surgery. Under cardiopulmonary bypass, the foreign body was removed with a neodymium magnet through a transaortic approach. The operation necessitated a significant expansion of the surgical procedure to explore and suture the removed fragment bed in the interventricular septum. The postoperative period and rehabilitation were uneventful.

This article provides historical and statistical information related to the heart gunshot wounds, and discusses aspects of diagnosis and treatment strategies.

The incidence of infectious complications after sternotomy in cardiac surgery is 4%, including deep lesions with the development of anterior mediastinitis and osteomyelitis of the sternum. The solution to the problem of ensuring this formidable risk in cardiac surgery, current issues determine their early diagnosis and the choice of surgical tactics, which are developed by a number of factors: the severity of the patient’s initial condition, the duration and conclusion of cardiac surgery, the timing of development and prevalence of the inflammatory process, as well as the diagnostic and therapeutic capabilities of the medical hospital.

The present clinical observation indicates that purulent sternomediastinitis in the form (type III according to the classification of Slesarenko S.S. (2005)) requires a staged surgical tactic, including: active surgical debridement of wounds using local negative pressure technologies, modern pharmacological agents of both (epidermal growth factor) and general (targeted antibiotic therapy) effects, followed by a reconstructive and restorative stage (after stopping the inflammatory process), performing restoration of the sternum and restoration of the soft tissue defect of the anterior chest wall.

Thus, a staged personalized approach to visiting a patient with late purulent sternomediastinitis allows achieving a positive result while maintaining a high level of quality of life for the patient.

A persistent left superior vena cava is a significant congenital anomaly of the intrathoracic veins that occurs when the left superior cardinal vein fails to obliterate. Most commonly, it is observed in conjunction with a right superior vena cava, while isolated cases are rare. The overwhelming majority of cases are identified in patients with cardiac arrhythmias. The presence of a persistent left superior vena cava may cause technical difficulties and iatrogenic injuries during surgical interventions. Preoperative echocardiography and computed tomographic phlebography enable the detection of this anomaly.

Background. Global population aging has led to a significant increase in femoral neck fractures (FNF) among elderly patients. Despite the widespread use of cannulated screws, complication rates reach 46%, prompting the search for alternative techniques such as Biplanar Double-Supported Fixation (BDSF).

Objective. To present a rare complication of BDSF – periprosthetic subtrochanteric fracture – and analyze its etiological factors.

Materials and Methods. We describe a clinical case of a 64-year-old female with Garden type II FNF complicated by a periprosthetic fracture 1.5 months after BDSF. Data from a cohort of 31 patients who underwent BDSF between September 2021 and December 2024 at City Clinical Hospital No. 31 were analyzed.

Results. Periprosthetic subtrochanteric fracture occurred in 3.2% of cases (n=1). Revision osteosynthesis with an intramedullary nail resulted in a successful outcome.

Conclusion. This case highlights the necessity of strict adherence to the biomechanical principles of BDSF (Biplane Double-Supported Fixation) and the development of a guiding device for distal screw insertion, which would minimize the risk of repeat peri-implant femoral fractures.

The article presents a clinical observation of patient with a large stone in the right ureteropelvic segment and a calculus in the lower third of the right ureter. The specific features of litholytic therapy in patients of this category include low compliance, diet violation, the patology of endocrine system and initial causes of recurrent urolithiasis, and a high risk of developing renal colic attacks.

The first clinical observation in domestic donor practice of the development of erythrocyte hemolysis during hardware plasmapheresis in a donor with a decrease of the activity of glucose-6-phosphate dehydrogenase in erythrocytes is presented.

A 68-year-old female patient with a benign tumor in the right breast tested for ABO blood group phenotype using a solid-phase test. The presence of the B antigen and anti-A and anti-B antibodies was detected. This result was confirmed by a gel test. A sectoral resection of the right breast was performed. The postoperative period was uneventful. Based on available information, this case report is the first to describe the detection of anti-B antibodies in a patient with blood type B.

The article presents a clinical observation of a 41-year-old female patient with lymphoma undergoing autologous stem cell transplantation is presented. Evidence-based red blood cell and platelet transfusion strategies contributed to the successful treatment of this patient with profound thrombocytopenia after stem cell transplantation. It is demonstrated that thromboelastography can be used in diagnostic monitoring of platelet transfusion efficacy.

Dynamic monitoring of the patient for 3 years is described. Based on the cone beam computed tomography data, the linear and angular parameters of the mandible and the location of the third molar were evaluated, which eventually led to independent tooth eruption.

Introduction. Trapezius muscle paralysis is a severe pathology. Loss of its function causes significant statodynamic disorders in the patient, leading to a significant decrease in the «quality of life». Despite the availability of technical capabilities and timely appeal of this contingent of patients for qualified medical care, untimely correct diagnosis is often noted, which in turn leads to late implementation of treatment measures and a decrease in their effectiveness. This situation is associated with a lack of information in specialized literary sources on the diagnosis and treatment of patients with trapezius muscle paralysis.

The purpose of the clinical lecture is to improve the quality of medical care for patients with trapezius muscle paralysis by familiarizing a wide range of doctors of various specialties with modern views on diagnostics and neuro-orthopedic treatment of patients with this pathology.

Main part. The main part of the clinical lecture examines in detail the etiology, diagnostics, conservative and surgical treatment of patients with trapezius muscle paralysis. The importance of conducting a correct clinical examination of patients with suspected trapezius muscle paralysis is outlined. Much attention is paid to the presentation of the applied methods of surgical orthopedic treatment.

Conclusion. It is noted that a full physical examination of patients with trapezius muscle paralysis is a guarantee of establishing a correct diagnosis and further effective treatment. Due to the current lack of effective and widely available pathogenetically substantiated technologies for neurosurgical treatment of this pathology, performing an orthopedic operation using the Eden-Lange method as modified by Elhassan ensures sufficient leveling of statodynamic disorders that have arisen in patients, improving their “quality of life” indicators to an acceptable level.

This article presents a brief biography of Academician V.I. Voyachek, including his contributions to the development of medical science, military healthcare, and the Military Medical Academy.

Justification: The Military Medical Museum occupies a special place in the museum community of Russia. Created during the Great Patriotic War, it became a continuation of the traditions of medical museums that previously existed in Russia. A huge role in the creation of the museum, the formation of its funds belongs to the first chief Alexei Nikolaevich Maksimenkov. The long-term management of the museum showed his deep understanding of all aspects of museum work, the ability to use the capabilities of the exposition and funds for scientific, educational, educational purposes. Thanks to A.N. Maksimenkov, the task of studying, systematizing, and scientific description of materials received by the museum funds was successfully solved. With the direct participation of A. N. Maksimenkov, the museum developed medical documents for the work «The Experience of Soviet Medicine during the Great Patriotic War of 1941–1945», which became a great contribution to the history of Soviet medical science.

A huge role belongs to A. N. Maksimenkov in the restoration of the estate of N. I. Pirogov in the estate of Cherry and the creation on its basis of a memorial complex of an outstanding surgeon.

A.N. Maksimenkov was a co-author and editor of publications on operative surgery and topographic anatomy, many of which were awarded high prizes.

A.N. Maksimenkov is a brilliant specialist in the field of operative surgery and topographic anatomy, a talented teacher, methodologist, historian of medicine, who made his unique contribution to the coverage of the life and work of many domestic scientists.