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, it may reflect its disorders. CABG, in turn, can be considered as a procedure that triggers stress and adaptive mechanisms that can significantly affect the metabolism of aminothiols. However, to date, data on this effect of CABG is 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 to identify the presence or absence of their association with each other. Currently, there is still insufficient information about the features of the aminothiol system in patients with coronary heart disease and about changes in this system in the postoperative period after CABG.
Material and methods. The present study was performed on the basis of the M.F. Vladimirsky State Medical University of the Russian Academy of Sciences.
A prospective examination of 40 patients and 40 healthy volunteers was conducted: group 1 – patients (n = 40) with multivessel coronary artery disease who underwent complete myocardial revascularization at the M. F. Vladimirsky State Medical University in the period from January 2022 to January 2023; group 2 – healthy volunteers (n = 40), a control group for calculating the norms of the level of aminothiols in the blood.
Results. The level of glutathione before surgery, mmol/l (GSH, mkM) in the study group was statistically significantly lower than the level of glutathione in healthy volunteers (787.2±170.9 in the study group and 1019.9±106.4 in the group of healthy volunteers, p<0.001).
The groups did not significantly differ in the level of the oxidized form of glutathione (GSSG), mkmol/l (p = 0.665). The ratio of glutathione and glutathione disulfide was statistically significantly higher in healthy volunteers compared with patients from the main group (p<0.001).
The level of cysteine and glutathione in the study group decreased in dynamics (p<0.001).
The level of cysteine after surgery, mmol/l correlated with the amplitude of systolic movement of the mitral valve fibrous ring (MAPSE) (R = 0.380, p = 0.048).
The level of glutathione, mmol/l before surgery was negatively correlated with the level of glucose before surgery (R = -0.225, p = 0.044), iLP before surgery (R = -0.284,
p = 0.011), E/A before surgery (R = -0.291, p = 0.009), Ve” (Latin) before surgery (R = -0.463, p = 0.003), positively correlated with MAPSE (R = 0.326, p = 0.003) and TAPSE (R = 0.479, p<0.001) before surgery.
The level of glutathione, mmol/l one year after surgery was negatively correlated with EF (R = -0.317, p = 0.046), positively correlated with TAPSE (R = 0.334, p = 0.035) before surgery, with CSR (R = 0.335, p = 0.035), IXO (R = 0.319, p = 0.045) in the long–term period, negatively – with glucose levels (R = -0.315, p = 0.048) and EF (R = -0.344, p = 0.030).
In the long term, one year after surgery, the quality of life of the patients in the study group was lower than the quality of life of healthy volunteers (4.5 (3; 7) and 0 (0;0), MannWhitney criterion, p<0.001).
Conclusion. In our article, we analyzed changes in two interrelated biochemical cycles, the S–adenosylmethionine cycle and the glutathione cycle, occurring in patients with cardiac surgery in response to surgery. In the postoperative period, we observed a decrease in blood glutathione levels in patients undergoing cardiac surgery (CABG).
In the course of our study, we observed the protective effects of S-adenosyl methionine, cysteine, and glutathione after coronary artery bypass surgery, and the high redox potential of aminothiols negatively correlates with the severity of the patients’ clinical condition, assessed using instrumental (echocardiography) and laboratory examination methods.

Purpose: To evaluate the long-term (24 months) results of drug-coated balloon catheters in the treatment of bifurcation stenoses of the left main coronary artery (LMCA).
Methods: A controlled, randomized, prospective study included 150 patients who underwent provisional T-stenting left main coronary artery were included in the study. Patients were randomised into 2 groups by envelope method. In group 1 (n = 75) – final kissing-dilatation after provisional LMCA T-stenting was performed with a drug-coated balloon (DCB) – in the lateral bifurcation branch and with a standard uncoated balloon catheter – in the main branch. In group 2 (n = 75) – final kissing-dilatation was performed with a non-plaque balloon catheter in both the main and lateral bifurcation branches. Patients of both groups were additionally randomized into subgroups of ‘true’ and ‘false’ bifurcation stenoses (Medina classification). Inclusion criteria: bifurcation lesions of the left main coronary artery according to intravascular imaging methods (OST, IVUS); side branch diameter of at least 2.5 mm; confirmed myocardial ischemia in the bifurcation lesion basin (according to FFR, exercise tests, scintigraphy); stable angina of functional class II-IV or proven painless ischemia. Exclusion criteria: implantation of two stents for bifurcation lesion of the LMCA (culotte/crush); severe calcification of the LMCA; extended lesion (more than 25 mm); acute coronary syndrome; previous interventions on the LMCA; side branch diameter less than 2.5 mm; patient’s refusal of intervention. The long-term results were evaluated after 24 months.
Results: The long-term results were followed up in 133 patients. After 24 months, the rate of restenosis at the side branch orifice was significantly higher in Group 2 compared to Group 1, amounting to 19.2% and 8%, respectively (p = 0.044) (method used: Pearson Chi-square). However, when analyzing the cumulative MACE value after 24 months, no statistically significant differences were found (p = 0.303) (method used: Pearson Chi-square).
Conclusions: the use of drug-coated balloon catheters in patients with bifurcation stenosis of the left main coronary artery is an effective and safe method of treatment, and in some cases, it is the most effective and safe method of treatment.

Current recommendations for the treatment of patients with acute coronary syndrome (ACS) suggest the use of early invasive tactics aimed at rapid restoration of blood flow in the coronary arteries. Despite the results of numerous studies confirming the effectiveness of this approach, surgical revascularization is performed with a significant time delay in some patients. One of the reasons for this is the patient’s untimely request for qualified medical care or the complete absence of such.
The aim of the study was to evaluate the treatment results of patients with acute myocardial infarction with ST segment elevation who were admitted to the hospital 48 hours after the manifestation of pain syndrome.
Materials and methods. In the framework of this study, the treatment results of 69 patients who suffered acute myocardial infarction with ST segment elevation were analyzed. The patients were divided into two groups depending on the time characteristics of hospitalization and treatment tactics. Group 1 included 24 patients who were admitted to the hospital a few days after the onset of pain. At the time of admission, the condition of all patients remained stable: there was no pain syndrome, life-threatening cardiac arrhythmias, and hemodynamic parameters were within the physiological norm. After additional diagnostic examination and verification of ischemia, all patients in this group underwent coronary angiography (CAG). Group 2 consisted of 45 patients who were initially hospitalized in the central district hospitals of the Orel and Kursk regions for symptoms of acute myocardial infarction. Due to the refusal of patients from surgical treatment.
Results. Before revascularization, all patients had manifestations of various classes of angina pectoris and heart failure. After revascularization, 32 (46.4%) patients in both groups had no symptoms of angina pectoris, and 23 (33.3%) patients had no symptoms of heart failure. Clinical manifestations of angina pectoris of functional class I (FC) were observed in 21 (30.4%) patients, of FC II – in 13 (18.8%), of FC III – in 3 (4.3%) patients. Symptoms of heart failure of FC I were recorded in 30 (43.4%), FC II – in 14 (20.3%) , FC III – in 2(2.9%) patients of both groups. In most patients in both the first and second groups after the performed endovascular treatment, manifestations of angina and heart failure remained, although their severity decreased.
Conclusion. Late revascularization in patients with ST-segment elevation myocardial infarction has a positive effect on myocardial contractility and reduces the functional classes of angina and heart failure.

Objective: to assess coronary circulation in patients before planned surgical correction of abdominal aortic aneurysm.
Methods: it is a cohort prospective study, which included a comprehensive examination of 71 patients (68 men and 3 women) aged 51 to 80 years with abdominal aortic aneurysm in combination with atherosclerotic lesions of the coronary arteries. All patients underwent electrocardiography, echocardiography, dobutamine stress test, ultrasound duplex scanning of arterial vessels, selective multiposition coronary angiography and computed tomography. Data processing was performed using Statistica 10.0 and StatPlus software.
Results: the majority (59.2%) were patients in the 61–70-year-old age group and men (95.8%). In our group of patients, coronary heart disease was previously diagnosed in 73.2% (n = 52). According to recived data, 58 people (81.7%) had damage to at least one of the coronary arteries. At the same time, among patients with clinically significant coronary artery stenosis (more than 50%, n = 53), damage to 3 or more vessels was most often detected (45.3%). In 19 people. (26.8%) IHD was not diagnosed before the CGF (a group of asymptomatic patients with IHD), while 14 people (73.6%) were diagnosed with coronary artery stenosis, of which 11 people (57.9%) had lumen damage of more than 50%, and 2 people (10.5%) had more than 70%. Moreover, 2-vessel damage was diagnosed with the highest frequency (42.9%). The frequency of coronary artery damage in symptomatic patients with IHD (n = 52) was 84.6% (n = 44), and in asymptomatic patients (n = 19) – 73.6% (n = 14).
Conclusion: The revealed high frequency of coronary artery disease in both symptomatic and asymptomatic patients underlines the importance of cardiac risk assessment in the form of routine coronary angiography in patients before elective surgical correction of abdominal aortic aneurysm.

Purpose of the study: To analyze the long-term results (up to 20 years) of open surgical treatment of infrarenal aortic aneurysms with and without occlusive-stenotic lesions of the ilio-femoral segment.
Materials and methods: The long-term results of surgical treatment of infrarenal aortic aneurysms were analyzed in 145 patients. Groups: 1 (without lesion IFS, n = 99, 68%) and 2 (with lesion IFS, n = 46, 32%). Observation period: 12±7 years.
Results: In group 1, re-interventions were 19% (n = 19), in group 2 – 43% (n = 20; p = 0.003). Primary patency in group 1 was 81% at 20 years, in group 2 – 15% (p<0.001). Freedom from re-interventions in group 1: 5 years – 89%, 10 years – 75%, 20 years – 71%; in group 2: 5 years – 76%, 10 years – 45%, 20 years – 16% (p = 0.001). Limb preservation in group 1 was 91% after 20 years, in group 2 – 52% (p = 0.001). Major amputations: group 1 – 2% (n = 2), group 2 – 15% (n = 7; p = 0.003). Mortality: group 1 – 23% (n = 23), group 2 – 37% (n = 17; p = 0.08). Cumulative survival did not differ: group 1 (5 years – 90%, 10 years – 65%, 20 years – 52%); group 2 (5 years – 85%, 10 years – 54%, 20 years – 36%; p = 0.08).
Conclusion:
1. Patients with AAA and lesions IFS have worse remote results after surgery in terms of primary patency, limb salvage and frequency of repeated interventions, but survival does not differ between the groups.
2. In patients with AAA without lesions IFS, repeated interventions are associated with aneurysmal dilation of the thoracic aorta and arteries of the lower extremities. In case of lesions IFS, interventions are caused by branch thrombosis and progressive ischemia of the lower extremities.
3. Regular monitoring of patients after AAA surgery allows for timely detection of complications and correction, which increases the duration and quality of life.

Trauma in both peacetime and wartime is always accompanied by difficulty in diagnosis. Complications that develop when trying to preserve the affected limb lead to an increase in mortality of up to 15%. The incidence of septic complications in patients with vascular injury increases by 30–40%.
Aim: the purpose of this study was to determine the information content and specificity of diagnostic methods in patients who were exposed to traumatic effects with high kinetic energy and resulted in injury to the main vessels.
Materials and methods: we used the entire range of instrumental diagnostics at the stage of specialized care, including an innovative assessment of the viability of muscle tissue using ultrasound diagnostics.
Results: the results of computed tomography, both native and contrast, selective angiography, magnetic resonance imaging, scintigraphy, fluorescent angiography, laser Doppler flowmetry, thermography, duplex vascular scanning and energy Doppler with microcirculation studies were analyzed. The positive aspects of each technique are revealed.
Conclusion: radiation diagnostics using X-ray contrast agents is the gold standard in the examination of patients with major vascular injury, but in a critical patient condition, it is important to have methods in your arsenal that allow you to assess the blood supply to the limb and the degree of ischemic damage to the muscle tissue with minimal trauma.

Atherosclerosis of the carotid arteries leads to global changes in structure, a decrease in the volume of gray matter and an increase in white matter, the appearance of chronic cerebral circulatory failure and cognitive dysfunction. Patients with significant stenosis require surgical treatment, which, on the one hand, can improve cognitive status and quality of life, on the other hand, is a risk factor for its aggravation in the immediate or remote postoperative period.
Aim: study of the incidence of cognitive impairment and identification of risk factors for their development in patients with carotid artery atherosclerosis in the perioperative period.
Materials and methods. A prospective observational single–center study included 60 patients with atherosclerosis of arteries of various localizations who underwent planned surgical treatment. In the perioperative period, cognitive status was examined using the Montreal Cognitive Assessment (MoCA). The first test was performed one day before surgery, and again on the 5th day after surgery.
Results. Depending on the MoCA test result, patients were divided into two groups: Group 1 – 22 patients without cognitive impairment, average MoCA test value was 27.4±1.2 points; Group 2 – 38 patients with cognitive impairment, average MoCA test value was 21.9±3.4 points. Statistically significant differences were found between the groups for the MoCA test (p <0.001). Patients in Group 2 had reduced visual-constructive skills, speech, attention, memory, and orientation. Age is a key factor influencing cognitive status, which is due to the presence of a negative correlation of moderate strength with the total MoCA test score (r = –0.481; p<0.001), as well as with speech (r = –0.426; p<0.001), visual-constructive skills (r = –0.417; p<0.001) and memory (r = –0.283; p = 0.031). Atherosclerosis of the carotid arteries has a negative correlation with memory (r = –0.46; p<0.001), and lower extremity atherosclerosis has a positive correlation with the total MoCA score (r = 0.318; p = 0.013). After surgery, the average MoCA test score in the groups was 26.8±2.2 and 23.3±2.9 points (p<0.001), respectively. In the postoperative period, a negative relationship was established between abstract thinking and the degree of carotid artery stenosis (r = –0.503; p = 0.047), surgical intervention (r = –0.321; p = 0.029), endotracheal anesthesia (r = –0.355; p = 0.015), duration of surgery and attention (r = –0.435; p = 0.026), endotracheal anesthesia and orientation (r = –0.325; p = 0.028).
Conclusion. The study found that 63% of patients with arterial atherosclerosis admitted for planned treatment were diagnosed with cognitive impairment for the first time. Multiple factors negatively affect the cognitive status of patients with carotid artery atherosclerosis.

Chronic posttraumatic instability of the acromioclavicular joint is often accompanied by pain and dysfunction of the limb. Known methods of surgical treatment of this pathology have their advantages and disadvantages. A relatively simple and accessible method of stabilizing the acromioclavicular joint in chronic cases is the reconstruction of the coracoclavicular ligaments with a loop encircling the coracoid process of the scapula and the clavicle, using a tendon graft reinforced with a synthetic tape. This surgical treatment method does not involve the formation of holes in the bones, which increase the risk of pathological fractures in the postoperative period.
Aim. To assess the horizontal and vertical stability of the acromioclavicular joint when it is fixed with a loop of synthetic tape encircling the coracoid process of the scapula and the clavicle, and a half-loop with two-bundle transosseous fixation to the clavicle.
Materials and methods. In a biomechanical experiment on 14 acromioclavicular joints in 7 cadavers, the displacement of the acromial end of the clavicle in the anterior, posterior and superior directions was determined under a load of 70 N. The measurements were performed sequentially: with an intact ligamentous apparatus, after crossing the acromioclavicular ligament, after crossing the coracoclavicular ligaments with stabilization of the acromial end of the clavicle with the studied encircling loop, then with a half-loop with transosseous fixation to the clavicle at the attachment sites of the trapezoid and conoid ligaments. A synthetic tape “FiberTape” folded in two was used as a model of a reinforced tendon graft.
Results. The intersection of the acromioclavicular ligament resulted in a significant increase in the displacement of the acromial end of the clavicle under load superior by 3,3 mm (61,4%), posterior by 1,5 mm (24,5%) and anterior by 1,9 mm (24,6%). Stabilization with a encircling loop, as well as a half-loop with transosseous fixation to the clavicle restored the anterior and superior stability of the acromioclavicular joint to the initial level. The residual posterior displacement exceeded the initial one by 0,5 mm (8,4%) and 0,4 mm (7,1%), respectively. When comparing the fixation methods, no significant differences in stability were found.
Conclusions. In case of complete failure of the ligamentous apparatus of the acromioclavicular joint, isolated reconstruction of the coracoclavicular ligaments restores vertical and horizontal stability by more than 90% of the original. Reconstruction of the coracoclavicular ligaments with a loop encircling the coracoid process of the scapula and the acromial end of the clavicle is not inferior in its effectiveness to the use of a half-loop with a two-bundle transosseous fixation to the clavicle.

The aim of the study was to evaluate the diagnostic capabilities and treatment outcomes of patients with early and late paracolostomy complications after obstructive colon resection for the complicated course of DBTC. Systematization of technical errors that are most often made during surgical intervention during the imposition of terminal colostomae. Optimization of surgical correction methods and management of patients with complicated colostomy.
Materials and methods. A single-center, randomized, retrospective study was conducted with the participation of 50 patients with paracolostomy complications who were treated at the Vladimir State Clinical Hospital after obstructive colon resections for DBTC from 2019–2024. There were 31 (62%) men and 19 (38%) women. The average age of the patients was 56.2±11.3 years. In 24 (48%) (group I) cases, there was a clinical picture of peritonitis. At admission, 26 (52%) (group II) patients had a clinical picture of acute diverticulitis, but without peritonitis. Surgical interventions were performed in 100% of cases.
Results. In 8 (16%) cases, free gas was detected on an abdominal X-ray. All 24 patients with a peritonitis clinic and a rengenological picture of hollow organ perforation underwent emergency surgery in the form of laparotomy, Hartmann surgery with resection of a section of the colon with diverticular perforation. In the group of patients (n-26) who underwent surgery on a delayed basis, after anti-inflammatory and antimicrobial therapy, in 13 (26%) cases, ultrasound revealed acute diverticulitis of the sigmoid colon with the formation of a paracollar infiltrate and with local accumulation of fluid. Necrosis of the colostomy occurred in 9 (18%) patients. Colostomy retraction was registered in 8 (16%) cases. Colostomy bleeding occurred in 4 (8%) cases. A parastomal abscess occurred in 4 (8%) patients. Paracolostomy phlegmon was registered in 3 (6%) cases. Paracolostomy dermatitis was registered in 8 (16%) cases. A paracolostomy hernia was registered in 6 (12%) cases. Colostomy stricture occurred in 7 (14%) patients. Colostomy malignancy occurred in 3 (6%) patients.
Conclusion. Colostomy is one of the most common colon surgeries performed under special conditions and is life–saving in desperate situations. The improvement of the colostomy technique, the choice of the level and location of its formation, as well as preoperative marking on the anterior abdominal wall, are factors that reduce the number of paracolostomy complications in patients with perforated diverticulitis of the colon.

Rationale: The influence of genetic factors on the clinical manifestations of perianal fistulas has not been studied so far and requires further investigation.
Aims: to study the clinical significance of polymorphic variants of TNFA G308A, IL 1b T31C, IL4 C589T, IL10 G1082A and C592A genes in blood samples from patients with perianal fistulas.
Materials and methods: A study of gene polymorphism was conducted in 71 patients with anal and rectal fistulas aged 24 to 74 years who were undergoing outpatient treatment by a proctologist. Diagnosis was based on clinical data, instrumental examination results, as well as confirmed during surgical intervention. Genetic testing was conducted in 2023–2024.
Results: In the study group, the prevalence of homozygous gene mutation was 22.5% for variant T31C of the IL1b gene, 5.6% for variant C589T of the IL4 gene, 36.6% for variant G1082 of the IL10 gene, 9.9% for variant C592A of the IL10 gene, and 1.4% for variant G308A of the TNFa gene.
Conclusions: The results of the study showed that the IL1b T31C gene mutation, the frequency of which increases with age, is associated with an increased risk of developing pararectal fistulas. This relationship can be traced in the older age group of men and women.The probability of developing pararectal fistulas after early paraproctitis increases with an increase in the frequency of mutations in the IL1b T31C, IL10 G1082A and C592A genes. After surgery, the recurrence of the pararectal fistula develops with an increase in the frequency of mutations of the IL1b T31C and IL10 C592A genes to 40% and 20%, respectively.

Backgraund: treatment of thoracoabdominal wounds at the advanced stages of qualified care is not only associated with a high probability of diagnostic and tactical errors, but also accompanied by high mortality, significant risks of developing postoperative complications.
Aims: to analyze diagnostic and therapeutic capabilities, as well as the results of treatment of thoracoabdominal wounds at the stage of qualified surgical care in a modern armed conflict.
Materials and methods: a comparative retrospective analysis of medical records of 200 military personnel who received gunshot thoracoabdominal wounds in the period from 2022 to 2023 was conducted. All wounds were of a combined gunshot nature. The formation of the research database and analysis was carried out using the Microsoft Office Excel 2013 application program.
Results: the frequency of undetected penetrating wounds of the chest and / or abdomen at the stage of qualified surgical care was 16% of the total number of wounded. In doubtful cases 6% of the wounded were sent for сomputed tomography of the chest and abdomen, according to the results of which 3.5% were operated on, 2.5% underwent dynamic observation at the next stages. The frequency of thoracotomy in thoracoabdominal wounds at the stage of qualified surgical care in this study was 4.5%, laparotomy was performed in 84.5% of the wounded. The tactics of dynamic observation in patients with penetrating abdominal wounds were implemented in 4.5% of the wounded.
Conclusions: the leading methods of early diagnostics of thoracoabdominal wounds at the stages of qualified surgical care are radiography, as well as ultrasound examination of the chest and abdomen. An important factor in the multi-stage surgical treatment of these patients is the reduction of surgical invasion. Improvement of conservative therapy methods will reduce the number of “unjustified” thoraco-/ and laparotomies at the stages of medical evacuation. Further study of these issues will reduce the incidence of postoperative complications, mortality, reduce the duration of treatment and financial costs, and speed up the return of military personnel to duty.

Rationale. The treatment of patients with gunshot wounds of soft tissues is a complex task for the entire healthcare system. Despite the achievements of modern medicine, the problem of purulent – septic complications of gunshot injury remains one of the most urgent. The development and application of new methods of gunshot wound treatment makes it possible to improve the results of specialized medical care for victims.
Objective: To evaluate the effectiveness and safety of using a medical device – carbon atraumatic wipes “InKar” and epidermal growth factor with silver sulfadiazine in the complex treatment of soft tissue gunshot wounds complicated by a purulent-necrotic process.
Materials and methods. A retrospective, randomized, single-center, clinical trial was conducted on two parallel groups of patients. The study involved 86 wounded with gunshot wounds to the soft tissues of the trunk and limbs, brought from the area of the SMO. The main group included 46 patients who, in the complex local treatment of gunshot wounds, used carbon absorbent and therapeutic wipes “InKar” (in phase I) with the treatment of wound surfaces with “Ebermin” ointment during bandages. The control group included 40 patients who received standard treatment. The criteria for assessing the dynamics of the wound process were: cytological and bacteriological studies of wound exudate, visual and photographic assessment of the appearance of granulation tissue in the wound, and the timing of its purification. The dynamics of the systemic inflammatory response syndrome was based on clinical and laboratory data, and quality of life was assessed using the SF 36 questionnaire.
Results. The use of carbon and therapeutic bandages for the local treatment of gunshot wounds in symbiosis with epidermal growth factor and silver sulfadiazine in the main group provided (twice) faster wound healing, the absence of complications (progression of the purulent -necrotic process, secondary infection) and a significant reduction in systemic inflammatory response syndrome and treatment time, according to compared with patients in the control group. An assessment of the quality of life of the wounded in both groups confirmed a faster recovery of functional, physical, and psycho-emotional parameters in the patients of the main cohort.
Conclusion: effective and safe treatment of gunshot wounds is possible with the rational and competent (depending on the phase of the wound process) use of modern wound coverings. At the same time, new prospects are opening up for the use of epidermal growth factors in broad clinical practice, which provide a reliable regenerative component in the healing of gunshot wounds complicated by purulent infection of various localization.

Today, the treatment of wounded with gunshot fractures of long bones of the extremities is the most important task of military traumatology and orthopedics. In the context of armed conflicts of recent decades, the nature of military operations is constantly changing and the damaging effects of modern firearms and ammunition are increasing, which is why the treatment of this category of patients requires constant improvement. Traditionally, medical care for the wounded with fractures of long bones of the extremities consisted of timely primary surgical treatment and therapeutic and transport immobilization, which should preferably be performed by extrafocal osteosynthesis using rod external fixation devices (EFD). However, the existing versions and modifications of EFD have different biomechanical and ergonomic characteristics, which, in our opinion, require further revision in order to improve the quality of medical care for the wounded at the stages of medical evacuation.
Objective: based on the analysis of biomechanical parameters, assess the stability of external fixation of bone fragments in the constructed loading models “bone – EFD” using various versions of rod EFD using the example of a diaphyseal comminuted fracture of the tibia (type C according to the AO classification).
Materials and methods: the material for this study was a 3D printed model of the tibia, built on the basis of CT in the Mimics program. The model took into account spongy and cortical bone tissue. Then, in the SolidWorks automated design system, models of external fixation devices were built, which were then combined with the bone model. Next, a comminuted fracture of the bone diaphysis was formed, type C according to the AO classification. Modeling of the bone – external fixation device system loading was carried out in the Ansys finite element analysis system. Quantitative calculation of the biomechanical characteristics of external fixation was carried out using the finite element method (FE).
Results and conclusions: based on the analysis of the biomechanical characteristics, it was revealed that the highest stability indicators for fixing a comminuted fracture are found in the rod external fixation device, the connecting nodes of which were made of titanium alloy. At the same time, the devices, the connecting units of which were made of other materials, demonstrated a sufficient degree of fixation during long loading cycles, without experiencing fatigue damage either in bone tissue or in the elements of the device, which confirms the possibility of using various modifications of rod EFDs in the treatment of comminuted, including gunshot, fractures of the diaphysis of long tubular bones in clinical practice.

The aim of the study: to analyze the treatment results of patients with small intestinal fistulas after gunshot wounds to the abdomen and to choose the optimal surgical tactics for these complications.
Materials and methods. The analysis of diagnostics and treatment results was carried out for 58 patients who were operated on at the stage of qualified medical care for gunshot wounds to the abdomen with damage to the small intestine. In the late period of the course of traumatic disease at the stage of specialized care, they were diagnosed with unformed (n = 31) and formed (n = 27) fistulas of the small intestine. According to the type of atmospheric-intestinal anastomoses, the wounded were classified into 5 groups.
Results. Diagnostics was carried out using clinical, radiological, endoscopic methods with mandatory fistulograms and computed tomography. Local treatment included: dressing purulent wounds, protecting surrounding tissues from the effects of aggressive intestinal secretions, reducing chyme loss by installing obturator plugs. General treatment was aimed at normalizing homeostasis, replenishing water-electrolyte and protein losses. Patients with multiple organ failure (n = 30) underwent extracorporeal detoxification. All patients were operated on at different times. Surgical tactics were determined by the localization of the small intestinal fistula, its complications, the size of the defect, the time of its occurrence and the type of atmospheric-intestinal anastomosis. The scope of operations was aimed at eliminating the fistula and restoring the passage of food through the intestine.
Conclusion. Diagnostics and treatment of this severe category of wounded should be carried out at the stages of specialized medical care by a multidisciplinary team of specialists with a personalized approach in each specific case of atmospheric-intestinal anastomosis after gunshot injuries of the abdominal organs.

Rationale: during auto-HSCT, it is of great importance to monitor the patient’s condition after discharge for control of side effects, correction of accompanying therapy and assessing the patient’s recovery.
Objective: to study the dynamics of quality of life (QoL) and symptoms in patients with hematological malignancies after auto-HSCT using the electronic HESA system (Health – Electronic Self-Assessment).
Methods: The data were analyzed in patients with hematological malignancies who underwent auto-HSCT from March 2023 to November 2024. Patients filled out questionnaires based on HESA before auto-HSCT and at discharge, as well as remotely at different times after discharge. HESA is a secure web platform based on standardized HM-PRO and HADS questionnaires. Data obtained using HESA were used to analyze the dynamics of QoL by HM-PRO and dynamics of anxiety/depression by HADS and to identify significant changes in QoL and psychological health at different times after discharge.
Results: the data were obtained on 119 patients (male/female 55/64) aged from 19 years to 72 years (mean age 43 years); 48% patients had Hodgkin lymphoma (HL), 21% – non-Hodgkin lymphoma (NL) and 31% – multiple myeloma (MM). Prior to auto-HSCT, 56% of patients had significantly impairment of emotional functioning, 42% – physical functioning, 20% – social functioning, and 40% had significant problems due to impaired eating and drinking habits. In 40% of patients, symptoms had a significant impact on their condition. Most often, patients experienced severe fatigue (69%), insufficient energy (65%) and hair loss (43%). 14% and 10% of patients had borderline/elevated levels of anxiety/depression. After discharge, 38% of patients completed HESA remotely (maximum duration of monitoring – 22 months, median – 11 months). During monitoring, a part of patients recorded a deterioration in certain indicators: 38% – in terms of QoL impairment, 18% – in terms of symptom effect; 18% and 27% have an increase in anxiety and depression, respectively. At the end of the follow-up 29% patients had significant negative dynamics in QoL, 16% – significant increase in the symptoms effect. In 16% and 24%, respectively, the increasing of anxiety and depression was revealed. The treating physicians used information, obtained with HESA for interaction with patients to optimize the accompanying therapy.
Conclusion: the use of HESA in patients with hematological malignancies undergoing auto-HSCT should be used for timely interaction with the patient and can contribute to the implementation of patient-oriented care.

Rationale. Antithrombin III (AT) is one of the most important natural inhibitors of blood coagulation. Antithrombin deficiency is usually detected when a patient has recurrent venous thrombosis and pulmonary embolism. Antithrombin activity is significantly enhanced in the presence of heparin, and the anticoagulant effect of heparin depends on the presence of antithrombin.
Objective: to identify patterns of AT infusions in a multidisciplinary hospital, to assess the compliance of AT use with medical care standards.
Methods. Retrospectively, based on the materials of 44,221 electronic medical records, the determination of plasma levels and the administration of AT to patients of the Pirogov Center hospital in 2024 were studied. The data were analyzed using descriptive statistics at a significance level of 0.05.
Results. Of the 44,221 patients of the hospital, the AT concentration was determined in 48 people (in 1 – twice) (0.1%): 26 women and 22 men aged 51.8 ± 14.2 (hereinafter: mean ± standard deviation) years, from 23 to 85 years.
AT level – 98.1 ± 21.1% (from 43 to 125%).
Fatal outcome – 1 (in a patient with an AT level of 43%).
37 antithrombin activity results were within normal limits. 8 – unavailable, usually due to testing on the eve of hospital discharge. 5 results – below normal.
In 2024, AT was administered to 2 patients.
Patient V., 34 years old. Pancreatic necrosis, sepsis. Treatment period is 54 days. On the 3rd day of hospitalization, the AT level was 61%. 4 vials of the drug were administered (1 vial per day). The AT level increased to 80%. 50 doses of red blood cells and 3 doses of plasma were transfused.
Patient M., 79 years old. Ischemic stroke, sepsis. Treatment period is 22 days. 1 vial of the drug was administered. No blood was transfused.
Both patients were discharged with improvement.
10 patients (21%) received blood transfusion therapy:
Conclusion. Both the determination of activity and the order of antithrombin infusion:
– are absent from the standards of medical care,
– are prescribed by individual doctors to search for the causes of possible thrombophilia and antithrombotic therapy, respectively.
The level of antithrombin in the group of blood recipients was 81.6±19.9%, which is significantly lower than in the group of non-recipients of blood was 105.8±5.7% (t-criterion 3.501, p = 0.001).

Rationale. Autoimmune thyroiditis (AIT) is an organ-specific autoimmune disorder characterized by lymphocytic infiltration of the thyroid tissue, impaired tolerance to thyroid antigens, and the production of organ-specific autoantibodies.
Objective. The aim of this study is to review current data regarding immunotherapeutic approaches to the treatment of AIT.
Methods. The analysis was conducted based on literature published between 2019 and 2025, selected from the PubMed, Scopus, Web of Science, and eLIBRARY databases. Included were publications focused on the pathogenesis of AIT and immunotherapeutic approaches that met the criteria of originality and scientific validity.
Results. Key immunopathogenetic mechanisms implicated in AIT development were examined, including activation of autoreactive CD4+ cells, deficiency and dysfunction of regulatory T cells, hyperactivity of B-lymphocytes, and dysregulation of pro-inflammatory cytokines. Contemporary immunotherapeutic approaches are presented, encompassing monoclonal antibodies (particularly anti-CD20), therapies utilizing regulatory T cells, administration of synthetic peptide vaccines, and targeting of Toll-like receptors.
Conclusion. Immunotherapy aimed at restoring antigen-specific immune tolerance represents a promising direction in the pathogenetic treatment of AIT. The most substantiated strategies involve selective modulation of critical immune components. Despite encouraging experimental findings, the integration of these approaches into clinical practice is currently limited by the absence of large-scale randomized trials and insufficient evidence base.

Rationale. Multiple sclerosis (MS) is a chronic autoimmune disease of the central nervous system characterized by demyelination, axonal damage, and progressive neurological impairment.
Objective. The aim of this study is to analyze current literature data addressing the use of immunomodulatory therapy in the management of MS symptoms.
Methods. A literature review was conducted using sources published from 2019 to 2025 in PubMed, Scopus, Web of Science, and eLIBRARY.RU databases. The analysis included systematic reviews, meta-analyses, original research articles, and randomized controlled trials reporting data on the efficacy and safety of immunotherapy.
Results. It has been established that therapy with immunomodulatory agents and interferon-based drugs reduces the frequency of relapses and lesion activity on magnetic resonance imaging without significant adverse effects. Sphingosine-1-phosphate modulators have demonstrated efficacy in limiting lymphocyte migration and reducing inflammation in the central nervous system. Anti-CD20 monoclonal antibodies significantly reduce the risk of disability progression as well as the level of neurofilament light chain, which is considered a marker of neuroaxonal damage. Adverse effects associated with most therapies did not exceed control group values.
Conclusion. Immunomodulatory therapy in MS is effective in reducing the activity of the disease and the rate of progression of neurological deficits. Its effect on persistent symptoms such as cognitive impairment and fatigue requires further study.

This review examines thematic articles published from 2011 to 2025, which examined technical aspects, immediate and long-term results of using microwave ablation for the destruction of primary and secondary malignant liver tumors, and a comparative assessment of various thermal degradation techniques. In the course of reviewing the research results, it was found that the use of microwave ablation (MVA) for the destruction of secondary liver tumors allows achieving similar treatment results with surgical interventions and expands the possibilities of radical surgical treatment in somatically burdened patients.

Rationale. On September 1, 2025, new Rules for the Procurement, Storage, Transportation and Clinical Use of Donor Blood and its Components came into force in Russia, legalizing three new clinical concepts: massive transfusion, massive blood loss and massive transfusion protocol (MTP). The following questions need to be answered: 1) What is massive blood loss? 2) How long does a massive transfusion last? 3) How does a MTP differ from a guide to providing medical care?
Objective: to search for the definitions of “massive blood loss” and “massive transfusion protocol”, to assess the compliance of the MTP rules with blood transfusion standards and the achievements of evidence-based medicine in the field of transfusiology.
Methods. A search of reviews, meta-analyses and randomized clinical trials was conducted using the words “massive blood loss”, “massive transfusion protocol” in Russian and English in the electronic libraries of Russia (eLibrary.ru) and the USA (pubmed. ncbi.nlm.nih.gov).
Results. The term “massive blood loss” is incorrect without a time frame. MTP is best represented as 7 components: 1) start, 2) command, 3) tranexamic acid, 4) testing, 5) blood transfusion, 6) temperature and 7) termination.
Conclusion. As in any emergency and complex situation requiring a rapid response, the readiness of both blood providers and recipients with their standard operating procedures and MTP ensures an effective response and increases the chances of saving patients.

The article presents a clinical observation of multistep endovascular treatment of congenital arteriovenous malformation of the pelvis. 

Rationale. Given the rarity of the pathology, the risks associated with it, and the variability of treatment methods, as well as the absence of similar reported cases in scientific databases, we found it necessary to share our experience in treating a patient with thoracic outlet syndrome in combination with an additional cervical rib on the left, aneurysm of the left subclavian artery, thrombosis of the subclavian and axillary arteries on the left, and critical ischemia of the left upper limb.
Objective: demonstration of a case of surgical treatment of a patient with thoracic outlet syndrome in combination with aneurysm of the left subclavian artery, thrombosis of the subclavian, axillary and brachial arteries on the left, critical ischemia of the left upper limb.
Methods. A 36-year-old woman was admitted to the vascular surgery department complaining of pain in her left upper limb at rest, numbness and coldness of the fingers of her left hand. During the examination, according to the results of multispiral computed tomography with intravenous contrast, additional cervical ribs, compression of the left subclavian artery by the median stair muscle, occlusion of the left subclavian, axillary and brachial arteries, as well as an aneurysm of the left subclavian artery measuring 11x15 mm are determined.
Results. Resection of the accessory cervical rib, resection of the subclavian artery aneurysm with autovenous prosthetics, and arterio-arterial plasty of the brachial artery on the left were performed. The postoperative period was complicated by thrombosis of the brachial artery in the middle and distal third of the shoulder on the left, and therefore thrombectomy was performed from the arteries of the left upper limb, resection of the distal third of the brachial artery with autovenous prosthetics on the left. In the control multispiral computed tomography with intravenous contrast, the autovenous prosthesis is passable. The brachial, ulnar, and radial arteries contrast homogeneously throughout.
Conclusion. The above clinical case demonstrates the successful result of simultaneous surgical treatment of a patient with thoracic outlet syndrome combined with an additional cervical rib, subclavian artery aneurysm and arterial thrombosis of the left upper limb. The arterial form of thoracic outlet syndrome is the rarest of the described, but it can be the most dangerous in the prospect of limb preservation. With untimely surgical treatment, the aneurysm lumen may thrombose and cause embolization of the distal bed with a clinical picture of acute limb ischemia.

Celiac artery compression syndrome is a rare condition that causes chronic postprandial pain and weight loss, pathogenetically resulting from compression of the celiac trunk by the median arcuate ligament. This article presents a clinical case of an 18-year-old patient with recurrent symptoms following laparoscopic decompression and angioplasty, who was diagnosed with persistent stenosis of the celiac artery. A reoperation via an open approach was performed, involving complete decompression and splanchnic ganglionectomy. At the 4-year follow-up, sustained remission was observed: the pain syndrome was relieved, and no signs of restenosis were detected. When minimally invasive methods prove ineffective, open surgical treatment provides a reliable and long-term outcome.

Relevance. In modern surgical practice, simultaneous operations are becoming increasingly relevant, especially in complex clinical scenarios such as complicated locally advanced gastric cancer in combination with acute ischemic stroke. To this day, the optimal timing and surgical approach remain the subject of discussion due to the high risks of mortality and disability.
Aim. The aim is to improve patient outcomes, reduce surgical trauma, and enhance the quality of medical care – making this direction a key focus for modern surgery and oncology. On a broader scale, this work’s mission is to provide results that could serve as a foundation for international guidelines, helping to reduce mortality and improve patients’ quality of life.
Case Description. We present a clinical case of a 69-year-old male patient diagnosed with ischemic stroke in the left carotid artery territory, atherothrombotic subtype. The patient had 65% stenosis of the left internal carotid artery with signs of plaque instability, and 45% stenosis on the right. He was also diagnosed with cancer of the gastric body and cardia (cT4N0M0), complicated by tumor breakdown and gastric bleeding. A multidisciplinary medical board concluded that a simultaneous operation was the most optimal and the only tactically justified approach in this situation.
Conclusion. The topic of simultaneous surgery for locally advanced complicated gastric cancer during the acute phase of ischemic stroke is extremely original and highly relevant due to the increasing number of patients with comorbid conditions and the need for integrated surgical solutions. This clinical case may serve as a model for building an optimal surgical strategy for similar patient groups.

This paper presents a clinical case of treating a 22-year-old female patient with a malignant cystic tumor of the pancreas. At the initial consultation, due to her age, no oncological history, small size of the tumor, no cancerous growth according to biopsy data, and no clinical manifestations, dynamic observation was recommended. In dynamics, after 6 months, an increase in the size of the pancreatic tumor was detected. After a comprehensive additional examination, indications for surgery were established and laparoscopic spleen-preserving distal resection of the pancreas according to the Warshaw type was performed. Postoperative pathohistological examination: mucinous cystic tumor of the pancreas with high-grade microfoci of epithelial dysplasia (Ca in situ). It is concluded that an  oncoguarded approach to cystic tumors of the pancreas should be used,  including in young people.

Ogilvy syndrome is a rare form of intestinal obstruction. It is characterized by a significant expansion of all parts of the colon in the absence of any mechanical obstruction. It is characterized by a significant expansion of all parts of the colon in the absence of any mechanical obstruction. The pathogenesis of the syndrome is based on an imbalance in the nervous regulation of the motor function of the colon. Ogilvy syndrome can be initiated by a wide variety of factors, including surgical interventions performed outside the abdominal cavity and retroperitoneal space. We observed an elderly patient who, after surgery in the form of metallosteosynthesis of the left fibula, developed persistent colon paresis due to a fracture of both ankles of the left tibia with dislocation of fragments (Ogilvy syndrome). Attempts to resolve paresis by conservative methods did not lead to success. During the operation, a significant expansion (up to 10 cm) of the lumen of the entire colon was found without structural changes in its wall. The operation was completed by transanal drainage of the colon.

Diseases of the arteries of the lower extremities are extremely widespread in patients with diabetes mellitus. Patients with multilevel atherosclerotic lesion of the arteries of the lower extremities on the background of diabetes mellitus have a high risk of critical ischemia, and in accordance with this, the number of amputations and the number of deaths increases. Our clinical case describes the importance of timely revascularization of the arteries of the lower extremities in patients with diabetes mellitus. The possibility of simultaneous surgery in such patients, including endovascular recanalization with balloon angioplasty and distal amputation, which allows to preserve the supporting function of the lower limb. Our article presents a clinical case of successful repeated retrograde endovascular treatment followed by amputation of the middle and distal phalanx of the little digit of the right lower limb in a patient with a lesion of the arteries of the tibia on the background of diabetes mellitus.

The elimination of extensive soft tissue defects resulting from high-energy trauma or injuries  is a complex and urgent task of modern surgery. In most cases, soft tissue deficiency does not allow the wound to be closed initially, and spontaneous healing is a lengthy process that is associated with the development of various complications. Traditional methods of autoplasty using microsurgical techniques, including vascularized grafts, require specialized tools, differ in technical complexity and the duration of the surgical aid. The most affordable alternative in different phases of the wound process for deep and extensive wound defects is increasingly the use of a method of controlled increase in skin surface area by mechanical stretching or the method of metered tissue distraction (MMTD).
The article presents a clinical observation using MMTD in its own modification as the first stage of reconstructive and restorative treatment.

In total, from 1832 to 1881, N.I. Pirogov published more than 100 works devoted to medical and pedagogical activity. However, there is no historical-genetic and comparative analysis of the content of these works. The aim of the study was the content analysis of the lifetime works of N.I. Pirogov as sources for studying his life, work and contribution to medicine and pedagogy. For this purpose, 40 works by N.I. Pirogov were studied. The analysis of the circumstances of the publications and the content analysis were carried out using historical, genetic and comparative methods. It was shown that from 1832 to 1840, the experimental, clinical and anatomical works by N.I. Pirogov were published in Latin and German and were not widely accessible to doctors. Russian-language clinical and anatomical works appeared in 1842. Some of them were duplicated in German and French. The most popular atlas was “Surgical Anatomy of Arterial Trunks and Fasciae,” which went through several editions from 1837 to 1881. This is explained by the fact that ligation of arteries for aneurysms in the 19th century required a good knowledge of anatomy. N.I. Pirogov’s clinical works touched on issues of general, hospital, reconstructive and plastic surgery, traumatology and orthopedics, vascular surgery and general anesthesia, deontology, etc. Their number is large, so not all of them are mentioned in the article. A large place in the lifetime bibliography of N.I. Pirogov is occupied by works on military field surgery, military medical and sanitary affairs, published in 1849-1879. The socio-political works of N.I. Pirogov, published in 1856–1868, left a deep mark on Russian pedagogy, and his unfinished diary, published after his death, became the moral testament of the great physician-humanist. Thus, the lifetime bibliography of N.I. Pirogov allows not only to study his life and work, but also to evaluate his contribution to medicine and pedagogy.

The article is devoted to the main milestones of the glorious work and creative path of the outstanding general practitioner Georgy Fyodorovich Lang. Research, clinical, pedagogical and organizational activities cover a wide range of problems of therapy, cardiology, pulmonology, gastroenterology, hepatology, hematology, rheumatology, educational activities and healthcare organization. The contribution of Professor Lang G.F. in the training of medical, therapeutic and scientific personnel of domestic healthcare is noted.

A brief biography of the Honorary Doctor of the Pirogov Center, Academician of the Russian Academy of Sciences Yuri Lobzin and his contribution to the formation of the modern scientific concept of «infectology» is presented.