Amyloidoses are a group of conditions in which extracellular amyloid deposits (misfolded proteins) are present in the form of fibrils. A special Congo red stain is used for their detection. Amyloid deposits are frequently found in periarticular tissues across various disease entities, and their clinical interpretation is essential: transthyretin amyloid (ATTR) in the carpal tunnel may serve as an early marker of future ATTR cardiomyopathy; a persistent focus of chronic inflammation (e.g., chronic osteomyelitis) is associated with a risk of AA amyloidosis, including cardiac involvement; bacterial amyloids (curli) are considered potential factors that sustain inflammation and initiate amyloidogenesis in periarticular tissues. The concept of amyloid-associated conditions highlights the role of amyloid infiltration of periarticular tissues in the pathogenesis of enthesopathies and the impact of dysproteinosis on extracellular matrix properties and persistent enthesis remodeling.
The early detection of amyloid in surgical biopsies of periarticular tissue has practical significance: its presence should be considered as a “warning sign” requiring mandatory subtyping of the modern proteomic techniques (including LC-MS/MS). This approach improves the accuracy of early diagnosis of ATTR and AL variants of cardiac involvement prior to clinical manifestation of the disease and influences the further treatment strategy for the patient.

Coronary heart disease occupies a leading position in the structure of causes of death and disability of the adult population. In the Russian Federation, there is an increase in the number of surgical revascularizations, which requires improved methods of intraoperative quality control of coronary bypass surgery. Despite the use of ultrasound Doppler flowmetry as the “gold standard” for assessing the patency of shunts, this method does not allow us to characterize the restoration of perfusion at the microcirculatory level, which is especially important for the prevention of perioperative myocardial infarction. Laser Doppler flowmetry is a promising method for intraoperative monitoring of cardiac microcirculation, however, the amount of published data in this area remains limited, which determines the need for further study of the features of myocardial perfusion during coronary bypass surgery.
Aim. Improving the results of coronary bypass surgery by improving the control of revascularization effectiveness by direct assessment of myocardial perfusion.
Materials and methods. To assess microcirculation, laser Doppler flowmetry was used to determine the main diagnostic parameters, such as M (average blood perfusion in the microcirculation system), M_nutr (average nutritional blood flow or fraction of blood flow through capillaries) and M_bypass (part of blood flow through arteriovenous anastomoses). Definitive control of bypass surgery efficiency was carried out by ultrasonic Doppler flowmetry.
Results. In most cases, the increase in total perfusion (∆М) after myocardial revascularization was 20%. This moderate increase is explained by the initially low microcirculation rates in the areas of ischemic myocardium. A detailed analysis revealed that the increase in nutritional (capillary) blood flow (∆М_nutr) was more pronounced and reached 60%, which indicates the restoration of blood supply to the heart. At the same time, bypass blood flow (M_bypass) parameters remained stable. A comparison of laser Doppler flowmetry with the results of ultrasound Doppler flowmetry of shunts showed that an increase in average perfusion was observed only when the volumetric blood flow rate through the shunts was ≥25 ml/min.
Conclusion. The study confirms the effectiveness of using laser Doppler flowmetry for intraoperative assessment of myocardial perfusion during coronary bypass surgery. Further improvement of measurement methods and technical support will allow us to consider this method as a leading tool for quality control of myocardial revascularization.

Backgraund: Right ventricular apical pacing is believed to induce myocardial remodeling with the development of fibrosis, leading to the progression of heart failure. The interventricular septum has been suggested in some studies as an alternative pacing site; however, convincing evidence of its superiority remains insufficient.
Aims: To evaluate the impact of right ventricular lead localization (right ventricular apex vs. interventricular septum) on the development of heart failure and myocardial fibrosis through a comparative analysis of galectin-3 and NT-proANP dynamics in patients after pacemaker implantation.
Materials and methods: This open-label prospective study enrolled 127 patients with indications for pacemaker implantation. Group 1 (n = 58) received a pacemaker with the ventricular lead positioned at the right ventricular apex. Group 2 (n = 69) received a pacemaker with the lead positioned in the interventricular septum. Laboratory analysis of N-terminal pro-atrial natriuretic peptide (NT-proANP) and galectin-3 was performed before implantation, as well as at 6 and 12 months post-implantation, to assess the severity of heart failure and the extent of myocardial fibrosis.
Results: Key findings included elevated baseline levels of NT-proANP and galectin-3 in both Group 1 [1586.2 (820.7-2694.1) pg/mL and 9.2 (5.9-18.2) ng/mL, respectively] and Group 2 [1848.3 (1111.7-2680.3) pg/mL and 9.9 (5.9-18.2) ng/mL, respectively]. A statistically significant decrease in NT-proANP levels was observed in both groups between the 6- and 12-month follow-up visits (p = 0.015 and p = 0.002) and at 12 months post-implantation (p<0.001 and p<0.001). Galectin-3 levels decreased significantly in both groups at 6 months (p = 0.002 and p = 0.004) and 12 months (p<0.001 and p<0.001). In Group 2, a statistically significant decrease in galectin-3 was also observed between the 6- and 12-month follow-up visits (p = 0.008); no such difference was found in Group 1 (p = 0.277). Intergroup comparison revealed no statistically significant differences at any of the follow-up time points. ROC analysis revealed a threshold value of NT-proANP of 2448.65 pg/mL as a predictor of one-year mortality (AUC 0.739; p = 0.049), with a sensitivity of 83.3% and a specificity of 68.1%.
Conclusion: The decrease in NT-proANP levels at 12 months in both groups indicates a restoration of ventricular synchrony following a period of bradyarrhythmia. The decrease in galectin-3 after the 6-month follow-up in Group 2 suggests a beneficial effect of septal pacing on the progression of myocardial fibrosis. A high preoperative NT-proANP level serves as a prognostic factor for mortality.

Backgraund: Due to the anatomical and physiological features of the thyroid gland, surgery is accompanied by a high risk of bleeding. Intraoperative bleeding worsens the conditions of surgical access and can lead to traumatization of vital anatomical structures, which is fraught with the development of postoperative hypoparathyroidism and recurrent laryngeal nerve paresis. Bleeding in the early postoperative period creates a risk of compression hematoma formation, which can cause asphyxia. In order to minimize the risks of surgical treatment and prevent complications, methods of preoperative patient preparation have been actively developed in recent years.
Aims: A comprehensive assessment of the dynamics of thyroid gland volume and blood supply parameters following selective bilateral embolization of its arteries in patients with diffuse toxic goiter.
Materials and methods: A combined retrospective and prospective clinical study was conducted, involving patients who underwent thyroid artery embolization as a preparatory step prior to total thyroidectomy. Morphometric (volume, echostructure) and hemodynamic parameters (linear and volumetric blood flow velocity, peripheral resistance indices) were assessed using ultrasound Doppler ultrasonography preoperatively and within the first 48 hours post-embolization.
Results: Endovascular embolization resulted in a statistically significant and sequential reduction in thyroid parenchyma volume. A significant decrease in linear blood flow velocity was observed in all four main feeding arteries (superior and inferior thyroid arteries). The most pronounced hemodynamic and morphometric effect was noted in the early stages (first 24 hours) post-intervention.
Conclusions: The obtained results confirm the high efficacy and rationale for using selective thyroid artery embolization as a preparatory step before radical surgical treatment of diffuse toxic goiter. This method minimizes intraoperative risks, primarily by reducing organ blood supply intensity and decreasing its volume, which improves the visualization of fine anatomical structures and reduces the likelihood of their iatrogenic injury during thyroidectomy.

Objective. To evaluate the outcomes of robot-assisted (DaVinci) and laparoscopic surgeries in patients with malignant neoplasms of the uterine body and cervix.
Material and methods. Medical records of 177 patients who underwent robotic (DaVinci) or laparoscopic surgery for uterine body and cervical cancer between 2009 and 2024 at the N.I. Pirogov National Medical and Surgical Center were retrospectively analyzed. Perioperative outcomes of the two techniques were compared. The groups were comparable in baseline characteristics.
Results. Robot-assisted surgeries demonstrated significantly shorter operative time (p = 0,015) and reduced blood loss (p<0,0001) compared to laparoscopic procedures. The number of lymph nodes removed was comparable. Pelvic lymphadenectomy was performed significantly more frequently in the robotic group (p = 0,0043). Operative time was longer in the robotic group (260 min against 190 min; p = 0,18), attributable to the performance of para-aortic lymphadenectomy (9,7% against 0%). Complications were rare across all groups.
Conclusion. Both techniques demonstrate comparable safety and efficacy. However, the choice of approach should consider technological availability, disease stage, and the surgical team’s expertise. Future development of this field involves integrating fluorescent navigation and analyzing long-term oncological outcomes. These results highlight the necessity of personalized approaches in surgical management of gynecological malignancies.

Backgraund: esophageal cancer ranks ninth among the most common human malignancies in the world. Treatment of patients with thoracic esophageal cancer remains one of the most challenging tasks of clinical oncology.
The preferred method of treatment is neoadjuvant (or perioperative) therapy followed by esophagectomy, with a 5-year survival rate of 40–50%. The low sensitivity of esophageal cancer to existing conservative therapy makes surgery the main method of treatment for patients with this disease. Surgical treatment of malignant esophageal tumors cannot be called standardized, as many technical details may differ between surgeons, centers, and countries. The probability of unreliable assessment of the tumor process prevalence increases in case of complicated esophageal cancer. Thus, paracancrotic inflammation with involvement of adjacent anatomical structures significantly complicates intraoperative diagnosis, which leads either to unjustified combined operations or to unjustified reduction of the operation volume to palliative.
Aims: to study topographo-anatomical features in patients with complicated locally advanced esophageal cancer in order to increase the reliability of intraoperative revision data and, as a consequence, to increase the performance of radical operations and reduce the number of palliative (R-1, R-2) resections.
Materials and methods: from 2005 to 2013, 343 patients were operated on for intrathoracic esophageal cancer at the Leningrad Regional Oncologic Dispensary. Of these, 140 patients (40.8%) had complicated locally advanced esophageal cancer (LECECEC). A total of 273 patients were included in the study. Postoperative complications and mortality were categorized into surgical and non-surgical complications.
Results: in the group of patients with OMRRP, 82 patients (58.6%) underwent combined operations; 58 patients (41.4%) underwent symptomatic surgical interventions (endoscopic stent placement in the area of tumor stricture, gastrostomy formation). The study included patients who underwent standard esophageal resections (133 observations) and were considered as a control group.
Conclusions: patients with complicated forms of locally advanced thoracic esophageal cancer, in the absence of distant metastases and contraindications to chemoradiotherapy and neoadjuvant chemotherapy, should be considered as candidates for combined operations. Taking into account topographo-anatomical features of complicated forms of locally advanced esophageal cancer, reliable intraoperative assessment of resectability of esophageal tumor using special techniques is an important factor allowing to increase the number of radical operations and reduce the number of palliative resections and symptomatic operations. The immediate results of combined operations are comparable to those of standard esophageal resections.

Relevance. Appendagitis (torsion of the epiploic appendage) is a rare abdominal disease (0.04–0.3% of all patients with acute abdominal surgery diseases). Most literature sources note that this is a self-limiting condition, requiring primarily conservative treatment. However, cases of serious complications (intra-abdominal abscesses, peritonitis, and intestinal obstruction) have been described, necessitating surgical intervention.
Objective. To analyze literature and our own data, and propose an optimal treatment algorithm for patients with appendicitis.
Patients and Methods. A retrospective analysis of the treatment of 49 patients diagnosed with appendicitis over a 5-year period beginning in 2020, who were admitted to the surgical department of the Pirogov National Medical and Surgical Center. To identify risk factors and propose a treatment strategy for patients with appendagitis, we assessed possible predisposing factors, changes in blood C-reactive protein levels, and the treatment methods used (conservative or surgical).
Results. Initially, surgical treatment was used in two patients (4.1%). Conservative treatment with nonsteroidal anti-inflammatory drugs (NSAIDs) was administered to 47 patients. Of these, 22 patients also received antibacterial therapy. Complications requiring surgical intervention were identified in two patients in the conservative treatment group. No complications were observed in the surgical group. Conservative treatment was associated with a longer hospital stay (5.30±2.74 hospital days with conservative treatment versus 4.00±1.41 hospital days with the initial surgical strategy). Antibacterial therapy was more often used in patients with elevated C-reactive protein (CRP) levels at hospitalization, but its use did not influence management.
Conclusion. The primary diagnostic method for diagnosing appendagitis is abdominal CT scanning. Patients with a confirmed diagnosis of appendagitis are recommended to undergo conservative treatment with NSAIDs. If pain persists and CRP levels increase in the blood within the first two days, surgical treatment is indicated, including diagnostic laparoscopy and removal of the necrotic epiploic appendage. Antibacterial therapy is appropriate for complicated cases with the development of paracolic infiltrate and peritonitis.

Aim. Improving treatment outcomes for patients undergoing resection and reconstructive interventions on the colon by improving methods for preventing colonic anastomosis failure.
Materials and methods. The study included 96 patients undergoing treatment for colon diseases. Seventy-seven patients underwent resection with primary interintestinal anastomosis, while 19 patients underwent closure of previously established stomas, which is considered reconstructive surgery. To analyze the frequency of early postoperative complications, all patients were divided into two groups: main and control. In the main group, consisting of 47 patients, specially developed preventive and therapeutic measures were used in the postoperative period to reduce the risk of colonic anastomotic leakage (CAL). The control group included 49 patients who, after resection and reconstructive operations on the colon, received standard medical care based on generally accepted principles for managing such patients.
Results. In patients of the main group (n = 47), in the early postoperative period, the developed methods for the prevention of CAL were used: transcolonal local laser stimulation, transcolonal local administration of the antiseptic decasan, dynaton and mexidol, as well as NO-containing drugs in the area of the formed colonic anastomosis. Patients in the control group (n = 49) received standard, generally accepted treatment in the early postoperative period without the use of developed methods for preventing CAL. No cases of CAL were observed in the study group in the early postoperative period, whereas CAL developed in 4 patients (8.1%) in the control group.
Conclusion. Thus, the proposed methods for preventing colonic anastomotic failure contribute to improving the results of resection and reconstructive interventions on the colon due to timely healing of the anastomotic line and a reduction in the incidence of infectious and inflammatory postoperative complications, including cases of anastomotic failure.

Relevance: purulent sternomediastinitis is one of the most serious complications of cardiac surgery (from 0.4 to 16%) with high disability (up to 32%) and mortality rate up to 48%. Multifactorial development of sternal infection is associated with the preoperative comorbid state of patients, with the peculiarities of cardiac surgery, the nature of the course of the wound postoperative period, diagnosis and surgical tactics of the purulent-septic process that has arisen.
Materials and methods. A retrospective and prospective analysis of the results of complex treatment of 24 patients with postoperative sternomediastinitis was carried out, which accounted for 0.5% of the total number of cardiac surgical interventions during the four-year research period. The first group (control) included 10 (41.6%) people who were treated with a “one-step” tactic using the standard “open” method of purulent necrotic chest wound management. The second (main) group consisted of 14 (58.4%) patients, whose treatment was based on the sequential principle of providing specialized surgical care.
Results. Active surgical rehabilitation tactics were fundamental in the treatment of patients with purulent sternomedistinitis. The single-stage IVO method was applied in 40.5%, the two-stage (rehabilitation and reconstructive) in 59.5% of cases. The introduction of early sanitizing surgical technologies and vacuum-assisted instillation dressings in patients of the study group II reduced the time of final suppression and microbial wound seeding by 2.5 times, which reduced the amount of reinfection of wounds by 45.2% and helped prevent the development of osteomyelitis of the rib-sternal structures. The strategy of the second (reconstructive stage) in group II patients was aimed at restoring the skeletal function of the sternum (rheosteosynthesis using polymer clamps of the “clamp” type) and replacing the soft-tissue wound defect of the anterior chest wall with secondary dermatension sutures. This made it possible to improve the quality of life of the subjects, reduce the duration of hospitalization and the level of disability of the victims, and avoid deaths.
Conclusion. Stratification of patients with purulent sternomediastinitis after cardiac surgery in accordance with the principles of: antimicrobial therapy control strategies; systematization of “two – stage” surgical tactics depending on the type of septic process spread and the general somatic condition of the patient; rational application of modern methods of local wound management, allowed for a personalized approach and improved treatment results for this formidable complication.

The objectiv was characteristics of the path of development of the complication of concomitant diseases with calculous cholecystitis with obstructive jaundice.
Materials and methods. The data of 60 patients with non–cancerous mechanical jaundice who were admitted to the surgical department of the CHUZ KB “Russian RailwaysMedicine” in Saratov were analyzed. They had various complications of cholecystocholedocholithiasis: strictures of the bile ducts, pancreatitis, residual choledocholithiasis, and Mirizzi syndrome. The most common concomitant disease was generalized atherosclerosis in 42 (70,0%) cases, followed by hypertension in 25 (41,7%), coronary artery disease in 17 (28,3%), obesity in 11 (18,3%), chronic cerebral ischemia in 8 (13,3%), and diabetes mellitus in 5 (8,3%). In addition to determining the blood levels of total and direct bilirubin, alkaline phosphatase, ASL, ALT, leukocytosis, and the amount of CEC and MSM in the blood of hospitalized patients, comorbidity scales (CIRS, Kaplan-Fenstein, Charlson), as well as indicators of activation of endothelial dysfunction (IL-6, IL-8, CRP) and ischemia were studied. myocardium (blood levels of troponin and NTproNBB). All patients underwent minor traumatic biliary decompression of the biliary tract, followed by laparoscopic cholecystectomy.
Results. In patients with non-cancerous breast cancer, a significant reaction of markers of endothelial dysfunction and myocardial ischemia was revealed in the form of an increase in their plasma content. In the perioperative period, it increased both after ERCP and after laparoscopic cholecystectomy. These markers correlated with each other and with the severity of jaundice.
Conclusions. the development of GI complications leads to the progression of endothelial dysfunction with the development of ischemia of organs and tissues. This causes the occurrence of a syndrome of mutual aggravation, which increases with endosurgical trauma. The blood levels of markers of endothelial dysfunction and myocardial ischemia in such patients can be considered, as a predictor of emerging changes and postoperative complications of an organ and systemic nature.

Rationale: Pilonidal sinus is a common condition frequently encountered by surgeons and coloproctologists. Its prevalence is approximately 0.5–1.0% of the population. The majority of patients with pilonidal sinus undergo surgical intervention before the age of 30. Postoperative complications occur in 13–24% of patients, disease recurrence is observed in 6–30%, and pathological scarring develops in 13–17%.
Aim: To improve treatment outcomes for patients with pilonidal sinus complicated by single and multiple fistulas in the sacrococcygeal–gluteal region by developing new surgical techniques and refining approaches to patient care in the preoperative and postoperative periods.
Materials and Methods: This research paper presents the results of a clinical study and subsequent treatment of 159 patients suffering from a pilonidal sinus complicated by single and multiple fistulas. When choosing the treatment method, parameters such as the extent and severity of the inflammatory process, the topographic-anatomical features of the sacrococcygeal and gluteal region, the specifics of its blood supply, as well as the tendency to form pathological scars were taken into account. Based on this, surgical options and a complex of therapeutic measures aimed at improving the effectiveness of treatment for the observed patients have been proposed and implemented.
Results: This multifactorial and personalized approach contributed to more successful treatment outcomes compared to data from other studies: early postoperative complications occurred in 12 patients (7.5%), disease recurrence was observed in 5 patients (3.2%), and hypertrophic scars were recorded in 6 operated patients (3.7%). The average length of hospital stay was 9.7±0.34 days.
Conclusion: Analysis of data from the treatment of 159 patients with a pilonidal sinus complicated by fistulas in the sacrococcygeal and gluteal region (SCGR) showed that to achieve favorable short-term and long-term postoperative outcomes, the following is necessary: more thorough preoperative preparation; individualized selection of the surgical technique based on the location and number of fistulous tracts; consideration of the topographic-anatomical structure and blood supply characteristics of the sacrococcygeal and gluteal region, the predisposition to excessive scarring, the size of the postoperative wound, as well as rational postoperative management tailored to the individual characteristics of each patient.

The article presents the experience of the staged treatment of 31 patients with gunshot wounds to the abdomen, who were complicated by the formation of intestinal fistulas. A two-stage approach was used, including preparatory (conservative) and reconstructive-restorative stages. The severity of the injuries, the condition of the wounds, the number and volume of surgical interventions, and the treatment results are analyzed. The classified signs of “Open abdomen” were evaluated in detail, including the presence or absence of infectious and adhesive processes and entero-atmospheric fistulas according to Bjork M. (2016). Additionally, the severity of infectious processes, degree of malnutrition, and other factors were analyzed.. The article focuses on practical approaches to conservative treatment at the initial stage and the characteristics of reconstructive surgical interventions. It presents a differentiated, multidisciplinary algorithm for the perioperative management of patients with intestinal fistulas. Based on the data analyzed, recommendations for treating wounded patients with this condition have been formulated.

In the structure of modern combat gunshot injuries, combined pelvioabdominal mine-explosive wounds that occur when heterogeneous damaging factors of an explosive device are simultaneously exposed to the body are particularly severe and extensive. The anatomical proximity of the vital organs of the abdominal cavity, pelvis, retroperitoneal space and bone structures contribute to the wounding agents to inflict massive crushing and damage in various variations.
Objective: to improve the results of diagnosis and treatment of gunshot pelvioabdominal wounds and related complications at the stage of specialized medical care in a multidisciplinary hospital.
Materials and methods. A retrospective analysis and a single-center study of the treatment of 136 male wounded with combined gunshot wounds of the abdominal cavity and pelvis were conducted. The immediate and long-term results of providing qualified and specialized medical care, treating complications using the tactics of stage-by-stage surgical interventions of general surgical, traumatological and urological profiles are analyzed.
Results: damage to the bladder (17.4%), pelvic bones (25.9%), small (26.8%) and colon (14.7%) intestines, major vessels and other organs (13.3%) was most often noted in combination with wounds to the intra-abdominal rectum. With extraperitoneal localization of rectal wounds, injuries to the bladder and ureters (51.3%), pelvic bones (35.5%), main vessels (1.7%) and small intestine (9.7%) were most often diagnosed. The volume of qualified medical care is represented by surgical interventions aimed at: stopping bleeding, sealing hollow organs, removing intestinal contents from the passage through the damaged rectum, applying epicystostomy, stabilizing fractures of the pelvis and hip with rod devices. The nature of surgical interventions at the stage of providing specialized medical care to this contingent of wounded was characterized by the use of high-tech, minimally invasive and reconstructive techniques. The total number of complications was 86.6%, of which 52.4% were purulent-septic. The widespread use of modern diagnostic and treatment techniques has made it possible to quickly identify and eliminate complications of urological, traumatological and general surgical profiles. Compliance with step-by-step surgical and reconstructive rehabilitation treatment of pelvioabdominal gunshot wounds led to a significant reduction in the number of purulent-septic complications (up to 12.8%) with the achievement of satisfactory results of physical and emotional rehabilitation of patients, minimizing the level of disability (9.6%).
Conclusion. Further improvement of the diagnosis and stage treatment of pelviobdominal gunshot wounds remains relevant and requires high-quality practical and theoretical training of a multidisciplinary team of military field surgery specialists, with a personalized approach to the timing, volume, and nature of surgical interventions for this severe group of wounded patients.

Introduction: All patients who have undergone hip amputation develop a decrease in the moment of force of the muscles of the flexors and extensors of the thigh stump, which is a consequence of muscle tissue atrophy due to hypodynamia, which is experienced by the victim who has suffered an injury. This significantly complicates rehabilitation measures, especially the development of the patient’s skills in using a prosthesis and the formation of a walking stereotype. The effectiveness of using a standard physical therapy complex in this situation remains low, as patients develop reflex spasms in the muscles of the lumbosacral spine, sacroiliac joint, and gluteal group. The use of postisometric relaxation (PIR) techniques in the comprehensive rehabilitation of these patients can help to reduce these spasms, thereby increasing the effectiveness of using the standard physical therapy complex.
Objective: To evaluate the effect of using the PIR technique for the muscles of the lumbosacral spine, sacroiliac joint, and gluteal group in the rehabilitation of patients with a thigh stump on the moment of force of the flexor and extensor muscles of the thigh stump in the dynamics of the rehabilitation process.
Materials and methods: The materials presented in this work are based on observations of men who underwent thigh amputation at the level of the middle third, divided according to the use of the PIR technique in the rehabilitation process.
Results: The data obtained show changes in the moment of force of both flexor and extensor muscles of the thigh stump during the rehabilitation process, depending on the use of PIR and the type of constitution.
Discussion: In the dynamics of the rehabilitation process, an increase in the values of the muscle force moment was revealed, both for the flexors and for the extensors of the thigh stump, and the growth of indicators was noted throughout the study in amputees who used PIR. The best values of the muscle force moment of the stump were revealed in hypersthenics, and the lowest values belong to patients of the asthenic type of constitution.
Conclusion: The use of the PIR technique for the muscles of the lumbosacral spine, sacroiliac joint, and gluteal group in rehabilitation allows for a shorter period of time to increase the muscle force moment values of both the flexors and the extensors of the femoral stump in the dynamics of the rehabilitation process, thereby increasing its effectiveness.

Metacarpal fractures account for a third of all hand fractures. These injuries most often occur in patients of working age. However, despite the high prevalence and social significance of metacarpal fractures, no domestic epidemiological studies have been conducted.
Objective: To determine the epidemiological characteristics of a cohort of adult patients requiring surgical treatment for metacarpal fractures.
Materials and methods: an analysis of the clinical histories of patients with II-V fractures of metatarsals, who were treated at the Center for Wrist Surgery and Reconstructive Microsurgery of Yudin City Clinical Hospital in the period from 2022 to 2024. Statistical processing of data obtained was carried out using SPSS Statistics 28.
Results: 1152 patients with 1346 bone fractures were evaluated. According to the results of the analysis, it was revealed that the most traumatized is the V metatarsal bone in the subcapitular and diaphyseal divisions. The majority of injuries are suffered by men between 20 and 40 years old. The calendar and seasonal dependence of metacarpal fractures was determined – the greatest number of injuries occurred on weekends, with a peak in summer. Determined the leading mechanism of injury.
Conclusion: for the first time, domestic epidemiological data characterizing fractures of II-V metatarsals were comparable with foreign ones. The identified dependencies make it possible to better organize the work of the trauma department and to disperse the workload on the staff.

Rationale: The choice of surgical treatment tactics for postoperative ventral hernias (PVH) is still based on a subjective visual assessment of computed tomography (CT) examinations by a surgeon, which leads to variability of solutions and lack of standardization. There are no approved software packages for automatic analysis of the anatomy of the anterior abdominal wall.
Objective: To develop a method for the automatic calculation of key surgical parameters (RDR, hernial sac volume) based on the semantic segmentation of the structures of the anterior abdominal wall using the convolutional neural network U-Net to objectify preoperative planning.
Methods: A retrospective single–center study was conducted based on data from 25 patients with PVH of categories W2-W3 (2024–2025). Manual segmentation of the right and left rectus abdominis muscles and hernial sac on CT sections was performed. The U-Net model was trained with a Focal Loss function and data augmentation. Based on the segmentation results, the algorithm automatically calculated the RDR (Rectus Diastasis Ratio) parameter and the volume of the hernial sac, forming a prognostic conclusion about the need for a component separation technique (CST).
Results: The model demonstrated stable learning (validation losses: 0,0015). The segmentation quality of the hernial sac was 74,9%. The automatic calculation of RDR allowed us to correctly classify treatment tactics for all patients: with RDR >1,5, simple plastic surgery is recommended (40% of patients), with RDR <1,5 – CST (60% of patients). The analysis time is reduced to 2–3 minutes per patient versus 30-60 minutes for manual assessment.
Conclusion: The proposed method based on the U-Net convolutional neural network makes it possible to automatically identify key structures of the anterior abdominal wall on CT images. This creates the basis for the development of decision support systems capable of quantifying hernial defect parameters and objectifying preoperative planning.

Rationale: Daratumumab is a monoclonal antibody against CD38, which is located on the surface of multiple myeloma (MM) cells. This has made CD38 a target for immunotherapy against MM. CD38 is also present on red blood cells and platelets. Therefore, anti-CD38 antibodies can interfere with routine immunohematological testing and distort their results.
Objective: To identify patterns in immunohematological testing and transfusion therapy in patients receiving daratumumab.
Methods: A retrospective study, using electronic medical records, examined the results of immunohematological testing and transfusion therapy for 75 inpatients at the Pirogov Center receiving daratumumab in 2025.
Results: Based on the results of treatment at the Pirogov Center in 2025, 12.0% of patients receiving daratumumab required red blood cell transfusions, while 29.3% required platelet transfusions. A positive test for irregular anti-erythrocyte antibodies, characterized by weak and fluctuating agglutination, was recorded in 4 of 9 red blood cell recipients. Transfusion of donor red blood cell suspensions containing leukodepleted red blood cells in PAGGSM, compatible with ABO, Rh, and Kell blood group antigens, with visual assessment of hemolysis, ensures adequate transfusion support for patients receiving daratumumab.
Conclusion: Specific aspects of the evaluation and transfusion support of patients receiving daratumumab should be included in the clinical guidelines for “Multiple Myeloma”.

Objective. To summarize the evolution of laboratory and digital approaches to early diagnosis and prediction of infectious complications in surgery, from classical leukocyte intoxication indices to artificial intelligence–based systems.
Materials and methods. A targeted literature analysis was performed on leukocyte intoxication indices, composite hematologic indices (NLR, PLR, SII, DNI), biochemical markers (C reactive protein, procalcitonin, presepsin), novel hematology analyzer parameters (MDW), immunophenotypic markers (monocytic HLA DR, CD14/CD16 subsets), metagenomic next-generation sequencing (mNGS), and machine learning models for early sepsis detection.
Results. Classical leukocyte indices remain useful as inexpensive tools for risk stratification but are limited by subjectivity and low specificity for bacterial infection. Composite hematologic indices and MDW improve early sepsis detection by leveraging routinely available complete blood count data. Biochemical markers, particularly procalcitonin and presepsin, provide higher diagnostic and prognostic accuracy, yet are influenced by surgical trauma and require careful interpretation of their kinetics. Immunophenotypic markers of monocytes reflect functional reprogramming of innate immunity and allow assessment of immune dysregulation. mNGS markedly increases pathogen detection rates and shortens time to etiologic diagnosis, but its use is constrained by high cost and technical complexity. Machine learning models based on electronic health record data outperform traditional scores (SIRS, qSOFA) for early sepsis prediction, while facing challenges of overfitting, alarm fatigue and limited external validation.
Conclusions. Modern strategies for early detection of infectious complications in surgical patients should rely on integrated use of readily available hematologic and biochemical markers, immunophenotyping, and AI driven tools embedded in electronic health records. Standardization of assays, economic evaluation and multicenter validation are crucial prerequisites for widespread clinical implementation.

Rationale: The blood service is a bridge between donors and recipients. The third category of participants in the blood collection and transfusion processes are medical personnel and volunteers. The uniqueness of both the social base and processes of the blood service have determined its unique changes in the COVID-19 era.
Objective: To identify patterns in the collection and transfusion of donor blood during the COVID-19 pandemic.
Methods: A search for reviews, meta-analyses, and randomized clinical trials was conducted using the terms “blood service,” “blood collection,” “blood transfusion,” “SARS-CoV-2,” and “COVID-19” in electronic libraries in Russia (eLibrary.ru) and the United States (pubmed.ncbi.nlm.nih.gov). The obtained data were compared with the results of the Pirogov Center COVID-19 Hospital. A total of 72 publications were selected for analysis.
Results: The following topics were structured and discussed: 1) general issues, 2) blood banking issues, 3) blood collection issues, and 4) anti-COVID plasma.
Conclusion: When preparing for a possible future pandemic, it is important to consider the following: 1) COVID-19 pandemic warning signs were coronavirus outbreaks in the previous two decades; 2) it will be important to quickly determine whether there is a risk of transmission of a new pandemic virus through blood; 3) blood service professionals must be prepared for changes in work, policies, and procedures; 4) donor health and safety issues will be a key focus; 5) blood handlers may also be involved in new activities; 6) Scenario development, tabletop exercises, and training will allow blood handlers to prepare for the unknowns of the next pandemic.

Background: Non-occlusive mesenteric ischemia (NOMI) accounts for up to 30% of all cases of acute mesenteric ischemia and is associated with the highest mortality, ranging from 50% to 93%. Despite the clinical significance of this condition, early diagnosis remains challenging, and effective algorithms for treatment and prevention have not yet been fully established.
Aim: The aim of this review was to systematize current data on the diagnosis and treatment of NOMI, to evaluate existing clinical approaches, and to identify the most promising strategies for reducing mortality.
Materials and Methods: Publications over the past decade addressing NOMI were analyzed. Particular attention was given to data on the diagnostic accuracy of contrast-enhanced computed tomography, angiography, and biomarkers (notably I-FABP), as well as to the reported effectiveness of conservative and surgical treatment strategies.
Results: Contrast-enhanced CT demonstrated high sensitivity in detecting early ischemic changes, angiography confirmed its role as the diagnostic gold standard, and I-FABP showed sensitivity up to 90% and specificity up to 80.3%. The use of vasodilators (papaverine, prostaglandin E1, nitroglycerin) reduced mortality from 34.2% to 22.6% and decreased the rate of surgical interventions from 15.3% to 5.0%.
Discussion: The findings suggest that an integrated approach combining advanced imaging techniques, biomarker-based diagnostics, and vasodilator therapy, together with minimally invasive surgical interventions, may contribute to reduced mortality in NOMI. However, the current evidence base remains limited, highlighting the need for further multicenter st

Rationale: Pediatric bronchial asthma (BA) remains a major concern in clinical practice due to its high prevalence and substantial impact on quality of life. Long-term disease prognosis may vary depending on the selected treatment strategy.
Objective: To analyze the efficacy of current pharmacological treatments for pediatric BA and to assess long-term clinical outcomes.
Methods: A structured review of publications from PubMed, Scopus, Web of Science, Cochrane Library, and eLibrary databases was conducted for the period 2019–2025. The analysis included randomized controlled trials, cohort studies, and meta-analyses addressing the effectiveness of asthma therapy in patients under 18 years of age.
Results: Inhaled glucocorticosteroids are the foundation of maintenance therapy and demonstrate high efficacy when administered at the lowest effective dose. With long-term use of high doses, suppression of the hypothalamic–pituitary–adrenal axis may occur; however, no significant effects on children’s growth or mineral metabolism have been identified. Excessive use of short-acting β₂-agonists is associated with an increased risk of exacerbations. Biological therapy has shown effectiveness in children with severe allergic asthma phenotypes and marked eosinophilia.
Conclusion: Current pharmacological strategies, including inhaled glucocorticosteroids, β₂-agonists, leukotriene receptor antagonists, and monoclonal antibodies – not only provide symptom control but also influence long-term outcomes. Close safety monitoring and adherence to principles of personalized treatment are essential.

Rationale: Irritable bowel syndrome (IBS) is one of the most common functional gastrointestinal disorders. One of the potentially significant pathophysiological factors in IBS is small intestinal bacterial overgrowth (SIBO), characterized by microbial imbalance in the small intestine.
Objective: To review current data on therapeutic approaches to SIBO in patients with IBS.
Methods: The review includes publications from PubMed, Scopus, Web of Science, Cochrane Library, and eLIBRARY.RU databases from 2019 to 2025. The selection included randomized clinical trials, meta-analyses, and systematic reviews focusing on the diagnosis and treatment of SIBO in the context of IBS. Studies with low levels of evidence or small sample sizes were excluded.
Results: Analysis of the included sources showed that the prevalence of SIBO in IBS patients ranges from 30% to 85%, with the highest rates observed in the diarrheal subtype. Rifaximin is the most extensively studied antibacterial agent and is associated with a significant reduction in bloating, abdominal pain, and stool irregularities. A carbohydrate-restricted diet has demonstrated positive effects on stool frequency, consistency, and abdominal pain. Probiotics containing Bacillus subtilis and Bacillus coagulans have shown efficacy in alleviating abdominal pain and improving quality of life.
Conclusion: The coexistence of IBS and SIBO requires a comprehensive diagnostic and therapeutic approach. Rifaximin remains the treatment of choice for antibacterial therapy. Dietary interventions and probiotics serve as effective adjunctive measures. Further research is needed to standardize diagnostics, stratify patients, and assess the long-term efficacy of combined treatment strategies.

The aim of the work – to inform a wide range of medical specialists about modern views on their diagnosis and treatment of patients with foot pathology resulting from the combined effects of cold and wet environmental conditions.
Materials and research methods. In the review on the basis of 28 special domestic and foreign literature sources the modern view on pathogenesis, diagnosis, treatment and prevention of Nonfreezing cold injury (NFCI) is presented. Its current clinical classifications by degrees of severity and stages of the course of the pathological process are given.
Conclusion. It is revealed that despite the general great progress in medicine in the last decades, no significant improvement of NFCI treatment results has been achieved. The reason for this is the fragmentary study of pathophysiological features of the occurrence and development of this pathological process. As a consequence, the absence of schemes of effective complex pathogenetically based treatment and prevention of the disease. The problem of treatment of foot pathology resulting from the combined effect of cold and wet environmental conditions is still waiting for specialists to find a solution.

Rationale. Minimally invasive coronary surgery (MICS) combines advantages of both traditional bypass surgery and endovascular procedures. As minimally invasive surgeries become more common, postoperative wound complications are likely to rise. Objective: improve the outcomes of wound complications after minimally invasive coronary surgery. Methods: the study was conducted in cardiosurgical and surgical departments. Study included 5 patients with surgical site infection after MIDCAB. There were 3 (60%) women and 2 (40%) men among the participants. All clinical cases were diagnosed with type 2 diabetes, and 3 (60%) cases had grade II obesity, while 2 (40%) cases had grade I obesity. Results: average time for wound complications was 6.6 days. Surgical treatments were performed an average of 2.2 times, and vacuum therapy began after 13.8 days, lasting 9.6 days in an intermediate mode. On average, 5 dressings were performed. Antibacterial therapy lasted 11.4 days. Secondary sutures were applied approximately 10 days later. In a single case, a fistula was formed, but there were no recurrences. Conclusion: clinical experience shows that vacuum therapy accelerates the transition of the wound to healing, reducing the time required for wound closure and restoring the patients’ ability to work after MICS.

Abrikossoff’s tumor is a rare benign tumor originating from Schwann cells. It accounts for 1% of all benign esophageal tumors and has a potential for malignancy. Even small tumors (<10 mm) can be malignant. At the N.N. Burdenko Central Clinical Hospital of the I.M. Sechenov First Moscow State Medical University, endoscopic submucosal dissection) was performed on 4 patients with granular cell tumors (GCT) of the esophagus <20 mm. ESD is the preferred method for removing tumors up to 30 mm. For very small tumors (<10 mm), EMR (endoscopic mucosal resection) can be used; for tumors 20-30 mm in size, especially with signs of invasion into the muscular layer, submucosal tunneling endoscopic resection (STER) is an option. Surgical treatment is indicated for tumors >35 mm and/or signs of invasion into the muscular layer. Due to the risk of malignancy and the need to differentiate them from other malignant submucosal neoplasms, such as GIST, esophageal GCTs should be removed. The choice of treatment method depends on the tumor’s size, location, and depth of invasion, as determined by endoscopic ultrasound.

Purpose: to demonstrate the successful experience of performing videothoracoscopic removal of leiomyomas of different parts of the esophagus, including large ones, and the presence of progressive dysphagia. To show the features of preoperative risk and determination of the operating tactics of treatment, namely the possibilities of thoracoscopy in comparison with standard thoracotomy. To evaluate the optimality and effectiveness of the surgical technique used – videothoracoscopic removal of esophageal leiomyomas of different sizes and localization.
Materials and methods. Cases of successful surgical treatment of esophageal leiomyomas by videothoracoscopic removal are presented.
Conclusion. Good immediate and long-term results of treatment prove the effectiveness and safety of the surgical technique used. It should be noted that the feature of the presented cases is not only the successful surgical intervention, but also allows to eliminate the pathological process regardless of the location of leiomyomas.

This article describes a clinical case that occurred in the practice of surgeons. A patient suffering from cavernous tuberculosis underwent atypical resection of the lower lobe (S6) of the right lung in a non-specialized medical facility. After the operation, she developed postresection empyema of the pleura with bronchopleural fistula.
In February 2022, patient H., 26 years old, developed symptoms that she considered signs of illness: a paroxysmal cough, an increase in body temperature to 38 degrees and severe headaches. X-ray examination, in particular computed tomography of the chest organs (CT of the chest), showed the presence of a cavity formation in S6 of the lower lobe of the right lung and multiple focal lesions in the upper lobe of the same lung. Based on the data obtained, an abscess of the lower lobe of the right lung with polysegmental pneumonia was diagnosed. S6 resection of the right lung was performed as part of the general medical network. After a histological examination, tuberculosis of the right lung was diagnosed. However, microbiological studies of diagnostic materials (sputum and surgical material) have not been conducted in the general medical network. The patient was prescribed anti-tuberculosis therapy in accordance with the treatment regimen for drug-sensitive tuberculosis. In the course of treatment, undesirable reactions were observed, due to which therapy was canceled. A month after the operation, bronchopulmonary fistulas with a diameter of up to 2 mm were detected on a control computed tomography of the chest organs (CT of the chest), which indicated a deterioration in the condition. The patient applied to CTRI, where she underwent repeated resection of her right lung (anatomical resection S6) with partial pleurectomy. In the postoperative period, an artificial pneumoperitoneum (APP) was additionally installed in a volume of 1200 ml, which made it possible to compress the right lung by lifting the right dome of the diaphragm. The drains were removed on the 34th day.
After a follow-up CT scan, histological examination and detection of mycobacterium tuberculosis (MBT) DNA in the biomaterial after a previous operation, as well as taking into account individual intolerance, anti-tuberculosis therapy in the amount of RHAmE was prescribed against the background of maintenance therapy. There was a positive trend and good tolerability of the treatment. As a result of the treatment, the patient showed positive dynamics both clinically and radiographically. After 12 months, the entire complex of medical measures was completed, and the woman was able to return to normal life.

A promising approach to treating eventration is to replace the abdominal wall with a synthetic material. Depending on the specific clinical situation, the prosthesis can be placed above or below the aponeurosis of the rectus abdominis muscles, and in the presence of intra-abdominal hypertension, it can be used to cover the abdominal wall defect without suturing the edges of the aponeurosis. In this case, the prosthesis may come into contact with the abdominal organs, which can lead to the development of intestinal fistulas. The article presents a clinical case of the elimination of recurrent partial eventeration in an elderly cancer patient after resection of the stomach, duodenum, pancreas, and splenectomy. The bottom of the defect was formed by internal organs that were fixed to the edges of the wound and the peritoneum. The eventeration was eliminated by applying skin sutures with additional reinforcement using a domestic polyester prosthesis with a fluoropolymer coating that has anti-adhesive properties. The postoperative wound healed by secondary intention.

Lower urinary tract infections (LUTIs) are one of the most common bacterial infections in women, accounting for about a quarter of all infectious and inflammatory processes. The incidence of postcoital cystitis is due to the low position of the external opening of the urethra, which facilitates the entry of bacteria during sexual intercourse. This article presents a case of a patient with chronic postcoital cystitis caused by external urethral diverticulum. Conservative therapy was not effective enough, so it was decided to perform a surgical procedure called urethral transposition. The surgery involved creating a new position for the external opening of the urethra and removing the hymenal-urethral adhesions. The patient’s recovery was successful, and six months later, the symptoms disappeared, improving her quality of life. This study demonstrates the effectiveness of urethral transposition.

Introduction. According to the WHO Disability Report (2011), more than a billion people, or about 15% of the world’s population, live with some form of disability. The proportion of disabled people in Russia is around 7–8% and is expected to increase, especially with the ongoing conflict in Ukraine. By 2023, the total number of disabled people in Russia had reached 10.9 million, with 10.2 million disabled adults.2 Military Medical Academy named after S.M. Kirov, St. Petersburg
According to the WHO (2025), rehabilitation, along with health promotion, disease prevention, treatment, and palliative care, is an integral part of universal health coverage. Currently, an estimated 2.4 billion people worldwide suffer from pathological conditions that may require rehabilitation. Every third person at some point in their life needs rehabilitation due to congenital, acute, or chronic diseases. The need for medical rehabilitation technologies among people with disabilities is 99.8%. Despite the timely and high-quality provision of medical care to the wounded, injured, and sick during combat operations, a number of problems remain unresolved in the medical rehabilitation of disabled people with upper and lower limb amputations due to combat injuries, followed by prosthetics.
The purpose of the clinical lecture is to familiarize a wide range of doctors from various specialties with the old and newly developed rehabilitation routes for military personnel and the high-tech prosthetics used for participants in the special military operation with amputated limbs due to combat injuries.
The main part. The main part of the clinical lecture provides a detailed overview of the concept of high-tech prosthetics and rehabilitation. It describes the algorithm for conducting a prosthetic company, as well as the stages and deadlines for prosthetics in military medical organizations. Special attention is given to quality control in prosthetics. The assessment of the quality of rehabilitation for patients with limb amputations should be conducted comprehensively, taking into account the following key components of quality: structural component, procedural component, and outcome component. The current customer journey of a military personnel with limb amputations from the combat zone to the end of the prosthetics stage is presented in detail. The average prosthetic time is 119-225 days. There is a great need to create a new prosthetics and rehabilitation system for participants in the special military operation, as the current system has a number of drawbacks and problems. A new project has been presented to create a new prosthetics and rehabilitation system for participants in the special military operation, with the goal, objectives, and key provisions outlined. The target customer journey for a soldier with limb amputations in the new prosthetics and rehabilitation system for participants in the special military operation has been described in detail. The average prosthetics time is 65-120 days.
Conclusion. In order to ensure effective prosthetics and rehabilitation under the new system, the Unified Prosthetics Center of the Russian Ministry of Defense (UPC) has been established. The organization of its work has been presented in detail. It should be noted that the UPC is organizationally part of the Unified Center for Coordination of Comprehensive Rehabilitation, Prosthetics, and Support for Military Personnel with Limited Health Opportunities of the Russian Ministry of Defense, while the General Military Medical Directorate of the Russian Ministry of Defense performs a number of tasks to ensure the effective implementation of prosthetics and rehabilitation measures for the successful operation and functioning of the new system of prosthetics and rehabilitation for participants in the Special Military Operation. A universal standard for providing prosthetic services to individuals with limb amputations due to combat injuries has been developed.

This article provides a brief biography of N.N. Burdenko, his contributions to the development of medical science, and the military and civilian healthcare system in the country.

This article provides a brief biography of Dmitry Ivanovich Vyvodtsev, a renowned Russian surgeon and anatomist. Vyvodtsev’s work on postmortem embalming, including the embalming of Nikolai Ivanovich Pirogov’s body, was widely recognized worldwide. His methods have remained relevant to this day. Additionally, Vyvodtsev’s research on the anatomy of the vascular system, particularly the lymphatic network in the lungs, is highly significant and interesting.

The article is devoted to the history of the emergence of a surgical approach to the rejuvenation of living organisms in experimental and clinical medical practice. The pioneers of this field are the outstanding European experimenters, the Austrian professor-physiologist Eugen Steinach (1861-1944) and the French surgeon of Russian origin, Professor Samuel (Sergey) Abramovich Voronoff (1866-1951). The article provides a detailed analysis of the unique surgical interventions performed on laboratory animals and living humans in the early 20th century, which were the first attempts at surgical rejuvenation of animal organisms in the history of medicine.