Background: Pneumonectomy remains a necessary intervention for certain patients with locally advanced non-small cell lung cancer (NSCLC); however, the prognostic significance of surgical side remains controversial. Right-sided resection is traditionally associated with a higher risk.

Objective: To evaluate postoperative outcomes of pneumonectomy based on the side of resection.

Materials and Methods: This multicenter retrospective study included 326 patients who underwent radical pneumonectomy for NSCLC between 2015 and 2024 in three oncology centers. Left-sided resections were performed in 188 patients (57.7%) and rightsided in 138 patients (42.3%). Postoperative complications were classified according to the Thoracic Morbidity and Mortality system. Overall survival (OS) and disease-free survival were evaluated using the Kaplan-Meier method. Predictors of early mortality and bronchopleural fistula were analyzed by multivariate logistic regression.

Results: The overall complication rate was 42.9%, but significantly higher after right-sided pneumonectomy (51.4% vs. 33.0%; p=0.009). The incidence of bronchopleural fistula was markedly higher among patients who underwent right-sided surgery (15.6%) compared to those who underwent left-sided surgery (0.7%; p=0.003). Furthermore, a significant difference was observed in 30-day and 90-day mortality rates: for right-sided resection, the rates were 14.5% and 20.3%, respectively, whereas after left-sided resection they were only 3.2% and 6.4% (p<0.001). Median overall survival was 4.05 years after left-sided pneumonectomy and only 1.99 years after right-sided pneumonectomy (p=0.003); similarly, median disease-free survival differed, being 1.17 years and 0.53 years, respectively (p=0.069). Multivariate analysis identified a single independent factor associated with development of bronchopleural fistula, which was right-sided pneumonectomy (OR=16.2; 95% CI=2.07-126.98; p=0.008).

Conclusions: Right-sided pneumonectomy is associated with higher risk of severe complications, bronchopleural fistula, early mortality, and poorer survival outcomes. This procedure should be considered high-risk, requiring rigorous patient selection and the implementation of preventive strategies.

Background: Ligamentous-foraminal stenosis caused by hypertrophy of transforaminal ligaments represents a rare but clinically significant form of spinal nerve root compression. Due to the limited research on this pathology and the lack of a unified surgical approach, minimally invasive techniques aimed at targeted decompression of neural structures are particularly relevant.

Objective: To improve treatment outcomes in patients with ligamentous-foraminal stenosis by refining the technique of endoscopic transforaminal decompression.

Materials and Methods: A retrospective analysis was conducted on the treatment outcomes of 20 patients with confirmed ligamentous-foraminal stenosis who underwent endoscopic transforaminal decompression using an “outside-in” approach. Treatment efficacy was assessed by analyzing pain intensity using the Visual Analog Scale (VAS) and functional limitation using the Oswestry Disability Index (ODI) before and after surgery.

Results: The average preoperative VAS score was 8.1 ± 0.6, and ODI score was 70.4 ± 11.5. Postoperative assessments demonstrated a statistically significant reduction in pain and improvement in functional status. In all patients, hypertrophied transforaminal ligaments were identified; complete decompression of the nerve roots was achieved following resection of these structures. The average hospital stay was one day, and no complications were observed.

Conclusions: Endoscopic transforaminal decompression is a clinically effective and pathogenetically justified method for treating ligamentous foraminal stenosis of the lumbar spine.

Objective: To evaluate the cardioprotective potential and hemodynamic impact of beating-heart coronary artery bypass grafting (CABG) performed with parallel cardiopulmonary bypass in patients with reduced left ventricular ejection fraction (LVEF).

Materials and Methods: A single-center prospective randomized controlled blinded trial included 90 patients with LVEF <35% who underwent CABG surgery. The patients were divided into two groups. In the first group (n=60), surgery was performed under cardiopulmonary bypass with cardioplegia (CP). Patients in the second group (n=30) underwent surgery on a beating heart with parallel CPB (pCPB). The primary endpoint was the concentration of troponin I on the first postoperative day (POD). Secondary endpoints included hemodynamic parameters, vasoactive-inotropic score (VIS), markers of myocardial injury (CK, CK-MB) and heart failure (BNP, NTproBNP); postoperative complications, 30-day mortality, and long-term survival.

Results: Troponin I levels on the first POD were not significantly different between the groups, with values of 3.61 (2.32-7.51) ng/ml in the CP group and 5.25 (2.41-10.89) ng/ml in the pCPB group, р=0.327. Preoperative cardiac index was significantly higher in the pCPB group compared to the CP group (p=0.036); however, no statistically significant differences were observed at subsequent stages of the study. Mean pulmonary artery pressure, pulmonary capillary wedge pressure, mean arterial pressure also did not differ significantly between the groups. The postoperative period was similar between the two groups in terms of complications. The 30-day mortality was 1.7% (1/60) in the CP group and 6.7% (2/30) in the pCPB group (p = 0.257). Within one year after randomization, mortality was 3.3% (2 patients) in the CP group and 23% (7 patients) in the pCPB group (HR 7.5, 95% CI 1.6-36, p=0.012).

Conclusions: Beating-heart CABG with parallel CPB in high-risk patients does not provide a cardioprotective effect and does not reduce troponin I levels. The use of this technique in patients with reduced LVEF does not affect cardiac index, the need for inotropic/vasopressor support, the incidence of complications or in-hospital mortality, but it is associated with poorer long-term patient survival at 1 year.

Background: Currently, burn treatment remains highly relevant and complex issue in modern medicine due to the widespread prevalence of burn injuries. According to the World Health Organization, burn injuries rank second to third among all types of injuries worldwide. In the Russian Federation, burns account for approximately 3-4% of all injuries.

Objective: To analyze the histomorphological features of the wound healing process when using biological wound dressings.

Materials and Methods: This study analyzed the wound healing process at the tissue level in 14 patients who required early surgical treatment. Inclusion criteria were the presence of borderline or deep burn wounds requiring necrectomy, age between 18 to 45 years, and wound surface area of 2% to 12%. Exclusion criteria included patients admitted more than 5 days after the burn injury or those with a wound area exceeding 15%.

Results: The study demonstrated the advantages of biological wound dressings compared to synthetic ones in the treatment of burn wounds. Histomorphological analysis revealed differences in tissue response with and without the use of such dressings. Biological wound dressings, such as “ChitoPran”, promote the formation of multilayered keratinizing stratified squamous epithelium and the proliferation of the dermal layer. Particularly important is the stimulation of loose connective tissue formation at the base of the wound, which contributes to more effective wound healing.

Conclusions: Histological analysis confirms that the use of biological wound dressings in the treatment of borderline and deep burns contributes to creation of optimal conditions for wound healing. This leads to a reduction in hospital bed-days, a decrease in the number of dressings changes and, consequently, a reduction in economic costs.

Objective: To determine the incidence and structure of postoperative pulmonary complications (PPCs) and to identify independent risk factors for their development in patients undergoing cardiac surgery with cardiopulmonary bypass (CPB).

Materials and Methods: A retrospective single-center study included 658 patients who underwent cardiac surgery in 2024. Demographic, anamnestic, intra- and postoperative data were analyzed. Univariate and multivariate logistic regression analyses were used to identify risk factors for postoperative complications.

Results: PPCs were observed in 71 (10.8%) patients. Atelectasis was the most common complication (7.9%). The incidence of PPCs among smokers was 24.5% (compared to 4.1% among non-smokers), and among obese patients – 21.8% (compared to 6.3% in patients with BMI <30). Multivariate analysis revealed an independent association with the development of PPCs for age >65 years (OR 6.14; 95% CI 3.38–11.16), CPB duration >120 min (OR 5.86; 95% CI 3.57–9.60), smoking history (OR 5.92; 95% CI 2.89– 12.15), obesity (BMI ≥30 kg/m²; OR 5.12; 95% CI 2.70–9.81), and combined surgery (OR 4.69; 95% CI 2.46–8.94). The presence of chronic obstructive pulmonary disease (OR 1.94; 95% CI 1.11–3.39) and pulmonary hypertension (OR 2,14; 95% CI 1.79–5.52) was also associated with an increased risk (all p < 0.001).

Conclusions: The identified modifiable risk factors (smoking, obesity) highlight the importance of preoperative optimization. Nonmodifiable factors (age, type of surgery) define a high-risk group requiring increased attention and early prevention of PPC. The findings may contribute to the development of risk stratification algorithms in cardiac surgery practice.

Background: The implementation and application of modern mathematical models for data analysis in the radiological diagnosis of congenital heart defects (CHD) represents a significant challenge. The use of modern neural networks for predicting CHD has the potential to reduce the incidence of undiagnosed cases.

Objective: To compare the areas of heart and its chambers, including the atrial to ventricular ratios, during the second trimester obstetric screening between fetuses with and without CHD.

Materials and Methods: An observational non-randomized study was conducted involving 85 pregnant women during the second trimester obstetric screening. The patients were divided into two groups: Group I (n=45) – pregnant women with healthy fetuses and Group II (n=40) – pregnant women carrying fetuses with CHD. During the examination, the areas of the heart and its chambers were determined, and the cardio-cardial index (CCI) was calculated in healthy fetuses and in the fetuses with СHD. The atrial to ventricular area ratios were evaluated in both healthy fetuses and fetuses with CHD. The study was conducted using a Samsung H60 ultrasound scanner (Samsung Medison, South Korea) in the Perinatal Center of Children’s Regional Clinical Hospital (Krasnodar). Statistical analysis of data from 132 cases was performed using the STATISTICA 13.3 software package (TIBCO Software Inc., USA).

Results: Reference values were determined for the area of the heart (2.57-3.97 mm2) and for the areas of its chambers: right atrium (RA) 0.26-0.46 mm2, left atrium (LA) 0.27-0.53 mm2, right ventricle (RV) 0.25-0.46 mm2, left ventricle (LV) 0.34-0.64 mm2. A significant difference from the reference values was observed in fetuses with CHD: RA ≤ 0.25 mm2 or ≥ 0.47 mm2; LA ≤ 0.26 mm2 or ≥ 0.54 mm2; RV ≤ 0.24 mm2 or ≥ 0.47 mm2; LV ≤ 0.33 mm2 or ≥ 0.65 mm2. The CCI was 0.11-0.14 in healthy fetuses, 0.05-0.25 in fetuses with CHD. In congenital heart defects, the ratios depend on the type of malformation and are determined by right heart overload resulting from the characteristics of fetal circulation.

Conclusion: Determination of the fetal heart area in the range of 2.57 mm2 to 3.97 mm2 during the second trimester obstetric screening allows for the exclusion of CHD with high probability. Evaluation of CCI is a valuable diagnostic method: the range of 0.11-0.14 is associated with healthy fetuses, while in fetuses with CHD, the values vary widely due to altered fetal blood flow, indicating the presence of cardiovascular pathology in CHD with increased pulmonary blood flow and in anomalies of the pulmonary venous connection. In cases of CHD with decreased pulmonary blood flow, conotruncal anomalies or CHD with obstruction of systemic blood flow, fetal cardiac MRI should be performed alongside fetal echocardiography to ensure an accurate diagnosis. Improving ultrasound methods and equipment, as well as the introduction of fetal cardiac MRI, are expected to enhance the early detection of CHD and should become an important tool in routine practice of radiologists, enabling the integration of mathematical analysis into clinical practice. 

Background: Current technological advancements, including the miniaturization of endoscopic instruments and improved image quality, have established retrograde intrarenal surgery (RIRS) as a leading treatment method for patients with kidney stones smaller than 20 mm. In daily practice, we encounter cases that fall outside standard clinical guidelines. Such cases include patients with nephrolithiasis and renal anomalies. The development of small-caliber flexible endoscopes with highly maneuverable distal tip, combined with holmium laser technology, the use of nitinol baskets for stone displacement and extraction, as well as the application of aspirating access sheaths and active irrigation, have made it possible to perform effective and safe endoscopic lithotripsy in patients with renal anomalies.

Objective: To analyze the outcomes of retrograde intrarenal surgery using a holmium laser and an aspirating ureteral access sheath in patients with renal anomalies (complete and incomplete renal duplication, horseshoe kidney, renal ectopia, renal malrotation, polycystic kidney disease) and nephrolithiasis.

Materials and Methods: A retrospective study was conducted at the Regional Clinical Hospital No. 2 and the Scientific Research Institute – Ochapovsky Regional Clinical Hospital No. 1. Between 2022 and 2024, we analyzed the treatment outcomes of 80 patients with urolithiasis and renal anomalies. The study included 30 patients with duplex kidney (18 with incomplete and 12 with complete duplication), 22 with horseshoe kidney, 18 with renal ectopia and malrotation, and 10 with polycystic kidney disease. Ureteral stents were placed in all patients 10–14 days prior to RIRS. Depending on the visual assessment of ureteral diameter, a 10 Ch, 12 Ch or 14 Ch aspirating ureteral access sheath with a flexible distal tip and hydrophilic coating was selected. The advantage of an access sheath with a flexible tip lies in its ability to advance it directly to the lithotripsy site. Laser lithotripsy of stones was performed with active aspiration of fragments. At the end of the procedure, a ureteral stent was placed in all patients. Postoperatively, all patients underwent low-dose CT to assess for residual fragments and determine the need for repeat RIRS. Results: A total of 95 RIRS procedures were performed in 80 patients (38 women and 42 men). The mean age was 40 ± 15 years. The success rate, assessed by the stone-free rate (SFR) on postoperative day 1, was 81.25%. After repeat procedures, this rate increased to 95%. SFR was considered positive for residual fragments smaller than 2 mm. Repeat procedures were performed in 6 patients with duplex kidney (2 with complete and 4 with incomplete duplication), as well as in 5 patients with horseshoe kidney, 3 patients with ectopia and renal malrotation, and 1 patient with polycystic kidney disease. Reinterventions were performed on day 3 after the initial procedure. The following results are presented collectively for all groups. The mean stone size was 11.06 ± 3.98 mm, with a density of 1017 ± 235.8 Hounsfield Units (HU). The mean operative time was 50.4 ± 5 minutes, and the mean hospital stay was 5 ± 1 days. Complications classified as Clavien-Dindo grade I (macrohematuria, pain, fever) occurred in 11.25% of patients, primarily on postoperative days 1–2, and were minor. Grade II complications were observed in 6.25% of patients, including cases of acute pyelonephritis in 3 patients on the first postoperative day and in 2 patients on the second postoperative day, which were successfully managed with antibiotic therapy. One patient with a horseshoe kidney developed urosepsis within 6 hours postoperatively, requiring intensive care and hemoperfusion. The overall complication rate was 18.75%. No Grade III or Grade V complications were reported.

Conclusions: In patients with renal anomalies and urolithiasis, retrograde intrarenal surgery using an aspirating ureteral access sheath is an effective and safe method, characterized by a high SFR and a low complication rate. This method should be considered a firstline treatment option and a viable alternative to extracorporeal shock wave lithotripsy or percutaneous nephrolithotomy. Each case requires an individualized approach to ensure patient safety and achieve optimal outcomes. Further research is needed to optimize surgical techniques and define indications for RIRS in various renal anomalies, as the majority of publications focus on horseshoe kidney.

Background: Standard mortality indicators are insufficient for assessing the burden of malignant neoplasms (MN). Years of Potential Life Lost (YPLL) account for both the number of deaths and the age at death, providing a more precise estimate of the socio‑economic impact and informing the prioritization of preventive measures.

Objective: To analyze the dynamics of sex‑ and age‑specific YPLL due to MN in Russia (2018–2023) and to identify groups with the highest losses in the economically active population.

Materials and Methods: Aggregated Rosstat mortality data (Form C‑51) on MN among individuals aged 15–79 years (2018–2023) were obtained. YPLL were calculated following the methodology of Russian Research Institute of Health (sum of the products of the number of deaths and the remaining years of life; midpoints of age intervals; life expectancy standards: men 69 years; women 79 years). YPLL rates were standardized per 100,000 individuals within each sex and age group. Statistical analysis: descriptive methods; trends and projections up to 2030 – linear regression (OLS); critical significance level p=0.05; software: IBM SPSS 26.0 (IBM Corporation, USA), MS Excel 2019 (Microsoft Corporation, USA).

Results: Overall mortality and YPLL rates decreased in both sexes (10% over 2018–2023: from 2,127.7 to 1,906.6 per 100,000 population). A total of 1.173 million premature deaths occurred (607.4 thousand women; 565.5 thousand men), accumulating 13.495 million YPLL (8.734 million women; 4.760 million men). The largest absolute YPLL were observed in men aged 45–64 (~75% of all PYLL) and women aged 50–69 (>60%). An increase in YPLL was noted among women aged 15–19 years (+33% from 2018 to 2023) along with localized increases in 2023 (in several female and male age groups). The proportion of female YPLL rose from 63.6% (2018) to 65.6% (2023), projected to 68.4% by 2030.

Conclusions: Economically significant YPLL due to MN are concentrated among men aged 45–64 and women aged 50–69, targeted prevention and early diagnosis in these groups are essential. Program targets should be based on national life expectancy standards (69/79 years), rather than on elevated international thresholds.

Background: Thrombosis of the portal venous system remains an insufficiently studied area within abdominal surgery. The relative rarity of the disease, its non-specific clinical presentation, difficulties in instrumental diagnostics, and the mortality rate of up to 25- 60% highlight the need to standardize the diagnostic process and underscore the relevance of research.

Objective: To evaluate the capabilities of clinical, laboratory, and instrumental diagnostic methods for portal venous system thrombosis and develop an effective clinical diagnostic algorithm.

Materials and Methods: The study included 48 patients observed between 2014 and 2024. Group 1 consisted of 22 patients (45.8%) with acute primary portomesenteric thrombosis. Group 2 included 26 patients (54.2%) with secondary thrombosis of the portal venous system. All patients underwent triplex ultrasound of the portal vein and computed tomography for thrombus visualization and assessment of linear and volumetric blood flow velocities. Statistical analysis was performed using a statistical software package.

Results: Triplex ultrasound of the portal venous system provides additional information about blood flow status even in the presence of pronounced intestinal pneumatosis, however, it has demonstrated low sensitivity and specificity in confirming the diagnosis and in differentiating between types of portomesenteric thrombosis. Computed tomography with bolus contrast enhancement was performed in 35 patients (72.9%). The obtained images clearly visualized the main vessels of the portal venous system, its major tributaries, and smaller branches. Detailed evaluation of the venous lumen, the presence of the thrombi and approximate estimation of their “age” was conducted. Furthermore, computed tomography enabled objective assessment of the extent of internal organ involvement caused by impaired portal venous blood flow.

Conclusions: The key factor for successful treatment of patients with portomesenteric thrombosis is the time interval between disease onset and the initiation of targeted therapy, which considers the clinical and pathogenetic features of different disease types.

Background: Femoropopliteal bypass remains a priority surgical method for treating extensive atherosclerosis of the lower limb arteries. Selecting the optimal intervention strategy is challenging even for experienced vascular surgeons, which highlights the relevance of this study.

Objective: To identify the optimal method for femoropopliteal bypass in patients with extensive lower limb arterial lesions, depending on the availability of the autologous vein and the risk of graft thrombosis.

Materials and methods: The retrospective study was conducted involving 490 patients who underwent inpatient treatment from 2016 to 2020. Various bypass techniques were performed: reversed autologous vein grafts were used in 266 patients; in situ technique in 59 patients, ex situ technique with orthotopic placement of autologous vein in 66 patients, with upper limb veins in 73 patients, arterialized small diameter great saphenous veins in 17 patients, and synthetic graft in 9 patients. For the final analysis, patients were divided into two groups: Group 1 included patients with great saphenous vein of adequate length and diameter, who underwent bypass grafting using a reversed great saphenous vein (n=246), in situ (n=54), or ex situ (n=62) techniques; Group 2 included patients with a small diameter great saphenous vein who underwent bypass using upper extremity veins (n=61), a previously arterialized great saphenous vein (n=17), or synthetic prosthesis (n=9). Clinical observation was carried out during the hospitalization and the subsequent period (47.6±12.3 months). Statistical analysis was performed using IBM SPSS version 26 (IBM Corporation, USA).

Results: In Group 1, the best outcomes in terms of graft thrombosis prevention were demonstrated with the use of a reversed autologous vein above the knee joint (OR 0.503, 95% CI 0.293-0.865, p=0.013). The use of in situ and ex situ techniques for bypass grafting below the knee joint was associated with a significantly increased risk of thrombosis (OR 1.256, 95% CI 1.001-1.577, p=0.049 and OR 1.174, 95% CI 1.023-1.348, p=0.023, respectively). In Group 2, a significantly increased risk of thrombosis was observed only with the use of synthetic graft (OR 9.583, 95% CI 2.166-42.395, p=0.003).

Conclusions: For patients with available great saphenous veins of suitable size, the optimal approach is femoropopliteal bypass using a reversed autologous vein, which minimizes the risk of thrombosis. In cases where a suitable great saphenous vein is not available, the use of synthetic grafts is recommended to be avoided due to the increased risk of thrombosis, with preference given to other available materials such as upper limb veins or arterialized small great saphenous veins. 

Background: Ventral hernias remain a significant challenge in clinical practice worldwide. Scientific research in herniology focuses on improving the efficacy of hernioplasty and reducing perioperative complications. Currently, the absence of standardized protocol for preclinical studies on implantable materials in laboratory animals complicates the comparison of results and the selection of the optimal approach.

Objective: To develop and validate a hernia defect model for anterior abdominal wall hernia repair.

Materials and methods: An algorithm for modeling anterior abdominal wall hernia for experiments in herniology is proposed. The model was developed using laboratory Wistar rats. After surgical procedure, ultrasound examinations of the anterior abdominal wall were performed on days 30, 60 and 120. Subsequently, the rats were euthanized, and mechanical testing was conducted using a universal testing machine РЭМ-0,2-1 (Metrotest, Russia). Statistical analysis was performed using Excel (Microsoft Corporation, USA) and Statistica 13 software (Dell Software Company, USA) with the application of the nonparametric Mann-Whitney test. Furthermore, histological examination of anterior abdominal wall biopsy samples was conducted in the study groups. 

Conclusions: The proposed anterior abdominal wall hernia model can be used as a basis for preclinical research on new hernioprostheses. 

Objective: To evaluate the potential application of rehabilitation strategies based on the principles of ontogenetic development of higher mental functions in the medical rehabilitation of patients with chronic disorders of consciousness.

Clinical Case: The dynamics of consciousness recovery were monitored in patient V., who had suffered a subarachnoid hemorrhage resulting from rupture of an anterior cerebral artery – anterior communicating artery aneurysm. The study was conducted over the course of two consecutive medical rehabilitation programs, with a one-year interval between them. The rehabilitation strategies of clinical and psychological intervention were based on theoretical concepts of the ontogenetic development of higher mental functions introduced into Russian psychology by L.S. Vygotsky.

Conclusions: The results of the study suggest that understanding of the patterns of ontogenetic development of higher mental functions, as described in L.S. Vygotsky’s cultural-historical theory, can assist specialists of a multidisciplinary rehabilitation team in setting rational goals and planning effective medical rehabilitation strategies for patients with chronic disorders of consciousness. 

Objective: To analyze the diagnostic capabilities of ECG-gated CT angiography based on a clinical case of a patient with an abdominal aortic aneurysm.

Clinical case: A 64-year-old patient with an infrarenal abdominal aortic aneurysm was admitted to the vascular surgery department for surgical treatment. During the preoperative evaluation, which included echocardiography and a positive treadmill test, ECG-gated CT angiography not only confirmed the presence of an abdominal aortic aneurysm but also revealed a hemodynamically significant  stenosis of the right coronary artery. These findings, verified by subsequent invasive coronary angiography, resulted in a change in treatment strategy. Coronary artery stenting was initially performed, with vascular surgery postponed.

Conclusions: ECG-gated CT angiography demonstrates high diagnostic value in the comprehensive evaluation of patients with aortic aneurysm, enabling the assessment of both the aorta and coronary arteries in a single examination. Therefore, it is a valuable tool in the comprehensive preoperative assessment of patients with concomitant vascular pathology. 

The article focuses on the specific aspects of nonclinical studies (NCS) and the cunduct of pharmacological investigations of in vivo gene therapy medicinal products (GTMPs) which involve the administration of vectors with recombinant nucleic acids into the patient’s body for the correction of genetic disorders and treatment of oncological diseases. As of 2025 approximately 20 in vivo GTMPs have been authorized worldwide, including 3 in the Russian Federation. Due to the rapid technological advances and limited expertise in regulatory assessment, harmonized requirements for preclinical studies are lacking. The article emphasizes the necessity of harmonizing the Eurasian Economic Union regulations with the European Union standards conducting preclinical in vivo studies of GTMPs, the general outline of the NCS is provided, the risks associated with the use of this class of medical products are indicated, and the key aspects of pharmacological studies identified as a result of the analysis of public assessment reports from global GTMP developers, are noted. 

Scar formation remains a significant limitation in conventional wound care, often leading to functional impairment and aesthetic concerns. In recent years, exosome-based therapies have emerged as a novel regenerative strategy capable of accelerating wound healing while reducing fibrosis. Nanosized extracellular vesicles derived from sources such as mesenchymal stem cells, adipose tissue, and platelets, carry bioactive molecules that regulate inflammation, stimulate angiogenesis, and remodel the extracellular matrix. Preclinical and clinical evidence increasingly supports their potential to facilitate scar-free skin regeneration. This review highlights the therapeutic applications, clinical advancements, and emerging trends in exosome-based wound healing strategies. It also examines current challenges – including scalability, regulatory approval, and delivery methods – and proposes future directions to enhance clinical translation. 

Pulmonary embolism remains one of the leading causes of mortality worldwide. Timely diagnosis and treatment can improve both survival rates and the long-term quality of life in patients. The pre-test probability stratification for pulmonary embolism enables the exclusion of diagnostic methods associated with potential complications due to both radiation exposure and contrast agent administration.

The article presents scales for assessing the probability of pulmonary embolism, the risk of complications, adverse outcomes, and recurrence of thromboembolism. The advantages and disadvantages of the presented scales for practical use are discussed, along with specific considerations for their use in different patient groups.

Hypoxia is a common complication of critical conditions in neonatology and pediatrics, leading to impaired oxidative processes, development of acidosis, decreased cellular energy balance, excessive neurotransmitters, disruption of glial and neuronal metabolism. Equally important is the prevention of hypoxic brain injury during anesthesia. A promising and actively developing approach that allows physicians to manage anesthetic risks is the assessment of cerebral hemodynamics, particularly through the use of near-infrared spectroscopy. This method enables non-invasive monitoring of regional cerebral oxygenation, which at least theoretically, may help  anesthesiologists and intensivists prevent hypoxic complications in children. Each method used in clinical practice has its advantages and disadvantages. One of the limitations of near-infrared spectroscopy is the lack of clearly defined diagnostic criteria and the insufficient evidence supporting its efficacy and clinical relevance in improving postoperative outcomes in both the short and long term. Nevertheless, measurements based on the Beer-Lambert law, supported by numerous publications and studies, provides a reliable foundation for further research afocused on improving monitoring strategies and timely correction of hypoxic and ishemic cerebral brain changes through NIRS-based cerebral oxygenation monitoring. 

This article addresses the current issue of recurrent varicose veins in the lower extremities after endovenous interventions. An analysis of the recurrence rates and potential causes, depending on the treatment method used, is presented. The article emphasizes the existing shortcomings in recurrence prevention and proposes promising directions for the further development of effective corrective strategies.