Background. Prediction of cardiac complications following orthopaedic and trauma surgery is necessary to improve the quality of treating the elderly patients.

Objective. To assess the effectiveness of prognostic scores of perioperative cardiac risk in patients with proximal femoral fracture.

Material and Methods. We retrospectively reviewed 918 hospital patients with proximal hip fracture from January, 1 2018 to December, 31 2019. Perioperative cardiac risks were assessed using the Goldman Risk Index, Revised Cardiac Risk Index (Lee Index) and Gupta Perioperative Cardiac Risk Index.

Results. Cardiac complications occurred in 7 (0.76%) of 918 patients, 6 (0.65%) patients developed acute myocardial infarction, 1 (0.11%) patient suffered from complete atrioventricular block. Receiver operating characteristic (ROC) curve analysis of the relationship between the time from injury to surgery and cardiovascular complications did not give statistically significant results (AUC (area under a curve) = 0.574, 95% CI (confidence interval): 0.352–0.796). When compared the presence of cardiac complications with the Lee Criteria predictions, significant differences were revealed (p = 0.007), and the Goldman Index data were not statistically significant (p = 0.151). The area under the ROC curve of the corresponding relationship between the prognosis of cardiac complications and the Gupta Index was 0.782 with 95% CI: 0.574–0.991 (p = 0.017), the sensitivity and specificity of the model were 83.3% and 70.4%, respectively.

Conclusion. The Goldman Index and Lee Index have no significant value for predicting perioperative cardiac complications in patients with proximal femoral fracture. The Gupta Index has an acceptable level of sensitivity and specificity in predicting cardiac complications.

Background. One of the reasons for the lack of standardized approaches to treating lumbar and thoracolumbar spine traumatic injuries is inconclusive information on relative contribution of various factors to pedicle screw fixation stability.

Objective. To determine risk factors that influence pedicle screw fixation stability in patients with unstable traumatic injuries of a lumbar spine and thoracolumbar junction.

Material and Methods. This was a retrospective evaluation of 192 spinal instrumentations. Patients with type А3, A4, B1, B2 and C injuries of lumbar and thoracolumbar spine were enrolled. Pedicle screw fixation was used either as a stand-alone technique or in combination with anterior column reconstruction. If required, decompression of nerve roots and spinal cord was performed. Cases with pedicle screw fixation failure were registered. Logistic regression analysis was used to assess predictive significance of potential risk factors.

Results. Complication rate growth was associated with a decrease in bone radiodensity, posterior decompression extensiveness, lumbosacral fixation and residual kyphotic deformity. Anterior column reconstruction and additional pedicle screw installation led to a decline in complication rate while anterior decompression and fixation length did not influence fixation stability.

Conclusion. In most cases, pedicle screw fixation system failure is associated with altered bone quality; however, surgical approach may also impact complication rate and should be taken into account when planning surgical intervention. Anterior column reconstruction and additional pedicle screw installation are associated with the decline in complication rate; the influence of those options is comparable. Anterior decompression does not influence pedicle screw fixation stability; consequently, it is preferable in cases with considerable risk of pedicle screw fixation failure.

Objective. The study objective was to compare the effects of minimally invasive and traditional surgical approaches for treating patients with unruptured intracranial aneurysms (UIAs) to assess efficacy and safety of the keyhole concept in neurosurgery.

Material and Methods. We conducted a comparative analysis of the microsurgical treatment outcomes of 204 patients harbouring UIAs who were operated on from 2014 to 2019. Patients were divided into two groups: operated on using traditional approach (n = 85, 41.7%) and minimally invasive approach (n = 119, 58.3%). Patients of the first group were operated on using pterional (n = 31), orbitozygomatic (n = 16) and lateral supraorbital (n = 38) approaches; in the second group, patients underwent surgery using trans-eyebrow supraorbital (n = 35), minimal pterional (n = 38), trans-eyebrow transorbital (n = 20) and transpalpebral transorbital (n = 26) approaches. Rate of intraoperative and postoperative complications, surgery duration and postoperative in-hospital stay period were the factors to compare. The Modified Rankin Scale was used as a neurological outcomes measure. Also cosmetic results of surgery, hypesthesia from the site of the surgical approach, temporomandibular joint disorder and facial asymmetry were evaluated.

Results. Compared to the traditional approach, minimally invasive technique incurred shorter surgery duration (р = 0.051) and inpatient stay (р > 0.001). Intraoperative and postoperative complication rates (р > 0.05) as well as functional outcomes (р > 0.05) were comparable between the two groups, while cosmetic effects (р < 0.05) were greater in minimally invasive group of UIA patients.

Conclusion. Microsurgical treatment of UIA patients using minimally invasive approach is considered safe and effective. Adequate selection of patients for operation and exhaustive neuroimaging data assessment for choosing of neurosurgical technique are obligatory factors for keyhole surgery. The authors recommend using minimally invasive concept only for experienced neurosurgical teams in specialized clinics.

Background. Over the last 15 years, there have been many recommendations for the management of patients with thyroid nodules, based on the assessment of various ultrasound (US) criteria in B-mode. In 2020, the EU-TIRADS system (2017) was included in Russian Clinical Practice Guidelines. Shear wave elastography (SWE) increases the diagnostic efficacy of ultrasonic B-mode examination of thyroid nodules and can be recommended to be included in the current classification system.

Objective. The study aims to assess the diagnostic efficacy of multiparametric US combining SWE and color flow mapping in differentiating between benign and malignant thyroid nodules to define their stage according to the EU-TIRADS system and decide on the need for fine-needle aspiration biopsy.

Material and Methods. A total of 150 thyroid nodules from 116 patients were analyzed. Lesions were then classified according to the EU-TIRADS system, SWE with an assessment of the color map and tissue stiffness was performed (Emean). In all tumors, cytological and histological (in operated patients) verification was carried out.

Results. After B-mode US with color flow mapping, differentiation of palpable thyroid abnormalities by the EU-TIRADS system was carried out. 78 nodules were classified as EU-TIRADS 2 (52%), 42 as EU-TIRADS 3 (28%), 26 as EU-TIRADS 4 (17.3%), 4 as EU-TIRADS 5 (2.7%). On cytological examination 42 tumor nodules were detected. Of these, 6 (14.3%) cases were reported as papillary thyroid carcinoma, 36 (85.7%) as follicular neoplasm, 22 (61%) among the last prove to be follicular carcinoma. Qualitative and quantitative evaluation of elastograms was performed. Benign nodules were colored primarily in blue, while suspicious for malignancy revealed red areas of different size. Elasticity index in benign nodules was 24.3 ± 5.63 kPa for colloid goiter, 27.8 ± 6.35 kPa for cellular goiter; in suspicious for malignancy this index was 80.9 ± 50.9 kPa for follicular neoplasm, 114 ± 56.8 kPa for papillary thyroid cancer. The stiffness cutoff value for malignancy indicated with ROC-analysis was estimated as 45.4 kPa. Mean elasticity index (kPa) was significantly higher in suspicious for malignancy nodules than in benign nodules (р < 0.05). Of 120 (80%) nodules, primarily assessed as benign and defined as EU-TIRADS 2 and 3, 18 (12%) nodules after SWE revealed areas of high stiffness exceeding the cutoff value. After that, these nodules were transferred to EU-TIRADS 4 and 5, and these stages require fine-needle aspiration. Of these, 11 (7.3%) cases were reported as follicular neoplasm, 6 (4%) among the last prove to be follicular thyroid carcinoma.

Conclusion. Using multiparametric approach with SWE will give the opportunity to classify correctly the nodule according to the EU-TIRADS and to identify greater number of thyroid tumors for fine-needle aspiration. SWE made it possible to increase the specificity of US using the EU-TIRADS system. The characteristics of the SWE score were: sensitivity = 81%, specificity = 90.3%, positive predictive value = 88%, negative predictive value = 91%, and accuracy of comprehensive study = 88.4%.

Background. Scientists around the world are interested in applying physical phenomena to various fields of science. The development of entire areas united by one concept (‘plasma medicine’, etc.) stands as an outstanding example. This study focuses on only two concepts of interest, which are plasma jet and electric field, as far as results of their combined use in clinical practice and in surgery remain understudied.

Objective. Experimental evaluation of the effectiveness of physical methods of treatment in skin wound healing.

Material and Methods. Animal testing involved 45 small laboratory animals (rats). They were divided into 5 groups of 9 according to methods for experimental wound healing. To generate the plasma jet, a portable generator was used, which is the original development of specialists of the Peter the Great St. Petersburg Polytechnic University. Planimetric and histological measurements were analysed. The antibacterial effectiveness of methods under research was investigated using Staphylococcus aureus 209P, cultivated in vitro on 6- and 12-millimeter discs.

Discussion. A combination of non-thermal atmospheric pressure plasma and frequency-modulated electric field signal exhibited the ability to accelerate eschar separation by 52.1% (p < 0.05) and stimulate restorative regeneration by 56% (p < 0.05). Combination of physical methods of treatment demonstrated pronounced antibacterial effect. A histological examination on biopsy sample on the 21st day of observation revealed formed (mature) granulations and large number of newly formed vessels. The cellular composition of epidermal basement membrane showed high level of differentiation.

Conclusion. The data obtained suggest that the use of the proposed methods in clinical practice will improve the treatment process of the patients with wounds of different etiology.

Background. Chronic bacterial prostatitis is a common disease clinically diagnosed based on signs of inflammation and the presence of infection in the prostatic fluid. Standard antibiotic therapy in most cases does not lead to a decrease in the number of recurrences. In this regard, an integrated approach is often used in therapy, and in addition to antibacterial therapy, biostimulators, extracts of various plants and animals are prescribed. One of the main advantages of these prescriptions is that the drugs have minimal side effects.

Objective. To assess the effectiveness of Adenoprosin® in the combined treatment of patients with chronic bacterial prostatitis.

Material and Methods. 60 patients aged 24–50 (average age is 31.3 ± 2.8 years) with chronic bacterial prostatitis were examined and treated, the duration of the disease ranged from 6 months to 15 years (average duration of the disease is 1.5 ± 0.3 years). The patients were divided into two groups: group I included 30 patients who were treated with antibacterial drugs and Adenoprosin®, group II included 30 patients who were treated with antibacterial drugs only. The course of treatment lasted 30 days, the total time of observation of the patients was 3 months. Clinical control was carried out during the first visit to the urologist, on the 14th, 28th, 45th and 90th days from the start of therapy and included filling out the following: The National Institutes of Health Chronic Prostatitis Symptom Index (NIH-CPSI), The International Prostate Symptom Score (IPSS) and Quality of Life (QoL), as well as the International Index of Erectile Function (IIEF-5) questionnaire in order to identify the possible effect of therapy on sexual function.

Results. The analysis revealed that the use of the Adenoprosin® in complex therapy in patients with chronic bacterial prostatitis reduces the overall score of the NIH-CPSI questionnaire by an average of 4 points. When conducting a questionnaire at the end of treatment, 2 (6.6%) patients in the group II noted dissatisfaction with the therapy, on the 90th day of observation, complaints of dissatisfaction with the treatment remained in 1 (3.3%) patient. In 5 (16.6%) patients of the group II, against the background of the therapy, there was no subjective improvement in the treatment; on the 90th day of observation, the number of unsatisfied patients remained the same. Microscopic examination of the prostatic fluid and microflora after 28-day-treatment showed the decrease in leukocytes (less than 10 leukocytes in the field of view) in 25 (80%) patients of the group I. This point was higher in comparison with 21 (70%) patients of the group II. In 5 (16.6%) patients of the group I, the number of leukocytes in the prostatic fluid was in the range of 10–20 in the field of view, all patients previously had recurrent forms of the disease. The number of leukocytes more than 10 was in 7 (23.3%) patients of the group II after antibacterial therapy. Among them, 5 (16.6%) patients had recurrent forms of the disease, and 2 (6.6%) patients were diagnosed with prostatitis for the first time. Thus, the use of combination therapy in the group I, to a greater extent, reduced the inflammatory markers of the disease.

Conclusion. The Adenoprosin® in complex therapy has a proven anti-inflammatory effect on the prostate gland, reduces the pain rapidly, decreases the total score of prostatic symptoms when analyzing the NIH-CPSI questionnaires, improves erectile function, reduces markers of inflammation in the pre-fetal gland and can be recommended for patients with chronic bacterial inflammation in the prostate gland.

The paper discusses the etiology, pathogenesis, classification, principles of diagnosis and tactics of surgical treatment of dural arteriovenous fistulas. The study presents two case reports of successful treatment of patients with symptomatic dural arteriovenous fistulas.

The treatment of pulmonary valve disease is one of the urgent problems of modern cardiology and cardiac surgery. In most cases, pulmonary valve abnormalities are congenital. Synthetic conduits (homografts) and bioprosphetic valves are currently used in the surgical treatment of patients with the diseases mentioned above. Pulmonary valve surgical prosthetics allows one to normalize the circulatory dynamics and condition of the patient, however, time-dependent degradation results in conduit and valve dysfunction. The abnormal circulatory dynamics caused by valve and conduit dysfunction is linked to exercise intolerance, arrhythmia, right ventricular failure, and sudden death. Starting in childhood, affected patients undergo repeated openheart surgeries to restore valve function and potentially reduce morbidity and mortality. Percutaneous transcatheter treatment of the pulmonary valve stenosis with the Melody® valve (Medtronic Inc.) has been performed in a large number of patients worldwide. Despite minimal invasiveness, this procedure restores pulmonary valve function and reduces repeated open-heart interventions. Recent clinical trials have shown excellent and durable results in terms of both restoring valve function and decreasing right ventricular outflow tract obstruction.
In this study, we want to reflect the relevance of the Melody transcatheter valve and present our first experience of its usage.

Obstructive jaundice may be caused by many different diseases associated with bile duct obstruction leading to severely impaired liver function as well as injuries of other organs and systems. Early identification of the causes and nature of hyperbilirubinemia is of paramount importance in patient management and decreases the incidence of serious complications and fatalities.
Radiology techniques are extremely helpful for the differential diagnosis of obstructive jaundice. High awareness of these methods’ possibilities and their rational use allow one to choose the most appropriate treatment strategy and determine disease outcome. The study describes the feasibility and proper order of various diagnostic methods employed to examine patients with suspected obstructive jaundice.

Due to its asymptomatic nature, orthostatic hypotension can be diagnosed only by means of orthostatic challenge. One should try to define the causes of orthostatic hypotension in every single case because treating illness that lead to orthostatic hypotension will improve patient’s health outcomes. The main target for therapy should be improving patient’s functional status, reducing orthostatic symptoms as well as risk for falls and syncopes, but not maintaining arterial blood pressure within certain limits. Doctors need to be aware of the methods for diagnosing the orthostatic hypotension to provide patients with the better quality of life.
The first part of the systematic review was published in the Innovative Medicine of Kuban, no. 4, 2018.