Background: During COVID‑19 pandemic all countries of the world face increase in mortality of the population for different kinds of causes in comparison with previous years, but this increase could be explained not only by the registered COVID‑19 death cases. In this article the problem of excess mortality in the period of COVID‑19 pandemic for all reasons is discussed.
Objective: Assessment of the average scale and structure of excess mortality in the period of COVID‑19 pandemic in terms of International Classification of Diseases – 10 (ICD‑10) in the Russian Federation and also in the certain territorial subjects of the Russian Federation including those of the Southern Federal District.
Material and methods: Data of the state mortality statistics during 2019–2020 are used. Level of excess mortality was defined as a difference between the number of the dead from the particular reasons during the analyzed period of time (2020) in comparison with the same period of time in previous year. Cartograms and charts are constructed by free service Datawrapper (https://app.datawrapper. de/).
Results: In total in the year 2021 there were by 340279 death cases more, than in 2019. The general average mortality rate in Russia from all kinds of causes was 1460.2 ± 299.0 (variation coefficient 0.19) in 100 thousand people. That is 19.2% higher, than in 2019 (1225.1 in 100 thousand people). In structure of the excess death reasons the first place took the death causes connected with the new coronavirus infection – 42.5% of all excessive death cases. The second and third places belong to such causes as blood circulatory system diseases (28.6%) and diseases of respiratory organs (11.0%). In 2020 the number of working‑age people who died from blood circulatory system diseases was by 23432 more, than in 2019. In some types of diseases, the level of the general mortality decreased. Malignant neoplasms dominate in terms of the decrease of the number of mortal cases – in 2020 died 2939 people less, than in 2020. At the same time, the specific weight of number of the working‑age people who died of malignant neoplasms in 2020 in comparison with 2019 increased by 1.9% and was 22.0%. The general intensive indicator of mortality across Russia in such disease as “neoplasms” in 2020 was 202.0 cases, which is 2.5% higher than a target indicator of the federal project “Fight with Oncological Diseases”. This causes the need to increase the efficiency of participants activity in implementation of this federal project.
Conclusion: The pandemic of such disease as COVID‑19, disproportionately affected different territories of the country in terms of death rate of the population both from the death causes connected with the new coronavirus infection and from other reasons, first of all – from blood circulatory system diseases. Despite the additional financing of oncological service from the federal budget, during the pandemic mortality of adults of working‑age from malignant neoplasms grew, which can be connected not only with weak immune system of people with cancer but also with low efficiency of participants activity of the federal project “Fight with Oncological Diseases”.

Objective: Possibilities evaluation of achieving the target values of atherogenic lipoproteins in patients with coronary heart disease (CHD) in combination with renal dysfunction during drug correction with PCSK9 inhibitors.

Material and methods: The study included 76 men with CHD with very high cardiovascular risk divided into 2 groups: without chronic kidney disease (CKD) (n = 39) and with stage IIIA–IIIB CKD (n = 37). All patients did not reach the target values of lowdensity lipoprotein cholesterol (LDL cholesterol) after 8 weeks of the maximum dose of atorvastatin and ezetimibe, which was the motivation for the use of PCSK9‑alirocumab inhibitors, with control of the lipid profile and glomerular filtration rate for 6 months.

Results: In the group of patients with CHD, 87.1% of patients (n = 34) reached the target values of LDL cholesterol, the level of LDL cholesterol decreased from 4.41 ± 0.19 mmol to 1.28 ± 0.14 mmol (p < 0.001), in the group of patients with CHD + CKD stage IIIA–IIIB 56.7% of patients reached the target values (n = 21), the LDL cholesterol level decreased from 4.6 ± 0.2 mmol to 1.37 ± 0.09 mmol (p < 0.001). There was no statistically significant change in the glomerular filtration rate during the study.

Conclusion: The results of this study demonstrate the obvious effectiveness of PCSK9 inhibitors in achieving LDL cholesterol target values in patients with coronary heart disease with a very high cardiovascular risk. During the study, a decrease in the level of LDL cholesterol by more than 70% was noted. The absence of CKD in CHD patients increases the chance of achieving LDL cholesterol target values by 81% (OR 0.19).

Background: Despite the wide variety of epithelial coccygeal passage treatment methods, the choice of the type of surgery is still an issue to be discussed. It is due to the heterogeneity of the clinical material, the variety of pathological processes and development of the pathology. In spite of the absence of serious complications in most cases, it causes a significant deterioration of life quality and reduction of work capacity in patients of the most active age group.

Objective: Improvement of the treatment results of patients with epithelial coccygeal passage complicated by an abscess by means of vacuum therapy of a sutured postoperative wound (Russian Patent 2764499 date 07.04.2021).

Material and methods: The study included 59 patients: 19 people in the main group, who underwent surgical treatment of the epithelial coccygeal passage complicated by an abscess, using vacuum therapy according to the proposed method. A retrospective analysis of the medical histories of patients who underwent surgical treatment of the epithelial coccygeal passage complicated by an abscess has been carried out by means of the traditional method of wound closure with drainage. These patients were included in the control group of 40 people.

Results: In the control group purulent-inflammatory complications were recorded in 4 (10%) patients. Out of 19 people of the main group operated on according to the method proposed by us, purulent-septic complications were not recorded in any of the patients. Wound bandaging has been performed 71 times in 19 patients of the main group, and 454 times in 40 patients of the control group. For 19 patients of the main group the duration of the antibiotic therapy lasted 96 days, for 40 patients of the control group - 306 days. The average number of bed-days for patients of the control group was 10.63, in the main group - 7.56.

Conclusion: The use of the proposed method of surgical treatment of epithelial coccygeal passage complicated by an abscess, by means of vacuum therapy at all stages of treatment, made it possible to improve treatment results in patients of the main group.

Background: Despite the positive dynamics in this scientific area, the prevalence of drug pathology in Russia and other countries of the world remains unfavorable. Determination of laboratory markers of pathobiochemical processes which are characteristic to the patients with substance use disorder is promising from the standpoint of monitoring the course of the disease and evaluating the effectiveness of therapy.

Objective: To determine the characteristic changes in oxidative homeostasis of patients with addiction to psychostimulants and opioids at the rehabilitation and anti‑relapse stage.

Material and methods: The study was performed with the participation of 20 relatively healthy male volunteers and 18 male patients with addiction to opioids or psychostimulants who then became participants of the rehabilitation and anti‑relapse course of treatment. Changes in oxidative stress markers during rehabilitation and anti‑relapse treatment were studied.

Results: In comparison to the control values at the initial stage of the study, patients of the main group demonstrated decreased values of the iron‑reducing ability of blood plasma – by 25%, as well as those of the sorption radical ability of blood plasma – by 30%; the content of thiol groups of blood plasma proteins decreased by 24% while the concentration of glutathione in erythrocyte suspension lowered by 26%. The level of TBA‑reactive products in erythrocyte suspension corresponded to the control level. The performed rehabilitation manipulations contributed to the partial normalization of oxidative homeostasis, which was confirmed by a statistically significant increase in the ability of radical sorption of blood plasma by 20% and the concentration of reduced glutathione in erythrocyte suspension by 28% in comparison to the initial values of the corresponding parameters in patients of the 2nd group. The TBA‑reactive products remained within the control values.

Conclusion: The studied markers are suitable for monitoring the state of oxidative homeostasis in patients with opioid or psychostimulant addiction, the imbalance of which at the end of the rehabilitation and anti‑relapse stage also indicates the prospects for strengthening the antioxidant component as part of drug or nutritional correction.

Background: Reconstruction of the bulbous urethra with buccal graft (BG) is considered the “gold standard“ of surgical treatment of extended urethral stricture of this localization. There is still no consensus on the best location of BG. With its ventral fixation, there are a number of natural disadvantages associated with impaired BG vascularization.

Objective: To study our own results of surgical treatment of patients with extended recurrent stricture of the bulbous urethra, including our modified ventral onlay surgery technique.

Material and methods: 38 people were operated on, 14 of them underwent ventral onlay surgery, 12 - ventral onlay surgery in our modification, and 12 people had a dorsal onlay surgery. The patient groups were homogeneous according to the main indicators.

Results: It was found out that operations with ventral access showed a shorter duration compared to those with dorsal access, the ventral onlay operation in our modification had a significantly lower volume of blood loss than dorsal onlay. The most common complication in the long-term postoperative period was postmictional dribbling, prevailing in patients who had a standard ventral onlay surgery (35.7%). Recurrence of urethral stricture after surgery was in 7 patients (18.9%), the primary effectiveness of surgical treatment was 81.1%. Statistically significant differences between the ventral onlay/modified ventral onlay groups in the frequency of relapse were obtained. The average time to relapse was 26.5 ± 6.7 months. The second relapse occurred in 2 (5.4%) patients, thus, 94.6% of patients had no relapse (35 people).

Conclusion: The study of the postoperative results of urethroplasty in these patients showed a lower number of relapses and complications in the group of modified ventral onlay surgery.

Background: The incidence of gastrointestinal bleeding in patients with severe burns can reach up to 10%.

Objective: Evaluation of the risk factors for gastrointestinal bleeding and of the effectiveness of stress ulcer prophylaxis in patients with severe burns receiving proton pump inhibitors.

Material and methods: The study included the results of treatment of 270 patients with burns more than 10% of total body surface area (TBSA), in whom 13 potential risk factors for gastrointestinal bleeding were studied. All patients received omeprazole therapy with 40 mg № 1 intravenous or 20 mg № 2 orally. The data obtained were processed in Microsoft Office Excel 2007 and IBM SPSS 20.0.

Results: Significant risk factors for gastrointestinal bleeding were hypotension requiring treatment with vasopressors (dopamine ≥ 10 μg/kg/min or norepinephrine ≥ 0.5 μg/kg/min) for 2 or more days (χ² = 5.126; p = 0.024) and full thickness burns with more than 50% of total body surface area (χ² = 7.031; p = 0.008). The incidence of gastrointestinal bleeding was 4%. These bleedings were hemodynamically insignificant; in all cases, acute ulcers were the cause for them. There were no recurrences of bleeding and no repeated endoscopy or surgical treatment was required. The developed bleeding did not have a significant effect on mortality.

Conclusion: Using proton pump inhibitors minimizes the frequency and intensity of gastrointestinal bleeding and also prevents lifethreatening complications during their development. More complex prevention of stress ulceration is necessary for patients with full thickness burns more than 50% of TBSA which develop hypotension requiring long‑term vasopressor therapy.

Objective: Analysis of the results of the study of mineral metabolism and bone formation markers in patients with idiopathic scoliosis, depending on the magnitude of the deformity.

Material and methods: Based on the retrospective single‑center study in 30 patients diagnosed with scoliosis the preoperative parameters of calcium metabolism (total and ionized calcium, parathyroid hormone, 24‑hour urine calcium), phosphorus, bone formation markers (alkaline phosphatase, osteocalcin, P1NP in the blood), deoxypyridinoline in morning urine, blood levels of 25(OH)D have been analyzed. The patients were divided into 3 groups: with a deformity of 25–40 ° (group 1), 40–60 ° (group 2) and 60–80 ° (group 3) (n = 30). The mean age in all groups was 18.5 ± 4.7.

Results: In patients with idiopathic scoliosis, alkaline phosphatase and P1NP significantly exceeded normal values in the first group, which indicated a more high‑turnover type of bone remodeling with a deficient level of 25(OH)D. A higher excretion of deoxypyridinoline and a decrease in phosphorus in blood in patients with a deformity of 60–80 ° suggest a violation of the ratio of the processes of synthesis and resorption in bone tissue.

Conclusion: The study of mineral metabolism and all the main markers of bone formation made it possible to obtain a more complete picture of the state of metabolic processes in bone tissue, to obtain reliable data on the effect of some of them on the nature of bone remodeling and the magnitude of spinal deformity.

Background: The frequency of occurrence of infectious complications after hip arthroplasty in HIV-infected patients is extremely high. Revision arthroplasty for periprosthetic infection is the leader (64%) among the causes of early revision interventions. The search for ways to increase the efficiency of the sanitizing stage of treatment due to antibacterial coatings of the endoprosthesis components continues.

Objective: Demonstration of a clinical case of treatment of periprosthetic infection in an HIV-positive patient using a spacer and a femoral component of a hip joint endoprosthesis coated with linear Sp1 carbon chains and silver. 123 months after hip arthroplasty for stage 3 dysplastic coxarthrosis in HIV-positive patient of 42 years old developed an instability of the acetabular component with the growth of Staphylococcus aureus in punctates. A revision was performed with the removal of the endoprosthesis and the installation of an articulating spacer with the addition of antibiotics. 12 weeks later, a recurrence of periprosthetic infection occurred, and Enterococcus faecalis was detected in punctates. During re-endoprosthetics, there was an installation of an articulating spacer covered with a two-dimensionally ordered linear-chain carbon doped with silver, based on the Zimmer CPT femoral component and bone cement with antibiotics addition. After 3 months, the second stage of revision arthroplasty was performed with implantation of an individual acetabular component and a femoral component coated with two-dimensionally ordered linear-chain carbon doped with silver.

Conclusion: 4 months after the operation the patient returned to work, 12 months later the functional results were satisfactory. The use of components coated with two-dimensionally ordered linear-chain carbon doped with silver in an HIV-positive patient with recurrent periprosthetic infection made it possible to stop the infectious process, improve limb function and the quality of life.

This review focuses on the biological aspects of the use of cord blood as a valuable source of cells. The distinctive features of hematopoietic stem cells, cells of the immune system, mesenchymal stem cells are described. The analysis of the results of clinical research and development of therapeutic approaches using cord blood cells and umbilical cord for the treatment of various diseases has been carried out.

Currently, the target area of cord blood research is hematopoietic stem cell transplantation, as well as cellular immunotherapy of tumor diseases, treatment of neurological diseases and regenerative medicine.

The existing systems for describing thyroid nodules are highly informative and can be applied in routine practice, but suspicious criteria of thyroid nodules are based on the echographic pattern of papillary neoplasia, due to its predominance in the population. Follicular tumors are difficult to be differentiated between adenomas and follicular cancer, both echographically and morphologically. Despite the lower prevalence, this type of tumor has a high risk of aggressive course and relapse of 30–55% and this determines its early detection importance. The analysis of publications from 2009 to 2020 of existing TI‑RADS systems and national guidelines for the diagnosis of thyroid tumors, with an emphasis on the assessment of follicular tumors, was carried out. In Russia, at the beginning of 2021, the national guidelines require the use of EU‑TIRADS 2017, and the introduction of the national RU‑TIRADS is underway. Difficulties remain in the differential diagnosis of follicular tumors of different malignancy potential. It is possible that a combined risk assessment of echography, elastography, cytology, and molecular genetic studies will allow a more reliable stratification of the risks of thyroid nodules at the preoperative stage.

The epithelial‑to‑mesenchymal transition (EMT) is a cellular biological process, that occurs in a wide range of cells and tissues and is triggered by complex regulatory networks involving transcriptional control with SNAIL, ZEB1, ZEB2, Twist, SLUG, E‑cadherin, vimentin, tumor microenvironment and genetic characteristics. EMT is represented by the multi‑stage development and transformation of cells of the epithelial phenotype into cells that acquire mesenchymal features of various severity. These quasi‑mesenchymal cells are characterized by stemness, tumor heterogeneity, increasing invasiveness, drug resistance and a tendency to distant metastasis, which leads to the proliferation of neoplastic cells, tumor dissemination and initiation of metastasis, which induces the therapy resistance and the oncological recurrence.

This review is based on the latest scientific publications about the EMT phenomenon, indexed in PubMed. The aim of the study was to evaluate the biochemical and molecular pathogenetic mechanisms of EMT and the effect of EMT markers on the progression of neoplastic processes and the effectiveness of the treatment.

 Nowadays the proper EMT scheme that combines all the molecular transformations of sells with quasi‑mesenchymal phenotype doesn’t exist. But analyzing the features of this cellular program, we can find the proper therapy, that could be able to suppress the plasticity of cancer cells, prevent EMT induction by blocking contextual signals, and induce mesenchymal‑epithelial transition. All these aspects will lead to the reduction of the risk of tumor dissemination and the increase of the effectiveness of cancer treatment.