Background: Atrial fibrillation (AF) is reported to be one of the main etiological factors of ischemic stroke. Transcatheter occlusion of the left atrial appendage (LAAO) is an alternative to anticoagulant therapy in the thromboembolism prevention in atrial fibrillation patients with a high bleeding risk. The role of contrast-enhanced cardiac computed tomography (CT) for preoperative assessment and postoperative control has not been sufficiently studied to the present moment.

Objective: Comparison of the possibilities of transesophageal echocardiography (TEE) and computed tomography in pre- and postoperative imaging in the context of LAAO interventions.

Material and methods: This retrospective cohort study included 38 patients divided into 2 groups: in the first group TEE was used for intervention planning and postoperative control, patients of the second group were examined with CT. The indicators obtained during LAA measurements were assessed, as well as the result of the intervention – according to the risk of peripheral leakage into the left atrial appendage.

Results: The average left atrial appendage depth and orifice diameter according to transesophageal echocardiography were significantly smaller compared to computed tomography data (25.58 ± 4.65 versus 31.05 ± 6.41, p = 0.011; 17.21 ± 2.70 versus 18.55 ± 3.05 p = 0,006, respectively). In the computed tomography group, there was a not statistically significant trend towards a lower risk of leakage for 4–5 mm leaks (RR = 0.500; 95% CI 0.060–3.710) and for 2–3 mm leaks (RR = 0.500; 95% CI 0.150–1.540). In addition, 45 days after the intervention computed tomography revealed 5 cases of incomplete endothelialization of the device with the contrast agent leak into the LAA in the absence of peripheral leakage.

Conclusion: Contrast-enhanced cardiac computed tomography, unlike transesophageal echocardiography, allows to detect incomplete occlusive device endothelialization, which may influence the choice of postoperative antithrombotic therapy. The use of computed tomography in an intervention planning for the LAAO may reduce the risk of peripheral leakage, however, this hypothesis needs to be confirmed in studies with a larger number of patients.

Introduction: Skeletal muscles damage (direct and vicarious) slows down the recovery processes in patients with injuries of the musculoskeletal system. It occurs in the early postoperative period as well. An increase in the rigidity of the skeletal muscle extracellular matrix can reduce pain, tissue swelling, and accelerate the recovery of contractility.

Objective: The analyses of the effect of branched-chain amino acids (BCAAs) intake on the expression of IGF1 genes, type 1, 3 and 5 collagen, which are crucial in the composition of the skeletal muscle extracellular matrix, as well as on the muscle membrane damage against the background of chronic damage to skeletal muscles.

Material and methods: 12 young healthy male subjects, skiers aged 19 (18; 22) received a placebo treatment (maltodextrin, 100 mg/kg body weight/day; n = 6) or a mixture of amino acids (leucine, isoleucine, valine – 50:25:20 mg/kg body weight/day respectively; n = 6). The treatment was received daily against the background of a large amount of aerobic high-intensity training (up to 22 hours per week). Before and after the amino acids intake a biopsy of the musculus vastus lateralis was performed, and venous blood samples were taken during the experiment.

Results: The intake of leucine against the background of training led not only to a pronounced increase in the level of IGF1 protein in blood by 1.5 times (which corresponds to the literature data), but also to a trend towards an increase in the expression of IGF1Ea mRNA by 1.8 times in the skeletal muscle, and a decrease in the level of markers of muscle membranes damage – creatine phosphokinase (CPK) activity and myoglobin. In addition, changes in the IGF1-dependent collagen genes expression strongly correlated with changes in IGF1Ea expression, but not with IGF1 protein in blood (pooled group, n = 12). Thus, the intake of leucine as a part of the essential amino acids can reduce damage to skeletal muscles caused by excessive physical activity, lack of physical activity, or direct trauma.

Conclusion: A 10-week BCAAs intake by individuals with documented chronic muscle membrane damage caused an increase of basal levels of IGF1 in blood and a trend towards increased IGF1Ea mRNA expression in skeletal muscle, and also caused a modest reduction in damage of skeletal muscle membrane.

Background: Colorectal cancer is now an urgent problem in oncology. Recently, specialists have been interested in a comparative analysis of differences in the clinical course of malignant tumors in the proximal and distal colon. The sections differ not only in their embryogenesis and sources of blood supply, but also in the clinical course and population and epidemiological characteristics. The issue of distinctive immunological characteristics of tumors of the colon depending on the location remains open.

Objective: A comparative analysis of local subpopulations of immunocompetent cells and an assessment of number of cells with the CD45+/- phenotype expressing toll-like receptors (TLRs) depending on the tumor location on the right or left sides of the colon.

Material and methods: The study included 50 patients with verified colon cancer. The majority of patients were females – 26 (52%), aged 67 ± 0.4 years, and 50% of patients with stage II disease. Depending on the tumor location (the right or left sides of the colon), the patients were divided into 2 groups of 25 people each. All patients underwent standard surgery at the initial stage. The obtained material was used for subsequent studies: a cell suspension was obtained from a tumor tissue fragment, the perifocal zone (1–3 cm from the tumor) which was processed using an antibody panel (Becton Dickinson, USA) to identify the main subpopulations of leukocytes and lymphocytes. Expression of TLRs (2, 3, 4, 8, 9) on CD45+, CD45- cell populations was also determined using the BD FACSCanto flow cytometer (Becton Dickinson, USA). Statistical processing of the results was performed using the STATISTICA 13.3 package (StatSoft Inc., USA).

Results: A comparative analysis of immunological parameters, depending on the tumor location on the right or left sides of the colon, showed:

1. Tissues of the right-sided tumors had a higher T-lymphocytic infiltration, compared to the left-sided tumors, while the latter showed a higher B-lymphocytic infiltration (p = 0.025).
2. Peritumoral zone tissues of left-sided tumors demonstrated a decrease of lymphocytes levels (p = 0.027), NKT – (p = 0.035), NK – (p = 0.041) and В lymphocytes (p = 0.038), and a significant increase in CD8+- (p = 0.02) and DP cells (p = 0.0018).
3. Left-sided tumors showed a percentage decrease of CD45- cells expressing TLR4 and TLR8, compared to right-sided tumors, by 38% (p = 0.038) and 25% (p = 0.043).
4. There was a decrease in the number of CD45+ cells expressing TLR2 and TLR4 in left-sided tumors by 54% (p = 0.035) and 33% (p = 0.04) respectively, than in right-sided tumors.
5. The percent of CD45- cells expressing TLR4 in the perifocal tissues of left-sided tumors decreased by 61% (p = 0.031) in comparison to the corresponding tissues in right-sided tumors.
6. The numbers of CD45+ cells expressing TLR2 and TLR4 were 81% (p = 0.02) and 87% (p = 0.018) lower respectively in the peritumoral tissues of left-sided tumors, compared to the corresponding tissues in right-sided tumors.

Conclusion: The revealed characteristics of the local subpopulations of immunocompetent cells and the numbers of CD45+/- cells expressing TLRs depending on the tumor location on the right or left sides of the colon can serve as a prognosis of the disease clinical course and the choice of further treatment tactics.

Objective: To study the effect of transcranial pulsed current stimulation (tPCS) therapy on cardiac arrhythmias developed after percutaneous transluminal coronary angioplasty (PTCA) with stenting in patients with myocardial infarction (MI).

Material and methods: Characteristics of patient groups: the comparison group (n = 17) – with myocardial infarction, after PTCA with stenting, standard treatment; the main group (n = 21) – the same and tPCS therapy. Control points of the study: 1st day – Electrocardiography (ECG), Echocardiography (ECHO), Creatine phosphokinase (CPK), Creatine phosphokinase-MB (CPK-MB), Troponin-I, potassium, β-endorphin; 5th day – the same without ECHO; 10th day – the same and ECG with the determination of harmony and quantum of the electromagnetic flux of the cardiac cycle. PTCA was performed using drug-eluting stents. tPCS therapy was performed in pulsed bipolar mode, current strength 2 mA, current frequency 77.5 Hz, session duration 45 min.

Results: In patients of the main group (against the background of tPCS therapy), the studied parameters of the cardiac cycle approached the optimal values. It was shown that intergroup differences in harmony (p = 0.002) and the size of the electromagnetic flux quantum of the cardiac cycle (p = 0.001) are statistically significant. Also, against the background of the tPCS therapy, the concentration of highly sensitive troponin-I is statistically significantly (p = 0.0042) lower by 109%. On the 5th and 10th days of the study, the serum concentration of β-endorphin in the main group was higher by 38.3 and 35.0% than in the comparison group (p < 0.05).

Conclusion: The results of the study clearly demonstrate the cardioprotective and antiarrhythmic potential of tPCS therapy in patients with myocardial infarction and cardiac arrhythmias after PTCA with stenting.

Objective: Improving the results of surgical treatment of portal hypertension complications in patients with liver cirrhosis.

Material and methods: The results of medical care for 328 patients with liver cirrhosis, who were treated in the surgical departments of the central district and city hospitals of the Krasnodar Region, were analyzed. The effectiveness of minimally invasive surgical treatment of portal hypertension complications in 832 patients with liver cirrhosis treated at the Regional Clinical Hospital no. 2 of the Ministry of Health of the Krasnodar Region were also evaluated.

Results: The mortality rate in patients with liver cirrhosis, admitted in first-level institutions of medical care due to acute bleeding from esophageal varices, reached 26.3%. In conditions of surgical treatment of complications of portal hypertension in a third-level institution of specialized care it did not exceed 4.7%.

Conclusion: The optimal approach to the surgical treatment of patients with liver cirrhosis is to stop the bleeding from esophageal varices at the first stage of medical care and to treat portal hypertension complications using minimally invasive technologies in a multidisciplinary clinic involving a multidisciplinary team of doctors.

Background: The study is devoted to the impact of a new coronavirus infection in combination with other diseases on the hospitalization outcomes. Features of mortality in the population during COVID-19 pandemic, including from blood circulatory system diseases, have been studied. However, there are few studies based on the large amount of data on the cases and outcomes of providing specialized hightech medical care to patients with cardiovascular diseases (CVD) and concomitant diagnosis of COVID-19.

Objective: The analysis of impact of a new coronavirus infection on the outcomes of hospitalization for circulatory system diseases.

Material and methods: Information about more than 350 thousand cases of hospitalization of patients with blood circulatory system diseases in the context of the COVID-19 pandemic has been analyzed, of which in 1875 cases a concomitant diagnosis of COVID-19 was established. The sources of information are the depersonalized registers of compulsory health insurance accounts. For assessment of the obtained data methods of descriptive statistics, simple (unweighted) arithmetic mean values, mean values, specific weights of indicator values, a mean square (standard) deviation from mean values were used. The analysis and descriptive part of the work were carried out by means of the Microsoft Excel spreadsheet software package.

Results: The outcomes of hospitalization of patients with suspected or confirmed diagnosis of COVID-19 were significantly worse than in other patients. Moreover, the frequency of lethal outcomes increases significantly in correlation with the age of patients and does not depend on the choice of treatment method – surgical or therapeutic.

Conclusion: COVID-19 significantly complicates provision of medical care in conditions of the round-the-clock hospital for blood circulatory system diseases. The risks of surgical interventions for circulatory system diseases in combination with COVID-19 are as high as with the use of therapeutic technologies. It is necessary to unify the indications and contraindications to surgical treatment of conditions related to acute coronary syndrome in cases of the presence of such concomitant pathology as COVID-19.

Pain syndrome is the most common reason for patients to seek medical care, the importance of which is steadily increasing in the structure of the total incidence. To optimize costs and ensure high-quality treatment of patients with chronic pain syndrome it is necessary to study existing drugs and methods and introduce new ones. Based on theoretical data on the use of inert gases in medicine, a hypothesis was put forward that xenon could have a pronounced analgesic effect when administered subcutaneously. This study is aimed at confirming the safety of xenon in parapulmonary administration to rats.

Amiodarone is a drug used in the treatment of life-threatening arrhythmias, which can lead to the development of amiodarone-induced thyrotoxicosis. In most cases this pathology can be treated by conservative methods; surgical treatment is resorted to in cases of thyrotoxicosis refractory to medical treatment. This case report describes surgical treatment of a patient with amiodarone-induced thyrotoxicosis, progressive heart failure, neurological pathology, bilateral pneumonia, functioning tracheostomy, systemic infectious process, multiple organ dysfunction syndrome, who was treated in the intensive care unit. Due to the lack of response to therapy with antithyroid drugs (thiamazole, lithium preparations and pulse therapy with prednisolone) and a progressive deterioration of the condition in a short period of time, according to vital indicators, the patient underwent thyroidectomy. In the postoperative period, there was a decrease in the occurrence of chronic heart failure symptoms. Medical control of cardiac arrhythmias was achieved. Surgical stage proceeded without complications in the period of 30-days. The patient was discharged for outpatient rehabilitation treatment.

Objective: Improvement of the treatment results of patients with implant-associated complications in the surgical site (SSI) by developing treatment tactics depending on the type of complication.

Material and methods: The analysis of the treatment results of 245 patients with implant-associated complications of SSI was carried out in patients with various pathologies of the spine who underwent inpatient treatment in the neurosurgical department no. 3 in Scientific Research Institute – Ochapovsky Regional Clinical Hospital no. 1 in the period from 2015 to 2020.

Results: Out of the 245 wound complications identified in clinic, partial or complete resolution of the problems was achieved in 241 (98.36%) cases. In 4 patients (1.63%), a negative trend was noted, even though the removal of the metal structure and the application and change of vacuum assisted closure (VAC) dressings were carried out in a timely manner. In these 4 cases, the generalization of the infectious process led to lethal outcome.

Conclusion: In a neurosurgical department with a high surgical activity, wound complications after spinal surgery using spinal implants, occur in no more than 2.36% of cases, provided that a set of preventive measures are carried out. More often, such complications develop after operations on the lumbar spine from the posterior access for infectious (16.58%) or oncological diseases (11.76%). The depth of suppuration, the period of the complication development from the moment of surgery, as well as the presence or absence of an interbody bone or fibrous block play a crucial role in the decision on the implants removal. In patients with implant-associated infections of the area of surgical intervention on the spine, the use of the proposed tactics and VAC bandages allowed to achieve positive treatment results in 98.36% of cases.

For many decades, the scientific community of medical professionals has wondered if there is a correlation between cough and gastroesophageal reflux. This problem is relevant for doctors of various specialties. The importance of this issue is due to practical application since it determines the tactics of diagnosis and treatment both for cough and gastroesophageal reflux. The article provides an analysis of Russian and foreign literature data, based on which we can conclude that there is a correlation between gastroesophageal reflux (gastroesophageal reflux disease) and cough.

Currently, there are limited data supporting the use of parathyroid hormone-related protein for the purposes of breast cancer detection and disease prognosis. This literature review covers research results on diagnostic potential of parathyroid hormone-related protein as a biomarker for breast cancer, as well as the information available in the scientific literature, reflecting obvious contradictions regarding clinical and prognostic importance of this protein in the primary breast cancer, correlation of its expression with the risk of bone metastasis and survival of patients. Results of preclinical and clinical research show, that parathyroid hormone-related protein inhibits tumor progression and decreases its metastasis at early stages of the disease, which improves the survival rate, but it has an opposite effect at the advanced stages of cancer, as it increases tumor development and metastasis, and reduces survival rates. Altogether, these studies prove an idea that parathyroid hormone-related protein plays a double role in breast cancer. Use of parathyroid hormone-related protein for breast cancer early detection and disease prognosis is currently becoming a subject of detailed scientific research studies, which is confirmed by the facts presented in this literature review.