Objective: Identification of the quantitative characteristics of changes in the arterial wall according to ultrasound, CT and MRI; development of the roadmap for the use of radiology diagnostic methods.
Material and methods: 548 studies of 483 patients with atherosclerosis were analyzed (15 ultrasound studies, 483 – CTA and 50 – MRI). In the comparison group (n = 17) in patients without atherosclerosis, an analysis of MRI data of the aortic wall was performed. According to CTA, signs of atherosclerotic degeneration were assessed. According to the MRI data, indicators of aortic distensibility, Young’s modulus of the aortic wall (MPa), systolic distension of the aorta (ml), aortic wall enhancement index during contrast enhancement were calculated.
Results: During the performance of ultrasound in all cases (n = 15), the analysis of the elastic properties of the aortic wall is difficult due to the artifact from calcification. Adverse CT signs of the occurrence of intraoperative vascular complications: the presence of an intraluminal thrombus, an uneven internal aortic contour of more than half of the circumference with an aortic wall thickness of more than 5 mm. According to MRI data in patients with atherosclerosis, aortic distensibility was reduced to 14.42 ± 2.95%, Young’s modulus for the aortic wall was 0.77 ± 0.26 MPa, the index of contrast enhancement of the aortic wall was 1.73 ± 0.5, the volume of systolic aortic distension was 11.48 ± 1.84 ml. In patients with vascular events in the perioperative period, systolic aortic dilatation was 9.2 ml.
Conclusion: The signs which are expedient to consider when making a decision on surgical treatment have been identified. Significant limitations were identified in the assessment of elasticity by ultrasound. The wider use of MRI in atherosclerotic lesions looks promising.

Background: Currently, there are no clear recommendations on the timing of surgical intervention for the slow development of cauda equina syndrome (CES) against the background of lumbar spinal stenosis (LSS) at the lumbar level in elderly patients. The information on the long-term effectiveness of decompressive and stabilizing interventions (DSI) in the lumbar spine in this pathology is also limited.
Objective: To conduct a comparative analysis of the results of surgical treatment of elderly patients with LSS associated with CES after open and low-traumatic DSI.
Material and methods: The retrospective study included 37 patients operated on between 2000 and 2020 for CES caused by LSS. Two groups were distinguished: in the first group (n = 17), an open DSI was performed with the median approach, in the second group (n = 20) a low-traumatic DSI was performed according to the author’s method. Technical features of interventions and specificity of the postoperative period, preoperative instrumental data, clinical parameters in dynamics, and complications were compared.
Results: In a comparative analysis in the group of patients operated on with author’s low-traumatic DSI, smaller parameters were registered: the duration of the operation (p = 0.02), the blood loss (p = 0.003), the duration of inpatient treatment (p = 0.002), and the postoperative need for opioid analgesics (p < 0.05). In catamnesis, statistically significantly better clinical parameters of bladder sphincter control (p = 0.02) and motor function recovery (p = 0.01), Oswestry Disability Index (ODI) (p = 0.03) and the Short Form-36 (SF-36) (p = 0.01) were observed in patients of the group II, compared with the group I. A greater number of complications were noticed in the group of open DSI (p = 0.003), with a comparable frequency of reoperations in the follow-up period (p = 0.79).
Conclusion: In elderly patients with CES-associated LSS, the advantages of the author’s low-traumatic DSI in comparison with open DSI were established of less blood loss and duration of hospitalization, low need for postoperative analgesia, the minimum number of complications, and the dynamics of neurological symptoms, better recovery of ODI and SF-36 in catamnesis.

Background: Secondary postoperative diffuse peritonitis (SPDP) is one of the most severe complications of elective and emergency surgical interventions associated with a high mortality rate. To date, no optimal tactics of surgical treatment of SPDP has been developed.
Objective: The analysis of independent predictors of outcome depending on the method of surgical treatment – relaparotomy ondemand (RD) or vacuum-assisted laparostomy (VAL).
Material and methods: The study included 141 adult patients, male and female in the period from January 2014 to December 2020: group I (n = 63) – patients who received VAL method; group II (n = 78) – RD method. The method of multivariate logistic regression analysis was used to calculate the independent effects of potential predictor variables on the treatment outcome.
Results: The following independent predictors of treatment outcome in the RD group were identified: age, duration of hospital stay, number of relaparotomies, APACHE II score, Björck classification grade 1C at the 1st sanitation, bacteremia, Clavien–Dindo complications class 3a and 4a. For the VAL group: conversion of surgical tactics and bacteremia.
Conclusion: In patients with SPDP in the presence of risk factors for unfavorable outcomes, the use of VAL with staged sanitation of the abdominal cavity is indicated.

Background: Today protective ventilation is the predominant ventilation methodology. It includes the use of low tidal volume, inspiratory pressure limitation, and the application of positive end-expiratory pressure. However, several retrospective studies have shown that tidal volume, inspiratory pressure, and Positive End-Expiratory Pressure (PEEP) are not associated with patients’ treatment outcomes, but could be associated only when they influence driving pressure.
Objective: Optimization of the strategy of protective one-lung ventilation under the control of driving pressure, to reduce early postoperative respiratory complications in patients operated for lung cancer.
Material and methods: A prospective controlled study was conducted on 110 patients undergoing extended anatomical lung resections with subsequent comparison of clinical results depending on the level of driving pressure during one-lung ventilation. Postoperative pulmonary complications based on the Melbourne scale that appeared within 3 days after surgery became the endpoint.
Results: A correlation was established between the level of driving pressure and the level of PaO2 in the intraoperative period – high inverse (r = – 0.901). The greatest value in the development of postoperative respiratory failure is driving pressure, exceeding 15 cm of water (Odds ratio = 18.25). In the first 3 days, postoperative pulmonary complications, determined by the Melbourne group scale, occurred in 9 (8.2%) patients in whom the driving pressure exceeded 15 cm of water, and in 3 patients (2.7%) with a driving pressure level less than 15 cm of water (p = 0.016).
Conclusion: Driving pressure excess with values of more than 15 cm of water significantly increases the incidence of postoperative pulmonary complications. Fixed PEEP will be inappropriate both high and low, and individualized PEEP titrated by CStat may reduce driving pressure and become the next step in protective one-lung ventilation.

Introduction: The policy of mortality decline of the population of Russia, pursued by the state, requires consideration of the regional peculiarities of mortality in territorial subjects of the Russian Federation by gender and age. The regional situation on male and female mortality also should be considered when developing the measures directed to prevent various diseases including infectious ones. In this regard, the studies of gender and age indicators of mortality during the periods of infectious pandemics become relevant.
Objective: The analysis of gender and age rates of COVID-19 mortality in 2021 in order to substantiate the best management decisions in the sphere of the organization of medical care and statistical registration of lethal outcomes during the pandemic spread of dangerous viral infections.
Material and methods: The main source of information on mortality in 2020 is data of the State Statistics of Mortality of Rosstat. The data on mortality in 2021 are presented in the records on death cases in Federal State Information System “Unified State Register of Registration of Acts of Current State”. To evaluate the obtained data, simple (unweighted) arithmetic mean values, specific indicators, a root mean square (standard) deviation of the mean values, coefficient of variation were used (a measure of the spread of attribute values – the ratio of a standard deviation to the arithmetic-mean).
Results: In 2021 17.3% of total number of all deaths had COVID-19 as an initial cause of death. 248,134 cases of those were women (58.5%), 176,116 cases were men (41.5%). The mortality rate from COVID-19 increased by an average 1.7 times upon transition from one five-year-old age group to another, 85% of those who died from COVID-19 were aged 60 years and older. In 2021 the coronavirus infection of COVID-19 contributed significantly to female mortality more, than male mortality, which is inconsistent with the data on gender structure of COVID-19 mortality in other countries, as well as with the widespread belief that men are more vulnerable to this infection.
Conclusions: Growth rates of COVID-19 mortality depending on age resembles the aging rate, reflecting the biological nature of mortality. Total excess mortality is the better basis for assessment of changes in the population health during pandemics, than mortality from COVID-19 alone. The organization of systematic checks of correctness of coding the causes of death at the state registration of death is necessary.
Restrictions: Data of the Federal State Information System “Unified State Register of Registration of Acts of Current State” can differ from data of Rosstat which in 2022 became available to professional researchers later, than data of the Federal State Information System “Unified State Register of Registration of Acts of Current State”.

Objective: To study the evolution of approaches to surgical treatment in patients with open abdominal trauma.
Material and methods: The results of surgical treatment of 141 patients with open abdominal trauma at the age of 32.6 ± 7.3 years have been studied. In the main group of 73 patients, surgical tactics have been determined according to the results of the Focused Assessment with Sonography for Trauma (FAST) protocol and diagnostic video laparoscopy. In the control group of 68 patients, indications for laparotomy have been presented based on the proven fact of a penetrating wound in the abdominal cavity.
Results: In patients with unstable hemodynamics and signs of peritonitis there is no need for additional verification of the damage nature. In these cases, an emergency laparotomy is justified. In debatable cases diagnostic video laparoscopy should be the method of choice for the diagnosis. In 19 (27.9%) patients in the control group with the proven fact of a an abdominal penetrating wound during primary surgical treatment (PST), no injuries were detected during the examination of the abdominal organs and the laparotomy was exploratory.
Conclusion: A rational approach to assessment of the injuries severity using the FAST protocol and diagnostic video laparoscopy in patients of the main group made it possible to completely avoid exploratory laparotomy and increase the proportion of minimally invasive interventions to 50–70%. The accuracy of laparoscopic diagnostics was 98%.

Background: The need to minimize the immobilization of the elbow joint in multifragmental fractures of the distal metaepiphysis of the humerus is confirmed by a number of factors, including the complexity of its anatomical structure, the uniqueness of biomechanics, as well as the limited ability of hyaline cartilage to regenerate. The restoration of the motor potential of the limb in multifragmentary fractures of the distal metaepiphysis of the humerus determines the priority of the treatment technique, which allows the patient to return to his usual lifestyle in the near future.
Objective: Demonstration of the effectiveness of percutaneous spinal osteosynthesis with wires in fractures of distal metaepiphysis of the humerus in adolescent children.
Clinical cases: This paper describes two clinical cases in adolescent children with multifragmentary fractures (open and closed) of the distal part of humerus (12В and 13С according to the AO classification). In both cases, the treatment consisted of sequential application of skeletal traction, for fragments traction and their mobility increase, then closed reposition of fragments under the control of electron-optical converter with metal osteosynthesis with wires. Moreover, taking into consideration the U- and T-shape nature of the fractures, the first stage of reposition included stabilization and fixation of the distal fragments to each other and then to the proximal fragment.
Conclusion: In our opinion, it is the combination of traditional methods of treatment (application of skeletal traction system), modern technologies (EOC control), alternative (atypical) options for using metal structures that allow achieving good functional treatment results in this category of patients.

Background: Atypical hemolytic-uremic syndrome (aHUS) is a rare progressive form of systemic thrombotic microangiopathy (TMA), which develops due to uncontrolled activation of the alternative pathway of the complement system and is characterized by a predominant lesion of the vessels of the renal microcirculatory bed.
Clinical cases description: The article describes two clinical cases of aHUS, which demonstrate the difficulties of differential diagnosis of typical and atypical HUS at the initial stages of the disease.
Conclusion: Given the lack of clear laboratory criteria of aHUS, it is necessary to carry out a complex and consistent differential diagnosis of various TMA options, the exclusion of which makes it possible to make a correct diagnosis more accurately.

Relevance: Venous thromboembolic complications are a formidable condition with a high mortality risk, that is rather common in the practice of a physician of any specialty. Therefore, timely diagnosis and correct management of patients with thromboembolic complications are key to a favorable outcome of the disease. An urgent problem for science nowadays is the search and development of diagnostic approaches that give a complete description of a thrombotic event. One of these characteristics is the determination of the age of thrombosis; it is a clear understanding of this criterion that makes it possible to choose a successful treatment strategy for patients with similar complications.
Aim of study: To date, the assessment of the age of a thrombus is based mainly on the patient’s anamnestic data, which do not always correspond to the real situation, and imaging techniques based on indirect signs. Therefore, the ineffectiveness of therapy for the described conditions in some cases can be explained by an underestimation of the age of the thrombus. The development of scientific research in this direction seems promising and can lead to an improvement in the results of treatment of patients suffering from venous thromboembolic complications. This article is a review of the methods for thrombus age determination presented in the literature.

 Abdominal adhesions at the stage of surgical treatment limit the possibility of safe manipulation both at the stage of access and during the surgery. The number of complications associated with adhesions can be reduced by obtaining data on their localization.
The variety of methods for preoperative detection of abdominal adhesions is  very limited. Ultrasonography, magnetic resonance imaging and computed  tomography are used for this purpose. The article is the first part of a review  devoted to the study of diagnostic methods and reveals the possibilities of ultrasonography. 

Urine and saliva are the most accessible liquids for studying circadian oscillations coherent with the activity of ongoing metabolic processes, which are characterized by a change in the rate and direction of the formation of protons (H+) and electrons (ē). The existing balance of acid-base state (pH) and redox potential (Eh) is an important indicator of homeostasis, reflecting the state of energy metabolism, i.e., the process of dissimilation. If the stability of the main (basic) metabolism does not change during the day, then the rate of facultative energy-consuming processes increases significantly during the daytime and decreases at night.
Endogenous formation of hydrogen cations (H+) accompanies all transformation reactions of adenosine triphosphate. Thus, glycolysis is accompanied by lactic acidosis of the cytoplasm, and the tricarboxylic acid cycle performs a hydrogen-donor function, supplying protons (H+) to the respiratory chain of mitochondria. At the same time, depending on the rate of oxidative phosphorylation, a certain part of hydrogen cations (H+) is excreted into the intercellular space, from where it subsequently enters saliva and urine.
Daily oscillations of pH and Eh in the urine and oral fluid (saliva) of healthy people reflect the circadian rhythm of metabolic processes and can be important indicators of metabolic disorders in common diseases accompanied by impaired energy metabolism.