Objective: To compare predictive accuracy of the American Society of Anesthesiologists (ASA) score and various cardiac risk indices for perioperative cardiovascular (CV) complications in patients undergoing noncardiac surgery.

Materials and methods: We examined 243 patients (148 men and 95 women) aged 45 to 84 (66 [60-71] years) prior to their elective oncological and vascular surgery. We assessed patients using the ASA physical status classification system, Revised Cardiac Risk Index (RCRI), Gupta Myocardial Infarct or Cardiac Arrest (MICA) calculator, and Khoronenko cardiac risk index and analyzed perioperative CV complications.

Results: We detected complications in 30 (12.3%) patients, with 3 (1.24%) of them having 2 concomitant CV complications. One death (0.41%) was registered. The MICA risk calculator had the highest predictive value (AUC ROC = 0.753). Risk scores over 0.95% discriminated patients with perioperative CV complications with sensitivity and specificity of 73.3% and 67.45%, respectively.

Conclusions: We recommend using the MICA risk calculator to predict perioperative CV complications following elective oncological and vascular surgery.

Objective: To study immediate and long-term results of the tibioperoneal trunk repair (plastic reconstruction or prosthetic repair) during femoropopliteal bypass.

Materials and methods: In our retrospective cohort study we analyzed surgical treatment results of 109 patients with lower extremities atherosclerosis who were treated in the Vascular Surgery Unit of Interregional Clinical Diagnostic Center (Kazan, Russian Federation) from 2018 to 2020. 26 (23.8%) patients were hospitalized for stage IB-IIA acute arterial insufficiency with atherothrombosis, and 83 (76.1%) patients were admitted with critical limb ischemia (CLI) as a result of advanced atherosclerosis. Among the CLI patients, 43 (39.4%) of them had stage III chronic arterial insufficiency, and 40 (36.7%) patients had stage IV chronic arterial insufficiency. 

The study selection criteria included extensive femoral and popliteal arteries disease and significant stenosis or occlusion of the tibioperoneal trunk. TASC II type C lesions were detected in 2 (1.8%) patients, while 107 (98.2%) patients were diagnosed with TASC II type D lesions. Based on the GLASS classification, all 109 (100%) patients had FP grade 3-4 femoropopliteal lesions with concomitant IP grade 1-4 tibial lesion. The main group included 24 (22%) patients who underwent femoropopliteal bypass with plastic or prosthetic repair of the tibioperoneal trunk using an original technique. The control group included 85 (78%) patients who underwent bypass surgery without the tibioperoneal trunk repair. Isolated femorotibial bypass was performed in 7 (8.2%) patients, and 78 (91.7%) patients underwent femoropopliteal bypass with a reversed autogenous vein.

Results: We followed up patients for 2 years after surgery. Immediate technical success was 97.24% (106/109). Graft thrombosis was reported in 3 cases. No difference between the groups was observed. Long-term graft patency was significantly higher in the main group (P = .044) and significantly associated with age (RR = 0.96; 95% CI of 0.92 to 1.00, P = .03), type 2 diabetes mellitus (RR = 2.10; 95% CI of 1.10 to 4.10, P = .03), and history of the tibioperoneal trunk repair (RR = 0.43; 95% CI of 0.18 to 1.00, P = .06). Variables associated with patency in the univariate regression at a significance level P ≤ .1 were included in a multivariate model that demonstrated the combined effect of predictors on the outcome.

Conclusions: Femoropopliteal bypass with the tibioperoneal trunk repair improves treatment results in patients with extensive peripheral artery disease and immediately threatened limbs or a threat to a limb within 2 years.

Background: Computed tomography angiography (CTA) is the primary and minimally invasive imaging modality currently used for diagnosis and monitoring of intracranial aneurysms as well as preoperative planning of their treatment. However, its interpretation is time-consuming even for specially trained neuroradiologists. Nowadays little is known whether trained neural networks contribute to analyzing medical images and reduce the time to diagnosis, and how effective they are in detecting intracranial aneurysms according to the CTA findings.

Objective: To assess the diagnostic value of a convolutional neural network prototype in the intracranial aneurysm detection according to the brachiocephalic arteries CTA findings.

Materials and methods: We analyzed the 3D convolutional neural network prototype based at Kuban State University (Krasnodar, Russian Federation).This prototype was to determine the probability of intracranial aneurysms according to the brachiocephalic arteries CTA findings, obtained in the Radiology Department of Scientific Research Institute – Ochapovsky Regional Clinical Hospital No. 1. The study included 451 CTA scans of 205 patients with confirmed intracranial aneurysms and 246 patients without aneurysms.

Results: The sensitivity of the 3D convolutional neural network prototype in the aneurysms detection according to the brachiocephalic arteries CTA findings was 85.1%, the specificity was 95.1%, and the overall accuracy was 91%.

Conclusions: The 3D convolutional systems may predict aneurysms with a high accuracy as well as localize them with an accuracy of more than 90%. Such results require a larger dataset.

Background: 90% of C-sections are supported by spinal anesthesia, which is complicated by arterial hypotension in 60%-80% of cases. The perfusion index seems to be a significant prognostic tool for arterial hypotension.

Objective: Тo confirm the value of perfusion index in predicting arterial hypotension associated with the spinal anesthesia.

Materials and methods: The study included 105 female patients who underwent С-section under spinal anesthesia. A decrease in mean arterial pressure by ≤ 20% was considered as arterial hypotension. Baseline perfusion index was assessed with a pulse oximeter. Results: 68 patients (64.8%) developed arterial hypotension in the intraoperative period. In 37 (35.2%) parturient women there were no significant changes in blood pressure. A cut-off threshold of 3.1 with 75% sensitivity and 75% specificity was obtained with the ROC analysis. Arterial hypotension developed in 29.4% (n = 15) of parturient women with a perfusion index < 3.1 and in 72.2% (n = 39) of parturient women with a perfusion index > 3.1.

Conclusions: We can use the perfusion index threshold of 3.1 to identify parturient women with an increased risk of arterial hypotension associated with the spinal anesthesia for C-section. The arterial hypotension rate is significantly higher in women with an initial perfusion index > 3.1 compared with those with an initial perfusion index < 3.1.

Introduction: In modern clinical practice, there is no common and effective hemostatic agent for solid organs of the abdomen. Local agents such as hemostatic sponges, membranes, powders seem promising. The main advantages of hemostatic powders include relatively high efficacy, portability, versatility, as well as simplicity and low cost of manufacturing.

Objective: To study the hemostatic efficacy of hemostatic powders’ samples based on the sodium salt of carboxymethylcellulose (Na-CMC) in an acute in vivo experiment.

Materials and methods: The study was based at Kursk State Medical University. Fifty male Wistar rats (weighing 220-239 g) were selected as test animals. They were evenly divided into 5 groups: ARISTA AH, Cutanplast Powder, and Na-CMC hemostatic powders with 3 different dynamic viscosities: low (50-200 cP), medium (400-800 cP) and high (1500-3000 cP). Under general inhalation anesthesia, median laparotomy was performed in Wistar rats, the middle lobe of the liver was removed into the wound, and then marginal tangential resection was performed. We applied hemostatic powders of each group to the resulting wound, and then estimated the bleeding time and the volume of blood loss. We used the Mann-Whitney test (P ≤ .05) to assess the statistical significance of differences between the study groups.

Results: We recorded the minimum bleeding time and the smallest volume of blood loss for the samples based on the Na-CMC and found no statistically significant differences between the viscosities groups.

Conclusions: With Na-CMC hemostatic powder the bleeding time and the volume of blood loss were reduced by 3.6 and 2.2 times, respectively, comparing to the control group. These results were considered statistically significant (P ≤ .05).

Background: Despite the high prevalence of internal carotid artery (ICA) anomalies, there is still no consensus on which parameters should be used to evaluate their local hemodynamics and what significance each parameter holds.

Objective: To determine the significance of various ultrasound parameters for evaluating the local hemodynamics of ICA anomalies.

Materials and methods: In our cross-sectional observational study 427 outpatients underwent carotid ultrasound. To evaluate the significance of various ultrasound parameters for local hemodynamics assessment, we used a cluster analysis for the entire sample (n = 386), taking into account the deformation coefficient, angle of deformation, blood flow turbulence at the site of maximum deformation, and peak blood flow velocity at the site of maximum deformation. Based on the cluster analysis results, we did a discriminant function analysis.

Results: During the clustering of patients from the total sample (n = 386), 3 clusters were formed. We did a discriminant function analysis to evaluate the indicators used. We found that all of them had a small Wilks’ Lambda indicating their greater discriminatory ability. The deformation coefficient was the most significant parameter as it had the smallest value (0.26). “Tolerance” analysis showed that the deformation coefficient is the most independent indicator (0.67).

Conclusions: Our study showed that the most significant and independent parameter for evaluating the local hemodynamics of ICA anomalies is the deformation coefficient, with the blood flow turbulence being the least significant parameter.

Background: First PCR-confirmed COVID-19 cases among Russian children were reported in early March 2020. Chest computed tomography (CT) is the most sensitive imaging modality in diagnosing early signs of viral lung damage. Limited data are available on clinical and laboratory features of COVID-19 in children and on their correlation with imaging findings. Studying COVID-19 features in children is crucial for modern medicine, which makes our research relevant.

Objective: To determine the diagnostic efficacy and correlation between laboratory, clinical, and CT findings in children and adolescents with COVID-19.

Materials and methods: From February 2020 to February 2021 372 patients with suspected COVID-19 were admitted to Morozov Children’s City Clinical Hospital (Moscow, Russian Federation). This retrospective study included 158 patients who presented with positive oropharyngeal and nasopharyngeal swab results, IgM and IgG test results, changes in complete blood count, blood biochemistry and coagulation test results, clinical symptoms, and suspected SARS-CoV-2 pneumonia based on chest CT findings.

Results: Chest CT sensitivity and specificity for diagnosis of SARS-CoV-2 pneumonia were up to 98% and 85%, respectively. We considered that severe respiratory motion artifacts in young children under general anesthesia adversely affected the diagnostic efficacy. Sensitivity and specificity in this group were up to 89% and 71%, respectively.

Conclusions: Viral pneumonia signs on chest CT scans were statistically significantly more frequent in children with cough, respiratory failure signs, lymphopenia, and increased D-dimer and C-reactive protein levels. One of these signs or a combination of them are an indication for chest CT in children with suspected SARS-CoV-2 pneumonia.

Objective: To evaluate the capabilities of the Olea Sphere automated software for the quantitative assessment of ischemic damage to the brain parenchyma during computed tomography (CT) in patients with acute cerebrovascular accident and its role in choosing the optimal treatment strategy in everyday clinical practice.

Materials and methods: We retrospectively analyzed the data from 129 patients with suspected stroke who underwent perfusion CT within 24 hours of admission to the hospital. The Olea Sphere data were used to assess the volume of the infarct core, which was defined as an area with a relative cerebral blood flow less than 40%, the volume of the penumbra area, where Tmax exceeded 6 s, and ultimately the core-penumbra ratio.

Results: With the Olea Sphere automated software, we were able to assess the volume of the ischemic changes in the brain parenchyma, particularly, the average volume of the infarct core in 129 patients was 21.95 (1-206) ml, the average volume of the penumbra area was 57.01 (2-357) ml, the core-penumbra ratio was 2.65, and mean time from CT to the start of treatment was 1.2 (0.9-1.9) hours. This quantitative data processing powered by the Olea Sphere provided the indications for the following endovascular treatment in patients with stroke: thrombus extraction in the acute period was performed in 51 patients (72.8%), transluminal balloon angioplasty with stent placement – in 12 patients (17.1%), and carotid endarterectomy in the long-term period – in 5 (9.6%) patients.

Conclusions: We discovered that the Olea Sphere automated software can be used to assess ischemic changes in the brain and to make decisions related to patients with acute cerebrovascular accident in emergency conditions.

Background: Studies on reconstructive neurosurgical interventions are always relevant due to the persistence of cranial defects, mainly caused by traumatic brain injuries (TBI). To provide medical care to the patients with cranial defects more efficiently, it is necessary to assess a large number of surgical interventions in studies.

Objective: To analyze data on reconstructive neurosurgical interventions performed at Novosibirsk hospitals.

Methods: We performed a multicenter observational retrospective non-randomized study of the total cranioplasty surgical interventions from 2016 to 2022. The study involved five neurosurgical departments in Novosibirsk hospitals. In 450 of 673 cases the inclusion criteria were met.

Results: The majority of patients (n = 361; 80.2%) underwent surgical interventions in federal health facilities. Urban residents prevailed (n = 260) among the patients who met the inclusion criteria. Craniectomies were mainly indicated for the consequences of TBI (n = 319; 70.9%). Time to cranioplasty ranged from 0.1 to 320 months (mean: 23.9 ± 39.2; median: 11.6 months). There were non-clinically significant differences in terms of primary and reconstructive operations between the defects caused by TBI and other conditions. In 51.1% of cases, we found two features describing the size and complexity of the skull defect. In 19.3% of cases, patients were diagnosed with a skull defect (affected anatomical areas were specified).

Conclusions: Over seven years, 450 Novosibirsk residents underwent cranioplasty in five neurosurgical Novosibirsk hospitals (mean: 64.3 surgical interventions a year). Comparing the recent results with previous studies data in terms of performed craniectomies, we found that reconstructive interventions are lacking 99.7 cases per year. To reduce the time to cranioplasty, it is necessary to make a registry of patients with skull defects.

Background: Salivary gland tumors account for up to 5% of all head and neck neoplasms. Ultrasonography is one of the main diagnostic modalities for the salivary gland pathology; however, its diagnostic potential is under scrutiny. Fine needle aspiration cytology is considered the main diagnostic method, although its role in the differential diagnosis is disputable.

Objective: To identify, based on morphology results, the effectiveness of the main ultrasonographic signs indicating major salivary gland neoplasms in the differential diagnosis and study these signs, to evaluate the effectiveness of fine needle aspiration in the diagnosis of benign and malignant major salivary gland neoplasms.

Materials and methods: This retrospective study evaluated a group of 220 patients. We calculated sensitivity, specificity, and accuracy of qualitative ultrasonographic signs of salivary gland neoplasms, analyzed the fine needle aspiration effectiveness, and compared results accuracy by calculating Pearson’s empirical χ-square.

Results: Common ultrasonographic signs of benign salivary gland neoplasms included a clear contour (97.5%) and decreased echogenicity (72.7%). Malignant tumors frequently presented with a clear contour (76.7%), uneven contour (72.1%), and decreased echogenicity (69.8%). Fine needle aspiration sensitivity and specificity in the diagnosis of benign neoplasms were 75.5% and 53.6%, respectively. Fine needle aspiration sensitivity and specificity in respect of malignant tumors were 50% and 94%, respectively. Pearson’s χ-square value for the clear contour had significant differences in favor of benign neoplasms.

Discussion: Benign and malignant salivary gland neoplasms often have a similar ultrasonographic pattern. A significant diagnostic sign of malignant tumors is the uneven contour. We compared the effectiveness of cytological differentiation between benign and malignant neoplasms and found high rates of specificity and accuracy for malignant tumor diagnosis.

Conclusions: Clear contour and decreased echogenicity are significant ultrasonographic signs in the differentiation of benign neoplasms. Uneven contour is a significant differentiating factor for malignant neoplasms. Cytology can be used for initial morphology in diagnosing major salivary gland neoplasms, but in half of the cases it fails to identify the nature and type of the tumor.

Background: Little is known about the brainstem in healthy three-year-old children; yet there is a need for further studies because children at this age are growing and developing rapidly.

Objective: To study differences in the brainstem and its cavities in healthy three-year-old children, considering the sex and bilateral asymmetry.

Materials and methods: We retrospectively analyzed 120 MRI scans of healthy three-year-old children (60 boys and 60 girls) to study the brainstem features. The following parameters of the brain stem structures were assessed: 1) the length of the pons (mm), 2) the height of the pons (mm), 3) the length of the medulla oblongata (mm), 4) the height of the medulla oblongata at the upper and lower borders (mm), 5) the length and height of the vermis (mm), 6) the width of the cerebellum (mm), 7) the length, width, height of the cerebellar hemispheres (mm), 8) the length and height of the third ventricle, 9) the length of the cerebral aqueduct (mm), 10) the length and height of the fourth ventricle (mm). We assessed the compliance of quantitative parameters with the normal distribution according to the Kolmogorov-Smirnov criterion. We used Microsoft Excel 2016 tables to accumulate, correct and systemize the raw data. Statistica 10.0 software (StatSoft. Inc., USA) along with the corresponding statistical method provided the digital data. The differences were considered significant at P < .05.

Results: We aimed to study sex-related differences in the basic sizes of the brainstem. The length and height of the pons, the length of the third and the fourth ventricles, and the size of the cerebellar hemispheres were greater in boys. We found a bilateral asymmetry in cerebellar hemispheres (length, width, and height).

Conclusions: The changes in the complex brainstem of three-year-old children are sex-dependent and consist in active transformations of its structures.

Objective: To present outcomes of mitral valve reinterventions for recurrent degenerative mitral regurgitation.

Materials and methods: From May 2017 to February 2021 3 male patients aged 43, 50, and 54 years and an 18-year-old female patient underwent mitral valve reinterventions with an autopericardial strip at Scientific Research Institute – Specialized Cardiac Surgery Clinical Hospital named after Academician B.A. Korolev. Three patients had primary mitral valve annuloplasty using a support ring and 1 patient using an autopericardial strip. In this patient group recurrent mitral regurgitation developed within 6-33 months between the primary repair and reintervention (20 ± 13.5 months on average).

Results: No hospital mortality was reported. Cardiopulmonary bypass duration averaged 109.8 ± 19.7 minutes, and myocardial ischemia lasted 77.5 ± 10.1 minutes. Two patients had an adjunctive repeat radiofrequency Maze procedure, with the supraventricular rhythm restored in 1 patient. Echocardiography demonstrated that mitral regurgitation did not exceed grade 1 at discharge. Reintervention using an autopericardial strip for recurrent mitral regurgitation significantly reduces sizes of the left atrium and left ventricle. Ejection fraction did not change after the intervention. Mitral valve peak gradient in all cases did not exceed 9 mm Hg.

Conclusions: The key to a successful mitral valve reintervention is a qualitative analysis of the recurrence causes and use of various techniques and materials for intervention on the mitral valvular complex. Mitral valve reinterventions, especially in young patients, are justified if certain safety conditions are met and have similar outcomes to primary interventions.

Objective: To determine the surgical possibilities of the one-stage laparoscopic repair in the obstructed ureteropelvic junction (UPJ) complicated with nephrolithiasis in combination with the retrograde intrarenal surgery.

Case report: The patient A., a 36-year-old male complaining about dragging pains in the right lumbar region was admitted to Urology Unit No. 1 of Krasnodar Regional Clinical Hospital No. 2. The patient underwent ultrasound examination, CT, and dynamic renal scintigraphy. The findings were as follows: the enlargement of pelvicalyceal system in the right kidney (calyx up to 22 mm, pelvis up to 50 mm), 5 calyx concrements and 2 pelvic concrements 6 to 8 mm in size, obstruction at the level of the right UPJ up to 10 mm in length, III grade hydronephrosis on the right according to Lopatkin classification.

Conclusions: The combination of laparoscopic surgery and retrograde intrarenal surgery with the flexible ureteroscope and holmium laser is an effective and safe method for the treatment of UPJ obstruction complicated with nephrolithiasis.

Background: Obscure gastrointestinal bleedings accounting for 5%-30% of all gastrointestinal bleedings continue to be a challenge and usually originate from the small bowel.

Clinical case: We present a case of a female patient hospitalized with signs of gastrointestinal bleeding three times within 3 months. We could not identify the source of bleeding using standard methods, such as abdominal computed tomography and ultrasonography, esophagogastroduodenoscopy, and colonoscopy. We detected a Meckel’s diverticulum during a diagnostic laparoscopy and performed wedge resection of the small bowel. Histopathology results revealed an acute progressive ulcer in the wall of the small bowel diverticulum.

Conclusions: Diagnostic laparoscopy is one of the available minimally invasive procedures, which in some cases can successfully identify the source of small bowel bleeding.

Current research is focused on practical implications of magnesium-based implants largely due to their biodegradability and ability to promote bone healing and formation. However, the mechanism underlying the osteogenesis regulation by magnesium is still unclear.

We describe cellular and molecular mechanisms underlying the effect of magnesium ions (Mg2+) on bone growth following the device implantation. The presented data demonstrate magnesium-induced activation of canonical Wnt/β-catenin signaling pathway in human bone marrow stromal cells resulting in their differentiation into osteoblasts, osteogenic effect and recovery of bone defects. We describe the role of the molecular mechanisms responsible for osteopromotive properties of Mg2+ and associated with unique transient receptor potential melastatin 7 (TRPM7) cation channels mediating the Mg2+ influx. TRPM7-mediated Mg2+ influx is important for platelet-derived growth factor (PDGF)-induced proliferation, adhesion, and migration of human osteoblasts, as well as for promotion of Mg2+-associated bone regeneration.

We discuss the effect of Mg2+ on intracellular signaling processes, expression of the vascular endothelial growth factor (VEGF), hypoxia-inducible factor-2α, and peroxisome proliferator-activated receptor-γ coactivator 1α. Mg2+ can promote bone regeneration by enhancing the production of type X collagen and VEGF by osteogenic cells in bone marrow.