Objective: To compare the endovascular treatment results in patients with spinal arteriovenous malformations (AVM) based on the proposed algorithm.

   Materials and methods: We retrospectively analyzed the endovascular treatment results in 72 patients with various types of spinal AVMs for 2014-2021. We formed 2 main groups of patients based on the developed indications for neurophysiological monitoring and provocative tests (NFM and PT): group 1 (n = 63) was treated according to the algorithm, and group 2 (n = 9) was treated before the algorithm was implemented. Group 1 was divided into subgroup 1.1 (n = 42) including patients with no indications for NFM and PT and subgroup 1.2 (n = 21) with patients indicated for NFM and PT. Subgroup 1.2 was further divided into subsubgroup 1.2A (n = 2) with patients indicated for NFM and PT yet to be informative due to severe neurological deficit and subsubgroup 1.2B (n = 19) with patients that had indications for and successfully underwent NFM and PT. We compared patients between groups 1 and 2, subsubgroup 1.2B and group 2 to evaluate the effectiveness of the algorithm (radical nature of the treatment, functional status assessment, complications).

   Results: Radical nature of spinal AVM treatment in group 1 was 79 % compared with 44 % in group 2 (P = 0.043). There was a significant improvement in motor function in group 1 compared with group 2 in each follow-up period (Р ≤ 0.007). Comparison of subsubgroup 1.2B and group 2 showed no significant differences (P = .05). The treatment led to complications in 5 patients (7 % of the total number of patients with spinal AVMs): 4 patients in group 2 and 1 patient in subsubgroup 1.2B. The effectiveness of the developed criteria was indirectly confirmed by difference in complications number between subsubgroup 1.2B and group 2 (P = 0.001).

   Conclusions: Group 1 showed better treatment results, significant clinical improvement, high radical nature of treatment, and a low percentage of complications compared with group 2. The proposed algorithm proved effective for main tasks of endovascular treatment of spinal AVMs.

   Background: Thrombocytopenia occurs in 1-5 % of newborns (platelet count < 150 × 109/L). Low platelet count of 50 × 109/L leads to the hemorrhagic syndrome, with one of its causes being neonatal alloimmune thrombocytopenia resulting from incompatibility between the mother and the fetus with human platelet antigens (HPA) inherited from the father and absent in the mother, which leads to the formation of maternal antibodies. Anti-HPA-1a, anti-HPA-5b, anti-HPA-3a, and anti-HPA-3b antibodies are clinically significant as they destroy fetal/neonatal platelets causing severe complications (intracranial hemorrhage in 20 % of cases and prenatal or postnatal death in 10 % of cases). Adequate diagnosis is a key to a successful treatment approach, which largely depends on the thrombocytopenia cause.

   Objective: To determine the alloimmune nature of neonatal thrombocytopenia and the specificity of antibodies in the mother’s blood.

   Materials and methods: We studied blood samples of parents (21 pairs) of newborns with thrombocytopenia in Saint Petersburg, Russian Federation. We used flow cytometry to determine alloantibodies in the maternal plasma after incubation with paternal platelets and staining with Goat F(ab’)2 Anti-Human IgG-FITC and CD41-PE monoclonal antibodies. Allosensitization index was calculated as the percentage of IgG-positive cells to the number of cells fixing anti-CD41 antibodies. At the value of ≥ 15 %, antiplatelet alloantibodies were considered present in a sample. We used a molecular detection system of the FluoVista analyzer (Inno-Train, Germany) for genetic testing with allele-specific primers. Alleles of genes encoding the expression of HPA-1, HPA-2, HPA-3, HPA-4, HPA-5, HPA-6, HPA-9, and HPA-15 antigens were determined by a real-time polymerase chain reaction using a set of HPA-FluoGene reagents (Inno-Train, Germany). Genomic DNA was isolated using the DNA-sorb-B set (AmpliSens, Russian Federation).

   Results: We found that 8 of 21 (38 %) mothers had antibodies against paternal platelets. During genotyping in mother/father pairs, incompatible combinations of platelet antigens were revealed: HPA-1b/HPA-1a in 9 pairs (HPA-1a antigen absent on the maternal platelets and present on the paternal platelets), of which 5 mothers (55%) had antibodies with a probable specificity to anti-HPA-1a; HPA-1a/HPA-1b incompatibility in 4 pairs, with 2 (50 %) mothers having antibodies with an anti-HPA-1b specificity. HPA-3a/HPA-3b incompatibility was observed in 4 pairs, with antibodies (probably anti-HPA3b) in 1 mother (25%). HPA-2a/HPA-2b, HPA-5a/HPA-5b, HPA-15a/HPA-15b, HPA-15b/HPA-15a incompatibilities were detected (1 case each in 21 pairs), with no antibodies found in mothers. The probable specificity of the antibodies was distributed as follows: 62 % for anti-HPA-1a, 25% for anti-HPA-1b, and 13 % for anti-HPA-3a.

   Conclusions: We confirmed the immune nature of neonatal thrombocytopenia and determined the probable specificity of maternal alloantibodies in 8 of 21 cases.

   Background: Talus fractures are one of the most dangerous injuries leading to serious consequences. Quite a lot of treatment methods have been proposed, but the use of the Ilizarov apparatus is relatively rare.

   Objective: To justify the use of the Ilizarov apparatus in the talus fracture treatment by studying radiomorphological parameters of the foot bones at different stages of follow-up.

   Methods: We used radiography and multislice computed tomography (MSCT) in 25 patients treated for talus injuries by the Ilizarov apparatus to study radiographic and radiomorphological features of the foot bones at different stages of follow-up. We analyzed normal parameters of the foot bones forming the ankle joint in 15 patients.

   Results and discussion: Dynamics of talus radiomorphology during its fracture or fracture-dislocation are characterized by a gradual increase in the bone density at the union site. The local density of the talus at the fracture site gradually increased and exceeded 500 HU in 6 months. The organotypic adjustment at the union site did not end by this time, given the architecture of the talus and the biomechanics of the foot. We observed a decrease in the total densities of the talus and calcaneus during fixation by the Ilizarov apparatus and their gradual return to normal values after removal of the apparatus.

   Conclusions: Talus fracture treatment by transosseous osteosynthesis using the Ilizarov apparatus makes it possible to get immediate good results, especially using a configuration with hinges allowing for early mobilization of the ankle joint and loading in the early stages of treatment.

   Introduction: Visual assessment of endomyocardial biopsy (EMB) specimens may result in errors due to the human factor and inability to obtain quantitative data on the intensity of immunohistochemical (IHC) reactions and severity of pathological changes in the heart transplant. Detailed digital characterization of EMB specimens based on automated or semi-automated computer-assisted morphometry improves the diagnostic accuracy of EMB.

   Objective: To develop a method of and algorithms for digital computer-assisted analysis of EMB specimens to quantify pathomorphological and immunophenotypic changes in the myocardium of patients with various types and grades of heart transplant rejection.

   Materials and methods: We studied 257 EMB specimens from 56 heart transplant recipients at Scientific Research Institute – Ochapovsky Regional Clinical Hospital No. 1 (Krasnodar, Russian Federation). Sections were stained with hematoxylin and eosin. We used the streptavidin-biotin method to determine the CD68 expression and computer-assisted morphometry of digital images to measure the area of pathological changes and CD68 expression.

   Results: When developing a method for computer-assisted analysis of EMB specimens, we proposed a new evaluation criterion: staining area coefficient (%) that is a ratio of the total stained area to the total section area. We created and field-tested algorithms for digital morphometric analysis to assess the intensity of IHC reactions and to identify the relative area of pathological changes in the EBM specimens.

   Conclusions: New digital criteria for diagnosing heart transplant rejections are to improve the accuracy of EMB results interpretation, but can also be used for analyzing other biopsy specimens.

   Objective: To evaluate the prognostic value of predictors of severe acute pancreatitis in patients with nasogastric (NG) and nasojejunal (NJ) feeding.

   Materials and methods: Our open-label randomized controlled study was carried out in the intensive care unit of Neftyanik Occupational Health Facility (Tyumen, Russian Federation) between November 2012 and October 2018 and included 64 patients who had predictors of severe acute pancreatitis (APACHE II score > 8, C-reactive protein [CRP] > 150 mg/L, SOFA score > 2) and could start early NG and NJ feeding. We evaluated the prognostic value of APACHE II, SOFA, BISAP, blood urea, and CRP in the general group and for different enteral feeding methods during the first 24 hours and in 48 hours. Data were statistically processed using the SPSS 26 software.

   Results: Only one prognostic model was statistically significant for the first 24 hours and included APACHE II (AUC = 0.705, 95 % CI 0.577-0.834, P = 0.005, cutoff threshold of 8.5, sensitivity of 0.394, and specificity of 0.935 for all patients). In 48 hours models of the following groups were statistically significant: that of all patients, which included APACHE II, CRP, and blood urea (AUC = 0.904, 95 % CI 0.826-0.983, P < .001, cutoff threshold of 0.65, sensitivity of 0.818, and specificity of 0.935), NJ feeding group with CRP (AUC = 0.775, 95% CI 0.611-0.94, P < .001, cutoff threshold of 209.0 mg/L, sensitivity of 0.529, and specificity of 1.0), and NG feeding group with APACHE II (AUC = 0.767, 95% CI 0.599-0.934, P < 0.001, cutoff threshold of 9, sensitivity of 0.625, and specificity of 0.882).

   Conclusions: Enteral feeding method does not affect the prognostic criteria for severe acute pancreatitis. 48 hours after admission is the best period period for severity prognosis, and the model with such independent predictors as APACHE II, blood CRP, and urea showed the best quality prognosis. If these predictors could not be used at once, we recommend APACHE II for NG feeding and blood CRP for NJ feeding.

   Objective: To determine the diagnostic significance of sonographic signs indicating the parotid glands’ condition in children with juvenile recurrent parotitis (JRP).

   Materials and methods: We examined 42 patients with JRP and 30 children aged 3-17 years from the control group. Both groups underwent B-mode and color Doppler ultrasonography of parotid glands to assess linear dimensions, contours, structures, echogenicity, pronouncement of the stromal component, parenchymal vascularization, and condition of intraglandular lymph nodes. The diagnostic significance of the sonographic signs was assessed by ROC analysis.

   Results and discussion: We found significant differences between the study and control groups in terms of such sonographic signs as gland enlargement, decreased parenchymal echogenicity, change in the echotexture, increased stromal component, increased parenchymal vascularization, and reactive parotid lymph nodes (P < .05). With the high-frequency probe we were able to study the structure of JRP-associated hypoechoic foci in the parenchyma and prove that they are not cystic dilatation of the ducts but foci of infiltration around the peripheral ducts with structurally altered walls.

   Conclusions: Ultrasonography plays a pivotal role in the JRP diagnosis and can identify its most significant sonographic signs, such as increased size, distinctive changes in the parenchymal echotexture, decreased echogenicity, and increased parenchymal vascularization.

   Background: The pathogenesis of slow/no-reflow phenomena is a critical socio-medical problem due to high mortality and work disability rates in patients with ST-segment elevation myocardial infarction (STEMI). Slow/no-reflow phenomena are multifactorial involving 4 key elements: 1) distal embolization of the coronary bed of the infarct-related coronary artery; 2) ischemic damage to the myocardium; 3) reperfusion injury of the heart muscle; 4) individual (genetic) susceptibility of the microcirculation to injury.

   Objective: To analyze the outcomes of percutaneous coronary interventions (PCI) in patients with STEMI and TIMI 0 blood flow of an infarct-related coronary artery based on the strategy to restore antegrade blood flow (balloon predilation or dilation of an infarctrelated artery).

   Materials and methods: We analyzed treatment outcomes of 209 patients with STEMI and TIMI 0 blood flow. The patients were grouped based on the PCI strategy: group 1 included 147 patients who underwent balloon angioplasty to restore antegrade blood flow, and group 2 included 62 patients who underwent dilation of an infarct-related coronary artery.

   Results: Our study found that direct stenting in STEMI patients was associated with statistically significantly lower risk of slow/noreflow phenomena (P = 0.001, Pearson’s χ²) and, as a result, better functional outcomes of treatment (chronic heart failure grade classified according to Strazhesko-Vasilenko and by left ventricular ejection fraction) that were also statistically significant (P = 0.001, Pearson’s χ²).

   Conclusions: Our study demonstrated that the risk of slow/no-reflow phenomena in patients with TIMI 0 blood flow of an infarctrelated coronary artery was statistically significantly lower (P = .001, Pearson’s χ²) in the group of patients who underwent dilation of an infarct-related coronary artery to restore antegrade blood flow. Functional outcomes (chronic heart failure grade and overall survival) were also better in this group of patients (P = .001, Pearson’s Chi-square). Moreover, dilation of an infarct-related coronary artery was associated with preserved left ventricular ejection fraction compared with the group of patients who underwent balloon angioplasty to restore antegrade blood flow (P < 0.001, Pearson’s χ²).

   Background: The prevalence and severity of allergic diseases, including pollinosis, are increasing worldwide. Hay fever develops due to the complex interaction of genes and manifests itself due to exogenous factors. The main environmental etiology of allergy is plant pollen. Continuous study and analysis of the air pollen spectrum constitute the basis of air monitoring and are important in developing preventive measures for allergic diseases.

   Objective: To perform an air pollen monitoring in Kr snodar and to assess the treatment of patients with pollinosis in various cities and districts of the Krasnodar Region according to the Krasnodar Regional Allergy Center data.

   Materials and methods: We retrospectively analyzed the patients seeking medical care due to allergy in the Krasnodar Region using the statistical data obtained in 2022 from the Krasnodar Regional Allergy Center. We assessed the effects of air pollen pollution according to the data of air pollen monitoring in Krasnodar during the main activity of herbaceous plants’ taxa (from April 1, 2022 to October 31, 2022). We used AeRobiology and Microsoft Excel 2010 tools for data processing and development of the main parameters of the pollen season.

   Results: According to the Krasnodar Regional Allergy Center data, there were 37,212 people diagnosed with J45.0, J46 and 20,012 people diagnosed with J30.1-30.4 in 2022. We identified 8 allergenic taxa of herbaceous plants in the Krasnodar air. We found that the total seasonal pollen concentration increased by an average of 1.8 in 2022 compared to previous monitoring periods in 2018-2021.

   Conclusions: Comparative assessment of the prevalence of pollinosis and the air pollen monitoring are important for effective medical care.

   Objective: To develop a biological implant that is an acellular dermal matrix (ADM), evaluate its use as a support material in tensionfree hernioplasty for ventral hernia, and compare it to that of the commercially available implant Permacol^TM.

   Materials and methods: ADM was derived from the porcine dermis (Landrace breed) decellularized using detergents and enzymes. The quality of devitalization was assessed in vitro. We performed sublay hernioplasty in 4-month-old Landrace pigs using ADM (experimental group) and Permacol^TM (control group). The specimens were explanted on day 120 of the experiment for histological and immunohistochemical examination.

   Results: All cellular elements were removed by the detergent-enzymatic treatment of the dermis; the native architecture of the dermis was slightly disrupted. The specimens of the commercially available chemically cross-linked biomaterial Permacol^TM had better mechanical properties than ADM specimens; however, there were no significant differences in terms of cytotoxicity. The state of the tissues after the explantation (number of fibroblasts and endothelial cells) showed no differences in the result of using ADM and Permacol^TM. In 120 days, the materials integrated into the tissues without the formation of adhesions or inflammation.

   Conclusions: Our findings show that ADM does not have cytotoxic properties, has adequate biomechanical parameters to effectively reinforce supporting soft tissues, does not cause an inflammatory response during implantation, and integrates fully into tissues. Our study demonstrates the effectiveness and utility of the developed ADM in surgical treatment of anterior abdominal wall defects.

   Objective: To describe a rare case of surgical treatment of aortic valve papillary fibroelastoma in combination with coronary artery bypass grafting.

   Clinical case: The patient was hospitalized with a suspected mass on the left coronary cusp of the aortic valve and complained of retrosternal pain that appeared during moderate exertion and brisk walking and went away with rest. The patient history revealed that these clinical manifestations began in February 2022 and were treated by coronary stenting. Since May 2022 the patient noticed symptoms of recurrent angina. Transthoracic echocardiogram dated June 14, 2022 revealed a 13 × 12 mm additional mobile mass on the left coronary cusp. On June 30, 2022 the patient had an open surgery: mass removal, coronary artery bypass grafting of the anterior descending artery, and coronary artery bypass grafting of the circumflex artery. During the aortic valve exploration, the mass was visualized on the left coronary cusp on the side of the left ventricle. The mass was removed by precision marginal excision.

   Conclusions: To timely examine patients, refer them for surgical treatment, preserve and prolong their life, and improve its quality, clinical practitioners should know clinical manifestations and challenges in screening for aortic valve papillary fibroelastoma.

   Introduction: Despite the medical advances, burns remain a serious challenge and require new and promising treatment options, such as biomedical technologies with a high potential for burn wound treatment. However, high cost and complexity of biotechnologies limit their routine use, but autologous tissues, such as stromal vascular fraction (SVF) and autologous platelet-rich plasma (PRP), overcome these shortcomings.

   Objective: To demonstrate a successful case of using a combination of adipose-derived SVF and autologous PRP during autologous skin grafting in a severely burned patient.

   Material and methods: We present a successful case of 84-year-old Patient B. treated at Saint Petersburg I. I. Dzhanelidze Research Institute of Emergency Medicine in September-October 2022. He was diagnosed with a 11% (6%) / II-III degree flame burn of the head, neck, trunk, and upper extremities and first-degree inhalation injury. At the first stage, the general condition of the patient was stabilized, and he was prepared for surgery. At the second stage, on day 25 of treatment we performed skin grafting using split-thickness autografts with rare perforations and application of SVF and autologous PRP on a burn wound. We evaluated the treatment effectiveness using planimetry, cytology, and histology.

   Results: We observed complete engraftment of the autograft with no lysis or rejection during the first dressing change on day 3 after surgery and complete skin restoration on day 11. Cytologic findings over time showed an active decrease in inflammatory cells and an increase in regenerative cells, indicating successful wound healing. Histology demonstrated formation of normal stratified squamous epithelium with areas of hyperkeratosis and young granulation tissue in the superficial layers of the dermis on day 6.

   Conclusions: Our case demonstrated that the combination of SVF and autologous PRP facilitates split-thickness skin autograft engraftment.

   Objective: To describe an improved technique for dilatational tracheostomy.

   Clinical case: We report a case of severe community-acquired polysegmental viral pneumonia, grade 2 respiratory failure. After the start of antiviral therapy and staged respiratory support, the female patient was placed on mechanical ventilation 12 hours following hospital admission due to an increasing systemic inflammatory response and cytokine storm. In 20 hours, a dilatational tracheostomy using a modified technique was performed. Advantages of the modified technique are low trauma, short duration (5-10 minutes), significantly rarer wound infection (important benefit due to the COVID-19 features), significantly rarer postoperative scarring and cicatricial stenosis of the trachea. Technical improvement of dilatational tracheostomy allows for optimal management of critically ill patients (multiple organ failure, severe sepsis, considerable total body surface area burns with concomitant inhalation injury), which will significantly increase treatment efficiency, reduce the number of complications, and speed up the hospital discharge.

   Background: According to the International Working Group on the Diabetic Foot (2015), 28 % of diabetic foot ulcers result in major amputations. Over 30 % of patients with diabetic foot undergo major amputations that result in death in 13.0 %-14.0 % of the cases.

   Clinical case: In our experience of treating a female patient with diabetic foot complications, we observed that such cases require a multidisciplinary approach to determine management strategies, as well as strict surgery staging. Early plastic and reconstructive surgery demonstrated its positive impact on postoperative wound closure.

   Conclusions: We managed the infection and achieved the complete closure of the major wound and primary intention healing through the multidisciplinary approach and strict adherence to surgical staging (debridement, revascularization, reconstruction). Thus, patient quality of life and rehabilitation potential significantly improved.

   Fistulas of various etiologies are one of the severe and life-threatening diseases of the upper respiratory tract. The most common cause is bronchial stump failure after pulmonary resection, usually pneumonectomy. The incidence and mortality of this complication is 3 %-4 % and 12.5 %-71.2 %, respectively. Despite the fact that many devices and methods have been described to date, it is usually treated with surgical closure. Standard surgical approaches are associated with significant morbidity and mortality and are not reliably successful. In recent years, cell therapies aimed to stimulate tissue healing rose to prominence and can be considered a potential treatment method. We review current trends in bronchopleural fistula treatment using cell therapy and report cases of the bronchopleural fistula treatment according to the research protocol developed in our clinic. Although clinical experience is quite limited owing to a small number of patients in the most studies, the information on safety and tolerance can help plan future larger trials with innovative methods to further improve clinical results.

   Hernias of the anterior abdominal wall remain one of the most common surgery pathologies. There is no unified approach to modeling anterior abdominal wall hernias in the world scientific community. In order to systematize the available knowledge in this field and to contribute to the formation of a unified idea of how to create a hernia model in a laboratory animal, it seems logical to study the accumulated experience of researchers in the field of experimental herniology. We found out that hernia defects generally modeled on male laboratory rats. To understand the tissue reaction to the prosthetic material a fenestration was performed in the anterior abdominal wall (including peritoneum) except for the skin and subcutaneous fat. A replacement or prosthetic material tailored to the fenestration was sutured end-to-end into the abdominal wall. We chose laboratory rats because they are easy to take care of and cheaper than larger laboratory animals.

   This review discusses the role of capsule endoscopy in diagnosing suspected small bowel bleeding and compares guidelines of the European Society of Gastrointestinal Endoscopy (ESGE), the American College of Gastroenterology (ACG), the American Society for Gastrointestinal Endoscopy (ASGE), the Canadian Association of Gastroenterology (CAG), and the consensus document of 4 Japanese medical societies. European and North American experts recommend capsule endoscopy as a first-line diagnostic modality for suspected small bowel bleeding without life-threatening signs in adult patients when ileocolonoscopy and esophagogastroduodenoscopy failed to be informative. Japanese experts, on the contrary, prefer cross-sectional imaging “from the chest to the pelvis” and consider capsule endoscopy as an alternative.