Background: Extensive surgical procedures play a key role in treatment of various lung diseases. Nevertheless, these complex procedures are associated with a high risk of early postoperative complications.

Objective: To evaluate outcomes of the early postoperative period in patients with various lung diseases and determine risk factors for postoperative complications.

Material and methods: We analyzed postoperative complications in 377 patients who underwent extensive lung surgery. The mean age was 45.7 ± 5.2 years. The majority of patients (56.0%) had malignant or benign lung tumors. Lobectomy was the most common type of surgery. Pneumonectomy accounted for 26.5%.

Results: The overall rate of cardiovascular complications was 8.2%. The highest number of complications was observed after right-sided pneumonectomy (21.7%). Respiratory complications after right-sided pneumonectomy accounted for 34.8%. Lobectomy and bilobectomy had lower rates of complications (4.4% and 6.3%, respectively). The highest number of systemic complications was also recorded after right-sided pneumonectomy (23.9%), whereas lobectomy had a lower risk (4.4%). Patients with primary lung tumors had significantly more complications (32.2%) compared with patients without cancer (10.8%). The main risk factors were male gender (odds ratio [OR], 1.6; 95% CI, 1.1-2.2; P = .032), age ≥60 years (OR, 1.9; 95% CI, 1.5-2.6; P = .001), smoking (OR, 1.7; 95% CI, 1.2-2.5; P = .019), C-reactive protein level >3 mg/dL (OR, 1.8; 95% CI, 1.1-2.7; P = .015) and forced expiratory volume in the first second of expiration (FEV1) <60% (OR, 1.5; 95% CI, 1.1-2.2; P = .042), surgery duration ≥180 minutes (OR, 1.8; 95% CI, 1.3-2.3; P = .002), and anesthesia without additional epidural analgesia (OR, 1.5; 95% CI, 1.2-2.1; P = .007).

Conclusions: The complication rate after extensive lung surgery was 22.8%, with the highest rate after right-sided pneumonectomy (4.8%). Respiratory complications predominated (14.1%): hydrothorax/pneumothorax (5.0%), acute respiratory distress syndrome (4.2%), pneumonia (2.9%), and ventilator-associated tracheobronchitis (2.1%). The main risk factors were male gender, age ≥60 years, smoking, FEV1 <60%, long surgery, no epidural analgesia, and high crystalloid infusion rate.

Background: Congenital heart diseases (CHD) are one of the most common birth defects, occurring in 5-9 per 1000 newborns. CHD are the second leading cause of infant mortality and account for 47% of all causes of death from birth defects.

The main method for assessing the anatomy and function of the heart is 2-dimensional ultrasonography. Artificial intelligence (AI) technologies are great at recognizing images, thus facilitating quick scanning and analysis of visual information in order to speed up and simplify the diagnostic ultrasonography.

All AI software for obstetrics use static images. In our study conducted at the National Medical Research Center for Obstetrics, Gynecology and Perinatology named after Academician V.I. Kulakov (Moscow, Russian Federation) in 2022-2023, we used video files including 1-5 standard heart views for each fetus.

Objective: To create a data set for development of an AI tool that improves the quality of fetal CHD diagnosis and to develop an algorithm for examining the fetal heart using AI. Resulting medical reports could be either “normal” (correct structure of the heart; no sign of CHD) or “abnormal” (incorrect structure of the heart; CHD cannot be excluded; extended fetal echocardiography is recommended as soon as possible).

Materials and methods: The examination was conducted at 18-21 weeks’ gestation. Each examination contained video files of 5 standard views of the heart per patient. Each view is at least 25 frames. Verification was performed by confirming/changing the diagnosis by a physician and confirming the diagnosis after birth.

Conclusions: As a result, the task of determining zones of the fetal chest and heart was solved with an approximate accuracy of 98%; the task of classifying the heart view on the frame was solved with an approximate accuracy of 82%, and the task of determining the disease on the heart views was solved with an approximate accuracy of 77%.

Introduction: As the rate of congenital heart diseases (CHD) remains high, medical imaging specialists face a task of early diagnosis of CHD with minimal cost and burden to pregnant women and fetuses and need to verify the prenatal diagnosis in order to develop a strategy for managing pregnant women carrying a fetus with CHD.

Objective: To optimize diagnostic measures in fetuses with CHD by comparing fetal echocardiography and cardiac magnetic resonance imaging (MRI).

Materials and methods: We retrospectively evaluated findings from 35 fetal standard ultrasonography reports, 29 echocardiography reports, and 35 fetal autopsy reports (termination for medical reasons). We assessed 18 cases of CHD diagnosed by ultrasonography findings on the second screening; in 34% of the cases patients also underwent MRI at that time and a repeated procedure 30 weeks later.

Results: When standard ultrasonography and an extended protocol with echocardiography were used together, diagnostic errors were 14.3%. In 85.7% of the fetuses, the findings of different imaging techniques fully coincided with the autopsy findings.

Conclusions: In this cohort of pregnant women, the second screening should include more examinations to verify the diagnosis of CHD. Based on the first screening findings (increased nuchal translucency thickness and ductus venosus pulsatility index) patients should be referred to an expert for the second screening. If necessary, to verify the diagnosis of CHD ultrasonography and MRI can be combined during the third screening (34-36 weeks) in order to plan postnatal management of the newborn. The proposed algorithm for fetal CHD diagnosis enables to minimize the likelihood of error and maintain continuity of care between obstetricians-gynecologists, ultrasonographers, radiologists, neonatologists, and cardiologists.

Background: Despite advances made in combustiology, the method and timing of wound closure remain a matter of debate. There are 2 decisive factors in engraftment of a full-thickness skin graft: infection degree and level of wound bed vascularization. Reasons for unsuccessful engraftment are insufficient hemostasis, late surgery, and exposed subcutaneous fat. Full-thickness skin grafting for wounds of various origins optimizes improvement of long-term cosmetic and functional results of surgery.

Objective: To improve treatment results in patients with wounds of various etiologies by improving methods of full-thickness skin autografting.

Materials and methods: This study was conducted in the Scientific Research Institute – Ochapovsky Regional Clinical Hospital No. 1 (Krasnodar, Russian Federation) and analyzed data from 64 patients (age, 18-65 years) who underwent full-thickness skin autografting. The patients were grouped based on the surgery type.

In group 1 (23 patients with acute burn injury), granulation tissue was excised, and the wound defect was closed using a full-thickness skin autograft. In group 2 (21 patients with scar deformities of the skin), scar tissue was excised, and full-thickness skin autografting was performed. Group 3 (20 patients with traumatic skin detachment without bone injury) underwent skin grafting by the Krasovitov method.

Results: Time to engraftment in group 1 was median 10.0 (7.5; 15.0) days; in group 2, 15.0 (13.0; 18.0) days, and in group 3, 28 (14.8; 44.3) days. We found statistically significant differences when comparing the groups using the Kruskal-Wallis test (P < .0001).

Conclusions: New developed methods for full-thickness skin autografting in patients with granulation tissue and scar deformities can significantly increase the treatment effectiveness.

Background: The development of alcohol dependence syndrome is accompanied by disturbances of neuroplasticity in neural circuits, the imbalance of neurotransmitter metabolism and immune and hormonal statuses in the central nervous system, which are reflected in changes in peripheral markers. Therefore, determining neuropeptide levels in body fluids is a potentially promising strategy for laboratory monitoring of substance use.

Objective: To determine characteristics of changes in oral fluid and serum levels of protein markers and hormones in patients with alcohol dependence syndrome during rehabilitation.

Materials and methods: We formed 2 groups of male participants: a control group of apparently healthy volunteers (n = 30) and a group of patients with alcohol dependence syndrome, which was similar in size, age, and gender (20-40 years) to the controls. At the time of admission to the rehabilitation program and 3 months later, serum and oral fluid samples were collected. We used an enzyme-linked immunosorbent assay to determine levels of brain-derived neurotrophic factor (BDNF), glial cell line–derived neurotrophic factor, neuropeptide Y, orexin, pituitary adenylate cyclase-activating peptide, corticotropin, and cortisol in the body fluids.

Results: Laboratory findings revealed that it is possible to determine neuropeptides and hormones in the oral fluid. The wide variability of findings in the oral fluid and no statistically significant correlation with corresponding serum levels were characteristic of the most protein markers. Only the BDNF levels were statistically significantly reduced (3.2-fold decrease) in both the serum and oral fluid. Analysis of the serum and oral fluid BDNF and cortisol levels revealed a moderate correlation (r = 0.51, P = .0189).

Conclusions: For laboratory monitoring of alcohol dependence syndrome, it is possible to determine oral fluid BDNF, which, like cortisol, has demonstrated a statistically significant moderate correlation between the serum and oral fluid levels.

Candida species have an impact on human skin health and occasionally can lead to catastrophic conditions, such as skin cancer. The nitrogen supply in growth media regulates MEP2 gene expression. MEP2 protein may regulate the amount of ammonium accessible to cells by directly affecting ammonium assimilation. Reducing MEP2 expression removed its potential to drive filamentous growth.

This study aimed to examine serial imaging of the MEP2 gene with chaos game representation (CGR) and frequency chaos game representation (FCGR). In addition, the effect of mutations in Candida albicans strains on MEP2 docking with lauramine oxide (LDAO) was investigated. The MEP2 gene was selected for 10 Candida species from the National Center for Biotechnology Information to compare DNA sequences using conventional and portray methods (CGR and FCGR). The molecular docking between MEP2 and LDAO was determined using the HDOCK server.

CGR findings revealed that Candida margitis, Candida orthopsilosis, Candida dubliniensis, Candida theae, and C albicans had approximately 65% of the same characteristics. According to FCGR, there was a 75% similarity between C albicans, C theae, C dubliniensis, C orthopsilosis, and C margitis. In certain strains, but not all a mutation in the conserved region of the protein caused a change in the docking residue of LDAO with MEP2.

The CGR and FCGR protocols are considered practical and reliable tools for identifying protein and DNA sequence similarities. Approximately 80% of the existing algorithms for determining multiple sequence alignments are similar to traditional methods. Targeted treatment will be possible as determining MEP2 mutations is crucial for using Candida as a nitrogen source.

Objective: To assess the level of occupational rehabilitation among patients who underwent surgery for multidrug-resistant (MDR) and extensively drug-resistant (XDR) tuberculosis in the long-term period compared with patients who refused surgery and opted solely for conservative management.

Material and methods: We analyzed long-term outcomes of surgical treatment for destructive pulmonary tuberculosis caused by MDR and XDR Mycobacterium tuberculosis in 976 patients (group 1). Furthermore, we evaluated long-term outcomes of 888 patients (group 2) who had an ineffective main chemotherapy course (regimens IV and V) or relapses after an initially effective chemotherapy course and were managed conservatively because they refused surgery.

Results: One year after the surgery or surgery consultation, the complete clinical response, ie, cavity closure and elimination of bacilli (CV-, MBT-), was achieved in 99.5% of the operated patients, in contrast to only 5.3% among those who refused surgery. At the 5-year mark after the surgery/consultation, we observed the sustained effectiveness in 97.7% of the operated patients compared with only 3.2% among those who refused surgery. During the 12 years of follow-up, tuberculosis-related deaths occurred in 9 operated patients (0.8%) and 643 patients (72.4%) who refused surgery. Furthermore, 78.9% of the patients treated surgically were able to return to work in the long-term period, in contrast to only 2.6% of those who refused surgery.

Conclusions: Our analysis revealed that the complete clinical response one year after the surgery/surgery consultation was 18.8 times more common in the patients who underwent surgery compared with those who refused it. Similarly, the complete clinical response 5 years after the surgery/consultation was 30.5 times higher in the operated patients. Tuberculosis-related deaths during the follow-up were 90.5 times more common among the patients who refused surgery. Furthermore, the 5-year survival rate among the operated patients was 3.3 times higher, and occupational rehabilitation was 30.3 times more common compared with those who refused surgery.

Background: Many studies on cerebral atherosclerosis and its treatment have been conducted over the past 60 years. Several modifications of open surgical treatment (carotid endarterectomy) have been proposed. There are several techniques of carotid endarterectomy; however, there is no consensus on advantages of any of these techniques.

Objective: To analyze the anatomy and geometry of the common carotid artery bifurcation in patients with hemodynamically significant stenoses of the internal carotid artery.

Materials and methods: To study geometric parameters, we used computed tomography data of patients operated on at the Scientific Research Institute – Ochapovsky Regional Clinical Hospital No. 1 (Krasnodar, Russian Federation). The patients underwent the following procedures: classical, eversion, or glomus-sparing carotid endarterectomy. We built geometric models using specialized software and studied hemodynamics at the common carotid artery bifurcation in the early postoperative period (1 day after surgery) and 1 year after surgery.

Results and conclusion: Zones at risk for atherosclerotic plaque formation are mainly in the common carotid artery. This phenomenon is explained by the surgery technique, namely, by the fact that the cut line of the atherosclerotic plaque is located in this region. Models built on the basis of computed tomographic angiograms 1 year after surgery demonstrate a decrease in the area of zones at risk. This might be due to the arterial wall smoothing and neointima formation.

Introduction: Treatment of upper gastrointestinal bleeding (UGIB) is a complex challenge due to the wide range of causes and factors affecting hospitalization outcomes.

Objective: To study the impact of various factors on 30-day hospital outcomes using machine learning (ML) tools.

Materials and methods: We compiled a retrospective data set that includes clinical, laboratory, and imaging data of 101 patients. The database was divided into 2 groups by UGIB etiology: ulcer and variceal bleedings. Both etiological groups were processed using ML tools in 2 steps: imputation by the MICE (multiple imputation by chained equations) model and factor importance analysis using the Random Forest model.

Results: Analysis revealed that the most prognostically valuable parameters in both groups were well-known mortality predictors and emerging predictive factors, such as creatinine, blood pressure, activated partial thromboplastin time, level of consciousness, urea, lactate, comorbidity status, procalcitonin, ferritin, and total protein.

Conclusions: The application of advanced tools confirmed the significance of popular and validated mortality predictors and contributed to the development of predictors, both explored and unexplored ones.

Background: We present a new original method of modeling an intra-articular fracture of the long tubular bone in laboratory animals.

Objective: To create a new experimental model of an intra-articular fracture of the long tubular bone and to approve it for comprehensive evaluation of morphofunctional parameters of cartilage and bone healing.

Materials and methods: The experiment was performed on 30 white sexually mature Wistar rats. Modeling involved layer-by-layer dissection of tissues along the anteromedial surface and formation of an incomplete fracture of the femoral medial condyle using a sharp L-shaped working end of an 0.2 × 0.2 сm instrument perpendicular to the medial condyle with a slight single muscle force. The rats were euthanized in groups of 10 animals on days 7, 14, and 30. We performed knee radiography and determined blood osteocalcin and BMP-7 levels. The Mankin score was used in the histological evaluation of the articular cartilage changes. The groups were compared using the Kruskal-Wallis test. P < .05 was considered statistically significant.

Results: We noted statistically significant differences (P < .0001) when comparing the groups using the Mankin score. The post hoc test revealed statistically significant differences in the Mankin scores between days 7 and 14 (P = .014) and between days 7 and 30 (P < .0001). Group comparisons showed no statistically significant differences in blood osteocalcin levels (P = .518). However, there were statistically significant differences (P = .0028) between the groups in blood BMP-7 levels. The post hoc test revealed statistically significant differences in blood BMP-7 levels between days 7 and 14 (P = .048) and between days 14 and 30 (P = .0195).

Conclusions: The developed experimental model of intra-articular fractures of long tubular bones allows for a comprehensive assessment of reparative processes of cartilage and bone tissue. The model is close to the real mechanism of pathology development.

Background: The percentage of clean-wound infection remains fairly high so far: 2% to 5%. Therefore, monitoring wound healing is a critical task in modern surgery.

Objective: To develop and test a dressing material with halochromic dye in order to determine the suppuration of a clean wound of the skin and soft tissues.

Material and methods: The experiment was conducted on 30 Wistar rats: clean wounds were formed and then covered with a dressing soaked in halochromic dye. During the experiment, we measured the pH of the wounds and wound area and determined the qualitative and quantitative composition of the wound microflora. Statistical analysis was conducted using the Wilcoxon test; the level of significance was taken at 0.05.

Results: We found that the initial wound area was 253 (248; 257) mm² and the surface pH, 5.80 (5.55; 5.90). Clean wounds covered with a dressing material were not treated with medication. It led to their infection and a change in the color of the dressing material on average on day 4 (4; 5) of the experiment. After removal of the dressing material, we noted that the pH of the wounds was 7.79 (7.68; 7.88) and the wound area, 238 (234.3; 242.5) mm²; the differences compared with the data on day 1 were statistically significant. When analyzing the degree of wound contamination after removal of the dressing material, we found that the wound contained aerobic and anaerobic microorganisms and microscopic fungi, the level of which statistically significantly exceeded the maximum permissible level, confirming development of the wound infection.

Conclusions: The use of a dressing material with halochromic dye, which changes its color in response to the pH of the wound, facilitates timely detection of the development of the wound infection.

Objective: To develop a detergent-enzymatic method and evaluate the quality of a decellularized pulp scaffold for regenerative endodontics.

Materials and methods: Biomaterial and mesenchymal stem cells (MSCs) were derived from dental pulp that was obtained following third molar extraction indicated for orthodontic reasons in patients aged 14-18 years. The detergent-enzymatic method enabled to obtain a decellularized scaffold from pulp samples. The proliferative activity and viability of dental pulp-derived MSCs were assessed using trypan blue staining and XTT assay. To assess tissue response, Wistar rats underwent subcutaneous implantation of native and decellularized dental pulp. Explanted samples were stained with hematoxylin-eosin on days 7 and 14.

Results: The detergent-enzymatic treatment of the dental pulp demonstrated the absence of nuclear material, whereas the histoarchitecture of the dental pulp was disturbed. The DNA content in the sample of the decellularized scaffold was 22.79 ± 2.1 ng/mg of tissue; the amount of DNA in the native sample was 78.5 ± 5.4 ng/mg of tissue. According to XTT assay results, no cytotoxicity of the decellularized scaffold against MSCs was found. Biopsy specimens of the rats with implanted decellularized dental pulp were characterized by no signs of inflammation.

Conclusions: The study results will enable to create a biomaterial that can be the base of a tissue-engineered structure of the dental pulp and be used for the regeneration of the pulp-dentin complex.

Objective: To present a case of reconstruction of a full-thickness lower eyelid defect.

Case report: Male patient Y. aged 71 years was admitted to the Scientific Research Institute – Ochapovsky Regional Clinical Hospital No. 1 (Krasnodar, Russian Federation) with the diagnosis: cancer of skin of the lateral canthus of the left eye, T1N0M0, stage I, clinical group II. According to the medical history, the neoplasm was self-detected 5 years ago. Histology findings revealed micronodular basal cell carcinoma.

After a general clinical examination, the patient underwent surgery to remove the neoplasm of the lower eyelid skin and lateral canthus and reconstruct the defect using a lateral infraorbital fat pad flap, local tissues, and a free autologous cartilage graft. The configuration of the soft tissues of the eyelid was restored. Soft tissue edema was not observed. The functional state of the lacrimal apparatus was fully preserved. The esthetics of the soft tissue was rehabilitated.

Conclusions: Reconstruction in such esthetically significant area as the middle third of the face is associated with special requirements for graft formation and positioning. A gentle and functionally justified method for restoring the parameters of the tarsal plate, conjunctival sac, and lower eyelid skin ensures complete rehabilitation of patients and improves their quality of life.

Liver transplant is one of the most effective ways to treat hepatocellular carcinoma (HCC). Thanks to the implementation of the Milan criteria, developed almost 30 years ago, 5-year survival rates for patients who underwent a transplant for HCC increased and reached the rates for patients with nontumor indications. Despite the emergence of alternative stratification systems, extrahepatic metastases remain a key contraindication to a liver transplant. Nevertheless, there have been reported cases of liver transplants in spite of the contraindication not only in times of diagnostic limitations but also in the 21st century.

We have previously reported our own case of a patient who underwent a liver transplant in spite of pulmonary lesions, which postoperatively were found to be HCC metastases. In this part of the review, we discuss similar cases from the literature.

If metastatic lesions are successfully treated, a related donor is available, and other modalities are seen as less preferable in terms of the disease prognosis, a liver transplant may be considered an appropriate way to prolong the patient’s life, although such approach should not be recommended for widespread use.

Background: Сomplex choledocholithiasis remains an urgent socio-medical problem in modern medicine. This pathology is more common in patients with cholelithiasis and causes such complications as obstructive jaundice, acute and chronic pancreatitis, cholangitis, etc. Effective treatment depends on proper preoperative examination, which is quite challenging. In such cases, minimally invasive diagnostic methods play a fundamental role. Endoscopic cholangioscopy is an effective and highly informative method for diagnosis and treatment of biliary diseases including сomplex choledocholithiasis; in many cases it is the only examination technique that allows for a reliable diagnosis. The effectiveness of this technique and possibilities of its implementation by leading specialists in the Russian Federation and around the world remain important issues.

Objective: To summarize available literature data on possibilities of using cholangioscopy in diagnosis and treatment of сomplex choledocholithiasis.

Materials and methods: We conducted a literature review using PubMed and eLIBRARY. Our goal was to cover the most up-to-date medical articles published on the subject in the past 10 years. Studies included in our review are based on experimental and clinical data. Thus, we obtained the most reliable results that can be used in further research and practice.

Results: We found that cholangioscopy has significant clinical value, which confirms its role as an important diagnostic and therapeutic approach in addition to endoscopic retrograde cholangiopancreatography in treatment of complex choledocholithiasis. This technique should be further thoroughly studied.

This article aims to analyze modern endoscopic techniques of sentinel lymph node biopsy and axillary lymph node dissection in breast cancer surgery.

Owing to more accurate diagnosis and minimized patient morbidity and risks, endoscopic techniques have significantly expanded capabilities of breast cancer surgery.

We review the main endoscopic techniques of sentinel lymph node biopsy and axillary lymph node dissection, analyze their efficacy and safety, and compare their benefits with those of conventional open techniques.

The article discusses results of recent studies regarding diagnostic accuracy and complication rates. Furthermore, we discuss the impact of endoscopic axillary lymph node dissection on the prognosis and quality of life in patients with breast cancer.

Sodium-glucose cotransporter 2 inhibitors (SGLT2i) have emerged as a revolutionary class of drugs with far-reaching protective effects in multiple organs. The protective potential of SGLT2i is much broader than that of the classical concept of glucose control and consists of an entire conglomerate of associated pleiotropic effects. This study aims to provide a descriptive review of the pleiotropic therapeutic potential of SGLT2i. The first part of the literature review examined the use of SGLT2i in cardiology and nephrology. The use of SGLT2i represents an innovative approach to improving patients’ quality of life and course of heart failure and chronic kidney disease, regardless of left ventricular ejection fraction and type 2 diabetes.

Currently, the literature has limited information on potential risks of pulmonary toxicity in patients receiving anticancer therapy. Nevertheless, this complication is not uncommon in some patients and can manifest in various patterns of changes in the lung parenchyma.