Background: There is no doubt that hemodynamic monitoring plays a crucial role in cardiac surgery. Research is generally aimed to identify optimal strategies for maintaining hemodynamic stability, reducing complications, and minimizing recovery time after surgery.

Objective: To study the effect of echocardiography-guided goal-directed hemodynamic and fluid therapy on perioperative outcomes of mitral valve replacement (MVR).

Material and methods: We analyzed data from 146 patients with mitral regurgitation who underwent MVR. The patients were grouped by standard hemodynamic therapy (comparison group, n=74) and goal-directed therapy (main group, n=72). The study groups were representative, and preoperative clinical, laboratory, and imaging data did not differ significantly between the groups. The study period began with the induction of general anesthesia and ended with hemodynamic stabilization achieved. This point of clinical recovery was defined as the successful extubation and absence of vasoactive support; the dose of inotropes and/or vasopressors was either completely weaned off or remained unchanged for >8 hours.

Results: The study groups differed in several key parameters. The anesthesia time decreased from 255 to 223 minutes (P=.02), and the cardiopulmonary bypass time from 94 to 82 minutes (P<.001). The volume of fluids until hemodynamic stabilization was achieved was higher in the comparison group (P=.002). Inotropes were used more often in the comparison group (P><.05). The mechanical ventilation time in the main group and the comparison group was 7.33 and 13 hours, respectively (P><.001); the intensive care unit length of stay was 1.1 and 1.8 hours (P=.014), respectively. The incidence of acute myocardial ischemia was lower in the main group (2.8% vs 12.2%, P=.026). Conclusions: Goal-directed hemodynamic and fluid therapy significantly improves MVR outcomes and reduces the risk of postoperative complications and long-term use of cardiovascular drugs.> <.001) . The volume of fluids until hemodynamic stabilization was achieved was higher in the comparison group (P=.002). Inotropes were used more often in the comparison group (P <.05) ). The mechanical ventilation time in the main group and the comparison group was 7.33 and 13 hours, respectively (P <.001) ; the intensive care unit length of stay was 1.1 and 1.8 hours (P=.014), respectively. The incidence of acute myocardial ischemia was lower in the main group (2.8% vs 12.2%, P=.026).

Conclusions: Goal-directed hemodynamic and fluid therapy significantly improves MVR outcomes and reduces the risk of postoperative complications and long-term use of cardiovascular drugs.

Background: Issues concerning necessity, advisability, and the method of mesh fixation during laparoscopic inguinal hernia repair are actively debated. Their solution shall decrease the rate of late mesh-associated complications and improve the quality of life of patients in the long-term postoperative period. We developed an original method of mesh fixation during transabdominal preperitoneal (TAPP) repair (Russian patent RU2814607С1, May 30, 2023).

Objective: To evaluate results of using a new method of mesh fixation during TAPP repair.

Materials and methods: The observational study included 79 patients with inguinal hernias who underwent TAPP repair. All the patients were divided into 3 groups. The main group comprised 27 patients (34.2%) who underwent mesh fixation according to our proposed method. The first control group (standard mesh fixation using a stapler) consisted of 30 patients (38%), and the second control group included 22 patients (27.8%) whose meshes were not fixed. We evaluated the overall complication rate, pain duration and severity, rates of mesh migration or shrinkage, and hernia recurrence rate in the early and long-term postoperative periods. Ultrasonography was used to assess the mesh condition before the discharge and 6 months after the surgery. Quality of life in the long-term postoperative period was measured by the Carolinas Comfort Scale (CCS). The data were analyzed with Statistica 10.0 (StatSoft Inc, USA).

Results: The first control group in which the meshes were fixed with a stapler had significantly higher pain severity and duration in the early postoperative period (U = 17; P= .01) than those of the main and the second control groups. In the first control group there was also a significantly higher rate of early complications compared with the main (P= .008) and the second control groups (P= .006). Six months after the surgery, mesh displacement and hernia recurrence were found in 1 (4.5%) patient from the second control group. No hernia recurrences were observed in the main and the first control group. CCS scores in the main and the second control groups had no significant differences: 27.3 ± 11.2 and 26.8 ± 8.6, respectively. The CCS score in the first control group (44.2 ± 7.3) was significantly lower (U = 14; P= .007) due to a greater number of patients (13.4%) with chronic pain and foreign body sensation in the implantation site.

Conclusions: The proposed method of mesh fixation offers a low rate of postoperative complications and sufficient reliable mesh fixation, thus improving quality of life postsurgery.

Objective: To investigate metabolite changes in patients with leukoaraiosis employing multivoxel magnetic resonance spectroscopy (MRS) with the focus on periventricular white matter and explicate the biochemical alterations associated with leukoaraiosis and their impact on lesion load.

Methods: This prospective study was conducted on 64 patients with a known history of leukoaraiosis (mean age, 66.40±8.96 years; 54 men and 10 women) referred for magnetic resonance imaging, wherein MRS was performed. For comparison, 128 age- and gender-matched healthy individuals (mean age, 61.98±8.18 years; 40 men and 88 women) who comprised the control group also underwent MRS. We correlated metabolite ratios (NAA/Cr, NAA/Cho, and Cho/Cr) analyzed on MRS with lesion load measured by semiautomated software.

Results: The NAA/Cr ratio was significantly lower, whereas the NAA/Cho ratio was significantly higher in the control group compared with the patients with leukoaraiosis (P <.0001) . The Cho/Cr ratio was also significantly higher in the controls compared with the patients with leukoaraiosis (P <.0034) . This suggests that patients with leukoaraiosis exhibit significant metabolic differences compared with healthy controls. We observed no correlation between the metabolite ratios and lesion load, which indicates that the degree of white matter hyperintensities is not related to the metabolic changes in leukoaraiosis.

Conclusions: This study explicates the understanding of leukoaraiosis and underscores the potential of MRS as a biomarker for early diagnosis of leukoaraiosis.

Objective: To assess the effectiveness of ultrasonography and contrast-enhanced computed tomography (CT) in diagnosing acute appendicitis.

Material and methods: The study group included 912 patients with suspected acute appendicitis who underwent imaging and surgery. The inclusion criterion is the availability of histopathological findings. To assess the diagnostic effectiveness, we determined sensitivity (Se), specificity (Sp), accuracy (Ac), and positive (PPV) and negative (NPV) predictive values using the corresponding formulas. Statistical analyses were performed using MedCalc, version 20.013 (MedCalc Software Ltd, Belgium). The diagnostic effectiveness is presented as receiver operating characteristic curves.

Results: Preoperative imaging enabled to establish the correct diagnosis of acute appendicitis in 92.4% of patients. The diagnostic effectiveness of ultrasonography in the study group (n=912) was Se, 68.34%; Sp, 56.5%; Ac, 67.4%; PPV, 95%; NPV, 12.9%; that of contrast-enhanced CT, Se, 94.4%; Sp, 76.9%; Ac, 92.5%; PPV, 97.1%; NPV, 62.5%. The appendiceal diameter cutoff was >6.8 mm for ultrasonography, with Se of 91.3% and Sp of 57.1%, area under the curve (AUC), 0.720 (P >6.6 mm for contrast-enhanced CT, with Se of 95.5% and Sp of 83.3%, AUC, 0.966 (P <.0001).

Conclusions: Ultrasonography has sufficient diagnostic effectiveness as the first-line imaging in patients with suspected acute appendicitis. Contrast-enhanced CT has higher effectiveness in diagnosing acute appendicitis and should be used in patients with negative ultrasonography findings, high risk of complicated acute appendicitis and as an additional tool for differential diagnosis.

Background: COVID-19 is mainly a respiratory infection; however, in some cases, it can result in cardiac complications in pregnant women leading to the development of myocarditis.

Material and methods: In 2021-2022 we studied the impact of COVID-19-associated myocarditis on the course of pregnancy in the Republican Perinatal Center (Tashkent, Republic of Uzbekistan). We examined a total of 147 pregnant women with myocarditis (of them, 95 women had COVID-19 while pregnant and 52 women had chronic focal myocarditis). The patients underwent electrocardiography, echocardiography, ultrasonography, and laboratory studies (troponin T1).

Results: COVID-19 in pregnant women can lead to COVID-19-associated myocarditis with signs of circulatory failure (68%), in contrast to chronic focal myocarditis with impaired circulation and chronic heart failure (84.7%). Metabolic changes on echocardiography were more typical of COVID-19-associated myocarditis (group 1) than indolent focal myocarditis (group 2); however, pathological changes were more common in group 2, indicating more pronounced changes in the myocardium of pregnant women with chronic focal myocarditis.

Conclusions: The course of gestation in women with COVID-19-associated myocarditis was characterized by the hypertensive syndrome, increased risk of miscarriage, intrauterine growth restriction, and nonreassuring fetal status, but these complications were less common compared with group 2 with chronic focal myocarditis, in which case operative vaginal delivery is indicated.

Importance: Cutaneous melanoma is regarded as the most lethal form of skin cancer. According to the literature, issues associated with accurate prognosis and early detection of relapses hinder effective treatment of melanomas. Over the past 20 years, microRNAs have been shown to modulate various biological processes. Disruption of microRNA expression and activity can contribute to the risk of cancer development, including cutaneous melanoma. Therefore, we decided to study some microRNAs as biomarkers for future use in cutaneous melanoma diagnosis.

Objective: To analyze the expression of microRNA-205, microRNA-199a-3p, microRNA-146a-5p in tumor tissue of patients diagnosed with cutaneous melanoma.

Materials and methods: We quantified the expression of microRNA-205, microRNA-199a-3p, microRNA-146a-5p using the realtime polymerase chain reaction in biopsy specimens from patients with melanoma (n=14). For all the specimens, the cycle threshold (Ct) value was 0.1 (qPCRsoft 3.0, Analytik Jena, Germany). Statistical analysis was performed using Statistica 7.0 (StatSoft, USA). Furthermore, we conducted a bioinformatics search for microRNA target genes using DIANA-mirPath v.3.0 (DIANA-Lab, Greece) and constructed gene interaction networks using STRING (https://string-db.org/).

Results: We detected 2 of 3 microRNAs in the group of patients with cutaneous melanoma: microRNA-205 and microRNA-146a-5p. In both the control group and the group of patients with melanoma, 1 of 3 microRNAs, namely miR-146a-5p, was found. The mean ∆Ct value of microRNA-146a-5p was 3.81±2.03 in the control group and 2.26±1.34 in the patients with melanoma. Due to the wide range of values in the control group and the group of patients with cutaneous melanoma, microRNA-146a-5p cannot be considered an informative biomarker. At the same time, we found high expression of microRNA-205 in the group of patients with cutaneous melanoma.

Conclusions: microRNA-205 was found to be valuable in melanoma diagnosis. However, further studies with larger sample size and additional stratification by histopathological features are needed.

Background: Circulating tumor cells (CTCs) play an important role in hematogenous metastasis of malignant tumors. Small cell lung cancer (SCLC) is the most aggressive form of lung cancer with the highest number of detected CTCs.

Objective: To evaluate the presence and number of CTCs as an immunosuppression factor in SCLC.

Materials and methods: In 30 patients with stage III-IV SCLC, CTCs were detected using the CellSearch system (Veridex LLC, Belgium) before treatment. The participants were divided into groups based on presence of CTCs. Flow cytometry was used to assess T- and natural killer (NK)-cellular components of the immune system and revealed that the CTC presence in patients with SCLCwas accompanied by low levels of NK cells expressing CD335+, granzyme B, and perforin and lower levels of helper T cells with markers of early activation (CD38 and CD69). Lower levels of CD8+CD69+ activated cytotoxic T cells were observed with the highest level of CTCs (>50). Thus, a decrease in the quantitative and functional parameters of T and NK cells in presence of CTCs can be regarded as one of the immunosuppression factors in patients with SCLC.

Results: The presence of CTCs, regardless of their number in the blood of patients with SCLC, is characterized by suppression of the innate immune system: decreased functional activity of NK cells, which, even with the preservedtotal number of NK cells, leads to a decrease in their antitumor potential and is often observed in case of widespread metastases. A similar pattern was noted in the analysis of the adaptive immune system, namely, the T cells.

Conclusions: As with other malignant tumors, the presence of CTCs in patients with SCLC can be regarded as one of the immunosuppression factors.

Relevance: Diagnosing pancreatic necrosis and its complications is challenging despite the widespread use of state-of-the-art highprecision imaging methods in routine practice.

Objective: To determine topographic features of local complications of pancreatic necrosis using ultrasonography and their effect on the disease outcome.

Materials and methods: We examined 92 patients (mean age, 42.8±4.6 years) with moderate and severe pancreatic necrosis. There were 4 types (models) of pancreatic necrosis according to the spread of local complications: central, 25 cases (27.2%); left, 32 (34.8%); right, 16 (17.4%), and mixed, 19 (20.6%). We used ultrasound machines: LOGIQe (GE HealthCare, USA), MyLab 70 (Esaote, Italy), Voluson S10 (GE HealthCare, USA), with convex and linear transducers (5.0 and 7.5 MHz). Analyses were conducted with Microsoft Excel 2017 (Microsoft Corp, USA) using mean values, 95% CI, the χ2 test, and the P value.

Results: We determined a diagnostic ultrasonographic algorithm, topographic relationship of local complications and abdominal organs, and ways of inflammation and necrosis spread, and compared disease outcomes for different configurations of foci. Discussion: The most popular landmark was the parapancreatic fiber and omental bursa (93.4%); the least, the paranephrium (28.3%) (χ2=135.674; P <.001) Leakage along Gerota and Toldt fascias showed no differences between the left and right sides (χ2=0.028; P=.867 and χ2=0.001; P=.977). Among the isolated foci, “stripes” (41.4%) (χ2=26.561; P <.001), “ovals” (20.7%) (χ2=75.625; P <.001) ), and “drops” (17.2%) (χ2=47.207; P <.001) were more common findings than complex configurations (“horseshoes” and “butterflies”).

Conclusions: The refined diagnosis of local complications of pancreatic necrosis, ultrasonographic manifestations, and syntopy enable to predict the effectiveness of ultrasonography-guided percutaneous drainage and choose an optimal surgical approach.

Background: One of the most important problems in medicine today is prevention of chronic kidney disease development and progression in patients who underwent radical nephrectomy. Surgical removal of one kidney initiates adaptive functional and morphological restructuring in the other one. Changes in the condition of the remaining kidney have been sufficiently detailed, whereas systemic metabolic disorders induced by surgical stress, which occur during remodeling of the kidney parenchyma and functional restructuring of the kidney, remain overlooked. Both local processes of recovery, adaptation, and compensation in the remaining kidney and the endocrine and metabolic response as a whole should be examined. Only adequate pharmacological modulation of the endocrine-metabolic stress response to surgery will contribute to providing optimal conditions for proper anatomical and functional adaptation of the remaining kidney and preventing kidney diseases.

Objective: To justify an algorithm for patient management in the early postoperative period after radical nephrectomy that minimizes risks of dysfunction of the remaining kidney.

Materials and methods: We examined 2 groups of patients who underwent radical nephrectomy, one of which additionally received a synthetic adaptogen, Selank, for 2 weeks after the surgery.

Results: The patients additionally receiving Selank had significantly better results in terms of the dynamics of recovery initiated by surgery: disorders of biogenic amine metabolism, psycho-emotional disorders, vegetative-vascular disorders, and glomerular filtration rates.

Conclusions: The surgery is a strong stressor that disrupts adaptive mechanisms both at systemic and organ levels. The combination of these pathological processes ultimately results in an overload of the compensatory capabilities of the remaining kidney, which requires pharmacological support from day 1 after surgery. Given the mechanism of disrupted adaptive reactivity due to neuro-endocrine regulation disorders, synthetic adaptogens based on regulatory peptides may be the best solution.

We report a case of emergency endoscopic decompression for acute left-sided malignant colonic obstruction in a 63-year-old patient. A rectosigmoid colon tumor was detected by unenhanced radiography, multislice computed tomography, and barium enema. We performed an emergency colonoscopy, which confirmed the rectosigmoid colon tumor, and successful endoscopic decompression with the self-expandable metal stent placement. Seven days later, the patient underwent radical surgery in the second stage: open resection of the rectosigmoid colon with end-to-end decendorectoanastomosis. On day 7 after the second surgery, the patient was discharged from the clinic in a satisfactory condition.

This article analyzes 10 cases of agenesis of the vermiform appendix with clinical presentation of acute appendicitis. Given that this pathology occurs in 1 of 100000 surgical interventions for acute appendicitis according to the literature, it can be assumed that this number of observations was based on the analysis of the results of 1 million interventions.

The article reports clinical (including intraoperative), laboratory, and imaging findings and gives recommendations for detection of agenesis of the vermiform appendix and treatment of abdominal pain syndrome.

Background: Astrocytoma is a common pediatric brain tumor that poses a significant health burden. Recent advancements in artificial intelligence (AI), particularly neural network algorithms, have been studied for their precision and efficiency in medical diagnostics via effectively analyzing imaging data to identify patterns and anomalies.

Objective: To systematically review AI-based diagnostic tools with neural network algorithms’ methodologies, sensitivities, specificities, and potential clinical integration for pediatric astrocytoma, providing a consolidated perspective on their overall performance and impact on clinical decision-making.

Methods: As per PRISMA 2020 guidelines, we conducted a comprehensive search in PubMed, Scopus, and ScienceDirect on February 5, 2024. The search strategy was guided by a PECO question focusing on pediatric astrocytoma diagnosis using AI algorithms vs computed tomography or magnetic resonance imaging (MRI). Keywords were terms related to AI and neural network algorithms. We included studies analyzing the diagnostic accuracy of AI-based methods in cases of pediatric astrocytoma (World Health Organization grades 1-3), with no restrictions on a publication year or country. We excluded papers written in languages other than English or Bahasa Indonesia and nonhuman studies. Data was assessed using the Effective Public Health Practice Project tool.

Results: Of 454 articles screened, 6 met inclusion criteria. These studies varied in design, location, and sample size, ranging from 10 to 135 subjects. The AI methods showed high sensitivity and specificity, often surpassing traditional radiological techniques. Notably, neural network algorithms using 3-dimensional MRI demonstrated improved accuracy compared with 2-dimensional MRI (96% vs 77%). The AI models exhibited performance levels comparable to or exceeding that of expert radiologists, with metrics such as tumor classification accuracy of 92% and high values of the area under the receiver operating characteristic curve.

Conclusions: AI with neural network algorithms shows significant promise in enhancing accuracy of pediatric astrocytoma diagnosis. The studies reviewed indicate that these advanced methods can achieve superior sensitivity and specificity compared with conventional diagnostic techniques. Integrating AI into clinical practice could substantially improve diagnostic precision and patient outcomes.

Sodium-glucose cotransporter 2 inhibitors (SGLT2i) are now uncovering new possibilities in the field of internal medicine owing to their diverse protective effects. In the second part of the literature review, we explore potential applications of SGLT2i in hepatology, neurology, ophthalmology, and oncology, mechanisms of action of such drugs as dapagliflozin, empagliflozin, canagliflozin, etc, and their effect on different organs and systems.

Hypertension is common among older people and often accompanied by frailty. Physicians are in need of comprehensive assessment tools to effectively manage hypertension in older patients.

We conducted a literature search and evaluated current studies, systematic reviews and meta-analyses, exploring the relationship between hypertension and frailty. Based on the analysis findings, we developed an IT solution with hypertension management elements for geriatric physicians. This article exemplifies the work with the literature and a no-code platform (IT system for developing medical solutions without programming knowledge) to create a clinical decision support system for geriatric physicians. This system will be used in subsequent studies using real-world data.

The number of interventions for left main coronary bifurcation lesions in the Russian Federation increase annually. Such lesions are among the most challenging cases for endovascular treatment due to a high risk of cardiovascular complications. They are difficult to assess by angiography, and surgeons frequently encounter difficulties during interventions. To avoid complications and improve long-term outcomes, it is crucial to accurately determine the appropriateness of an intervention, assess characteristics of the lesion, and choose the most effective treatment strategy, and intravascular imaging methods, such as fractional flow reserve measurement, intravascular ultrasonography, and optical coherence tomography, can assist in doing so. Recent research demonstrates the effectiveness of these imaging methods at each stage of surgery; however, several contentious and debatable issues that warrant attention and further investigation remain. This article reviews the latest research regarding the use of intravascular imaging to optimize percutaneous coronary interventions in patients with left main coronary bifurcation lesions, as well as to highlight unresolved issues that require further exploration.

Background: Status asthmaticus (SA) in children and adolescents is a medical emergency that requires immediate specialized care in an intensive care unit.

Objective: To determine the current state of the problem regarding etiopathogenesis, diagnosis, and intensive care management of pediatric SA.

Materials and methods: We searched keywords (status asthmaticus, children and adolescents, glucocorticoids, intensive care, mechanical ventilation) in the Cochrane Library, PubMed, and Medscape and analyzed the found papers. We selected 42 sources for the review. The inclusion criterion was the description of the pathogenesis, clinical manifestations, and intensive care features in children and adolescents with SA. The exclusion criterion was the information on etiopathogenesis, clinical manifestations, and emergency care in adults and older adults with SA.

Results: Glucocorticoids and β₂-agonists are the first line of therapy in SA. Oxygen therapy, including high-flow oxygen delivery and noninvasive positive pressure ventilation, is critical in pediatric cases. The second-line treatment includes methylxanthines, anticholinergic drugs, and magnesium sulfate. In case of drug treatment failure, children are intubated and placed on mechanical ventilation.

Conclusions: Pediatric SA is a medical emergency with a high mortality risk, requiring competent emergency care. Knowledge of step-by-step intensive therapy will improve the management of this condition in children and adolescents.

Background: Heart failure is the outcome of most cardiovascular diseases. Its prevalence continues to increase annually, which emphasizes the importance of developing therapeutic strategies to prevent adverse outcomes. This article reviews current data on the effect of vagus nerve stimulation on the course of chronic heart failure.

Objective: To summarize available literature data on the effect of vagus nerve stimulation on the course of chronic heart failure.

Materials and methods: We searched PubMed and eLIBRARY for the relevant information over the last 20 years using the following keywords: vagus nerve, heart failure, stimulation, ejection fraction. The search was performed by titles, abstracts, and keywords.

Results: This review revealed that vagus nerve stimulation has favorable effects in patients with heart failure and warrants further careful investigation.

Preeclampsia is a multisystem disorder that manifests after 20 weeks’ gestation. It is a leading cause of maternal and fetal morbidity and mortality. Approximately 25% of early-onset preeclampsia cases are severe, and 85% of pregnant women with severe preeclampsia develop multiple organ failure. Stillbirth and early neonatal mortality in women with early-onset preeclampsia are 3%-5% higher than those in cases of late-onset preeclampsia. Birth asphyxia is diagnosed in 100% of newborns. Invasive respiratory support is required in 80% of cases. Every fourth newborn has cardiovascular and central nervous system issues.

The analyzed literature demonstrated a possibility of pregnancy prolongation in early-onset preeclampsia using different therapeutic apheresis techniques, which can reduce negative consequences for newborns and mothers.