Background: Type 1 diastematomyelia is a rare congenital spinal anomaly in which the spinal cord is separated by an osseous septum into 2 hemicords. Pediatric patients often present with neurological disorders and spinal deformities, which significantly impair their quality of life. Conventional surgical treatment includes septal resection and osteoplastic laminotomy but is often accompanied by significant traumatization, risks of damage to neural structures, increased intraoperative blood loss, iatrogenic spinal instability, and postlaminectomy spinal deformity progression. Modern 3D technologies enable to improve the accuracy of surgery, ensuring gentler treatment of the posterior spinal structures.
Objective: To compare the effectiveness and safety of an individualized navigation template for osteoplastic laminotomy with those of the traditional surgical approach in patients with type 1 diastematomyelia.
Materials and methods: The retrospective study included 13 patients (age, 4-12 years) with type 1 diastematomyelia. In the main group (n=6), we used individualized 3D navigation templates, whereas the control group (n=7) underwent conventional laminotomy. The data (operation time, blood loss volume, C-reactive protein level, complications) were analyzed using Statistica (TIBCO Software Inc, USA). Quantitative values were compared using a t test, and P < .05 was considered statistically significant.
Results: The application of the navigation template significantly reduced osteotomy duration and blood loss compared with the conventional method (P < .05). The C-reactive protein level on the first postoperative day did not differ significantly between the groups (P > .05), indicating a similar postoperative inflammatory response. One control patient had a neurological complication, which resolved within 3 months.
Conclusions: An individualized navigation template for type 1 diastematomyelia increases the accuracy of bone resection and reduces the traumatic nature of the surgery. This approach holds promise for its widespread implementation in clinical practice, particularly in cases of complex congenital spinal anomalies.

Background: In recent years, there has been a clear trend towards an increase in the incidence of acute non-ST-segment elevation myocardial infarction compared to ST-segment elevation myocardial infarction. Accordingly, studies investigating the effect of late revascularization on cardiac function in patients with non-ST-segment elevation myocardial infarction are increasingly relevant. Objective: To analyze the outcomes of surgical and medical treatment in patients with non-ST-segment elevation myocardial infarction during the subacute phase of myocardial necrosis.
Materials and methods: The outcomes of therapy in 77 patients who were examined and treated in the cardiology departments of the Oryol Regional Clinical Hospital and Kursk City Emergency Clinical Hospital were analyzed. All patients were initially admitted to the internal medicine departments of central district hospitals in the Oryol and Kursk regions with non-specific clinical presentations. In these hospitals, the patients underwent a thorough evaluation, were diagnosed with non-ST-segment elevation myocardial infarction, and received comprehensive conservative treatment. Subsequently, all patients were recommended for hospitalization in the cardiology department of the vascular center for elective coronary angiography. Based on the subsequent treatment strategy, the patients were divided into two groups: Group 1 (n = 42) included patients who underwent coronary angiography in the Kursk and Oryol regional vascular centers, Group 2 (n = 35) included patients who received medical therapy only, as they refused hospitalization in the regional vascular center for elective surgical treatment.
Results: Two months after revascularization, analysis of cardiac function indicators showed that the majority of patients in Group 1 had no symptoms of angina and heart failure (52.4% and 59.5%, respectively), whereas in Group 2 these rates were 8.5% and 14.2%. At the same time, a reduction in the functional class of angina pectoris was observed in 76.1% of patients in Group 1 and 44.8% in Group 2, and functional class of heart failure improved in 69.4% and 37.6%, respectively.
Conclusion: Late myocardial revascularization promotes positive changes in left ventricular systolic function in patients with non-ST-segment elevation acute coronary syndrome. The absence of timely revascularization is associated with more pronounced clinical manifestations of both angina and heart failure. These results further confirm that timely restoration of coronary blood flow plays a crucial role in improving patient prognosis and quality of life.

Background: Despite the incorporation of neoadjuvant chemoradiotherapy into the standard treatment of locally advanced rectal cancer, significant variability in therapeutic response persists. This highlights the need for patient stratification using prognostic biomarkers. The identification of reliable morphological and immunohistochemical predictors of tumor resistance may enhance the effectiveness of personalized treatment strategies.
Objective: To assess the prognostic value of cancer stem cell markers and components of the tumor microenvironment in predicting response to chemoradiotherapy in patients with locally advanced rectal cancer.
Materials and Methods: The study included histological blocks obtained from biopsy and postoperative speciments of 75 patients with histoligically confirmed rectal adenocarcinoma who had undergone neoadjuvant chemoradiotherapy. Tumor regression grade (TRG) and immunohistochemical expression of ALDH1, TWIST, CD44, E-cadherin, LAG3, and CD20 were evaluated. Cut-off values were determined using ROC analysis. Associations between marker expression, clinicopathologic features, and treatment response were assessed. Results: A statistically significant association was found between poor response to chemoradiotherapy (TRG 2–3) and high expression of the following markers: ALDH1 >20% in 78.4% of patients (vs 26.3% in the TRG 0–1 group), TWIST >15% in 73.0% (vs 31.6%), CD44 >25% in 64.9% (vs 23.7%), LAG3 >10% in 64.9% (vs 28.9%), and CD20 >25% in 62.2% (vs 21.1%). Reduced E-cadherin expression (<30%) was observed in 62.2% of patients with TRG 2–3, compared to 23.7% in the marked morphological response group.
Conclusions: Assessment of the expression levels of the pathomorphological markers ALDH1, TWIST, CD44, E-cadherin, LAG3, and CD20 represents a significant prognostic indicator of tumor response to chemoradiotherapy. Integration of a comprehensive evaluation algorithm may facilitate personalize treatment strategies for patients with locally advanced rectal cancer.

Background: Given the rising incidence of cancer, particularly lung cancer, along with advancements in molecular genetic research, there is an increasing need to implement modern diagnostic approaches based on the assessment of molecular alterations. The study of molecular genetic changes in lung cancer is a critical step toward the timely initiation of targeted therapies and the prediction of disease progression. The establishment of molecular genetic study registry will enable the systematic collection and analysis of data on the genomics of non-small cell lung cancer (NSCLC), tumor histology, disease stages, and treatment strategies. Furthermore, such a registry will enhance accurate epidemiological analyses and, in the future, support the identification of cancer distribution patterns as well as monitoring of treatment outcomes.
Objective: Сreation of a registry for molecular-genetic data for personalized treatment of lung cancer.
Materials and methods: An analysis of 128 clinical cases diagnosed with NSCLC was conducted using Next–Generation Sequencing (NGS) on the MiSeqDX platform (Illumina, USA) in accordance with the manufacturer’s instructions.
Results: In the course of the study, the obtained results, including genetic data, were systematically organized in a registry, on the basis of which both population characteristics and individual patient data were generated. The most frequently identified mutations were in the KRAS and EGFR genes: 28% and 19%, respectively. Some patients were found to have rare mutations in ALK (2%), BRAF (1%), RET (2%), which may require specific targeted therapies. Among the 128 patients, 49 cases of various co-mutations were identified, which may affect treatment resistance and disease progression.
Сonclusion: The implementation of a molecular genetic research registry has enabled a comprehensive analysis of population characteristics and personalized treatment strategies for individual patients.

Background: Central nervous system (CNS) tumors are associated with high rates of progression and mortality. Several biomarkers have been identified and investigated for their role in tumor progression, including Epidermal Growth Factor-Like Domain 7 (EGFL7). This study aims to evaluate the clinicopathological and prognostic significance of EGFL7 overexpression in CNS tumor.
Methods: The literature search was conducted using PubMed, ScienceDirect, and Web of Science. Studies were selected according to PRISMA guidelines and analyzed using Review Manager 5.4 (Cochrane Collaboration, UK).
Results: A total of 313 patients with CNS tumors from six eligible studies were included in this meta-analysis. EGFL7 overexpression was significantly associated with tumor grade and Karnofsky Performance Status (KPS) score (OR, 6.86; 95% CI, 2.41 – 19.57; p, 0.0003; and OR, 2.92; 95% CI, 1.52 – 5.59; p, 0.001 respectively). Furthermore, EGFL7 overexpression was significantly associated with the poorer overall survival (HR, 1.64; 95% CI, 1.02 – 2.63; p, 0.04).
Conclusions: EGFL7 overexpression is associated with clinicopathologic characteristics and patient prognosis in CNS tumors. This highlights the potential of the marker as a valuable tool for diagnosis and disease risk assessment, contributing to enhanced personalization of treatment strategies and cancer monitoring.

Objective: To evaluate the prognostic significance of Epithelial Mesenchymal Transition (EMT) transition markers and their association with clinicopathological characteristics of cutaneous melanoma.
Materials and Methods: Histopathological and immunohistochemical examination of primary tumor tissue samples was performed in 101 patients with cutaneous melanoma of stage pT1a–1b. The study evaluated the expression of E-cadherin, TWIST, vimentin, Ki-67, Melan-A, and S100 markers.
Results: A significant correlation was identified between the expression of TWIST, vimentin, and E-cadherin and the depth of tumor invasion, primary tumor ulceration, and risk of progression. Disease progression was observed in patients with TWIST and vimentin expression levels > 20%, and E-cadherin expression < 80%. Ulceration of the skin was significantly associated with enhanced EMT features and a greater risk of metastatic dissemination.
Conclusion: The analysis of the obtained results confirms the clinical significance of epithelial–mesenchymal transition markers as independent predictors of disease outcome, also emphasizes the key role of ulceration as an important morphological risk factor for disease progression. The proposed prognostic model, based on the assessment of relative expression levels of TWIST, vimentin, and E-cadherin, provides reliable classification of patients according to their risk of complication development.

Background: Currently, the primary laboratory profile of trace element status in individuals consuming alcohol and other psychoactive substances, as well as the main mechanisms and consequences of these changes, is well understood. It substantiates the need for further research development for assessing the potential to monitoring the development and progression of dependence syndrome and evaluating the effectiveness of therapy and rehabilitation.
Objective: To characterize the features of the trace element composition of hair in patients with alcohol and psychostimulant dependence syndrome during the first three months of the rehabilitation period.
Materials and methods: The study involved three groups of subjects, including a group of 30 healthy volunteers. The second group (n=35) consisted of patients with alcohol dependence syndrome, the third group (n=31) included patients with psychostimulant dependence syndrome. Biological samples were collected at two stages of the study: upon admission of patients to a medical and preventive institution for rehabilitation and 3 months after its start. The trace element composition in subjects’ hair was determined by inductively coupled plasma optical emission spectrometry.
Results: At baseline, patients with alcohol dependence syndrome were characterized by a 2.0-fold decrease in calcium levels and a 2.7-fold increase in manganese levels in their hair. Three months after the start of rehabilitation, calcium levels increased to within the control range. Iron concentration increased 4.1-fold relative to baseline. Manganese levels remained elevated with a 3.6-fold increase. In patients with psychostimulant dependence syndrome, manganese levels were elevated 2.7-fold at baseline and 4.7-fold after three months. Distribution of the second group into subgroups made it possible to establish that in the abstinent subgroup from alcohol consumption, the baseline iron levels were 3.4 times higher, and zinc levels were 23% higher compared to the subgroup of individuals who experienced ethanol relapse.
Conclusions: Patients with psychoactive substance dependence syndrome were characterized by high manganese concentrations, otherwise, the laboratory profile was similar to control values. A detailed analysis revealed that the onset of alcohol relapse was associated with reduced levels of iron and zinc in hair.

Background: Railway workers are exposed to occupational conditions that contribute to the development and progression of spinal disorders. Surgical treatment in these patients should include rapid and effective functional recovery, as well as full occupational rehabilitation.
Objective: To analyze the long-term outcomes of microdiscectomy (MD) and total disk arthroplasty (TDA) for the treatment of lumbar intervertebral disc (IVD) herniations in railway workers and to identify factors predicting the risk of unfavorable postoperative outcomes.
Materials and methods: Between 2010 and 2020, a total of 522 surgical procedures were performed for lumbar IVD herniations in railway workers: MD in group I and TDA in group II. Clinical data were retrospectively analyzed for 481 patients at a mean postoperative follow-up of 8 years (320 patients in group I and 161 patients in group II). Particular attention was given to cases with unfavorable treatment outcomes, which were identified in 98 patients (67 in group I and 31 in group II).
Results: Based on univariate logistic regression analysis, risk factors associated with the development of unsatisfactory clinical outcomes were determined for each patient subgroup. For patients who underwent MD: BMI of 30-35 kg/m2, high physical workload, substantial reduction in the height of the operated spinal segment relative to the adjacent upper segments, facet joint (FJ) degeneration of grade II or higher according to Fujiwara A., IVD degeneration of grade III or higher according to Pfirrmann C., apparent diffusion coefficient (ADC) value of the operated IVD <1370 mm²/s, and change of profession due to illness. For patients who underwent TDA: age over 40 years, BMI over 35 kg/m2, smoking, disc herniation migration, FJ degeneration greater than grade according to Fujiwara A., FJ degeneration above grade II according to Fujiwara A., IVD degeneration above grade III according to Pfirrmann C., presence of posterior osteophytes, facet angle greater than 60°, Modic type I–II changes in bone marrow and endplates of the operated segment prior to surgery, ADC value of the operated IVD <1200 mm²/s, and inability to maintain preoperative occupational status.
Conclusions: The use of the proposed surgical strategy along with preoperative correction of the identified risk factors may reduce the incidence of unsatisfactory clinical outcomes, increase the rate of return to work and decrease the economic burden on the enterprise.

Background: The development of infectious postoperative complications remains a significant challenge in modern surgical practice. Such complications prolong patient hospitalization, worsen overall well-being, and cause cosmetic defects in the suture area. To prevent postoperative infectious complications, an innovative method of implanting a new surgical suture material in laboratory animals was developed and successfully tested. The material is unique due to its coating of calcium hydroxyapatite enriched with metal ions known for their antibacterial properties. The experimental results confirm the effectiveness of the proposed technology (Russian Patent No. RU 2819984 C1, dated May 28, 2024).
Objective: To study the reparative processes in skeletal muscle tissue after implantation of surgical suture material modified with metal-substituted calcium hydroxyapatite in experiment.
Materials and methods: An experimental study was conducted on 40 white male rats. To model a linear surgical wound, a sterile surgical scalpel was used. The wound was located over the trapezius muscle, 1 cm lateral to the posterior midline. The incision measured 2.5cm in length and was made from cranial to caudal along the spine. The penetration depth was approximately 4 mm, including subcutaneous fat and muscle tissue. The experimenter manually placed layered sutures using simple interrupted suture without tissue tension. Stitches were applied to ensure precise approximation of the wound edges. The surgeon was unaware of the group allocation of the suture material. Four experimental groups of 10 animals each were formed, according to the composition of the suture material (unmodified, modified with calcium hydroxyapatite, substituted with zinc, silver, copper). On day 10, muscle tissue samples were taken for histological preparations. Morphological analysis included assessment of cellular composition of granulation tissue, its area, the degree of perivascular edema, and the number of hemocapillaries. The research results are presented with qualitative and semi-quantitative data, such as transverse striation, perivascular edema. Qualitative data were statistically processed using the MatLab R2018b data analysis system of the Statistics Toolbox software package.
Results: Morphometric analysis of histological preparations showed that the area of granulation tissue in the experimental groups was lower than in the comparison group, while the values in the group using filaments modified with zinc-substituted calcium hydroxyapatite were 49% lower compared to the control group. Also, a decrease in the number of granulocytes to 3.6 per high-power field was observed in the experimental group. Application of modified sutures resulted in tissue characterized by a high density of newly formed hemocapillaries.
Conclusions: When implanting suture material modified with metal-substituted calcium hydroxyapatite into muscle tissue, a reduction in the severity of inflammation and the development of conditions favorable for muscle tissue regeneration are observed. The antibacterial properties and enhanced regenerative activity of the tested material may help address a key challenge in surgical practice – the prevention of postoperative complications at the surgical site.

Background: The development of materials capable of regenerating damaged tissues and their implementation in medical practice is a promising direction in tissue engineering and regenerative medicine.
Objective: To investigate physicomechanical and chemical properties of marine collagen-based matrices for tissue engineering through in vitro experiments.
Materials and methods: The study materials included two experimental marine collagen-based matrices: one was produced using 10% glutaraldehyde as a cross-linking agent (Group 1), while 10% glyoxal was added during the production of the second sample (Group 2). A bovine collagen-based matrix served as the control (Group 3). The deformation degree, sorption capacity, adhesion degree, and pH were determined. Statistical analysis was performed using Statistica 13.0 Pro (Dell Software, USA).
Results: The deformation degree in group 3 was 8.11% lower than in group 1 (Р = .99) and 31.88% lower than in group 2 (Р = .0053). The sorption capacity (mass) in group 3 was 7.2 times higher than in group 1 (Р = .0144) and 18.22 times higher than in group 2 (Р = .0001). The sorption capacity (volume) in group 3 was 4 times higher than in group 1 (Р = .0102) and 7.88 times higher than in group 2 (Р = .0001). The adhesion degree in group 1 was 1.32 times higher than in group 2 (Р ≥ .05) and 1.09 times higher than in group 3 (Р ≥ .05). The pH level in group 3 was 1.12 times higher than in group 1 (Р ≥ .05) and 1.17 times higher than in group 2 (Р = .0383).
Conclusions: The performance analysis revealed numerous shortcomings of the pilot samples with 10% glyoxal, warranting their exclusion from further studies. The samples with 10% glutaraldehyde demonstrated comparable or superior performance to the control group.

Background: Primary tracheal cancer is an extremely rare form of cancer. Of particular concern is the situation when such a primary tumor occurs at the site of a previously performed reconstructive surgery due to cicatricial stenosis of the trachea. This combination of factors significantly complicates the diagnosis and treatment of the disease, turning each such clinical case into a unique case of skin malignancy, previously used to replace a defect in the anterior wall of the trachea, requiring special attention from specialists.
Materials and Methods: The subject of the study was a patient with primary tracheal cancer who underwent reconstructive plastic surgery about 30 years ago, including the use of a cervical skin flap to repair the anterior wall of the trachea in post-tracheostomy cicatricial granulation stenosis. At the time of detection of tumor restenosis, the patient was undergoing treatment for infiltrative tuberculosis of the upper lobe of the right lung. After a course of anti-tuberculosis drug treatment, cervicosternotomy, circular tracheal resection with the formation of an anastomosis with a skin pad, and cervical-mediastinal lymphadenectomy were performed. During the intraoperative revision performed after a transverse tracheotomy, a cauliflower-like tumor was identified, originating from the distal part of the cutaneous tracheal graft, which was formed approximately 30 years ago during the final stage of surgery for cicatricial tracheal stenosis. Morphological examination of the tissue sample revealed keratinizing squamous cell carcinoma of mucosa from the skin previously used for tracheal reconstruction. No metastases were found in the lymph nodes. The postoperative period was uneventful, with uninterrupted continuation of anti-tuberculosis therapy.
Results: The clinical case demonstrates the potential for malignant transformation of skin tissue previously used in reconstructive surgery for cicatricial stenosis of the trachea, as well as confirming the possibility of radical surgery with complete tumor removal (R0).
Conclusions: Malignant transformation of cutaneous tissue incorporated into the respiratory tract during reconstructive surgery is a possible but extremely rare complication of staged reconstructive surgery. This clinical case represents a unique phenomenon, highlighting the importance of oncological monitoring and long-term follow-up of patients who have undergone such reconstructions.

Atherosclerosis of the aortoiliac segment complicated by calcification remains one of the key issues of vascular surgery. The gold standard for treating extensive occlusion of the aortoiliac segment is aortofemoral bypass surgery. In the presence of severe calcification, alternative surgical interventions include thoracofemoral bypass (TFB) or axillofemoral bypass (AFB). However, with calcification of the descending thoracic aorta and calcification of the subclavian and axillary arteries, the preferred surgical option is linear aortofemoral bypass using intraoperative balloon occlusion of the aorta and iliac arteries.
This article presents a case of linear aortofemoral bypass surgery in a patient with diffuse calcification of the aortoiliac segment, using balloon occlusion of the aorta.

Background: Morbid obesity is associated with unique physiological alterations that elevate the risk of perioperative complications. Spinal anesthesia represents a promising approach that may reduce the risks related to general anesthesia; however, its safety and efficacy in morbidly obese patients require further investigation.
Objective: To evaluate the safety, efficacy, and potential benefits of spinal anesthesia in morbidly obese patients and to develop recommendations for minimizing associated risks.
Materials and Methods: An analysis of 12 studies (2013–2023) involving over 1,500 morbidly obese patients was conducted. Clinical outcomes, complication rates, and patient satisfaction were evaluated. Data from randomized controlled trials, meta-analyses, and large cohort studies were utilized.
Results: Spinal anesthesia in morbidly obese patients is associated with fewer respiratory complications (odds ratio 0.4; 95% CI 0.3–0.6), reduced opioid requirements, and shorter recovery time compared to general anesthesia. However, technical challenges due to anatomical characteristics, an increased risk of hypotension (15%), and a moderately higher incidence of post-dural puncture headache (3%) were observed.
Conclusions: Spinal anesthesia may be a safe and effective option for morbidly obese patients when thorough planning and monitoring are implemented.

Background: Acute pancreatitis (AP) is one of the most common diseases of the gastrointestinal tract, with a severe form developing in 20% to 30% of patients and associated with mortality rate of 10% to 30%. The recommendations of the working group of the International Association of Pancreatology (2013), the consensus of the World Society of Emergency Surgery Congress (2019), and the recommendations of the American Gastroenterological Association do not include sections on pain management in acute pancreatitis. In the Russian clinical guidelines, analgesia is not even included as part of the basic therapy. For pain relief in AP, nonsteroidal antiinflammatory drugs, opioid analgesics, and regional analgesia methods are used.
Objective: To analyze the scientific literature on the use of regional analgesia methods in patients with acute pancreatitis.
Materials and methods: The publication search was conducted for the period from 1979 to 2024 using the Elibrary, PubMed and Google Scholar databases with the following search terms: acute pancreatitis, analgesia, epidural analgesia, paravertebral anesthesia, transversus abdominis plane block, thoracic epidural analgesia, paravertebral block, and erector spinae plane block. Articles reporting the use of regional analgesia in AP were included in the analysis. The date of the last search was December 25, 2024. A total of 442 publications were identified, of which 415 were excluded. The remaining 27 publications formed the basis of this review. Results: This review describes celiac plexus blocks, bilateral paravertebral blocks, epidural analgesia, transverse abdominis plane blocks, and a new erector spinae plane block. Numerous studies demonstrate that the use of regional analgesia as part of multimodal analgesia for AP effectively manages pain and significantly improves analgesic quality.
Conclusions: Further studies are required to determine the optimal technique for interfascial blocks in acute pancreatitis and to evaluate their efficacy and safety.

Background: Periodontitis, a prevalent chronic inflammatory disease, can lead to severe dental complications, including secondary adentia. It is closely associated with numerous life-threatening pathologies, including atherosclerosis, type 2 diabetes mellitus, and Alzheimer’s disease. A promising direction for developing new treatments for periodontitis is the implementation of approaches successfully used in other fields of medicine in dental practice.
Objective: To analyze and summarize the results of preclinical studies, observational research, and randomized controlled trials of drugs with pleiotropic effects that may positively influence disease mechanisms. Among the potential therapeutic approaches considered are anti-inflammatory agents (monoclonal antibodies, kinase inhibitors, proteasome inhibitors), as well as drugs used ininternal medicine that possess anti-inflammatory, immunomodulatory, antibacterial, antibiofilm, and osteoprotective properties (e.g., metformin, incretinmimetics, pirfenidone, and statins).

This literature review systematizes current approaches to lower limb revascularization, including surgical techniques used in the treatment of critical limb ischemia in patients with multifocal atherosclerotic arterial disease. The study analyzes the criteria for selecting surgical interventions and compares the advantages and disadvantages of interventional treatment methods in patients at high risk of atherosclerotic complications.

Introduction: Multiple organ dysfunction syndrome (MODS) is a common complication and leading cause of mortality in cardiac surgery patients. To date, effective therapeutic methods and preventive strategies for this condition remain undeveloped. Identification of the role of systemic inflammatory response syndrome (SIRS) as a key component in MODS pathogenesis facilitates the development of novel treatment approaches targeting the disease’s pathogenic mechanisms. The use of new pharmacological agents with anti-inflammatory properties as a part of comprehensive MODS therapy may significantly improve treatment efficacy and clinical outcomes in cardiac surgery patients.
Objective: To systematize information on the pathophysiology of MODS, detailing the contribution of SIRS, as well as data on prevention and therapy methods.
Materials and methods: In this study, scientific articles relevant to this topic were analyzed through searches of PubMed, Google Scholar, UpToDate, EMBASE databases. The search for relevant articles was performed using the following keywords: “multiple organ dysfunction syndrome”, “systemic inflammatory response syndrome”, “ischemia/reperfusion syndrome”, “mitochondrial failure”, “endothelial dysfunction”, “inhaled nitric oxide”, as well as their Russian equivalents. Inclusion criteria: relevance to selected review topic; alignment with one of the selected study designs (randomized clinical trials, experimental studies, and previously published literature reviews); studies related to a cohort of cardiac surgery patients. Exclusion criteria: studies focused on clinical observations or single case reports; studies with questionable data or results, as determined by analysis using established protocols (PRISMA, STROBE, SANRA, EQUATOR).
Results: The following aspects were analyzed: the central role of SIRS as a key factor in the development of MODS; the pathogenesis of MODS, including ischemia-reperfusion injury, endothelial dysfunction, and microcirculatory disorders; and a shift in therapeutic focus from strategies aimed exclusively at replacing organ function to preventive approaches and targeted interventions addressing the underlying pathogenetic mechanisms.
Conclusion: Understanding the key aspects of MODS pathogenesis may guide therapeutic progress, by enabling specific targeting of the pathogenetic mechanisms involved in MODS development.

Wound healing is a dynamic and complex biological process involving hemostasis, inflammation, proliferation, and remodeling. While traditional wound care promotes tissue closure, it often results in fibrosis and scarring. Recent advances have identified exosomes – nanosized extracellular vesicles secreted by various cell types – as critical regulators of intercellular communication during wound healing. These vesicles carry a diverse cargo of proteins, lipids, and nucleic acids that modulate immune responses, stimulate angiogenesis, promote extracellular matrix remodeling, and influence cellular behavior across different healing phases. This review provides a mechanistic overview of how exosomes impact the biology of wound healing, from their biogenesis and molecular composition to their functional roles in cellular crosstalk, with a focus on their therapeutic relevance in enhancing regenerative outcomes.