Background: During periods of increasing respiratory infections, stratifying patient care for virus-associated lung injury is crucial.

Objective: To develop a prognostic model for the outcome of viral lung injury using machine learning algorithms.

Materials and methods: The study included 295 patients with COVID-associated pneumonia, divided into two groups: 1) deceased (n=78) and 2) survivors (n=217). Data processing was performed using IDE R Studio (Version 4.3.1). The prognostic model was created using potential predictors and machine learning algorithms: multivariate logistic regression, random forest, and stochastic gradient boosting. A 5-fold cross-validation method (KFold) was used. Prediction models for mortality were implemented in Google Colaboratory with Python. Model quality was assessed by metrics such as ROC-AUC and confusion matrix, which provided measures like precision, recall, sensitivity, specificity, and F1-score.

Results: The prognostic outcome model was based on mortality predictors, demonstrating a high level of statistical significance between the predicted groups, with significant predictors including the presence of two or more comorbidities, respiratory failure above grade 2, pronounced myalgia and dyspnea, neutrophil-to-lymphocyte ratio >5.1, a critical decrease in eosinophil count accompanied by elevated ESR, glucose, AST, CRP, urea levels, and decreased hemoglobin (p<0.05).

Conclusion: The mortality risk prediction model developed using machine learning methods, particularly the random forest algorithm (AUC=0.99), demonstrates high accuracy and enables the assessment of mortality risk at hospital admission, guiding management decisions and optimizing treatment strategies.

Objective: To develop high-accuracy neural network model for the diagnosis and prediction of the severity of mitral regurgitation as assessed by echocardiography.

Materials and methods: A total of 80 patients were divided into two groups: Group 1 included 42 patients with an eccentric mitral regurgitation jet, and Group 2 included 37 patients with a central mitral regurgitation jet. All patients underwent transthoracic echocardiography with assessment of mitral regurgitation severity based on the percentage ratio of the regurgitation jet area to the left atrial area. The vena contracta, proximal isovelocity surface area radius, and the magnitude of the horizontal color Doppler expansion artifact were measured. The effective regurgitant orifice area and mitral regurgitant volume were calculated.

Results. A neural network model was developed that predicts “moderate” and “severe” forms of mitral regurgitation based on echocardiography data with highest possible accuracy (100%). The accuracy for predicting the “mild” form was slightly lower (83.33%).

Background: Lung cancer is the most common primary malignant lung tumor. Coronary artery disease (CAD) is the leading cause of death worldwide. In clinical practice, cases of lung cancer complicated by CAD are encountered, which are associated with a high risk of mortality.

Materials and methods: This study analyzed the results of examination, treatment, and follow-up of patients who underwent elective surgery from 01.01.2015 to 01.06.2024. All patients were divided into two groups according to the selected myocardial revascularization method:

•  Group 1: patients with lung tumors who underwent simultaneous surgery (coronary artery bypass grafting + lung resection) (71 patients);

•  Group 2: patients with lung tumors who underwent percutaneous coronary intervention with delayed lung surgery (resection or lobectomy) (94 patients).

Results: Early in-hospital complications were observed frequently in patients after coronary artery bypass grafting than after percutaneous coronary intervention: acute heart failure – 9.86% vs 0%, p=0.02; atrial fibrillation – 15.4% vs 0%, p=0.013; sepsis – 8.45% vs 0%, p=0.004; post-hypoxic encephalopathy – 9.86% vs 0%, p=0.002).

Mortality was observed in the coronary artery bypass grafting group (2 patients) and was not recorded in the percutaneous coronary intervention group; however, did not reach statistically significant difference. During long-term follow-up (6 months to 6 years), mortality due to cancer progression was similarly high in both groups, whereas cardiovascular mortality and ischemic events were comparably low in Groups 1 and 2.

Conclusion: The obtained data demonstrate a higher incidence of various complications in the early in-hospital period after coronary artery bypass grafting, which is associated with the greater invasiveness of the method; however, these features do not affect long-term patient survival.

Objectives: To identify predictors of complications in corrective surgeries in patients with post-traumatic deformities of the lower thoracic and lumbar spine.

Materials and methods: A total of 152 adult patients with post-traumatic deformities of the lower thoracic and lumbar spine were included. The patients were divided into two groups depending on the correction method. Each group was subdivided into two subgroups:

Group 1 (n=64) consisted of patients who underwent staged surgical treatment, which included correction using an external fixation device. It was followed by ventral or dorsal stabilization of the injured spinal motion segments, reconstruction of the anterior column and corporodesis. Depending on whether surgical mobilization of the injured spinal motion segments was performed prior to correction with external fixation, Group 1 was subdivided into subgroup 1.1 (n=46) and subgroup 1.2 (n=18).

Group 2 (n=88) included patients who underwent single-stage surgical treatment involving correction through surgical mobilization of the injured spinal motion segments, transpedicular fixation, anterior column reconstruction, and corporodesis. Depending on the surgical approaches, Group 2 was divided into subgroup 2.1 (n=53) – procedures with combined approaches, and subgroup 2.2 (n=35) – procedures with the posterior approach.

The analysis of factors influencing the incidence of complications included the methods of deformity correction, the complexity of deformities (angular or angulation-translation), the severity of preoperative neurological deficit, the localization of deformity, the duration of surgery, and the volume of blood loss.

Conclusions: In the surgical treatment of post-traumatic deformities with posterior approaches, the most significant predictor of intraoperative cerebrospinal fluid leakage, wound infection, neurological complications, and partial loss of correction is the spondylometric complexity of the deformity with vertebral translation.

In single-stage surgeries performed through combined approaches using the DVD sequence, deformity complexity with a translational component is a predictor of wound infection and respiratory complications.

In posterior approach surgeries, the risk of neurological complications increases in patients with an initial absent or minimal neurological deficit.

For staged treatment of post-traumatic deformities with preliminary repositioning of an external fixation device, no statistically significant predictors of complications were identified.

Objective: To evaluate the frequency and main causes of recurrence following endovenous procedures in patients with varicose vein disease of the lower extremities.

Materials and methods: A retrospective analysis of medical records and outpatient cards of 1,647 patients with varicose vein disease of the lower extremities who underwent endovenous surgery between 2021 and 2025 was conducted. Data analysis was performed using SPSS version 25 and Microsoft Excel.

Results: The recurrence rate within 12 to 36 months after surgery was 3.1% (51 cases). The cumulative recurrence rate increased progressively, reaching 0.18% during the first year, 1.39% during the second year, and 3.1% during the third year. Clinically, recurrences were primarily observed as neoangiogenesis (56.7%) or true recurrent varicose veins (43.1%).

Risk factors for varicose vein recurrence after endovenous procedures included age over 65 years, BMI more than 34 kg/m², a history of type 2 diabetes mellitus (glycated hemoglobin >8%), chronic heart failure of functional class II or higher, the presence of incompetent perforating veins of the thigh and leg, a diameter of functioning tributaries >3 mm in in the thigh and >5mm in the lower leg, the presence of a functioning anterior accessory great saphenous vein with a diameter >3 mm, a Giacomini vein diameter >3.5 mm, a residual stump of the great saphenous vein at the saphenofemoral junction exceeding 1 cm, the exposure power <7 W and laser energy density <80 J/cm², and a great saphenous vein trunk diameter >8 mm.

Conclusion: Identification of the most common risk factors for recurrence of varicose veins after previous endovenous procedures through a comprehensive analysis of clinical, demographic, and instrumental parameters as well as procedural characteristics, allows for the development of a personalized therapeutic approach for each patient and effectively prevents the occurrence of similar complications.

Objective: To investigate the stiffness indices of normal submandibular (SMG) and parotid (PG) salivary glands using two-dimensional (2D-SWE) and point (pSWE) shear wave elastography, and to assess the diagnostic capabilities of shear wave elastography in the differential diagnosis of major salivary gland (MSG) neoplasms.

Material and methods: A retrospective analysis of medical data was performed in 51 volunteers with normal PG and SMG (Group 1) and 77 patients with tumors of the PG and SMG (Group 2). For 2D-SWE, minimum, median, and maximum values, SD (kPa) were analyzed. For pSWE, median stiffness, median shear modulus, and mean shear modulus (kPa) were evaluated.

Results: Statistically significant differences in parenchymal stiffness of normal PG and SMG (p<0.05) were obtained: the median 2D-SWE for normal PG was 36.83 kPa (Q1-Q3:31.92-44.6), the median for SMG was 29.31 kPa (Q1-Q3:26.39-34.94); SD for PG was 13.55 kPa (Q1-Q3:11.63-18.78), for SMG was 11.53 kPa (Q1-Q3:9.73-12.65); median pSWE for PG was 35.52 kPa (Q1-Q3:32.08-43.84), for SMG was 30.34 kPa (Q1-Q3:26.91-36.20); shear modulus pSWE for PMG was 11.84 kPa (Q1-Q3:10.69-14.62), and for SMG-10.02 kPa (Q1-Q3:8.83-11.34). Comparison of 2D-SWE and pSWE data between subgroups revealed statistically significant differences between normal PG and PC tumors (p=<0.0001 for U=350; p=0.0157 for U=601) and between subgroups 1.2/2.2 (p=<0.0001 for U=17; p=0.032 for U=60). No significant differences were observed in the SD of 2D-SWE between normal PG and PG tumor subgroups (p=0.323), or in the minimum 2D-SWE values between normal SMG and SMG tumor subgroups (p=0.68).

Conclusion: Stiffness values in the normal PG are higher than those in SMG (p<0.05). Stiffness differs significantly between benign and malignant PG tumors (p<0.05). Shear wave elastography is not effective for the differential diagnosis of SMG tumors.

Background: Knee osteoarthritis (OA) is a degenerative and complex disease influenced by mechanical, neurological, and psychological factors. Due to its increasing prevalence associated with aging and obesity, it is essential to understand how different types of exercise affect psychological well-being, neurobiological indicators, and cellular oxygenation is essential for optimizing recovery. Objective: To compare the effectiveness of weight-bearing and non-weight-bearing exercises on psychological well-being, neurobiological markers, and cellular oxygenation.

Methods: Eighty volunteers with persistent knee pain (≥3 months) were enrolled in a single-blind randomized controlled trial conducted at the Riphah Rehabilitation Center in Lahore, Pakistan. Participants aged 40 years and older were randomly allocated to two intervention groups. Both groups received baseline treatment, Group A additionally performed non-weight-bearing exercises, whereas Group B performed weight-bearing exercises, including quadriceps strengthening, for a duration of six weeks. Outcomes were assessed using the Depression Anxiety and Stress Scale (DASS 2.1), ELISA, and arterial blood gas analysis to evaluate oxygenation. Data were analyzed using SPSS version 25, with a p < 0.05 considered statistically significant.

Results: Following the intervention, significant improvements were observed in stress, anxiety, depression, BDNF level, and oxygenation in both the weight-bearing and non-weight-bearing exercise groups (p < 0.05). Comparative analysis revealed no significant difference in anxiety between the groups; however, the weight-bearing group demonstrated significantly greater improvements in stress, depression, BDNF levels, and oxygenation (p < 0.05).

Conclusion: Both interventions resulted in improvements in psychological and physiological outcomes among patients with knee osteoarthritis. However, weight-bearing exercises demonstrated greater benefits in terms of neurobiological markers and psychological well-being.

Background: Restoration of the load-bearing function of long bones in the treatment of post-resection defects remains a significant challenge in modern surgery.

Objective: To evaluate early osseointegration of porous titanium and carbon-based implants in a model of long bone defects in immunodeficient mice.

Materials and methods: The study was conducted on 21 male Balb/c Nude mice. The animals were divided into three groups: Group 1 (n=7) control group, in which a femoral bone defect was created; Group 2 (n=7), in which a titanium implant was placed into the defect, Group 3 (n=7), in which a carbon nanostructured implant was placed into the defect. Fourteen days after injury introduction and implant placement, radiographic examination of the femur was performed, and serum levels of alkaline phosphatase, total calcium, and procollagen type 1 N-terminal propeptide (P1NP) in animals were assessed.

Results: Alkaline phosphatase levels in Groups 2 and 3 were higher than those in Group 1 by 1.3-fold (p=0.002) and 1.4-fold (p=0.0002), respectively. Total calcium levels were comparable across all groups, with no statistically significant differences observed. P1NP levels increased in Groups 2 and 3 compared with Group 1 by 5.1% (p=0.002) and 7.8% (p=0.0002), respectively; moreover, P1NP values in Group 3 were 3.4% higher than those in Group 2 (p=0.0035).

Conclusion: The carbon nanostructured material demonstrated superior osseointegration compared with the titanium implant, which was associated with higher circulating P1NP levels.

The article presents a clinical case of a 65-year-old female patient with stage IV adenocarcinoma of the right lung harboring an EGFR-mutated (L858R). The key feature of this case is the sequential modification of targeted therapy: initial stabilization with osimertinib, transient progression with associate complications during Gefitinib therapy, and subsequent restoration of disease control following reintroduction of osimertinib. A comprehensive palliative care approach is described in detail, including repeated thoracenteses, long-term pleural drainage, and supportive therapy aimed at symptom control and maintenance of the patient’s functional status. This case highlights the importance of integrating palliative interventions into oncological practice from the early stages of treatment, as well as the advantages of original targeted agents in overcoming tumor resistance.

Objective: Surgical treatment of patients with concomitant cardiovascular disease, abdominal aortic aneurysm, and renal tumor presents a significant clinical challenge due to the increased complexity of procedures. The use of simultaneous surgical treatment employing robotic technologies represents a minimally invasive and optimal approach that reduces the risks of intraoperative and postoperative complications and positively influences therapeutic outcomes.

Clinical case: Patient M., 73 years old, was admitted for elective surgical treatment to the Department of Vascular Surgery at the State Budgetary Healthcare Institution “Scientific Research Institute – Ochapovsky Regional Clinical Hospital No. 1” in April 2025. According to the medical history, in October 2024, he experienced an episode of ischemic stroke in the territory of the anterior cerebral artery (October 20, 2024), resulting in an ischemic lesion in the right cerebral hemisphere (parietal and frontal lobes). In December 2024, he was hospitalized in the Department of Vascular Surgery, where multislice computed tomography (MSCT) revealed critical bilateral stenosis of the internal carotid arteries. Subsequently, the patient underwent staged procedures (December 26, 2024 and January 24, 2025): glomus-sparing carotid endarterectomies of the left and right common, external, and internal carotid arteries, respectively. MSCT performed on December 2, 2024, also revealed an abdominal aortic aneurysm without signs of dissection or rupture, classified as a type 2 according to A.V. Pokrovsky’s classification, as well as a right renal tumor.

Following a multidisciplinary consultation involving cardiovascular surgeons, urologists, anesthesiologists-intensivists, interventional radiologists, and cardiologists, a combined robot-assisted surgical treatment was considered. Due to the specific anatomy of the aneurysm neck, the endovascular techniques for correcting abdominal aortic aneurysm was impossible. The patient was recommended to undergo a simultaneous robot-assisted procedure, including resection the aneurysmal segment of the aorta, implantation of an aortic graft, and nephrectomy with tumor removal.

The surgery was performed in April 2025. The total duration of the procedure was 370 minutes, with an estimated intraoperative blood loss of approximately 200 mL. The patient was extubated 120 minutes after completion of the operation directly on the operating table and was subsequently transferred to the intensive care unit.

On the second postoperative day, the patient was mobilized and transferred from the intensive care unit to a general ward. By the eighth postoperative day, he was stabilized, and discharged home in stable condition. Histopathological examination confirmed a diagnosis of highly differentiated clear cell renal cell carcinoma, nuclear grade 1, with complete excision achieved within the boundaries of healthy tissue.

Objective: To demonstrate the advantages of using a modified aesthetic surgical approach in performing modified radical neck lymph node dissection and thyroidectomy in a patient diagnosed with papillary thyroid cancer.

Case report: A clinical case of surgical treatment of a 47-year-old female patient who was admitted to the Scientific Research Institute – Ochapovsky Regional Clinical Hospital No. 1 with an confirmed diagnosis of papillary thyroid cancer, staged сT1N1bM0. The disease was detected during a medical examination of the population and confirmed by ultrasound and cytology results.

An ultrasound examination revealed characteristic features of papillary thyroid cancer with the presence of metastases in the regional lymph nodes on the left and focal changes in both thyroid lobes (TI-RADS 3-5). Fine-needle aspiration biopsy of the thyroid nodules and cervical lymph nodes confirmed the diagnosis of papillary thyroid carcinoma with metastasis to the left cervical lymph node.

Surgical intervention was performed to remove the primary tumor and regional metastases, including total thyroidectomy, central neck lymph node dissection, and a left-sided type III modified radical neck dissection through an incision along the midline cervical fold. The surgical approach provided optimal conditions for performing a radical procedure while enabling reconstruction of the soft tissue structure of the neck, minimizing cosmetic defects and preventing potential complications.

Conclusion: Extensive surgical interventions in aesthetically significant areas performed through standard approaches may sometimes negatively affect long-term cosmetic and functional outcomes. The proposed surgical approach, integrating principles of oncology, plastic and reconstructive surgery, systematizes experience from these disciplines to develop the most effective therapeutic strategies for complex cases, in which improving quality of life is a primary objective.

Unruptured cerebral aneurysms are detected in 3–5% of the adult population. Aneurysm rupture results in intracranial hemorrhage, with a mortality rate of approximately 45% and disability in about 30% of cases. Risk assessment scales for rupture of unruptured aneurysms (UCAS, ISUIA, PHASES, UIATS, ELAPSS) were developed to guide treatment strategy; however, their practical application has revealed a systematically underestimation of hemorrhage risk. In particular, a meta-analysis of more than 1,500 cases of aneurysmal hemorrhage demonstrated that 50–80% of the observed aneurysms had initially been classified as low risk, indicating significant limitations of current rupture risk assessment tools and highlighting the need for the development of dynamic models to predict hemorrhage probability that account for changes in clinical status and aneurysm morphology over time.

The presented clinical case of middle cerebral artery aneurysm management illustrates the necessity to transform current approaches to determining treatment strategies for unruptured aneurysms.

Renal cell carcinoma is one of the most common oncourological malignancies and is associated with high mortality. Approximately 120,000 new cases of renal cell carcinoma are diagnosed worldwide each year, accounting for nearly 2% of the global cancer incidence.

Tumor thrombosis of the inferior vena cava develops in 25-30% of cases and represents a life-threatening condition. According to current clinical guidelines, nephrectomy with thrombectomy is indicated in these patients as a radical surgical procedure or as a cytoreductive procedure within a multimodal treatment strategy. Analysis of surgical outcomes and perioperative management in patients with renal cancer complicated by “high-level” tumor thrombosis of levels III and IV (according to the Mayo Clinic classification) is critically important for improving treatment outcomes in this challenging patient population.

The patient’s initial general condition (tumor-related intoxication, anemia, hyperazotemia, venous thrombosis of the lower extremities, along with comorbidities) and the extent of surgical intervention determine a high risk of complications (up to 93%) and in-hospital mortality (up to 10%). Preoperative risk assessment and careful preoperative preparation are essential for the safe surgical intervention and early rehabilitation.

Currently, there are no universally accepted management algorithms for patients with tumor thrombosis of the inferior vena cava, and existing recommendations are largely general and do not consider the patient’s clinical condition or the specifics of the surgical intervention. The review aims to integrate current data on the pathophysiological features of the disease, perioperative complications, methods for their prevention and treatment in order to develop individualized approaches to patient management.

Background: Robot-assisted radical nephrectomy with inferior vena cava (IVC) thrombectomy for renal cell carcinoma (RCC) is a complex intervention whose development requires evaluation in comparison with the traditional open method.

Objective: To evaluate the efficacy, safety, and technical features of robot-assisted radical nephrectomy (RARN) with IVC thrombectomy.

Materials and methods: A systematic literature search was conducted in databases (PubMed, Google Scholar, eLibrary) from 1987 to 2025 using keywords related to RCC, IVC tumor thrombus, and robot-assisted surgery.

Conclusion: The review demonstrates that RARN with IVC thrombectomy is a feasible and safe alternative to open surgery, providing comparable operative time while offering significant advantages: reduced intraoperative blood loss, frequency of blood transfusions, overall complication rate, and length of hospital stay. Implementation of the method requires a multidisciplinary approach, highly qualified surgical team, and careful patient selection. Further multicenter prospective studies are necessary for final confirmation of efficacy and standardization of the technique.

This review examines the use of spider-silk-based materials in regenerative medicine. Spider silk possesses a unique combination of mechanical and biological properties, making it a promising biomaterial for tissue engineering. An analysis of in vivo studies in animal models and the first clinical trials is presented, demonstrating the ability of spider silk to direct cell growth, accelerate wound healing, and promote peripheral nerve regeneration. The prospects for large-scale production of spider silk and its medical applications are discussed.

Background: The annually increasing number of surgical procedures worldwide makes the issue of adequate perioperative fluid therapy controversial. In the operating room, patients are exposed to various anesthetic and surgical factors, while their hemodynamics constantly change due to surgical trauma, blood loss, and other factors. Therefore, the question of the necessity of intraoperative fluid therapy remains particularly critical.

Objective: To analyze various methods for assessing a patient’s volume status and predicting their response to fluid therapy.

Materials and methods: The publication search was conducted independently by two researchers using databases and electronic libraries, including PubMed (MEDLINE), Cochrane Library, Google Scholar, and eLibrary. Following the selection process, the 40 most informative publications were identified, which formed the basis of this review.

Results: This review describes static hemodynamic parameters, functional tests (mini-fluid challenge, passive leg raise, and end-expiratory occlusion test), and dynamic diagnostic methods (pulse pressure variation, systolic pressure variation and stroke volume variation, inferior vena cava collapsibility index, left ventricular outflow tract velocity time integral, respiratory variation of peak systolic velocity, corrected carotid flow time, and internal jugular vein distensibility index). Numerous studies have demonstrated the superior predictive value of dynamic methods compared to static parameters; however, no universal diagnostic method currently exists.

Conclusion: The search for the optimal combination of methods to assess a patient’s volume status and predict their response to fluid therapy remains a subject for further research.

Exoprosthetic rehabilitation based on the use of osseointegrated implants is considered the most optimal method of restorative treatment for finger amputations. One of the main factors hindering its further development is the excessive brevity and fragmentation of information in specialized literature concerning the use of osseointegrated implants in exoprosthetics. This ultimately results in a lack of information on this issue among medical professionals and, consequently, in poorer rehabilitation outcomes in patients with finger stumps amputations.

A search of publications from the Russian Science Citation Index (RSCI), Cochrane, Scopus, and Web of Science databases was conducted for the past 10 years. The types and designs of osseointegrated implants for exoprosthetic replacement of lost fingers are presented. Existing technologies for the placement of osseointegrated implants and the functional assessment of exoprosthetic outcomes are reviewed. Potential risks of complications are evaluated. Promising directions for further research and development are highlighted.

The article focuses on the specific design features of nonclinical studies (NCS) of in vivo gene therapy medicinal products which involve the administration of vectors with recombinant nucleic acids into the patient’s body for the correction of genetic disorders and treatment of oncological diseases. This work highlights the key aspects of conducting pharmacokinetic and toxicological studies, identified through the analysis of expert reports from global gene therapy medicinal products manufacturers. These aspects include dose selection and route of administration; identification of specific studies applicable to all in vivo gene therapy medicinal products and the justification of study lists for products using different types of vectors; as well as duration of studies and the selection of appropriate models to demonstrate product safety and to detect potential adverse effects associated with their use.