Palliative endobiliary interventions for malignant obstruction of the biliary tract at the planning stage require a multidisciplinary approach with mandatory consideration of all the anatomical features of the block and clinical manifestations of the pathology. Transhepatic stenting requires differentiated use of both the design features of biliary stents and the technology of their implantation and positioning. This article discusses the promise of intraductal ablation, brachytherapy, photodynamic therapy, and external beam radiation, which can prolong biliary stent patency and minimize the need for repeated intervention.

The review examines the organization of specialized medical care for victims having burn injury in Primorsky Region. Thermal injury continues to occupy a significant place in the structure of domestic and industrial injuries in the Russian Federation. Every year, more than 300 calls about patients having thermal damage are received in Primorsky Region TCDM. For five years (from 2017 to 2021), specialists of the Primorsky TCDM made 178 visits to regional medical institutions, 160 seriously burned people were delivered to the specialized department by ground and air transport. There is still a need for round-the-clock collection of medical and sanitary information about the severely burned patients in medical institutions of Primorsky Territory and the organization of interaction with a specialized department. The Regional TCDM organized timely evacuation of patients having deep thermal traumas to the burn unit of FEDMC. It allowed performing surgical treatment tactics, including effective early removal of necrotic tissues. An analysis of appeals to the dispatcher's office of the Territorial Center for Disaster Medicine regarding severe thermal injury, as well as a statistical analysis of victims from remote areas of the Primorsky Territory delivered to the burn department in Vladivostok were conducted. It is emphasized that timely transportation of patients having severe burn injuries is the first step in the system of active treatment of victims which allows conducting early surgical treatment and reducing the number of complications, and improving treatment results.

The article presents modern literature review on arthroplasty of the shoulder joint in complex fractures of the proximal humerus. Anatomical and physiological prerequisites for the selection of hemiarthroplasty (HA) or reversible arthroplasty (RA) as a method of treatment of these fractures are critically evaluated. The essential role of social factors in the formation of a therapeutic strategy is stated. The impossibility of a universal approach in the selection of the method of surgical replacement of the joint in case of severe fractures of the shoulder is pointed out.

Objective: The following study highlights the experimental assessment of carboxy therapy affecting tissue regeneration with the standard IIIB degree burns among rats. All procedures were approved by the bioethics committee. Terminal procedures were conducted in accordance with EU directive on the protection of laboratory animals.
Methods: The present study included 48 female Wistar rats (180-220g, 6-8 weeks old). Animals were obtained from Rappolovo nursery for laboratory animals. Rats were held under normal conditions of light, room temperature and humidity in laboratory vivarium. The animals were divided into two groups control and experimental (n=24). Each group underwent standard burns infliction. Experimental burn was modeled in each group according to standardized research method of the dermatotropic influence of medicines. Experimental group was treated with subcutaneous administration of 0.5 ml medical CО2 3 times in intact area approx. 0.5 cm from the edge of the lesion. In control group burns healed spontaneously. The fixation of the material and the production of micropreparations was carried out using standard histological techniques. Microscopic diagnostics included a semi-quantitative assessment of the tinctorial properties of collagen fibers, measurement of their linear parameters, as well as calculation of the specific area of the microvasculature in the subepidermal area of the regenerate.
Results: After terminal procedures, tissue samples were collected and processed with standard histological protocol. The analysis included tinctorial assessment of the maturity rate of collagen fibers, their linear dimensions as well as assessment of area taken by capillaries in subepidermal region.
Conclusions: Present study showed increased area taken by capillaries in the subepidermal part of the wound in carboxytreated rats compared to spontaneous healing. Collagen fibers reached intact-like structure by 14 days in experimental group, whereas spontaneous heling revealed mature collagen fibers by the day 21. Thus, carboxytherapy demonstrated a potential positive effect on the wound healing through the stimulation of microvasculature in regeneration area.

Objective: The aim of the study was to assess non-professional risk factors for COVID-19 infection in medical workers and predictors of the development of severe clinical forms of the disease.
Methods: The authors developed two online questionnaires to analyze the features of the clinical manifestations of COVID-19 and the impact of various risk factors on the employees of the Ministry of Defense. Questionnaires were filled out by 366 medical workers who had previously had a new coronavirus infection, and 306 employees who were intact for this disease.
Results: When assessing the risk factors for SARS-CoV-2 infection, it was found that factors such as irregular preventive intake of vitamin D and multivitamins increased the risk of infection of employees of the Ministry of Defense by 1.5-2 times. The majority of employees (281 or 76.8%) suffered the disease in the form of acute respiratory infection (ARI) of mild or moderate severity, 23.2% (85 people) had a lesion of the pulmonary parenchyma in the form of interstitial pneumonia. The most severe clinical forms of COVID-19 occurred in employees in the age group older than 40 years, with a body mass index corresponding to overweight (more than 25.0), having chronic diseases of the genitourinary system, diabetes mellitus, and low physical activity.
Conclusions: According to the results of the conducted study, the main clinical manifestations of the new coronavirus infection among medical workers, their severity in various forms of the disease, the leading non-professional risk factors for infection and predictors of the development of more severe clinical forms of COVID-19 were determined.

Objective: The purpose of this study was to analyze the structure of morbidity and the results of treatment of children with EA in the Far Eastern Federal District.
Methods: The retrospective analysis of the annual reports of pediatric surgeons of all 11 regions of the Far Eastern Federal District. Total 46 children with EA were born from 2019 to 2021, 1 child died because of severe comorbidity before surgery, 1 was operated in Moscow. 44 children having A, B, C, D types of EA by Gross were treated by regional surgeons.
Results: 64% of children were boys and 36% - girls, half of the children were born prematurely, every fourth was fed before getting diagnosis. The most common form was EA with lower tracheoesophageal fistula (93%). Combined malformations were found in 60% of cases, the most frequent was cardiac anomaly. Anastomosis was applied in 86% of operated, the rest underwent staged procedures. 81% are alive after applying anastomosis, 33% after coloesophageal replacement. Thoracoscopic AP treatment is widely used in regions having much higher population density than the Far East, but there is a tendency to improve this indicator. As for our district, there are several ways to improve surgical care: concentration of patients of the same profile in one or two regional centers or involvement of leading Russian specialists in providing high-tech medical care.
Conclusions: The peculiarities of the logistics of the region lead to the idea of creating a single Far Eastern multidisciplinary surgical center providing counseling, transportation, diagnostics and treatment of patients with congenital malformations at the modern level.

Objective: To study the state of pulmonary function tests (PFTs) in patients having non-allergic variant of bronchial asthma (NABA) and chronic obstructive pulmonary disease (COPD) either particularly or in combination with diabetes mellitus type 2 (DM2) in the context of the effect of glycemic control on PFTs.
Methods: Such groups of patients as patients having NABA (n=61), patients suffering NABA combined with DM2 (n=20), patients with COPD (n=55); and patients having diagnosed COPD combined with DM2 (n=12) were examined. The blood glucose level was determined by the hexokinase method, the level of glycated hemoglobin was measured using the immunoinhibition method. PFTs were evaluated using spirometry, bronchodilator test, and body plethysmography (MasterScreen SN5112116, CareFusion 234 GmbH).
Results: Statistically significant decrease of VС, FVC, and an increase of Raw in the group of patients with a combination of NABA and DM2 compared with the group having NABA was observed. An increase of Raw in the group with a combination of COPD and DM2 in comparison with the group having COPD was observed. Moreover negative correlations between the parameters of PFTs in different groups and the degree of carbohydrate metabolism disorders were detected.
Conclusions: PFT indexes of patients having obstructive pulmonary pathology on the background of carbohydrate metabolism disorder tend to decrease due to different factors, especially glication of proteins.

Objective: Comparative analysis of the effect of budesonide and low-volume artificial lung ventilation (ALV) on pulmonary volemia, oxygen transport and respiratory biomechanics in patients having cardio-respiratory comorbidity during сoronary artery bypass graft (CABG) with artificial blood circulation (ABC).
Methods: The clinical study included 50 patients having cardiorespiratory comorbidity with a median age of 66 years who were admitted to the clinic of the Far Eastern Federal University for planned CABG in conditions of ABC. The patients were divided into 2 groups by random sampling method. The first group consisted of 25 patients who underwent low-volume artificial lung ventilation (ALV) with inhalation of nebulized budesonide during ABC; the second – 25 patients underwent isolated low-volume ALV during ABC. The study was carried out in three stages: before the start of ABC, after its completion and a day after CABG. Extravascular lung water index (ELWI) and pulmonary vascular permeability index (PVPI) were registered using method of transpulmonary thermodilution. Oxygen transport indicators were determined: oxygen delivery index (DO2I) and oxygen consumption index (VO2I), pulmonary blood bypass fraction (Qs/Qt), oxygenation index (OI).
Results: After turning off ABC in the first group, the ELWI decreased by 23%, in the second group it declined by 8%. Among patients treated with budesonide, PVPI significantly decreased after providing ABC. However among patients of the second group it remained unchanged. DO2I remained in the reference range among all patients. However VO2I was below it with a minimum value in the second group after ABC stopping. In this cohort the level of Qs/Qt was significantly higher, and OI was lower than in patients of the first group. The resistance of the lung tissue decreased on the background of an increase in its compliance among patients who received budesonide immediately after ABC and 2 hours after it. In the second group there was opposite dynamics of these indicators.
Conclusions:The combination of low-volume ALV and inhalation of nebulized budesonide during ABC stabilizes the volemic status of the lungs, improves their oxygenating function and respiratory biomechanics in the postperfusion and early postoperative periods of CABG.

Objective: The aim of the study was to establish the relationship between the effectiveness of chemotherapy (CMT) in case of breast cancer and the risk of recurrence with polymorphism of glutathione-S-transferase (GSTT1, GSTM1) genes.
Methods: The study involved 132 women having breast cancer diagnosed, aged 23 to 79 years (average age 48 ± 13 years). They received chemotherapy treatment (neoadjuvant (NACMT), adjuvant (ACMT)). The detection of deletion (null) genotypes GSTM1 and GSTT1 was carried out using multiplex PCR followed by analysis of the melting curves of the reaction products.
Results: Statistically significant connection between the presence of a null genotype GSTM1-0 and a reduced risk of breast cancer recurrence in patients having stage III BC (RR = 0.721; 95% CI: 0.524-0.992, p = 0.034). At the same time, the precense of GSTT1-0 genotype didn't have statistically significant effect on the risk of recurrence (RR = 0.543; 95% CI: 0.274– 1.077, p = 0.015). However, the tendency of the prevalence of GSTT1 0/0 among patients without recurrnece of breast cancer persisted.
Conclusions: The lack of activity of the GSTT1 or GSTM1 enzymes in carriers of null genotypes can lead to a decrease in detoxification capacity and, accordingly, to a longer circulation of active metabolites of medicine and reactive oxygen species. It prolongs the time of exposure of chemotherapy drugs on tumor cells. The functionally active enzymes may increase the risk of breast cancer recurrence due to rapid elimination of drugs.

Objective: Verification of predictors and forecasting basal cell skin cancer recurrence (BCSC) after conducting photodynamic therapy (PDT) based on machine learning methods (ML).
Methods: The prospective study of 170 patients (117 women and 53 men) was conducted. The median age was 68 years. All patients got PDT treatment on BCSC. Potential predictors of BCSC were analyzed. Primary outcome measure was the fact of tumor development recurrence.
Results: During 4-year observation period the recurrence of the disease took place in 18 cases (10.6% of patients). Processing and analyzing data with the assistance of machine learning methods (ML) allowed to highlight the predictors connected with the development of BCSC recurrence development linearly and non linearly. There are such predictors as: 2nd stage of the process, its morphea-like form, localization in the thoracic cage area, the level of ESR and glucose in the blood. The most accurate forecast of BCSC recurrence was gotten using model based on multiple linear regression (LR). It was proved by high levels of quality indexes (the area under ROCcurve – 0.893, sensitivity – 0.849, specificity – 0.889). Predictive accuracy of the stochastic gradient boosting model (SGB) was less significant.
Conclusions. PDT is an effective BCSC treatment method. It is proved by the results of prospective observation of patients for the period of 4 years. ML methods are an informative tool to verify predictors and forecast BCSC recurrence. Forecasting models based on multiple LR demonstrate much higher accuracy compared with SGB.

Objective: The aim of the study is to objectify and evaluate urodynamic changes in women having urinary incontinence before and after performing synthetic sling operations.
Methods: During the period from 2002 to 2020 104 women were observed (average age 54 years) who underwent trocar synthetic sling surgery. The group under observation included patients with a combined form of incontinence. The main method of urodynamic diagnosis was non-invasive 2-day uroflowmonitoring.
Results: When comparing the data before and after TSS operation the following changes were found: an increase in the minimum capacity and a decrease in the maximum released volume, but together with this, the change in the average effective volume was unreliable. At the same time the structure of urination has radically changed. The indicators of the average value of the maximum flow have decreased and the entire speed profile has changed in general.
Conclusions: Uroflowmetric monitoring makes it possible to identify objectively, adequately and non-invasively the urodynamic disorders in patients with urinary incontinence, which occur both in the preoperative and postoperative periods. According to the neurophysiological model these changes can be explained by the influence of the implant on micturition reflexes.

Objective:To establish age and sex patterns of axial section areas and the volume of the ascending and descending colon in children and adolescents according to the data of intravital imaging.
Methods: On computed tomograms of the abdominal cavity of 75 children and adolescents, divided into 4 groups (early childhood, first childhood, second childhood, adolescence), the areas of axial sections, the height and volume of the ascending and descending colon were determined. The obtained data were subjected to statistical variation processing.
Results: The average value of the index of the areas of axial sections of the ascending colon among the examined patients of the 1st group was 7.0±0.4 cm². It increased in the 4th group up to 11.0±0.6 cm² (p<0.001). The level of this indicator among girls increased from 7.0±1.1 cm² to 10.5±0.6 cm2 (p=0.013), among boys it increased from 7.0±0.5 cm² to 11.5±1.1 cm² (p<0.001). In children of early childhood, the average value of the volume of the ascending colon was 41.5±3.3 cm³. It increased in the 4th group up to 118.4±6.7 cm³ (p<0.001). An increase in the recorded level of this section among girls was from 39.9±6.8 cm3 to 112.3±6.9 cm3 (p<0.001), and among boys – from 42.0±3.9 cm3 to 125.1±11.9 cm3 (p<0.001). The average level of the index of the area of axial sections of the descending colon among all examined increased from the 1st to the 4th group. It increased from 2.5±0.2 cm2 to 4.3±0.4 cm² (p=0.005), in girls – from 2.4±0.2 cm² to 4.0±0.4 cm² (p=0.089), and in boys – from 2.5±0.3 cm² to 4.6±0.8 cm² (p=0.030). The value of the indicator of the volume of the descending colon increased from the 1st to the 4th group from 20.9±2.4 cm3 to 60.4±7.2 cm³ (p<0.001), among girls – from 20.3±0.9 cm³ to 56.2±7.5 cm³ (p=0.017), and among boys – from 21.1±3.1 cm³ to 65.0±12.9 cm³ (p=0.001).
Conclusions: As a result of the conducted research, it was found that there are no sex differences in the morphometric parameters of the ascending and descending colons within the same age group. A reliable increase in the average level of the areas of axial sections of the ascending colon in each age group in comparison with the previous one without dividing by sex was established only among the surveyed children of the second age group in comparison with children of the first age group from 8.0±0.4 cm to 9.4±0.4 cm (p=0.044), among girls – from 7.8±0.5 cm to 9.7±0.6 cm (p=0.032). A significant increase in the average value of the areas of axial sections of the descending colon in each age group in comparison with the previous one wasn’t determined. A significant increase in the indicator of the volume of the ascending colon was found among girls of the second childhood group compared with the examined children of the first age group (p=0.003) and adolescence compared with children of the second childhood group (p=0.042), and among boys of the first childhood group compared with the period of early childhood (p=0.019). A significant increase in the average value of the volume of the descending colon in each age group in comparison with the previous one was determined in children of the second childhood period in comparison with the examined children of the first period from 26.4±2.4 cm³ to 43.5±5.5 cm³ (p=0.005), among boys – from 26.2±3.6 cm³ to 48.8±10.2 cm³ (p=0.027).

The results of modeling acute myocardial infarction on 20 male Wistar rats aged 24 months are presented. Ischemic effect is carried out by local injection of 1.5% sclerosant ethoxysclerol (0.25 ml) into the thickness of the myocardium under general anesthesia using non-traumatic needle with silicone coating, which allows to simulate acute myocardial infarction with minimal invasive effect on the animal's body, minimal trauma, little duration of intervention, low mortality, frequency of complications and absence of systemic action of drugs.

Surgical technique and suture material applied in laparotomic wound suturing are important factors determining the risk of incisional hernias and other wound complications. Optimization of laparotomic wound closure will undoubtedly reduce the frequency of postoperative complications, including incisional hernias and subsequent secondary surgeries in patients. Thus it will improve their quality of life and, in economic terms, significantly reducing the cost of health care resources. Despite the great work carried out in this area by many groups of medical specialists and scientists around the world, today there is no single, generally accepted and proven advantage of the technique for closing a laparotomic wound.

The article presents a clinical case of a staged surgical treatment of a 43-year-old patient with an open intra-articular multi-splintered fracture of the distal femur (33, type C 3.3), complicated by a 5 cm defect of the diaphysial portion of the bone. The injury was gotten in an accident. Primary medical care was provided in Central Distict Hospital (CDH), in the form of primary surgical treatment of an open fracture and skeletal traction. After 3 weeks, the patient was transferred to a level 1 trauma center. There he underwent step-by-step operations using a distal femoral interlock plate and minimally invasive technique for primary osteosynthesis. Subsequently, during the next year, 2 more reconstructive operations were performed with simultaneous elongation of the femur, on a previously installed plate. The result is a complete anatomical and functional restoration of the knee joint and limb supportability.

The article presents clinical observations of surgical treatment of 2 patients aged over 60 years having polyfocal fractures of the proximal humerus on the background of osteoporosis. The patients were operated in the clinic on the basis of the KGAUZ "VKB No. 2". In both cases, the injury was got on streets. Patients fell on a slippery sidewalk. In the first week after the injury, internal osteosynthesis was performed according to the original technique: open reposition and interfragmental compression with a wire loop in combination with fixation of the fracture with a lockable plate for the proximal shoulder. As a result, anatomical restoration of the humeral head and the interrelation of the shoulder joint was achieved. Compression stable osteosynthesis according to the method developed by us allowed patients to begin active rehabilitation in the early postoperative period without risk of secondary displacement. We noted a clear advantage of the developed method of osteosynthesis in comparison with the use of a standard PHILOS-type interlocked plate.

The article presents a clinical case of a rare form of a complicated course of occlusive thrombosis in the inferior vena cava system, namely, blue pain phlegmasia. The detailed course of the disease is shown including all the stages of treatment. The changes of blood parameters at different stages of the disease were mentioned. The performed instrumental methods of investigation were indicated. The analysis of the conducted complex treatment has been carried out.

Lobar emphysema still remains a significant issue of pediatric surgery. It accounts for 14% of all congenital anomalies of the respiratory system. The development of intra-thoracic tension syndrome leads to a critical oxygen supply disorder. The main method of treatment of congenital pathology in case of severe respiratory disorders is operative. However, an unrecognized anomaly of lung development leads to incorrect surgical tactics. A clinical case of surgical treatment of a newborn with lobar emphysema of the lung complicated by intra-thoracic tension syndrome is presented. Video-assisted thoracoscopic resection of the lower lobe of the left lung was performed. Six months after the intervention, a complete restoration of the function of external respiration was detected. Timely full-fledged surgical treatment contributed to the elimination of the cause of the development of an urgent condition in congenital lung abnormality, effective restoration of organ functions and favorable outcome.

Primorsky Region is an epidemic focus of hemorrhagic fever with renal syndrome , where the morbidity is caused by two orthohunts of the Hantaan virus (including its variant Amur) and Seoul. The average long-term morbidity rate in Primorsky Region for 10 years (2011-2020) accounted for 2.7 per 100 thousand people, (in some years up to 4.4 per 100 thousand people). The mortality rate made 3.2% (in 2018 – 9.1%). Distribution of the clinical forms of the disease for the last 10 years showed that moderate form of the disease is prevalent (66%), severe forms accounted for about 30% of all regional cases. A clinical case of severe hemorrhagic fever with renal syndrome, complicated by subarachnoid hemorrhage, gastric bleeding, acute renal failure, rupture of the kidney capsule and encephalopathy with hallucinosis of intoxication genesis is presented. The treatment resulted in the patient's recovery.

The article presents a clinical case of endovascular treatment practice of a patient after carotid endarterectomy complicated by ischemic stroke. It is pointed out that early diagnosis allows well-timed detection of complications in the postoperative period and timely selection of treatment methods. The method of intravascular thromboectomy, which significantly reduces the onset of complications in the first hours after surgery, is described in detail. The tactics of management of patients with acute disorders of cerebral circulation during operations on brachiocephalic arteries are analyzed.