The effectiveness of a method for preparation of a stromal vascular fraction of adipose tissue mechanically by passage between syringes using disposable adapters as used in regenerative and aesthetic surgery, is discussed. Attention was focused on assessing the lipoaspirate flow parameters for different treatment protocols and different adapter design parameters used in practice. Studies using finite element modeling addressed the effective length and diameter of the adapters.

The review is devoted to modern treatment technologies for wound infection. The majority of studies are devoted to pharmacological and surgical methods. A few reports describe non-drug methods including photo and laser therapy. We analyze the main types of phototherapy for complicated wound infection, mechanisms of action and therapeutic effects.

OBJECTIVE:To evaluate the immediate outcomes and safety of simultaneous Maze procedure in patients with isolated and multivalvular heart disease via right-sided mini-thoracotomy. MATERIAL AND METHODS:A retrospective analysis of postoperative outcomes included 21 patients with various valvular heart diseases and atrial septal defects with atrial fibrillation. All patients underwent heart valve surgery with cryoablation (left atrial, right atrial or biatrial «Maze» approach) via right-sided mini-thoracotomy. RESULTS:There were no unfavorable outcomes. Mean surgery time was 214 min (193; 241), cardiopulmonary bypass time - 116 min (96; 133), aortic cross-clamping time - 90 min (76; 97). Intraoperative blood loss was approximately 500 mL (400; 600). Conversion to sternotomy was required in 1 case (4.8%). In most case (90.5%), length of ICU-stay was 1 day, hospital-stay - 7 days (7; 10). Twenty patients (95.2%) had sinus rhythm at discharge. CONCLUSION:Simultaneous heart valve surgery and Maze procedure are effective and reproducible. This approach is associated with low mortality, preservation of thoracic wall stability, favorable cosmetic results and stable sinus rhythm in 95.4% of patients. Left atrial and biatrial variants of this procedure can be successfully performed depending on the type of atrial fibrillation and specific valve disease.

Obesity, being a global epidemic of the 21st century, increases the likelihood of various diseases and conditions that are associated with increased mortality. Given the risks associated with obesity throughout life, identifying early predictors of its development is a priority task of prevention. OBJECTIVE:Assessment of the prognostic significance of laboratory parameters, functional tests and instrumental examination data for the early diagnosis of obesity and associated metabolic disorders. MATERIAL AND METHODS:The studies were conducted at the Scientific and Clinical Center 1 of the B.V. Petrovsky Russian Scientific Center of Surgery with the participation of 77 patients (43 men and 34 women) aged 33 to 65 years. After signing voluntary informed consent for a special study with the processing of their personal data, all patients underwent a comprehensive clinical, laboratory and functional examination. The study design provided for a three-time examination of patients with an interval of 6 and 12 months. To search for predictors of early diagnosis of obesity and metabolic disorders, we used an algorithm for constructing a mathematical model of multiple regression. The dynamics of the body mass index and the insulin resistance index served as the resulting feature. RESULTS:To build a mathematical predictive model, a matrix of independent variables was formed, including parameters characterizing the biochemical status of patients, the severity of systemic inflammation, body composition, as well as arterial stiffness and vascular condition based on the results of ultrasound duplex scanning of the brachiocephalic arteries. The choice of the most informative set of independent variables that act as predictors provides for achieving the maximum additive effect in explaining the variance of the resulting feature. The construction of the actual mathematical multiple regression model was based on the results of the selection of independent factors carried out using the method of sequential hypothesis testing. As a result of applying the algorithm of sequential hypothesis testing, three independent variables (predictors) were identified to predict the degree of BMI increase and four variables to predict the development of metabolic disorders. The accuracy of the developed model, verified at the final stage of the study, showed its high information content. CONCLUSION:Two clusters of predictors were identified: the cluster of predictors for the risk of obesity development includes the systemic inflammatory response index, the triglyceride-glucose index and the blood leptin level. The cluster of biomarkers of metabolic disorders consists of the atherogenicity coefficient, the blood malondialdehyde level, the systemic inflammation index and the body roundness index.

The epidemic of overweight and obesity, which has reached the proportions of a total crisis in health care in recent years, affects more than 1 billion people worldwide, of whom 2.8 million die annually. The polymodal nature of the pathogenesis of obesity, manifested by the participation of multiple pathological processes, allows us to consider the complex use of physiotherapeutic effects as the most effective therapeutic strategy, the implementation of which allows us to achieve a high clinical result due to the synergistic interaction of therapeutic physical factors. Objective. Development and evaluation of the effectiveness of preventive and personalized technologies based on the predominant use of therapeutic physical factors that have a pathogenetic effect on key patterns of metabolically unhealthy obesity. Material and methods: The studies were conducted at the Scientific and Clinical Center 1 of the Russian Scientific Center of Surgery named after academician B.V. Petrovsky with the participation of 157 patients (89 men and 68 women) aged 30 to 70 years. A prospective, controlled, comparative, randomized study was performed. Using the simple fixed randomization method, all patients were divided into 2 groups: control (77 patients) and experimental (80 patients). In the main group, patients received a course of complex exposure to therapeutic physical factors aimed at correcting their metabolic profile (thermotherapy, oxygen and aromatherapy, vibration massage of the back and lower extremities, relaxation music therapy, pressotherapy, dry carbon dioxide baths and general air cryotherapy). The course of complex physiotherapeutic exposure was carried out twice with an interval of 6—8 months. Patients in the control group did not undergo correction of the metabolic profile. The design of the study provided for a three-fold examination of patients in the main and control groups: before the complex program of physiotherapeutic correction of the metabolic profile, after the first and second courses. Results. Conducting a complex course of physiotherapy had a reliable corrective effect on the parameters of the metabolic profile of patients with obesity, including a reliable decrease in anthropometric indices, improvement of the lipid spectrum of the blood, a decrease in insulin resistance, a decrease in the level of leptin and the severity of sluggish systemic inflammation. Conducting a comparative assessment of the effectiveness of a course of complex physiotherapeutic intervention in the main group compared to the control group, performed using the correlation adaptometry algorithm, made it possible to establish a reliable decrease in the weight of the correlation graph in the main group, which indicates an increase in functional reserves. To implement a personalized approach to the use of a complex of physiotherapeutic interventions, an algorithm for identifying predictor biomarkers that allow predicting the expected clinical effectiveness was used. As a result, informative indicators were identified for predicting the effectiveness of using the developed physiotherapeutic complex to reduce body mass index and insulin resistance. Conclusion. Using the correlation adaptometry method, the effectiveness of using the developed technologies based on the complex use of therapeutic physical factors affecting the main clinical and metabolic manifestations of obesity was proven. The identified predictors of the effectiveness of physiotherapeutic correction of obesity have criterion significance for forming a prognosis of the expected clinical effect at the initial stage (before the start of therapy).

OBJECTIVE:To substantiate the medical device design for mechanical processing of adipose tissue. MATERIAL AND METHODS:Enzymatic method using collagenase and mechanical method for obtaining the stromal vascular fraction (SVF) are compared. The authors emphasized the disadvantages of enzymatic method, such as high cost and duration of process. The main criteria for developing the design were cell viability after processing of adipose tissue and available processing in a minimum number of passages manually without automated mechanical stands. RESULTS:The proposed design allows two unidirectional passages to obtain processed lipoaspirate for SVF harvesting. Experimental studies demonstrate that meshes with a minimum cell size of 100 μm allow high cell viability comparable to enzymatic method. Moreover, this design can be used to develop a disposable medical device. CONCLUSION:Our results will underlie development of a disposable medical device for mechanical processing of adipose tissue.

Degradable ureteral stent not requiring redo procedure for removal is an important issue in modern urology. This device could solve the problem of «forgotten stent» often leading to long-term complications. The authors describe the prototype of biodegradable ureteral stent based on poly(L-lactide-co-ε-caprolactone) and present the first results of its testing. Characteristics of synthesized polymer meet the requirements in medicine. Tests of rod-shaped stent prototypes showed that material has sufficient strength and elasticity. Analysis of stent degradation in artificial urine environment at 37 ºC showed that it retains strength for at least 2 weeks. No suppression of cell growth confirms no cellular toxicity. New material based on poly(L-lactide-co-ε-caprolactone) is promising for development of experimental samples of biodegradable ureteral stents and further in vivo testing.

Rationale: Human aging is accompanied by various somatic diseases that increase the biological age and reduce the period of active longevity. For the development of effective methods of premature aging prevention it is necessary to expand the search of predictors of forming pathological reactions, their system analysis and selection of the factors of influence capable to activate the processes of sanogenesis. Objective. System analysis of pathological changes in various functional systems of the organism, formed in the process of ontogenesis, and evaluation of the effectiveness of the preventive potential of polymodal physiotherapy in terms of preserving the level of health in elderly patients. Material and methods. The studies were conducted on the basis of the Scientific and Clinical Center 1 of the Russian National Cancer Center named after Acad. B.V. Petrovsky with the participation of 80 patients (46 men and 34 women) aged from 20 to 90 years. After signing a voluntary informed consent for a special study with the processing of their personal data, all patients underwent a comprehensive clinical, laboratory and functional examination. Patients were divided into two groups by simple fixed randomization method. The comparison group (n=40) received moderate physical activity, reduced caloric intake and vitamin therapy. Patients of the main group (n=40) additionally received physiotherapeutic complex, which included multimodal influences using Alpha LED Ohu Light-Spa apparatus, hyper-hypoxitherapy, pressotherapy, dry carbon dioxide baths. Preventive courses were repeated twice with an interval of 6 months. All studies were performed before and 6 months after the completion of the preventive course. Results. In the process of aging, disorders develop in various systems of the human body, which leads to an increase in biological age and aging rate, while in women these processes are formed more slowly. Pathological reactions in elderly patients were characterized by disturbances in carbohydrate and lipid metabolism, activation of pro- oxidant and inflammatory reactions, smaller relative telomere sizes. It has been established that the problems preventing active and healthy longevity are formed early enough and preventive measures should be started at a young and early adulthood. In patients of the comparison group, the twofold application of the preventive course had no noticeable favorable effect, moreover, the severity of lipid metabolism disorders even increased. Additional to standard recommendations application of a complex of physiotherapeutic procedures had a pronounced prophylactic effect, which was manifested in reduction of biological age, optimization of carbohydrate and lipid metabolism, reduction of activity of inflammatory reactions. Conclusion. The leading role of metabolic reactions disorders, which are based on insulin resistance, in patients in ontogenesis has been revealed, which leads to the increase of biological age and aging rate. Standard recommendations for the prevention of pathological aging are not effective enough, whereas complex physiotherapy due to polymodality of realization of its therapeutic potential can activate sanogenetic reactions and unlike drugs has no side effects.

Premature aging of a person is caused by many reasons, among which great importance is given to chronic somatic diseases. Their presence is largely accompanied by numerous pathological reactions, which are quite difficult to correct by the use of drugs, which, as a rule, have specific therapeutic effects. At the same time, combined physiotherapy is devoid of these disadvantages and can activate sanogenetic processes. OBJECTIVE:To analyze predictors of pathological manifestations of premature aging and to evaluate predictors of the effectiveness of combined physiotherapy to reduce the rate of premature aging. MATERIAL AND METHODS:The studies were conducted at the Scientific and Clinical Center 1 of the B.V. Petrovsky Russian Scientific Center of Surgery with the participation of 80 patients (46 men and 34 women) aged 20 to 90 years. After signing voluntary informed consent for a special study with the processing of their personal data, all patients underwent a comprehensive clinical, laboratory and functional examination. Using the method of simple fixed randomization, patients were divided into two groups. The comparison group (n=40) received moderate physical activity, reduced calorie intake and vitamin therapy. Patients of the main group (n=40) additionally received a physiotherapeutic complex, which included multimodal effects using the Alpha LED Oxy Light-Spa device, hyper-hypoxytherapy, pressotherapy, dry carbon dioxide baths. Preventive courses were repeated twice with an interval of 6 months. All studies were conducted before and 6 months after the completion of each preventive course. Multiple linear and logistic regression analysis was used to identify predictors. RESULTS:Premature aging processes are associated with the presence of chronic somatic pathology, which disrupts insulin regulation of carbohydrate and lipid metabolism, increases the rate of aging and is accompanied by activation of inflammation processes and a decrease in the relative length of telomeres. Correlation and regression analysis made it possible to isolate the main predictors of premature aging, the regression of which became one of the goals of physiotherapeutic effects on these parameters. It has been proven that the effectiveness of combined physiotherapy increases with more significant disorders caused by the presence of chronic somatic pathology. CONCLUSION:The leading role of insulin resistance in the formation of pathological reactions characterizing premature aging in patients with chronic somatic diseases has been revealed. Analysis of dynamic processes in the use of combined physiotherapy and predictors of its effectiveness allowed us to assume that physiotherapeutic effects have a therapeutic effect to a greater extent than a preventive one.

Given the common risk factors and mechanisms of development, the radical treatment of colorectal cancer in patients with concomitant cardiovascular diseases (CVD) requires the integration of oncologists, cardiologists, and other specialists from related disciplines. For optimal monitoring of onco-cardiology patients, a multidisciplinary approach is required and, accordingly, the creation of professional cardio-oncological teams. The review presents a clinical case of surgical treatment of coronary heart disease and newly diagnosed adenocarcinoma of the ascending colon in a 75‑year-old patient. The features of the management and rehabilitation of the patient at all stages of inpatient surgical oncology treatment in a multidisciplinary surgical clinic are described.

Postoperative pain is a pressing medical problem, as it significantly reduces the quality of life of patients after surgical treatment. Chronic postoperative pain further disables patients and impairs their functional activity. Being a widespread interdisciplinary problem, postoperative pain requires the integration of various pain management methods in complex multimodal pain management in the acute period and treatment programs for its chronicity. The paper examines the possibilities of reflexology methods for the relief of acute and treatment of chronic postoperative pain. Integration of reflex effects from the first days after surgery makes it possible to more effectively and safely solve the problems of acute and chronic postoperative pain.

Life expectancy In Russia in 2023, according to preliminary data, exceeded 73 years, returning to the pre-pandemic level. The increase in life expectancy is associated both with an improvement in the quality of medical care In Russia and with a more responsible attitude towards the health of citizens, which is confirmed by an improvement in the quality of nutrition, a decrease in alcohol consumption and an increase in the number of people involved in sports. At the same time, there are many signs of aging, both cellular and molecular, some of the main ones are genome stability, telomere shortening, epigenetic alterations, impaired proteostasis and nutrient recognition, mitochondrial dysfunction, depletion of the stem cell pool and changes in intercellular interactions, extracellular matrix rigidity, as well as retrotransposon activation and chronic inflammation. For these reasons, in modern healthcare, the tasks of preventing premature aging and treating age-related diseases are becoming priorities.MATERIAL AND METHODS:In total, at the first stage of work (in 2023), we examined 80 people, whose average age was 59.6±0.7 years. When analyzing and assessing data, the study adopted a division into age groups (WHO). The following indicators were studied: HbA1, fructosamine, HDL cholesterol, LDL cholesterol, insulin, homocysteine, C-peptide, TSH, free T4, prolactin, total testosterone, cortisol, arginine, asymmetric dimethylarginine, leptin, TNF-a, ferritin, interleukin 1 and 6, telomere length, creatinine, uric acid and urea.RESULTS:As a result of the study, it was revealed that the aging process of the body affects many indicators, while the main markers that changed in men aged 18 to 44 years were total testosterone, leptin and telomere length; aged 44 to 60 years - HbA1, fructosamine, HDL cholesterol, homocysteine, C-peptide, total testosterone, leptin and telomere length; from 60 to 75 years - fructosamine, HDL cholesterol and telomere length and for 75-90 years - HbA1, HDL cholesterol, insulin, total testosterone, leptin and telomere length, interleukin 6 and uric acid. In women aged 18 to 44 years, only an increase in leptin was observed against the background of shortening telomere length; at the age of 44 to 60 years, the main markers that changed were total testosterone, leptin and telomere length; for the age group 60-75 years - indicators of HbA1, homocysteine, C-peptide, prolactin, total testosterone and leptin, interleukin 6 and uric acid, telomere length was shorter by only 2%; in the age group of 75-90 years, the main markers that changed were insulin, total testosterone, leptin, interleukin 6, while the indicators of uric acid, urea and telomere length differed from the reference values by 2-4%. Shortening of telomere length in all age groups, both men and women, indicates the presence of signs of premature aging. In an individual analysis, data were obtained on a more dramatic shortening of telomeres in 16 subjects in the presence of impaired glucose tolerance and insulin secretion, especially in comparison with healthy subjects, which was confirmed by the data of glycated hemoglobin (HbA1c), while, with shortening of telomere length, the HbA1 indicator was significantly higher (6.8±0.5) than in individuals with long telomeres and no chronic pathology (5.1±0.4).CONCLUSION:A system of highly valid methods and panels of markers has been developed that indicate the presence of aging processes, taking into account gender and age characteristics, which can be used to identify premature aging processes, monitor individual health and maintain active longevity, as well as for the prevention of age-associated diseases.

INTRODUCTION:As a prevention of falls in elderly people with chronic cerebral ischemia, it is necessary to carry out rehabilitation measures with the inclusion of training aimed at improving statolocomotor and cognitive functions, improving proprioceptive sensitivity and reaction speed to external stimuli.AIMS:To compare the effectiveness of inclusion of hardware balance training on Huber («LPG-Systems», France) and C-mill («Physiomed Elektromedizin AG», Germany) simulators in complex postural control rehabilitation programs for elderly patients with chronic cerebral ischemia (CCI).MATERIAL AND METHODS:The study included 48 patients (19 men, 29 women), 81% of whom had moderate cognitive impairment. The median age was 76.2±8.5 years. The median Morse scale score before rehabilitation was 50.2 (CI 74-80). The patients were divided into three groups by randomization method: the patients of the 1st comparison group (n=16) were assigned to the Huber stabilizer; the patients of the 2nd comparison group (n=16) underwent training on the track with BOS-video reconstruction of walking «C-mill»; the patients of the control group (n=16) underwent the course of therapeutic gymnastics according to the developed method. The duration of the course in each group amounted to 8 therapeutic procedures. In the dynamics of the conducted trainings we evaluated: the risk of falls, parameters of postural disorders in statics and dynamics, as well as criteria determining cognitive dysfunction and quality of life of patients.RESULTS:A pronounced improvement of static and dynamic postural indices was observed in the first comparison group, where there was a significant improvement of stabilometric indices: «SL» (p=0.001), amplitude of saggital sway (p=0.014), walking speed (p=0.001) and percentage of hitting the marks (p=0.001). The second comparison group showed significant improvement in dynamic balance parameters: walking speed (p=0.001), stride width (p=0.006), percentage of hitting the marks (p=0.001).CONCLUSION:Training on rehabilitation simulators according to the applied methods contributed to the improvement of fall risk related indicators as well as the effectiveness of improving motor performance in older adults with HIM compared to the control group. However, training on the stable-platform induced more significant clinical effects on both static and dynamic balance.

OBJECTIVE:To analyze the quality of life in patients receiving immunotherapy and overall response rate in case of additional magnetotherapy.MATERIAL AND METHODS:The study included 3 cohorts of patients (n=48) with various disseminated malignancies (melanoma, lung cancer, kidney cancer) who received immunotherapy. In the study groups, all patients additionally took courses of rehabilitation based on magnetotherapy. In the control cohorts, patients underwent courses of immunotherapy without additional magnetic therapy. Treatment efficacy was assessed according to iRECIST 1.1 criteria. The Russian version of the EORTC QLQ-C30 questionnaire was used to study the quality of life. We analyzed adverse events using the CTCAE 5.0 criteria.RESULTS:In patients with melanoma, the most common response to systemic treatment was stabilization (41.7% in the study group and 30.8% in the control group). The objective response rate was higher in the study group (33.3% vs. 23.1%). There was also significant improvement in the quality of life after treatment in the study group (by 23.5%). In the control group, the indicator worsened by 4.8%. Overall health improved by 12.8% in the study group and 10.3% in the control group. In patients with lung cancer, response to systemic treatment with stabilization was achieved in 33.3% of patients in the study group and 20% of patients in the control group. The objective response rate was 33.3% and 20%, respectively. Analysis of the study group revealed improvement of overall health by 9.6% and overall quality of life by 38.6%. In the control group, overall health improved by 4.8% and quality of life remained the same. In patients with kidney cancer, the objective response rate was 40% and 42.9%, respectively. Disease stabilization was achieved in 40% and 28.6% of patients, respectively. Overall health improved by 16.7% and 6.3%, overall quality of life - by 19% and 9.1%, respectively.CONCLUSION:Magnetic therapy during the course of immunotherapy improved the overall quality of life and reduced severity of adverse events. Further study of magnetotherapy as an accompanying rehabilitation technique is required.

Introduction. A modern promising trend in coloproctology is the use of minimally invasive surgical technologies in the surgical treatment of extra- and transsphincteric perianal fistulas, in particular laser technology FiLaC (Fistula Laser Closure). Surgical treatment of patients with extra- and transsphincteric perianal fistulas requires proper routing, stratification of the used methods of surgical treatment, postoperative rehabilitation and dynamic evaluation of the obtained results, including in the long-term period. Purpose of the study. In a comparative aspect, to evaluate the long-term results of surgical treatment of trans- and extrasphincteric perianal fistulas using the standard FiLaC technology and the developed modified FiLaC technology and the use of 2 or 4-component complex programs of physiotherapeutic postoperative rehabilitation. Material and methods. The study included 180 operated patients with trans- and extrasphincteric perianal fistulas, who were divided into two groups depending on the method of surgical intervention. In the 1st group (90 patients), the standard FiLaC technology was used for minimally invasive surgical treatment of fistulas; in the 2nd group (90 patients), a modified FiLaC technology, which provides for the opening of purulent streaks and laser coagulation of the intrasphincteric part of the fistula with a Biolitec laser (power 12 W, 100 J/cm), was applied. Each group was divided into 3 subgroups depending on the postoperative rehabilitation program used: in the 1st (main group), a 4-component program of postoperative rehabilitation was used, in the 2nd (comparison group) — a 2-component program, and in the 3rd (control group), the program of postoperative rehabilitation was not used. To evaluate the results obtained, the authors used a basic set (clinical examination with an assessment of the general condition, laboratory tests, high-resolution anoscopy, examination of the fistula tract with a button probe), additional instrumental methods (transrectal ultrasound (TRUS) with sonoelastometry, examination of the functional state of the rectal obturator), as well as a subjective assessment of the degree of improvement after treatment on the Clinical Global Impression Scale (Srikrishna S., Robinson D., Cardozo L. (2010)) and an assessment of the quality of life according to the SF-36 questionnaire (Ware JE et al. SF-36 Health Survey. Manual and interpretation guide. The Health Institute, New England Medical Center. Boston, Mass. 1993), which allow assessing the dynamics of the patient’s clinical and functional status in the process of rehabilitation, which is an urgent topic of scientific research. Long-term results were tracked over a period of 19 months up to 3 years (median 31 months). Results and discussion. The comparative analysis of the long-term results (up to 3 years), depending on the type of minimally invasive surgical treatment and the postoperative rehabilitation program used, showed that in the group of patients operated on using the FiLaC technology, the majority had good results — 96.7% of patients in the main group, 90,1% in the comparison group and 84% in the control group. In the comparative analysis of the long-term results of treatment (up to 3 years) in the patients with chronic paraproctitis after performing surgery using a modified FiLaC technology under the influence of the developed postoperative rehabilitation programs, it was found that: 59 people (65,5%) had good characteristics, 19 people (21.1%) had satisfactory characteristics, and 12 people (13,4%) had unsatisfactory characteristics. The differences were statistically significant p=0,002, which indicates that the long-term results were statistically significantly better in the main group than in patients of the control group who did not have rehabilitation measures. Conclusions. The obtained results demonstrated the benefits of using the modified FiLaC technology in the surgical treatment of transsphincteric and extrasphincteric fistulas of the rectum, which was confirmed by a 1,3-fold decrease in the incidence of relapses compared with the data obtained using the traditional FiLaC technology. The proportion of relapses in the main group of patients (when using a 4-component program of postoperative rehabilitation) decreased by 5,8 (comparison group) and 16,1 (control group) times, respectively (median observations 31 months), which allows us to recommend the developed modified FiLaC technology and comprehensive postoperative rehabilitation programs for wide introduction into the clinical practice of coloproctologists in the surgical treatment of transsphincteric and extrasphincteric perianal fistulas.

Проблема дисбактериозов сохраняет свою актуальность для мировой медицины. Причем речь идет о значительно замедляющих процессы послеоперационной реабилитации последствиях как бесконтрольного приема антибактериальных препаратов, так и обоснованного применения антибиотиков у хирургических больных. Это предопределяет необходимость стимулирования механизма восстановления микробиоты. В статье представлен наиболее эффективный вариант восстановления нормальной микрофлоры путем использования аутологичных пробиотических штаммов в реабилитационном периоде.