Cardiovascular diseases (CVDs) are one of the most common causes of death in the developed as well as in the developing world. Despite improvements in primary prevention, the prevalence of CVD has continued to rise in recent years. Thus, the issues of molecular pathophysiology of CVD and search for new biomarkers related to early and reliable prevention and diagnosis of these diseases still hold relevance today. New genomic techniques provide innovative tools to solve this problem. A research of the current scientific literature clearly indicates that among transcriptomic biomarkers, micro-ribonucleic acids (miRNAs) are the most promising. The microRNAs (miRNAs) are small (~22 nucleotides) non-coding RNAs which regulate gene expression at the post-transcriptional level via inhibition of the translation of messenger RNA (mRNA) or by inducing the degradation of specific miRNAs. The lack of consensus regarding methodologies used for miRNA quantification is one of the main limiting factors in the application of these transcripts. Various studies have proposed the use of circulating miRNAs as biological markers of the acute coronary syndrome, coronary artery disease, heart failure, arrhythmias, myocardial infarction, etc. MiRNAs are involved in many cellular processes such as proliferation, vasculogenesis, apoptosis, cell growth and differentiation, and tumorigenesis.This review considers the most fully studied and clinically significant miRNAs, which physiological role makes them potential biomarkers for various CVDs.

Background: As the severity of comorbid diseases increases, risks of cardiopulmonary bypass (CPB) complications significantly increase. A complex of the procedure’s damaging factors provokes a systemic inflammatory response that in some cases is accompanied by the damage to target organs, transitioning from chronic organ dysfunctions into acute ones. Some studies on the use of minimal invasive extracorporeal circulation (MiECC) systems show their advantage over conventional extracorporeal circulation (CECC); however, the diversity of MiECC systems, patients, and outcomes precludes us from confidently extrapolating these data to older comorbid patients.Objective: To compare the severity of systemic inflammation and treatment outcomes in comorbid patients who underwent cardiac surgery with CECC and MiECC.Methods: We conducted a retrospective cohort study of 760 patients who consecutively underwent elective cardiac operations in 2019-2022. Inclusion criteria: comorbid status (age-adjusted Charlson Comorbidity Index score of ≥6); CPB time ≥90 min. Exclusion criteria: emergency surgery, refusal to participate in the study. A total of 68 patients met the inclusion criteria. We formed 2 study groups based on the extracorporeal circulation method: CECC group (n = 51) and MiECC group (n = 17). Control points: before CPB and 24 hours after the surgery (lactate; creatinine; oxygenation index, hemolysis level). For systemic inflammatory response markers: 1 hour after the CPB start and 24 hours after the CPB end (interleukin 6; interleukin 10; procalcitonin; C-reactive protein; soluble Triggering Receptor Expressed on Myeloid Cells-1 [sTREM-1]). We evaluated respiratory and renal complications, drainage-related hemorrhages, hemostatic disorders, the need for sympathomimetic drugs, and the length of stay in an intensive care unit and inpatient hospital.Results: Between the groups there were no statistically significant differences in gender and anthropometric characteristics, surgery types, and main perfusion parameters. In the CECC group, we observed significantly higher doses of vasoconstrictors (norepinephrine) as well as a decrease in urine output and lung injury and an increase in lactate and hemolysis. The systemic inflammatory response markers were also significantly higher.Conclusion: Compared with CECC, MiECC does not significantly affect the frequency of organ dysfunctions; however, it reduces the severity of the systemic inflammatory response and immune suppression that are trigger mechanisms for multiple organ dysfunction syndrome. It is particularly important for patients with chronic organ dysfunctions. A range of indications for MiECC systems should be defined given its high cost and off-target effect on pleiotropic factors of systemic inflammatory response development. Received 6 April 2023. Revised 17 August 2023. Accepted 18 August 2023. Funding: The study was conducted within the framework of the research project "Development of minimally invasive and hybrid technologies for surgical treatment of heart diseases". Conflict of interest: The authors declare no conflict of interest. Contribution of the authorsConception and study design: A.Sh. Revishvili, G.P. Plotnikov, V.A. PopovData collection and analysis: R.A. Kornelyuk, L.B. Berikashvili, I.P. Komkov, E.S. Malyshenko, V.M. ZemskovStatistical analysis: L.B. BerikashviliDrafting the article: R.A. Kornelyuk, G.P. Plotnikov, L.B. Berikashvili Critical revision of the article: G.P. PlotnikovFinal approval of the version to be published: A.Sh. Revishvili, R.A. Kornelyuk, G.P. Plotnikov, L.B. Berikashvili, I.P. Komkov, E.S. Malyshenko, V.M. Zemskov, V.A. Popov

Neuromuscular disorders are extremely common in critically ill patients; they significantly affect the recovery time and limit the quality of subsequent life. Until now, it is difficult to assess the presence of such disorders in intensive care units. The presented literature analysis of the current state of the issues of epidemiology, pathogenesis and pathophysiology of critical illness polyneuromyopathy (CIPNM) determines the current directions in the diagnosis and treatment of this pathology

A classification of monocyte subpopulations developed in 2010 with coverage of the immunobiological properties of cells, their functional activity and participation in various pathological processes (inflammatory, cardiovascular diseases, strokes, myocardial infarctions, aortic aneurysms, surgical modification of heart valves, diabetes, burns, etc.). The diagnostic and prognostic aspects of the analysis of monocytic subpopulations are considered. The unique data obtained by the staff of the Gamaleya Institute of epidemiology and microbiology. They consist in the fact that various physical forms of unmodified native type 1 collagen are powder, i.e. crushed bundles of collagen fibers, a hydrogel or a solution of extracellular matrix peptides, as well as a suspension of collagen fibers obtained from a powder, when applied to the surface of acute and chronic and diabetic wounds, bedsores, trophic ulcers, etc., can provide a pronounced anti-inflammatory, reparative, remodulating and regenerative effect on condition of wounds, providing their accelerated healing due to the local accumulation of “regenerative” subpopulations of Mon3 monocytes, which can be most directly used in burn tissue lesions. In this case, the analysis of monocytic subpopulations is of paramount importance. Moreover, possible potentiating effects of additional use in burns under the control of the analysis of monocyte subpopulations of powerful modern pluripotent immunomodulators – polyoxidonium, galavit and their possible combination with local use of collagen preparations are discussed. Finally, we obtained preliminary data indicating the development in burned patients of a deficiency in the absolute and relative content of the most important “patrolling” non-classical subpopulation of CD14+CD16++ monocytes compared with healthy primary (non-professional) donors, which can be a very important finding in the diagnosis and prognosis and substantiation of new methods of treatment of burns.

АКТУАЛЬНОСТЬ: В настоящее время наблюдается увеличение количества пациентов, которые классифицируются как пациенты с хроническим критическим состоянием. Основной причиной данного явления представляется то, что в результате внедрения более современных подходов лечения пациентов снизилась госпитальная летальность, и часть выживших пациентов переходит в категорию пациентов с хроническим критическим состоянием. ЦЕЛЬ ИССЛЕДОВАНИЯ: Целью настоящего обзора является изучение показателей иммунного статуса пациентов с хроническим критическим состоянием. МАТЕРИАЛЫ И МЕТОДЫ: Для поиска статей использованы международные базы данных PubMed и Google Scholar. Использованы запросы: «chronically critically ill patients AND immune», «chronic critical illness AND immune», «persistent inflammation, immunosuppression, and catabolism syndrome AND immune». Поиск ограничен статьями, опубликованными в период с 2012 г. по август 2022 г. Критерии включения: (1) пациенты, которым диагностировано хроническое критическое состояние (ХКС) или синдром персистирующего воспаления, иммуносупрессии и катаболизма (ПИКС); (2) группами сравнения являются хотя бы одна из указанных — пациенты с быстрым восстановлением, здоровые добровольцы; (3) конечными точками исследования являются показатели иммунитета, воспаления и катаболизма; (4) оригинальные исследования. Для оценки достоверности результатов проведена оценка риска систематической ошибки для исследований, включенных в анализ. Инструмент оценки систематической ошибки: ROBINS-E (The Risk Of Bias In Non-randomized Studies — of Exposure). Оценка систематической ошибки проводилась по методу Delphi в 2 этапа тремя исследователями. РЕЗУЛЬТАТЫ: Пациенты с хроническим критическим состоянием имеют иммуносупрессивный статус, который отражается в сниженном уровне HLA-DR и ALC, на фоне более высоких значений sPD-L1 и IL-10. Результаты изучения иммунного статуса пациента в настоящее время имеют высокий и средний риск систематической ошибки, а потому должны рассматриваться как результаты низкого качества. ВЫВОДЫ: Хроническое критическое состояние в настоящее время является малоизученным явлением, с которым периодически сталкиваются врачи отделения реанимации и интенсивной терапии. Вопрос относительно иммунного статуса пациентов с ХКС остается открытым, так как современных данных недостаточно для формирования окончательных выводов. На основании обзора литературы можно утверждать, что требуется дальнейшее проведение проспективных исследований для изучения иммунного статуса пациентов с хроническим критическим состоянием.

INTRODUCTION: Currently, there is an increase in the number of patients who are classified as chronically critically ill patients. OBJECTIVE: The review is aimed at studying the indicators of the immune status of chronically critically ill patients. MATERIALS AND METHODS: PubMed and Google Scholar were used to identify relevant articles. The following 3 searches were performed: “chronically critically ill patients AND immune”, “chronic critical illness AND immune”, “persistent inflammation, immunosuppression, and catabolism syndrome AND immune”. The literature review was limited from 2012 to August 2022. The inclusion criteria were as follows: (1) patients with chronic critical illness (CCI) or persistent inflammation, immunosuppression and catabolism syndrome (PICS); (2) comparison groups are at least one of the specified — patients undergoing rapid recovery, healthy volunteers; (3) parameters of the immune status, inflammation and catabolism are the study endpoints; (4) original articles. To assess the validity of the results, a risk of bias assessment was performed for each study included in the analysis. The risk of bias in non-randomised studies of exposures (ROBINS-E) tool was used. The Delphi method was executed in two rounds by three researchers to assess bias. RESULTS: Chronically critically ill patients with the immunosuppressive status have reduced levels of HLA-DR and ALC and elevated sPD-L1 and IL-10 levels. The results of the studies were rated at ‘high’ and ‘moderate’ risk of reporting bias. Their findings should be considered as low-quality results. CONCLUSIONS: Chronic critical illness is a poorly understood condition that periodically occurs in patients in the ICU. The immune status of chronically critically ill patients is a debatable issue, as the current data are insufficient to draw a definitive conclusion. Based on the systematic review, further prospective trials are required to study the immune status of chronically critically ill patients.

A general nonspecific adaptive reaction, stress developing during the sequential implementation of the stages “anxiety,” “resistance,” and “resolution,” is considered in a limited cohort of patients who died and survived after cardiac surgery with cardiopulmonary bypass. Immune markers of the stress reaction and its ambiguous changes in patients died and discharged from the clinic with improved health are considered. Interesting innovations for changing the condition of patients are found; they can be used for assessing and predicting the outcome of cardiac surgery, as well as for substantiating immunomodulatory therapy in alternative clinical and immunological changes in the state of health.

In patients undergoing cardiosurgical operations under conditions of extracorporeal circulation, continued high-volume controlled hemodiafiltration was used, the content of subpopulations of M1, M2, M3, CD4+ monocytes, and total monocytes was studied in the circulation before surgery and on days 3 and 10 after it. Previously unknown data have been discovered that can be used in the diagnosis and prognosis of cardiac surgery.

Highlights. Maze V significantly reduces the recurrence of AF compared to bipolar RFA for PVI in the short and mid-term period. Aim. To assess the effectiveness and safety of pulmonary vein isolation (PVI) in comparison with Maze V for treating paroxysmal atrial fibrillation (AF) concomitant to coronary artery bypass grafting (CABG). Methods. Medical records of 139 patients with coronary artery disease and concomitant paroxysmal AF were retrospectively analyzed. All patients were divided into two groups: Group 1 patients (n = 71) underwent CABG + bipolar radiofrequency ablation for PVI, and Group 2 patients (n = 68) underwent Maze V + CABG. Propensity score-matched (PSM) analysis with a 1:1 nearest-neighbor matching was done. 30 patients were selected from each group. The exclusion criteria were as follows: emergent CABG, concomitant valvular heart disease, non-paroxysmal AF, decompensation of chronic diseases, and cancer. On-pump CABG was performed at normothermia with warm blood hyperkalemia cardioplegia. RFA for PVI and Maze V were performed before CABG under parallel perfusion without aortic cross-clamping. The primary and secondary endpoints included recurrent AF/atrial flutter, sinus rhythm at discharge and in the long-term period, permanent pacemaker implantation, major cardiovascular and cerebrovascular events. Results. After the PSM analysis, the CABG+Maze V group and CABG+RFA for PVI differed significantly in the duration of surgery (330 [310; 375] vs. 255 [225; 270] min, p = 0.0001), cardiopulmonary bypass time (131 [113; 144] min vs. 89 [74; 98] min, p = 0.0001), duration of AF treatment (53 [44; 59] min vs. 10 [9; 12] min, p = 0.0001). The structure and rate of complications in both groups were comparable. There were no in-patient deaths. Recurrent AF/atrial flutter significantly reduced in the CABG+Maze V group compared to the CABG+RFA for PVI group (13.3% vs. 33.3%, respectively; p = 0.044). Sinus rhythm was restored in all cases. The rate of transient sinus node dysfunction (no more than 5 days) was 6.7% in the Group 1 and 16.6% in the Group 2. The difference did not reach statistical significance (p = 0.128). The 12-months cumulative freedom from AF/atrial flutter without antiarrhythmic drug therapy was significantly higher in the CABG+Maze V group compared to the CABG+RFA for PVI group (97% vs. 83.5%, respectively; p = 0.020). The freedom from MACE in both groups was 96.7%. Conclusion. Maze V for treating concomitant paroxysmal AF prolonged the duration of cardiopulmonary bypass and the surgery itself, but did not affect the postoperative period, indicating its safety and effectiveness. Maze V procedure concomitant to CABG significantly reduced the recurrence of AF compared to RFA for PVI both in the short- and mid-term period. Thus, it is reasonable to perform Maze V+CABG in patients with paroxysmal AF and a high risk of disease progression.

The authors present a 75-year-old patient with renal cell carcinoma and subdiaphragmatic inferior vena cava thrombosis. Renal cell carcinoma stage III T3bN1M0, inferior vena cava thrombosis, anemia, severe intoxication syndrome, coronary artery disease, multivessel atherosclerotic lesion of coronary arteries, angina pectoris class 2, paroxysmal atrial fibrillation, chronic heart failure NYHA class IIa and post-inflammatory lung lesion after previous viral pneumonia were diagnosed at admission. A council included urologist, oncologist, cardiac surgeon, endovascular surgeon, cardiologist, anesthesiologist and specialists for X-ray diagnosis. Stage-by-stage surgical treatment was preferred with off-pump internal mammary artery grafting at the first stage and right-sided nephrectomy with thrombectomy from inferior vena cava at the second stage. Nephrectomy with thrombectomy from inferior vena cava is the «gold standard» for patients with renal cell carcinoma and inferior vena cava thrombosis. This highly traumatic surgery requires not only accurate surgical technique, but also specific approach to perioperative examination and therapy. Treatment of such patients is recommended to be carried out in a highly specialized multi-field hospital. Teamwork and surgical experience are very important. Team of specialists (oncologists, surgeons, cardiac surgeons, urologists, vascular surgeons, anesthesiologists, transfusiologists, diagnostic specialists) harmonizing a single management strategy at all stages of treatment increases effectiveness of treatment.

Highlights. Plasma separation and cytokine hemoperfusion effectively stop cytokine shock, but prolonged extracorporeal therapy in patients with COVID-19 has demonstrated effectiveness in reducing organ dysfunction without significantly affecting extent of lung parenchyma damage.Aim. To assess the safety and efficacy of extracorporeal therapy in patients with COVID-19.Methods. The study included 27 patients aged 67±9.7 [min 38, max 87] years with a laboratory-confirmed SARS-CoV-2 and bilateral polysegmental pneumonia, various concomitant chronic diseases who were admitted to Intensive Care Unit and received extracorporeal therapies. All patients had the mean NEWS score of 6.9±2.7 [min 4, max 9] and the mean SOFA score of 8.1±3.1 [min 3, max 16] at admission to the ICU. 19 patients (70.4%) had severe lung lesions over 75% according to the chest CT scans. 48 extracorporeal therapies were performed using the Multifiltrate (Fresenius Medical Care, Germany) and Aquarius (Nikkiso Aquarius RCA, Great Britain) medical devices. Indications for extracorporeal therapy initiation included cytokine storm associated with acute respiratory distress syndrome and septic shock.Results. Generally, each patient received at least one extracorporeal therapy. 11 patients underwent 2 to 6 sessions. Isolated plasma separation and hemoperfusion helped to reduce vasopressor / cardiotonic support, slightly improved ventilation parameters, with a significant, but not long-term decrease in the levels of inflammation markers. Combining different modalities of extracorporeal therapy that provide rapid elimination of agents, controlled temperature response and hydration, maintaining homeostasis and detoxification, appeared to be most optimal. Extracorporeal therapy did not improve the volume of lung parenchyma or lung parenchyma damage. However, 19 (70.4%) patients who received extracorporeal therapy transitioned from mechanical ventilation to spontaneous breathing, whereas 8 (29.6%) patients had severe lung lesions (over 75%) according to the repeated chest CT scans. The mean length of stay in the ICU among survivors was 9±3.5 [min 4, max 22]. The 28-day mortality and in-hospital mortality rate was 25.9% (7).Conclusion. Prolonged extracorporeal therapy in patients with SARS-Cov-2 has demonstrated efficacy in relieving organ dysfunctions and shock states, but did not significantly affect the remaining lung parenchyma damage.

The timely diagnosis of both sepsis and septic shock can be challenging in severely burned patients. Monitoring methods providing early diagnosis of organ dysfunction development are of great importance. Assessment of the glomerular filtration rate with central hemodynamic parameters can be considered as a component of comprehensive monitoring of effectiveness of septic shock therapy. Aim: to determine the relationship between the target mean arterial pressure and glomerular filtration rate parameters in the treatment of severely burned patients with septic shock. Material and methods. 158 severely burned patients with septic shock were included in the study, of them 121 patients represented a retrospective historical group, and 37 patients constituted a prospective group. The main criteria of treatment efficacy were 28-day and hospital mortality. Results. In the patients of prospective group, 28-days mortality decreased down to 16.2% compared with 33.9% in the retrospective group, and hospital mortality dropped down to 29.7% vs 42.1%, respectively (P<0.05). Conclusion. Extended hemodynamic and metabolic (renal function assessment) monitoring of intensive therapy of severely burned patients with septic shock helps targeted adjustment of fluid therapy and provides earlier beginning of extracorporeal blood therapy thus favoring better survival rate.

The article presents the results of a prospective on e-c enter observational clinical study. The level of therapeutic drug monitoring antibiotics was studied in patients with sepsis. The objective: to assess the impact of pharmacokinetics and pharmacodynamics parameters of the main classes of antibacterial drugs using specific indices to improve the effectiveness of ongoing antimicrobial therapy in patients with sepsis asscoaited with the infectious process with pa n-r esistant nosocomial microflora. Subjects and Methods. A total of 8 patients with sepsis meetiing the criteria of Sepsi s-3 were included. Carbapenems, oxazolidinones, and aminoglycosides were used in the treatment. Concentrations of drugs in blood plasma were studied by hig h-p erformance liquid chromatography with mass spectrometry. Analysis of the effectiveness of treatment was performed on the third day of therapy. Results. The T > MIC index reached 40% of the time interval between the two administrations for MIC for Pseudomonas aeruginosa in only two cases for group II carbapenems. In both cases, high peak concentrations of the drug (19.5 and 35.4 m g/L , respectively) were observed, a low static volume of antibiotic distribution (0.06 l/k g and 0,09 l/k g) and reduced total clearance of the drug (7.18 and 4.11 m l/h r) were noted. The peak concentration of amikacin was low (3.35 m g/l ), while the time to achieve it and the level of static volume distribution (356.5 liters) increased. The peak concentration of linezolid was reduced in all observations and amounted to 4.04 and 3.35 m g/l . The time of its achievement was increased (3.27 and 6.6 hours), the ratio of AU C / M IC was low and made 76.8 and 59.2. The resolution of organ dysfunction and reduction of manifestations of infectious intoxication were noted only in three patients on the third day of observation. Conclusion. Static pharmacokineti c/p harmacodynamic criteria may serve as a guideline for antimicrobial therapy. Limitations in changing the tactics of antimicrobial therapy based on the use instruction nevertheless allow optimizing treatment by controlling the volume of distribution of the drug, presence of renal or hepatic insufficiency that, however, does not guarantee treatment success. The volume of therapeutic drug monitoring of antibiotics sufficient for compilation of static pharmakinetic models, does not meet the requirements of modern intensive care.

Мета. Проаналізувати досвід застосування екстракорпоральних методів лікування пацієнтів з SARS-CoV-2. Методи. Проведено 48 екстракорпоральних процедур 27 пацієнтам з лабораторно підтвердженим SARS-CoV-2, двобічною пневмонією та різними супутніми хронічними захворюваннями. Всі пацієнти мали середній бал за шкалою SOFA 8,1 ± 3,1 [мінімум 3, максимум 16] під час надходження до відділення інтенсивної терапії. 19 пацієнтів (70,4%) мали тяжке ушкодження легенів більше 75% за даними комп’ютерної томографії грудної клітини. Показання до початка екстракорпоральної терапії включали цитокіновий шторм, пов’язаний з гострим респіраторним дистрес-синдромом (ГРДС) і септичним шоком. Отримані результати. В цілому кожен пацієнт пройшов як мінімум одну процедуру екстракорпоральної терапії. 11 пацієнтів пройшли від 2 до 6 сеансів. Ізольоване відділення плазми і гемоперфузія дозволили знизити вазопресорну/кардіотонічну підтримку, дещо поліпшити параметри вентиляції, зі значною виразністю, але не тривалим зниженням рівня маркерів запалення. Найбільш раціональним виявилося поєднання методів, що забезпечують швидке видалення агентів, тривалу корекцію гомеостазу і детоксикацію, контрольовану температурну реакцію і гідратацію. Екстракорпоральна терапія не вплинула на обсяг і виразність ушкодження паренхіми легені. 19 (70,4%) пацієнтів, які отримували екстракорпоральну терапію, були переведені з ШВЛ на самостійне дихання, тоді як 8 (29,6%) пацієнтів мали важкі ураження легень понад 75% за даними повторної комп’ютерної томографії грудної клітини. Середня тривалість перебування у відділенні інтенсивної терапії серед тих, що вижили, склала 9 ± 3,5 [хв. 4 макс. 22]. 28-денна летальність і госпітальна летальність склали 25,9% (7). Висновок. Тривала екстракорпоральна терапія у пацієнтів з SARS-Cov-2 продемонструвала ефективність в корекції дисфункцій органів і шокових станів, але не призвела до значного поліпшення виразності тяжкості пошкодженої паренхіми легені.

Цель – оценить эффективность симультанного хирургического лечения фибрилляции предсердий (ФП) при коррекции митрально-аортальных пороков сердца.

Актуальность. Доказательная база того, что раннее питание безопасно, ускоряет послеоперационное восстановление и повышает комфорт пациентов после операций на желудочно-кишечном тракте, постоянно увеличивается. Но дискуссии, посвященные способам кормления больных после эзофагэктомии (ЭЭ) с одномоментной пластикой пищевода и сроку его начала, длятся последние несколько лет. Опыт, представленный в литературе, обосновывает необходимость дальнейшего изучения этой темы. Данное исследование позволяет сравнить результаты лечения пациентов с ранним пероральным питанием (РПП) и пациентов с поздним началом перорального питания. Цель исследования. Улучшить результаты лечения пациентов после ЭЭ с пластикой желудочной трубкой путем выбора метода нутритивной поддержки в послеоперационном периоде. Материалы и методы. 40 пациентов после ЭЭ с одномоментной пластикой пищевода желудочной трубкой было включено в проспективное рандомизированное исследование. Пациенты разделены на две группы: РПП с 1-го послеоперационного дня (1 ПОД) и группу контроля с парентеральным питанием с 1-х суток и началом перорального приема пищи на 5 ПОД. Проводилось сравнение результатов их лечения. Результаты. Сравнивая результаты лечения обеих групп, мы не установили статистически значимого различия в количестве пациентов с послеоперационными осложнениями в основной и контрольной группах. У пациентов группы РПП отмечалось статистически значимое более раннее отхождение газов — 2 vs 4 (3–5,5) ПОД (р = 0,001) и появление стула — 3 (2–3) vs 4 (2–4,5) ПОД (р = 0,0002). Ранняя активизация и питание, отсутствие пареза кишечника позволили отметить тенденцию к снижению общего времени послеоперационного пребывания в стационаре — 7 (6,5–8,5) vs 8 (7–9) ПОД (р = 0,1). Заключение. Раннее пероральное питание у пациентов, перенесших ЭЭ с одномоментной пластикой пищевода, безопасно и эффективно. Однако его применение в рутинной практике возможно только при условии соблюдения хирургической безопасности и в рамках программы периоперационного обеспечения, включающей все компоненты ускоренной реабилитации.

Scientific achievements of the third millennium -55 -Самооценка здоровья отражает у школьников субъективную сторону состояния здоровья.Каждый третий школьник оценил состояние своего здоровья как отличное или хорошее, 40,6% -как удовлетворительное, а каждый четвертый школьник оценил как плохое, или очень плохое.С возрастом школьников самооценка здоровья становится более высокой: удельный вес выпускников, оценивающих свое здоровье как отличное и хорошее, увеличивается до 59,8%; соответственно уменьшается количество школьников одиннадцатых классов с самооценкой здоровья плохое или очень плохое до 11,6% (

Introduction. Despite increasing trends toward the early initiation of oral feeding after gastrointestinal surgeries, current evidence about feeding patients after esophagectomy (EE) with gastric tube reconstruction has not been convincing. The further research is needed. The present clinical trial aimed to compare the clinical outcomes of early oral feeding (EOF) with late oral feeding following EE with gastric conduit reconstruction. Objectives. To improve the results of treatment of patients after EE with gastric tube reconstruction by choosing the method of nutritional support in the postoperative period. Materials and methods. Forty patients undergoing esophagectomy with gastric conduit reconstruction enrolled in this prospective randomized controlled trial, and were randomly assigned to a group starting EOF on the first postoperative day (POD) and another group that remained nil by mouth and got parenteral feeding until the 5 POD. The clinical and surgical outcomes were compared between the two groups. Results. Comparing the treatment results of both groups, we did not find a statistically significant difference in the number of patients with postoperative complications in the main and control groups. The patients of EOF group had statistically significant earlier gas discharge-2 vs 4 (3–5.5) POD (p = 0.001) and the appearance of stool — 3 (2–3) vs 4 (2–4.5) POD (p = 0.0002). Early activisation and nutrition support, the absence of intestinal paresis allowed us to note a tendency to reduction of the total time of postoperative hospital stay — 7 (6.5–8.5) vs 8 (7–9) POD (p = 0.1). Conclusions. Early oral nutrition in patients who have undergone EE with gastric conduit reconstruction is safe and effective. However, its use in routine practice is possible only if surgical safety is observed and within the framework of a perioperative support program that includes all the components of ERAS protocol.

Scientific achievements of the third millennium -67 -Вывод.Грыжа пищеводного отверстия диафрагмы является состоянием, значительно ухудшающим качество жизни больных.Единственным эффективным способом лечения

Purpose. To assess changes in the degree of pulmonary injury in patients with Sars-CoV-2 after extracorporeal hemocorrection methods (ECHCM).Material and methods. 27 patients with Sars-CoV-2 underwent 48 ECHCM procedures - plasma separation, nonselective cytosorption hemoperfusion, dialysis-filtration techniques. After arriving in the hospital all patients underwent MSCT of the chest organs. The examination was conducted according to the standard protocol of MSCT of the chest organs and reconstruction of soft and high-resolution on a Philips Ingenuity CT 64 multi- detector computed tomograph. The following scanning parameters were used for the standard protocol: 64 × 0.625 collimation, 1 mm reconstruction, 0.5 mm increment. The patient was lying on his back with his arms thrown back behind his head during the procedure. A scan area including the chest was planned by the plan scan. Assessment of the scans was carried out in the Diсom-images viewing module of medical hardware- software complex “ArchiMed” (Med-Ray. Russia, 2004). The percentage of lung parenchyma lesions as well as the severity (CT-1–4) were evaluated according to the recommendations “Radiation diagnosis of coronavirus disease (COVID-19): organization, methodology, interpretation of the results”. CT examinations were compared not earlier than 4 days before ECHCM and not later than 5 days after.Result. With isolated plasmaseparation, the “ground glass” zones passed into the consolidation zones, the total volume of the lesion decreased and the pneumatization increased. In isolated hemoperfusion the dynamics is multidirectional: there are more consolidation zones, less ground glass zones in general, the process is stabilized and the zones of lung tissue damage are reduced. With isolated hemodiafiltration, the consolidation zones decreased, the pneumatization of the lung tissue increased, and subsequently the volume of the lesion and the consolidation zones increased significantly. By combined procedures there are multidirectional dynamics.Conclusion. The effect of ECMGC use on the degree and volume of lung tissue damage in patients with Sars- CoV-2 was not revealed.