Introduction. Diffuse purulent peritonitis is considered a prevalent and severe pathological condition in clinical practice. The diagnosis and effective treatment of this condition have been subjects of study for decades, yielding certain advancements. Despite these efforts, mortality rates associated with severe forms remain high, varying considerably from 25–29% to 65%. This review analyzes the five-year experience in treating severe forms of diffuse purulent peritonitis at the G.G. Kuvatov Republican Clinical Hospital (Ufa, Russia), highlighting a broad spectrum of etiological factors and identifying the most significant predictors influencing patient outcomes. Aim. This study aims to examine etiological factors contributing to peritonitis and to identify confounders that increase the risk of adverse outcomes. In addition, we determine optimal surgical strategies tailored to specific disease characteristics. Materials and methods. From 2019 to 2023, a total of 121 patients diagnosed with diffuse purulent peritonitis were treated at Department No. 2 (Department of Purulent Surgery) of the Republican Clinical Hospital named after G.G. Kuvatov. The therapeutic approach was guided by the principles of modern purulent surgery, current National Clinical Recommendations, and individualized patient assessment. Results and discussion.The overall mortality rate was 35.54%. The factors influencing treatment outcomes in patients with peritonitis are critical for determining therapeutic strategies and refining prognostic assessments. The Mannheim peritonitis index (MPI) is widely regarded as a reliable tool for assessing the severity of intra-abdominal inflammation; however, some researchers question its universal applicability. Several alternative methods for evaluating peritonitis severity and prognosis are currently available. Conclusion. Female sex, the presence of malignant neoplasms, complicated colonic pathology, fistulas in the proximal gastrointestinal tract, and laparostomy wounds were among the most unfavorable prognostic factors. The MPI correlates with disease severity, with values exceeding 24 serving as a marker for severe peritonitis. Planned relaparotomies for peritoneal lavage remain a valuable approach in treating patients with diffuse purulent peritonitis. The integration of advanced technologies and methods may contribute to improving treatment outcomes in the future.

Introduction. The optimal completion strategy for surgical interventions following resection of the distal colon and proximal rectum in elective and delayed operations remains a subject of active scientific debate, particularly in patients with perifocal abscesses, pelvic inflammatory disease, or inadequate preoperative bowel preparation. Aim. This study aims to compare the outcomes of Hartmann’s procedure, distal colon resection, and anterior resection of rectum with primary anastomosis and protective stoma in patients with the compensated and chronic forms of colonic obstruction, perifocal abscesses, the hypertrophy of anastomosed segments, and unsatisfactory preoperative bowel preparation. Materials and methods. The study included 97 patients. Group 1 comprised 43 patients who underwent Hartmann’s procedure. Group 2 included 54 patients who received either distal colon resection or anterior resection of rectum with primary anastomosis and protective stoma (preoperatively or during surgery). Results and discussion. Postoperative mortality was 2.3% in Group 1 and 1.8% in Group 2. Postoperative complications occurred in 13.9% and 16.7% of cases, respectively. Reconstructive operations were carried out in 79.1% of patients in Group 1 versus 100% in Group 2. Furthermore, Group 1 exhibited a higher incidence of inflammatory complications (21.1%) compared to Group 2 (15.1%). Conclusion. A primary anastomosis with a protective proximal stoma demonstrates comparable rates of anastomotic leakage, inflammatory complications, and mortality to Hartmann’s procedure in patients with colon tumors complicated by compensated intestinal obstruction, perifocal abscesses, and unsatisfactory preoperative bowel preparation (fecal contamination). Furthermore, the reconstructive phase following primary anastomosis is technically less complex and less traumatic, offering reduced surgical complexity and invasiveness.

Introduction. Glioblastoma exhibits high aggressiveness and complex mechanisms of therapy resistance. Tumor necrosis factor receptor-associated protein 1 (TRAP1) participates in metabolic regulation and tumor cell resistance to apoptosis; however, its role in glioblastoma remains understudied. Materials and methods. Glioma cell lines T98G and human brain astrocytes (HBA) were used as controls. TRAP1 expression was suppressed via the lentiviral transduction method using short hairpin RNA (shRNA). Exosomes were isolated from culture medium by ultracentrifugation and subsequently identified by typical markers (TSG101, CD63, and ALIX). The protein-level expression of TRAP1 and key glycolytic enzymes was analyzed by western blot analysis. Cell viability was assessed using the MTT assay, while apoptosis levels were measured using Annexin V-FITC/PI staining. In addition, ATP production was analyzed using bioluminescent methods. Results and discussion. TRAP1 was overexpressed in T98G cells, including in exosomes, while HBA exhibited moderate to low TRAP1 levels. The suppression of TRAP1 in T98G cells resulted in a decrease in glycolytic enzyme expression, an increase in apoptosis, and a decrease in cell viability. TRAP1 overexpression facilitated metabolic reprogramming toward aerobic glycolysis, along with reducing ATP synthesis. Exosomal TRAP1 likely participates in intercellular communication, promoting tumor adaptation to stress and the formation of a pro-tumor microenvironment. Conclusion. These findings support the pivotal role of TRAP1 in regulating metabolic status and maintaining aggressive phenotypes in glioblastoma. The targeted inhibition of TRAP1 may become a promising therapeutic strategy for glioblastoma, aimed at reducing tumor cell viability and limiting metabolic flexibility.

Aggressive and therapy-resistant glioblastoma is among the most lethal malignant tumors in humans. Complete surgical resection is often unachievable; therefore, combination chemoradiotherapy is used to target tumor cells residual beyond the resection margin. This approach induces DNA damage in tumor cells and activates the apoptosis pathway. Unfortunately, recurrence remains a major clinical challenge, frequently manifesting as more aggressive and treatmentresistant glioblastoma phenotypes. The DNA repair and damage response (DDR) pathways are critical for maintaining genome stability. While defects in these mechanisms contribute to oncogenesis, they also make tumor cells vulnerable to DNA-damaging therapy, as the cells become dependent on residual repair capacity. It is of paramount importance to understand the molecular components of these mechanisms and to identify potential therapeutic/pharmacological targets for improving outcomes in glioblastoma patients. A subpopulation of stem-like cells, designated as glioblastoma cancer stem cells (CSCs), has been identified as a critical factor in the initiation, maintenance, and recurrence of tumors. These cells exhibit therapy resistance due to enhanced DNA repair capacity. In addition, emerging evidence suggests a link between carbohydrate metabolism and DNA repair pathways, thereby revealing novel therapeutic vulnerabilities in glioblastoma. This review examines current strategies targeting DNA repair mechanisms in glioblastoma. We present a synopsis of recent advancements in research concerning the mechanisms and factors involved in the elimination of DNA damage induced by ionizing radiation and temozolomide (TMZ). Furthermore, we explore the potential of DNA repair pathway inhibitors under investigation in preclinical and clinical trials.

Triple-negative breast cancer (TNBC) represents one of the most aggressive subtypes of breast cancer, characterized by the absence of key molecular targets including estrogen receptors (ER), progesterone receptors (PR), and HER2. This molecular profile significantly limits treatment modalities, establishing chemotherapy as the definitive treatment. The high rates of recurrences and metastasis, along with the lack of specific targeted therapies, make TNBC a major clinical challenge. This article evaluates critical prognostic and predictive biomarkers of TNBC, including BRCA1/BRCA2 gene mutations, PD-L1 expression, tumor-infiltrating lymphocytes (TILs), circulating tumor cells (CTCs), and circulating tumor DNA (ctDNA). These markers are pivotal for outcome prediction and treatment optimization. Moreover, a transformative approach to TNBC treatment is represented by personalized medicine based on molecular profiling supported by artificial intelligence (AI). The integration of artificial intelligence (AI) facilitates the analysis of substantial data sets, the accurate prediction of clinical outcomes, and the formulation of customized treatment strategies for individual patients. Thus, this article analyzes current data concerning prognostic and predictive markers of TNBC, with a particular emphasis on their clinical utility and the potential for personalized therapy.

In Russia, breast cancer is the most prevalent oncological pathology among female patients, accounting for approximately 22.5% of all cancer cases. Approximately 90% of mortalities associated with this condition are attributed to the metastasis of cancer cells. Consequently, the effective detection of metastases within the regional lymphatic system during breast tumor progression is a critical diagnostic component. In recent decades, methodologies for verifying metastatic regional lymph nodes in breast cancer patients have advanced significantly, demonstrating high efficacy. The identification of sentinel lymph nodes became feasible through the use of various dyes, radioisotopes, and superparamagnetic nanoparticles. Detection techniques for metastatically affected formations include radioisotope lymphoscintigraphy, single-photon emission computed tomography (SPECT) often in combination with computed tomography (CT), and positron emission tomography (PET) typically integrated with CT. The accumulated data enabled an assessment of the advantages and limitations of current diagnostic methods. Radioisotope lymphoscintigraphy offers minimal invasiveness, high accuracy, and a low risk of complications; however, it remains insufficiently safe and cost-prohibitive. The application of superparamagnetic nanoparticles exerts negligible adverse effects on the human body and is characterized by straightforward administration. However, this method remains understudied, with its implementation being limited. Although the SPECT in combination with CT offers high sensitivity, thereby facilitating precise sentinel lymph node localization, it is associated with. exposure to ionizing radiation for the patient and the associated high procedural costs. Published data confirm the significance and efficacy of modern techniques for verifying metastatic regional lymph nodes in breast cancer. Therefore, the optimal diagnostic approaches can be selected, while reducing the invasiveness of mastectomy and lymph node dissection, improving survival rates, and decreasing the probability of recurrence or cancer progression.

This article analyzes 63 scientific works dedicated to the diagnosis of peripheral lung lesions (PLL). The differential diagnosis of PLL poses challenges due to the diversity of underlying pathologies, which may include tuberculoma, cancer, and benign tumors. The absence of a unified diagnostic algorithm often necessitates surgical intervention. Non-invasive methods, including radiography, computed tomography (CT), positron emission tomography (PET), and sputum analysis, exhibit limited diagnostic yield, particularly for small lesions. The combination of fiberoptic bronchoscopy with endoscopic ultrasound (EUS) and transthoracic biopsy enhances diagnostic accuracy; however, they carry risks such as pneumothorax. Video-assisted thoracoscopic surgery (VATS) is an effective modality when biopsies are inconclusive, especially for lesions of less than 3 cm. It ensures high diagnostic accuracy and reduces hospitalization duration. Videoassisted thoracoscopic biopsy offers diagnostic accuracy comparable to that of open biopsy, while exhibiting reduced invasiveness. Conventional thoracotomy remains indicated for large or hard-to-reach lesions. It is recommended that a comprehensive approach combining CT, characterized by high informative value, and PET scan, characterized by high sensitivity and specificity for nodules >10 mm, with invasive methods be used. VATS proves effective for lesions below 3 cm, while thoracotomy is applied to large lesions. An individualized approach remains essential for optimal diagnosis. Despite the advancements, the challenge of differential diagnosis persists.

Introduction. Cutaneous melanoma is a highly aggressive malignancy with a significant risk of metastasis. Current treatment strategies include surgical resection, immunotherapy, and targeted therapy directed at mutations in the MAPK/ ERK pathway, particularly BRAF V600E. Despite the efficacy of dual BRAF/MEK inhibition, the rapid development of drug resistance remains a challenge, prompting interest in combination immunotherapy plus targeted therapy. Aim. This study aimed to evaluate the efficacy and tolerability of triple therapy, involving atezolizumab, vemurafenib, and cobimetinib in patients with BRAF V600 mutation-driven metastatic melanoma following failure of prior lines of therapy. Materials and methods. We present a detailed case report of a patient with metastatic cutaneous melanoma who achieved disease stabilization for 27 months following surgery and first-line therapy with dabrafenib and trametinib. After subsequent progression, second- and third-line therapies with pembrolizumab followed by pembrolizumab and lenvatinib were administered; however, both therapies proved ineffective. Fourth-line therapy with atezolizumab, vemurafenib, and cobimetinib demonstrated a significant clinical response. Results and discussion. Following six months of triple therapy, positron emission tomography/computed tomography (PET/CT) confirmed complete metabolic regression of the previously identified lesions, including those in the intrathoracic lymph nodes and pulmonary metastases. The treatment was well tolerated, with no grade 3–4 adverse events. Conclusion. This clinical case highlights the potential of the atezolizumab, vemurafenib, and cobimetinib therapy in patients with pretreated BRAF V600E-mutated metastatic melanoma. This regimen may benefit patients with acquired resistance to BRAF/MEK inhibitors and immune checkpoint inhibitors. The findings underscore the importance of personalized treatment strategies and the need for further research in this area.

Introduction. Bronchoplastic surgery with the formation of a polybronchial anastomosis in lung cancer allows bilobectomy or pneumonectomy to be avoided. Aim. This study evaluates the results of bronchoplastic surgery with polybronchial anastomosis formation in lung cancer treatment. Materials and methods. The minimum volume standards in surgery for patients in Russia and Kazakhstan are the right lower lobectomy. However, given the bullous changes observed in the right upper lobe and three remaining segments, this approach carries a risk of postoperative complications, including bulla rupture with fistula formation and pleural cavity infection. Consequently, we implemented an organ-sparing treatment strategy, which involved middle lobectomy, S6 segmentectomy, and sleeve resection of the intermediate, lower lobe, and B8 segmental bronchi, accompanied by the formation of polybronchial anastomosis between three bronchi. To prevent the development of bronchopleural fistula, we used a free pericardial fat pad. Results. The postoperative period was uneventful. At the 20-month follow-up, no recurrence was detected. Discussion. Bronchoplastic surgeries offer patients a better quality of life in comparison to pneumonectomy or bilobectomy, while maintaining equivalent recurrence-free survival rates as a radical treatment method. Conclusion. Bronchoplastic surgery is an effective approach for the treatment of lung cancer.

Introduction. Squamous cell carcinoma (SCC) is the second most prevalent form of skin cancer, following basal cell carcinoma. The development of SCC on scarred tissue leads to a more aggressive form of the disease, characterized by a high metastatic potential. Surgical excision remains the primary treatment modality, with advanced reconstructive surgery techniques employed for defect repair. Materials and methods. We present the following clinical case. A 60-yearold female patient exhibited an extensive post-burn scar on her back, which was sustained at the age of fifteen. A clinical examination revealed an infiltrative-ulcerative tumor measuring 27x21 cm located on the right scapular region. The diagnosis was squamous cell carcinoma of the back, stage T3N2M0, clinical stage IVa, group II. Treatment involved tumor excision with the subsequent defect repair using a free split-thickness skin graft. The postoperative period was uneventful. Results and discussion. The free skin graft achieved over 95% uptake, successfully covering the wound surface. Prophylactic lymph node dissection demonstrated no impact on recurrence-free survival in the absence of regional metastases. Conclusion. SCC arising within burn scars tends to exhibit a more aggressive clinical behavior and is often diagnosed at advanced stages. To prevent malignant transformation of burn scars, we recommend meticulous wound care with protection against trauma and early skin grafting. Any alterations indicating a potential malignant transformation warrant excisional biopsy or radical excision. Patients require close monitoring post-treatment for the early detection of metastases.

Introduction. Thyrotoxic states are the result of an overproduction of thyroid hormones. Statistics from Russia indicate an increasing incidence of thyrotoxicosis, with 132 cases documented per 100,000 population in 2018. Diffuse toxic goiter is among the most frequent pathologies associated with thyrotoxic conditions. Hyperthyroidism can also result from toxic thyroid adenomas. Toxic nodular goiter is a condition that can manifest in various ways, including single lobe involvement with a solitary nodule or multiple nodules within one or both lobes. The clinical features of these adenomas encompass local symptoms, including cosmetic concerns, and systemic thyrotoxicosis, which inform subsequent management strategies. Aim. The development of personalized, minimally invasive approaches for treating thyroid neoplasms is driven by the need to preserve functioning organ tissue. Materials and methods. This article details a clinical case involving a patient diagnosed with nodular goiter exhibiting signs of thyrotoxicosis. We developed a combined surgical intervention, involving staged ethanol sclerotherapy followed by radiofrequency ablation of the nodule. Results and discussion. The minimally invasive thyroid intervention resulted in the normalization of hormonal balance, a 7-fold reduction in nodule size, an improvement in quality of life, and the restoration of natural neck contours. Conclusion. The study highlights the potential of interventional endocrine surgery as a means of preserving organ function in patients with toxic nodular formations.

Introduction. Diffuse symmetric lipomatosis (Madelung’s disease) is a rare and poorly understood disorder. This condition is characterized by diffuse proliferation of adipose tissue, leading to significant functional and aesthetic impairments. The documentation of clinical cases is essential to improve understanding of this pathology and formulate efficacious therapeutic strategies relevant to general practitioners, oncologists, otolaryngologists, neurologists, and thoracic surgeons. Aim. This study reports the findings from clinical observation in a 63-year-old patient with diffuse symmetric lipomatosis involving the neck, with intermuscular infiltration and compression of upper airways. We present an example of surgical management and subsequent follow-up care for such patients. Materials and methods. This article reports the treatment outcome of a 63-year-old male patient with substantial diffuse proliferation of adipose tissue in the neck region. The clinical, instrumental, and laboratory investigations included magnetic resonance imaging (MRI), fiberoptic bronchoscopy, fiberoptic laryngoscopy, fiberoptic gastroduodenoscopy, and fine-needle aspiration biopsy (FNAB). The surgical intervention involved open lipectomy with subsequent histopathological examination of the resected tissue. Results and discussion. The patient initially presented with substantial diffuse proliferation of adipose tissue affecting neck mobility and inducing symptoms related to airway compression. MRI revealed systemic benign lipomatosis, without significant cervical or mediastinal lymphadenopathy. The surgical intervention involved the removal of 1,800 grams of adipose tissue through an open lipectomy. In the postoperative period, the patient reported significant improvements in breathing, enhanced neck mobility, and a satisfactory cosmetic effect. However, disease recurrence was observed three years after surgery. Conclusion. This case report confirms the efficacy of open lipectomy as a treatment option for Madelung’s disease, particularly for relieving airway compression symptoms. However, the high risk of recurrence underscores the need for further investigation to formulate long-term management strategies for this condition.