Radical prostatectomy was first performed more than 100 years ago and has since become the gold standard in treatment of localized prostate cancer. Open surgery has been almost entirely replaced by robotic operations referred to as robot-assisted radical prostatectomy (RARP). Th e article introduces the basics of this innovative standard of operative access and tackles medical and historical aspects, oncological, medical and economic management pros and contras of robotic aid over open radical prostatectomy. Surgical trauma in RARP is clearly less pronounced compared to open surgery due to a much earlier postoperative mobilisation and a faster rehabilitation of patients leading to a statistically significant reduction in the length of hospital stay after RARP. Along with advances in intracorporeal imaging with 16-fold optical magnification coupled with shorter urethral catheterisation, RARP facilitates an earlier start of pelvic floor exercises, which reduces postoperative incontinence and need for pain relievers. Th e already mentioned technical advantages of the robotic method hold value to both patient and surgeon by securing instant access for an experienced colleague without interrupting the surgery. Noteworthy, the increasing advancement of robotic systems across the globe is leading urologist surgeons to abandon open operations. A drawback of the robotic method is much higher economic costs. However, greater expenditures may pay off in the long run by shorter hospital stays, faster rehabilitation and fewer complications demanding extra management and care.

Introduction. High incidence of influenza and other acute respiratory diseases is an important medical and social problem. Coronavirus accounts for 4 to 20 % of ARVI cases. In late 2019, the People’s Republic of China experienced an outbreak of a new coronavirus infection with the epicentre in Wuhan. Th e virus spread rapidly across all continents except Antarctica. On 11 March 2020, the spread was declared a pandemic.

Materials and methods. The study reports an assay of 72 cases of treating the new coronavirus infection at the Municipal Clinical Hospital No. 8 for the period of 10.04–18.05.2020. Th e average age was 54.1 ± 16.0 years. In all patients, diagnosis was confirmed by PCR-identifi cation of the SARS coronavirus RNA in nasopharyngeal mucosa smears.

Results and discussion. Asymptomatic infection was confirmed in 6.9 % of cases. In the most severe clinical cases, the level of pulmonary tissue lesion constituted 10–25 %. Medium-severe symptoms were prevailing (62.5 %) and age-dependent in degree. Chronic morbidity aggravates the course of the disease. Timely treatment of surgical pathologies signifi cantly improves prognosis. Th e new coronavirus infection has high mortality rates (27.8 %).

Conclusion. Successful treatment of the new coronavirus infection precludes decompensation of concomitant diseases. Th e new coronavirus infection is hazardous in terms of both contagiosity and mortality rate.

Introduction. Avascular necrosis of the femoral head (AVNFH) is a relatively rare complex disease that occurs in people of working age and leads to disability due to irreversible changes in the aff ected hip joint. Aetiology of the disease has not been reliably established so far.

Materials and methods. Among a total of 42,877 residents of Ufa surveyed, 71 were diagnosed with AVNFH. Patients granted an informed consent to conduct the survey, access the outpatient history of concomitant pathology, perform hip X-ray and laboratory blood tests.

Results and discussion. Th e AVNFH incidence rate was 166 per 100,000 people, with the men to women ratio 1:1.5 and average age of manifestation 50 years. Secondary necrosis was established in 14, and bilateral lesion — in 42 % of cases. A family with hereditary AVNFH (mother, daughter and grandmother) was observed. A significantly higher incidence rate was observed with children in mononational families, which suggests a protective role of crossbreeding against this pathology. In 31 % of patients, the disease manifested atypically resembling lumbago with sciatica, which entailed a late AVNFH diagnosis. Smoking and long-term contact with chemicals were identified as the risk factors, and hypertension, chronic cerebral ischemia, anaemia, hypercholesterolemia and chronic inflammation — as associated disorders. A radiological profi le of the disease is described.

Conclusion. Th e study allowed a precise estimation of the AVNFH incidence rate as 1 per 600 people. Idiopathic AVNFH occurred in 86 % of cases, with smoking and professional long-term contact with chemical agents as associated risk factors. Pedigree studies exposed a low incident rate in ethnically mixed families. AVNFH was shown comorbid with the hypertensive disease in 56 and chronic cerebral ischemia — in 42 % of patients. Atypical lumbago-sciatica-like symptoms in 1/3 of AVNFH cases warrant the need to conduct hip X-ray and MRI in this category of patients.

Background. With numerous extraction protocols for total RNA and RNA fractions, like microRNA (miRNA) and long non-coding RNA (lncRNA), available for various cell and tissue types, obtaining a high quantitative and qualitative yield from some special material, such as the nucleus pulposus, remains challenging. Nucleus pulposus is troublesome to manage in common RNA isolation protocols due to low cell content and high biopolymer concentrations, including proteoglycans and glycoproteins, which impair overall purity and yield. A major lack of reproducible methods for total and fraction RNA isolation directly from the nucleus pulposus impedes effective real-time PCR applications for downstream miRNA and lncRNA expression profiling in the course of intervertebral disc degeneration. In this study, we exploit the collagenase type II lytic properties to facilitate extraction of total and fraction RNA from the nucleus pulposus and compare results with the standard RNA isolation method.

Materials and methods. Nucleus pulposus samples (n = 8) were obtained from September 2017 to December 2018 from patients with herniated discs in the lumbosacral spine diagnosed during surgery. Equal portions of samples were processed with the standard and original RNA isolation protocols.

Results and discussion. Th e enzymatic lysis method for total and fraction RNA isolation from the nucleus pulposus of intervertebral discs demonstrated excellent integrity and high purity. No protein, polysaccharide or collagen contamination was detected.

Conclusion. Th e method reported allows an improved quantitative and qualitative total and fraction RNA yield from the nucleus pulposus of intervertebral discs. Th e method can be used in future research on miRNA and lncRNA expression profiling with real-time PCR by improving the average cycle threshold value.

Neurofi bromatosis type I (NF1) is a common hereditary tumour syndrome with autosomal dominant type of inheritance. Average worldwide incidence rate of NF1 is 1:3000, equal in men and women. Th e disease develops with a heterozygous mutation in the oncosupressor neurofi bromin-encoding gene NF1. No NF1-associated most common mutations have been found, with over 1400 mutations being described along the gene. No clinical and genetic correlations are observed for NF1, and its symptoms may vary considerably within same inheritance group. Typical NF1 manifestations include pigmented patches and multiple cutaneous or subcutaneous neurofi bromas, oft en disfi guring in degree. Pathogenetic therapy for NF1 is not yet developed, whilst surgical tumourectomy may lead to recurrence and new tumour development in other localities on the body. Molecular genetic research on putative interfaces with epigenetic factors and gene expression patterns may open promising future avenues. Further, establishing a marker NF1 mutation in NF1 patients will allow secondary prevention of the disease. A survey of russian NF1-related literature reveals prevalence of individual clinical case descriptions. In the Russian Federation, studies of NF1-associated mutations in gene NF1 originate from Moscow and Bashkortostan, which sets off advancement of Bashkir medical genetics and urges further developments. In Bashkortostan, 10 NF1-associated mutations were described from 16 patients. Th e reported mutations с.1278G>A (p.Trp426Х), с.1570G>A (p.Glu540Lys), с.1973_1974delTC (р.Leu658ProfsX10), с.3526_3528delAGA (p.Arg1176del), с.3826delC (р.Arg1276GlufsX8), с.4514+5G>A, c.5758_5761delTTGA (p.Leu1920AsnfsX7) in the NF1 gene are new to science. Further research into other genes’ and microRNA expression in patients with various clinical manifestations of NF1 should be aimed at discovering its possible involvement in disease pathogenesis.

Colonic diverticulitis poses an adverse medical and social problem for its prevalence, variety of clinical manifestations and complications and is becoming menacing as the people’s life expectancy reaches beyond 80 years. Many of the traditional principles no longer apply. This situation warrants an earlier diagnosis of colonic diverticulitis, its adequate treatment and prevention. The article presents a review of current literature on the conservative treatment of inflammatory colonic diverticulitis. The past 20 years have witnessed a noticeable increase to 20 % of hospitalisation rate with complicated diverticulitis and a higher associated financial burden. We discuss issues in the diagnosis and criteria for diverticulitis severity assessment with laboratory, biochemical data and radiation imaging (computer tomography, magnetic resonance imaging, ultrasound, colonoscopy). A critical overview is provided on anti-inflammatory and antibiotic drug usage in recurrence prevention and treatment of acute and recurrent diverticulitis, aside to recommendations in outpatient care. Despite a manifold of clinical studies and guidelines available, the adequate choice of drugs, dosages and duration of treatment remains an open challenge.

Tissue engineering is a medical science dealing with reproduction of biological tissues and organs. This area of medicine opens avenues for creation of organs and tissues using biomaterials and nanostructures to sustain their development, maintenance and function repair in a living organism. The scope of tissue engineering is an artificial recreation of tissues at the fi nest structural level. Prerequisite requirements are a cell source (a donor), artificial extracellular matrix and growth factor. The first organ, which was extracorporally created and successfully introduced in medical practice, is skin. Recent years have witnessed a major leap in 3D technology for reproduction of biological structures. Increasing attention is being paid towards controlled design and production of 2D–3D structures consisting of biological materials and viable cells, the procedure defined as bioproduction or bioprototyping. Skin substitutes obtained with the bioprototyping technology possess a wide range of medical applications, primarily to compensate for resident skin deficiency in wound healing.

Introduction. In patients with COVID-19, acute pulmonary lesion grows on inflammation and microvascular thrombosis. Thromboinflammation may develop outside alveolar endothelium and affect endothelium of the heart, kidneys, intestine and other vital organs leading to a multiple-organ insufficiency and possible lethal outcomes. Treatment and prevention of SARS-CoV-2 in the Russian Federation should comply with the Interim Methodological Guidelines of the Russian Ministry of Health that support the global mainstream of COVID-19 containment measures and are updated regularly with new evidence on drug effectiveness, including anticoagulants.

Materials and methods. We review a clinical case of effective treatment of a COVID19 patient with prior coronary surgery from the perspective of the Interim Methodical Guidelines of different editions and international clinical experience in anticoagulant therapy.

Results and discussion. A retrospective analysis of the patient’s treatment demonstrated the efficacy of thromboelastography in rapid assessment of blood hypercoagulation and parnaparin sodium as a drug of choice among low-molecular heparins in a combined setting with dual antiplatelet therapy. Etiotropic therapy rendered to this patient is currently considered less effective.

Conclusion. Combination of anticoagulants with antiaggregants is shown effective under high risks of thrombosis and a background COVID-19 infection, if justified clinically. In cases of complicated diff erential diagnosis, selection of optimal management strategy, anticoagulant and/or antiplatelet therapy monitoring, a good practice is to rely on both the available domestic guidelines and latest meta-analyses combined with international clinical experience.

Background. Vaginal sarcomas are rare malignant mesenchymal neoplasms. Incidence rate of vulvar and vaginal sarcomas ranges from 1 to 3%. Vaginal sarcomas are usually represented by leiomyosarcomas in reproductive-age women. More seldom are soft tissue fibrosarcomas, angiosarcomas, malignant fi brous histiocytomas and alveolar soft tissue sarcomas. Tumours induced by prior radiation therapy deserve special concern. In oncogynaecology, radiation therapy is commonly applied in cervical and endometrial cancer therapy. According to some evidence, average development time of a secondary tumour after completion of radiation therapy is 10.8 years. The relative risk of vaginal cancer increases by a factor of 300 after radiation therapy.

Materials and methods. The reported clinical case represents a rare vaginal tumour, angiosarcoma, developed 26 years after radiation therapy for gynaecological cancer.

Results and discussion. A 78 years-old patient underwent combined tumourectomy of the posterior vaginal wall with resection of the anterior rectal wall and application of preventive transversostoma. No postoperative complications were observed.

Conclusion. Surgical treatment is a method of choice with patients of such kind and allows local containment of the disease.

Background. Acute appendicitis is a common emergency surgical pathology, with laparoscopic appendectomy being the “gold standard” in its treatment.

Aim. We report a clinical case of laparoscopic appendectomy with immersive appendiceal stump closure in a patient with vermiform appendix abnormality.

Materials and methods. Patient K. was emergently admitted to the Surgical Hospital of Ekaterininskaya Clinic in June 2019 with a clinical picture of acute appendicitis. Symptoms, disease anamnesis, instrumental and laboratory examinations conformed to acute appendicitis.

Results and discussion. The patient was rendered an emergent surgery. Intraoperative picture corresponded to acute phlegmonous appendicitis with malformation (a wide conical base) of the vermiform appendix. Immersive appendiceal stump closure was chosen as treatment. Alternative opinions coexist on justifying a particular appendiceal stump closure strategy. Immersive treatment is our method of choice in terms of implementation and safety in the particular clinical case. Th is method requires the surgeon’s technical experience.

Conclusion. A clinical case is reported of performing laparoscopic appendectomy with immersive appendiceal stump closure in a patient with vermiform appendix malformation. Despite the appendix abnormality, immersive treatment of the appendiceal stump was justified as safe in this case and entailed no complications in postoperative period.

Introduction. The growth of oncological morbidity and the advent of novel surgery methods to improve quality of life and longevity entail a steady growth of noncardiac surgery in elderly patients. Provided the general aging of the population, an increase in the number of comorbid patients and a growing use of medical implanted devices, the assessment of main risk factors for perioperative complications acquires a higher relevance.

Materials and methods. On the basis of a clinical case of an elderly patient, approaches to perioperative risk assessment; methods for risk factor isolation during the preoperative stage; and the importance of informing the patient about the incurred risk are discussed.

Results and discussion. A postmortem examination established stage IV coronary atherosclerosis of 3rd degree, stenosis of left and right coronary artery lumen to 60–80%, atherosclerotic plaque wall raptures in the left coronary artery with haemorrhage into the base (“unstable plaque”), ischemic myocardial dystrophy, pockets of abnormal myocardial blood flow. Th e conducted analysis of the clinical case, along with a review of existing literature sources and American and European guidelines for cardiac risk assessment in non-surgical patients, demonstrates the need for updating domestic recommendations on perioperative risk assessment. Such a revision should complement the current international experience with the meta-analysis of the prognostic value of stress tests, routine coronary angiography and preventive pre-surgical coronary recanalisation.

Conclusion. It can be concluded that the existing clinical recommendations and risk assessment scales fail to provide immediate solutions to ensure sufficient patient’s safety in the operating room; rather, these documents should only be considered as a vector for decision making in particular clinical circumstances.

Oncology was officially acknowledged as a separate branch of medical science 75 years ago. Historically, it was landmarked by Order No. 323 of the People’s Commissariat for Health of the USSR of April 30, 1945 “On efforts to improve national oncology care”. This decision triggered deployment of a network of oncological institutions that covered almost the entire country in relatively short time and persists today. Aside to rapid revival of existing cancer institutions, new research centres for oncology and radiology, cancer dispensaries and rooms were being set up to gear universal and comprehensive case archival, due-time tumour diagnostics and vocational training, along with manifold other measures to contain cancer. A milestone event was the erection of the Oncological Society in 1954 by the Scientific Council Presidium of the USSR Ministry of Health. The Moscow and All-Union oncological societies contributed greatly to establishment of the Oncology Service and promoted the prestige of Soviet oncology, professional activity in the Union’s republics and overall effectiveness against cancer. Involvement of outstanding scientists, leading oncologists and healthcare decision makers in fostering the Oncology Service cannot be overstated. Today, a progress is made towards understanding the roots of cancer, supply of medical institutions with state-of-the-art equipment, implementation of effective diagnostic and therapy practices. Nevertheless, as yet timely remain further enhancement of preventive medicine, deployment of regional programs for cancer monitoring, education and higher-level professional training, remodelling of diagnostics and care in specialised oncological and primary medical institutions, creation of a unified system for prevention, earlier diagnosis and treatment of cancer.