Background. Femoral approach in endovascular surgery remains relevant being, however, associated with the risk of fatal and non­fatal complications. Modern techniques for instrumental haemostasis achieved with the Angio­Seal device (Terumo Corporation, Japan) provide an opportunity to reduce the number of fatal and non­fatal complications. Aim. A multicentre assay of the efficacy and safety of instrumental puncture closure using Angio­Seal devices (Terumo Corporation, Japan) in various settings and clinical situations.

Materials and methods. A multicentre retrospective analysis of 1088 use cases of the Angio­Seal device  (Terumo Corporation, Japan) for “primary” and “complicated” instrumental haemostasis after femoral access  has been conducted for the years 2018–2020. The mean patient age was 62.3 ± 11.6 years, including 845 men (78.0%) and 243 women (22.0%). Five centres for routine and emergency endovascular radiology participated in the study.

Results. The Angio­Seal device (Terumo Corporation, Japan) demonstrated a high method efficiency, with a  97.0% success rate of “primary” instrumental haemostasis (1055 of 1088 total successful haemostatic  procedures) in various clinical settings. Arterial thrombosis at the approach side had a 3.0% complication rate  (5 of 33 observations), all other complication types associated with haemorrhagic events (8 cases) or device malfunction and damage (20 cases).

Discussion. The assay conducted suggests that the incidence of “complicated” instrumental haemostasis  relates to technical drawbacks of the device application that required advance planning. The key identified  prerequisites for a successful Angio­Seal application (Terumo Corporation, Japan) are the alignment of anchor tube­delivery through soft tissue into the vessel lumen and its positioning inside the vessel.

Conclusion. The constructive features and instrumental haemostatic technique realised in the Angio­Seal  device (Terumo Corporation, Japan) enable an effective and safe primary sealing of arterial puncture site in 97% cases.

Background. At the end of 2019, a new coronavirus infection emerged in the People’s Republic of China. On March 11, 2020, the World Health Organization announced the start of the COVID­19 pandemic. During 2018, 2068 patients with malignant neoplasms of the vulva were identified, with the majority of patients aged 75–79 years. Surgical treatment is currently the main treatment method for vulva cancer (VC) patients. According to most authors, surgical treatment is the only method providing good long­term results. One of the approaches to reducing the volume of surgical treatment in such patients is the selective biopsy of the sentinel lymph node (SLN).

Aim. To apply the method of SLN biopsy in VC patients with the purpose of reducing the amount of surgical treatment and surgical complications, as well as shortening hospital stay in the context of the COVID­19 pandemic.

Materials and methods. This paper presents the results of surgical treatment of 19 patients with malignant neoplasms of the vulva. All the patients were at risk for a complicated course of COVID­19 due to age and concomitant pathologies. In 13 cases, vulvectomy with SLN biopsy was performed. SLN biopsy was performed by radioisotope lymphoscintigraphy.

Results and discussion.A decrease in the duration of hospital stay and the absence of surgical complications characteristic of lymphadenectomies were noted.

Conclusion. Reducing the duration of hospital stay in the context of the COVID­19 pandemic is an urgent task. The method of SLN biopsy in patients with invasive squamous cell carcinoma of the vulva with T1A — T2 was found to be effective, allowing the amount of surgical treatment to be reduced. Vulvectomy accompanied by SLN biopsy is the surgical treatment of choice in the context of strict anti­epidemiological measures in the COVID­19 pandemic.

Background. Acute bleeding of parenchymal organs in blunt soft tissue traumas, sharp force injuries, bullet and shrapnel wounds is often life­threatening due to hypoxia combined with haemorrhagic shock. Hypoxia and haemorrhagic shock develop due to a continuous blood outflow from multiple gaping non­contractile blood vessels. A safe and effective organ­preserving surgery in parenchymal haemorrhage has not been developed to date.

Materials and methods. A survey of scientific and patent literature has been conducted on techniques for parenchymal bleeding haemostasis based on topical cooling and heating­aided surgical interventions. Sources were mined in the Espacenet, Google Patent, eLibrary, Google Scholar, Web of Science, Scopus and PubMed databases.

Results and discussion.An original method for parenchymal bleeding arrest was proposed in Russia at the end of the 20th century. The method is based on a safe transverse organ compression at vascular trunk to provide safe ischemia of the injured organ portion and using topical wound heating to trigger blood clotting. The compression is done with a surgical tool usually used for a gentle gastric or gut constriction. Mechanical  compression is applied at a force that ensures a complete constriction of the organ’s blood vessels arresting blood outflow from gaping vessels of the wound. Local hyperthermia of the wound surface is provided by a solid sterile object application with a smooth and slippery surface at +42–45 °C. Ischaemia and heating of the bleeding part of parenchymal organ are halted in 5–15 min. An adequacy criterion for the method is absolute haemostasis.

Conclusion.An immediate arrest of blood supply to the wound surface complemented by heating at +42–45°С untill absolute haemostasis has been shown a sole rapid haemostatic technique effective in all forms of parenchymal haemorrhage. The entire peritoneal surface irrigation with 50% glycerol of pH 7.4 at +37–42 °С is advised to prevent postoperative abdominal adhesions at completion of surgery.

Background. Inhaled administration of antibacterial drugs (ABD) is a new insufficiently studied area of modern pulmonology. Its feasible advantages comprise a targeted drug delivery to the infection site, amplified antibiotic concentration in tracheobronchial secretion and reduced systemic toxicity risks. The most common inhaled ABDs include aminoglycosides and polymyxin­E (colistin).

Aim. A comparison of patient cohorts with severe community­acquired pneumonia induced by Klebsiella pneumoniae receiving and not receiving inhaled colistin.

Materials and methods. The study conducted is a retrospective multicentre controlled non­randomised assay. Among the 45 patients included, 20 were and 25 were not receiving colistin inhalation. The endpoint was survival. Data were analysed with Statistica 6.0.

Results and discussion. The cohorts differed significantly neither in the main clinical and laboratory values, nor in point scoring of severity and outcome. However, statistical significance was obtained for differences in the ALV (p = 0.04) and pneumonia resolution (p = 0.044) times.

Conclusion. Inhaled polymyxin­supplemented therapy for severe community­acquired pneumonia induced by Kl. pneumoniae significantly reduces the ALV and pneumonia resolution times in elderly and senile patients but does not affect survival.

Background. Combined valve lesions affect more than one valve, which may hamper a correct estimation of the individual valve severity. The study aimed to assess the outcome of transaortic mitral valve replacement (TAMVR) in a bivalve replacement procedure.

Materials and methods. A retrospective study was conducted with 19 patients having TAMVR during bivalve replacement. The mean patient age was 58 ± 8.6 years, including 10 male patients. Diabetes mellitus was diagnosed in 3 patients, atrial fibrillation — in 14, coronary heart disease — in 2, chronic obstructive pulmonary disease — in 2, stroke in history — in 1, chronic heart failure stage 3–4 (NYHA) — in 19 patients.  Infectious endocarditis as the disease aetiology was found in 4 patients. Two patients had previous heart surgery. Echocardiography: mean left ventricular ejection fraction 55 ± 7.3 %, mean pulmonary artery pressure 47 ± 13.7 mm Hg, median aortic valve fibrous ring diameter 23 (21–25) mm.

Results and discussion. Mechanical replacement was performed in 12 cases. Median surgery time was 160 (150–185) min, median myocardial ischaemia (MI) time — 67 ± 9.7 min and artificial circulation (AC) time — 87 ± 12.5 min. Resternotomy for bleeding was performed in 2 patients, with median postoperative blood loss  300 (212–587) mL. Early postoperative delirium developed in 4 patients, acute renal failure requiring  haemodialysis — in 1 patient. Stroke, perioperative myocardial damage and conduction disorder requiring pacemaker implantation not observed in postoperative period. Median artificial lung ventilation time (ALV) was 9.5 (6–15) h, ≥24 h — in two cases. One lethal early postoperative case was registered.

Conclusion. TAMVR in a bivalve replacement setting is a safe technique with short AC, MI and surgery times and can be recommended in patients with a wide aortic valve fibrous ring.

Background. One of the main long­term quality criteria for treatment and prevention of echinococcosis is postoperative relapse, which rate varies widely within 3–54% between medical facilities. The genetic traits of recurrent liver echinococcosis comprise an important subject of research into its etiopathogenetic factors for  an effective prognosis of cyst relapse and treatment personalisation.

Materials and methods. Bashkir State Medical University (Ufa, Russia) provided facilities to study targeted  chemoprophylaxis efficacy in a case of relapsed liver echinococcosis with haplotype CYP1A2F1*A/A (AA) and the  UM phenotype of ultrarapid albendazole sulfoxide­to­albendazole sulfone metaboliser.

Results and discussion. The clinical case presented illustrates the rationale behind personalised  chemoprevention of recurrent echinococcosis with albendazole based on genotyping data. Genotyping allows  detection of an ultrafast metaboliser haplotype in blood implicating a rapid degradation of administered albendazole, reduced antiparasitic impact of drug therapy and more feasible relapse, in contrast with a normal metaboliser phenotype.

Conclusion. A successful secondary prevention of relapsed echinococcosis suggests the efficacy of personalising  albendazole­based chemoprophylaxis of recurrent echinococcosis with genotyping data.

Background. Cystic pulmonary hypoplasia is a malformation of terminal bronchial tree as a cystic dilatation of various size at the level of subsegmental bronchi or bronchioles, which accounts for 60–80% of the overall malformation incidence.

Materials and methods. We present a descriptive case of general clinical picture, diagnostic radiological examination and choosing a strategy for surgical diagnosis and treatment of cystic pulmonary hypoplasia. Patient K., 57 yo, was admitted to the Republican Clinical Tuberculosis Dispensary with fibroatelectasis of the right lung lower lobe and underlying subcompensated diabetes type II, inspected by a phthisiatrician, thoracic surgeon and referred for surgical treatment.

Results and discussion. A careful history inspection and X­ray data in most cases suffice to successfully diagnose the congenital type of cystic pulmonary defects. Treatment in such patients is personalised, with preference towards surgical intervention. A correct diagnosis is usually conditioned by a detailed and careful examination of the lung morbid morphology during surgery.

Conclusion. Modern instrumental methods, with multispiral computed tomography in particular, are key to correctly diagnose a malformation. Relevant case reports are of interest and importance to advance research into causative factors of the disease.

Background. Every percutaneous coronary intervention (PCI) is potentially causative of severe surgical accidents. Routine manipulations with catheters, guidewire, delivery systems or stents can damage vascular walls leading to immediate complications like extravasation. In interventional cardiology, ruptures occur in 0.19–0.93% of PCI cases. The endovascular surgeon is to immediately react in case of an accident and decide on further action to  repair the coronary artery rupture.

Materials and methods. The article describes a clinical case of a PCI complication, extravasation type IIICS, during a routine stenting of anterior interventricular artery. Stent­grafting at rapture was decided upon conclusive analysis of the situation.

Results and discussion. A percutaneous coronary intervention, including routine surgery, potentially poses diverse complications. Extravasation is an expectable complication type. The endovascular surgeon must be sufficiently experienced to decide on an appropriate tactics. The outcome of stent­graft implantation was satisfactory.

Conclusion. Stent­graft placement may be a method of choice in a PCI complication of surgery like extravasation type IIICS.

This review paper focuses on the search for innovative directions in the study of COVID­19 viral infection with the purpose of improving the methods of its treatment and vaccination. Thus far, comprehensive data have been obtained on the ability of nonretroviral RNA viruses, including those replicated in the cytoplasm, to integrate fragments of their genomes into the host DNA. This mechanism provided by the reverse  transcriptase and integrase of endogenous retroelements leads to the persistence of nonretroviral RNA viruses  through the expression of viral proteins by the host genome, which may serve as a prerequisite for the survival of such viruses. DNA integration events play a role in the development of both the immunological response and protective antiviral responses through the RNA interference system. These mechanisms may depend on the phylogenetically ancient fossils of nonretroviral RNA sequences in animal genomes. The discovery of SARS-CoV-2 fragments in COVID­19 recovered patients suggests that the pathogenesis of this disease may be associated with the integration of SARS-CoV-2 genome fragments in the human genome by means of proteins of endogenous retroviral elements. This assumption can be confirmed by the data about the development in older patients of predominantly severe forms of COVID­19 with “hyperactive” immune reactions, which normally weaken with ageing. This may be attributed to age­related abnormal activation of  retrocells, which contribute to reverse transcription and integration of exogenous viruses. This assumption is supported by the presence of coronavirus components in the nuclei of infected cells and the change in the expression of LINE­1 in the lung tissue cells of SARS patients. Due to the probable role of retrocells in the COVID­19 pathogenesis, LINE­1 reverse transcriptase inhibitors and targeted therapy using microRNAs may be offered as promising treatments for COVID­19.

Medulloblastomas (MBs) are the most common malignant neoplasms of the central nervous system in children. MB is a persistent disease associated with a high level of morbidity and mortality, thus requiring aggressive therapeutical approaches. Clinical and histological features of tumours are used for their classification and prognosis. Despite significant progress in the study of MB, its molecular basis remains to be fully understood.  MicroRNAs (miRNAs) are short non­coding RNAs (ncRNAs) that function as key regulators of various biological processes, including the development, differentiation, metabolism, proliferation and apoptosis of cells. MiRNAs regulate genes at the post­transcriptional level. Aberrant expression of miRNAs correlates with various cancers. This altered expression may result from mutation, methylation, deletion and amplification of miRNA coding regions. In this review, we discuss the role of miRNAs in MB and their potential use in the diagnosis, prognosis and treatment of this malignant tumour. As a fast­growing field in biomedical sciences, miRNAs studies will revolutionize the treatment of MB.

This review presents data on the predominant mechanisms of metastatic progression of ovarian cancer. The  morphological and functional features of the greater omentum are shown, both promoting the spread of  cancer cells and having an antitumour effect. The ratio of these two mutually opposite properties depends on  the cellular composition, the content of extracellular matrix molecules and the biomechanical properties of the greater omentum during carcinogenesis. Milky spots are the main site of cancer cell implantation. They differ  from lymph nodes in a simpler structure and a unique cellular composition (macrophages, B cells, CD4+ and CD8+ T lymphocytes, other immune cells) changing significantly during metastasis. М2­macrophages,  adipocytes, CD33+ and CD4+ CD25high CD127low Т­suppressors promote migration, invasion, growth and colonization of cancer cells. The majority of the molecules synthesized in the greater omentum during metastasis also stimulate this process. The exceptions are E­cadherin, CXCL10, CXCL11, CXCR3, which inhibit the growth of tumour foci. In addition, CD8+ T lymphocytes and M1 macrophages also have antitumor  effects. Since ovarian cancer is characterized by high mortality, mainly due to metastases, the issue of  optimizing methods for predicting the treatment effectiveness depending on the cellular composition and expression of specific molecules in the milky spots of the greater omentum is urgent. These indicators can be applied in clinical practice using molecular genetic and immunohistochemical methods. In order to determine the need for omenectomy in the surgical treatment of ovarian cancer and to predict the outcome, it is advisable to study the morphological and functional properties of the greater omentum and to determine the number of immunocompetent cells and the nature of the expression of genes associated with the worst prognosis, those encoding activin­A, N­cadherin, CCL23, CD36, CD44, CF­1/M­CSF, FABP4, GRO­α, GRO­β, IL­8, ITGA2, MMP9, TP53, VEGF, VEGFR. These molecules are associated with adhesion and angiogenesis systems that play a key role in metastasis. Promising directions in the therapy of metastatic ovarian cancer can be stimulation of the transition of M2­ to M1­macrophages, activation of the anti­tumour antigen­specific response of CD8+ T cells using phagocytes, adaptive transfer of natural killer cells, the use of inhibitors of Wnt pathways,  CCR1, CD36, FABP4, PAD4, ITGA2.

The prevention of malignant neoplasms in a healthy population is a priority task of national healthcare systems.  Population screening and genetic counselling programmes allow identification of not only precancerous conditions,  but also a genetic susceptibility to tumour diseases. Most hereditary cancers are passed on following an autosomal dominant pattern. Timely screening in healthy individuals, who may be potential carriers of mutated genes, facilitates the development of personalized preventive measures. The history of breast and/or ovarian cancer in  close relatives is an important factor in early detection of genetic mutations in healthy patients, both women and men. The history of breast, ovarian or prostate cancer in close relatives increases significantly the chances of detecting a germinal mutation in the BRCA1 and BRCA2 genes in a proband. Genes associated with an increased risk of developing pancreatic cancer are BRCA1, BRCA2, CDKN2A, PALB2, PRSS1 and STK11. The most common syndromes of genetic mutations increasing the risk of cancer development include hereditary breast and ovarian cancer syndrome, Lynch syndrome, familial adenomatous polyposis, Peutz—Jeghers syndrome and Lee­Fraumeni syndrome, multiple endocrine neoplasia syndrome.