Background. Cardiorenal syndrome is one of the most common comorbid associations in the framework of cardiovascular pathology and plays a significant, both medical and socio-economic role. Type II cardiorenal syndrome is an association with a cascade of mutually aggravating processes leading to irreversible processes, significantly affecting the prognosis for the patient. The most important task in understanding this problem is an early immunological assessment of the risk of decompensation. Therefore, much attention is paid to the use of modern marker proteins in this issue.

The aim. Analyze modern literature sources on the use of new immunological cytokines for early diagnosis of type II cardiorenal syndrome progression.

Materials and methods. A non-systematic literary review was conducted, including 106 sources of domestic and foreign literature published in the period from 2011 to 2026. The search was conducted in the leading databases: MEDLINE, Embase, PubMed, RSCI and eLibrary. Key terms such as "cardiorenal syndrome", "chronic kidney disease", "chronic heart failure", "inflammation", "comorbidity", as well as their combinations were used. 53 sources were selected for the analysis, represented by literary reviews, meta-analyses and original research. Based on the results of the review, three key groups of proinflammatory cytokines were identified, their diagnostic and prognostic properties were analyzed.

Results. For additional diagnosis of cardiorenal syndrome, in addition to general inflammatory markers such as C ‒reactive protein, interleukins, tumor necrosis factor – α, it is necessary to study markers regulating the processes of secondary (pathological angiogenesis): vascular endothelial growth factor type A, thrombospondin type 1, angiopoietin type 2, pentraxin ‒ 3, as well as markers regulating the deposition of collagen followed by the formation of tissue fibrosis: serum amyloid component P, galectin ‒ 3, transforming growth factor beta ‒ 1.   

Conclusion. Early immunological diagnosis of the progression of cardiorenal syndrome is an important preventive task in the practical management of such patients. The study of new immunological cytokines is of important scientific and practical interest.

Background. Non-bacterial thrombotic endocarditis is a disease with sterile vegetations on cardiac valves, typically associated with malignancy, antiphospholipid syndrome and inflammatory diseases such as systemic lupus erythematosus. Differential diagnosis with infective endocarditis is important due to the different approaches to therapy.

The aim. To analyze the data of literature on diagnosis of non-bacterial thrombotic endocarditis, diagnostic tools, including transthoracic and transesophageal echocardiography, differential diagnosis with infective endocarditis and therapeutic approaches.

Results. Non-bacterial thrombotic endocarditis is a severe condition that requires timely diagnosis and management. Vegetations are a characteristic feature, unlike infectious endocarditis, they are sterile and represent deposits of fibrin and platelets on the valves. The vegetations are usually friable and embolization is common presentation of these disease. The clinical presentation of this disease involves embolic events and valvular complications, generally regurgitation. The diagnosis is primarily based on echocardiography. The sensitivity of transesophageal echocardiography is higher than that of transthoracic echocardiography.  It is necessary to exclude infectious endocarditis using comprehensive microbiological and serological studies and polymerase chain reaction. Anticoagulant therapy should be initiated in all patient promptly upon the diagnosis of non-bacterial thrombotic endocarditis.

Conclusion. The identification of valvular vegetations via echocardiography in patients with malignancy, autoimmune diseases, antiphospholipid syndrome who are at an elevated risk for non-bacterial thrombotic endocarditis and have no infection serves as a salient indication in support of a diagnosis of non-bacterial thrombotic endocarditis. Anticoagulant therapy is indicated for this disease.

Background. Patients with obesity are at a high risk of developing surgical site infection after spinal surgery due to inadequate concentrations of systemic antibiotics in adipose tissue and technical difficulties of the procedure.

Aim. To evaluate the role of local application of vancomycin powder in reducing the incidence of surgical site infection during transpedicular fixation in patients with obesity.

Materials and methods. A prospective controlled non-randomized study in two sequential cohorts was conducted. The study included 112 patients with body mass index over 35 kg/m² who underwent elective transpedicular fixation of the lumbar spine. The control group (n=56) received standard prophylaxis (intravenous cefazolin 2 g). The intervention group (n=56) additionally received 1 g of vancomycin powder topically during surgery. The primary endpoint was the incidence of deep surgical site infection within 180 days.

Results. The incidence of deep surgical site infection was 25.0 % (14/56) in the control group and 14.3 % (8/56) in the vancomycin group (odds ratio 0.50; 95 % confidence interval: 0.19–1.30, p=0.15). Topical vancomycin significantly reduced the incidence of early (within 30 days) deep infections from 17.9 % to 5.4 % (p=0.04). The rate of superficial surgical site infection did not differ between groups (12.5 % vs. 8.9 %, p=0.54). No statistically significant increase in acute kidney injury (1.8 % vs. 3.6 %, p=0.56) or clinically significant seromas (1.8 % vs. 3.6 %, p=0.61) was observed. Vancomycin resistance was detected in 25 % of pathogens causing deep surgical site infection in the intervention group.

Conclusion. Topical application of vancomycin powder during transpedicular fixation in patients with obesity is a safe method that significantly reduces the incidence of early deep surgical site infection. Large randomized trials are needed for definitive recommendations.

Background. Currently, there are no models for predicting 7-day mortality after vascular reconstruction for use in frontline medical settings.

Objective: To develop and validate a multivariate prognostic model for 7-day mortality after vascular reconstruction for gunshot wounds to peripheral arteries.

Materials and Methods: This retrospective cohort study included 71 patients (male, 32.4 ± 7.6 years) undergoing surgery from January 2025 to May 2026. The primary endpoint was 7-day mortality. LASSO regularization, Bayesian logistic regression, Bayesian network, random forest with SHAP interpretation, dose-response analysis with cubic splines, and Monte Carlo sensitivity analysis were used.

Results. Mortality was 7.0% (5/71), all cases in the mine blast injury group (19.2%). LASSO selected 6 predictors. AUC was 0.964 (95% credible interval 0.921–0.993), C-index was 0.958. Nonlinear thresholds were identified: time to reperfusion >2.4 h (p=0.004) and lactate >12 mmol/L (p=0.011). A metabolic fatality index (lactate × time) >45 in mine blast injury resulted in 100% mortality.

Conclusion. The model has high discrimination and excellent calibration. The threshold effects of ischemia and lactatemia were confirmed. A metabolic fatality index >45 in combination with mine blast injury is an absolute predictor of mortality.

Background. The choice of revascularization strategy for gunshot wounds to major arteries remains subjective. The lack of precise intraoperative criteria can lead to reconstructions with a high risk of amputation thrombosis.

Aim. To develop and validate an algorithm for selecting a revascularization strategy based on intraoperative ultrasound angiometry using machine learning methods.

Materials and Methods. This prospective study included 32 patients (34 injured arteries). Peak systolic blood flow velocity, volumetric blood flow, and resistance index were measured intraoperatively. The following methods were used: ROC analysis with the delta method, LASSO regularization, k-means clustering (silhouette estimation, Davis-Boldin index, Gap index), Ward hierarchical clustering, principal component analysis, random forest with variable importance calculation (Gini impurity reduction and permutation-based importance), XGBoost gradient boosting with 10-fold cross-validation and grid hyperparameter search, Bayesian logistic regression with Cauchy priors (Gelman-Rubin statistic for convergence assessment), Kaplan-Meier survival analysis, Cox regression with proportional hazards testing, nomogram construction with bootstrap validation (1000 samples), and calculation of the in-house predictive accuracy index.

Results. The developed algorithm demonstrated the area under the ROC curve of 0.978 (95 % confidence interval 0.942–1.000). The XGBoost method achieved the area under the ROC curve of 0.989 (95 % confidence interval 0.965–1.000). Optimal threshold values: peak systolic velocity greater than 41.2 cm/s (sensitivity 96.4 %, specificity 92.3 %), volume blood flow greater than 48.7 ml/min (sensitivity 92.9 %, specificity 100 %). Cluster analysis revealed three phenotypes (average silhouette width 0.73). Thirty-day patency of the reconstruction zone was: with direct anastomosis - 92.8 %, with autovenous grafting - 87.5 %. The amputation rate was reduced from 21.9 % to 6.25% (p=0.018 by Fisher's exact test). The C-index of the prognostic nomogram was 0.965.

Conclusion. Intraoperative ultrasound angiometry using machine learning methods reduces the amputation rate by more than threefold.

Relevance. The long-term success of coronary artery bypass grafting is largely determined by the late patency of bypass grafts. Among all conduits, the left internal mammary artery consistently shows the best outcomes. However, most comparative studies are based on heterogeneous institutional experiences and include both on-pump and off-pump techniques. There is a lack of large-scale, single-surgeon series comparing long-term patency of mammary and autologous vein grafts to the anterior interventricular artery using a uniform off-pump sternotomy approach.

Aim. To compare, by means of control graft angiography, the long-term patency of autologous vein aortocoronary bypasses and mammary artery bypasses to the anterior interventricular artery following off-pump coronary surgery through a median sternotomy, all performed by one surgeon.

Materials and Methods. Between September 1997 and December 2024, 7422 off-pump coronary bypass operations were performed in the department. From May 2001 onward, 6829 of these (92 %) were carried out via median sternotomy. Control angiography was undertaken in 1059 patients (15.5 %). For the present analysis, we selected 843 patients operated on by a single surgeon. Among them, 652 received an autologous vein aortocoronary graft to the anterior interventricular artery, and 191 received a mammary artery graft to the same vessel.

Results. The patency rates for mammary artery grafts at 5, 10, and 15 years were 91 %, 77 %, and 56 %, respectively, versus 88 %, 70 %, and 41 % for vein grafts. These differences were not statistically significant (p = 0.09).

Conclusion. In off-pump coronary bypass grafting to the anterior interventricular artery via sternotomy performed by a single surgeon, the long-term patency of autologous vein grafts may be comparable to that of mammary artery grafts.

Background. Hereditary liver diseases are a significant social problem, often hindering early diagnosis. The lack of pathognomonic symptoms for most liver diseases in the preclinical and early stages of disease development leads to low detection rates and frequent diagnostic errors. Therefore, studying the informativeness of biochemical and clinical indicators is currently relevant.

The aim of this study was to investigate informative diagnostic indicators for hereditary liver diseases.

Materials and Methods. Archival medical records from the gastroenterology department were analyzed, identifying 67 patients (aged 4 months to 17 years) who underwent inpatient treatment between 2024 and 2025. Based on the data obtained, a group of patients with hereditary (study) and non-hereditary (control) liver pathology was identified, and the main biochemical and clinical indicators of diagnostic value were studied.

Results. The study showed that the most informative biochemical abnormalities in hereditary liver diseases include total bilirubin, alkaline phosphatase, alanine aminotransferase, and triglyceride levels (p < 0.05). Hereditary liver diseases typically present with early onset and are often asymptomatic or minimally symptomatic. The most common clinical signs are splenomegaly and hepatomegaly (p < 0.001). Hereditary liver disease is often associated with extrahepatic manifestations, including neurological and respiratory symptoms (p < 0.05).

Conclusion. The data obtained can serve as a basis for improving diagnostic algorithms, reducing the time to diagnosis, and initiating timely pathogenetic therapy, ultimately improving the prognosis and quality of life of patients with hereditary liver disease. Keywords: hereditary liver pathology, biochemical markers, informativeness of biochemical markers.

Background. A lymphocele is an acquired cystic formation containing lymph and, in the vast majority of cases, is an iatrogenic complication (following lymphadenectomy, vascular surgery, kidney transplantation). Spontaneous and post-traumatic lymphoceles of soft tissues without bone fracture are extremely rare. In the available Russian literature, there are no descriptions of post-traumatic lymphoceles of the thigh formed after baric trauma (being run over by a car).

Case description. A 37-year-old male. The mechanism of injury was the wheel of a 1.4-ton car crossing the middle third of the left thigh while the patient was in a horizontal position. There was no fracture due to the limb being "pressed into" soft ground. On the 2nd day after the injury, a painless mass appeared on the inner surface of the thigh, which increased upon verticalization. On the 5th day, the diameter of the mass reached 15 cm.

Ultrasound with color Doppler mapping was performed, which ruled out a false aneurysm of the femoral artery and verified a lymphocele with a volume of 50 ml containing a single septum. Open excision with cavity suturing was performed. The postoperative period was uneventful. No recurrence was noted after 21 days.

Conclusion. A case of post-traumatic thigh lymphocele in the absence of a fracture is described for the first time in the Russian literature. Ultrasound with color duplex mapping is the "gold standard" for differential diagnosis. Open excision is indicated for a septate (loculated) structure due to the ineffectiveness of sclerotherapy.

Background. Liver hemangiomas are common focal, predominantly vascular lesions, often small in size, that typically present asymptomatically. They are typically diagnosed incidentally. At this stage, surgery is not performed, and observation is recommended. Large and giant hemangiomas are an indication for surgical treatment, including liver transplantation.

Aim. To discuss a clinical observation of liver transplantation for giant hemangioma.

Case description. The patient was admitted to the clinic complaining of pain in the right upper quadrant and abdominal distension. A diagnosis of giant hemangioma of the liver was made. The gigantic size of the lesion, its rapid growth, and the high risk of complications and liver failure led to the need for orthotopic liver transplantation from a deceased donor. The postoperative course was uneventful. The patient was discharged in satisfactory condition.

Conclusion. A liver hemangioma is a benign tumor that is asymptomatic until it reaches a certain size. Giant liver hemangiomas are typically accompanied by complications requiring aggressive surgical management. In cases where minimally invasive methods (radiofrequency ablation, endovascular occlusion of the feeding artery) and atypical or anatomical liver resection are ineffective or impossible, transplantation is the only definitive treatment option.

Background. An analysis of the historical development of embryology as a science allows us to trace the evolution of scientific ideas, research methods and key discoveries that have formed the basis of modern technologies and are of particular importance in the context of modern challenges in the field of reproductive health and genetic diseases. 

Aim. To analyze and systematize the main stages of the development of embryology as a scientific discipline, to consider the formation of science through the prism of discoveries and achievements of outstanding scientists, to identify patterns of formation of modern methods of human embryonic development research.

Materials and methods. A narrative review of the literature has been performed. Historical data were used in the work, as well as modern research in the field of human embryology. Methods of historical analysis and systematization of scientific achievements were applied.

Results. The article describes the important achievements and scientific discoveries of scientists who have contributed to the development of embryology. The study systematized key achievements in the field of embryology from ancient times to the present, identified fundamental discoveries that determined the development of science: from the first descriptions of embryonic development to modern molecular genetic research. The role of Russian scientists in the formation of the experimental field of embryology has been established. The main stages of the formation of science are defined, including the transition from descriptive methods to experimental research.

Conclusion. This article provides a concise overview of the development and evolution of embryology as a scientific discipline, as well as the key discoveries and achievements that have influenced its progress. The analysis demonstrates the consistent nature of embryology's development and the continuity between scientific achievements. The findings highlight the importance of a comprehensive approach to the study of embryogenesis and its application in clinical practice. This material is intended for a broad audience, primarily students and faculty at medical universities, as well as residents, postgraduate students, and practicing physicians in various fields.