BACKGROUND. Acute pancreatitis is an aseptic inflammation of the demarcation type based on necrosis of pancreatic acinar cells, and enzymatic aggression, followed by expanding necrosis and dystrophy of the gland, in which damage to surrounding tissues, as well as distant organs and systems, and the addition of a secondary purulent infection are possible. An important pathogenetic aspect of the severe course of acute pancreatitis is endothelial dysfunction. The latter often begins as a diffuse activation of coagulation, which further potentiates the progression of the systemic inflammatory response syndrome and, thereby, complicates the course of acute pancreatitis. There is a connection between the activation of coagulation and the severity of inflammation. Traumatic tissue injury, followed by hypoperfusion, hemodilution, hypothermia, and acidosis cause acute post-traumatic coagulopathy. The inflammatory process activates the coagulation system, reduces the activity of natural anticoagulants and disrupts the functioning of the fibrinolytic system, thereby leading to thrombosis.

   AIM OF STUDY. Improving the results of treatment of patients with severe acute pancreatitis by choosing the optimal method of extracorporeal hemocorrection and anticoagulant therapy.

   MATERIAL AND METHODS. The present retrospective-prospective study included 76 patients (50 (65.7 %) men and 26 (34.2 %) women) diagnosed with severe acute pancreatitis. To assess the effectiveness of the therapy, the patients were divided into 2 groups: the control group (n=34), based on the retrospective analysis of case histories, included patients who received standard conservative therapy. The severity of the condition was assessed using APACHE II, SOFA, MARSHALL and Ranson scales, and amounted to 16.8 ± 4.2, 3.44 ± 1.32, 2.6 ± 0.64, 3.8 ± 0.52 points, respectively. The main group (n=42) included patients whose treatment was supplemented with the use of low molecular weight heparin preparations, extracorporeal methods of hemocorrection with the inclusion of cytokine adsorption together with renal replacement therapy. The severity of the condition of the 2nd group’s patients was assessed using APACHE II, SOFA, MARSHALL and Ranson scales, and amounted to 16.6 ± 3.4, 3.26 ± 1.24, 2.5 ± 0.72, 3.6 ± 0.48 points, respectively.

   CONCLUSION. As a result of expanded therapeutic tactics for severe acute pancreatitis (SAP) using sorption methods of extracorporeal hemocorrection, anticoagulant therapy with low molecular weight heparin, as well as the inclusion of saline enteral solution in the therapeutic regimen to restore intestinal propulsive function, it was possible to reduce the number of purulent-septic complications by 1.6 times, cases of development of multiple organ failure by 1.5 times, and mortality by 1.7 times.

   BACKGROUND. Absolute numbers of platelets are of key importance for determining the severity of multiple organ failure in sepsis, while their fluctuations within normal values are not taken into account. At the same time, early detection of a downward trend in this parameter may have greater predictive value in predicting disease outcomes.

   AIM OF STUDY. To identify trends in changes in platelet levels in patients with widespread peritonitis and determine the possible relationship of these changes with the outcome of the disease.

   MATERIAL AND METHODS. The basis of the work was an analysis of the results of treatment of 220 patients with diffuse secondary peritonitis who were treated at the Elizavetinskaya Hospital in 2013–2019. A correlation analysis was conducted to identify relationships between disease outcomes, assessed according to the severity of postoperative complications, and the degree of platelet reduction, expressed in platelet ratio. The further ROC analysis allowed us to identify a threshold value of the platelet ratio, which excess indicated a high risk of an unfavorable outcome.

   RESULTS. Based on the data obtained, the threshold value of the platelet ratio in the first two days has no clinical significance. At the same time, starting from the third 3^rd day of the postoperative period, the quality of the resulting classifier increased, which confirms the prognostic significance of the threshold value of the platelet ratio, which was 1.72 on the third 3^rd day after surgery. In other words, a decrease in platelet levels more than 1.72-fold on the 3^rd day indicates a high risk of an unfavorable outcome, which may be associated primarily with intra-abdominal complications. This provision also indirectly confirms the fact that among patients with platelet ratio (PR) values exceeding 1.72 on the 3^rd day, 68.7 % ultimately underwent repeated surgical interventions (33 patients out of 48 with high PR values, and the overall mortality rate was 72.1 %.Similar indicators in the subgroup with low PR values were 27.6 % of reoperated patients (29 of 105) and 26.7 % of unfavorable outcomes.

   CONCLUSION. The results obtained indicate that the degree of platelet reduction, rather than their absolute levels, has greater predictive value in patients operated on for diffuse peritonitis.

   BACKGROUND. Theoretical data convincingly support the use of extracorporeal hemocorrection (ECHC) methods in the treatment of sepsis. However, a large number of researchers have still not been able to convincingly prove the advantage of ECHC methods; there is no unanimity of opinion. We tried to analyze our own experience in using ECHC methods in the treatment of abdominal sepsis over the past 3 years.

   AIM OF STUDY. To analyze the use of ECHC methods in the early stages of treatment of abdominal sepsis, to determine whether their use had an advantage for survival.

   STUDY DESIGN. Prospective cohort.

   DESCRIPTION OF THE METHOD. In 50 cases (group 1), ECHC was performed early after surgery. The median time from admission to the intensive care unit after surgery to the start of ECHC was 25.3 (17.7; 36.5) hours. When determining the ECHC modality, we were guided by the individual approach and clinical experience of the ECHC specialist. Apheresis methods alone were performed in 8 % of patients (4/50), a combination of apheresis methods and renal replacement therapy was performed in 40 % (20/50), renal replacement therapy (RRT) methods were performed in 98 % (46/50), plasmapheresis/plasma exchange/selective plasma filtration were performed in 30 % (15/50), selective hemosorption of cytokines was performed in 4 % (2/50), selective hemosorption lipopolysaccharides was performed in 24 % (12/50). We analyzed outcomes, assessments of the severity of functional disorders and sepsis-associated organ dysfunction according to the APACHE scales II and SOFA and their dynamics, probabilities of outcomes depending on the scores on the indices (logistic regression); life times, cumulative survival rate (Kaplan-Meier method).

   SAMPLE CHARACTERISTICS. There were 113 patients after emergency laparotomy due to widespread peritonitis, abdominal sepsis, aged from 23 to 90 years. 67 men, 46 women. In 50 cases of observation (group 1), ECHC was performed in the early stages ; in 63 cases, methods of active hemocorrection were not used (group 2). In group 1 there were 35 patients with septic shock and 15 patients with stable hemodynamics (subgroup 1/shock and subgroup 1/sepsis). In group 2 there were 20 patients with shock and 43 with stable hemodynamics (subgroup 2/shock and subgroup 2/sepsis).

   RESEARCH RESULTS ECHC. Methods allowed survival of patients with more severe APACHE scores II and SOFA: in survivors in subgroup 1/shock Me 29 (24; 31) versus 23 (14; 26) in the subgroup 2/shock and 8 (4; 10) versus 4 (2; 6) points, p=0.048 and p = 0.010; with stable hemodynamics in survivors in subgroup 1/sepsis Me 20 (17; 22) versus 15 (11; 19) in subgroup 2/sepsis, p=0.016. ECHC changed the survival threshold in favor of more severe patients from 29 to 33 points; reduced the likelihood of an unfavorable outcome 1.2-fold for each point on the APACHE scale II and 1,276 times over the entire range of estimates; prolonged survival time in hemodynamically unstable patients at a significance level of p = 0.083, shifting the first quartile of survival from 1 to 12 days, the median from 12 to 20, the third quartile from 27 to 45 days. When performing ECHC, the cumulative survival rate was higher throughout the entire hospital observation period: 0.886 (95 % CI 0.780–0.939) in 2 days versus 0.700 (95 % CI 0.499–0.802); 0.800 (95 % CI 0.667–0.868) in 10 days versus 0.545 (95 % CI 0.325–0.658); 0.653 (95 % CI 0.494–0.734) in 14 days versus 0.416 (95 % CI 1.185–0.533). Overall mortality from all causes was 35.4 % (40/113), 67.3 (37/55) with shock, 5.2 % (3/58) with stable hemodynamics. The maximum risk of an unfavorable outcome occurred in the early stages: 30 % (12/40) of all deaths occurred in the first 4 days after surgery, 20 % (8/40) in the first 24 hours. In shock patients, 10-day mortality was lower when performing ECHC: 20.0 % (7/35) versus 45.0 % (9/20), p = 0.050, 1^st stage. Fisher’s test, P = 0.38 insufficient. Hospital mortality in the shock subgroups was equal, all the advantages of ECHC achieved in the early stages were lost; although in most late outcomes the peritonitis was relieved; which was confirmed during the section.

   CONCLUSIONS. The power of the study was sufficient to identify statistically significant advantages of extracorporeal hemocorrection in the treatment of abdominal sepsis based on APACHE index estimates II and SOFA. For the Kaplan–Meier method, differences were obtained for shock patients at a significance level of 0.083; the number of observations must be doubled to detect statistically significant differences. The final results of hospital mortality require additional in-depth analysis, since in the later stages many deaths were not associated with abdominal sepsis and occurred with already resolved peritonitis. It is necessary to understand to what extent they were associated with experienced sepsis, and to what extent with comorbid pathology; whether there was an association with methods of extracorporeal hemocorrection.

   BACKGROUND. The high incidence of various complications and the persistent mortality remain relevant to the search for new approaches in the treatment of victims with poisoning by corrosive substances.

   OBJECTIVE. To increase the effectiveness of the therapeutic complex in case of corrosive poisoning by adding intestinal lavage.

   MATERIAL AND METHODS. We examined 73 patients (34.3 % of women and 65.7 % of men) with acute oral poisoning by acetic acid (35.6 % of the total number of patients) and alkali — NaOH (64.4 %) aged from 27 to 65 years (43 (33.0; 56.0) years). Endoscopic examination before the start of treatment in all the patients revealed 2–3^rd degree chemical burns of the mucous membrane of the mouth, pharynx, esophagus and stomach. The treatment of 38 patients (study group) included intestinal lavage using an enteral solution in a volume of 4.5 liters in the first 6 hours after taking the poison. The comparison group consisted of 35 patients who received standard therapy. The groups were identical in age, sex, type and severity of poisoning.

   RESULTS. Patients who received intestinal lavage showed a clear positive dynamics of the process of cleansing the affected areas of the mucous membrane of the esophagus and stomach from necrotic masses and the appearance of granulations already on the 5^th day. In the comparison group, by this time there were no signs of healing of local defects in the mucous membrane of the esophagus and stomach.

   CONCLUSION. The inclusion of intestinal lavage in the treatment complex helps reduce the regeneration time of the mucous membrane of the gastrointestinal tract in case of damage and inflammation caused by poisoning by corrosive substances, a decrease in the incidence of extraintestinal complications, in particular pneumonia (by 17.1 %), which is reflected in a decrease in mortality (by 5.7%) and a decrease in the duration of hospitalization by 2.1 times.

   AIM. To study the possibilities of using risk factors, data from instrumental research methods identified at the preoperative stage as independent variables for predicting the development of complications after mitral valve surgery.

   MATERIAL AND METHODS. The study included 103 patients, 46 men and 57 women, who underwent surgical correction of mitral valve defect and were treated at the Cardiac Surgery Department of Chelyabinsk Regional Clinical Hospital № 1 in the period from 2014 to 2019. Among those patients, the presence of anemia at the preoperative stage (blood hemoglobin level less than 100 g/l) was detected in 13 (12,6 %) cases; obesity (BMI more than 30 kg/m²) — in 57 (55,3 %) cases; transfusion of blood and its components in anamnesis — in 14 (13,6 %) cases; type 2 diabetes mellitus — in 7 (6,8 %) cases; stroke in anamnesis — in 9 (8,7 %) cases; chronic Hepatitis C — in 6 (5,8 %) cases; HIV infection — in 4 (3,9 %) cases; antibiotic therapy before surgery was indicated in 21 (20,4 %) cases; edema of the lower extremities was detected in 40 (38,8 %) cases; an increase in body temperature before surgery — in 19 (18,4 %) cases; the presence of atrial fibrillation before surgery — in 63 (61,2 %) cases. The systematization of the source information was entered into a Microsoft Office Excel 2016 spreadsheet. Statistical analysis was carried out using the IBM SPSS Statistics v.26 program (developed by IBM Corporation). Binary logistic regression was used as a method of mathematical data analysis. Instrumental research methods: electrocardiography (ECG), echocardiography (ECHO-CG); coronary angiography was performed according to indications.

   RESULTS. The presence of risk factors such as anemia, obesity, as well as an increase in the size of the right atrium can be used as an independent variable to predict the development of complications. An increase in the diameter of the pulmonary artery trunk, and the presence of edema of the lower extremities reduces the risk of complications. The likelihood of developing complications after mitral valve surgery predicted by the logistic regression method was 53,4 %. The resulting model predicts the absence of complications with the likelihood of 82,5 %. The development of complications was correctly predicted in 93,3 % of cases.

   CONCLUSION. This model can be used as an additional tool in predicting the development of complications after mitral valve surgery.

   RELEVANCE. Efficiency and safety of compression hemostasis with esophageal self-expanding nitinol stents Danis compared to the Sengstaken–Blakemore tube in the treatment program of refractory esophageal bleeding still remains a controversial issue.

   AIM OF THE STUDY. To conduct a comparative analysis of the effectiveness of Danis self-expanding compression hemostasis nitinol stent and the Sengstaken-Blakemore tube for variceal esophageal bleeding refractory to drug and endoscopic treatment.

   MATERIAL AND METHODS. The first comparison group included 44 patients, in whose complex treatment program tamponade with a Sengstaken-Blakemore tube was used to save lives. The second main group of the study consisted of 15 patients in whom compression hemostasis was performed using Danis self-expanding nitinol stent. Statistical processing was carried out using the Kolmogorov-Smirnov, Student, χ² and Fisher exact tests. Differences were considered statistically significant at p ≤ 0.05.

   RESULTS. In the comparison group, complications occurred in 44 (100 %), in the main group complications were observed in 8 patients (53.3 %). Accordingly, reliable mechanical hemostasis was achieved in 33 (75.0 %) and 13 clinical observations (86.7 %); trophic changes in the esophageal mucosa were detected in 12 (27.2 %) and 8 patients (53.3 %). When assessing the function of external respiration, 5^th and 2^nd degrees of decrease in the ventilation capacity of the lungs, as well as 3^rd and 1^st degrees of decrease in the vital capacity of the lungs were established. The overall mortality was 56.8 % in the comparison group and 26.7 % in the main group.

   CONCLUSION. Self-expanding compression hemostasis nitinol stent Danis as a bridge to the choice of definitive therapy compared to tamponade with the Sengstaken–Blakemore tube is a promising alternative first-line treatment for patients with refractory esophageal bleeding. At the same time, it is necessary to conduct randomized controlled studies to confirm the safety and effectiveness of self-expanding nitinol stents.

   INTRODUCTION. Despite the improvements and success in the management of thrombosis, the prognosis of thrombotic complications in comorbid patients remains extremely unfavorable. Understanding this problem suggests that it is rational to pay more attention to the prevention of thrombosis in order to avoid thrombotic complications in the first place, and there is an urgent need to improve the ability to predict the development of complications and, most importantly, death. Therefore, some inexpensive, but effective methods of risk assessment need to be developed and integrated in clinical practice.

   AIM OF STUDY. To assess which laboratory markers can be associated with higher probability of fatal outcome in patients with thrombotic complications.

   MATERIAL AND METHODS. The retrospective cross-sectional study included 283 patients who were admitted to the N.V. Sklifosovsky Research Institute for Emergency Medicine in 2021. Minimum age was 21 years, maximum age was 96 years, median age – 68 (59,0; 76,5) years. 161 (56,9 %) patients were males, 122 (43,1 %) – females. Group I included 226 patients with thrombotic complications; Group II included 57 (20,1 %) patients who died during hospitalization. The patients were diagnosed with the following thrombotic complications: pulmonary embolism (PE) was diagnosed in 28 (9.9 %), acute coronary syndrome with ST segment elevation in 38 (13.4 %), arterial thrombosis in 84 (29.7 %), venous thrombosis in 54 (19.1 %), thrombophlebitis in 22 (7.8 %), and systemic thromboembolism in 7 (2.5 %) patients.

   RESULTS. It was established that the decrease in the estimated glomerular filtration to the levels of stage 3 (and lower) chronic kidney disease (AUC — 0,881, sensitivity — 86.92 %, specificity — 85.71 %), hemoglobin level — to less than 120 g/L (AUC — 0,690, sensitivity — 77,21 %, specificity — 55,1 %), as well as hypoalbuminemia (AUC — 0,905, sensitivity — 78,89 %, specificity — 91,18 %) statistically significantly increased the likelihood of death by 19 (OR 19.276, 95 % CI [7,792–47.687], p < 0.001), 4 (OR 4.158, 95 % CI [2.177–7.939], p < 0.001), and 30 (OR 30,000, 95 % CI [9.93–90,610], p < 0.001) times, respectively. The statistical analysis using the univariate logistic regression model revealed that such diseases as coronary artery disease (OR 8,6, 95 % CI [2,6–28,466], p < 0.001), chronic heart failure (CHF) (OR 13,714, 95 % CI [4,784–39,313], p < 0.001), atrial fibrillation (OR 3,455, 95 % CI [1,830–6,525], p < 0.001), type 2 diabetes (OR 2.5, 95 % CI [1,286–4,858[, p = 0.007), postinfarction cardiosclerosis (OR 3,734, 95 % CI [1,953–7,142], p < 0.001), and previous stroke (OR 3,319, 95 % CI [1,519–6,490], p = 0.002) made an independent contribution to death prediction. During the study, we calculated the patients’ serum albumin-to-creatinine ratio (sACR). ROC analysis revealed a cut-off point for sACR to be 0.33 g/mmol as having the best predictive ability of death (AUC — 0.920, 84.3 % sensitivity, 85.29 % specificity). It was established that sACR less than 0.33 g/mmol increased the probability of death by 26 times (OR 26.3806, 95 % CI [9.4573.57], p < 0.001).

   CONCLUSION. Serum albumin-to-creatinine content ratio can be used as a predictor of fatal outcome in comorbid patients with thrombotic complications.

   AIM OF STUDY. To assess the types and scope of first aid for pelvic injuries in women in conditions of local military conflict.

   MATERIAL AND METHODS. To achieve this goal, an analysis of injuries received during local military operations carried out in the Republic of Chechnya from 1991 to 2000 was carried out. The treatment was carried out on the basis of the surgical hospital of medical organization No. 9 in Grozny. The severity of the injury was determined retrospectively using the Field Surgery Scale, distinguishing four degrees of severity. Injured patients with combined injuries to the chest, abdomen, and head were excluded. The average age of patients was 34 [28; 40] years. The total number was 86.

   RESULTS. As the study shows, group A included 54 (62.8 %), and group B included 32 (37.2 %) patients. The distribution by group is presented as follows: in group A, 44 (51.2 %) shrapnel wounds, 10 (11.6 %) gunshot wounds. In group B, there were, respectively, 25 shrapnel (29.1 %) and 7 gunshot (8.1 %) wounds. Further analysis showed that penetrating wounds predominated, which were observed in 67 (77.9 %) cases, non-penetrating wounds were only revealed in 19 (22.1 %) cases (r = 0.97, p < 0.05, statistically significant). Distribution by groups: in group A there were 48 (55.8 %) and 6 (7.0 %), respectively, in group B there were 19 (22.1 %) and 13 (15.1 %) observations. Anti-shock measures, which include pain relief and infusion therapy, were carried out in 31 (36.0 %) cases in group A and in 5 (5.8 %) cases in group B (r = 0.97, p < 0 .05, statistically significant). At the same time, in the group of patients where first aid was provided by random witnesses or as self-help, the n

   BACKGROUND. Among the forms of suicidal behavior, self-poisoning is the most common one, often occurring as a result of taking various medications, the second place among them is occupied by antihypertensive and antiarrhythmic drugs. Studying the structure of mental disorders in suicide victims with poisoning by these drugs is necessary to prevent repeated suicidal acts.

   AIM OF STUDY. To study the clinical and psychopathological features of mental disorders in patients with acute poisoning by hypotensive and antiarrhythmic drugs as a result of suicidal acts.

   MATERIAL AND METHODS. The results of a psychopathological study were analyzed in 122 patients (age 15–93) with antihypertensive and antiarthymic drugs poisoning as the suicidal attempt.

   RESULTS. In the structure of mental disorders in patients with suicidal poisoning by hypotensive and antiarrhythmic drugs, anxiety-depressive reactions associated with stress prevailed (F43.20–43.25) — 65.6 %. Endogenous mental pathology was detected in 19.7 % of patients, of which endogenous depression (F32–F34) — in 13.1 %, depressive — delusional states with schizophrenia (F20) — in 6.6 %. Organic personality, affective psychotic and delusional disorders (F06–F07) were diagnosed in 14.7 % of patients. In 45.9 % of patients, acute poisoning occurred against the background of comorbid somatic pathology, in 87.5 % of them — of cardiovascular genesis. Typological variants of early postsuicidal states in the studied contingent of patients are as follows: critical type of postsuicide (54.9 %), manipulative (16.4 %), fixed (14.8 %), unspecified (13.9 %); their significance for assessing repeated suicidal risk was determined.

   CONCLUSION. The findings of the study complement the understanding of the patterns of suicidal behavior in patients with self-poisoning, which will improve approaches to the prevention of suicide through drug poisoning.

   RELEVANCE. It is known that patients with severe cases of the novel coronavirus infection (COVID-19) are characterized by the development of COVID-19-associated dysautonomia (COVID-19-DA). At the moment, there are no studies examining the impact of this phenomenon on the course and outcomes of the disease in the most severe cohort of patients with COVID-19, namely those requiring venovenous extracorporeal membrane oxygenation (VV ECMO).

  AIM OF STUDY. The purpose of the presented work is to study the effect of different COVID-19-DA phenotypes on the performance parameters and effectiveness of VV ECMO, gas exchange and hemodynamics in patients with COVID-19.

   MATERIAL AND METHODS. The study included 20 patients, 12 (60%) women, 8 (40%) men, with COVID-19 who underwent VV ECMO. Patients underwent 24-hour Holter monitoring with assessment of the spectral parameters of heart rate variability (HRV): the low-frequency component (LF), the high-frequency component (HF), the ratio of the low-frequency component to the high frequency component (LF / HF) on days 1, 3, 5 of the VV ECMO. Patients were divided into three groups based on the identified COVID-19-DA phenotypes. The groups were compared in terms of gas exchange, hemodynamics, and VV ECMO performance parameters.

   RESULTS. The level of partial pressure of carbon dioxide in arterial blood (paCO₂) in the phenotype with low sympathetic tone and high tone of the parasympathetic division of the autonomic nervous system (ANS) (lShP) was significantly higher than in the phenotype with normal sympathetic tone and high tone of the parasympathetic division of the ANS (nShP) with equal VV ECMO performance parameters. The heart rate (HR) in the nShP phenotype was significantly lower than in the lShP phenotype. A significant increase in respiratory dysfunction was revealed over time in the lShP phenotype. Weaning from VV ECMO in the nShP phenotype was successful in 50 %, whereas in the lShP phenotype, weaning from VV ECMO was observed in 7,2 % of patients. No significant differences in the mortality rate were obtained. The most common cause of death in both groups was septic shock.

   CONCLUSIONS. The COVID-19-DA phenotype, manifested by decreased tone of the sympathetic division and increased tone of the parasympathetic division of the ANS, leads to low efficiency of VV ECMO, resulting in a statistically significantly less frequent ECMO discontinuation in those patients.

   The incidence of non-traumatic subarachnoid hemorrhage due to rupture of cerebral aneurysms and subsequent disability motivates the search for predictors of severe course and unfavorable outcome of the disease for early intensive treatment. NSE, S100-B, GFAP markers have proven themselves well for assessing the dynamics of treatment for diseases of the nervous system and detecting neurological nosologies. The use of the above proteins in aneurysmal hemorrhage opens up new perspectives in assessing the clinical status of the patient in the early stages, developing further treatment strategies, as well as helps draw conclusions about the outcome of the disease and possible disability of the patient. The studies collected in the review motivate continued research of the neuromarkers in aneurysmal hemorrhage.

   The presented literature review is devoted to the role of the endothelial relaxing factor – nitric oxide (NO) – in the regulation of cerebral blood flow in patients with ruptured intracranial aneurysms. Modern views on the physiology of NO, methods of regulation and autoregulation of its synthesis are described, experimental and clinical data on the disruption of the production of the endothelial relaxing factor in subarachnoid hemorrhage are presented.

   Mechanical damage to the esophagus is a severe urgent pathology characterized by the development of life-threatening complications. With all the variety of modern diagnostic and treatment technologies, the mortality rate in this category of patients remains quite high, which requires the search for new approaches to this problem. An analysis of modern approaches to the treatment of mechanical injuries of the esophagus and their complications was carried out. In the practice of surgery for esophageal injuries, minimally invasive technologies are becoming increasingly common, including endovideosurgical and oral endoscopic interventions. A special place in this is occupied by endoscopic vacuum therapy, which results have been sufficiently studied in the treatment of complications of gastrointestinal surgery. At the same time, the use of this technology in patients with mechanical damage to the esophagus is limited to small series of observations, which requires further study.

   In the present review, we consider theoretical background and results of the first studies of SARS-CoV-2 effect on the intestine and its microbiome. The data obtained indicate the long-term virus persistence in the cells of intestinal mucosa. In addition, acceleration of microbial cells and microbial metabolites translocation associated with inflammatory processes in the intestinal endothelial cells caused by the virus was also discussed. COVID-19 has a great impact on structure and functional activity of the intestinal microbiome. The decrease in species diversity and minor species dominations that are not found in the microbiome of healthy controls were observed. The gut microbiome is considered to be an important influencer on COVID-19 progression and outcome.

   BACKGROUND. An ingrown toenail is one of the reasons for surgical intervention: it accounts for up to 20 % of all operations in clinics. At the same time, conservative and surgical approaches to treatment are not reliable enough: up to 70% of cases are complicated by relapses.

   AIM OF STUDY. To study the topographic location and ratio of cells in the growth zone of the nail plate, necessary for planning the volume of intervention in the treatment of ingrown toenails.

   MATERIAL AND METHODS. The material for conducting our own research was samples of the cadaver nail complex, without identified pathologies, from 20 objects of different ages and genders. Studies were carried out using histological, immunofluorescent and microscopic methods.

   The results were compared with available literature data, clarifying the most important structural features. The data obtained will make it possible to reasonably plan the volume of intervention during operations for ingrown nails, as well as to reduce the number of unsatisfactory results of operations on the nail complex in case of injury and nail diseases.

   Two clinical observations of effective treatment of patients with critical ischemia of the lower extremities using plasma-free lysate autologous platelets. Both patients were male, 73 and 53 years old. Both were diagnosed with total damage to the arteries of the infrainguinal zone. One of them had previously undergone endarterectomy from the femoral artery with subsequent thrombosis. After examination and joint discussion with x-ray endovascular surgeons, they were found inoperable. Due to the ineffectiveness of standard conservative therapy, the patient was offered local administration of plasma-free lysate autologous platelets. After receiving written informed consent, the procedure for collecting venous blood and obtaining plasma-free lysate autologous platelets and the introduction of this drug into the muscles of the leg from the side of ischemia according to the original method. The method for assessing microcirculation was three-phase scintigraphy : before treatment, both patients showed a significant decrease in the inclusion of osteotropic radiopharmaceutical in the soft tissues of the legs. For areas of radiopharmaceutical hyperfixation, relative accumulation coefficients were calculated: for one patient, the calculation results demonstrated the formation of foci of aseptic necrosis. When patients were re-hospitalized after 6 months, there was an improvement in local status and relief of rest pain. According to scintigraphy, a significant improvement in microcirculation was noted; no foci of aseptic necrosis were identified. Thus,  the use of plasma-free lysate autologous platelets in combination with complex conservative therapy has demonstrated positive results; this method can be considered as an alternative revascularization ischemic limb.

   The diagnosis of diseases from the group of autoimmune encephalitis (AE) requires a detailed analysis of clinical data and correlation of results from a wide range of laboratory and instrumental research methods. This article presents three clinical cases of patients with AE. In one patient, AE was associated with a malignant neoplasm, in the second one – with the novel coronavirus infection, and in the third patient, no comorbid pathology was detected. The specific type of encephalitis was determined for each of the three patients. The diagnosis of “autoimmune limbic encephalitis” was established in two patients based on visualization of changes in the medial temporal structures in the magnetic resonance imaging of the brain, detection of pathological bioelectrical activity in the temporal lobe cortex in electroencephalography, and pleocytosis in cerebrospinal fluid. The diagnosis of “anti-NMDA receptor encephalitis” was made based on the detection of specific antibodies to the subunit of the corresponding receptor. Neurological deficit regression was observed in two patients after the application of combined immune therapy methods and in one patient without the use of immune therapy.

   BACKGROUND. Road transport injuries (RTI) are the leading cause of death among the working-age population at present. Often, severe combined trauma is accompanied by significant damage to the chest with the development of severe respiratory disorders. Standard methods of intensive therapy for respiratory failure are often ineffective. The use of extracorporeal membrane oxygenation (ECMO) can be an effective method of reducing mortality in this category of patients, even
in conditions where it is impossible to use systemic anticoagulation.

   AIM OF THE STUDY. Consider the use of ECMO in patients with serious polytrauma trauma and a high risk of hemorrhagic complications.

   MATERIAL AND METHODS. Patient R., 43 years old, got a severe combined injury in a traffic accident; due to progressive acute respiratory failure, veno-venous ECMO (VV-ECMO) was performed for 11 days.

   RESULTS. This report reviews a clinical observation of the successful use of VV-ECMO in a patient with severe acute respiratory distress syndrome as a result of polytrauma in a road accident. Due to the high risk of hemorrhagic complications, the procedure was performed without the use of systemic anticoagulation, which is a rather rare case in modern intensive care. On the 11^th day, the VV-ECMO procedure was stopped. On the 7^th day of VV-ECMO, an intense hemorrhagic syndrome developed as a complication, which was successfully treated. On the 13^th day after weaning, the patient was transferred from the intensive care unit to the rehabilitation center.

   CONCLUSIONS. The venovenous extracorporeal membrane oxygenation method can be considered as part of the treatment of severe acute respiratory distress syndrome as a result of severe chest trauma when standard methods of respiratory support are ineffective. With a high risk of hemorrhagic complications, which is often observed in patients in this category, it is possible to use venovenous extracorporeal membrane oxygenation without systemic anticoagulation.

   Poststernotomy mediastinitis is the most severe and dangerous complication in cardiac surgery. Treatment of such patients still poses great difficulties for the surgeon dealing with this problem. At the reconstructive stage, they consist in the lack of criteria for choosing a method of plastic surgery and standardized surgical technologies. The use of autologous tissues is generally performed: greater omentum and muscle flaps. The article presents the experience of treating a patient with poststernotomy mediastinitis. The surgery was two-staged. The effectiveness of using vacuum-assisted dressings has been demonstrated. Performing final debridement and wound preparation followed by repair of the defect with a full-thickness flap of the pectoralis major muscle on the perforating branch of the internal thoracic artery led to the patient’s recovery.

   We report a clinical observation of intramuscular myxoma, mimicking a psoas abscess. Surgical minimally invasive treatment of the disease has been suggested. This clinical observation shows an example of the effective use of minimally invasive treatment methods in surgical practice, as an alternative to open surgery.