At the present time, approximately 80% patients experience postoperative pain which is the leading entity in the overall structure of chronic pain. The aim of this article is investigation of reasons and risk factors underlying its development. Based on the information provided in domestic and international sources in open databases, analysis of these problems has been carried out. Selection of adequate therapy is particularly important against the background of the need for long-term intake of strong analgesics or the impossibility of pain management due to the neurogenic aetiology of the disease. In this connection, it is necessary to study factors predisposing patients to development of chronic postoperative pain and resort to prevention measures in order to reduce the risk of pain syndrome development.

Perinatal pathologies serve as the basis for a great variety of diseases in teenagers and adults including the especially frequent and important
diseases of the nervous system which is vulnerable during the period of ante- and early postnatal development, especially against the background of genetic
predisposition to it. This leads to development of pathology also manifesting at later stages of life. In this connection, the review presents molecular and
genetic predictors of endothelial dysfunction and impairment of angio- and neurogenesis during the perinatal period. The article presents facts related to the influence of endothelial dysfunction as a trigger for pregnancy pathology and fetal-programmed diseases. A discussion regarding the contribution made by the congenital and by the acquired into basic mechanisms of fetal development including the brain and its pathologies

The article presents a review of literature dated 2011-2020 devoted to results of surgical treatment of small diaphragmatic hernias and
gastroesophageal reflux disease. Small hernias are encountered with the frequency of 90%. The study discusses modern problems in application of different surgical methods for treatment of this pathology. Based on the review of domestic and foreign literature, we aimed to determine advantages of laparoscopic ant-reflux surgery versus conservative treatment and open surgery methods. Search for the materials was carried out in Scopus, Web of science, PubMed, e-library, Ulrich’s Periodicals Directory, Google Scholar and AGRIS databases. The keywords used were “small diaphragmatic hernias”, “operative treatment” and “gastroesophageal reflux disease”. The purpose of search for literature was to reveal main indications and selection criteria for laparoscopic ant-reflux surgery as well as to draw a comparison between results of cruroraphia and Nissen fundoplication by the frequency of relapse and complications. Additionally, we aimed to compare different operative techniques for fundoplication and to determine the most optimal one for improvement of the patients’ quality of life. Advantages of laparoscopic anti-reflux surgery in comparison with conservative treatment and open surgery methods have been revealed.

The review presents recommendations for pre-hospital management of traumatic haemorrhagic shock (PHMTHS), details of its performance,
criteria for evaluation of efficacy and results of application. The main principles of PHMTHS developed during military activity of armed forces of the
USA and their allies in Iraq and Afghanistan were: controlled hypotension, early infusion of tranexamic acid and the priority of blood loss replacement via
transfusion. PHMTHS performed according to the stated principles leads to a significant decrease in the number of lethal outcome cases. This offers prospects for application of similar tactics of pre-hospital management in civilian medicine.

Aim of study. Evaluation of long-term outcomes of surgical treatment and quality of life in patients operated for atrial fibrillation with simultaneous correction of valvular pathology, IHD and congenital heart defect.
Material and methods. A retrospective cohort study was carried out. The study enrolled 104 patients within the period of 2013-2016 who had undergone
surgical treatment of atrial fibrillation (AF) via the Maze IV and leftsideMaze method with application of radiofrequency ablation (RFA) and cryoablation as
the energy source with simultaneous resection of left atrial appendage (LAA). Mean age of the patients was 61.6 (±7.4) years. Among them, 60 were female
(75%) and 20 were male (25%). The efficacy of recovery and sustain of the sinus rhythm was evaluated via Holter monitoring. All patients underwent EchoCG and ECG. The patients’ quality of life was assessed according to the eight main indices of the SF-36 questionnaire later used for both in-person consultations and remote surveying. Statistical processing of the data was performed via methods of descriptive statistics and analysis of survival rates (Kaplan-Meier estimator and life tables).
Results. Long-term outcomes in 80 among 104 patients subject to surgical treatment of AF and LAA resection were analysed. A total of six lethal outcome
cases with no cardiac origin were registered. In the long term, sinus rhythm was preserved in 63 among 74 patients (85%). It is also worth noting that longterm observation of the patient showed no development of cardiovascular accidents (CVA). According to the SF-36 questionnaire, a statistically significant improvement of quality of life in the patients according to all scales in comparison to the baseline values was acquired.
Conclusion. Maze IV and leftsideMaze surgery using RFA and cryoablation as the energy source are effective methods for AF treatment. Sinus rhythm in the
late post-operative period is preserved in 85% of the patients. Simultaneous treatment of AF and correction of valvular pathology, IHD or congenital cardiac
pathology improves functional characteristics of the heart. LA appendage resection decreases the risk of cerebrovascular accident development significantly

Aim of study. To study gender-based association of high anxiety and depression with ischaemic heart disease exemplified by open population of the city of Krasnoyarsk.
Material and methods. A representative sample formed from unoccupied population permanently residing in the city of Krasnoyarsk aged 25-64.
Psychometric testing was performed via the Hospital Anxiety and Depression Scale (HADS), the prevalence of ischaemic heart disease was determined based on conventional epidemiological criteria.
Results. High values of age-adjusted prevalence of anxiety and depression in the studied sample amounted to 40.1% and 35.0% respectively with no association with the gender. Ischaemic heart disease (IHD) was registered in 10.6% of the patients (15.8% male and 8.6% female subjects, p=0.092). Statistically significant association between IHD and high anxiety (OR=2.39; 95% CI 1.19-4.8; p=0.013) and depression (OR=2.1; 95% CI 1.1-4.1; p=0.031). Gender-discrete analysis has shown analogical associations of IHD with anxiety (OR=4.41; 95% CI 1.57-12.38; р=0.004) and depression (OR=2.91; 95% CI 1.20-7.10; р=0.027) in the female group. Analysis has shown absence of interrelation between the studied risk factors and IHD in the male group of patients.
Conclusion. The factor of gender defines association between high anxiety and depression scores according to the HADS in open population of the city of
Krasnoyarsk.

Aim of study. Comparative analysis of antibacterial activity of silver oxides (Ag0,2O, Ag1O, Ag2O) in relation to clinical strains of Staphylococcus aureus
obtained from patients with orthopaedic infection.
Material and methods. Films of silver oxides were coated on paper surface in vacuum via the method of ion-plasma arc sputtering of the metallic target.
Isolation of S.aureus was performed via standard manual methods from January to June 2021, identification was carried out via the MALDI-TOF-MS
method. Sensitivity to antibiotics was evaluated according to EUCAST (2021, v.11.0) requirements. Antibacterial activity of the silver oxide samples obtained
against 130 clinical strains of S.aureus was analysed in liquid nutrient broth with subsequent measurement of optical density.
Results. Over 90% of the clinical strains of S.aureus isolated from patients with orthopaedic infection were sensitive to the silver oxides obtained. The
amount of oxygen in the compound exerted almost no influence on the sensitivity to the oxides: even a minimum ratio between silver and oxygen provided a pronounced antibacterial effect. Additionally, the sensitivity to silver oxides did not depend on the MRSA resistance phenotype and the compounds were effective against XDR strains of S.aureus in 96.7% of the cases.
Conclusion. All tested samples of silver oxides (Ag0,2O, Ag1O, Ag2O) were characterised by pronounced antibacterial activity against S. aureus. The data
obtained point to prospects in application of silver oxides for prevention and treatment of orthopaedic infection induced by Staphylococcus aureus without
regard for the sensitivity phenotype of the pathogen.

Aim of study. To reveal changes in renal parenchymal thickness in hydronephrosis patients before and after surgery depending on the patient’s age.
Materials and methods. Archived medical histories of 350 patients after surgery for congenital hydronephrosis within 1990-2020 were studied. The age of patients at the moment of surgery varied from one month to 18 years. The dynamics of change in the parenchymal layer thickness of the impaired kidney was evaluated based on ultrasound protocols of kidney scanning before and after the surgery.
Results. The maximum decrease in renal parenchyma before surgery was noted in the group of patients aged 15-18 years: 46.00% and 59.68% on the poles and in the lower third, respectively. The minimum decrease was registered in patients aged 0-3 months: 24.43% on the poles and 49.06% in the middle third of the kidney. The best renal parenchyma restoration after surgery was registered in group 1: 94.04% on the poles and 87.74% in the middle third. Low percentages of parenchymal regeneration were observed in the 7th age group: 69.11% and 61.52%, respectively. The values of loss and restoration of parenchyma in each age group were statistically reliable at p≤0.001.
Conclusion. Patients operated at the age before 3 months were observed to have the minimum decrease in the thickness of the renal parenchymal layer
before surgery with maximum values associated with restoration of renal parenchyma after surgical correction. The probability of complete equivalence of parenchymal thickness of the operated kidney to the healthy one reliably declines with increasing age at the moment of operation.

Malignancies during pregnancy are usually treated similarly to the malignancies in non-pregnant patients. Results of controlled therapeutic trials
are typically not available. However, registered studies associated with some of the most common malignancies exist. In case of ovarian cancer, due to its rarity – especially with the primary metastatic cases – only individual case reports are available. The article presents a case with par aortal abdominal, thoracic and cervical lymph node metastasis in a 33-years-old pregnant female. She was treated with primary systemic chemotherapy since early pregnancy. At 32 weeks of gestation, the patient gave birth to a girl (1460g) by caesarean section. Subsequently, the patient received 3 more cycles of chemotherapy with carboplatin/paclitaxel and bevacizumab for 30 months as well as letrozole maintenance therapy. Three years after the initial diagnosis, complete instrumental assessmentshowed unremarkable results without tumour recurrence

Aim of study. To determine specific clinical and diagnostic predictors and symptoms of different preeclampsia phenotypes.
Material and methods. A double-centre retrospective case-control study was performed including analysis of somatic status data, obstetric and gynaecological history and peculiarities in pregnancy progression and delivery of 373 female patients. The control group was constituted by 200 female subjects whose physiological pregnancy concluded with term delivery. The main group enrolled 173 patients, the course of pregnancy of which was complicated by development of severe preeclampsia (PE) including placental PE (early) – 44 cases (25%) and severe maternal PE (late) – 129 cases (75%). Over 100 potential clinical and anamnestic risk factors for PE, peculiarities in pregnancy progression and delivery outcomes have been analysed.
Results. Despite of the similarity between clinical parameters of different PE phenotypes, placental PE (pPE) is characterised by a more significant arterial
hypertension (p=0.0311) and proteinuria (p=0.0005) growing over the course of a day. Therewith, a reliable correlation has been established between the
level of diastolic blood pressure and proteinuria (OR=0.87; 95% CI 0.77-0.93; p<0.0001). Maternal PE (mPE) is characterised by growth of symptoms within
the period of 1-3 weeks. Significantly more frequently, maternal PE is developed against the background of pathological BMI growth (OR=4.1, p=0.105) and gestational diabetes mellitus (OR=3.6; p=0.0432). Perinatal outcomes in pPE are characterised by high rates of stillbirth (22.7%) and fetal growth retardation (82.6%).
Conclusion. Placental (early) PE is characterised by a more severe progression with specific clinical and ultrasound predictors, which makes it possible to outline a cohort of females for closer monitoring and preventive procedures.

Aim of study. To reveal peculiarities in topography and quantitative content of subcutaneous tissue in adolescents with different values of BMI and sexual
dimorphism index.
Material and methods. A total of 498 male and female adolescents of European ethnicity were studied. The methods applied were anthropometry,
caliperometry, ultrasound scanning of subcutaneous tissue, the method for BMI and sexual dimorphism calculation by J.M. Tanner (1951) and statistical
analysis.
Results. Sexual inversion manifested by gynecomorphy was revealed in 11.0% male patients and andromorphy was observed in 22.5% female patients.
Caliperometry provided the following results: obesity in male adolescents lead to a statistically significant increase in the skinfold thickness as compared
to subjects with normal BMI in the following areas: abdomen – 39mm [38.6; 41.17] against 13.15mm [12.57; 16.8] (2.97-fold); rear shoulder – 18.25mm
[16.94; 20.13] against 6.25mm [5.47; 8.58] (2.90-fold); back – 28mm [26.13; 29.98] against 10.5 [9.93; 12.67] (2.67-fold). Female adolescents with obesity were noted to have statistically significant increase in skinfold thickness in the following areas: front shoulder – 21.3mm [20.73; 23.46] against 5.7mm [4.61; 7.39] (3.73-fold); above pectoral muscles – 15.0mm [13.25; 20.12] against 5.7mm [4.13; 7.0] (2.63-fold); abdomen: 37.0mm [31.18; 39.42] against 16.0mm [11.10;18.54] and thigh: 42.3mm [40.13; 45.64] against 18.3mm [17.92; 20.72] (2.31-fold). It has been shown that assessment of topology and thickness of skinfolds on certain body parts depending on the BMI and morphotype of subjects will make it possible to reveal their predisposition to sexual inversion and include them into the risk group.
Conclusion. Through the method of caliperometry (identical sonography data) and anthropometry, a pattern in skinfold distribution depending on the
morphotype has been determined. Target biomarkers for topography and thickness of skinfolds characteristic to subjects with sexual inversion have been studied.

Abstract. Light chain proximal tubulopathy (LCPT) is a disease characterised by accumulation of monoclonal immunoglobulins produced by tumour clones
of plasma cells or B-lymphocytes in the epithelium of proximal renal tubules. One of LCPT forms is the crystal one, against the background of which
epithelium of proximal renal tubules accumulates crystal structures of different sizes and shapes. This work presents an observation of a kidney transplant
patient with crystal LCPT. The patient was admitted with azotaemia and underwent renal biopsy in order to establish the diagnosis. Morphological analysis drew attention to necrosis of epithelium of proximal renal tubules. Electron microscopy visualised crystal structures, immunohistochemical analysis of which revealed their monotypy in relation to lambda light chains of immunoglobulins. LCPT was diagnosed based on the comparison of the morphological picture and clinical data.

Rosette-forming glioneuronal tumour (RGNT) is a rare primary tumour of the central nervous system with a low degree of malignancy. Using
such databases as PubMed, Web of Science and Google Scholar as well as terms “rosette and forming and glioneuronal”, we found 153 RGNT cases dated 2002-2020. Low occurrence of the disease and absence of specific symptoms make it possible to perform a differential diagnosis judging from the clinical picture. Clinical manifestations of the disease are rather variable and depend on the tumour location. Magnet-resonance tomography is the leading method for diagnosis of such disease. The article presents a case of successful treatment of a patient RGNT of the fourth ventricle. Subtotal resection of the tumour was performed due to its diffuse growth. Tumour residue is subject to dynamic follow-up observation

Abstract. Congenital leucosis is an extremely rare disease registered in 4.3-8.6 children among 1,000,000 newborns. Congenital leucosis is usually registered
in children during 3 first days or 3 initial months of life. The disease is characterised by rapid clinical progression, oftentimes fulminant clinical manifestations and aggressive development. The clinical case described presents the changes revealed via ultrasound imaging of a 10-months-old child with congenital leucosis with rapid and aggressive progression.

Abstract. The article presents a case of diagnostics of arteriovenous thrombosis of the umbilical cord. At the gestational age of 36+4, ovoid echogenic parietal inclusions in the umbilical vein lumen and fragmented increase in the venous wall echogenicity were detected. One day later, a healthy preterm male child was born through natural delivery with the Apgar score of 6-7 and weight of 2280g. Histological analysis of placenta identified arteriovenous thrombosis
combined with cavernous haemangioma of the umbilical cord.

Abstract. Modern strategy for management of spondyloarthritis (SpA) is aimed at the earliest possible diagnosis and treatment of diseases. Emergence of nonradiographic SpA in clinical practice necessitates differential diagnosis of this condition from a wide range of diseases including juvenile spondylodysplasia. The article presents a clinical case of newly-diagnosed Scheuermann-Mau disease in an adult patient.