Background. The maze procedure aims to eliminate atrial fibrillation (AF), restore sinus rhythm (SR) and atrial contractility. However, conflicting evidence exists regarding the extent of atrial remodelling in various techniques, which directed the focus of our study.
Objectives. An atrial remodelling comparison after a cut-and-sew maze-3 surgery and its biatrial cryo-maze modification using 2D echocardiography.
Methods. The study is a retrospective uncontrolled interrupted two-cohort time-series trial, with patients selected by pseudorandomisation according to a normal sinus rhythm-maintaining AF surgery method. A total of 217 maze-3 and 113 cryo-maze combined cardiac interventions have been performed within 2012–2021. The interventions included valve repair, coronary artery bypass grafting and their combination. Due to differences in long-term follow-up, the cohorts were pseudorandomised to select by 50 restored vs. maintained sinus rhythm patients using a nearest-neighbour classifier coupled with logistic regression. Mean follow-up period was 6 (1–17) months. The patients had paroxysmal, persistent and longstanding persistent AF. Echocardiography values prior to and long-term post-surgery were further analysed to determine the atrial remodelling dynamics.
Results. A statistically significant atrial volume reduction is evident in a long-term within-cohort comparison. Meanwhile, a statistically more pronounced remodelling is observed between cohorts after maze-3 procedure. The cohort 1 vs. 2 estimates are: mean left atrial volume 120/125 mL³ (p = 0.011), left atrial size in apical view 52/53 mm (p = 0.023), right atrial size in apical view 58/62 mm (p = 0.004), right atrial size in parasternal short axis view 43/45 mm (p = 0.004), right atrial area in apical 4-chamber view 25/28 cm² (p = 0.007). Maintained atrial pacing patients had positive systolic atrial function recovery rates (E/A ratio increased to average 1.5) in the long-term in both comparison cohorts.
Conclusion. Remodelling is biatrial after all the maze procedures compared. A more pronounced atrial volume reduction occurs after maze-3 surgery. The presence of sinus rhythm is facilitated by cardiac conduction leading to mechanical and electrical remodelling of the atria.

Background. Despite ample research on the coronavirus infection sequence and therapy, the incidence of adverse outcomes remains very high. Sepsis stands among the major factors greatly complicating treatment and increasing the risk of death. A timely identification of highrisk sepsis patients is a cornerstone of effective sepsis prevention.
Objectives. A comparative prognostic power assessment between the quick Sequential Organ Failure Assessment (qSOFA) scale, National Early Warning Score (NEWS), Initial Prehospital Rapid Emergency Medicine Score (REMS) and the Systemic Inflammatory Response Syndrome (SIRS) criteria for sepsis detection in anaesthetic intensive care patients with a diagnosis: SARS-CoV-2, virus unidentified.
Methods. A retrospective observational study included 166 patients over 18-year age with unconfirmed infection (ICD-10 code U07.2). The qSOFA, NEWS, REMS and SIRS point estimates were obtained from each patient. The patients were retrospectively divided in two cohorts by sepsis presence (Sepsis-3 criteria) to determine the express scales power in evaluating the risk of sepsis (estimated as area under ROC curve, AUROC).
Results. Data on 102 patients were included in the final analysis. Fifty-eight (57%) patients were terminal, and 55 (54%) developed sepsis. The estimates are as follows: NEWS — AUROC 0.848 [95% confidence interval (CI) 0.764–0.912], sensitivity 76.36% [95% CI 63.0–86.8], specificity 82.98% [95% CI 69.2–92.4], optimal cut-off threshold >5 points; qSOFA — AUROC 0.700 [95% CI 0.602–0.787], sensitivity 76.36% [95% CI 63.0–86.8], specificity 61.70% [95% CI 46.4–75.5], optimal cut-off threshold >0 points; REMS — AUROC 0.739 [95% CI 0.643–0.821], sensitivity 69.09% [95% CI 55.2–80.9], specificity 65.96% [95% CI 50.7–79.1], optimal cut-off threshold >5 points; SIRS criteria — AUROC 0.723 [95% CI 0.626–0.807], sensitivity 98.18% [95% CI 90.3–100.0], specificity 31.91% [95% CI 19.1–47.1], optimal cut-off threshold >0 points.
Conclusion. The NEWS scale revealed a good prognostic power to estimate the risk of sepsis in patients with suspected COVID-19 disease. The qSOFA, REMS scales and SIRS criteria possess a good calibration capacity, albeit insufficient resolution, which limits their prognostic value.

Background. The comorbidity of arterial hypertension (AH) and obstructive sleep apnea syndrome (OSA) is becoming increasingly common in clinical practice. However, the priority strategy for selecting antihypertensive therapy in such patients is yet to be defined. 24-hour blood pressure monitoring is important for determining an approach to controlling hypertension.
Objectives. To study specific features of 24-hour blood pressure monitoring in comorbid AH– OSA patients.
Methods. A total of 130 AH patients were surveyed. The main cohort (1) included AH–OSA patients (n = 90, mean age 54.93 ± 1.04 years), control cohort (2) — non-OSA AH patients (n = 40, mean age 57.92 ± 1.29 years). All patients had a general clinical examination with 24-hour blood pressure monitoring. OSA was verified in overnight respiratory polygraphy using an Alice PDx diagnostic appliance (USA).
Results. The following specific features of 24-hour blood pressure monitoring were identified in the comorbid patients: a statistically significant growth of mean 24-hour systolic and average BP, as well as mean nocturnal systolic, diastolic and average BP; a statistically significant growth of mean 24-hour systolic, diastolic and average BP load indices. In addition, the AH-OSA patients had the statistically higher pulse pressure, systolic and average BP variability, as well as morning BP surge rate. The 24-hour BP dynamics in OSA patients had predominant morbid profiles and higher non-dipper and night-peaker rates compared to the control cohort.
Conclusion. The identified specific features reflect a high risk of adverse cardiovascular events in AH–OSA comorbid patients, an earlier damage of target organs and negative prognosis of comorbidity, which warrants a further analysis of AH-specific clinical picture and personalisation of blood pressure control measures in such patients.

Background. Optimal reconstruction after gastrectomy (GE) in gastric cancer (GC) is currently a pressing issue, with research continuing to advance functional methods, especially those preserving duodenal passage, to improve the patient’s quality of life (QOL) and nutritional status (NS).
Objectives. An evaluation of randomised clinical trials (RCTs) targeting GC patients with radical GE and comparing duodenal passage-preserving (DPP) and non-preserving (NDPP) reconstruction techniques in terms of immediate outcomes, post-gastrectomy syndrome, NS and QOL.
Methods. Sources were mined in the PubMed, Cochrane Library, Google Scholar electronic databases, as well as CyberLeninka and eLibrary national resources. The RCTs meeting eligibility criteria (15 publications) were covered in a meta-analysis. Outcome variations were defined via odds ratio (OR), standard error estimated with 95% CI, statistical significance was assumed at p <0.05. Review Manager (RevMan v. 5.4., the Cochrane Collaboration, 2020) was used for statistical data processing.
Results. A total of 15 RCTs were surveyed (1,766 patients; 722 in DPP and 1,044 in NDPP cohort). The complication and mortality rates did not differ significantly between cohorts. The meta-analysis elicited a significant advantage of DPP-GE regarding the dumping syndrome incidence at all post-surgery terms cumulatively (OR = 0.32 [95% CI: 0.22–0.48], p = 0.00001), as well as the 3- and 12-month terms, with no difference observed for 24 months. No statistically significant DPP vs. NDPP cohort variations have been found regarding reflux, stasis syndrome or NS values. The RCTs were evidently diverse with respect to QOL assessment techniques; 4 of 7 publications reported DPP advantages, and 3 — no significant variation in QOL between the DPP and NDPP cohorts.
Conclusion. Further research is necessary to substantiate optimal reconstruction methods, particularly those restoring food passage through duodenum after GE, to facilitate the patient’s most favourable QOL and NS.

Background. Bedaquiline is currently a drug of choice in therapy for extensively and multidrug-resistant tuberculosis. It is indicated for children from a 6-year age and young adults as part of a combination chemotherapy, in compliance with the medical council’s (MC) regulation on active extensively and multidrug-resistant tuberculosis.
Clinical Cases Description. The article describes the clinical cases of bedaquiline treatment of extensively drug-resistant tuberculosis in сhildren. Patient B., 16 yo, was routinely admitted to a children’s ward of the Orenburg Regional Clinical Antituberculosis Dispensary with the preliminary diagnosis: exudative pleurisy-complicated S1,2 infiltrative focal tuberculosis of left lung. Mycobactérium tuberculósis (MBT) (-). Complaints of cough, painful chest at deep breath, 37.3°C-elevated body temperature. Chest X-ray: left focal shadows in S1,2, intensive homogeneous darkening due to pleural effusion from diaphragm to anterior segment of rib III. An urgent pleural puncture was performed to sample fluid for MBTculture and PCR resistance tests to streptomycin and rifampicin. The patient was treated with anti-tuberculosis drugs according to the IV chemotherapy regimen. Taking into account the MBTculture results, the Medical Board took the decision to start using the V chemotherapy regimen with the inclusion of up to 180 doses of bedaquiline. The patient received anti-TB drugs according to chemotherapy regimen IV. Based on the pleural fluid PCR tests, the MC prescribed a conversion to chemotherapy regimen V with adding bedaquiline up to 180 doses. After 7 months of positive dynamics, the patient was transferred to continuation phase at a children’s sanatorium. Patient S., 10 yo, was routinely admitted to a children’s ward of the Orenburg Regional Clinical Antituberculosis Dispensary with the diagnosis: two-sided bronchopulmonary intrathoracic lymph nodes tuberculosis (ILNTB), calcification phase, MBT (-), follow-up care level I. Given the child’s triple contact with tuberculosis carriers, including extensively drug-resistant (XDR) tuberculosis, the MC prescribed antibacterial drug chemotherapy IF regimen V with adding bedaquiline up to 180 doses: pyrazinamide (Z), prothionamide (Pto), para-aminosalicylic acid (PAS), cycloserine (Cs), bedaquiline (Bq) concurrently with vitamins and hepatoprotectors (ZPtoPASCsBq). After 4 months of positive dynamics, the patient was transferred to anti-bacterial therapy continuation phase 4 (ZPtoCsPAS) for up to 12 months at a children’s sanatorium.
Conclusion. The clinical cases presented demonstrate the efficacy of bedaquiline in adolescents having extensively drug-resistant focal pulmonary tuberculosis and intrathoracic lymph nodes tuberculosis. The prescription of bedaquiline in this age cohort requires careful justification and a monitoring of adverse reactions and antituberculosis chemotherapy complications.

Background. Ectopic are 3% of all pregnancies, with 4.1–10% of them entailing lethal consequences, which exposes the imperfection of current operative techniques. v-NOTES (vaginal— natural orifice transluminal endoscopic surgery) is an emerging surgical technique offering solutions to achieve a good aesthetic effect coupled with a minimally invasive intervention and fewer trocar-associated complications. This article presents our first clinical experience with v-NOTES in a patient with tubal pregnancy.
Clinical case description. Patient V., 28 yo, a first-time pregnancy, admitted emergently with complaints of genital bloody discharge and abdominal pain. Beta-hCG 2,200 mU/mL on examination, with a 48-h increase by 400 U. In ultrasound (US): pregnancy not located in uterine cavity, an inclusion (gestational sac?) visualised extraovarially on the right from uterus. Progressive right tubal pregnancy in repeated US.
The patient was advised with v-NOTES as a surgical procedure. An informed voluntary consent has been obtained.
A posterior colpotomy with intra-abdominal port placement was performed under endotracheal anaesthesia in lithotomy position. CO₂ insufflation to 14 mmHg. Laparoscopy revealed about 30 mL liquid blood in Douglas pouch of abdominal cavity; sanitated. Ampulla of right fallopian tube contained a 2.5 x 1.5 cm bluish-coloured gestational sac. Right antegrade tubectomy performed with ultrasonic scissors and a bipolar clamp for the specimen evacuation via port. Colporrhaphy. Blood loss 35 mL, surgery time 35 min. Pain visual analogue scale (VAS) score 2 in first postoperative 24 h. The patient was discharged on day 2.
Conclusion. v-NOTES is an emerging surgical technique alternative to laparoscopic access, which combines the benefits of minimal invasiveness and good aesthetics. More surgical practice and multicentre trials are necessary to draw definitive conclusions.

Background. Congenital hyperinsulinism (CHI) is a hereditary disorder presenting with the hypersecretion of insulin by pancreatic beta cells and further development of hypoglycaemia. CHI is an orphan disease. According to the European sources, its incidence averages to 1:30,000– 1:50,000 newborns.
Clinical Cases Description. This article describes two clinical CHI cases in girls. Case 1: a girl, born on 20.06.2017, was admitted to a paediatric unit of the Children’s Territorial Clinical Hospital for a seizure syndrome. CHI was diagnosed in the age of one month. At 5 months, the girl was confirmed a focal CHI with adenomatous focus localised in pancreatic head; a subtotal head resection has been performed facilitating a compensation. The girl was discharged in a satisfactory condition for a local residence outpatient follow-up. Case 2: the patient was diagnosed with CHI at 1 year 4 months upon admission to an endocrinology unit of the Children’s Territorial Clinical Hospital. The girl was redirected to the National Medical Research Centre for Endocrinology, where CHI was confirmed and indicated for a proglycem treatment. The child was followed-up at the Centre to adjust therapy. In July 2020, a fasting test with background proglycem therapy of 2.9 mg/kg/day (62.5 mg/day) revealed a medicated compensation. The patient was discharged with improvement for a resident endocrinologist follow-up with a recommendation of proglycem at a prescribed dosage upon vital indications.
Conclusion. The clinical cases illustrate that, despite rarity and a marked heterogeneity, CHI can be timely diagnosed and properly treated in children. An adequate therapy can facilitate the disease compensation and prevent lifetime neurological complications.

Background. Urinary incontinence is associated with chronic psycho-emotional stress. Stress management should be part of a comprehensive treatment for urinary incontinence.
Objectives. An assessment of hypercatecholaminaemia severity and dynamics in repeated courses of TES therapy for stress urinary incontinence.
Methods. A total of 100 stress urinary incontinence patients were divided between a comparison and two main cohorts. Main cohort 1 (n = 30) received a modern standard treatment in combination with TES therapy. TES therapy was performed in three courses (1 session per day for 7 days): course 1 on admission, course 2 in 3 months after course 1, course 3 in 6 months after course 1. Main cohort 2 (n = 40) received a modern standard treatment in combination with two short courses of TES-therapy (2 sessions per day for 7 days): course 1 on admission, course 2 in 6 months after course 1. The comparison cohort (n = 30) only had standard treatment. Catecholamine concentrations were assessed over time in each cohort.
Results. Catecholamine concentrations were >2 times higher before treatment in all cohorts vs. healthy volunteers. The comparison cohort revealed adrenaline and noradrenaline concentrations 71.2% (p < 0.05) and 84.0% (p < 0.05) higher vs. healthy volunteers, respectively, by month 6 of the trial. Main cohort 1 had the concentrations of adrenaline and noradrenaline 2.1 (p < 0.05) and 1.5 (p < 0.05) times higher, respectively, vs. healthy volunteers. Main cohort 2 showed an adrenaline concentration 12.5% (p < 0.05) and noradrenaline — 2.4% higher (p = 0.15) vs. healthy volunteers.
Conclusion. TES therapy affects urinary incontinence hypercatecholaminaemia, demonstrating a favourable homeostatic impact on neuroimmunoendocrine regulation.