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In the Strategic Academic Leadership Program, the number of publications included in the 1% of the most cited ones in the Web of Science Core Collection database over previous 10 full years is used as an indicator of research potential of universities and scientific centers. The purpose of this study was to analyze the segment of Highly Cited Papers and Hot Papers on surgery using the Essential Science Indicators (ESI) analytical application. According to ESI data, relevant for March 2020, highly cited publications on medicine have formed 2.425 research fronts including 211 ones in surgery. We have analyzed the directions of researches in surgery characterized by the greatest number of citations.

The paper is a narrative review of the literature on the use of direct oral anticoagulants (DOACs) for the VTE treatment in challenging patients: senile age (≥75 years), impaired renal function (estimated glomerular filtration rate ≤50 ml/min), fragility (one of the previous characteristics and/or bodyweight ≤50 kg). The paper discusses the studies of EINSTEIN DVT and PE (rivaroxaban), AMPLIFY (apixaban), HOKUSAI-VTE (edoxaban), RE-COVER I and II (dabigatran) in the focus of the secondary analysis in the pre-specified patient's subgroups, as well as their pooled analyzes and meta-analyzes. Based on the results of this review, it was concluded that in a subgroup of senile age patients, dabigatran increases the risk of major bleeding by 4.8 times and has no advantages over vitamin K antagonists (VKA); rivaroxaban and apixaban retain superiority over VKA on the safety outcomes and reduce the risk of major bleeding by 73% and 77%. In the subgroup of patients with impaired renal function, the use of apixaban and dabigatran is associated with an increase in the risk of major bleeding by 6.5 and 7.3 times, and these DOACs do not have advantages over VKA; rivaroxaban retains its superiority over VKA and reduces the risk of major bleeding by 78%. For fragile patients, a secondary analysis is available only for rivaroxaban, which remains superior to VKA on safety endpoints and reduces the risk of major bleeding by 73%. In the absence of direct comparisons between the available DOACs, the presented data can be used as a rational approach for the choice of appropriate treatment for VTE in challenging patients.

The purpose of this study was to efficacy of mexidol in the prevention of toxic damage to the heart in acute pancreatitis., Material and Methods: The paper presents the results of experimental studies conducted on 30 adult mongrel adult dogs, which simulated acute focal pancreatic necrosis. We studied the influence of mexidol in the complex therapy for changes in the qualitative and quantitative composition of the lipid tissue structures of the heart, the intensity of processes of lipid peroxidation, antioxidant capacity, phospholipase A 2 activity and morphofunctional state of the heart muscle in experimental acute focal pancreatic necrosis. Th., Results and Discussion: The preventive use of antioxidant drug mexidol in complex treatment of acute focal pancreatic necrosis, which limits the development of endogenous intoxication, increased intensity of lipid peroxidation and restores antioxidant capacity, reduces leading to phospholipase activity in tissue structures of the heart, corrigiruet lipid metabolism and morphofunctional state of the heart, and, consequently, toxic damage to the heart during endotoxic.

The urgency of the problem. The incidence of various thromboembolic complications in patients with oncopathology reaches 5-12%. When treating VTE in patients with oncology it is necessary to choose between two generally recognized alternatives. The recommended two-component scheme of the initiating phase of anticoagulant therapy with subsequent long-term admission of VKA is fraught with the development of clinically significant bleeding during the initial selection of the dose of warfarin and an increased risk of recurrence of VTE. Long-term parenteral use of LMWH is often negatively treated by patients and adversely affects compliance. For these reasons, enteral administration of new oral anticoagulants is promising for prolonged anticoagulant therapy in this category of patients. The paper cites three clinical cases of treatment of patients with acute venous thrombosis of deep veins against a background of different oncological processes. In the first case - the operated previously for cancer, in the second case - to be treated over oncological process and in the third case - in the primary cancer detection., Discussion: The results of the studies of EINSTEIN-DVT and EINSTEIN-PE allow us to consider the use of rivaroxaban in the treatment of patients with VTE on the background of oncopathology. The possibility of its use from the first day, in our opinion, is a significant advantage, since it allows us to reveal the clinical effectiveness of anticoagulant therapy already during the first stage of treatment, since NOAKs does not imply the possibility of laboratory monitoring.

In the article provides an analysis of own of clinical experience peculiarities of carrying out of anesthesia, when performing 466 various tracheo-bronhoplastiс of operations for the period from 1979 to 2014 the year a one team of surgeons. Preoperative preparation, anesthesia and postoperative management of patients are key to improving treatment outcomes. Full arsenal of modern methods of ventilation lets you choose for each stage of surgery is most convenient for the surgeon and patient-safe way to maintain gas exchange. Presented in this paper our anestiology experience allows you to discuss and elect the proposed management of patients through the selection and optimization of the method that best meets modern requirements.

Aim: To summarize the data of 'no-touch isolation technique' (NIT) for pancreatoduodenectomy and radical antegrade modular pancreato-splenectomy (RAMPS) for pancreatic malignancies., Material and Methods: We looked through Pubmed and Cochrane databases for scientific papers published from January 2000 until September 2014., Results: Eight studies were included. There were 7 retrospective cohort studies and one randomized controlled trial (RCT). Mean operation time and blood loss were 267 min (198-386 min) and 132 ml (331-744 ml) respectively. Mean morbidity rate was 35% (17-58%). There was no 30-day mortality. Mean incidence of R0-resection varied from 50% to 97% with average value 84%. Median survival was reported in 3 studies (17, 18 and 26 months). Five-year actuarial overall survival was reported in 4 studies (31, 36, 40 and 53%)., Conclusion: Positive results of NIT and RAMPS might justify further evaluation of the method in pancreatic cancer. Prospective randomized controlled trials needs to be done to demonstrate the oncological value of this novel surgical technique.

The paper analyzes the results of a survey of 37 patients with acute ulcerative gastroduodenal hemorrhage. During endoscopy found that 7 patients the cause of bleeding was gastric ulcer, duodenal ulcer in 27 and 3 concomitant ulcer. Hemostasis was evaluated by J. Forrest and the severity of blood loss was assessed by the A.A. Shalimov: with blood loss was mild in 11 patients, the average degree--12 and with severe--14. In all patients on admission in the peripheral blood were studied state of cellular, humoral and cytokine profile: CD3+, CD4+, CD8+, CD4+/CD8 + and CD19+, FI, FF, CEC, IgA, M, G, TNF-α, IFN-γ, IL-1, IL-2, IL-4, IL-6, IL-8 and IL-10. In general patients with on admission revealed significant changes in the immune and cytokine status. In cellular immunity occurs immunosuppression. Disturbances in humoral immunity manifests itself in increased levels of lymphocytes in blood loss and hardships of all multi-directional changes in the concentration of immunoglobulins depending on the amount of blood loss. When there is an imbalance in cytokine status, the depth of which depends on the degree of blood loss.

Aim: Developing an algorithm of diagnosis and treatment of wound defects in patients with neuroischemic form of diabetic foot syndrome, study of the effectiveness of collagen implants in closing of wound defects., Material and Methods: The paper describes the diagnostic algorithm for patients with wound defects in neuroischemic form of DFS. Wound cleansing from areas of necrosis, purulent-fibrinous plaque, biofilm of the wound was conducted on the day of hospitalization using hydrosurgery ultrasonic cavitation. We propose the method of closing the wound defect with high-tech biomaterials based on type I collagen., Results: Implantation of type I collagen increased the relative rate of wound healing, reduced the amount of high amputation, and significantly reduced the average time of patients' stay in hospitals and their transfer to outpatient treatment., Conclusions: 1. Patients with neuroischemic form of diabetic foot syndrome should be timely and promptly pass the diagnostic phase. 2. Ultrasonic debridement is most effective method of wound preparation before its closure. 3. The use of bioplastic material Collost in patients with neuroischemic form of diabetic foot syndrome increases the rate of wound healing that leads to decrease the average patient's stay in hospital and reduce high amputations. 4. The average patient's stay in hospital reduced up to 20% that decreases the treatment costs of such category of patients.