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Aim. To estimate the detection rate of heart failure (HF), using various diagnosis criteria, among patients aftr 12 months after hospital treatment for coronavirus disease 2019 (COVID-19).Material and methods. The study included 185 patients from the TARGET-VIP registry who came for a visit 12 months after hospitalization for COVID-19. To identify HF with reduced (HFrEF) and mildly reduced (HFmrEF) ejection fraction (EF), the European Society of Cardiology (ESC) criteria (2016 and 2021) were used. To identify HF with preserved EF (HFpEF), we used the ESC criteria (2016 and 2021), as well as the 2018 Russian guidelines and H2FPEF score.Results. In the analyzed group, there were no patients with EF Conclusion. Among the examined patients 12 months after hospital treatment for COVID-19, there were no cases of HFrEF and HFmrEF. The proportion of HFpEF cases, depending on the diagnostic criteria used, varied significantly from 2,2 to 31,4%. The previously established diagnosis of HF was confirmed in 83% of cases at a visit 12 months after discharge from the hospital. Using the 2016 ESC criteria and the corresponding 2020 Russian Society of Cardiology guidelines, the proportion of newly diagnosed HF was 78% of all patients.

Aim. To evaluate the medical treatment of patients with cardiovascular disease (CVD) during the first year of follow-up after hospitalization for coronavirus disease 2019 (COVID-19) in a prospective registry.Material and methods. The material for the study was obtained from the database of the TARGET-VIP inhospital registry. The registry included 1130 people. Of 863 patients discharged from the hospital with a diagnosis of COVID-19, 473 (548%) patients with CVD were selected, and 31 (40,8%) patients were selected from 76 patients in whom the diagnosis of COVID-19 was not confirmed with CVD.Results. At the stage of discharge from the hospital, the quality of therapy for CVD was insufficient on average, the frequency of proper prescriptions was 59,5%. During the first year, there was a significant trend towards a decrease in the prevalence of antihypertensive therapy for hypertension (p=0,018), anticoagulants for atrial fibrillation (pConclusion. In the TARGET-VIP registry after discharge from the hospital, the prevalence of proper appointments for CVD was insufficient. During the first year of observation, patients with CVD showed a significant decrease in the frequency of proper prescription of antihypertensive therapy for hypertension and anticoagulants for atrial fibrillation. When comparing groups of patients with confirmed and non-confirmed COVID-19, a higher average rate of adherence to proper prescriptions was found in patients with confirmed COVID-19. However, significant differences were found only 30-60 days after discharge.

—A new method of interactive identification is proposed—trusted identification of a person using untrusted devices (e.g., smartphones, tablets, etc.). It is shown that static, unchangeable, or almost invariable biometric features can be used in criminology, but it is impractical for digital economy computer systems. It is inefficient to use fingerprints, iris and retina, vascular pattern, etc., as characteristics. On the contrary, it is necessary to use inherent human dynamic characteristics , for example, those manifested in reflexes. As such, eye movements can be used when reading and/or tracking a stimulus, as well as saccades, pulse wave, and others. For decision-making it is proposed to use artificial neural networks.

Aim. To assess long-term outcomes within 12 months after hospital treatment of patients with coronavirus disease 2019 (COVID-19) as part of a prospective registry.Material and methods. Outcomes in the posthospital period were assessed in 827 patients diagnosed with COVID-19 (age, 58,0±14,8 years; men, 51,3%). For periods of 30-60 days, 6 and 12 months after discharge from the hospital, cases of death, nonfatal myocardial infarction (MI) and stroke, hospitalization, acute respiratory viral infections/influenza were assessed. The follow-up period was 13,0±1,5 months.Results. During the follow-up period, 35 (4,2%) patients died, 6 (0,73%) and 4 (0,48%) cases of MI and stroke were registered. In addition, 142 (17%) patients were hospitalized, while 217 (26,2%) patients had acute respiratory viral infections/ influenza. Factors of age and length of intensive care unit stay were significantly associated (pConclusion. A prospective follow-up of 827 patients in the TARGET-VIP registry revealed that 12-month mortality was 4,2%, while more than half of the deaths (54%) were registered in the first 90 days, including 31% — for the first month after discharge from the hospital. The most common events were hospitalizations (17,0%) and acute respiratory viral infections/influenza (26,2%), while the rarest were myocardial infarction (0,73%) and stroke (0,48%). The key factors associated with 12-month mortality in the post-COVID-19 period were older age and intensive care unit stay during the reference hospitalization. A higher readmission rate during the follow-up period was associated with older age, and the prevalence of acute respiratory viral infections /influenza during the follow-up period was associated with younger patients and female sex.

Material and methods. Ultrasound ablation has been performed in 165 patients with metastatic liver cancer (metastases of colorectal cancer as a rule) and in 17 patients with unresectable pancreatic neoplasms for the period from April 2009 to December 2017. All patients with metastatic liver cancer underwent previous surgery for primary tumor. In 53% of cases unresectable pancreatic tumor was complicated by mechanical jaundice that required biliary drainage and stenting before ablation. Ultrasound and contrast-enhanced CT were applied to assess changes of tumor dimensions, its structure compared with initial data, vascularization grade, continued growth or de novo metastases with positive changes within destruction area. Percutaneous biopsy of liver and pancreatic tumors was carried out in 136 patients (75%) to assess morphological changes of tumor in pre- and postoperative period. Results. There were no intra – and postoperative complications. Three types of changes occurring within destruction area were revealed. Positive changes including changes of tumor structure, reduced dimensions and volume were observed in 76 (46%) patients. 38 (23%) patients had either augmentation of dimensions and volume of destruction area or appearance of additional tumor tissue on the periphery of metastasis. De novo liver metastases or other distant ones occurred in 51 (31%) patients with positive changes in destruction area. Oncologists of our center evaluated immediate and long-term outcomes of combined treatment. Reduced tumor dimension on the background of mild or absent pain syndrome were confirmed in 12 (72%) patients after ablation of pancreatic tumor. In 8 out of 12 patients weight gain and absent pain syndrome were observed within 48 months. Conclusion. Ultrasound ablation is effective and safe for local destruction of secondary liver tumors and unresectable pancreatic tumors. This approach is indicated for inoperable cases and as a stage of combined treatment.

Objective: to study the basic characteristics of changes revealed by MRI in patients with syringomyelia associated arachnopathy before and after surgery.Materials and methods. MRI was performed in 58 pat ients with syringomyelia before and after surgery in period from 2013 to 2016.Results.The diagnosis “syringomyelia” was approved in 41 patients. There was huge regression (more than 50% of volume) of syringomyelia cavity in 17 (41.4%) patients. In 20 (48.7%) patients marked decrease in size syringomyelia cavity (less than 50%), the volume expansion of the front and rear of cerebrospinal fluid spaces.Conclusions. The use of modern MRI Protocol in various types of syringomyelia allows not only to detect and give a comprehensive feature cavities, but also to detect adhesions, location and length, as well as to assess the dynamics of the disease after surgical treatment.

The article is dedicated to the description of the experience of automation of the processes of statistical reporting on salaries in Federal State Budgetary Institution «NationalPirogovMedicalSurgicalCenter» of Ministry of Health of theRussian Federationwith the use of information systems. According to the current legislation of theRussian Federation, within the framework of the successful implementation of the «Road Map» on a national scale, statistical information about salaries of employees of social institutions is collected in various sections of data reporting. It became necessary to develop a tool to promptly collect, process and analyze data on salaries to provide statistical information to social institutions. The purpose of this article is to familiarize oneself with the concept of multidimensional data representation and to structure information on multidimensional analytical reports within the framework of practical application for solving economic problems related to the formation of statistical reporting on salaries. The algorithm and the procedure for the formation of multidimensional analytical reports are described, both from the methodological and from the practical point of view. As a material for this study, the normative and legal acts of the Russian Federation, statistical and analytical materials of the section «Salaries of certain categories of workers in the social sphere and science» of the Federal State Statistics Service of the Russian Federation, scientific publications and articles of the periodical press, as well as the results of their own research were used. To facilitate the perception, special attention is given to the description of the basic concepts of multidimensional analytical reporting: measure, performance variables, value. The authors not only gave a definition of multidimensional analytical reporting, but also demonstrated a visual representation of the multidimensional information space of performance variables. Based on these definitions, the article describes the system for developing multidimensional analytical reporting, examines the stages of designing a multidimensional analytical representation of data, and demonstrates how to set up a multidimensional analytical report for building a multi-level hierarchy in accordance with pre-selected performance variables and dimensions. Methods of working with multidimensional analytical reporting are also described on the example of the implementation of the formation of the multidimensional analytical report «Statistical reporting on salaries» in the information system of the Federal State Budgetary Institution «NationalPirogovMedicalSurgicalCenter» of Ministry of Health of theRussian Federation. As a result, the effectiveness of multidimensional analytical reports for collecting, monitoring and analyzing statistical information on salaries was proved. Conducting in-depth analysis and evaluating the results of the implementation of salary targets are the basis for further modeling of the pay system and forecasting of financial results. Thus, the introduction of multidimensional analytical reporting made it possible to facilitate the labor-intensive process of making strategic management decisions by the administration of the institution. The authors concluded that the availability of such a tool in the healthcare system could help accelerating the operational processing of information for data analysis, as well as the generation of reports in various sections with an established depth of detail.

Routine diagnostic methods have limitations in terms of predicting the ventilation function of the lungs before and after surgery. It was decided to investigate the possibilities of dual-energy CT (DECT) using xenon in assessment of lung ventilation function.Objective: to master the methods of examination of patients with pulmonary pathology, evaluate the possibility of justifying the volume of operative intervention and prediction of postoperative lung function based on the hybrid images.Materials and methods. For the study, 12 patients with different pulmonary pathologies were selected (COPD – 5, lung cancer – 4, bronchiectasis – 3). Results. It was found that the use of DECT with xenon reflects the functional state of lung tissue.Conclusions. DECT with xenon have potential for planning surgical intervention and introducing the method into modern protocols of preoperative preparation.

Objective : to study the basic characteristics of changes revealed by MRI in patients with syringomyelia associated with Chiari malformations type I before and after surgery. Materials and methods. MRI was performed in 70 patients with syringomyelia before and after surgery in period from 2015 to 2016. Results. There was almost complete regression of syringomyelia cavity in 11 (16%) patients. The reduction in size of syringomyelia cavity was in 50 (71%) patients. Size of syringomyelia cavity has not changed in 9 (13%) patients. Conclusions. The use of modern MRI Protocol allows to evaluate the long-term consequences of surgical treatment in patients with Chiari malformation associated with syringomyelia and to evaluate further the prognosis of this disease.

The article presents the results of identification and detailed issues of organization and control of rational pharmacotherapy in the framework of the provision of inpatient medical and diagnostic support. The regulatory mechanisms for managing the automated formation and execution of medical prescriptions for drugs and their subsequent performance by the nursing staff in the medical information system are analyzed from the standpoint of work optimizing and reducing the workload of medical personnel and risk of probable errors. The particular attention is paid to the system of controlled personalized and multiple writing off of drugs, targeted to generation of baseline data for rationing drug consumption, predicting their consumption and managing the procurement of drugs at the level of the medical organization.

Aim. To characterize patients admitted to hospital with suspected or documented COVID-19 infection and community-acquired pneumonia (CAP) and to assess the prevalence of concomitant cardiovascular, non-cardiac diseases, prehospital cardiovascular therapy and outcomes of in-hospital treatment. Material and methods. The TARGET-VIP registry includes patients admitted to the N. I. Pirogov National Medical and Surgical Center with suspected or documented COVID-19 infection and/or CAP for the period from April 6, 2020 to July 2, 2020. COVID-19 infection was diagnosed using polymerase chain reaction (PCR) tests and chest computed tomography (CT). Comorbid conditions and pre-hospital therapy were assessed. Results. A total of 1,130 patients were included in the registry (mean age, 57,5±12,8 years; men, 579 (51,2%)). Using PCR test, COVID-19 infection was established in 686 (60,7%) patients; using chest CT − 334 (29,6%) patients. The most numerous were the group with a combination of COVID-19 and CAP (n=662; 58,6%) and the group with CAP without positive PCR (n=402; 35,6%). The group of patients with COVID-19 without CAP was the smallest (n=24; 2,1%); in 3,7% of patients (n=42), CAP was not confirmed and PCR were negative. The proportion of people with cardiovascular diseases (CVD) according to the survey, in comparison with data of medical records, was higher by 2% (52,2 vs 50,2%); the proportion of persons with chronic non-cardiac diseases − higher by 6,7% (50,8 vs 44,1%). Among patients with CVD (n=598), compared with patients without CVD (n=532), following diseases was diagnosed significantly more often: diabetes (odds ratio (OR), 5,66; 95% confidence interval (CI), 3,52-9,12), respiratory disease (OR, 2.,7; 95% CI, 1,43-4,27), chronic kidney disease (OR, 3,32; 95% CI, 1,97-5,59), obesity (OR, 15,35; 95% CI, 6,62-35,59). Hospital mortality was 4,2% and significantly differs (4,7 times) in patients with and without COVID-19 according to PCR (6,6 vs 1,4%, p=0,0001), including among patients with CAP and positive or negative PCR (6,0 vs 1,2%, p=0,0002). Conclusion. COVID-19 infection was diagnosed in 60,7% of patients according to PCR and in 90,3% of patients according to the combination of PCR and chest CT. Among patients with CVD, the proportion of people with chronic noncardiac diseases was significantly higher (regardless of age and sex), in particular, with diabetes, chronic kidney disease and obesity. Questionnaires provided important data on the history of noncommunicable diseases and prehospital cardiovascular therapy. The mortality rate of patients with documented COVID-19 infection was 4,7 times higher than with undocumented.

To analyze immediate outcomes of 286 laparoscopic and robot-assisted interventions on the colon and rectum.There were 256 (89.51%) laparoscopic and 30 (10.49%) robot-assisted procedures. 233 (81.46%) operations were performed for rectum and colon cancer. Postoperative complications after colon cancer surgery were revealed in 11.11%, including anastomosis failure in 2.08% of cases. Postoperative complications after rectal cancer surgery occurred in 32.58% of cases including anastomosis failure after anterior rectectomy in 11.67%.Robot-assisted surgery is not advisable for colon diseases according to price-effectiveness ratio due to available laparoscopic approach. Preventive intestinal stoma in endoscopic low and ultra-low anterior rectal resection allows you to avoid clinically significant inconsistency of colorectal anastomosis. Laparoscopic procedure should be performed with Contour stitching-cutting device in low and ultra-low anterior rectal resection if there is technical complexity of one-stage rectum intersection below the tumor. Robot-assisted operations for rectal cancer have advantages due to three-dimensional imaging and better orientation, greater freedom of manipulation in confined spaces, and simplicity of lymphadenectomy.Цель исследования - оценка непосредственных результатов внедрения эндовидеохирургических технологий в колоректальной хирургии. Материал и методы. Представлен анализ непосредственных результатов 286 оперативных вмешательств, выполненных лапароскопически и робот-ассистированно на ободочной и прямой кишке. Лапароскопических операций было 256 (89,51%), робот-ассистированных - 30 (10,49%). 233 (81,46%) операции выполнены по поводу рака прямой и ободочной кишки. Результаты. Послеоперационные осложнения операций по поводу опухоли ободочной кишки выявлены в 11,11% наблюдений, из них несостоятельность швов анастомоза отмечена в 2,08%. Осложнения после операций по поводу рака прямой кишки зарегистрированы в 32,58% наблюдений, из них несостоятельность анастомоза после передней резекции прямой кишки была в 11,67%. Вывод. Применение робот-ассистированных технологий при операциях на ободочной кишке не может являться целесообразным ввиду доступности выполнения вмешательств лапароскопическим методом. Формирование превентивной кишечной стомы при видеоскопической низкой и ультранизкой передней резекции прямой кишки позволяет избежать развития клинически значимой несостоятельности швов колоректального анастомоза. При низкой и ультранизкой передней резекции прямой кишки в случае технической сложности одномоментного ее пересечения ниже опухоли лапароскопически-ассистированное вмешательство следует выполнять с применением сшивающе-режущего аппарата Contour. Роботические операции при раке прямой кишки имеют преимущества за счет трехмерного изображения и лучшей ориентации, большей степени свободы при манипуляциях в ограниченных пространствах, а также простоты выполнения лимфаденэктомии.

This article is devoted to a very actual and insufficiently imagine in the literature theme - innovation and digital technologies in clinical surgery and rehabilitation.To schow posibilities of modern digital and information technologies in clinical practice based on the experience of the Pirogov Center.Analysis of experience in the application of innovative technologies, robotic surgery, intraoperative navigation computer, robotic systems in medical rehabilitation, integrated operating room, surgical video communication systems in service of those doing the Pirogov Center for the past 10 years.Shows the feasibility of the considered technologies in modern clinical practice clinics.The experience of the Pirogov Center indicates that the extensive use in clinical practice of modern health care facilities of the latest high-tech equipment in conjunction with the introduction of process automation and digital integrated technology management and medical-diagnostic activity is an essential reserve to increase the activity of providing specialized, including high-tech medical care, carrying out a variety of scientific and educational activities.Работа посвящена весьма актуальной и недостаточно освещенной в научной литературе теме - инновационным и цифровым технологиям в клинической хирургии и реабилитации. Цель - освещение возможностей современных цифровых и информационных технологий в клинической практике с учетом опыта Пироговского Центра. Материал и методы. Анализ опыта применения инновационных технологий - роботизированной хирургии, интраоперационной компьютерной навигации, роботизированных комплексов в медицинской реабилитации, интегрированной операционной, видеокоммуникационных комплексов в хирургической службе, накопленного специалистами Пироговского Центра в течение последних 10 лет. Результаты. Показана целесообразность внедрения рассматриваемых технологий в клиническую практику современных клиник. Вывод. Опыт Пироговского Центра свидетельствует, что активное использование в клинической практике современных ЛПУ новейшего высокотехнологичного оборудования в сочетании с внедрением автоматизации процессов и цифровых интегрированных технологий в управление и лечебно-диагностическую деятельность является существенным резервом в повышении активности оказания специализированной, в том числе высокотехнологичной медицинской помощи, проведении различных научно-образовательных мероприятий.Работа посвящена весьма актуальной и недостаточно освещенной в научной литературе теме — инновационным и цифровым технологиям в клинической хирургии и реабилитации. Цель — освещение возможностей современных цифровых и информационных технологий в клинической практике с учетом опыта Пироговского Центра. Материал и методы. Анализ опыта применения инновационных технологий — роботизированной хирургии, интраоперационной компьютерной навигации, роботизированных комплексов в медицинской реабилитации, интегрированной операционной, видеокоммуникационных комплексов в хирургической службе, накопленного специалистами Пироговского Центра в течение последних 10 лет. Результаты. Показана целесообразность внедрения рассматриваемых технологий в клиническую практику современных клиник. Вывод. Опыт Пироговского Центра свидетельствует, что активное использование в клинической практике современных ЛПУ новейшего высокотехнологичного оборудования в сочетании с внедрением автоматизации процессов и цифровых интегрированных технологий в управление и лечебно-диагностическую деятельность является существенным резервом в повышении активности оказания специализированной, в том числе высокотехнологичной медицинской помощи, проведении различных научно-образовательных мероприятий.