Russian Journal of Pediatric Surgery, Anesthesia and Intensive Care

In this article, the editor-in-chief of the journal expresses gratitude to the journal’s reviewers who make valuable contributions to the improvement of the quality of scientific articles. Because of the joint efforts of the editorial board, publisher, authors, and reviewers, the journal was included in the international scientific database Scopus. The article provides a list of reviewers who participated in the work in 2023.

BACKGROUND: The relevance of this study was supported by the increasing number of infectious complications of bone augmentation in children and adults. Currently, porous titanium nickelide alloys are among the most preferred materials used in bone plasty. Despite the observable advantages of porous nickelide titanium alloys in terms of biochemical and biomechanical compatibility with the body, research on the antibacterial activity of alloys is ongoing to counter the development of infections at the implant–biological tissue border.

AIM: To perform an experimental study of the biocompatible antibacterial surface in porous titanium nickelide alloys with the addition of silver nanoparticles.

MATERIALS AND METHODS: Titanium nickelide alloys with 62% porosity were obtained using the self-propagating high-temperature synthesis method from nickel, titanium, and nanosilver powders at concentrations of 0.2 at.% Ag, 0.5 at.% Ag, and 1.0 at.% Ag, respectively. The experiment was conducted on nine sexually mature female white laboratory rats. They were divided into three groups, with three rats each. All animals were implanted with titanium nickelide along with porous granules of silver additives. The first group was the control, the second received 0.2 at.% silver, and the third received 0.5% silver. The standard method of incubating Staphylococcus epidermidis in liquid broth in the presence of the studied images was used to determine bactericidal activity, followed by seeding on solid media and counting colonies.

RESULTS: The antibacterial effect of the samples on S. epidermidis gradually increased with increasing silver concentration. The significance of the differences between the experiment and control was confirmed by Student’s criterion p < 0.005, whereas the sample without silver nanoparticles and the control do not differ significantly. Thus, these alloys may have bioactive properties because they contain silver nanoparticles. An alloy with a silver concentration of 0.5 at.% Ag showed the best antibacterial activity to S. epidermidis. In the clinical evaluation of the results of the experimental study, purulent inflammatory complications were not observed in all animals at all times. On day 75, the animals underwent computed tomography, which showed good occupancy of the bone defect and absence of a dystrophic effect on the area where the bone and soft tissue are in contact with the material.

CONCLUSIONS: If the concentration of silver nanoparticles is increased up to 0.5 at%, the antibacterial activity and cytocompatibility of the implant also increase. Clinical experimental evaluation in all groups of animals showed that osteointegration of alloys with 0.5 at.% Ag begins immediately after implantation and is completed 2 weeks earlier than that in the remaining groups.

BACKGROUND: Multiple-organ dysfunction syndrome is one of the most dangerous complications of critical illness in children, which helps determine the disease outcomes.

AIM: This study aimed to examine the features of multiple-organ dysfunction syndrome in children with severe central nervous system (CNS) infection and identify factors that determine disease outcomes.

MATERIALS AND METHODS: This single-center, retrospective, observational study enrolled 98 patients, which included 66 (67%) boys and 32 (33%) girls. The average age was 3.6 ± 2.5 years. The Glasgow coma scale (GCS) score was 8.8 ± 2.4 points. Shock was diagnosed in 43 (44%) patients. The average treatment duration in the intensive care unit (ICU) was 9.5 ± 6.2 days, the duration of mechanical ventilation was 6.0 ± 3.9 days, and the mortality rate was 9%. Depending on the outcome, the children were divided into groups I (recovery, n = 88) and II (death, n = 10). All indicators were recorded in the first 12 h from ICU admission.

RESULTS: The most pronounced phenomena of cardiovascular dysfunction, such as decreased Teicholtz ejection fraction (62.3 L/min), were observed when the pSOFA scale score was >10 points, which was statistically significant when compared with the indicators in children with a pSOFA scale score of <8 points. In all patients, regardless of age, a negative correlation of moderate strength was found between the pSOFA scale score and the Teicholtz ejection fraction, and it was pronounced in children aged 7–17 years (R = –0.41; p = 0.008). A positive correlation was found between heart rate and pSOFA scale score in children aged 7–17 years (R = 0.72; p = 0.009). In the evaluation of the discriminatory ability of the pSOFA scale and Phoenix sepsis scores regarding the outcome on the first day of treatment in the ICU, the latter has greater prognostic significance (area under the curve, 0.866 vs 0.838; sensitivity, 76% vs 72%; specificity, 82% vs 79%).

CONCLUSIONS: Low cardiac output syndrome and systemic hypoxia are key factors associated with fatal outcomes in children with severe CNS infections. The high clinical significance of the ejection fraction in predicting the outcomes of severe CNS infections in children, regardless of age, allows the use of this parameter for goal-oriented therapy.

The metaverse is a relatively new concept in technological advancement. It is a three-dimensional immersive environment including real and virtual world elements, in which various digital agents, more precisely, avatars, interact with each other and various activities (educational, cultural, and financial) can be carried out. It is an emerging controversial concept without precise definition and will likely continue to evolve as technology improves. Works of literature from 2020 to 2023, posted in the PubMed and Web of Science databases, were extracted using the following keywords: “metaverse”, “education”, “digital therapy”, “interdisciplinary consultation”, “medical Internet of things”, “virtual reality”, “superimposed reality”, “extended reality”, “mixed reality”, “lifelogging”, “mirror world”, “digital twins”, and “surgery”. In the PubMed search using the original terms, no publications were extracted in 2020, 9 in 2021, 161 in 2022, and 246 in 2023. In the healthcare context, metaverse technology refers to the use of virtual reality and interactive and other immersive technologies, such as augmented reality, to create simulated environments intended for training, education, and clinical applications. Various aspects of medicine such as digital therapeutics, multidisciplinary team discussions, medical Internet of things, surgical simulations, conferences and meetings, research programs, etc., are being explored. Depending on the requirements, the metaverse provides a versatile platform that can be modeled accordingly, providing a flexible tool for medical development. In this review, we discussed in detail the possible applications of the metaverse in surgery. All scoping rubrics are based on the sparse evidence in the scientific literature and are adequately evaluated to provide compelling evidence on the utility of the metaverse in the future of medicine.

In the last decade, the incidence of inflammatory bowel disease in children has been increasing. Some studies have reported the development of Crohn’s disease in patients with Hirschsprung disease and Hirschsprung-associated enterocolitis. Suggestions have been made about the possible causes of the development of Crohn’s-like lesions after intestinal resection in early childhood. This study aimed to summarize information about Hirschsprung-associated Crohn’s disease and Crohn’s-like lesions after surgical treatment of Hirschsprung disease. The search was carried out in scientific databases of eLibrary, PubMed, ScienceDirect, and Google Scholar. The search time interval was 2000–2023. Fourteen articles dedicated to Hirschsprung-associated Crohn’s disease were identified. Common pathogenesis factors in inflammatory bowel diseases and Hirschsprung-associated enterocolitis were identified, such as microbiota disturbance and chronic inflammation. Predisposing factors for pathological immune response to dysbiosis and incidence of enterocolitis included enteric nervous system dysfunction, impaired neuroimmune regulatory mechanisms, general immunological disturbance, and “immaturity” and abnormality of the barrier function of the intestinal mucosa. The “classic form” of Crohn’s disease may not develop in patients with Hirschsprung disease and recurrent attacks of enterocolitis but Crohn’s-like lesions. Persistent functional or organic obstruction after surgical treatment of Hirschsprung disease enhances the negative effect of predisposing factors, leading to chronic inflammation of the intestinal mucosa. Delayed occurrence of Hirschsprung-associated enterocolitis is a predisposing factor for the development of chronic inflammation. When Hirschsprung-associated enterocolitis occurs repeatedly, endoscopic assessment should be performed for the exclusion of Crohn’s disease and chronic inflammatory changes in the anastomosis area for treatment selection.

The use of robots in pancreatic surgery offers several advantages as an adjunct to laparoscopic surgery, including increased maneuverability of robotic instruments and three-dimensional (3D) visualization. To our knowledge, only two cases of robot-assisted distal pancreatectomy with spleen preservation in children have been reported worldwide. In this study, the patient was an 11-year-old boy who was admitted to a children’s hospital with complaints of recurrent upper abdominal pain. He was diagnosed with pancreatic tumor based on ultrasound findings. It was confirmed by magnetic resonance imaging, which revealed a well-defined heterogeneous formation at the border of the body and tail of the pancreas, measuring 2.28 × 2.73 × 2.62 cm with compression of the Wirsung duct. The surgical intervention was performed using a surgical robot VERSIUS (CMR, (UK). Splenic vessels were mobilized carefully, a tourniquet was placed around the body of the pancreas, and it was intersected using a stapler at the border of healthy tissue. The surgical intervention took 340 min, including robot installation time (docking time) of 15 min and a main console time of 325 min. No serious intraoperative complications, such as bleeding or damage to the vascular structures adjacent to the pancreas (branches of the celiac trunk and portal vein), were noted. Histological examination of the tumor confirmed the diagnosis of a solid pseudopapillary tumor. After surgery, the patient’s condition was stable. Recovery proceeded without complications. Magnetic resonance imaging of the abdominal cavity, which was performed 6 months after surgery, revealed no signs of disease recurrence. Robot-assisted surgery is an acceptable alternative to laparoscopic and open surgery for patients with solid pseudopapillary pancreatic tumors because robots offer additional connections, enable closure in improved 3D imaging, increase dexterity when handling instruments, and eliminate of hand tremors.

One of the causes of intussusception is the presence of Meckel’s diverticulum. Although Meckel’s diverticulum is the most common anomaly of the gastrointestinal tract, isolated cases of intussusception caused by the inversion of Meckel’s diverticulum into the lumen of the ileum have been described in world literature. Description of case. The patient was a 2-year-11-month boy who was transported by an ambulance team, with complaints of paroxysmal abdominal pain and single vomiting. Palpation revealed lower abdominal pain without signs of peritoneal irritation. The child underwent an ultrasound examination of the abdominal cavity, which revealed a layered structure consisting of the wall of the large and small intestines in the right lower quadrant. Thus, a diagnosis of intussusception was established. An attempt to conservatively straighten the intussusception during pneumoirrigoscopy was ineffective. Emergency laparoscopy was performed, and ileocecal intussusception was diagnosed, which was eliminated without technical difficulties. During the inspection of the ileum, a crater-shaped depression with a dense formation extending from it into the intestinal lumen was discovered on its antimesenteric edge 30 cm from the ileocecal angle. The operation was continued with a minilaparotomy in the right iliac region. Meckel’s diverticulum was manually inverted from the ileum, tied at the base, and cut off with the stump immersed in a purse-string suture. The postoperative period was event-free. On day 5 after the operation, the child was discharged home in a satisfactory condition. For any intussusception in children aged >1 year, the anatomical causes must be excluded, except for the possibility of an inverted Meckel’s diverticulum. Therefore, after successful intestinal disinvagination, a thorough revision of the ileum is necessary.

The paper describes the professional activities and merits of Margarita A. Barskaya, a pediatric surgeon, in celebration of her anniversary.