Aim: to analyse and estimate the incidence of pilonidal cyst cancer from 2023 to 2024.
Key points. In 2023, M. F. Safadi et al. published a review of the incidence of pilonidal cyst cancer, including 140 cases from 1900 to 2022. From 2023 to 2024, 14 observations of patients with malignant pilonidal cyst appeared in the literature. One case of malignant pilonidal transformation was reported in our practice. Patients’ age varied from 19 to 86 years (54.5 ± 11.9 years). Among the patients, males predominated — 88.9 % (137/154), the male: female ratio was 8.1 : 1. The time from the first diagnosis of a pilonidal cyst to the development of cancer in the cyst ranged from 1 month to 62 years. The mean interval from detection of pilonidal cyst to malignancy was 21.1 ± 13.6 years (median — 20.0 years). One of the reasons for malignant degeneration of pilonidal cysts may be the presence of concomitant hidradenitis suppurativa, which is included in follicular occlusion syndrome. However, the direct association of follicular occlusion syndrome with pilonidal cyst malignancy has not been definitively confirmed.
Conclusion. Malignancy of pilonidal cysts is a rare complication of a long-term inflammatory process in the sacrococcygeal region. The authors concluded that it is necessary to emphasise the presence of a concomitant follicular occlusion syndrome in patients, which may alter the usual management tactics of pilonidal disease.

Aim: to evaluate the effectiveness of educational technology using virtual reality in abdominal surgery.
Materials and methods. The study was conducted using the domestic virtual reality platform “Sechenov” and abdominal surgery simulators. When launching the software modules “Operation — Cholecystectomy” and “Operation — Gastric Resection”, an anatomical model of a human body with detailed internal organs of the abdominal cavity appears next to the user, and it has an anchor point in the center of the location. The tasks are completed through the assessment of the results of the survey of students using the Likert system, as well as several open clarifying questions. Based on the results of the analysis, two groups were formed: those students who had no experience working with virtual systems and students who had previous experience working in virtual reality simulators, including cases of rehabilitation after injuries.
Results. When analyzing the ergonomics of simulator control depending on the experience of using virtual reality outside of educational purposes, it was not possible to establish statistically significant differences (p = 0.393). However, depending on the experience of using virtual simulators for educational purposes, statistically significant differences were established (p = 0.014). When comparing data on satisfaction with participation in training depending on the experience of using virtual reality outside of educational purposes, no significant differences were found (p = 0.875). When analyzing the educational value of the teaching methodology depending on previous experience using virtual simulators, statistically significant differences were found (p = 0.023).
Conclusions. The virtual reality simulator in abdominal surgery provides the opportunity to add new educational scenarios; reduces the fear of mistakes in students; not only allows for training in manipulations but also serves as a teaching aid on the clinical anatomy of the stomach and hepatobiliary complex.

Aim: to systematise the data of available studies related to the association of papillomavirus infection with oesophageal squamous cell cancer.
Methods. A literature search was conducted in PubMed and Google Scholar databases. All full-text articles from 1995 to 2023 were included. The language of the studies was not a barrier to inclusion in this meta-analysis. A total of 130 literature sources were analysed. The meta-analysis was based on data from 17 case-control studies, which together account for 1912 oesophageal squamous cell tumour tissue samples and 2206 control samples of normal oesophageal tissue.
Key points. There is a growing body of research on the importance of human papillomavirus as a risk factor for oesophageal squamous cell cancer. However, the association of human papillomavirus with the risk of oesophageal cancer, despite the large number of studies on this topic, is still controversial.
Conclusions. The resulting relative risk (RR) of oesophageal squamous cell cancer in papillomavirus infection was 1.22 (95% confidence interval (95% CI): 1.11–1.35; p = 0.000023). Meanwhile, stratification of the data according to the ethnicity of the patients showed that the highest risk of oesophageal squamous cell cancer in papillomavirus infection was observed in patients of Asian ethnic group (RR = 1.34; 95% C: 1.26–1.42; p = 0.042). In the Arab ethnic group, the risk of oesophageal squamous cell cancer with papillomavirus infection was 1.27 (95% CI: 1.09–1.48; p = 0.005), while in Europeans it does not reach statistically significant values (p = 0.232).

Aim: to investigate the levels of various short-chain fatty acids (SCFAs) in the blood of patients with chronic heart failure (CHF) complicated by sarcopenia and to analyze their associations with clinical parameters of CHF and sarcopenia.
Materials and methods. This study included 76 patients with CHF (mean age — 68.0 ± 9.8 years). Plasma levels of SCFAs (e.g., acetic, propionic, and butyric acids) were determined using electrospray ionization mass spectrometry (ESI-MS). Sarcopenia was diagnosed according to the EWGSOP2 algorithm, which included assessments of muscle strength (mechanical dynamometry), muscle mass (bioimpedance analysis), and muscle function (SPPB tests).
Results. The plasma concentrations of butyric acid (C4) were on average 15,050 ng/mL (95% CI: 12,525–18,200) in patients without sarcopenia and 16,400 ng/mL (95% CI: 10,100–20,850) in patients with sarcopenia (p = 0.00003). Pentanoic acid (C5) levels were significantly lower: 472.0 ng/mL (95% CI: 368.2–551.2) in patients without sarcopenia versus 439.0 ng/mL (95% CI: 348.0–514.5) in patients with sarcopenia (p = 0.00001). Four distinct clusters of CHF patients were identified based on their clinical, laboratory, and SCFA profiles. These clusters reflected differences in the severity of CHF, the presence of sarcopenia, physical activity levels, and SCFA concentrations. The most pronounced differences in SCFA levels were observed between Clusters 2 and 3 (C4 levels: 18,650 ng/mL (95% CI: 14,950–21,950) and 10,600 ng/mL (95% CI: 9,220–12,600), respectively).
Conclusions. Differences in SCFA levels between clusters indicate potential links between SCFA metabolism, CHF, and sarcopenia progression. These differences may serve as biomarkers for identifying patients at high risk for sarcopenia and highlight the need for an individualized treatment approach, including SCFA metabolism and gut microbiota modulation.

Aim: to improve treatment outcomes for patients after open hemorrhoidectomy.
Materials and methods. The results of treatment of 62 patients after open hemorrhoidectomy by ultrasonic scalpel, who were randomized into the main and control groups, 31 persons in each group, were analyzed. The patients of the main group underwent dressing of postoperative wounds using water-soluble ointments in combination with laser irradiation daily from day 2 after the surgical intervention and further on days 14, 21 and 30. In the control group only dressing with the use of water-soluble ointments was performed. In the postoperative period the terms of wound healing were determined based on the data of visual inspection, anoscopy, planimetric and cytologic methods of examination. Microbiological (culture) examination, assessment of pain syndrome intensity using visual analog scale on days 1–7, 14, 21, and 30 after surgical treatment and quality of life using SF-36 questionnaire before hemorrhoidectomy and on day 30 after it were also performed.
Results. On day 30 wound healing occurred in 29/31 (94 %) patients of the main group and only in 5/31 (16 %) patients of the control group (p < 0.001). The growth of microorganisms in the main group was noted on day 2 in 31/31 (100 %) cases, on day 21 — in 20/28 (71 %) cases (p = 0.001); in the control group: on day 2 — in 27/31 (87 %), on day 21 — in 30/31 (97 %) cases, although the significance of differences was not achieved (p = 0.4). The level of pain syndrome was already lower from the second day after surgical treatment in patients of the main group and amounted to 5 (4; 6) points, in the control group — 6 (5; 7) (p = 0.016), and on day 30 — 0 (0; 0) points in the main group and 1 (0; 2) point in the control group (p < 0.001). Before treatment, the groups were comparable in quality of life; on day 30, statistically significant differences were noted in three indicators: physical functioning (PF) — 80 (75; 93) points in the main group vs. 80 (70; 80) points in the control group (p = 0.041); the criterion of role functioning due to emotional state (RE) — 100 (66; 100) points vs. 66 (17; 67) points (p = 0.002), and the criterion reflecting the intensity of pain and its impact on daily activities (BP) — 51 (37; 62) points vs. 41 (22; 51) points (p = 0.023).
Conclusion. Application of laser therapy after hemorrhoidectomy with ultrasonic scalpel promotes stimulation of reparation processes, shortening of postoperative wound healing time, reduction of bacterial contamination of wounds, reduction of pain syndrome intensity and improvement of quality-of-life indicators in patients of the main group in comparison with the control group.

Aim: to increase physicians’ awareness of differential diagnosis of autoimmune hepatitis and diffuse connective tissue disease using a clinical case as an example.
Key points. The article describes a clinical observation of a 34-year-old patient with dermatomyositis occurring against the background of atopic dermatitis and Gilbert’s syndrome, imitating autoimmune liver disease and complicated by the development of drug-induced liver injury. The complexity of diagnosis was determined by the development of skin lesions against the background of changes already present as a result of the atopic dermatitis, laboratory data (increased transaminase activity, bilirubin levels, and detection of antinuclear and anti-smooth muscle autoantibodies indicating a suspected liver disease), and the disappearance of a number of typical signs of the disease as a result of previously prescribed immunosuppressive therapy. The diagnosis was established through a thorough retrospective analysis of the clinical manifestations and anamnesis of the disease (a change in the nature of skin rashes and the predominance of increased activity of aspartate transaminase were noteworthy); the key moment for making the diagnosis was the detection of increased activity of creatine kinase and myositis-specific antibodies Jo-1. Morphological examination of liver tissue did not find signs of autoimmune hepatitis and liver fibrosis, but revealed centrilobular intracellular cholestasis and lymphohistiocytic infiltration, proliferative changes in the biliary epithelium, probably caused by drug-induced liver injury due to azathioprine intake. The issues of diagnostics and differential diagnosis of autoimmune hepatitis are considered, the strict necessity of morphological examination of the liver for diagnosis is discussed. Secondary liver injury in diffuse connective tissue disease and azathioprineinduced liver injury are analyzed.
Conclusion. Differential diagnosis of elevated serum transaminases should include not only liver disease, but also muscle tissue injury. When diagnosing autoimmune hepatitis, histological examination plays a key role, and verification of the diagnosis is impossible without morphological data.

Aim: to present the results of an Expert Consensus on standardization of indications for surgical treatment of gastroesophageal reflux disease (GERD).
Materials and methods. The issues of standardization of indications for surgical treatment of GERD were discussed by 39 experts – leading gastroenterologists and surgeons from 7 cities of Russia, representing 17 institutions. The list of questions for discussion was formed by the initiative group and sent to the experts. The experts reviewed recent literature, including existing clinical guidelines and consensuses, assessed the evidence base and suggested statements for voting based on the analysis of relevant provisions of foreign consensuses, high-level scientific publications, which set out information obtained in the course of studies that meet the criteria of evidence-based medicine, positions on this issue in the Russian Federation, and suggested statements for voting. Delphi method was used to reach the consensus.
Results. GERD is the most common benign esophageal disorder. Surgery is considered one of the treatment methods for GERD. In real clinical practice, selection of patients who may benefit from surgery is challenging. The results of surgical and conservative treatment of GERD are comparable. Surgical treatment should be performed in a specialized hospital only after a joint examination with a gastroenterologist confirming the diagnosis of GERD. An appropriate volume of preoperative diagnostic workup, matters related to surgical interventions in case of incomplete response to proton pump inhibitors (PPIs) and when extraesophageal manifestations of GERD are present were discussed. The consensus reviews the indications, contraindications and possible results of antireflux operations in patients with GERD. The value of endoscopy, esophageal manometry, pH monitoring/pH-impedance monitoring and X-ray polypositional examination of the upper gastrointestinal tract as a preoperative examination of the patient is analysed.
Conclusions. The experts reached the consensus on 20 statements on standardization of indications for surgical treatment of GERD.

Aim. The clinical guidelines are intended to provide information support for making decisions by gastroenterologists, general practitioners and internists that will improve the quality of medical care for patients with non-alcoholic fatty liver disease, taking into account the latest clinical data and principles of evidence-based medicine.
Key points. Clinical guidelines contain information about current views on etiology, risk factors and pathogenesis of nonalcoholic fatty liver disease, peculiarities of its clinical course. Also given recommendations provide information on current methods of laboratory and instrumental diagnostics, invasive and non-invasive tools for nonalcoholic fatty liver disease and its clinical phenotypes assessment, approaches to its treatment, considering the presence of comorbidities, features of dispensary monitoring and prophylaxis. The information is illustrated with algorithms of differential diagnosis and physician's actions. In addition, there is information for the patient and criteria for assessing the quality of medical care.
Conclusion. Awareness of specialists in the issues of diagnosis, treatment and follow-up of patients with nonalcoholic fatty liver disease contributes to the timely diagnosis and initiation of treatment, which in the long term will significantly affect their prognosis and quality of life.