In this study, we assessed the outcomes after surgical treatment of thoracic post-excision defects in 15 patients, using TiNi knitted surgical meshes and customized artificial TiNi-based ribs. Methods: Eight patients were diagnosed with advanced non-small cell lung cancer (NSCLC) invading the chest wall, of which five patients were T₃N₀M₀, two were T₃N₁M₀, and one was T₃N₂M₀. Squamous cell carcinoma was identified in three of these patients and adenocarcinoma in five. In two cases, chest wall resection and repair were performed for metastases of kidney cancer after radical nephrectomy. Three-dimensional CT reconstruction and X-ray scans were used to plan the surgery and customize the reinforcing TiNi-based implants. All patients received TiNi-based devices and were prospectively followed for a few years. Results: So far, there have been no lethal outcomes, and all implanted devices were consistent in follow-up examinations. Immediate complications were noted in three cases (ejection of air through the pleural drains, paroxysm of atrial fibrillation, and pleuritis), which were conservatively managed. In the long term, no complications, aftereffects, or instability of the thoracic cage were observed. Conclusion: TiNi-based devices used for extensive thoracic lesion repair in this context are promising and reliable biomaterials that demonstrate good functional, clinical, and cosmetic outcomes.

Samples of skin, tendons, muscles, and knitwear composed of NiTi wire are studied by uniaxial cyclic tension and stretching to rupture. The metal knitted mesh behaves similar to a superelastic material when stretched, similar to soft biological tissues. The superelasticity effect was found in NiTi wire, but not in the mesh composed of it. A softening effect similar to biological tissues is observed during the cyclic stretching of the mesh. The mechanical behavior of the NiTi mesh is similar to the biomechanical behavior of biological tissues. The discovered superelastic effects allow developing criteria for the selection and evaluation of mesh materials composed of titanium nickelide for soft tissue reconstructive surgery.

Macrophages are key components of the innate immune system. The variability of the macrophage’s participation in tumor progression, determined by their functional polarization, opens up a wide prospect for modulating their functional profile, primarily in the direction of increasing antitumor activity.The purpose of the studywas to provide up-to-date data on the process of macrophage polarization, mechanisms of its regulation, polarization markers and induction factors.Material and methods. A search was made for available literature sources published in Web of Science, Scopus and other databases. more than 160 sources devoted to the study of the process of macrophage polarization were found, of which 121 were included in this review.Results. This review presents data on the molecular mechanisms and gene signatures associated with M1 and M2 polarization of macrophages. We displayed information on metabolic, phenotypic characteristics and cytokine profile of M1- and M2-macrophages, as well as highlighted data on polarization factors and targets of their action.Conclusion. The information presented in the review can serve as an information base for the development of experimental and clinical approaches for editing the functional profile of macrophages in order to control their involvement in various pathological processes.

Objective. To study the possibilities of the ERAS program and immediate results in high-risk patients undergoing lung resection. Material and methods. The prospective study included 76 high-risk patients. All patients required lobar resection for various lung diseases. The risk of postoperative complications and mortality was stratified using the Thoracoscore and Thoracic Revised Cardiac Risk Index systems, as well as the American Society of Anesthesiologists Outcome Prediction Scale. At all perioperative stages, we assessed the possibilities for accelerated recovery and postoperative complications using the Thoracic Morbidity and Mortality System. Results. Patients were characterized by multiple comorbidities requiring long-term and individual preoperative correction. This prevented adherence to a single protocol at the outpatient stage. We intraoperatively observed severe adhesive process up to complete obliteration of pleural cavity that complicated the use of minimally invasive technologies. Lung tissue was characterized by emphysematous lesions and reduced elasticity that caused prolonged air release and formation of residual cavities. These features required two pleural drains in 42 (52.3%) cases that increased hospital-stay. Multimodal analgesia and early activation with rehabilitation were optimal elements of ERAS. Various postoperative abnormalities developed in 31 (40.8%) patients, mortality rate was 7.9% (n=6). Minor and serious complications prevailed (21 (27.6%) cases). Their correction was effective and not accompanied by fatal outcomes. Critical complications occurred in 10 (13.1%) patients and caused fatal outcomes in 6 (7.9%) cases. Conclusion. ERAS protocol among high-risk patients in thoracic surgery is possible in the form of separate elements included in perioperative support.

The aim of the study is to investigate the influence exerted by short-term outpatient pulmonary rehabilitation on functional indices and the course of the perioperative period for patients with lung cancer against the background of COPD Material and methods. According to the study design, lung cancer patients with planned surgical treatment were distributed between groups according to the COPD severity (stages II-IV). At the outpatient stage, evaluation of the pulmonary function and 6-minute walk test were performed. The results of the test and the functional indices were registered with further establishment of the pulmonary rehabilitation procedure complex for the patient. The exercises were performed at home and designed for the duration of two weeks. The complex included cycles of breathing, strength and aerobic exercises with individually adjusted intensity depending on the severity of clinical COPD manifestations and the baseline physical status. Upon completion of the training course, the patients underwent repeated spirometry and the 6-minute walk test. The results obtained were registered and analysed with subsequent surgical treatment of the patients. Results. Minimal changes in functional indices upon completion of the course were registered in patients with COPD stage II, which prevented achievement of statistical significance. Therewith, patients with COPD stages III and IV who had undergone the course of exercises were noted to show statistically reliable improvement of pulmonary function (FEV1) and improvement of the overall physical status, which is testified to by enhanced tolerance to externally imposed physical loads (p<0.01). Apart from that, decreased HR values (p<0.01)) growth of SpO2 values (p<0.01) and decreased shortness of breath (p<0.01) were registered in these groups after the 6-minute walk test. No statistically significant differences in relation to the number of postoperative complications or the term of in-hospital stay were revealed between the groups in the postoperative period. Conclusion. Performance of a pulmonary rehabilitation course during the preoperative period reliably improves functional indices in patients with COPD stage III and IV, which may be of crucial significance for determination of functional operability at the outpatient stage