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After data refinements, the average primary care exam was 18.0 minutes long (SD=13.5 min). On average, exams ran later than their scheduled duration by 1.2 minutes (SD=13.5 min). Visits scheduled for 10 or 15 minutes were more likely to exceed their allotted time than visits scheduled for 20 or 30 minutes. Time-stamped EHR data offer researchers and health systems an opportunity to measure exam length and other objects of interest related to time. Time-stamped EHR data offer researchers and health systems an opportunity to measure exam length and other objects of interest related to time.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. To report a rare case of Down's syndrome with congenital acute leukemia and congenital heart disease. We have retrospectively analyzed an electronic database of patients aged 0-17 years who underwent inpatient treatment of congenital heart disease at the Federal Center for Cardiovascular Surgery for the period from January 1, 2010 to December 31, 2018. Incidence of Down's syndrome in children with congenital heart defects was 5.36% of the total number of children with congenital heart defects. No gender differences were identified. The most common congenital heart defects were ventricular septal defect, atrioventricular septal defect, atrial septal defect, patent ductus arteriosus, tetralogy of Fallot. Down's syndrome and congenital heart disease were diagnosed prenatally in 33 out of 319 patients. A rare case of Down's syndrome combined with congenital heart disease and acute leukemia is described. Treatment outcome was unfavorable. Evere concomitant diseases in a child with Down's syndrome determine high postoperative morbidity and mortality. Prenatal diagnosis of Down's syndrome via screening of pregnant women for ultrasound and biochemical markers of this pathology is required. Evere concomitant diseases in a child with Down's syndrome determine high postoperative morbidity and mortality. Prenatal diagnosis of Down's syndrome via screening of pregnant women for ultrasound and biochemical markers of this pathology is required.Mortality rates in acute mesenteric ischemia remain at an extremely high level for many decades. Early diagnosis and selection of the optimal method of revascularization are among the ways to optimize tactics. The diagnostic study of choice is CT angiography. Its active and systemic use can help to detect ischemia at the reversible stage. The article examines in detail the indications for the application of this diagnostic study. The question of preference for the revascularization method remains debatable. The arguments of proponents of open and endovascular interventions on mesenteric vessels are presented. Other, still unresolved tactical issues are also considered, such as indications for re-operations and application of the principles of damage control tactics.This review is devoted to comparison of the most common methods of surgical treatment of pilonidal disease. It was found that «closed» methods of surgical treatment of pilonidal disease are effective and accompanied by favorable wound healing and good cosmetic effect. Long-term outcomes of «closed» techniques significantly depend on the choice of surgical treatment and follow-up period.Perforation of the esophagus is a serious and dangerous condition due to progressive development of mediastinitis and sepsis. This disease is often fatal. In the last decade, endoscopic stenting of the esophagus became more common in these patients as an alternative to traditional surgery. We report successful minimally invasive endoscopic treatment of esophageal perforation with post-burn necrosis of its wall.Posthepatectomy liver failure is one of the most serious complications of large liver resections. The analyzes the management and results of treatment of patients with severe posthepatectomy liver failure (Grade C ISGLS) in a specialized hepatosurgical department. In the period from January to December 2019, 175 liver resections were performed in the Department of liver and pancreatic surgery at the A.S. Loginov Moscow Clinical Scientific Center. Major-volume liver resections (hemihepatectomies and resections of more than three liver segments) were performed in 80 (45%) patients. DSS Crosslinker mw In 125 (71%) cases liver resctions were performed for malignant liver and bile duct diseases. Laparoscopic liver resections were performed in 77 (44%) patients. Postresection liver failure developed in 18 (10.2%) patients. Severe (class C according to ISGLS) developed in 6 (3.4%) patients. In the postoperative period (90-day mortality), 4 patients (2.3%) died, while in two patients, mortality was not associated with liver failure. Hyperbilirubinemia was observed for more than 5 days in 2 (33.3%), coagulopathy in 4 (66.6%), ascites in 5 (83.3%), encephalopathy in 5 (83.3%), hypoglycemia in 3 (50%), and uncontrolled sepsis in 2 (33.3%) patients, respectively. Correction of surgical complications was required in 100% of cases, which consisted in drainage of abscesses and abdominal bylomas, and the the bilio-digestive anastomosis fistulas. Inotropic support was required in all 6 (100%) patients, invasive ventilation in 4(66.6%), and extracorporeal detoxification in 5 (83.3%). Posthepatectomy liver failure is a complex problem even in a specialized center. A comprehensive approach to treatment allows to achieve noticeable results and reduce mortality. Posthepatectomy liver failure is a complex problem even in a specialized center. A comprehensive approach to treatment allows to achieve noticeable results and reduce mortality.