Extracellular vesicles (EVs) are cell-derived membrane vesicles which play an important role in cell-to-cell communication and physiology. EVs deliver biological information from producing to recipient cells by transport of different cargo such as proteins, mRNAs, microRNAs, non-coding RNAs and lipids. Adipose tissue EVs could regulate metabolic and inflammatory interactions inside adipose tissue depots as well as distal tissues. Thus, adipose tissue EVs are assumed to be implicated in obesity-associated pathologies, notably in insulin resistance and type 2 diabetes mellitus (T2DM). In this study we for the first time characterize EVs secreted by visceral (VAT) and subcutaneous adipose tissue (SAT) of patients with obesity and T2DM with standard methods as well as analyze their morphology with cryo-electron microscopy. Cryo-electron microscopy allowed us to visualize heterogeneous population of EVs of various size and morphology including single EVs and EVs with internal membrane structures in samples from obese patients as well from the control group. Single vesicles prevailed (up to 85% for SAT, up to 75% for VAT) and higher proportion of EVs with internal membrane structures compared to SAT was typical for VAT. Decreased size of single and double SAT EVs compared to VAT EVs, large proportion of multilayered EVs and all EVs with internal membrane structures secreted by VAT distinguished obese patients with/without T2DM from the control group. These findings could support the idea of modified biogenesis of EVs during obesity and T2DM.

The article presents the main stages of the development of ideas about a fairly rare pathology in clinical practice the syndrome of compression of the ventral trunk. Until the mid-nineteenth century, reports of the clinical picture of chronic abdominal ischemia were more descriptive. Serial pathoanatomic studies, comparison of anatomical features revealed at autopsy with clinical manifestations accompanying these changes, contributed to the isolation of chronic ischemic disease of the digestive system in a separate nosological form. The discovery of angiography contributed to the significant development of vascular surgery and the isolation of the ventral trunk compression syndrome as an independent disease, since it allowed for a lifetime comparison of the detected changes in blood vessels with the clinical manifestations of the disease. The term ventral trunk compression syndrome was first introduced by P. Harjola when describing a case of abdominal pain in a patient with compression of the ventral trunk by the neuroganglionic tissue of the ventral plexus. Later, J. Dunbar confirmed the Association of clinical manifestations of chronic abdominal pain with compression of the ventral trunk by the median arched ligament of the diaphragm. In English-language literature, the disease was named Dunbar syndrome. The effectiveness of eliminating the symptoms of this disease by surgical dissection of compression structures has been proven. Further study of this problem developed in parallel with the development of surgery in General in accordance with the emergence and introduction of new surgical technologies. The purpose of numerous studies was to study the etiopathogenetic mechanisms of the occurrence of a variety of clinical manifestations of this syndrome and improve the results of its treatment by improving known surgical techniques and introducing new ones.

The OBJECTIVE was to increase the safety of laparoscopic decompression of the abdominal trunk.METHODS AND MATERIALS. The results of treatment of 30 patients who underwent laparoscopic decompression of the celiac trunk were analyzed. Intraoperative bleeding requiring conversion to laparotomy occurred in two (6.7%) cases.RESULTS. To prevent such a complication, a method of preventive installation of a balloon catheter into the celiac trunk was introduced, which allows creating a temporary occlusion of the vessel in case of damage. A similar approach was used in 10 (33.3%) patients. The need to cover the lumen of the vessel with a balloon arose in one observation (3.3% of all patients and 10.0% using this technique). Bleeding from the inferior phrenic artery, which originated from the celiac trunk, was stopped by laparoscopic access.CONCLUSION. The experience presented in this paper allows us to consider the installation of a balloon boat in the celiac trunk as one of the possible ways to improve the safety of its laparoscopic decompression. Further research is needed to obtain a definitive picture of the effectiveness of this approach.

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Currently, bariatric (metabolic) surgery is the main effective treatment of obesity and associated pathological conditions. The features of the course of obesity as a chronic progressive disease, heterogeneous etiology, clinical manifestations and a steady increase in number of patients worldwide make the problem of bariatric interventions extremely urgent. The article presents the analysis of modern data concerning the choice of the method of surgical benefits in patients with obesity and their own clinical experience.