The purpose - was to perform a meta-analysis based on the results of randomized controlled trials that examined the efficacy and safety of using anti-VEGF (vascular endothelial growth factor (vascular endothelial growth factor, VEGF)) drugs as an auxiliary treatment for patients with glioblastoma (GBM). Material and methods. A search for randomized controlled trials was conducted in the Pubmed, EMBASE, eLibrary and Cohrane Library databases published from January 2008 to March 2019, which examined the efficacy and safety of using anti-VEGF agents as an auxiliary method of treating GBM patients. The odds ratio (OR) and 95% confidence interval (CI) were used to calculate the overall survival and progression-free survival values. Results. According to the eligibility criteria, 9 randomized controlled trials included in this meta-analysis that examine the results of using anti-VEGF drugs in 3189 patients with GBM. The overall survival rates of patients with GBM using anti-VEGF therapy exceed those in the group of patients with standard therapy without statistically significant differences (OR=0.89, 95% CI: 0.76, 1.04, p=0.13). Significant differences in progression-free survival were noted in favor of anti-VEGF agents (OR=0.70, 95% CI: 0.60, 0.82, p<0.00001). The performed subgroup analysis showed the absence of a statistically significant effect of bevacizumab on the overall survival rates of patients with GBM (OR=0.89, 95% CI: 0.75, 1.06, p=0.20). Using a combination of bevacizumab and standard therapy can significantly improve the progression-free survival rates in patients with GBM (OR=0.63, 95% CI: 0.51, 0.78, p<0.0001). Conclusion. The performed meta-analysis clearly demonstrated that the combination of anti-VEGF agents and standard therapy does not significantly increase the overall survival rate of patients with GBM. However, the use of anti-VEGF drugs statistically significantly improves the values of progression-free survival in patients with GBM.

Objective This retrospective clinical study was carried out to generate and cross-validate a scoring system for the identification of patients at risk of SSIs after spinal surgery. Methods A retrospective study was conducted, which included patients who underwent spinal surgery. The potential variables for SSIs were extracted from the database, including preoperative, intraoperative and postoperative risk factors for univariate and multivariate regression analyses. Results A total of 2347 patients were included in this retrospective clinical study. Postoperative SSIs were observed in 53 patients (2.2%). The multivariate logistic regression analysis revealed the following risk factors for SSIs after spinal surgery: diabetes mellitus ( P =0.029), body mass index ( P =0.008), low serum calcium concentration ( P =0.012), low pre- and postoperative albumin ( P =0.023, P =0.037), more than three operated segments ( P =0.008), operation time of more than 180 minutes ( P =0.019), estimated blood loss ( P =0.011), low postoperative hemoglobin ( P =0.017) and prolonged drainage time ( P =0.025). Each of these factors contributed 1 point to the risk score. The predicted rates of incidence for the low-, intermediate-, high-, and extremely high-risk categories in the validation set were 1.4%, 12%, 41.6%, and 66.6%, respectively. Conclusions Our scoring system allows for easy and validated risk stratification of SSIs after spinal surgery. Level of evidence III; Cross-sectional Observational Study.

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INTRODUCTION. Surgical site infections (SSIs) are one of the most serious adverse events that develop in patients after performing an operation of instrumental spinal fusion. A search of literary sources in various databases showed the presence of isolated studies devoted to studying the effectiveness of suprafascial local application of Vancomycin powder after performing an operation of posterior instrumental spinal fusion in preventing the development of SSIs. At the same time, the results of these studies are ambiguous and in many ways contradictory.The OBJECTIVE of this study was to study the effectiveness of the suprafascial local application of Vancomycin powder after performing the operation of the posterior instrumental spinal fusion in preventing the development of SSIs, and also to identify the main adverse drug reactions in the local use of this antibacterial drug.METHODS AND MATERIALS. The study included medical records of 219 patients who underwent surgery for posterior instrumental spinal fusion on the cervical, thoracic, and lumbosacral spine for various pathological conditions. Medical records of patients are divided into two groups: group I (comparison group) – 113 patients who used the standard protocol of prophylaxis of SSIs and group II (main group) – 106 patients who used the standard protocol of prophylaxis of SSIs in combination with suprafascial local use of Vancomycin powder. The analysis of the frequency of occurrence of SSIs after the operation of the posterior instrumental spinal fusion in the studied groups of respondents and the prevalence of undesirable medicinal phenomena in the case of local suprafascial application of Vancomycin powder was performed.RESULTS. The prevalence of SSI after posterior instrumental spinal fusion in the control group of patients was 4.2 %. At the same time, in the main group of patients, where the standard protocol was used in combination with suprafascial local use of Vancomycin powder for the purpose of prophylaxis of SSIs, there were no cases of SSIs development. We have not revealed any adverse drug reactions when using Vancomycin powder in patients of the main group.CONCLUSION. The local use of Vancomycin powder in patients after posterior instrumental spinal fusion is an effective and safe method of preventing the development of SSIs.