Research Institute of Emergency Care

INTRODUCTION: Patients with disorders of consciousness (DoC) represent a complex patient cohort requiring a multidisciplinary approach. Despite the availability of modern national clinical guidelines (2023), real-world clinical practice in Russia continues to be challenged by the use of outdated terminology, insufficient implementation of validated diagnostic scales, and a lack of standardized management approaches, including pain assessment and management. This study was prompted by the need to assess the current situation and identify key issues to improve the quality of care for patients with DoC in Russia. OBJECTIVE: To assess the current practices, awareness, and key challenges faced by Russian healthcare professionals in the diagnosis, treatment, and management of patients with chronic DoC. MATERIALS AND METHODS: In 2024, an anonymous online survey of 204 medical and paramedical professionals (anesthesiologists, neurologists, rehabilitation specialists, psychologists, nursing staff) from various regions of Russia was conducted. The 47-item questionnaire covered demographic data, terminology used, diagnostic scales, treatment and rehabilitation methods, as well as approaches to pain assessment and management. RESULTS: Despite modern clinical guidelines, outdated terminology persists in practice: apallic syndrome (13.3 %), vegetative state. Only 62.9 % of respondents use the validated Coma Recovery Scale-Revised (CRS-R) for DoC diagnosis, while 77.1 % still use non-relevant scales (Glasgow Coma Scale, Full Outline of UnResponsiveness — FOUR). 30 % of respondents, including physicians responsible for diagnosis, use exclusively these non-relevant tools. Significant differences in approaches were identified among specialists of different profiles (intensivists, neurologists, rehabilitation specialists). The majority of respondents (83 %) acknowledge that DoC patients experience pain; however, the assessment methods (autonomic signs, grimacing) are not standardized and can be non-specific. CONCLUSIONS: The study results indicate insufficient awareness and fragmented implementation of modern standards for the diagnosis and management of patients with DoC in Russia. The findings highlight the necessity of developing and implementing educational programs for healthcare professionals aimed at standardizing terminology, promoting the use of validated diagnostic scales (CRS-R), and harmonizing approaches to pain management.

Post-traumatic stress disorder (PTSD) is increasingly recognized as a significant contributor to cardiovascular morbidity and mortality. The aim of this review was to synthesize current evidence on the biological, behavioral, and clinical mechanisms linking PTSD with cardiovascular disease (CVD) and to highlight clinical implications for screening, prevention, and management. To achieve this, relevant studies were identified through targeted searches of PubMed, Scopus, Web of Science, and Google Scholar using combinations of terms related to PTSD, CVD, autonomic dysfunction, inflammation, endothelial function, and trauma-informed care. Priority was given to original clinical studies, systematic reviews, meta-analyses, and experimental research published between 1990 and 2025.Findings across large epidemiologic studies show that PTSD is associated with significantly higher rates of hypertension, coronary artery disease, myocardial infarction, stroke, metabolic syndrome, and cardiovascular mortality. Veterans represent the most extensively studied group, with multiple cohorts demonstrating a dose-response relationship between PTSD severity and cardiovascular risk. The review identifies several interconnected biological pathways that explain this association, including chronic sympathetic activation, reduced parasympathetic tone, impaired hypothalamic-pituitary-adrenal axis regulation, systemic inflammation, endothelial dysfunction, platelet hyperreactivity, coagulation abnormalities, oxidative stress, and metabolic disturbances. These mechanisms are further amplified by behavioral factors such as elevated smoking rates, physical inactivity, unhealthy diet, poor sleep, and reduced adherence to cardioprotective medications. Clinical challenges including healthcare avoidance, mistrust of medical environments, and frequent psychiatric comorbidities contribute to delayed diagnosis and poorer outcomes.Intervention studies suggest that treating PTSD through trauma-focused psychotherapy, selective serotonin reuptake inhibitors, prazosin for sleep symptoms, and structured exercise may improve physiological parameters relevant to cardiovascular risk. Integrated models of care that combine mental health and cardiovascular services, as well as emerging digital tools such as wearables and telepsychiatry, show promise for enhancing monitoring and preventive care.Overall, current evidence indicates that PTSD is a substantial and modifiable cardiovascular risk factor. Recognition of this relationship supports routine cardiovascular risk assessment in individuals with PTSD and systematic PTSD screening in cardiac care settings. Multidisciplinary, trauma-informed care models may be essential for reducing long-term cardiovascular morbidity in this high-risk population.

Introduction . Acute aortic dissection is a current and urgent problem in modern cardiac surgery. In the early stages of the dissection, the surgeon is faced with the dilemma of choosing the volume of intervention from the ascending part reconstruction only or radically ascending and aortic arch replacement. Hybrid systems for one-stage reconstruction of the thoracic aorta are currently being actively developed. The Frozen Elephant Trunk (FET) technique allow us to replacement ascending and arch of the aortae combined with antegrade stent grafting into the descending aorta from the classical sternotomy access. This type of operation doesn’t increase the time of the intervention, there isn’t stage-by-stage reconstruction of the aorta, adequate blood flow in the descending aorta and aortic vessels is restored, and the risks of an adverse outcome are reduced. Objective . To analyze the results of surgical treatment of acute aortic dissection type A, performed using the FET technique in a multidisciplinary surgical hospital – N.V. Sklifosovsky Research Institute for Emergency Medicine. Material and methods . The research included 18 patients which were operated from 2022 to 2024 in acute stage of aortic dissection. All patients were operated using a hybrid technique FET. Results . Multisystem organ failure developed in 5 patients (27.8%). Four patients (22.2%) required renal replacement therapy due to acute renal failure. In 38.9% of the subjects, prolonged artificial ventilation was complicated by pneumonia. Cerebral complications were observed in 6 patients (33.3%). Sepsis accompanied the course of the disease in 16.7% of cases. The 30-day mortality was 22.2%, in the study group. Conclusion . Using the hybrid prosthesis allowed us to obtain relatively satisfactory results of reconstruction thoracic aortae in case of the acute dissection in the early postoperative period.

Introduction . Articular hyaline cartilage has special structural and functional characteristics, which are critically important for preserving tissue grafts, containing cartilage elements. Allogeneic bone-cartilage grafts (BCG) could be very perspective in the treatment of joint defects. However, the widespread clinical use of BCG shows significant difficulties, associated with effective choice of preservation and sterilization methods. The aim of the study was to analyze modern methods of allogeneic BCG-preserving, according to their effect on the structural integrity of tissue, biomechanical properties and cellular viability. Material and methods . We systematized data from scientific publications selected in the Scopus, PubMed, eLibrary, and CyberLeninka databases for the period from 1980 to 2024, with a focus on research published over the past 15 years. Results . Cryopreservation is considered as the most convenient method for long-term storage of BCG, however, its effectiveness significantly depends on the optimization of protocols, including the selection of adequate cryoprotectors, freezing and thawing modes. Lyophilization successfully allows to preserve bone part of BCG, but it causes significant deformation of cartilaginous part, loss of its structural organization and mechanical properties. BCG-storage in liquid culture media and solutions ensures short-term preservation of the graft (about 2–3 weeks), longer storage is accompanied with progressive decrease of biomechanical characteristics and the development of matrix edema. The use of chemical agents (aldehydes, alcohols, glycerol) for BCG-preservation seems impractical due to their pronounced cytotoxic effect and negative effect on tissue architecture. Supercritical CO 2 treatment is considered as potentially promising method, targeted on combining tissue sterilization and preservation of structural properties. Conclusion . The development of effective methods for preserving allogeneic BCG, ensuring the maintenance of their structural and functional characteristics, remains an urgent interdisciplinary task, requiring integration of advances in cell biology, cryobiology and tissue engineering. At the current stage, cryopreservation is the most reasonable approach, while other methods require further experimental and clinical verification.

Injection of colored media remains pivotal for three‑dimensional appreciation of vascular anatomy since the pioneering work of Harvey, Ruysch and Swammerdam. Claude Gillot revived the approach for the study of the venous system by combining green‑latex infusion with post‑dissection vein painting (“colored segmentation”) to enhance anatomical education. To detail Gillot’s injection technique, evaluate its technical reliability, 400 fresh lower limbs (200 donors, mean age 75 years; Centre du Don des Corps, Paris) were irrigated with warm soapy water and injected via an ankle 19‑G butterfly into the great saphenous vein with filtered green latex (120–150 ml; 20 ml syringe; 20–30 kPa). Proximal femoral venous drainage prevented reflux. After 24 h polymerization the limbs were dissected; venous segments were painted according to a seven‑color palette. Patency, leakage and dissection time were recorded. Three exemplary specimens were photogrammetrically documented. Overall venous patency reached 93% with minimal segmental leakage (mean < 2 cm per limb). Dissection time per lower limb averaged ten hours. Gillot’s colored‑segmentation protocol provides a vivid, dependable and inexpensive platform for teaching and research in venous anatomy. Its flexibility and compatibility with digital capture surpass many contemporary embalming or silicone‑based perfusion techniques. Future work should integrate three‑dimensional models into virtual‑reality curricula and quantify learning outcomes.

A clinical case of a 35-year-old man with dissection of the left vertebral artery is presented, in connection with which dual antiplatelet therapy in the form of aspirin and clopidogrel, as well as anticoagulant therapy with enoxaparin, was prescribed to prevent the development of thromboembolic complications. On day 5, the patient developed numbness in the right extremities, dysphagia and dysarthria, increased ataxia, left-sided ptosis, right-sided hemiparesis and hemihypesthesia. A control MRI scan of the brain revealed a focus of ischemia in the medulla oblongata. Pharmacogenetic testing was performed with the study of genetic resistance to antiplatelet drugs with the determination of polymorphic variants rs4244285*2, rs4986893*3, rs12248560*17 of the CYP2C19 gene. It was revealed that the patient was a carrier of the CT genotype according to the rs12248560 polymorphic variant, the GA genotype according to the rs4244285 polymorphic variant, and the GG genotype according to the rs4986893 polymorphic variant of the CYP2C19 gene. This corresponds to a variant of an intermediate metabolizer with an indistinctly defined effect of clopidogrel. The above clinical observation with the development of delayed ischemic stroke after spinal artery dissection (DPA) draws attention to the problem of genetic resistance to antiplatelet agents in this patient population. The development of delayed ischemic stroke in DPA is the basis for determining genetic resistance to antiplatelet agents and the subsequent possible change in treatment tactics.

Minimally invasive spine surgery (MISS) offers superior clinical outcomes compared to traditional open techniques, particularly in reducing perioperative morbidity and promoting faster recovery. However, the high cost and limited availability of specialized instrumentation especially tubular retractors pose significant barriers in low-resource healthcare settings. This study presents an innovative, low-cost alternative using a modified 20 cc syringe as a tubular retractor in three representative MISS cases involving both degenerative and neoplastic pathologies. Three patients with diverse spinal conditions—a cervical spinal meningioma, thoracic metastatic compression, and a symptomatic lumbar facet cyst—underwent MISS using a custom-fabricated syringe retractor. The syringes were trimmed and notched to accommodate anatomical contours and secured with sterile adhesive film (Tegaderm). Surgical access was tailored to the lesion location using interlaminar or transpedicular approaches. Intraoperative stability, visualization, and ergonomics were assessed. All procedures were completed successfully without intraoperative complications. The cervical tumor was excised entirely, thoracic decompression was effectively achieved with adjunct vertebroplasty, and the lumbar cyst was resected with resolution of radiculopathy. No postoperative infections, neurological deficits, or spinal instability were noted during the follow-up period. This case series highlights the feasibility, safety, and clinical utility of a modified syringe as a cost-effective tubular retractor in MISS. The technique offers a reproducible solution for extending advanced spinal surgical care to under-resourced settings, reinforcing the value of frugal innovation in global neurosurgery.

BACKGROUND: Intestinal microcirculatory injuries in patients with severe acute pancreatitis result in neuroendocrine dysregulation, intestinal epithelial cell dysfunction, and impaired intestinal motility. AIM: This study aimed to assess the efficacy of enteral corrective therapy of intestinal failure in patients with severe acute pancreatitis using an enteral saline solution. METHODS: A multicenter, non-randomized clinical study included 146 patients with severe acute pancreatitis (112 [76.7%] males and 34 [23.3%] females, mean age: 50.8 [SD ± 13.7] years). The patients were divided into two groups. The control group included 52 patients (35 [67.3%] males and 17 [32.7%] females, mean age: 50.9 [SD ± 15.0] years) who received standard of care. The treatment group included 94 patients (69 [73.4%] males and 25 [26.6%] females, mean age: 46.6 [SD ± 9.5] years) who additionally received enteral therapy using an enteral saline solution. The solution’s composition was identical to that of chyme from the first part of the small intestine in apparently healthy individuals. Its acidic environment (pH 5.0–5.8) has a bacteriostatic effect and inhibits the growth of opportunistic and pathogenic microorganisms. Enteral therapy was provided via a nasointestinal tube, which was placed along the endoscopic instrument channel and attached to the ligament of Treitz. The solution (1500 mL) was administered at a rate of 6–10 mL/min with intra-abdominal pressure monitoring, which did not exceed 16 mmHg. The Mann–Whitney U test was used for intergroup comparisons. Differences were considered significant at p 0.05. RESULTS: The treatment group showed a decrease in intestinal injury marker (I-FABP) levels the day after starting enteral therapy. On days 2 and 7, there was a significant decrease in intestinal fatty acid binding protein (I-FABP) levels to 1.52 ng/mL (p = 0.049) and 1.42 ng/mL (p = 0.01), respectively. These values were comparable to the median I-FABP level in the control group (1.40 ng/mL), which was used as a reference. On day 2, the threshold value was comparable to the reference (p = 0.049), with a significant decrease on day 7 (p = 0.01). CONCLUSION: The findings confirm the efficacy of the enteral saline solution in patients with severe acute pancreatitis.

ABSTRACT. Poisoning with opioids, including methadone, occupies one of the leading positions in the structure of acute chemical poisonings with narcotic drugs. Often, these poisonings cause severe complications, which in some cases result in death. Traditional approaches to the treatment of these patients are in most cases limited and may be ineffective in the development of serious complications, such as refractory cardiogenic shock or acute respiratory distress syndrome; against this background, ECMO can serve not only as a method of supporting vital functions, but also as a means correction of metabolic disorders, providing optimal conditions for the body. An additional aspect that highlights the relevance of ECMO for methadone poisoning is the increasing availability of this technique in clinical practice and its potential for use in settings where other treatment methods have failed.The purpose of this work is to demonstrate the first experience of using extracorporeal membrane oxygenation in severe methadone poisoning.Results. Patient Sh., 27 years old, was found by the Emergency Medical Service (EMT) at home. At the time of examination, emergency medical services specialists examined the patient (GCS 3 points, bradypnea, hypotension, hypothermia), tracheal intubation was performed to ensure airway patency, and vasopressor support with norepinephrine was initiated. The patient was urgently taken to the intensive care unit, where effective circulatory arrest occurred, refractory to the ongoing intensive therapy, and therefore a specialized EMS ECMO team was called and VA ECMO was initiated.The patient was hospitalized in the intensive care unit of the regional vascular center (ICU RSC) of the N.V. Sklifosovsky Research Institute for Emergency Medicine, where the clinical diagnosis of “methadone poisoning” was established. Alcohol intoxication” (according to ICD-10 T40.3).Against the background of combined intensive therapy, restoration of cardiorespiratory function was noted, which made it possible to wean the VA ECMO system on the 4th day.On the 20th day (from the moment of hospitalization in the hospital), the patient in a stable somatic status was discharged from the N.V. Sklifosovsky Research Institute for Emergency Medicine.Conclusion. The observation we presented shows the effectiveness and feasibility of using VA ECMO in the development of refractory cardiogenic shock in methadone poisoning.