V.A. Negovsky Scientific Research Institute of General Reanimatology

Hypoxic-ischemic encephalopathy remains a leading cause of neonatal mortality and disability. Experimental data suggest potential neuroprotective properties of xenon; however, the mechanisms and extent of its effect are not fully understood. The study aimed to evaluate the neuroprotective properties of a xenon-oxygen mixture in a neonatal ischemia-hypoxia rat model using MRI and follow-up neurological assessment. The experiment involved Wistar rat pups (n = 16). Neonatal ischemia-hypoxia was induced by the Rice–Vannucci method. Thirty minutes post-hypoxia, animals received the 60-min inhalation of either nitrogen-oxygen (control, n = 8), or 50/50 xenon-oxygen mixture (n = 8). Brain MRI was performed on day 7. In the xenon group, brain lesion volume was significantly reduced by 25% compared to controls on day 7 (p = 0.001). Neurological development was assessed from day 3 to 28 using a combination of behavioral tests. Xenon-treated animals demonstrated earlier formation of forelimb and hindlimb grasping reflexes (p = 0.025 and p = 0.005), better hindlimb placement and cliff avoidance on day 7 (p = 0.045 and p = 0.03), and better preserved auditory startle response on day 14 (p = 0.035). Thus, early administration of a xenon-oxygen mixture after ischemia-hypoxia exerts pronounced neuroprotection in newborn rats, confirmed by reduced brain damage and improved neurological outcomes.

According to the Order of the Ministry of Health of the Russian Federation dated 04.27.2021 No 404n, as part of the medical screening of the adult population, it is mandatory to perform esophagogastroduodenoscopy at the first stage of medical examination at the age of 45 and colonoscopy for persons aged 40 years in the scope of the second stage of medical screening. The value of esophagogastroduodenoscopy and colonoscopy depends on the quality of the examination of the mucous membrane and the timely examination. There are many factors that prevent the achievement of the criteria for the quality of the study, including the lack or insufficient depth of procedural sedation and/or analgesia. The article presents guidelines for procedural sedation and/or analgesia in adult patients with esophagogastroduodenoscopy and colonoscopy. The recommendations are based on regulatory legal acts, guidelines, and the results of clinical trials and metanalyses. The evidence of the need for esophagogastroduodenoscopy and colonoscopy under conditions of procedural sedation and/or analgesia is substantiated. The recommendations describe algorithms for assessing the risk of lung aspiration and cardiopulmonary complications before performing endoscopic examinations. Based on the results of clinical studies, a technique of stepwise administration of propofol has been developed. Extended periprocedural monitoring of vital functions is proposed. The criteria for recovery and discharge of patient’s home are described. The developed recommendations are aimed at providing effective and safe procedural sedation and/or analgesia in adult patients with diagnostic esophagogastroduodenoscopy and colonoscopy.

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.

BACKGROUND: The suppurative lung disease accompanied by destruction of lung tissueinclude the pleural empyema with or without fistula, the lung abscess with or without sequestration, the gangrenous abscess and several other less frequent conditions. The mortality among patients with this profile, considered as critical illness, remains high due to the development of life-threatening complications. The early stratification of patients by the risk of such complications can be useful for the physician when choosing the strategy for personalized treatment. The genetic variability of the AQP4 gene, the expression of which on the surface of cells in the lungs and in the immune system may have the pathogenetic meaning for the development of lung diseases and their complications, is the source of early markers for predicting the course of suppurative lung diseases. Previously we have demonstrated that the polymorphic gene variants of AQP4 rs1058427 are associated with the septic shock development and the outcome of sepsis. The contribution of AQP4 into the development of pulmonary hypertension was not investigated previously. AIM: To clarify the contribution of the AQP4 gene polymorphic variants and pathogenically relevant immune cells levels to the development of pulmonary hypertension in patients with the suppurative lung disease. METHODS: The research included the patients aged 18–87 years with suppurative lung diseases developed after the previous community-acquired pneumonia. Pulmonary hypertension was detected using the echocardiography (as demonstrated by the parameters of systolic pressure in the pulmonary artery ≥36 mm.Hg. and regurgitation rate of the tricuspid valve ≥2.9 m/sec). In all patients, the genotypes of AQP4 rs1058427 were determined. RESULTS: The presence of the AQP4 rs1058427 minor allele Т in patients with the suppurative lung disease was associated with the development of pulmonary hypertension and with the increase in blood monocytes count, with the presence of minor genotypes GT or TT of AQP4 rs1058427 indicating the high risk of developing the pulmonary hypertension. In cases of separately analyzing the subgroups of patients with or without the previous episodes of laboratory confirmed COVID-19, the statistical significance of the association remained only for the carriers of the allele Т and with no documented history of COVID-19 episode. CONCLUSION: The presence of the minor allele AQP4 rs1058427 (genotypes GT or TT) in the genotype of patients with the suppurative disease of the lungs has determined the increased risk of developing the pulmonary hypertension and the increased blood monocytes count.

INTRODUCTION: Multimodal analgesia is a key component of enhanced recovery after surgery protocols, with nonsteroidal anti-inflammatory drugs (NSAIDs) playing a central role in pain management. However, the optimal method of administration — bolus versus continuous/prolonged infusion — remains a subject of ongoing debate. OBJECTIVE: This meta-analysis aims to compare the efficacy and safety of these two NSAID administration approaches in the postoperative setting. MATERIALS AND METHODS: A systematic literature search was conducted in PubMed, Cochrane CENTRAL and other sources up to March 2024. Only randomized controlled trials (RCTs) comparing continuous NSAID infusion (≥ 6 hours) with bolus administration in adult postoperative patients were included. The primary outcome was total opioid consumption; secondary outcomes included pain intensity (6–48 hours), incidence of postoperative nausea and vomiting, respiratory depression, and need for rescue analgesia. Statistical analysis was performed using STATA 18.0, applying a random-effects model with assessment of heterogeneity (I²) and publication bias (Egger’s test). The protocol was registered in INPLASY (INPLASY202550045). RESULTS: Of the 343 publications screened, six RCTs (n = 462) met the inclusion criteria. No significant differences were observed between the continuous infusion and bolus administration groups regarding opioid consumption (standardized mean difference [SMD] — –0.35; p = 0.219), pain scores, nausea, or respiratory depression. However, the need for additional analgesia was significantly higher in the infusion group [relative risk — RR] — 3.74; p < 0.001). Most studies had a moderate to high risk of bias. According to the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach, the certainty of the evidence was low to very low. CONCLUSIONS: Despite theoretical pharmacokinetic advantages, continuous NSAID infusion did not show clinical superiority over bolus administration. Both methods can be used in multimodal analgesia, but the choice should consider individual patient needs and institutional resources. Further high-quality, multicenter RCTs are warranted.

Objective: to clarify the pathogenesis of ischemic stroke in infectious diseases of the lower respiratory tract.Material and methods. We searched the PubMed database for original research articles, clinical reports, review articles, editorials, commentaries, and short communications published before June 25, 2025. Additional studies that were not captured through the primary database search were analyzed after manually examining the reference lists of the selected articles. Articles were selected based on the relevance of the title and abstract to the purpose of this review. Data from 160 sources were included in the analysis.Results. We have identified and analyzed in detail the mechanisms of ischemic stroke development in respiratory infections: activation of the coagulation system and disruption of natural anticoagulant and fibrinolytic mechanisms (1); interaction of the hemostasis system with innate immunity (2); the effect of infectious agents on the progression of atherosclerosis and the stability of the atherosclerotic plaque (3); the formation of thromboemboli in the pulmonary veins (4).Conclusion. Both bacterial and viral infections can initiate a procoagulant state mediated by tissue factor, von Willebrand factor, platelet activation, neutrophil extracellular traps and decreased activity of endogenous anticoagulants. The infectious process localized in the lungs, characterized by damage to the pulmonary vascular endothelium, alveolocytes, intraalveolar fibrin deposition, edema, cellular infiltration, in concert with hemostasis alterations create conditions for the formation of thrombi in the pulmonary vessels. Thus, the pulmonary veins and venules can be a source of cerebral thromboembolism. This mechanism of thromboembolic stroke development largely explains causes of acute cerebrovascular events in patients with lower respiratory tract infection without cardiovascular risk factors. Another mechanism of ischemic stroke is associated with direct or indirect effects of pathogens on the stability of atherosclerotic plaques in cerebral vessels, which, together with systemic procoagulant imbalance, leads to the formation of atherothrombosis. Given the significant pathogenetic relationship between acute infectious lung diseases and cardioembolic and atherothrombotic strokes, clinical alertness regarding acute cerebrovascular events should be included in monitoring and management of such patients.

Systemic inflammation in rheumatoid arthritis (RA) is associated with changes in both counts and composition of circulating inflammatory blood cells such as neutrophils and lymphocytes. Accurate monitoring of inflammation grade and disease status in patients with RA is important in the inpatient setting. Purpose of the study was to determine inflammatory indices derived from the general blood counts (GBC) in patients with active RA during inpatient treatment, and to search for association of these indices with clinical and laboratory parameters of the disease. The inflammatory indices (NLR, neutrophil-to-lymphocyte ratio; MLR, monocyte-to-lymphocyte ratio; PLR, platelet-to-lymphocyte ratio; SII – systemic immune inflammation index, SIRI, systemic inflammatory response index) were determined as based on the results of GBC performed using automated hematology analyzers in 43 patients with RA (55.8% males; aged 22 to 78 years; 88% with high disease activity) twice (at admission to hospitalization and at discharge). The average length of hospitalization was 14 [9;14] days. Common inflammatory markers (ESR and CRP) correlated with each other (rs = 0.64), i.e., we have found correlations between CRP and leukocyte counts (rs = 0.47), with PLR (rs = 0.43), and age of patients (rs = 0.34), as well as correlations of ESR with PLR (rs = 0.37) and age of RA patients (rs = 0.33). The SII index correlated strongly with NLR (rs = 0.85) and PLR (rs = 0.86), moderately with MLR (rs = 0.49), but not with SIRI (p 0.05). The SIRI index showed a correlation with DAS-28 degree (β = -0.072, p = 0.008). Markers obtained from GBC were not associated with age or sex of the examined individuals (except of SIRI, p = 0.027), no intergroup differences in the studied hematologic markers were found when classifying RA patients by the content of antibodies to cyclic citrullinated peptide, presence of erosions and systemic manifestations (except of PLR, p = 0.048). Only CRP and systemic immune inflammation index (SII) showed a significant decrease (p = 0.24 and p = 0.43, respectively) during hospitalization of patients with RA. No advantage was found for usage of two-component indices (NLR, MLR, PLR) as plausible tools, both for assessing inflammatory status and for management of patients with highly active RA. The SII index, combining the prognostic value of three parameters (platelets, neutrophils and lymphocytes), may be considered not only more powerful for predicting inflammation than single- or two-component hematologic markers, but also a valuable tool for monitoring inflammation and RA progression. Thus, the SII index (along with CRP) may be considered a potential biomarker for determining the outcome of inpatient treatment of patients with highly active RA.

The range of skin diseases in which it is necessary to moisturize the skin is wide and includes atopic dermatitis, ichthyosis, psoriasis, eczema, xerosis and even acne. In turn, the morbidity with these dermatoses is increasing, and their severity has been worsening in recent years. The search for alternative and additional treatment methods that minimize the need for corticosteroids and other topically applied drug products is one of the main challenges of dermatology. The new strategy for treatment of chronic skin diseases accompanied by dryness is called «emollients plus». Emollients plus — a new class of cognitive moisturizing agents, capable of providing a comprehensive approach to the treatment of frequent dermatosis accompanied by defects of the epidermal barrier precisely by restoring the barrier function of the skin and reducing the intensity of subjective manifestations. Unlike conventional emollients, which simply moisturize the skin, emollients plus contain active ingredients that have anti-inflammatory, anti-pruritic, antibacterial, antioxidant, modelling microbiome and epidermal barrier indicators properties, and this is not an exhaustive list. The article presents historical aspects of the evolution of skin softening products from vaseline and lanolin to modern classification including hydratants, occlusive agents, emollients, enhancers and «emollients plus». The mechanisms of action of topically applied agents of different classes and correct selection of emollient depending on the clinical situation are also considered.

The present study aimed to analyze the morphological and mechanical changes in neutrophils associated with infectious septic complications and IRF5 gene knockdown in macrophages. In our study, we evaluated the morphological properties of neutrophils, including the areas of the nucleus and the membrane, as well as the membrane roughness (Ra) and the degree of NET activation. Concurrently, the phenotypic and biomechanical changes occurring in macrophages were investigated subsequent to IRF5 knockdown. The expression levels of macrophage markers (iNOS, CD206), the mitochondrial content, and the mechanical properties were analyzed.