Like many other pathological infectious processes, sepsis is mainly studied in vivo using mice models. Over the past 30 years, such studies have led to significant achievements in understanding of the sepsis pathophysiology. However, unfortunately, none of them led to any «discoveries» in the treatment of patients. In this review, we question the relevance of the experimental models applied, list some aspects rarely taken into account and discuss ways to resolve the deadlock.

The text is a translation of the article: Cavail-lon J. M. New methods of treating sepsis: failure of animal models, Bull. Assoc. Anc. El. Inst. Pastor, 2017, 59, 230, 58—60. Translation from French by «Akademperevod», Moscow, Russia.

For many decades, the world community’s efforts have been aimed at reducing the neonatal and infant mortality from intrauterine infections. In 1990, the United Nations and the World Health Organization set out the priority of decreasing children mortality by 2015 году. In spite of impressive success in newborn treatment, mortality due to sepsis decreases slowly; when survive, postnatal children develop central nervous system impairments of different level of severity. In the recent decade, new data have emerged concerning the methods of intrauterine infections prophylaxis, diagnosis, and treatment. The purpose of the review is to present data concerning specifics of pregnancy course when infections develop, contemporary diagnostic methods including studies of interleukins, placenta morphology, allelic genes, and to reflect the current approach to the treatment of intrauterine infections in newborns. 

The purpose of this review of the 81 publications is to discuss the current national and international data on the prediction of neurological outcomes after sudden circulatory arrest (SCA) using molecular biomarkers. The review discusses the current state of the problem of neurological outcomes after a sudden circulatory arrest, the principal therapeutic measures to improve these outcomes and currently available clinical, laboratory, and instrumental methods of diagnosis and prediction of neurological outcomes after a sudden circulatory arrest. 

Mechanical ventilation is associated with a number of complications that increase the cost of treatment and the hospital mortality rate. In 2004, the term «ventilator-induced diaphragm dysfunction» (VIDD) was proposed to explain one of the reasons for the failure of respiratory support. At present, this term is understood as a combination of atrophy and weakness of the contractile function of the diaphragm caused directly by a long-term mechanical lung ventilation. Oxidative stress, proteolysis, mitochondrial dysfunction, as well as passive overdistension of the diaphragm fibers contribute greatly to the pathogenesis of VIDD. Since 30—80% of patients in the ICU require mechanical respiratory support and even 6—8 hours of mechanical lung ventilation can contribute to the development of a significant weakness of the diaphragm, it can be concluded that the VIDD is an extremely urgent problem in most patients. Its typical clinical presentation is characterized by impaired breathing mechanics and unsuccessful attempts to switch the patient to the spontaneous breathing in the absence of other valid reasons for respiratory disorders. The sonography is the most informative and accessible diagnostic method, and preservation of spontaneous breathing activity and the use of the latest mechanical ventilation modes are considered a promising approach to prevention and correction of the disorders. The search for an optimal strategy for lung ventilation, development of diagnostic and physiotherapeutic methods, as well as the consolidation of the work of a multidisciplinary team of specialists (anesthesiologists and intensive care specialists, neurologists, pulmonologists, surgeons, etc.) can help in solving this serious problem. A review of 122 sources about the VIDD presented data on the background of the issue, the definition of the problem, etiology and pathogenesis, clinical manifestations, methods of diagnosis, the effect of drugs, prevention and therapy. 

The purpose of the study was to determine the morphological characteristics of the repair process of the tracheal and bronchial mucosa after sanitation bronchoscopy using type I human  collagen solution  in patients with an inhalation  injury (II).

Materials and methods.  An open-label, randomized, prospective study included  59 patients with inhalation injury (2—3 severity  degree according  to the classification  of Yu. V. Sinev and A. Yu. Skripal'.  The main group consisted of 29 patients. They underwent a sanitation bronchoscopy using type I human collagen solution applied onto erosive and ulcerative lesions of the mucous membrane.  The reference group consisted  of 30 patients who underwent sanitation bronchoscopy in accordance with the standards of medical care. In order to assess the morphological  dynamics  of the repair process of the mucous membrane,  a morphological  study  of the bioptate obtained during endoscopic studies was carried out. The solution for the application was prepared by acid extraction of type I human collagen from ligaments and tendons as described  earlier (Russian Federation invention patent No. RU 2591544 C1).

Results. Complete  epithelization of the tracheal  and bronchial mucosa occurred  significantly  earlier (4 (3; 7) days) in patients with the 2nd  degree inhalation injury when using type 1 collagen application, than in those without the application (7 (4; 9) days) (n=15 and n=21 respectively; U=49.5; P=0.0004). In the case of the 3rd  degree inhalation injury, coating of ulcers of the tracheobronchial tree mucosa with the collagen solution also significantly reduced the epithelialization period on average to 8 (7; 10) days, while after the standard sanitation bronchoscopy, this period was 17 (12; 22) days (n=14 and n=9  respectively;  U=1; P=0.0001). The morphological  changes in patients of the main group were characterized by the absence of signs of a purulent inflammation, early appearance of macrophages and lymphocytes, and covering of type I collagen by simple cuboidal epithelium, while in the reference group, there was a severe purulent inflammation manifested by polymorphonuclear leukocyte  infiltration.

Conclusion. The sanitation bronchoscopy with simultaneous closure of the damaged areas of the mucous membrane with the type I human collagen solution  results  in relief of the inflammatory process which is confirmed by morphological  studies.

Use of antithrombotic aids (ATA)  significantly  impact  the prevention of life-threatening cardiovascular complications. ATA applications, however, are associated with a wide range of adverse digestive system responses. Due to, continuously growing clinical use of ATA this problem has become a current challenge of contemporary medicine.

Purpose of the study was to evaluate the patterns of digestive system damage in patients receiving ATA.

Materials and Methods. 672 patients were examined, 91.0% males, 46.7±17.4 years of age, who had digestive system changes that  occurred  due to ATA intake. 71 patients were admitted for treatment after gastrointestinal (GI) bleeding; other  patients were hospitalized  because of disorders  of the digestive  system or erosive and ulcerous changes of the digestive  system detected by endoscopy.  The following parameters were  evaluated:  GI bleeding sources, character of complaints,  the endoscopic patterns due to intake of different ATAs (low doses of aspirin, warfarin, clopidogrel,  dabigatran, rivaroxaban, low-molecular  heparin,  combined  therapy), and of risk factors for GI complications.

Results. The sources of GI bleeding (n=71) included  gastric ulcers and/or erosions (39.4%), duodenum ulcers and/or erosions (21.1%), colon ulcers and/or erosions (28.2%), unknown  (11.3%). The majority of 672 patients noticed  various  complaints:  sensation  of heaviness  in epigastrium (62.8%),  gastralgia  (46.7%),  burning  sensation (34.3%). Endoscopy found erosive esophagitis (13.2%), ulcers in stomach and/or duodenum (11.6%), multiple (  10) erosions of stomach or duodenum (17.1%), sporadic erosions of stomach or duodenum (24.4%). In 32.3% cases no erosive or ulcerous alterations were found. H. pylori was identified in 57.9% of patients. There was no significant difference in character of alterations in the upper digestive system between patients who received different ATA treatment, except of frequent erosive esophagitis in those patients who received dabigatran (16.8%). The elderly age (  65 years), ulcer history, concomitant intake of NSAIDS, H. pylori presence, and smoking habit were associated with a higher occurrence of pathological alterations of digestive system. Presence  of gastralgia  did not correlate with the development of erosive and ulcerous alterations.

Conclusion. In majority of patients who received ATA, the commonly observed erosive and ulcerous alterations in the digestive system might become a source of bleeding.

Purpose. To evaluate the role of ozonized erythrocytic mass transfusion in the restoration of damages in the architectonics of myocardium microvasculature and cardiomyocytes in case of a severe blood loss.

Materials and Methods. Two batches of experiments were conducted, 17 white outbred rats in each. The animals were anesthetized with thiopental sodium (25 mg/kg). Blood loss was caused by taking 3ml of blood from the tail artery of rats, which is 35% of the circulating blood volume. One hour after the blood loss, transfusion of autoerythrocytes with normal saline solution and Ringer’s solution infusion in 1:1 ratio was performed in the control batch. In the experimental batch, 3 ml of autoerythrocytes treated with ozonized saline solution with ozone concentration of 2 mg/l and 3 ml of Ringer’s solution (1:1 ratio) were administered to rats. Erythrocyte mass was prepared from 3 ml of the autoblood harvested from the animals 3 days before the experiment. On a post-transfusion day5, in both batches and in five intact animals, hearts were removed following the intraperitoneal thiopental sodium injection (100 mg/kg). The left ventricle wall specimen from each heart was removed for examination. Histologic sections were stained with hematoxylin and eosin. The preparations were visually examined and morphometric studies were performed using microvisor Vizo-103.

Results. It has been established that administration of ozonized erythrocyte for severe blood loss correction limited the decrease in numbers of capillary profiles and their diameters, formation of mixed and hyaline thrombi fully or partially occluding microvascular lumens, major hemorrhages and reduction of variation of nuclear profiles, decreased perivascular, pericellular, perinuclear, and endonuclear edema of myocardial tissue, cardiomyocyte overcontruction zone, and their ruptures.

Conclusion. The positive trends for microcirculation indices, vascularization density and myocardial edematization as prognostic markers in assessing potential posthypoxic rehabilitation of damaged tissues upon blood loss correction with ozonized erythrocyte mass might be explained by the antihypoxic, antioxidant, and detoxifying actions of ozone on erythrocytes and/or its metabolites (ozonides) in the body post-transfusion. 

The purpose of the research: to analyze the quality of medical care of patients who are at risk of developing acute kidney injury.

Materials and methods. The work is based on a retrospective analysis of medical records of 140 patients with an acute kidney injury developed during their stay the intensive care units, surgical and medical units of district hospitals the Irkutsk Oblast over the period from 2012 to 2017.

Results. Inadequate assessment of the risk of an acute kidney injury was identified in 61% of patients. The most common inadequately assessed damaging factors were critical conditions (in 36% (50/140), sepsis (27% (38/140), and nephrotoxic drugs (19% (26/140). Among inadequately evaluated predisposing factors that could be managed, the following ones were most common: chronic heart disease (in 42% (59/140), dehydration/hypovolaemia (34% (47/140), chronic kidney disease (29% (41/140), and anemia (25% (35/140). In patients at risk of an acute kidney injury, an inadequate examination and inadequate maintenance therapy were found in 66% and 56% cases, respectively. Analysis of implementation of supporting therapy in patients at risk of an acute kidney injury the following misconducting events were revealed: (i) no optimal volumic and perfusion support (59% (82/140) and (ii) no cancellation of nephrotoxic and improperly prescribed drugs (31% (44/140).

Conclusions. A good quality medical care restricted only by 24% of patients at risk of an acute kidney injury developed in the ICU, surgical and medical departments of district hospitals of the Irkutsk Oblast. The development of an acute kidney injury when exposed to nephrotoxic drugs and dehydration/ hypovolemia in 14% of cases was predictable and preventable.