Lithium chloride, which is used for the treatment of bipolar disorders, has a neuroprotective effect in conditions associated with acute and chronic circulatory disorders.

The purpose of the study: to investigate the efficacy of lithium chloride for the prevention of post-resuscitation death of hippocampal neurons during the post-resuscitation period.

Material and methods. Cardiac arrest for 10 minutes was evoked in mature male rats by intrathoracic clumping of the vascular bundle of the heart, followed by resuscitation. 40 mg/kg or 20 mg/kg of 4,2% lithium chloride (LiCl) was injected intraperitoneally 1 hour before cardiac arrest, on the 1st and 2nd day after resuscitation (n=9). Untreated animals received equivalent doses of saline (n=9). Rats after a sham surgery served as a reference group (n=10). The number of viable neurons in the CA1 and CA3/CA4 fields of the hippocampus was estimated in slides stained with cresyl violet by day 6 or 7 postresuscitation. In a separate series of experiments, at the same terms, we studied the effect of lithium chloride on the protein content of GSK3β (glycogen synthase kinase) in brain tissue using Western-Blot analysis.

Results. Histological assay showed that a 10-minute cardiac arrest resulted in a decrease in the number of viable neurons in the hippocampal CA1 field — by 37.5% (P0.001), in the CA3/CA4 field — by 12.9% (P0.05) vs. the reference group. Lithium treatment increased the number of viable neurons in resuscitated rats — in the CA1 field by 37% (P<0.01), in the CA3/CA4 field — by 11.5% (P0.1) vs. the untreated animals. It was found that lithium caused an increase in phosphorylated form of GSK3β: by 180% vs. the reference group (P[1]0.05), and by 150% vs. the untreated animals (P0.05).

Conclusion. Lithium treatment leads to a pronounced neuroprotection in the neuronal populations of the hippocampus post-resuscitation. This effect may be due to an increase in the content of the phosphorylated form of GSK3β protein. The results indicate a high potential of lithium for the prevention and treatment of neurodegenerative disorders caused by a temporary arrest of blood circulation. 

The second part of the overview presents and analyzes the current data on the methods of adjuvant pharmacological cardioprotection and possibilities of optimizing the anesthetic support and perioperative monitoring in high cardiac risk patients. Amendments made in international guidelines for the last 2–3 years on the basis of conclusive studies and meta-analyses have been examined. Cardioprotection mechanisms and information about its implementation in real clinical practice have been analysed. It has been shown that by no means all drugs under discussion can be widely used for prophytlactic purposes. Contemporary evidencebased recommendations concerning the optimization of anesthetic support and perioperative monitoring are given. A conclusion has been made that practical implementation of a comprehensive strategy aimed at reduction of the risk of cardiac complications might ensure decrease of both the incidence of severe cardiac complications and mortality due to them.

Effective implementation of the fast track concept after surgical treatment is impossible without control of pain in the early postoperative period. Regional methods might significantly improve the quality of postoperative analgesia and accelerate patient recovery as a component of multimodal pain therapy. The implementation of ultrasonic navigation in peripheral nerve blockade protocols has significantly increased the efficiency and safety of the blockade. Nevertheless, each method of regional anesthesia has its own indications, contraindications, and complications. The purpose of this review is to help with the right choice of the type of blockade of the anterior abdominal wall, depending on the surgery performed.

Purpose — to identify the possibility of improving the outcome of multimodality treatment of acute myocardial infarction (AMI) in type 2 diabetes mellitus (DM) patients by use of a succinate-containing drug.
Materials and methods. The results of examination and treatment of 86 men aged 40 to 70 years with clinical diagnosis of AMI and concomitant type 2 DM were analyzed. The patients were split into two groups depending on use of the succinate-containing drug. Patients of the control group (38 men, 58.3±7.1 years old) received the standard treatment that included percutaneous coronary intervention (PCI). In the main group under study (48 men, 57.6±7.6 years old), the standard therapy complex was complemented with administration of a succinate-containing drug (1.5% succinic acid solution), which was administered first 30–60 minutes prior to PCI intravenously at a dose of 10–12 ml/kg; then, daily once a day, for 5 days at a dose of 5–6 ml/kg. Peculiarities of the AMI clinical course, dynamics of myocardial contractility, values of acid-base balance (ABB), glucose and lactate content, lipid peroxidation (LPO) and antioxidant system (AOS), rheological properties of the blood were evaluated.
Results. During AMI type 2 DM patients developed compensated metabolic lactic acidosis and oxidative distress that manifested in considerable activation of LPO and insufficient activity of the enzymatic component of AOS, blood viscosity grew, elasticity of red blood cells fell. Decreased local and global myocardial contractility was noted as well. During PCI in this category of patients, cardiac rhythm disorders developed in 47.4% of cases, 23.7% of which were life threatening, such as multifocal ventricular extra systole and ventricular fibrillation. 
Conclusion. Administration of a succinate-containing drug during performance of PCI provided correction of the lipid peroxidation processes and rheological properties of the blood in the population studied, facilitated improvement of left ventricle’s systolic and diastolic function, reduced the risk of reperfusion complications.

Purpose. To improve the immediate results of surgical treatment of endogenous hypercorticism through
optimizing the perioperative management of patients using accelerated rehabilitation protocols.
Materials and methods. A randomized prospective study of 53 patients with a body mass index 35 kg/m2 was carried out. In the control group (n=27), TIVA based on propofol was used with postoperative analgesia by systemic administration of opioids. In the accelerated rehabilitation protocol group (n=26), we used anesthesia based on low-flow inhalation of desflurane with sympatholytic mixture infusion in intra- and postoperative periods, multimodal postoperative analgesia, and use of accelerated rehabilitation protocol in the perioperative period. The time of patients' achievement of BIS90 index, time of extubation, time of achievement of 10 points by the Aldrete scale and 0 points by the Bidway test, duration of stay in the in-patient hospital, number of postoperative complications were assessed. Effectiveness of analgesia was evaluated by the time of the first analgesia requirement, consumption of narcotic analgesic, VAS and Verbal Descriptor scale.
Results. The study revealed that the time of awakening and reaching 10 points by the Aldrete scale in patients of group 2 was significantly shorter than in group 1: 3 (2; 6) and 6.5 (3.5; 9) min respectively (P=0.046). They had fewer postoperative complications, shorter hospitalization time — 58 (39; 71) hours compared to the control group with 74.5 (58.5; 87) hours (P=0.032).

Conclusion. Perioperative management of obese patients after retroperitoneal video endoscopic adrenalectomy with the use of accelerated rehabilitation protocols contributed to earlier mobilization, reduction of the number of complications in the early postoperative period, reduction of the duration of stay in the in-patient hospital, which together facilitates improving the immediate results of surgical treatment of endogenous hypercorticism.

Purpose: to determine the informative value of the prediction of mortality of patients with sepsis using a combination of candidate markers — the quantitative content of circulating cell-free DNA (cfDNA) in plasma and allelic variants of TLR9 gene encoding-cellular recognition receptor TLR9 for DNA fragments.
Materials and methods. The study included patients from five ICU of 4 four hospitals (n=156). The patients were divided into 2 groups: (1) with sepsis (based on SEPSIS-3, 2016, criteria), (n=81) and with acute cerebrovascular event (n=75). CfDNA was isolated from patient’s blood plasma using organic solvents and its concentration was established by a spectrophotometer using fluorescent intercalating agent SYBR Green binding DNA with high affinity. Genotyping of rs352162 allele variants of TLR9 gene was carried out with the help of polymerase chain reaction using tetraprimers followed by separation of products via electrophoresis and their visualization. The cfDNA concentrations were compared in patients differ in TLR9 rs352162 genotypes and outcome was predicted in 30 days after hospitalization using the ROC analysis.
Results. As regards the cfDNA content, there was no significant difference between patients with sepsis (subgroups with abdominal or non-abdominal sepsis) from two different hospitals, and cfDNA concentration in groups of patients was not associated with the source of primary infection, which allowed increasing group size by pooling up the data. Pooled data have shown that the sensitivity and specificity of the lethal outcome prediction based on the cfDNA content depends on the genotype: in homozygotic patients withg TLR9 rs352162 CC genotype, the AUC was significantly higher than in the alternative group of patients with TLR9 rs352162 CT and TT genotypes.
Conclusion. The data we obtained suggest high informative value of establishing the genetic polymorphism of TLR9 as complimentary to determining the cfDNA concentration and may demonstrate potential usefulness of selecting patients according to their TLR9 genotype for investigations of the clinical effect of targeted drugs inhibiting interaction of cfDNA with receptor TLR9.

The onset of critical complications (multiple organ dysfunction syndrome, MODS) after coronary artery bypass grafting is the result of severe stress response. The key etiopathological factor of the induction phase of the complex pathological process, which ultimately leads to dysfunction of organs and systems, is the dysfunction of the immune response. The characteristics of reactions of the immune system in a particular individual are genetically determined and realized through innate immunity activation. 

Aim. To determine the role of TREM-1 gene polymorphism through the changes of sTREM serum levels and their contribution to the development of multiple organ dysfunction syndrome after coronary artery bypass grafting.

Materials and Methods. 132 patients with coronary atherosclerosis who had undergone coronary artery bypass grafting were included in the study. Of them, 30 patients had multiple organ dysfunction syndrome in the early postoperative period. sTREM serum levels were measured using enzyme immunoassay. Genotyping of polymorphic loci of the TREM-1 gene was performed with real-time allele-specific PCR using TaqMan system.

Results. Significant differences in sTREM levels among patients with and without MODS were found. sTREM levels depend on the carriage of certain allelic variants in the three polymorphic loci of the TREM-1 gene (rs1817537, rs2234246, rs3804277)

Conclusion. The relationships of the levels of the circulating soluble form of TREM-1 and the polymorphic variants of the coding TREM-1 gene with the severity of MODS were determined in coronary artery disease patients after coronary artery bypass grafting. 

Objective: to determine the feasibility of using C-reactive protein (CRP) and cholesterol levels as biochemical screening markers for multiple organ dysfunction syndrome (MODS) in patients after abdominal surgery.
Materials and methods. A prospective case-control study was performed in 192 patients who received
treatment at the Intensive Care Unit (ICU) after abdominal surgery. Patients were classified into two groups: Group 1 (n=95) of patients without MODS and Group 2 (n=97) of patients with MODS. The signs of MODS were identified based on 2001 SCCM/ACCP consensus conference criteria. During the first three post-operative days, total cholesterol and CRP levels were measured, and severity was assessed using prognostic scoring systems (SOFA and Apache III). Logistic regression analysis was used to evaluate five MODS prediction models based on total cholesterol levels, CRP levels, a combination of cholesterol and CRP levels as well as SOFA and Apache III scores.

Results. Cholesterol levels in Group 2 were found to be significantly lower than those in Group 1 (3.13 (2.6–3.74) mmol/l vs 4.09 (3.26–5.01) mmol/l; P0.05). Significantly increased CRP levels in Group 2 compared to Group 1 were found (168.7 (90.2–247.2) mg/l vs 85.9 (35.6–172.6) mg/l; P0.05). AUC, sensitivity, and specificity values were determined for the study models and scales based on total cholesterol levels (AUC 0.679; 95% confidence interval (CI) 0.625–0.732), CRP levels (AUC 0.67; 95% CI 0.6–0.74), a combination of cholesterol and CRP levels (AUC 0.819; 95% CI 0.721–0.917), SOFA score (AUC 0.786; 95% CI 0.744–0.829), and Apache III score (AUC 0.631; 95% CI 0.582–0.68). The optimal threshold was 3.4 mmol/l and 96.5 mg/l for cholesterol and CRP levels, respectively.
Conclusion. Total cholesterol and CRP monitoring revealed them as screening biomarkers informative for predicting MODS within the first three days after abdominal surgery. Using all these models, the probability of MODS development in a patient can be calculated as a function of the numerical value of the biomarker.