Objective. To assess the cystatin C (CysC) prognostic value for probability of death in patients with severe and extremely severe pneumonia associated with COVID-19.
Material and methods. A single-center prospective study included 72 patients with severe and extremely severe pneumonia associated with COVID-19 undergoing treatment in the ICU of multifunctional medical center from September 2020 to October 2021. Recovered survivors (N=55) were analyzed as a Group 1, nonsurvivors (N=17) were considered as a Group 2.
Results. The serum (s-CysC) and urine (u-CysC) CysC concentrations were significantly lower in Group 1 patients vs Group 2, averaging 1.31 mg/l vs 1.695 mg/l (P=0.013550), and 0.25 mg/l vs 0.94 mg/l (P=0.026308), respectively. Significant differences were also revealed in the subgroups differed by age (P=0.0094), platelet count (P=0.001), serum fibrinogen concentration (P=0.016), as well as CURB (P=0.02334), CRB-65 (P=0.032564), and SOFA (P=0.042042) scores. Therefore, s-CysC and u-CysC were statistically significant predictors of death in patients with pneumonia associated with severe and extremely severe COVID-19: 16.273 (95% CI: 2.503–105,814), P=0.003 and 1.281 (95% CI: 1.011–1.622), P=0.040, respectively. Urine and serum CysC were established as predictors of death in pneumonia associated with severe and extremely severe COVID-19, where u-CysC was defined as highly informative (ROC AUC 0.938 (95% CI: 0.867–1.000; P=0.000), with 90% sensitivity and specificity), and s-CysC — as informative (ROC AUC 0.863 (95%CI: 0.738–0.988; P=0.000) with 80% sensitivity and 72% specificity) predictive markers.
Conclusion. Levels of S-CysC and u-CysC are of high prognostic significance and may contribute to identifying patients at a high risk of unfavorable outcome (death) due to pneumonia associated with severe and extremely severe COVID-19. Both S-CysC and u-CysC concentrations increasing up to 1.44 mg/l and 0.86 mg/l, respectively, were associated with high probability of death.

The most common agent used for infusion therapy in patients with diabetic ketoacidosis (DKA) is isotonic 0.9% sodium chloride solution. However, infusion of required volumes can result in development of iatrogenic complications — i. e., worsening of metabolic hyperchloremic acidosis in DKA patients with already altered acid-base balance. Balanced crystalloid solutions can be used as alternative to saline.
Objective. To evaluate the feasibility of using meglumine sodium succinate (MSS) balanced crystalloid solution in DKA.
Material and methods. We examined 2 groups of patients, 30 subjects each, with moderate and severe diabetic ketoacidosis admitted to anesthesiology and intensive care unit. Patients from both groups were administered with insulin and an infusion therapy was employed according to current clinical guidelines for the management of patients with complications of diabetes mellitus. In the comparison group, infusion therapy included 0.9% sodium chloride, 4% potassium chloride, and 5% dextrose. In the study group MSS intravenous drip infusions 10 ml/kg/daily were added to the infusion protocol. Volumes and infusion rates were comparable in both groups. The following indicators were evaluated: time to resolution and DKA resolution rates during thorough monitoring (first 48 hours of therapy), the time (in hours) before discontinuation of insulin infusion; the time to complete consciousness recovery (15 items on the Glasgow Coma scale); the duration (in hours) of stay in the intensive care unit (ICU), dynamics of blood electrolytes; parameters of acid-base balance; levels of glycemia and lactatemia.
Results. All patients improved and were transferred from ICU, the mortality rate was 0%. Infusion of MSS shortened the time to DKA resolution (30.0 h [24.0 h; 36.0 h] in the study group, vs 44.5 h [36.5 h; 51.5 h] in the comparison group (P=0.001)); DKA resolution rates during 48 hours from initiation of therapy achieved 90.0% (27) in the study group, vs 66.7% (20) in the comparison group (P=0.060)); duration of intravenous insulin infusion was 32.0 h [24.5 h; 40.0 h] in the study group vs 48.0 h [40.0 h; 55.5 h] in the comparison group (P=0.001)); duration of ICU stay was 41.0 h [30.0 h; 48.0 h] in the study group, vs 56.0 h [50.0 h; 66.3 h] in the comparison group (P=0.001).
Conclusion. Infusion of a balanced succinate-containing crystalloid solution improves the results of DKA treatment, as compared to traditional infusion of 0.9% sodium chloride.

Objective: to study the risk factors for COVID-19 adverse outcomes in repurposed hospitals of various types.
Material and methods. A retrospective study was conducted in the ICUs of three repurposed hospitals: a municipal hospital, a federal center and a private clinic. Data of 369 patients were analyzed for the period from April to December 2020. Gender, age, BMI, NEWS score, severity of lung damage based on CT quantification, blood gases and pH, patterns of antibiotic administration during hospital stay (all classes and number of antimicrobials, regardless the sequence of administration), patterns of main drugs administration (glucocorticosteroids, lopinavir/ritonavir, tocilizumab/ solilumab, hydroxychloroquine) were evaluated as risk factors. Odds ratios (OR) and 95% confidence intervals (95% CI) were calculated by logistic regression.
Results. Patients from repurposed hospitals of various types were distinguishable in terms of distribution by sex, severity of lung damage, administered therapy, blood gases, and the number of antimicrobials used. Mortality rates were 21.8% in the federal center, 41.4% in the private clinic, and 77.2% in the municipal hospital. The most significant risk factors were: the severity of lung damage based on CT quantification (OR=3.694, 95% CI: 1.014–13.455, P=0.048) — in the federal center, patient’s age (OR=1.385, 95% CI: 1.034–1.854, P=0.029) and arterial oxygen tension (OR=0.806, 95% CI: 0.652–0.996) — in the municipal hospital, and patients’ age (OR=2.158, 95% CI: 1.616–2.880, P0.0001), number of antibiotics (OR=1.79, 95% CI: 1.332–2.406, P=0.0001), and blood pH (OR=0.381, 95% CI: 0.261–0.555, P0.0001) — in the private clinic.
Conclusion. Patient’s profiles in municipal, federal, and private ICU settings varied significantly in the first wave of the COVID-19 pandemic. Gender distribution and severity of the diseases were found as the most significant differences among them. Clinical outcomes were also different, with the lowest mortality rate in the federal center and the highest in the municipal hospital. Arterial pO_₂, blood pH, and the number of antimicrobials used in the course of treatment were the significant risk factors of fatal outcome (in some hospitals).

Better understanding of ischemic brain injury mechanisms is important for the development and improvement of diagnostic and therapeutic modalities for management of ischemic stroke. As experimental studies are on demand, there’s a need for relevant models of focal brain lesions. Photochemically induced thrombosis remains one of the most popular models of ischemic stroke.
The purpose of the review is to consider the pathogenesis and applicational relevance of the photochemical thrombosis in ischemic stroke modeling.
Material and methods. The information was searched using PubMed and Google Scholar databases and keywords «photothrombotic stroke» without language restrictions. 74 papers out of more than 600 sources were found the most relevant for the purpose of this review and selected for the analysis. Of these, more than 50% have been published in the last five years. The criterion for excluding a source was an inconsistency with the objectives of the review and low information content.
Results. We outlined a variety of features in modeling photothrombotic stroke, analyzed the advantages and disadvantages of the model, presented data on current method’s modifications, as well as approaches to evaluation of brain lesions in ischemic stroke induced by photothrombosis, and summarized information about the mechanisms of brain damage induced in this model.
Conclusion. Several advantages of the photothrombotic stroke model, such as low invasiveness, high reproducibility, inherent control of brain infarction volume and low mortality, determine its active use in experimental studies of ischemic stroke. Pathological processes in the brain modeled by photochemical thrombosis are similar to the processes occurring in acute ischemic cerebral circulation events. Therefore, this model provides insights into cellular and molecular mechanisms of ischemic brain damage, and can be used for developing novel therapeutic approaches for management of ischemic stroke.

Ultrasound-guided regional anesthesia can be an effective way to achieve analgesia during implantation of permanent intravenous port systems.
The aim of the study was to improve the quality of perioperative analgesia during placement of permanent intravenous port systems.
Material and methods. The prospective randomized study included 93 patients with malignant neoplasms. Patients were randomized into 3 groups, 31 people each, who were implanted with a permanent intravenous port system in 2019–2022. Group 1 patients were implanted under local infiltration anesthesia (LIA). Ultrasound-guided pectoral nerves block (PECS1) in group 2 was supplemented by LIA. In group 3 ultrasoundguided selective supraclavicular (SC) nerve block was supplemented with LIA. Pain intensity was assessed on a 100 mm visual analog scale (VAS) at rest and while moving at 8, 16, 32 and 72 hours after implantation. The inflammatory postoperative stress response was assessed by the dynamics of C-reactive protein (CRP), interleukin 1-β (IL 1-β), interleukin-6 (IL-6). We also analyzed the correlation of proinflammatory cytokines levels with VAS-measured pain intensity at the stages of the study taking into account a potential relationship between IL-6 and IL-1β fluctuations and the severity of inflammatory and neuropathic pain.
Results. In groups 2 (PECS1) and 3 (SC nerve block), pain intensity measured by VAS at rest and while conducting daily activities was significantly lower than in group 1 (LIA). CRP levels were also significantly lower in group 2 and 3 patients as compared to group 1. The lowest IL-6 and IL-1β concentrations after port implantation were revealed in a group 3 in 24 hours after the procedure, persisting through day 3. There was a correlationbetween proinflammatory cytokines levels and pain intensity.
Conclusion. Implantation of an intravenous port system under local infiltration anesthesia causes a significant inflammatory response in cancer patients, which can be balanced by regional techniques. Selective supraclavicular nerve block in combination with a local anesthesia for intravenous port implantation demonstrated the greatest analgesic potential and requires significantly reduced amounts of local anesthetic compared to pectoral nerves block in combination with LIA, or only local infiltration anesthesia.

Objctive. To evaluate the analgesic efficacy of prolonged erector spinae fascial plane (ESFP) block in patients with multiple rib fractures.
Material and methods. The study included 40 patients with multiple rib fractures. Based on anesthesia methods, patients were divided into 2 groups, where systemic analgesics were used for pain management in the control group (N=20), and additional supplementation with prolonged erector spinae fascial plane (ESFP) block in the main group (N=20). The study monitored the severity of pain measured by the numeric rating scale (NRS) at rest and during coughing, forced vital capacity (FVC), and the need for injectable narcotic analgesics.
Results. The NRS measures at rest in the main group were statistically significantly superior to the control group results: at stage II — 1.5 points (IQR: 1.0–3.0) vs 3.0 points (IQR: 3.0–4.0); at stage III — 2.0 points (IQR: 1.0–2.0) vs 4.0 points (IQR: 3.0–5.0); at stage IV — 1.5 points (IQR: 0.8–2.2) vs. 4.5 points (IQR: 4.0–5.0); at stage V — 1 point (IQR: 0–2,0) vs. 3.0 points (IQR: 2.8–4.0), respectively (P0.001). Percentages of predicted FVC depending on patient’s gender, age, height and weight in the control group were as follows: at stage II — 38± 8% (95%CI: 34–41); stage III — 44± 8% (95%CI: 40–47); stage IV — 41±10% (95%CI: 36–45) and stage V — 49±10% (95%CI: 45–53). In the main group, the following FVC values were obtained: 49±15% at stage II (95%CI: 42–56), 50±13% at stage III (95%CI: 44–57), 53±13% at stage IV (95%CI: 47–59), and 57±11% at stage V (95%CI: 52–63). Therefore, statistically significant FVC reduction in the control group vs the main group came up to 22%, 14%, 24% and 15% at stages II-V, respectively (P0.05). The amounts of injected narcotic analgesics on day 1 and day 2 after initiation of the study were 5.0 mg (IQR: 5–10) and 5.0 mg (IQR: 0–5.0) in the main group vs 10.0 mg (IQR: 5.0–15.0) and 7.5 mg (IQR: 5.0–10.0) in the control group, respectively (P0.05).
Conclusion. The prolonged erector spinae fascial plane block improves the quality of analgesia and FVC values in patients with multiple rib fractures.

Acute ischemic stroke is a serious problem for healthcare systems worldwide. Searching for the optimal neuroprotector is a contemporary challenge. Various studies have demonstrated neuroprotective properties of argon in ischemic brain damage models. However, the published data are inconsistent.
The aim of the study was to evaluate the effect of 24-hour argon-oxygen mixture (Ar 70%/O_₂ 30%) inhalation on the severity of neurological deficit and the extent of brain damage in rats after a photoinduced ischemic stroke.
Material and methods. The experiments were carried out on male Wistar rats weighing 430–530 g (N=26). Focal ischemic stroke was modeled in the sensorimotor cortex of the rat brain using photochemically induced vascular thrombosis. The animals were randomly divided into 3 groups: sham procedure + N_₂ 70%/O_₂ 30% inhalation (SP, N=6); stroke + N_₂ 70%/O_₂ 30% inhalation (Stroke, N=10); Stroke + Ar 70%/O_₂ 30% inhalation (Stroke+iAr, N=10). The limb placement test (LPT) was used for neurological assessment during 14 days. Additionally, on day 14 after the stroke, brain MRI with lesion size morphometry was performed. Summarized for days 3,7 and 14 LPT scores were lower in the Stroke and Stroke + iAr groups as compared to the SP group.
Results. Statistically significant differences in LPT scores between SP, Stroke, and Stroke+iAr groups were revealed on day 3 post-stroke: (scores: 14 (13; 14), 6.5 (4; 8), and 5 (3; 8), respectively, P=0.027). However, there was no statistical difference between the Stroke and Stroke+iAr groups.
Conclusion. 24-hour inhalation of argon-oxygen mixture (Ar 70%/O₂ 30%) after stroke does not reduce the extent of brain damage or the severity of neurological deficit.