The prognosis for recovery from a vegetative state (VS) remains underdeveloped.

Objective. To determine the feasibility of prognosis for recovery from a vegetative state based on clinical comparison of 18- fluorodeoxyglucose-PET (18FDGPET) and MRI (SCT) data.

Materials and methods. We compared and analyzed retrospectively cerebral PET and MRI (SCT) scans and relevant prognostic criteria (including revised coma recovery scale — CRS-R scores) prospectively during 6–84 months of follow-up in a cohort of 39 VS patients. All VS cases were of different etiologies, lasting for more than 2 months after brain damage (including 18 patients in chronic VS).

Pairwise comparison of groups was used (significance level P0.05) and multiple comparison for three groups with a Bonferroni correction at P0.017 was employed.

Results. Three patterns were identified when comparing 18FDGPET and MRI (SCT) neuro-images: pattern I — the area of functional alterations was larger than the area of structural damage, pattern II — complete matching of areas of structural and functional alterations, III — mixed pattern. Pattern I (69% of cases) was more common than patterns II (18%), and III (13%), P0.001. There were no differences in VS etiology, VC duration, CRS-R scores, patients’ gender and age between the groups of patients each falling into one of patterns. The outcome in a group with pattern I patients (all of them recovered from VS) was better than in other two groups exhibiting patterns II or III, each, P0.001. In a group of patients with pattern III the recovery was better than in pattern II (all patients remained in VS), P=0.018. The increases in the total CRS-R score values were as follows: 12,1±4,46; Me=12 (4–19), N=27 (patients with a pattern I); 0±1,54 (–2–1, Me=0, N=7 (patients with a pattern II); and 5,20±4,09/ Me=4 (1 — 10), N=5 (patients with a pattern III). Significant increases in neurological improvement were revealed in pattern I patients with non-chronic VS versus chronic VS, P=0.003.

Conclusion. Clinical comparison of PET/MRI (SCT) data showed certain potential to predict patient’s recovery from VS in 87% of cases. A retrospectively confirmed favorable prognosis in patients with pattern I was established in 69% cases, unfavorable (pattern II patients) was defined in 18% cases, regardless of other prognostic criteria, including chronic VS. Therefore, the data confirms the feasibility and clinical relevance of neurophysiological justification as a candidate approach for evaluating the prospect of recovering patients from VS.

Motor disorders are among the most common consequences of severe craniocerebral injury (traumatic brain injury — TBI). Deeper insights into pathophysiological mechanisms of these disorders is important both from a theoretical point of view and in terms of improving neurorehabilitation approaches.

The aim of the study was to investigate the correlation of right–sided posttraumatic hemiparesis severity with composite characteristics of fractional anisotropy (FA) in the segments of the corpus callosum (CC), corticospinal tract (CST) and the inferior fronto-occipital fasciculus (IFO) at different stages of traumatic disease (acute, subacute and long-term periods).

Material and methods. Cases of 43 patients with TBI were analyzed (28 men and 15 women aged 13 to 59 years, mean age 28±9 years). Forty patients were diagnosed with severe TBI with diffuse axonal damage, three patients had moderate severity TBI. Long-term follow up included continuous clinical and neurological examination with evaluation of patient’s level of consciousness using the CRS-R scale, and the degree of motor deficits in right-sided hemiparesis using a five-point scale. During three post-TBI periods (up to 1 month, from 1 to 6 months, and from 6 to 12 months), patients were examined using diffusion tensor MRI (DTI), tractography and FA. Motor, cortico-spinal tracts and IFO were divided by measurement grid, correlations between FA and scores of right-sided hemiparesis were calculated for each segment.

Results. FA correlations (P0.05) with the severity of hemiparesis were established not only for CST motor-specific segments, but also for some CC and IFO segments. In the early period of TBI significant correlations with hemiparesis severity were found not only in the contralateral CST segments, but also in the ipsilateral ones. Significant differences in FA in the related CC and CST segments were found between the groups with good and limited motor recovery: at all stages after TBI, FA was higher in patients with successful recovery.

Conclusion. The results of the study provide better insight into pathophysiological mechanisms of post-traumatic motor disorders development, therefore favoring optimization of therapeutic strategies.

Competent triage of patients with COVID-19 pneumonia is not only about efficient allocation of hospital resources, but also about making timely decisions that can ultimately save the patient's life. When healthcare facility is overloaded, computed tomography to assess the severity of COVID-19-associated pneumonia in each individual case is not always possible. Alternative solutions, however, are opted.

The aim of the study was to develop Lung UltraSound (LUS) protocols with high diagnostic potential for assessing the severity of pneumonia caused by COVID-19, which can be reliably used instead of CT during triage in an emergency setting.

Materials and methods. We conducted a retrospective analysis of data on 161 hospitalized patients with confirmed pneumonia caused by COVID-19, subjected to both CT and LUS within 24 hours after hospitalization. Three consecutive LUS protocols, including two LUS developed by the NMHC (National Medical Surgical Center) authors, were tested to choose the most reliable protocol for assessing the severity of lung damage in pneumonia caused by COVID-19 (based on correlation with chest CT results). We also checked the applicability of LUS for the prognosis of the disease.

Results. Moderate (50% CT) and severe (50% CT) lung damage can be distinguished when using both - the 16-zone and 12-zone LUS NMHC scanning protocols. The AUC for the ROC curves was almost identical: 0.83 (95% CI: 0.75–0.90 and 0.81 (95% CI: 0.73–0.88) for the 16-zone and 12-zone LUS NMHC protocols, respectively. The 16-zone LUS NMHC had an optimal threshold of 20 scores with a sensitivity of 67% and a specificity of 82%, while the 12-zone LUS NMHC provided an optimal threshold of 15 scores with the same sensitivity but lower specificity — only 73%. Neither the 16-zone nor the 12-zone NMHC LUS protocols could predict the outcome.

Conclusion. The newly developed 16- and 12-zone LUS NMHC scanning protocols for patients with pneumonia caused by COVID-19 proved to be easy to implement, demonstrating a strong correlation with CT results. The 16-zone LUS NMHC protocol is probably more relevant for triage of patients with more than 50% of pulmonary tissue involvement based on CT data. Both protocols can be useful in emergency settings and in medical institutions with limited or no access to CT.

Sepsis is one of the leading causes of death in kidney transplant recipients.

We present our experience of effective removal of bacterial endotoxins and endogenous inflammatory mediators using a multimodal hemosorbent in sepsis, caused by gram-negative polyresistant Klebsiella spp. including K. pneumoniae. The device was used in a 15 y.o. patient after treatment failure of graft-bed abscess and removal of kidney transplant.

Results. Two 24-hour sorption procedures on Days 3 and 5 post-transplantectomy in combination with renal replacement therapy resulted in consistent decrease of pro-inflammatory markers concentrations (procalcitonin — 15.111.47.2 ng/ml; C-reactive protein — 23419990 mg/l), preventing therefore further progression of multiple organ dysfunctions.

Conclusion. Inclusion of selective adsorption of cytokines and/or lipopolysaccharides into multimodal intensive therapy in an immunosuppressed pediatric patient with sepsis caused by resistant microorganisms improved treatment outcomes.

High concentration of sepsis-associated aromatic microbial metabolites (AMM) stands as a prognostically unfavorable factor, indicating the progression of multiple organ dysfunction and an increased risk of death in patients with sepsis and septic shock. This study is based on a hypothesis that excess of sepsis-associated AMM in patients with sepsis is caused by metabolic alterations (dysfunction) in the intestinal microbiota.

The aim of this study was to compare the potential of normobiota and pathobiota to bio-transform sepsis-associated metabolites of aromatic amino acids tyrosine and phenylalanine, such as phenyllactic acid(PhLA) and 4-hydroxyphenyllactic acid (4-HPhLA).

Materials and methods. Samples of intestinal contents of patients with septic shock (N=10, pathobiota) and healthy volunteers (N=9, normobiota) were placed in test tubes with the omnipurpose thioglycol medium. The clinical model of excessive inflow of sepsis-associated AMM into the intestine (for example, from blood or sites of inflammation) was reproduced in the in vitro experiment by adding PhLA or 4-HPhLA in clinically significant concentrations (25 mkM) into each test tube with pathobiota and normobiota. After incubation in a thermostat (37°, 24 hours), AMМ concentrations were measured in the samples with pathobiota and normobiota using GC-MS analysis.

Results. Concentration of AMM decreased within 24 hours in the tubes with normobiota after PhLA or 4-HPhLA were added. In the tubes with pathobiota, no decrease in AMM concentrations was documented after loading with PhLA or 4-HPhLA. Concentrations of PhLA (P=0.002) and 4-HPhLA (P0.001) were statistically significantly higher in pathobiota samples compared to normobiota.

Conclusion. The in vitro experiment demonstrates that after excessive load with sepsis-associated metabolites (PhLA, 4-HPhLA), the microbiota of healthy people is capable to bio-transform such metabolites to the end products of microbial metabolism, while pathobiota of septic patients exhibits altered biotransformational potential. This data demonstrate that microbiota dysfunction may contribute to the pathogenesis of sepsis.

Objective. Evaluation of myocardial expression of the pro-autophagic protein Beclin-1 after cardiac contusion in experimental animals with different stress resistance.

Materials and methods. The study included 68 white mongrel male rats weighing 250–300 g. After ranking for extreme variants of stress resistance, moderately stress-resistant rats (N=36) were excluded from the study. The remaining animals were split into the control (N=16) and study (N=16) groups, each group composed of 8 high stress resistant and 8 low stress resistant rats. In the study group, 24 hours after inflicted cardiac contusion, 5×5 mm myocardial tissue specimens were sampled from the intraventricular septum, anterior walls of the left and right ventricles, histological sections were made, and a reaction with primary polyclonal Anti-Beclin-1 antibodies was performed. Beclin-1 expression was evaluated under the microscope.

Results. Immunohistochemical evaluation revealed a statistically significant increase in Beclin-1 protein expression (P=0.0002) in the cytoplasm of cardiomyocytes in the study group vs the control group, regardless of animals’ baseline stress resistance. However, expression of Beclin-1 protein in the myocardium of highly stress-resistant rats (Me=4.3; LQ=4.0; HQ=4.3) was significantly higher versus low-resistant animals (Me=3.6; LQ=3.3; HQ=3.6) (P=0.0009).

Conclusion. Increased expression of Beclin-1 protein in the post-traumatic period of experimental cardiac contusion indicates autophagic flux activation. Intensity of autophagy varied depending on the animal’s stress resistance.

The purpose of this study was to assess acquired knowledge and practical skills in foreign medical students (FMS) after theoretical and practical training in cardiopulmonary resuscitation.

Material and methods. We conducted a prospective randomized trial «Simulation-based CPR training among international medical students: perspectives for medical education» envolving students undergoing training in the 31.05.01 specialty — General Medicine in English. Sealed envelope randomization was used to assign the participants (N=71) to 3 groups. European Resuscitation Council (ECR) educational Guidelines for Resuscitation was studied by students of all 3 groups. Group 1 (N=21) students did not receive additional training materials and practices. Group 2 (N=25) students were additionally provided with a link to a video lesson on CPR on the ECR Youtube channel. Students from Group 3 (N=25) were additionally involved in developing 3 mind maps: on the anatomy and physiology of the heart and CPR algorithm. All participants underwent theoretical training at the 1st stage, and «Basic Cardiopulmonary Resuscitation and Automated External Defibrillation (AED)» simulation training at the second stage. At the end of the course, students’ practical skill in performing continuous chest compressions were examined.

Results. The majority of examinees passed the ECR platform test on the first or second attempt. The participants of the simulation course demonstrated high learning efficiency: there were no statistically significant differences between the groups in the number and average frequency of compressions performed. Almost all participants correctly performed hand placement in the center of the chest for chest compression. Decompression phase efficiency reached 71–77% (P=0.811) in all groups. The majority of examinees performed chest compressions to the required depth and with the recommended frequency (P=0.62).

Conclusion. The educational project initiated by foreign students yielded positive results: acquired knowledge of CPR algorithm, gained essential techniques of performing chest compressions and giving rescue breaths, retained skills in using automated external defibrillator, as well as teamwork skills.