The heterogeneity of the patient population and the lack of uniform approaches to periprocedural management highlight the importance of investigating the predictors of catheter ablation (CA) related complications in patients with atrial arrhythmias.

Aim of the study: to identify risk factors for procedure-related (PR) and procedural sedation and analgesia (PSA)-related complications in patients with atrial arrhythmias.

Materials and Methods. A single-center retrospective cohort observational study analyzed 2,340 electronic medical records (EMRs) from the I.I. Mechnikov NWSMU database from 2015 to 2022. A total of 1,793 EMRs were included in the study. All the patients underwent radiofrequency CA for atrial arrhythmia under procedural sedation and analgesia. The risk factors for PR- and PSA-related complications were identified using single-factor regression analysis and multivariate logistic regression with Jamovi 2.3.21 and IBM SPSS Statistics 26 software.

Results. The PR- and PSA-related complication rates were 3.29% and 0.73 %, respectively. Hemopericardium/cardiac tamponade with an incidence of 1.45% and cerebral stroke/TIA documented in 1.17% of cases predominated among the PR complications. PSA-related complications included postoperative nausea and vomiting syndrome (0.22 %) and respiratory depression (requiring mechanical ventilation in 0.06% and non-invasive ventilation in 0.45%). Of all PR complications, 30.5% were documented in patients aged 70-74 years. BMI >30.0 kg/m2 (adjusted OR, 1.963; 95% CI, 1.09-3.36; P=0.023), age >69 years (adjusted OR, 3.081; 95% CI, 1.764-5.383; P<0.001), pain severity on the numerical rating scale (NRS) >3 points (adjusted OR, 4.317; 95% CI, 2.390-7.800; P<0.001), and previous CA procedure in the patient's history (adjusted OR, 10.276; 95% CI, 4.006-26.354; P<0.001) were found to be risk factors for the development of PR complications, whereas BMI >35 kg/m2 (adjusted OR, 4.955; 95% CI, 1.485-16.535; P=0.009) and duration of CA procedure >142 min (adjusted OR, 11.070; 95% CI, 2.440-50.228; P=0.002) were found to be risk factors of PSA complications.

Conclusion. The following independent predictors of CA-related complications were identified: patient-related factors such as BMI >30.0 kg/m2 and age >69 years, as well as procedure-related factors such as duration of CA >142 min, history of CA, and pain intensity >3 NPRS points.

Most patients with critical illness, regardless of the cause, develop activation of innate and adaptive immunity. This is often a critical process leading to organ dysfunction.

The aim of the review is to systematize information on monitoring the immune system in critical illness for physicians of different specialties (anesthesiology and intensive care, surgery, general practice, obstetrics and gynecology).

The review includes information from 83 recent national and international publications (mostly from 2023), available in the public domain and found by keyword search.

We have summarized the current understanding of the relationship between infections and the human immune system, as well as the clinical application of traditional markers of immune status. We provided data on novel promising markers for the assessment of immunity in patients with various diseases.

Limitations of the studies reviewed include the need for additional large-scale clinical trials of even the most promising markers, as well as a synthesis of the evidence for their performance. In addition, immune monitoring is likely to increase the cost of patient care, necessitating the development of more affordable research methods.

Conclusion. Almost all disorders in critically ill patients are associated with changes in the immune system. Management of patients based on their immune profile requires determination of a personalized strategy for immune modulation, treatment, and prevention of infection. Advanced monitoring of immune system functions will contribute to the personalization of medicine, and the continuous development of biological technologies will allow to improve its methods.

Enolases (ENOs) are involved in glycolysis, which is critical for providing energy to cells under hypoxic conditions. ENOs are attracting the attention of researchers as a potential diagnostic marker for critical conditions.

The aim of this review is to analyze the reasons limiting the clinical use of ENOs for diagnostic and prognostic purposes in critical conditions.

We selected and analyzed 87 publications in which ENOs assessment was mainly performed in patients with critical illness. Criteria for selecting relevant publications from PubMed and Elibrary were based on a presence of authors' recommendations or current guidelines on clinical use of ENOs for diagnostic or prognostic purposes.

Specific properties of human ENO isoenzymes were reviewed, clinical aspects and recommendations for their clinical use, as well as methodological and procedural errors in ENO testing were considered.

The following controversial issues were identified: the measured level of ENOs does not characterize the true enzymatic activity of their numerous molecular isoforms; identification of specific ENO isoforms using antibodies to structural subunits does not allow assessment of the true content and enzymatic activity of potentially circulating isoenzymes (e.g., gamma-gamma and alpha-gamma ENOs); the concept of cell specificity ascribed to heterodimers (in particular, gamma-alpha enolase is considered to be neuron-specific) is not supported by the results of the available studies, since this heterodimeric form of ENO is present in a variety of human tissues; some procedural issues are not taken into account (e.g., latent hemolysis, lack of standardized assessment methods, etc.).

Conclusion. The use of advanced diagnostic platforms based on the assessment of the content and enzymatic activity of each ENO isoform should provide valuable information on their specific role in the pathogenesis of diseases in the context of personalized medicine and will enable the evaluation of their diagnostic and prognostic significance, as well as the effectiveness of therapeutic interventions.

Assessment of the individual level of consciousness on admission of a patient with brain injury to the intensive care unit (ICU) is a priority task and a mandatory step in the overall assessment of neurological status. The Full Outline of UnResponsiveness (FOUR) scale, developed at the Mayo Clinic (USA) in 2005, is a widely used tool for comprehensive assessment of patients with altered state of consciousness. The lack of a validated Russian-language version of the FOUR scale has hindered its widespread use in clinical practice. Therefore, the official Russian version of the FOUR scale was developed and adapted for use in Russia after the first stage of the validation study (linguistic and cultural adaptation).

Aim. To evaluate the psychometric properties of the Russian version of the FOUR scale for comprehensive assessment of patients in altered state of consciousness.

Materials and Methods. As part of a prospective multicenter validation study, the psychometric properties of the scale (reliability, validity, and sensitivity) were evaluated in a group of 171 adult patients with altered conscious state of various etiologies, such as ischemic and hemorrhagic stroke, neuroinflammatory conditions, and traumatic brain injury. Patients’ responses were assessed on the first day of ICU stay and 2-3 days later by two ICU neurologists with at least three years of experience.

Results. High levels of validity and reliability were obtained for the Russian version of the FOUR scale for comprehensive assessment of unresponsive patients, including Spearman’s rank correlation coefficient r=0.99 (P<0.0001), Cohen’s κ=0.77 (P<0.001), Cronbach’s α=0.87 (P<0.0001). Regarding the sensitivity of the FOUR scale, no significant changes were found after comprehensive assessment of unresponsive patients on day 1 in the ICU and 2-3 days later (Wilcoxon test, P=0.906). There was a good correlation between the FOUR and Glasgow Coma Scale scores used to assess patients with altered state of consciousness, confirming the validity of the test with r=0.91 (P<0.0001).

Conclusion. The Russian version of the FOUR scale for comprehensive assessment of unresponsive patients is a valid, reliable, and sensitive clinical tool. Sufficiently verified level of psychometric properties allows its authorized use in Russia and other Russian-speaking countries. The scale is available for download via QR code and at the website of the International Scales and Questionnaires Validation Group at the Scientific Center of Neurology.

In the era of healthcare digital transformation, the scientific community faces the need for structured and available datasets for research and technological projects in the field of artificial intelligence, related to the development of new diagnostic and treatment methods.

Objective: to develop a dataset containing anonymized medical data of all patients treated at the Federal Research and Clinical Center of Intensive Care Medicine and Rehabilitology (FRCCR), and provide access for doctors and scientists of FRCCR and other centers to structured patient data for subsequent analysis and research. 

Materials and Methods. The FRCCR medical information system and the tools «Asclepius», PL/SQL, Microsoft Office Excel, Power Query M, Microsoft PowerBI, Open data editor, and Python were used for data collection and representation. To provide open access to the dataset and protect the personal data of patients, the information was anonymized.

Results. We introduce the RICD (Russian Intensive Care Dataset, https://fnkcrr-database.ru/) — the first dataset of intensive care patients in the Russian Federation, developed at FRCCR based on advanced principles and methods used in international open database projects — «eICU Program» from Philips Healthcare, «MIMIC-IV», and «MIMIC-III». The developed dataset contains information on 7,730 hospitalizations of 5,115 patients (including readmissions), covering data from 3,291 hospitalizations in the intensive care units (ICUs). The total number of records in the RICD exceeds 14 million. The RICD presents medical-anthropometric data, patient movement within the institution, diagnoses, information on therapy provided, results of laboratory tests, scale assessments, and outcomes of hospitalization. RICD also contains data on several vital parameters collected from bedside monitors and other equipment of ICUs, with up to 10 evaluations per hour.

Conclusion. The RICD allows for in-depth analysis and research of clinical practices in intensive care, enabling the development of clinical decision support tools and the application of machine learning methods to enhance diagnostic tools and improve patient outcomes. With its accessibility and detailed data structure, the dataset serves as a valuable tool for both scientific research and practical applications in intensive care.

The aim of the study was to evaluate the antimicrobial effect of single and repeated nitric oxide (NO) exposure on the major pathogens of nosocomial pneumonia isolated from the sputum of cardiac surgery patients.

Materials and Methods. A 24-hour culture of microorganisms from pan-resistant isolates of Pseudomonas aeruginosa, Escherichia coli, Acinetobacter baumannii, and Klebsiella pneumoniae from the sputum of inpatient cardiac surgery patients with nosocomial pneumonia, as well as strains of P. aeruginosa and E. coli from the American Type Culture Collection (ATCC), were exposed to 200 ppm NO (experimental sample) or medical air (control sample) in a sealed chamber for 30 minutes. After a single or 4 repeated gas exposure at 4 h intervals, Petri dishes were placed in a thermostat at 37°C and the results were evaluated at 24 and 48 h or at 12, 24, 36 and 48 h, respectively. Grown colonies were counted using an automated colony counter and recorded as CFU/mL.

Results. No growth of clinical isolates of P. aeruginosa and E. coli was observed 24 and 48 h after a single exposure to NO. Growth of A. baumannii was lower compared to controls at 24 h but continued at 48 h. No effect of a single exposure to 200 ppm NO on other microorganisms was observed. After 4 exposures to NO, the growth of ATCC E. coli was not detected, the growth of other experimental strains was significantly lower compared to the control (P<0.05).

Conclusion. Our results provide a rationale for the use of multiple intermittent inhalation of 220 ppm NO for the treatment of patients with hospital-acquired bacterial pneumonia.

Objective: to formulate recommendations and proposals for improving legislation in the field of protection of genomic and genetic information, including those obtained as a result of medical diagnostics.

Materials and methods. We analyzed 18 regulatory legal acts, including 4 international, 3 acts of foreign states, 11 domestic legislation and judicial practice in the area under study. In addition, scientific works on this topic were analyzed. In the course of the study, we used the formal-logical, dogmatic, comparative method and axiological approaches.

Results. We formulated the concepts of genomic and genetic information and demonstrated differences between these concepts. We showed topical issues of information protection, identified problems in the field of legal regulation of relevant relations, formulated recommendations and proposals for improving legal regulation.

Conclusion. Based on performed research results, we recommend: 1. To incorporate in the legislation of the Russian Federation the principle that would allow the use of genetic information for further research depending on certain cases using a criteria-based approach, when such use should meet important public interests, for example, contributes to developing methods for the treatment of serious and socially significant diseases. 2. Regulate relations in the field of obtaining consent for research of biological material for scientific purposes (for example, within the framework of the Federal Law "On Personal Data"). 3. To define in Federal Law No. 86-FZ of July 5, 1996 "On State Regulation in the Field of Genetic Engineering Activities" the cases that require ethical examination in order to comply with the principle of safety of clinical trials of gene diagnostic methods, as well as in other cases. 4. Medical organizations shall ensure compliance with the rules of professional ethics in terms of data confidentiality, carry out their depersonalization, notify patients in writing about compliance with such a regime and, as a result, provide guarantees for the protection of information about patients, as well as about their relatives.