Aim. To identify biomarkers for prediction and early diagnosis of infectious and inflammatory complications in patients after aortic surgery.

Materials and methods. The study included 57 patients who underwent surgical procedures on the aorta and its branches under cardiopulmonary bypass and myocardial ischemia. The cohort was divided into two groups: patients with an uneventful postoperative period (group 1, N=35) and patients with local infectious and inflammatory complications after surgery (group 2, N=22). Serum levels of procalcitonin (PCT), interleukins (IL-6 and IL-10), and aromatic microbial metabolites (AMM) were measured before surgery, upon admission, and six hours after admission to the ICU. On postoperative days 3 and 6 neutrophil, lymphocyte, and platelet counts were assessed, and neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) were calculated.

Results. There were no significant differences in sex, age, or comorbidities between groups 1 and 2. Patients in group 2 had a more severe intraoperative period and required a longer ICU stay. Predictive markers of complications included IL-6143.35 pg/mL at ICU admission (sensitivity 42.9%, specificity 90.9%, AUC 0.789, 95% CI 0.669–0.909, P0.001); PCT0.12 ng/mL 6 hours after ICU admission (sensitivity 90.9%, specificity 54.3%, AUC 0.762, 95% CI 0.634–0.891, P0. 001); NLR 7.8 on postoperative day 3 (sensitivity 72.7%, specificity 68.6%, AUC 0.710, 95% CI 0.571–0.850, P=0.003); and AMM (before and after surgery) 0.185 (sensitivity 77.3%, specificity 71.4%, AUC 0.780, 95% CI 0.651–0.909, P0.001).

Conclusion. Values of IL-6, PCT, NLR, and AMM reflect different features of the inflammation and can be used for prediction and early diagnosis of infectious and inflammatory complications in cardiac surgery patients.

Aim: to study the correlation of immune parameters in breast cancer patients undergoing general anesthesia and to evaluate the 1-year overall and recurrence-free survival after surgery depending on general anesthesia technique.

Materials and Methods. A post hoc analysis of data from a double-blind, randomized, controlled clinical trial involving 98 patients with operable breast cancer was performed. Patients were divided into two groups: 48 received inhalational anesthesia (IA) and 50 received total intravenous anesthesia (TIVA). Immune parameters (CRP, IgA, IgM, IgG, C3, C4, MMP-9, neutrophil and lymphocyte counts, etc.) were assessed before induction of anesthesia, 1 hour postoperatively, and 24 hours postoperatively. Spearman correlation coefficients and heat maps were used for analysis.

Results. In the IA group, significant uniform increases were observed in all immunoglobulin types at 1 and 24 hours postoperatively (all P<0.001; for IgA-IgG, R=0.928; for IgA-IgM, R=0.837; for IgG-IgM, R=0.815). A positive correlation was found between complement components (C3, C4) and immunoglobulins (P=0.011 — 0.023; R=0.313–0.363). In the TIVA group, changes were variable: immunoglobulin levels increased at 1 hour (P<0.001) but decreased at 24 hours (P<0.001). A strong positive correlation was identified between cytotoxic T cells and NK cells (P0.001; R=0.722). Neutrophil count showed no significant correlation with cytotoxic T or NK cells. One year after surgery, both groups demonstrated 100% overall and recurrence-free survival.

Conclusion. IA was associated with synchronized changes in humoral immunity components, whereas TIVA resulted in variable immune responses, suggesting potential differences in IA and TIVA effects on the immune system. However, no impact of anesthesia technique on overall or recurrence-free survival was observed. More research is needed to better understand how different anesthetics affect immune function and the potential impact of anesthesia technique on long-term cancer outcomes.

Prevention of brain injury during carotid endarterectomy (CEA) remains a significant challenge. Moderate controlled systemic hypothermia may serve as a potential neuroprotective measure during these procedures.

Aim of the study. To investigate the neuroprotective effects of moderate systemic hypothermia during CEA.

Materials and methods. Fifty-nine patients undergoing CEA under combined anesthesia were included. Patients were divided into two groups: the hypothermia group (N=33) and the normothermia control group (N=26). Both groups received standard measures to prevent cerebral ischemia. The hypothermia group received additional moderate systemic hypothermia aimed at a temperature range of 34–35°C. Cognitive function was assessed preoperatively and at 2, 5, and 30 days postoperatively using neurocognitive tests. Statistical analysis was performed with IBM SPSS Statistics.

Results. The incidence of cognitive impairment was 21.1% in the hypothermia group and 26.9% in the normothermia group. Postoperative cognitive impairment was more common in the normothermia group: 15.38% on day 5 and 11.5% on day 30 postoperatively compared to 12.1% and 6.1% in the hypothermia group (P<0.05).

Conclusion. This study demonstrated the neuroprotective effects of hypothermia, manifested by a reduced severity of cognitive impairment in the hypothermia group. Further research is needed to identify high-risk patients who would benefit most from this neuroprotective strategy and to optimize hypothermia protocols.

Scoring systems based on assessment of disease severity and patient condition are widely used for routing and predicting length of stay in the ICU. However, their effectiveness varies in patients with sepsis.

The aim of the study. To evaluate the effectiveness of scoring systems in routing and predicting ICU length of stay in patients with severe community-acquired pneumonia (CAP).

Materials and methods. Medical records of 664 patients from the Intensive Care for Severe CAP database of I. I. Mechnikov Northwestern State Medical University (2013–2023) were analyzed using the following scoring scales: CURB-65, PSI/PORT, SMART-COP, SCAP, REA-ICU, NEWS2, IDSA/ATS criteria, APACHE IV, CFS, and CCI. Statistical analysis was performed using Statistica 10.0, SPSS, and Stat Research (Center for Statistical Research) software.

Results. Among the study cohort, 96 patients (15%) had bacterial severe CAP (bCAP) and 568 patients (85%) had viral severe CAP (vCAP), all of whom were admitted to the ICU. A NEWS2 score ≥2 was observed in 74 (77.1%) bCAP patients and all vCAP patients (P<0.001). In contrast, 437 (76.9%) vCAP patients and 74 (77.1%) bCAP patients were classified as high risk according to SMART-COP (P=0.966). Delayed ICU admission (>7 days) was observed in older patients with severe bCAP, but did not significantly affect ICU length of stay or outcomes. A strong correlation was found between adverse outcome and predicted mortality using APACHE IV (η=0.966 for vCAP and η=0.807 for bCAP). However, no correlation was observed between predicted and actual ICU length of stay for both vCAP and bCAP patients (R²=0.0257, Kendall's W=0.018 for vCAP; R²=0.0294, Kendall's W=0.050 for bCAP). The predictive model accuracy for ICU stay >1 day or >14 days was not satisfactory. Model with vCAP patients adjusted for age (≥60 years) and APACHE IV exhibited moderate predictive accuracy for prolonged ICU stay (AUROC 0.610).

Conclusion. Differences were found in the applicability of the NEWS2, REA-ICU, and IDSA/ATS major criteria scoring systems for ICU routing of bCAP and vCAP patients. APACHE IV showed a strong correlation between predicted and actual mortality, but no correlation between predicted and actual ICU length of stay in severe CAP patients was found.

This report describes two clinical cases involving prolonged inhalation sedation using the AnaConDa device in the ICU. Both patients achieved and maintained adequate sedation levels throughout the treatment period. No significant adverse cardiovascular effects were observed.

Aim. To identify personalized morphological neuronal phenotypes based on the distribution pattern of the neuronal protein NeuN in the cerebral cortex layers.

Materials and Methods. A histologic study of the cerebral cortex was performed in rats (N=10). Tissue sections were stained with hematoxylin and eosin, and the neuronal nuclear protein NeuN was visualized by immunohistochemical staining. Analysis was performed by microscopy and image analysis software.

Results. NeuN immunohistochemical staining revealed distinct localization and intensity patterns within cortical neurons. Contrary to the definition of NeuN as a nuclear neuronal protein, its localization was observed in both the nucleus and cytoplasm in most neurons. The following neuronal phenotypes were identified based on NeuN staining patterns: 1) Neurons with stained nuclei but unstained cytoplasm; 2) Neurons with stained cytoplasm but unstained nuclei; 3) Neurons with stained nuclei and cytoplasm; 4) Fully stained neurons with no visible nuclei; 5) Neurons with stained processes (dendrites/axons). A significant difference was found between mean intensity of NeuN-positive neurons depending on the localization in the layers of the cerebral cortex.

Conclusion. Given the critical biological role of NeuN, the identified neuronal phenotypes based on NeuN localization warrant further research as they may reflect the functional states of neurons. The interpretation of the absence of NeuN staining as a marker of neuronal damage is not scientifically justified. Future studies using NeuN immunohistochemical staining should consider not only the total number of NeuN-positive neurons, but also their distinct phenotypes.

The survival rate of critically injured individuals with severe blood loss and cardiac arrest is close to zero.

Aim. To evaluate the feasibility of using emergency ultra-deep hypothermia (EUDH) in an experimental model of cardiac arrest induced by blood loss in nonhuman primates.

Materials and Methods. Five male olive baboons (Papio anubis), weighing 19.8 (18.8–23.8) kg, were subjected to severe blood loss leading to cardiac arrest. After 1 minute of observation and 3 minutes of cardiopulmonary resuscitation (CPR), aortic arch cooling was initiated using extracorporeal membrane oxygenation (ECMO) with a 4°C solution to achieve a nasopharyngeal temperature of 10°C. Whole-body cooling followed until a rectal temperature of 16°C was reached. Balloon catheters were used to disconnect the upper and lower halves of the body. Once the target temperatures were reached, the ECMO circuit was turned off and an open laparotomy was performed to simulate damage control strategies. One hour after cardiac arrest, slow rewarming began at a rate of 1°C per 10 minutes to 1°C per hour, accompanied by reinfusion of previously collected blood. After return of spontaneous circulation (ROSC), sustained breathing, and tracheal extubation, the animals were transferred to a vivarium.

Results. During deep hypothermia, cerebral oximetry values remained within normal limits in all animals. Sustained ROSC was recorded in 4 of 5 animals at temperatures between 22–25°C. Two animals survived to the end of the experiment but died after extubation, 44 and 19 hours after the start of the experiment. Cooling rates for survivors were 7–11 minutes compared to 23–37 minutes for non-survivors. Causes of death included systemic hypoperfusion with subsequent reperfusion syndrome as evidenced by progressive lactate elevation, elevated creatine phosphokinase levels, cerebral edema, myocardial ischemia, and transient coagulopathy.

Conclusion. EUDH supports adequate cerebral perfusion during temporary circulatory arrest. Recovery of cardiac activity and, in some cases, awakening are achievable during the rewarming phase. Causes of death and possible corrective measures require further investigation.