COVID-19 remains one of the most significant causes of hospital admissions and deaths, frequently associated with septic complications. Reliable and simple prognostic tools are required to identify patients at high risk of developing sepsis and death early on.

Aim of the study. To evaluate the prognostic ability of the REMS, NEWS, NEWS2, qSOFA, and SIRS criteria in predicting sepsis, septic shock, and mortality in patients with COVID-19.

Materials and methods. A retrospective study was performed on 870 patients with confirmed COVID-19 who were hospitalized in anesthesiology and intensive care units. REMS, NEWS, NEWS2, qSOFA, and SIRS scores were calculated for each patient upon admission. The predictive ability of the scales was evaluated using ROC analysis, temporal associations were assessed using the Cox proportional hazards model, and the cumulative risk of outcome was assessed using the Kaplan–Meier method.

Results. The REMS scale demonstrated satisfactory predictive ability for mortality and septic shock (AUC = 0.780 and 0.724, respectively) and unsatisfactory for sepsis (AUC = 0.677), p  0.0001. The NEWS, NEWS2, qSOFA, and SIRS scales showed unsatisfactory results for all outcomes. The Kaplan–Meier analysis showed that patients with high REMS scores developed sepsis or septic shock earlier and had shorter survival (p  0.0001). The Cox model identified REMS as the scale with the highest risk ratio (RR 1.215; 95% CI 1.178–1.254) and concordance index (C = 0.656).

Conclusion. The REMS, NEWS, NEWS2, qSOFA, and SIRS rapid scales have a statistically significant prognostic value, but only the REMS provides a satisfactory accuracy in predicting septic shock and death in patients with COVID-19. The study was limited by its single-center and retrospective design.

Objective: to compare the nutritional and metabolic effects of two amino acids-containing solutions, differed in amino acid profiles and sorbitol presence, when employed as a part of standardized combined post-operative nutritional support in patients undergoing surgery for abdominal cancer.

Materials and Methods. A prospective randomized study was conducted in two specialized hospitals. The study included 120 nutritionally stable patients aged 18–80 with stage I–III colorectal tumors and ASA class II–III anesthetic risk (mean BMI 25.3–27.6 kg/m²), who underwent elective abdominal surgeries and required parenteral administration of protein-carbohydrate nutrition solution (PCNS) for at least 5 days. Patients were randomly assigned into two groups for receiving PCNS formulations Amiparcenin or Aminoven formulated at 10-percent concentration (60 patients, each group). Both regimens involved administering an amino acid solution at 10 ml/kg/day in combination with a 10% dextrose solution at 10 ml/kg/day, alongside with early enteral feeding. The amino acid and nutritional profiles were assessed before initiation of nutritional support (T0), on the 2^nd (T1), and 5^th (T2) postoperative days. Key indicators included the sum of branched-chain amino acids (BCAA_sum), the sum of aromatic amino acids (AAA_sum), the ratio of BCAA/AAA, the integral indicator of amino acids in the urea cycle (UreaCycle_sum), and index ratios of ornithine to citrulline, arginine to ornithine, and arginine to citrulline. Additionally, total protein, albumin, nitrogen balance, bioimpedance indicator of active cellular mass (BIA ACM), creatinine, liver function markers, and electrolyte profiles were analyzed. To evaluate clinical equivalence, a two one-sided tests (TOST) analysis was employed with pre-defined limits of clinically acceptable difference (∆) for each parameter.

Results. By day 5, both groups showed statistically significant changes in total protein and albumin levels, reflecting the transition from the early catabolic phase and the impact of nutritional support; no intergroup differences were observed for these parameters, and the TOST analysis confirmed their equivalence within the predefined limits of ∆. The branched-chain amino acids (BCAA_sum) level increased from T0 to T1 and then stabilized at T2 in both groups; the factors «group» and the «group×period» interaction were not significant (p = 0.285 and p = 0.362, respectively), however, the equivalence of absolute BCAA_sum values at T2 with a narrow ∆ = 10 µmol/L was not confirmed (p-TOST> 0.05). For AAA_sum, differences were documented based on the «group» factor (p = 0.035) and the interaction «period×group» (p = 0.0099), with alignment of absolute values at T2. The ratio of BCAA/AAA and the index indicators of the urea cycle (Orn/Cit, Arg/Orn, Arg/Cit) remained stable, with no intergroup differences, and met the equivalence criteria throughout all observation periods. According to bio-impedance analysis, the Amiparcenin group showed a more significant increase in active cell mass (p by Friedman = 0.00001; intergroup p at T1 = 0.0048, at T2 = 0.00014), while the Aminoven group did not show significant dynamics; moreover, the TOST analysis with a wide ∆ showed formal equivalence in BIA ACM. Creatinine, urea, transaminases, and electrolyte levels remained comparable between the groups and were within clinically acceptable ranges; equivalence for these parameters was confirmed.

Conclusion. In the early postoperative period, Amiparcenin and Aminoven 10% solutions provide comparable amino acid and nutritional supply, and biochemical effects as a part of standardized combined nutritional support in patients with abdominal cancers. The studied regimens met equivalence criteria for most essential amino acid indicators (including BCAA/AAA), markers of inflammation, protein metabolism, liver and kidney function, and electrolyte balance. The differences found in absolute values of BCAA_sum, AAA_sum, UreaCycle_sum, and malondialdehyde (MDA) do not translate into clinically significant shifts during the first 5 days post-surgery.

Modulation of sphingosine-1-phosphate receptors exerts various neuroprotective effects under conditions of cerebral ischemia. In this study, we investigated the relationship between the lipid composition of brain tissue, lipid signaling, and the content of the proinflammatory cytokine TNFα, as well as the expression of its receptor, TNFR1.

 Objective. In a rat model of acute cerebral ischemia, to evaluate the effects of FTY720 on the lipid composition of brain tissue, ceramide concentration, and the expression of key enzymes involved in its synthesis, as well as on the contents of TNF-α and its receptor TNFR1.

Materials and Methods. The study was conducted on 37 male white non-linear rats weighing 180–230 g. Acute cerebral ischemia was induced by a combined procedure involving irreversible ligation of the left common carotid artery and reversible ligation of the right common carotid artery. The animals were divided into three groups: sham-operated, rats with acute cerebral ischemia, and rats with ischemia following prior administration of FTY720 (fingolimod). On the third day of observation, neurological deficits in surviving animals were assessed using the Garcia scale. The sphingolipid and phospholipid composition of brain tissue was examined using thin-layer chromatography. Ceramide concentration, the expression of enzymes involved in its biosynthetic, TNFα, and TNFR1 concentrations were evaluated using immunofluorescent microscopy.

Results. Pretreatment with fingolimod was associated with better survival rates: 31% in the FTY720 group vs. 20% in the Ischemia group (p = 0.043). Functional impairments on the Garcia scale were significantly less severe in the FTY720 group than in the Ischemia group: 14 [13.5; 15] vs. 11 [10; 12.5] scores (Me [Q1; Q3]), p < 0.01). FTY720 group also demonstrated a decrease in ceramide concentration in the brain tissue compared to the Ischemia group (p = 0.0005), along with downregulated expression of aSMase (p = 0.0012), nSMase (p = 0.0003) enzymes involved in its synthesis, of SPT (p = 0.0002), and CerS (p = 0.0001), a decrease in pro-inflammatory cytokine TNFα (p = 0.0003) concentration and normalized expression of its receptor TNFR1.

Conclusion. Preservation of phospholipid composition and reduction in the excessive production of ceramide and pro-inflammatory cytokines in the brain tissue are associated with less severe neurological deficits and improved survival rates in rats during the acute phase of cerebral ischemia.

Traumatic brain injury (TBI) remains one of the leading causes of disability, and current approaches to neuroprotection have limited efficacy. The inert gas krypton is considered a promising neuroprotective agent; however, data on its effects in TBI and on components of the neurovascular unit (NVU) are limited.

Objective. To evaluate the neuroprotective potential of krypton in rats with traumatic brain injury (TBI) in vivo and in NVU cell cultures subjected to oxygen-glucose deprivation (OGD) in vitro.

Materials and Methods. The study included 48 Wistar rats divided into 3 groups: SO (sham operated), TBI (N₂/O₂ 70/30 %), and TBI + iKr (Kr/O₂ 70/30 %). A model of controlled open brain contusion injury was used. On day 14, we assessed neurological deficits (limb placing test, LPT), the extent of brain injury (T2-weighted MRI slices), morphological changes (hematoxylin-eosin staining), and the expression of GFAP and Caspase-3 (fluorescent immunohistochemistry, IHC). IL-1β, IL-6, and TNF-α mRNA levels in the injury zone were determined by PCR. In vitro studies investigated the effect of krypton preconditioning (Kr/O₂ 79/21 %, 24 h) on the survival of neuronal (SH-SY5Y), glial (C6), and vascular endothelial (Ea.Hy926) cells during OGD (4–6 h).

Results. A significant neurological deficit of 2.5 (2; 5.25) scores was determined by the TBI modeling accompanied by a large volume of brain damage of 33 (28; 39) mm³. Krypton inhalation led to a reduction in the lesion volume to 18 (15; 26) mm³ and accelerated the recovery of sensorimotor functions: starting on day 7, the indicators in the TBI + iKr group were statistically significantly better than in the TBI group, and by day 14, they approached the values of the SO (control) group. In the TBI + iKr group, IL-1β and TNF-α levels in the affected hemisphere were nearly 50% lower than in the TBI group, while remaining higher than in the SO group; changes in IL-6 levels were insignificant. Histologically, less significant cerebral edema, spongiosis, and neuronal degeneration were observed in the TBI + iKr group. Immunohistochemical analysis revealed a trend toward more pronounced reactive gliosis (GFAP) with no differences in Caspase-3. In vitro, krypton preconditioning under OGD conditions did not improve the survival of neuronal, glial, and endothelial cells.

Conclusion. Krypton exerted significant neuroprotective effect in experimental TBI in rats, reducing neurological deficits, the extent of structural damage, and the severity of the inflammatory response. The absence of a protective effect in NVU cellular models underscores the essential role of systemic and intercellular interactions in the neuroprotective action of krypton and warrants further research into its mechanisms of action and dosing optimization.

Thermal injuries caused by external cold exposure remain one of the most significant multidisciplinary challenges in critical care medicine. In cases of refractory circulatory arrest resulting from hypothermia, the use of circulatory support methods, particularly the veno-arterial extracorporeal membrane oxygenation (VA ECMO) system, becomes specially grounded and desirable.

Objective. To demonstrate the successful use of veno-arterial ECMO in a patient with severe accidental hypothermia complicated by refractory circulatory arrest during the prehospital phase.

Materials and Methods. We present the clinical case of a 42-year-old patient with severe generalized hypothermia (temperature 20.0°C), marked hemodynamic instability, and subsequent development of refractory ventricular fibrillation. Given the ineffectiveness of standard resuscitation measures during the prehospital phase, we initiated VA ECMO followed by extracorporeal rewarming and comprehensive intensive care.

Results. Following initiation of VA ECMO and controlled warming, restoration of cardiac rhythm and cardiorespiratory function was achieved. Weaning from VA ECMO was performed on the third day, and from respiratory support within the first two days of the hospital stay. On the 22^nd day, the patient was discharged in a stable somatic condition without significant neurological deficits.

 Conclusion. Early prehospital initiation of VA ECMO as a part of comprehensive intensive care may represent an effective treatment option for severe accidental hypothermia complicated by refractory circulatory arrest.

Passive euthanasia and the withdrawal of life-sustaining treatment (LST) in modern Russian practice are normatively indistinguishable, leading to ethical, legal, and clinical-practical conflicts for intensive care physicians and increasing the moral distress among healthcare staff.

The purpose of this research is to clarify the distinctions between active and passive euthanasia and the cessation of futile life-sustaining treatment, as well as to demonstrate why these distinctions are not taken into account in Russian legislation and professional discourse.

Materials and Methods. The study included foreign and Russian bioethical and legal texts. A qualitative analysis of the historiography was conducted, supplemented by a structural-thematic analysis of the philosophical dilemmas associated with the end of life.

Results. The analysis identified three key lines of demarcation: 1) between active killing and allowing death through the refusal of intervention; 2) between passive euthanasia and the ethical cessation of LST; 3) between the physician's intention to hasten death and the intention to remove medical obstacles to the natural process of dying while being willing to continue assistance if the patient survives. It was shown that the Russian legal norm, which effectively criminalizes any forms of cessation of medical treatment, has developed against the backdrop of insufficient reflection on these distinctions and leads to a discrepancy between normative language and actual clinical practice, where doctors are forced to document treatment provision but often omit or alter it in practice.

Conclusion. The integration into the Russian context of more nuanced criteria for assessing intention, causality, and futility of treatment, developed in Western bioethics, combined with consideration of local sociocultural contexts and religious traditions, is a necessary condition for developing a coherent end-of-life regulation model that reduces moral distress for physicians and enhances patient trust in medical decisions.