Марина Vladimirovna Petrova

Acute cerebrovascular accidents (ACVA): ischaemic (I63) and haemorrhagic stroke (I60–I62), their consequences (I69), and traumatic brain injury (TBI, S06) are diseases associated with brain damage and occupy a leading place in the structure of mortality and primary disability in the Russian Federation. We present a narrative analysis of official state registry data for 2000–2024 (Rosstat, Moscow NIIOZMM) and the GBD 2021 international database. Cerebrovascular disease (CeVD, I60–I69) mortality decreased from approximately 315 (2000) to 168.5 per 100,000 population (2023); however, the trend stagnated in 2022–2023. Overall CeVD morbidity increased from 6,408,000 (2020) to 7,474,000 (2024). According to age-standardised GBD 2021 data, CeVD mortality in Russia remains among the highest in the world, its decline has slowed, and against the background of a high proportion of hemorrhagic stroke and a substantial contribution of modifiable risk factors (arterial hypertension, obesity, alcohol), strengthening of primary prevention is required. In Moscow, inpatient intracranial injury (S06) incidence rose by 12.0 % in 2022–2023. Analysis of the outcomes of the federal project “Fight against Cardiovascular Diseases” 2019–2024 revealed uneven achievement of targets. Key methodological gaps have been identified: the absence of a nosologically differentiated national stroke registry and the lack of a unified methodology for statistical recording of morbidity and mortality for these groups of diseases.

Introduction. The role of circadian (nocturnal) cerebral hypothermia in brain recovery following daytime activity is well recognized. The study aim is to investigate the clinical effects of craniocerebral hypothermia (CCH) administered in the evening in patients during the early post-stroke recovery period. Materials and methods. The study included 95 patients in the early recovery period after IS, of whom 70 comprised the main group and 25 — the comparison group. Patients in both groups received pharmacotherapy, physiotherapy (magnetotherapy, electrotherapy), therapeutic exercise, and massage. Treatment in the main group was supplemented with a course of CCH (10 daily sessions of 90 minutes each, administered between 20:00 and 22:00). Results. Patients in the main group showed significantly greater improvements in cognitive and motor functions, increased daily activity, and enhanced self-care ability and functional independence compared to the comparison group. In addition, patients in the main group showed improved sleep quality. Conclusion. This study indicates the feasibility of incorporating CCH into comprehensive rehabilitation programs for patients after IS, taking into account the physiological circadian rhythmicity of brain temperature changes, and provides a rationale for considering CCH as a nature-inspired (biomimetic) technology.

BACKGROUND: Cranio-cerebral hypothermia has demonstrated its effectiveness as part of a comprehensive therapy for acute ischemic stroke, positively influencing excitotoxicity and metabolic depression, and contributing to neurocytoprotection. The experience of using interval hypoxia-hyperoxia therapy in patients with stroke is lacking. Nevertheless, both methods are safe and can be used in the therapy and rehabilitation of stroke patients. Cranio-cerebral hypothermia and interval hypoxia-hyperoxia therapy can be rightly considered as biomimetic technologies, as their implementation involves the action of natural factors, which recreate the established evolutionary mechanisms of cellular protection and recovery following adverse factors and the development of pathology. AIM: To investigate the clinical effectiveness of cranio-cerebral hypothermia and interval hypoxia-hyperoxia therapy in the comprehensive rehabilitation of patients in the early recovery period of ischemic stroke. METHODS: The study included 255 patients in the early recovery period of moderate ischemic stroke (5–15 points on the NIHSS scale) with a degree of limitation in daily activities of 3–4 points on the modified Rankin scale. All patients received basic therapy, including medication, physiotherapy, therapeutic physical training, and massage. Those whose treatment was limited to this therapy constituted the control group (60 patients). Among the remaining patients, 120 received cranio-cerebral hypothermia (10–15 daily sessions lasting 90 minutes), and 75 underwent interval hypoxia-hyperoxia therapy (12–15 sessions). The effectiveness of the therapy was assessed using common scales describing neurological status, mobility and cognitive function. RESULTS: Testing with assessment scales revealed the highest effectiveness of comprehensive therapy in patient groups that utilized cranio-cerebral hypothermia and interval hypoxia-hyperoxia therapy compared to the results obtained in the control group. Statistically significant regression of neurological deficit was observed, along with increased mobility and self-care, improved levels of functional independence, enhanced cognitive functions, and reduced levels of anxiety and depression. CONCLUSION: The obtained data allow us to conclude on the advisability of including cranio-cerebral hypothermia and interval hypoxia-hyperoxia therapy in the rehabilitation programs for patients in the early recovery period of moderate ischemic stroke.

The aim of this study is to determine the prevalence of antibiotic resistance genetic markers in pathogens causing lower respiratory tract infections in patients with chronic critical illness. Materials and Methods . We analyzed genetic markers of resistance to antimicrobial agents in pathogens causing lower respiratory tract infections in 251 patients in a chronic critical condition who were admitted to the intensive care unit (ICU) in 2025. Pathogen identification and gene detection were performed using an automated analyzer and the real-time polymerase chain reaction (qPCR) method. Results . The predominance of three pathogens — Klebsiella pneumoniae , Acinetobacter baumannii , and Pseudomonas aeruginosa — was confirmed; these accounted for more than 40% of the identified infections. It was found that among the identified genetic determinants of resistance, the shv gene (58.35%) was predominant; this gene is responsible for the intrinsic resistance of K. pneumoniae and the acquired resistance of E. coli . The ctx-m-1 gene ranked second in prevalence at 55.80 %, and the tem gene ranked third at 50.29 %. Carbapenemase genes accounted for a significant proportion: ndm genes were detected in 41.45 % of samples, and genes of the oxa family were widely distributed — oxa-48-like was detected in 40.47 % of cases, oxa-40-like in 38.51 %, oxa-51-like in 34.38 %, and oxa-23-like in 18.86 %. Conclusion. Among patients with chronic critical illness admitted to the ICU, Gram-negative bacteria — including Klebsiella pneumoniae , Acinetobacter baumannii , and Pseudomonas aeruginosa — were the predominant pathogens causing lower respiratory tract infections in more than 40 % of cases. Two or more genetic markers of resistance were detected in 80.55% of the samples. The oxa- 51-like gene was detected in all A. baumannii strains. Carbapenemase genes ( ndm , oxa , kpc ) and beta-lactamase genes ( shv , ctx-m-1 , tem ) were prevalent.

Objective. To develop and justify an organizational and methodological model for open intensive care patient database using the Russian Intensive Care Database (RICD) based on regulatory, technical, and analytical solutions. Material and methods. Data were obtained from information system of the Federal Scientific Clinical Center of Intensive Care and Rehabilitation. Assessment of updates was based on documented changes in data structure and table composition, anonymization procedures and data quality control processes. Results. The update expanded database coverage to 2017–2025, refined its structure, implemented up-to-date reference classifications and introduced additional analytical layer. The current version (RICD 3.0) includes data on 8.135 patients, 10.938 hospitalizations, and more than 33 million records organized into 11 interrelated tables. A web-based access platform, educational and supporting materials, and open SQL code repository were developed. The database is used in scientific studies, including analysis of clinical practice patterns and organizational aspects of intensive care. Conclusions. Original approach reflects an implemented model for maintaining and updating open clinical dataset. It may be applicable to development and support of similar resources for secondary use of anonymized clinical data in healthcare organizations.

Introduction . Chronic disorders of consciousness (DoC) after severe brain injury are observed in patients requiring prolonged intensive care treatment and rehabilitation. Given the high medication burden, safe non-pharmacological approaches to consciousness recovery remain clinically relevant. One such approach is intermittent hypoxia–hyperoxia therapy (IHHT). The objective was to assess the effect of IHHT on the dynamics of consciousness recovery in patients with DoC after severe acquired brain injury. Materials and methods . Interim results of a prospective study are presented. Patients with DoC were assigned to a control group (n = 25), receiving standard therapy, and a main group (n = 24), in which treatment was supplemented with a 15-day IHHT course. The primary endpoint was an increase in the total Coma Recovery Scale–Revised (CRS-R) score by ≥3 points by day 30. Changes in the total CRS-R score and subscales, as well as transitions between diagnostic levels of consciousness, were additionally analyzed. Results . By day 30, a ≥3-point CRS-R increase was registered in 15/24 patients in the main group (62.5%) and 6/25 patients in the control group (24.0%); p = 0.009. The total CRS-R score by day 30 was higher in the main group: 16 [8.25; 22] versus 9 [6; 14] points; p = 0.022. CRS-R subscale analysis revealed significant between-group differences in auditory and visual functions, communication, and arousal. Improvement in the diagnostic level of consciousness was more frequent in the main group: 17/24 versus 7/25 patients; p = 0.004.Conclusion. In patients with DoC, adding IHHT to complex therapy was associated with more pronounced CRS-R improvement and a higher diagnostic level of consciousness by day 30.

The issue of liver failure arising from mechanical jaundice is a pressing issue for intensive care. The main goals of treatment are to replace and maintain liver function, prevent or minimize the development of secondary complications from organs and systems. Traditionally, a range of different methods is used in the diagnosis of liver failure arising from mechanical jaundice, ranging from instrumental, biochemical, serological, immunological, to the most complex molecular biological studies. However, generally accepted indicators do not always reflect the depth of damage to the liver parenchyma and the severity of the pathological process, which requires a search for specific markers of liver damage as indicators of the severity of the patient's condition and predictors of the outcome of the disease. Potential candidates should have high topical diagnostics, specificity and sensitivity in the first hours of the disease. According to the literature, the following biomarkers of liver injury potentially meet these requirements: liver form of fatty acid binding protein, 5-nucleotidase, liver arginase, hyaluronic acid. However, we believe that the issue of their reliability for assessing the condition of patients and predicting the outcome of liver failure against the background of mechanical jaundice remains insufficiently studied, which necessitates further research.

Perioperative malnutrition and protein-energy wasting remain key modifiable risk factors for complications, prolonged hospital stay, and increased costs in surgical patients. The updated 2026 FAR guidelines on perioperative nutritional support systematize evidence from 2021–2025 and present a comprehensive multidisciplinary approach to diagnosing and correcting malnutrition at all stages of surgical care. In contrast to the 2021 version, the new edition introduces a two-step model for nutritional assessment: expanded risk screening (NRS-2002, MUST, MST, and others) complemented by formal malnutrition diagnosis according to GLIM criteria, incorporating phenotypic and etiologic features as well as instrumental assessment of sarcopenia and clinical frailty. This enables a shift from simple risk stratification to outcome prediction and individualized selection of nutritional support strategies. The guidelines emphasize the pivotal role of the preoperative phase, including prehabilitation: correction of nutritional deficits, use of oral nutritional supplements and, when indicated, immunonutrition combined with exercise training and educational interventions. The postoperative section maintains a focus on early enteral nutrition and refines criteria for tolerance, options for direct oral feeding after selected procedures, and indications for supplemental and peripheral parenteral nutrition. For the first time, a distinct post-discharge phase is outlined, with recommendations on continued oral nutritional supplements in high-risk patients. Dedicated sections address the use of specialized formulas (lipid emulsions, omega-3 fatty acids, glutamine, fiber-enriched enteral feeds) and the prevention of refeeding syndrome, including identification of high-risk groups and initial treatment algorithms. The guidelines are fully integrated with ERAS principles, positioning nutritional support as an essential component of the patient pathway rather than an isolated module. The final section provides quality indicators and metrics for the delivery of nutritional and metabolic care, forming a foundation for the development of local protocols, clinical audit, and continuous improvement of practice In Russian surgical wards and intensive care units.

BACKGROUND: Ischemic stroke remains a significant problem. To date, there are no clinically proven treatments that specifically prevent or limit neuronal death due to ischemic injury. In this regard, the use of xenon appears promising, since it has a neuroprotective effect; however, its mechanism of action is not fully understood. AIM: To determine the effect of xenon at 0.5 minimum alveolar concentration (MAC) at different exposure times on the concentration of S100b protein in blood serum after ischemic brain injury in rats in an experiment. METHODS: To determine the effect of xenon at 0.5 MAC on the concentration of the neuron-specific protein S100b in blood serum, cerebral ischemia was modeled followed by reperfusion using the Long method in 50 male Wistar rats. After blood flow restoration, animals in the control group received an oxygen-air mixture, while animals in the study groups received xenon at 0.5 MAC at exposures of 30, 60, and 120 minutes. The comparison group consisted of sham-operated animals. To determine the concentration of S100b protein, venous blood was collected on days 1, 3, and 7 of the study from the caudal vein. The concentration of S100b protein in the post-ischemic period was determined using enzyme-linked immunosorbent assay. RESULTS: It was established that in animals of the control group, the concentration of S100b protein increased 12-fold (p = 0.0001) on day 1 relative to that in the comparison group and decreased over 7 days by only 3.4-fold (p = 0.001). Inhalation of xenon at 0.5 MAC with a 30-minute exposure had no significant effect on S100b concentration compared to the control group. Inhalation of xenon at 0.5 MAC with exposures of 60 and 120 minutes reduced S100b concentration on days 1 and 7 of the postoperative period by 2-fold compared to the control group and brought it closer to the level in sham-operated animals. CONCLUSION: Exposure to xenon at 0.5 MAC for 60 and 120 minutes led to a significant decrease in serum S100b concentration already on the first day. By day 7 of observation, serum S100b concentrations did not differ between the group of sham-operated animals and the study group of animals receiving xenon at 0.5 MAC at exposures of 60 and 120 minutes.

Introduction. The second part of this review focuses on clinical scenarios, in which standard analgesic regimens in cancer patients show limited efficacy or unacceptable tolerability, including mixed pain phenotypes, a pronounced neuropathic component, and chemotherapy-induced peripheral neuropathy (CIPN). We address pharmacological approaches that may be feasible for implementation with adequate clinical workflow organization, as well as experimental targets shaping the «next wave» of mechanism-based, targeted analgesia. The objective was to critically synthesize the available evidence on implementable and theoretically promising pharmacological analgesic strategies in patients with malignant disease. Materials and methods. In the second part, a narrative review was performed using the methodology for searching and critically evaluating sources described in detail in the first part of the series; the literature search was additionally updated as of 10.23.2025 with an emphasis on implemented and experimental pharmacological approaches. Sections. The following approaches are presented as promising methods suitable for routine implementation: xenon–O₂ in subanesthetic regimens as an option for rapid reduction of pain/anxiety with opioid-sparing potential; intrathecal analgesia using ziconotide as an effective strategy for generalized refractory pain with a prominent neuropathic component; and the 8% capsaicin patch as a local treatment for selected subtypes of painful focal CIPN/peripheral neuropathy. Experimental approaches with theoretically justified potential include anti-NGF antibodies, TrkA antagonists, selective NaV1.7 blockers, P2X3 (and P2X2/3) antagonists, as well as σ1 antagonists, KCC2 modulators, CSF1R inhibitors, and tetrahydrobiopterin. Conclusions. Xenon at subanesthetic concentrations appears to be the most promising approach. Intrathecal therapy remains a powerful option for the control of refractory pain but is associated with technical complexity and potential complications. The 8% capsaicin patch occupies a narrow yet clinically useful niche in focal painful neuropathy/CIPN. Experimental targets support the concept of phenotype-oriented analgesia; however, they are not yet ready for routine clinical use without further accumulation of robust clinical evidence.