[Efficacy of Mexidol in combination with cerebral revascularization in the treatment of ischemic stroke]. / Effektivnost' primeneniya Meksidola v kombinatsii s revaskulyarizatsiei golovnogo mozga v terapii ishemicheskogo insul'ta.

Stroke is an acute life-threatening condition; its outcome is determined by the degree of damage to brain tissue, the quality and speed of medical care in the first minutes and hours after its occurrence. The main mechanism of brain tissue damage during both ischemia and reperfusion is oxidative stress. The review covers adverse influence oxidative stress at the cerebral ischemia and reperfusion periodes of ischemic stroke. The results of preclinical studies demonstrating the ability of Mexidol to neutralize the effects of free radicals and activate antioxidant protection are presented. Data from clinical studies of the use of Mexidol in combination with thrombolysis in patients with ischemic stroke are reviewed.

[Efficacy and safety of non-immunogenic staphylokinase in the ischemic stroke in real-world clinical practice in the Sverdlovsk region]. / Effektivnost' i bezopasnost' primeneniya neimmunogennoi stafilokinazy v terapii patsientov s ishemicheskim insul'tom v usloviyakh real'noi klinicheskoi praktiki v Sverdlovskoi oblasti.

OBJECTIVE: To compare the efficacy and safety of non-immunogenic staphylokinase (Fortelysine) and alteplase in patients with ischemic stroke (IS) in real-world clinical practice. MATERIAL AND METHODS: A retrospective, observational, non-interventional study of data the register of the Territorial Compulsory Health Insurance Fund was conducted. The proportion of patients with a favorable outcome, the degree of disability at discharge from the hospital, the duration of hospitalization, the proportion of lethal outcome in the groups of Fortelysine and alteplase were evaluated. The effect of the Rankin scale points at the hospitalization, the choice of a medical organization, the month of hospitalization, the choice of a thrombolytic on achieving a favorable outcome was determined. RESULTS: The data of 1238 patients from 26 hospitals of the Sverdlovsk region were included. There were no statistically significant differences in the proportion of a favorable outcome between the groups of Fortelysine and alteplase (26% and 25% respectively, p=0.845). Mediana of duration of hospitalization in the Fortelysine group was one day less, which is statistically significant compared to the alteplase group (9 [7;12] and 10 [7;13] respectively, p<0.001). There were no differences in the frequency of mortality (11% and 13% respectively, p=0.331). The hospital, the year and month of hospitalization, the level of disability at the baseline have a statistically significant effect on the outcome of hospitalization. The choice of a thrombolytic drug did not have a statistically significant effect on the frequency of favorable outcome. CONCLUSIONS: The comparable efficacy and safety of Fortelysine and alteplase in IS has been proven in clinical study and confirmed by real-world clinical practice.

[Nonimmunogenic staphylokinase in the treatment of acute ischemic stroke (FRIDA trial results)]. / Neimmunogennaya stafilokinaza ­ novyi tromboliticheskii preparat v lechenii ishemicheskogo insul'ta (rezul'taty issledovaniya FRIDA).

AIM OF THE STUDY: To investigate the efficacy and safety of non-immunogenic staphylokinase (NS) compared with alteplase (A) in patients with acute ischemic stroke (AIS) within 4.5 h after symptom onset. MATERIAL AND METHODS: 336 patients with IS within 4.5 h after symptom onset were included in a randomized, open-label, multicenter, parallel-group, non-inferiority comparative trial of NS vs A (168 patients in each group). NS was administered as an intravenous bolus in a dose of 10 mg, regardless of body weight, over 10 s, A was administered as a bolus infusion in a dose of 0.9 mg/kg, maximum 90 mg over 1 hour. The primary efficacy endpoint was a favorable outcome, defined as a modified Rankin scale (mRS) score of 0-1 on day 90. Safety endpoints included all-cause mortality on day 90, symptomatic intracranial haemorrhage, and other serious adverse events (SAEs). RESULTS: At day 90, 84 (50%) patients reached the primary endpoint (mRS 0-1) in the NS group, 68 (41%) patients - in the A group (p=0.10, OR=1.47, 95% CI=0.93-2.32). The difference between groups NS and A was 9.5% (95% CI= -1.7-20.7) and the lower limit of the 95% CI did not cross the margin of non-inferiority (pnon-inferiority<0.0001). There were no significant differences in the frequency of deaths between the groups: on day 90, 17 (10%) patients in the NS group and 24 (14%) in the A group had died (p=0.32). There was a trend towards significant differences in the frequency of symptomatic intracranial haemorrhage: NS group - 5 (3%) patients, A group - 13 (8%) patients (p=0.087, OR=0.37, 95% CI=0.1-1.13). There were significant differences in the number of patients with SAEs: in the NS group - 22 (13%) patients, in the A group - 37 (22%) patients (p=0.044, OR=0.53, 95% CI=0.28-0.98). CONCLUSION: The presented results of the FRIDA trial are the first in the world to use a drug based on NS in patients with IS. It has been shown that a single bolus (within 10 s) administration of NS at a standard dose of 10 mg, regardless of body weight, allows to conduct fast, effective and safe thrombolytic therapy in patients with IS within 4.5 h after symptom onset. In further clinical tials of NS, it is planned to expand the therapeutic window beyond 4.5 h after symptom onset in patients with IS.

[Recommendations on telestroke in Europe]. / Evropeiskie rekomendatsii po telemeditsine insul'ta.

INTRODUCTION: This paper is an adapted translation of recommendations on telestroke provided by the European Stroke Organization. Lack of stroke specialists determines that many European rural areas remain underserved. Use of telemedicine in stroke care has shown to be safe, increase use of evidence-based therapy and enable coverage of large areas of low population density. An aim of the study is to summarise the following recommendations of the Telestroke Committee of the European Stroke Organization on the setup of telestroke networks in Europe: Hospitals participating in telestroke networks should be chosen according to criteria that include population density, transportation distance, geographic specifics and in-hospital infrastructure and professional resources. Three hospital categories are identified to be part of a hub-and-spoke network: (1) the Telemedicine Stroke Centre (an European Stroke Organization stroke centre or equivalent with specific infrastructure and setup for network and telemedicine support), (2) the telemedicine-assisted stroke Unit (equivalent to an European Stroke Organization stroke unit but without 24 h onsite stroke expertise) and (3) the telemedicine-assisted stroke ready hospital (only covering hyperacute treatment in the emergency department and transferring all patients for further treatment).

[The efficacy and safety of telethrombolysis in a newly opened stroke unit]. / Éffektivnost' i bezopasnost' teletrombolizisa pri otkrytii novogo pervichnogo sosudistogo otdeleniia.

AIM: To evaluate the efficacy, safety and limitations of telethrombolysis, stroke consultation by telemedicine, in a newly opened stroke unit. MATERIAL AND METHODS: Thirty-three patients (remote group) received intravenous thrombolysis via telemedicine in a new stroke unit from November 2016 to October 2017. Twenty-two patients retrospectively enrolled in the study received bedside thrombolysis (bedside group). The primary endpoint was the shift of modified Rankin scale (mRS) score at hospital discharge using ordinal logistic regression. RESULTS AND CONCLUSION: There was no significant difference in the scores on mRSscale between two groups. The average score on mRS at discharge was 4 in both groups, the percentage of patients with 0-2 score was 27.3% in the bedside group and 23.5% in the remote group. The rate of symptomatic hemorrhagic transformations was significantly higher in the remote group compared to the bedside group (29.4 and 4.5% respectively, p=0.022) with the similar mortality rate. The implementation of telethrombolysis in new stroke units appeared to be safe and effective. However, further clinical research is needed.

[A comparison of remote and bedside assessment of the NIH Stroke Scale in acute stroke patients]. / Sopostavlenie prikrovatnoi i distantsionnoi otsenok po shkale NIHSS u bol'nykh v ostreishem periode insul'ta.

AIM: Telestroke videoconference for conducting the National Institute of Health Stroke Scale (NIHSS) is recommended when direct bedside evaluation by a stroke specialist is not immediately available for hyperacute stroke assessment. However, some NIHSS-telestroke studies inherit systematic bias due to subjectivity of NIHSS administration. Authors aimed to evaluate NIHSS telestroke assessment, while implementing measures to minimize subjectivity bias. MATERIAL AND METHODS: Ninety acute stroke patients within 48 hours of onset were assessed by 6 stroke neurologists grouped in 15 pairs. Each pair of physicians assessed 6 patients. Patients were allocated through block randomization to a physician pair and order of bedside or remote assessment. Every patient was assessed once at the bedside and once remotely. Remote examination was performed by a neurologist through high-quality videoconferencing, assisted by a nurse at the patient's bedside. Kappa coefficients and the number of patients with a cumulative difference of ≤3 NIHSS points were calculated to compare bedside and remote measures. RESULTS: Cumulative difference of ≤3 NIHSS points was observed in 85.6% (95% CI 76.6%; 92.1%) cases. Therefore, every fifth remote examination may have been inaccurate. Quadratically weighted κ for total NIHSS score was 0.91 (95% CI 0.87; 0.95). Minimal agreements were for commands (κ=0.46), facial palsy (κ=0.43), and ataxia (κ=0.27). Remote assessments were longer than bedside: 8 minutes (IQR 7; 9) versus 6 (IQR 5; 8), p<0.001. CONCLUSION: NIHSS-telestroke assessment using high-quality videoconferencing in the acute stroke settings is closely matched with NIHSS-bedside assessment but it's credibility for clinical use needs further evaluation.

[Changes in lipid and carbohydrate metabolism in patients with severe sepsis of different etiology].

UNLABELLED: Different origin (heterogeneity) of sepsis is a key stone in many discussions regarding options for the course and outcome, despite the general rules of development of the pathogenic mechanisms. PURPOSE OF THE STUDY: To compare data of systemic inflammation (CRP, PCT, IL-8, IL-6, IL-4, TNF-alpha) and markers of endothelial dysfunction (NO, lactate, D-dimers), also lipid (cholesterol, triglycerides, HDL, LDL, VLDL) and carbohydrate metabolism between the two groups of patients with severe intra-abdominal infection (n = 109) and severe sepsis of other etiologies (n = 53). RESULTS: We found out a significant difference between the groups in serum levels of the CRP, IL-4 and cholesterol at all stages of the study. During severe abdominal sepsis was accompanied by a significantly higher level of cholesterol, LDL and VLDL, as well as higher values of glycaemia. Patients with sepsis other etiology showed a lighter and more dynamic course of the disease was significantly lower 28-day mortality.

[Perfusion-metabolic interaction in acute cerebral insufficiency. ACIPS study Part I. Cerebral blood flow evaluation].

Basic physiological position that metabolic requirements of brain determine perfusion characteristics of cerebral blood flow underlies the definition of syndrome of acute cerebral insufficiency. So there is a perfusion-metabolic interaction (PMI) in brain tissue at every moment. Based on this paradigm we should synchronize measurement of these components in intensive care practice. The goal of ACIPS study (Acute Cerebral Injury Protection System) is creating methodology of monitoring PMI and treatment algorithm based on this monitoring. In this article we present data that volume cerebral blood flow can be assessed by summing volume bloodflows on brachiocephalic vessels measured with triplex ultrasound. Such results are comparable with CT-perfusion results. Both methods can be used interchangeably if difference in -0.6-11.8 ml/kg/min isn't clinical significant.

[Polyneuropathy in intensive care patients].

Critical illness polyneuropathy is an acquired critical illness syndrome of neuromuscular problems as polyneuropathy and/or myopathy that is caused by long-term immobilization, clinically manifested by general muscle weakness and a main reason for difficulty weaning from the ventilator. The review gives an update on the history, epidemiology, etiology, pathogenesis, clinical picture, diagnosis, differential diagnosis, course, outcome, prevention, and treatment of critical illness care polyneuropathy.

[Prognostic evaluation of sleep in patients in a vegetative state].

Coma in the genuine sense is a dreamlike state that lasts not more than 3 weeks, thereafter it progresses to a vegetative stage of consciousness recovery, except when a patient has died or regained conscious wakefulness. Among those who have achieved the vegetative state progress to the following stage of recovery: mal consciousness or completely return to the initial cognitive level. Others remain in a persistent vegetative state. The registered cases of the vegetative state is as high as 100 per million population (S. Ashwal et al., 1996). This patient category remains terra incognita even for interdisciplinary analysis by neurologists and reanimatologists. Nonetheless, the emotional and financial support to manage this patient category is high. In searching for prognostic criteria for the outcome of a vegetative state, the authors attempted to analyze sleep, one of the earliest phylogenetic autonomic functions. Based on the hypothesis that the cognitive status cannot be regained if sleep is not recovered, the authors conducted a polysomnographic study in 64 patients. Preserved sleep patterns were observed in 27 (96%) of 28 patients with a good outcome versus 11 (31%) of 36 patients with a poor outcome. It is concluded that it is expedient to incorporate polysomnographic monitoring into the examination protocol for patients in a vegetative state.

[Correction of intracranial hypertension syndrome using hyperosmolar solutions in patients with severe brain damage (multicenter randomized clinical study)].

The paper presents the results of a muticenter study of the effect of 3 hyperosmolar solutions (15% mannitol solution, 10% sodium chloride solution, and the combined solution HyperHAES containing 7.2% sodium chloride and hydroxyethyl starch 200/0.5) on the value of intracranial pressure (ICP) (invasive ICP monitoring) and systemic hemodynamic parameters (PiCCOplus) in 94 clinical cases of intracranial hypertension (ICP more than 20 mm Hg) in 25 patients with acute cerebral pathology (severe brain injury, aneurysmatic subarachnoid hemorrhage). Intravenous infusion of the solutions was found to induce a reduction in ICP; however, this was most pronounced (by 30-40%) and longer (up to 4 hours) when HyperHAES solution was used. This solution produced not only an osmotic, but also hemodynamic effect.

[Acute cerebral insufficiency syndrome as a concept of neuroreanimatology].

The introduction of concepts of acute cerebral insufficiency syndrome into the clinical practice of a number of therapeutic-and-prophylactic institutions raises a lot of questions as to its clinical interpretation and approaches to diagnosing, monitoring, and treating patients who meet its criteria. By attempting to have methodologically adequate solutions of this problem, neuroresuscitators are making a complex scientific developments of reproducible modes of neuromonitoring and cerebrotropic intensive therapy. The theory of acute cerebral insufficiency and a cerebral protection complex becomes an area that determines researches in the development of new methods of intensive cerebrotropic therapy, as well as the ways of neuroreparation and neuroprotection as components of complex pathogenetic therapy for neuropathological syndromes resulting from the formation of pathological systems in response to abnormal determinants.