[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.

[Russian multicenter observational clinical study «Register of respiratory therapy for patients with stroke (RETAS)¼: a comparative analysis of the outcomes of stroke]. / Rossiiskoe mnogotsentrovoe observatsionnoe klinicheskoe issledovanie «Registr respiratornoi terapii u patsientov s ONMK (RETAS)¼: sravnitel'naya kharakteristika iskhodov insul'ta.

OBJECTIVE: To analyze the treatment of patients with severe stroke requiring respiratory support, and identify predictors of death. MATERIAL AND METHODS: A multicenter observational clinical study «REspiratory Therapy for Acute Stroke¼ (RETAS) was conducted under the aegis of the «Federation of Anaesthesiologists and Reanimatologists¼ (FAR). The study involved 14 clinical centers and included 1289 stroke patients with respiratory support. RESULTS: We found that initial hypoxemia in the 28-day period was associated with higher mortality than in absence of hypoxemia (in patients with 20 or more NIHSS scores) (76.22% versus 63.45%, p=0.004). Risk factors for lethal outcome: hyperventilation used to relieve intracranial hypertension compared with group of patients who were not treated with hyperventilation (in patients with 20 or more NIHSS scores) (79.55% versus 72.75%, p=0.0336); volume-controlled ventilation (VC) versus pressure-controlled ventilation (PC) (in patients with 20 or more NIHSS scores) (p<0.001); use of clinical methods for monitoring ICP in comparison with instrumental ones (87.64% versus 62.33%, p<0.001). It has been proved that the absence of nutritional insufficiency in patients with stroke is associated with a higher probability of a positive outcome (GOS 4 and 5) in comparison with patients with signs of nutritional insufficiency, for the group with NIHSS less than 14 points (p<0.001). CONCLUSIONS: A group of factors associated with a deterioration in the prognosis of outcomes in patients with stroke who are undergoing ventilation has been identified: hypoxemia at the start of respiratory support, lack of instrumental monitoring of ICP, the use of hyperventilation to correct ICP, ventilation with volume control (VC), as well as the presence of nutritional insufficiency.

[Hypoxic-ischemic brain damage in premature newborns]. / Gipoksicheski-ishemicheskie porazheniia golovnogo mozga u nedonoshennykh novorozhdennykh.

One of the main causes of cerebral dysfunction in premature newborns is hypoxia. High mortality and lifelong morbidity in these children is a frequent result of neonatal hypoxic brain damage. The article presents some data on the prevalence of neurological diseases that have arisen in the perinatal period, and highlights the key etiological factors leading to hypoxia in both the intranatal and early postnatal periods. The pathogenesis of hypoxic-ischemic brain lesions in premature infants is described in detail. At the same time, more careful consideration is given to the glutathione system, which protects against lipid peroxidation, the glutamate-calcium cascade, and the excitotoxicity mediated by it, as well as the processes of necrosis and apoptosis of nerve cells. The advantages and disadvantages of modern methods for diagnosing cerebral lesions are noted, and the principles of treatment of these disorders are analyzed.

[An analysis of outcomes in respiratory therapy in patients with acute stroke]. / Analiz iskhodov zabolevaniia u patsientov s ostrym narusheniem mozgovogo krovoobrashcheniia pri provedenii respiratornoi terapii.

AIM: To evaluate the effectiveness of mechanical ventilation in patients with stroke. MATERIAL AND METHODS: A retrospective analysis of 520 patients with acute cerebrovascular diseases requiring mechanical lung ventilation was performed. RESULTS AND CONCLUSION: In 44,6% of cases, the reason for transferring patients to mechanical ventilation was a worsening of neurological status; 69,1% of patients underwent prolonged respiratory support for a period of 3 days to 2 weeks. 54.2% of patients died. Half of the surviving patients had a severe disability. In patients of the older age group, the risk of an unfavorable outcome increased. Mortality increased and the rehabilitation potential decreased with the increase of age and duration of respiratory care. The results point to the need to create a unified concept for carrying out artificial ventilation of the lungs in patients of older age groups taking into account clinical and economic feasibility.

[An effect of cerebral hemodynamics in patients with cerebrovascular disorders on the in-hospital transportation]. / Vliianie vnutrigospital'noi transportirovki na tserebral'nuiu gemodinamiku u patsientov s sosudistoi patologiei golovnogo mozga.

In-hospital transportation of 76 patients with cerebrovascular disorders, including those in the first postoperative day, was performed. Two cerebral hemodynamic measurements were carried out five minutes before and immediately after transportation using transcranial Doppler sonography. Significant changes in cerebral blood flow in the operated patients were shown. No significant effect on the rate of cerebral blood flow was identified in patients with ischemic lesions.

[Effects of body positioning in patients with non-traumatic intracranial hemorrhages]. / Éffekty pozitsionirovaniia u bol'nykh s vnutricherepnymi netravmaticheskimi krovoizliianiiami.

The article presents an analysis of different methods of positioning patients with acute cerebral pathology. Changing of 'head-of-the bed' position is a routine and simple method of correction of intracranial hypertension. For the majority of patients with cerebral damage, regardless of the etiological factor, 15-30° 'head - of - the bed' position is preferable. However, in some cases head-of-bed manipulation can lead to the irreversible ischemic damage due to the reduction in systemic and perfusion pressure and cerebral blood flow. Thus, the selection of the optimal body position in different types of acute cerebral pathology remains a debated issue.

[EFFECT OF NEONATAL RESPIRATORY SUPPORT STRATEGIES IN THE ICU].

This review deals with the current trends in protective ventilation in newborns. Volumotrauma is the most common variant of ventilator-induced lung injury. The modern research is devoted to the study of biotrauma, which is the release of inflammatory mediators in response to mechanical ventilation. There is a correlation between the ventilator-induced lung injury and the development of chronic lung diseases in infants. Now we have the "new" form of bronchopulmonary dysplasia-parenchymal lung disease characterized by impaired growth and development of the alveoli and blood vessels of the pulmonary circulation. Some authors believe that the use of noninvasive ventilation as a starting method of respiratory support reduce the risk of bronchopulmonary dysplasia. The modern protective ventilation involves two main principles to reduce ventilator-induced lung injury: a decrease in tidal volume (V) and the principle of permissive hypercapnia. Application ofthe method of permissive hypercapnia and modes of the target volume can reduce the likelihood of ventilator-induced lung injury in newborn infants. Despite the limitation of the indications for mechanical ventilation in modern neonatology and widespread use of noninvasive ventilation for patients who really need mechanical ventilation, the use of modes with the target volume provides the best chance to reduce the complications of ventilation.

[The relaxation time anisotropy as a method of assessment of physico-chemical activity of the cerebrospinal fluid in acute stroke]. / Vremya relaksatsii anizotropii kak metod otsenki fiziko-khimicheskoi aktivnosti tserebrospinal'noi zhidkosti pri ostrom narushenii mozgovogo krovoobrashcheniya.

OBJECTIVE: To study the anisotropy relaxation time of the cerebrospinal fluid (CSF) in acute disorders of cerebral circulation compared by analyzing the kinetics of anisotropy relaxation of the dye «rhodamine 6G¼. MATERIAL AND METHODS: The study of the samples was performed using a laser confocal fluorescence microscope MicroTime 200 («PicoQuant GmbH¼). Authors used a laser operating at a wavelength of 470 nm with a time resolution of 8 PS with a pulse frequency of 10 MHz. RESULTS: Authors assessed this parameter in CSF of patients with different types of stroke. CONCLUSION: Confocal laser spectrometry can be considered as an objective method of studying CSF changes in patients with lesions of the central nervous system and control of patient status in a clinical setting.

[THROMBOLYTIC THERAPY OF ACUTE VASCULAR DISEASES IN IRKUTSK REGION].

Cardiovascular diseases rank first as the cause of mortality, morbidity, and disability. This paper concerns evolution of thrombolytic therapy for acute coronary syndrome and ischemic stroke in the Irkutsk region characterized by low population density.

[Non-invasive monitoring of intracranial pressure].

This manuscript presents an analysis of different intracranial pressure (ICP) non-invasive monitoring devices. External ventricular drainage still remains a "gold standard" оf neuromonitoring, but this manipulation can be not always feasible, because of contra-indications or absence of neurosurgery in this hospital. Also there is a risk of development infections or hemorrhage. In these conditions the great value is got by development of ways of non-invasive definition of VChD which would allow to carry out safe and, if necessary, numerous measurement of this parameter. Now, the leading place is occupied by various ultrasonic and telemetric methods. The question of accuracy of received data at non-invasive methods remains open and demands further specification.

[Influence of body position on intracranial pressure and cerebral hemodynamic in non-traumatic intracranial hemorrhages].

OBJECTIVE: Patient's body position is one of the most important principles of intensive therapy of intracranial hypertension syndrome. It is considered that the provision of the head end of a bed of 15-30 degrees is preferable for the majority of patients with cerebral pathology. We studied hemodynamic parameters at various tilt angles of the body in patients with non-traumatic intracranial hemorrhages. MATERIAL AND METHODS: Hemodynamic parameters (intracerebral pressure, cerebral perfusion, mean arterial pressure ) at various tilt angles were measured in 35 patients with intracranial hemorrhages. RESULTS: Using continuous monitoring of intracranial, cerebral perfusion and mean arterial pressure, we revealed the relationship between hemodynamic indicators and various tilt angles in patients with intracranial hemorrhages of non-traumatic genesis. CONCLUSION: Optimal positions of the head-end of a bed in different periods from disease onset are defined.

[Pharmacokinetics of essentiale N].

The optimum time of exposure of the Essentiale N hepatoprotector with an erythrocyte-leukocyte suspension has been determined in vitro using the blood of healthy donors. Variation of the drug distribution in the blood depending on the exposure time was studied by the method of UV absorption spectroscopy. It is established that the optimum exposure of Essentiale N with an erythrocyte-leukocyte suspension is about 10 min. This corresponds to a minimum concentration of Essentiale N in the supernatant phase, which is evidence for the maximum saturation of the cell composition by the preparation. At the same time, the degree of hemolysis does not exceed the normal physiological level.

[Extracorporeal liquor-corrective therapy of traumatic subarachnoidal hemorrhage].

Comprehensive analysis of criteria for the severity of clinical conditions in patients with craniocerebral injuries included characteristics of cerebrospinal fluid and lesions of hematoencephalic barrier (HEB). The study revealed the relationship between clinico-neurological conditions of the patients, liquor nitrite levels, and HEB permeability. An attempt was undertaken to evaluate efficiency of liquor-corrective treatment in combination with intense therapy in patients with severe cerebral injuries.

[Adaptive mechanisms of circulatory systems in children with pulmonary hypertension syndrome in congenital valvular defect].

To evaluate the condition of the nitrogen oxide system and adaptation reserves in children with pulmonary hypertension syndrome and congenital heart disease, we examined 64 patients aged 3 to 17 years. The examination included standard cardiological tests, measurements of nitrogen oxide metabolites in blood, the activity of oxidant and antioxidant systems. Blood pressure in the right ventricle and pulmonary artery was controlled by invasive (catheterization of heart cavities, monitoring with Swan-Ganz catheter) and noninvasive (ultrasound) methods. We came to the conclusion that the level of nitrogen oxide is associated with the severity of pulmonary hypertension and characterizes the condition of the oxidant and antioxidant systems.

[The application of variational cardiointervalography for optimization of anesthesia in outpatient surgery]. / Primenenie variatsionnoi kardiointervalografii dlia optimizatsii anesteziologicheskogo posobiia v khirurgii odnogo dnia.

The vegetative regulation condition was investigated by the method of variation cardio-interval-graphy in patients who underwent the intravenous anesthesia in the outpatient setting. The experience of using, on the differential basis, the sympathomimetic and vagotonic anesthetics for different-type vegetative tonus was analyzed. An optimal state in the vegetative regulation of the cardiovascular system, a stable hemodynamics and an adequate post-narcosis rehabilitation in the anesthetic management of one-day surgery were ensured owing to the suggested method in choosing an anesthetic.

[The role of nitric oxide in the pathogenesis of central nervous system damages]. / Rol' oksida azota v patogeneze porazhenii tsentral'noi nervnoi sistemy.

The review considers a role of the modulator nitric oxide--in the pathogenesis of central nervous system damages, first of all, of ischemic type. Multiple nitric oxide influences on cerebral blood flow, oxidant stress system and intracellular signaling mechanisms are shown. Investigation of nitric oxide system opens new perspectives for a therapy of acute and chronic brain ischemia.

[Clinical-radiological and laboratory parallels in respiratory distress syndrome in patients with gestosis]. / Kliniko-rentgenologicheskie i laboratornye paralleli pri respiratornom distress-sindrome u beremennykh s gestozom.

Clinical and laboratory studies were carried out in 125 pregnant patients with gestosis of different severity. Respiratory distress syndrome was diagnosed, its severity depending on the severity of patient's status. Platelet changes indicated involvement of the lung parenchyma and can serve as an additional laboratory criterion in the diagnosis of the respiratory distress syndrome in pregnant patients with gestosis.