INTRODUCTION: Central venous pressure (CVP) has long been considered one of the most reliable methods for assessing volemic status and responsiveness to infusion therapy in patients in intensive care. In recent years, attitudes toward CVP have shifted dramatically, but neither the published data nor the emergence of methods with proven efficacy have significantly changed practicing anesthesiologists' reliance on CVP measurement for diagnostic accuracy. OBJECTIVE: The aim of this study is to assess the existing data on the diagnostic accuracy of CVP in predicting patients' response to infusion therapy and to identify factors that influence these results. MATERIALS AND METHODS: A systematic review and meta-analysis were conducted on prospective cohort studies that examined the diagnostic accuracy of CVP in predicting response to infusion therapy. The primary endpoint was the area under the ROC curve (AUROC). The literature search was performed in the PubMed and CENTRAL databases up to March 2024. Meta-regression was used to assess the impact of covariates, including age, sex, and body mass index (BMI). Risk of bias was evaluated using the QUADAS-2 tool, and the certainty of evidence was assessed by the GRADE approach. RESULTS: A total of 84 studies, comprising data from 3729 patients (4472 observations), were included in the meta-analysis. The overall AUROC for CVP was 0.6 (95% CI [0.57; 0.62]), indicating low diagnostic accuracy (quality of evidence: moderate). The result was consistent in both ICU and perioperative settings. The diagnostic accuracy of CVP did not depend on ICU profile or surgical setting. Pooled sensitivity and specificity were 61 % and 65 %, respectively. Univariate meta-regression showed no significant impact of age, sex, or BMI on the results. Subgroup analysis indicated that mechanical ventilation and infusion load volume did not influence CVP's diagnostic accuracy. CONCLUSIONS: CVP has low diagnostic accuracy for assessing responsiveness to infusion therapy (moderate quality of evidence). Further studies are needed to evaluate the diagnostic accuracy of extreme CVP values, as well as other simple and accessible methods that could potentially replace this measure in clinical practice.

Introduction. The passive leg raising (PLR test) test is a widely used diagnostic test for assessing fluid responsiveness. However, there is no generally accepted methodology describing the details of its implementation.The objective was to establish criteria for conducting the PLR test based on the diagnostic accuracy of various variations.Materials and methods. A systematic review and meta-analysis included prospective cohort studies that evaluated the diagnostic accuracy of different PLR test variations. The primary endpoint was the area under the ROC curve (AUROC). The search was conducted up to March 2024 and included «snowball» method. The covariate influence was assessed via univariate meta-regression. The risk of bias was evaluated using QUADAS-2, and evidence certainty was assessed with GRADE.Results. The meta-analysis included 33 prospective cohort studies, 1,607 critically ill patients The AUROC for the PLR test was 0.882 [0.849; 0.916] (moderate certainty of evidence). Transthoracic and transesophageal echocardiography, transpulmonary thermodilution, and pulse contour analysis showed comparable results for assessing cardiac hemodynamics during PLR test, p = 0.253 (moderate certainty of evidence). Evaluating hemodynamic changes within the first two minutes of the PLR test increased diagnostic accuracy (high certainty of evidence). The starting body position (low Fowler’s position or supine) during the PLR test did not impact diagnostic accuracy (low certainty of evidence). Baseline covariates (age and gender) had no effect on diagnostic accuracy of the PLR test in critically ill patients (high certainty of evidence).Conclusion. For assessing fluid responsiveness in critically ill patients, the PLR test should include intracardiac hemodynamic assessment within two minutes using any common method. Low Fowler’s position is preferable starting position of the body for PLR test.

Osteosarcomas (OSTs) and Ewing’s sarcomas (EWSs) present significant challenges in pediatric and adolescent oncology due to their diverse pathological features and clinical behaviors. The advent of [18F]fluoro-2-deoxy-2-d-glucose positron emission tomography ([18F]FDG PET) has introduced new potential prognostic parameters, such as the SUVmax, MTV, and TLG, but their predictive value in patients with OST and EWS remains debatable. This systematic review and network meta-analysis were conducted in accordance with PRISMA-NMA guidelines. A comprehensive literature search covered studies from the last 15 years on [18F]FDG PET metabolic parameters in patients with OST and EWS. The prognostic value of [18F]FDG PET parameters, including pre- and posttreatment standardized uptake values (SUV1, SUV2 and the SUV2/SUV1 ratio), metabolic tumor volume (MTV1, MTV2) and total lesion glycolysis (TLG1, TLG2), on event-free survival and overall survival in patients with OST and EWS was examined. The data analysis involved traditional and network meta-analyses (NMA), including subgroup analyses and meta-regression. Our analysis included 20 studies with 858 patients. We found significant associations between higher SUV1, SUV2, MTV1 and TLG1 and survival outcomes. The NMA revealed the superior predictive strength of SUV2, MTV, and TLG over SUV1. Subgroup analysis highlighted the variable prognostic value of these parameters, particularly between pediatric and adult patients. Our study suggested that [18F]FDG PET parameters, particularly SUV2, MTV1, and TLG1, have significant prognostic value in patients with OST and EWS. Further research involving larger cohorts and standardized methodologies is essential to confirm and build upon these findings.

Soft-tissue sarcomas (STS) represent a diverse group of rare malignancies, underscoring the need for precise risk stratification. [18F]fluoro‑2‑deoxy‑2‑d‑glucose positron emission tomography ([18F]FDG PET) imaging parameters have been proposed as potential prognostic indicators in several cancer types, yet their significance in STS remains under investigation. This study aimed to synthesize the available evidence and assess the prognostic value of these parameters. A systematic review and meta-analysis was conducted, employing a comprehensive literature search across multiple databases. The prognostic value of [18F]FDG PET parameters, including pre- and post- treatment standardized uptake values (SUV1, SUV2), pretreatment metabolic tumor volume (MTV1) and total lesion glycolysis (TLG1) on event-free survival (EFS) and overall survival (OS) in patients with STS was examined. Thirty-one studies with 1,932 patients were identified. The analyses demonstrated significant relationships between higher SUV1 (hazard ratio, HR 1.68 for EFS and 3.07 for OS, p < 0.001), SUV2 (HR 3.13 for EFS and 2.09 for OS, p < 0.001 and p = 0.001 respectively), MTV1 (HR 2.29 for EFS and 3.05 for OS, p = 0.011 and p < 0.001 respectively), TLG1 (HR 2.85 for EFS and 3.23 for OS, p = 0.032 and p = 0.002 respectively) and poorer survival outcomes. However, the association of these parameters with survival outcomes was non-significant in pediatric patients. This study suggests that [18F]FDG PET parameters could serve as important prognostic markers in adults with STS, but not in pediatric patients. Future studies with larger cohorts and uniform methodologies are critical to confirm and build upon these findings.

Introduction: The reliability of statistical analysis and its results is becoming a focal point in scientific discourse, overshadowing concerns about statistical significance. Systematic reviews and meta-analyses are characterized by a range of serious statistical and methodological limitations, including insufficient statistical power, clinical and statistical heterogeneity, systematic errors, potential low quality of included examinations, limited data availability, and publication bias. In this context, “Trial Sequential Analysis” (TSA) emerges as a promising methodological tool used in combination with meta-analyses to enhance the precision and robustness of scientific conclusions. Objective: The study is aimed to demonstrating potential scenarios for the using TSA and its role in improving the reliability of scientific conclusions through meta-analyses published in Russian journals on anesthesiology-resuscitation, as well as the authors’ own meta-analyses.Methods: This study is a systematic review without a detailed description of the case studies. The search for meta-analyses was conducted using the keywords “meta-analysis”, “mortality”, “delirium”, “sedation”. Two researchers independently reviewed the titles and abstracts of the selected meta-analyses and extracted data. TSA was conducted for all meta-analyses using “TSA software” (Copenhagen, Denmark). Results: 6 studies were considered, and 7 TSA evaluations were performed. Six out of the seven TSA evaluations confirmed the conclusions of the pertinent meta-analyses. In one TSA, the cumulative Z-line did not reach the required sample size, highlighting the need for additional studies to definitively confirm the result. In two TSAs, the sample size in the meta-analysis was insufficient to draw definitive conclusions. The application of TSA in these cases could provide more substantiated and cautious conclusions.Conclusion: This study explores various scenarios for the application of TSA in meta-analyses published in both Russian and international journals in the fields of anesthesiology and resuscitation. The significance of TSA for enhancing the validity and clinical relevance of research findings was substantiated. Received 3 February 2024. Revised 18 March 2024. Accepted 20 March 2024. Funding: The study did not have sponsorship. Conflict of interest: The authors declare no conflict of interest. Contribution of the authorsConception and study design: M.Ya. YadgarovData collection and analysis: M.Ya. Yadgarov, L.B. Berikashvili, P.A. PolyakovStatistical analysis: M.Ya. Yadgarov, P.A. PolyakovDrafting the article: M.Ya. Yadgarov, L.B. Berikashvili, K.K. Kadantseva, A.V. Smirnova, I.V. Kuznetsov, A.A. YakovlevCritical revision of the article: V.V. LikhvantsevFinal approval of the version to be published: M.Ya. Yadgarov, L.B. Berikashvili, P.A. Polyakov, K.K. Kadantseva, A.V. Smirnova, I.V. Kuznetsov, A.A. Yakovlev, V.V. Likhvantsev

Актуальность. Достоверность статистического анализа и его результатов выходит на первый план научного дискурса, оттесняя вопросы статистической значимости. Систематические обзоры и метаанализы характеризуются серьезными статистическими и методологическими ограничениями, среди которых недостаточная статистическая мощность, клиническая и статистическая неоднородность, систематические ошибки, возможное низкое качество включенных исследований, ограниченная доступность данных в исследованиях и публикационное смещение. В этом контексте последовательный анализ исследований — перспективный методологический инструмент, применяемый в качестве дополнения к метаанализам с целью повышения точности и устойчивости научных выводов. Цель. Продемонстрировать сценарии использования последовательного анализа исследований и его роль в улучшении достоверности научных выводов на примере метаанализов в российских журналах по анестезио­логии-реаниматологии, а также метаанализов авторов. Методы. Выполнили систематический обзор без подробного описания исследований. Осуществили поиск метаанализов по ключевым словам: метаанализ, летальность, делирий, седация. Два исследователя провели независимую проверку названий и аннотаций отобранных метаанализов, а также извлекли данные. Для всех метаанализов выполнили последовательный анализ исследований с использованием программного обеспечения TSA software (Копенгаген, Дания). Результаты. Рассмотрели 6 исследований и осуществили 7 последовательных анализов исследований. Шесть из семи оценок подтвердили выводы соответствующих метаанализов. В одном последовательном анализе кумулятивная Z-линия не достигла необходимого размера выборки, что подчеркивает необходимость в дополнительных исследованиях для окончательного подтверждения результата. В двух последовательных анализах размер выборки был недостаточен для формирования окончательных выводов. Последовательный анализ исследований в этих случаях мог бы обеспечить более обоснованные и осторожные выводы. Заключение. Использование последовательного анализа исследований для повышения достоверности и клинической релевантности научных выводов обосновано. Поступила в редакцию 3 февраля 2024 г. Исправлена 18 марта 2024 г. Принята к печати 20 марта 2024 г. Финансирование Исследование не имело спонсорской поддержки. Конфликт интересов Авторы заявляют об отсутствии конфликта интересов. Вклад авторов Концепция и дизайн работы: М.Я. Ядгаров Сбор и анализ данных: М.Я. Ядгаров, Л.Б. Берикашвили, П.А. Поляков Статистическая обработка данных: М.Я. Ядгаров, П.А. Поляков Написание статьи: М.Я. Ядгаров, Л.Б. Берикашвили, К.К. Каданцева, А.В. Смирнова, И.В. Кузнецов, А.А. Яковлев Исправление статьи: В.В. Лихванцев Утверждение окончательного варианта статьи: все авторы

In the era of healthcare digital transformation, the scientific community faces the need for structured and available datasets for research and technological projects in the field of artificial intelligence, related to the development of new diagnostic and treatment methods.Objective: to develop a dataset containing anonymized medical data of all patients treated at the Federal Research and Clinical Center of Intensive Care Medicine and Rehabilitology (FRCCR), and provide access for doctors and scientists of FRCCR and other centers to structured patient data for subsequent analysis and research. Materials and Methods. The FRCCR medical information system and the tools «Asclepius», PL/SQL, Microsoft Office Excel, Power Query M, Microsoft PowerBI, Open data editor, and Python were used for data collection and representation. To provide open access to the dataset and protect the personal data of patients, the information was anonymized.Results. We introduce the RICD (Russian Intensive Care Dataset, https://fnkcrr-database.ru/) — the first dataset of intensive care patients in the Russian Federation, developed at FRCCR based on advanced principles and methods used in international open database projects — «eICU Program» from Philips Healthcare, «MIMIC-IV», and «MIMIC-III». The developed dataset contains information on 7,730 hospitalizations of 5,115 patients (including readmissions), covering data from 3,291 hospitalizations in the intensive care units (ICUs). The total number of records in the RICD exceeds 14 million. The RICD presents medical-anthropometric data, patient movement within the institution, diagnoses, information on therapy provided, results of laboratory tests, scale assessments, and outcomes of hospitalization. RICD also contains data on several vital parameters collected from bedside monitors and other equipment of ICUs, with up to 10 evaluations per hour.Conclusion. The RICD allows for in-depth analysis and research of clinical practices in intensive care, enabling the development of clinical decision support tools and the application of machine learning methods to enhance diagnostic tools and improve patient outcomes. With its accessibility and detailed data structure, the dataset serves as a valuable tool for both scientific research and practical applications in intensive care.

Metastatic processes remain the main cause of deaths in oncology. Methods of anesthesia, in particular regional anesthesia, are considered as potential modulators of the immune response and metastatic spread. The ambiguity of the available data on the effect of regional and general anesthesia on metastatic spread is partly due to the fact that general anesthetic in combined anesthesia is quite often not taken into account, and this, in turn, masks the possible influence of regional anesthesia. The purpose of this meta-analysis was to make a comparative assessment of the effect of general anesthesia and general anesthesia in combination with regional anesthesia on the relapse-free and overall survival of cancer patients after surgery. Materials and methods. We analyzed 8 randomized controlled trials involving 1822 patients and comparing the groups of cancer patients who were operated either under general anesthesia (total intravenous (TIVA) or inhalation (IA)), or general anesthesia in combination with regional anesthesia (TIVA+RA or IA+RA, respectively). Trial using combinations of inhaled and intravenous anesthetics was excluded from the analysis for a more accurate assessment of the effect of regional anesthesia. The study complies with the recommendations of the Cochrane Community and PRISMA standards. The protocol was registered on the INPLASY platform. We used PubMed, Google Scholar and CENTRAL databases. We used a subgroup analysis and GRADE tool to assess the quality of evidence. Results. There were no statistically significant differences in relapse-free and overall survival when comparing different anesthesia methods. For a relapse-free survival, comparing TIVA vs TIVA+RA resulted in no significant difference : OR=1.20 [95% CI 0.92-1.55]; when IA vs IA+RA were compared, OR=1.10 [95% CI 0.94-1.29]. Similar results were obtained for overall survival. Conclusion. Based on the meta-analysis results, regional anesthesia had no effect on relapse-free and overall survival in oncosurgery patients.

Background: As the severity of comorbid diseases increases, risks of cardiopulmonary bypass (CPB) complications significantly increase. A complex of the procedure’s damaging factors provokes a systemic inflammatory response that in some cases is accompanied by the damage to target organs, transitioning from chronic organ dysfunctions into acute ones. Some studies on the use of minimal invasive extracorporeal circulation (MiECC) systems show their advantage over conventional extracorporeal circulation (CECC); however, the diversity of MiECC systems, patients, and outcomes precludes us from confidently extrapolating these data to older comorbid patients.Objective: To compare the severity of systemic inflammation and treatment outcomes in comorbid patients who underwent cardiac surgery with CECC and MiECC.Methods: We conducted a retrospective cohort study of 760 patients who consecutively underwent elective cardiac operations in 2019-2022. Inclusion criteria: comorbid status (age-adjusted Charlson Comorbidity Index score of ≥6); CPB time ≥90 min. Exclusion criteria: emergency surgery, refusal to participate in the study. A total of 68 patients met the inclusion criteria. We formed 2 study groups based on the extracorporeal circulation method: CECC group (n = 51) and MiECC group (n = 17). Control points: before CPB and 24 hours after the surgery (lactate; creatinine; oxygenation index, hemolysis level). For systemic inflammatory response markers: 1 hour after the CPB start and 24 hours after the CPB end (interleukin 6; interleukin 10; procalcitonin; C-reactive protein; soluble Triggering Receptor Expressed on Myeloid Cells-1 [sTREM-1]). We evaluated respiratory and renal complications, drainage-related hemorrhages, hemostatic disorders, the need for sympathomimetic drugs, and the length of stay in an intensive care unit and inpatient hospital.Results: Between the groups there were no statistically significant differences in gender and anthropometric characteristics, surgery types, and main perfusion parameters. In the CECC group, we observed significantly higher doses of vasoconstrictors (norepinephrine) as well as a decrease in urine output and lung injury and an increase in lactate and hemolysis. The systemic inflammatory response markers were also significantly higher.Conclusion: Compared with CECC, MiECC does not significantly affect the frequency of organ dysfunctions; however, it reduces the severity of the systemic inflammatory response and immune suppression that are trigger mechanisms for multiple organ dysfunction syndrome. It is particularly important for patients with chronic organ dysfunctions. A range of indications for MiECC systems should be defined given its high cost and off-target effect on pleiotropic factors of systemic inflammatory response development. Received 6 April 2023. Revised 17 August 2023. Accepted 18 August 2023. Funding: The study was conducted within the framework of the research project "Development of minimally invasive and hybrid technologies for surgical treatment of heart diseases". Conflict of interest: The authors declare no conflict of interest. Contribution of the authorsConception and study design: A.Sh. Revishvili, G.P. Plotnikov, V.A. PopovData collection and analysis: R.A. Kornelyuk, L.B. Berikashvili, I.P. Komkov, E.S. Malyshenko, V.M. ZemskovStatistical analysis: L.B. BerikashviliDrafting the article: R.A. Kornelyuk, G.P. Plotnikov, L.B. Berikashvili Critical revision of the article: G.P. PlotnikovFinal approval of the version to be published: A.Sh. Revishvili, R.A. Kornelyuk, G.P. Plotnikov, L.B. Berikashvili, I.P. Komkov, E.S. Malyshenko, V.M. Zemskov, V.A. Popov

The aim of the study. To study the achievability and contingency to maintain an effective plasma lithium concentration in the perioperative period in patients undergoing carotid endarterectomy (CEAE) with oral intake of lithium carbonate pills. Materials and methods. It was a prospective study, as a preparatory stage of the multicenter «BINOS» (NCT05126238) RCT. The sample included 15 patients undergoing elective CEAE. In the course of this study, patients were administered oral lithium carbonate, 900 mg per day during 4 perioperative days: two days before the procedure, in the day of surgery and in the 1st postoperative day. Plasma lithium concentration was monitored every 24 hours during all 4 days from the onset of treatment. Results. Increased plasma lithium concentrations were found in blood samples taken at 48 hours (0.68 mmol/l [0.53–0.84, P = 0.004) and 72 hours (0.68 mmol/l [0.62–0.90, P < 0.001), as compared with the initial values (0.14 mmol/l [0.11–0.17).While during the period between 48 and 72 hours from the onset of treatment the plasma lithium concentration remained in the therapeutic range (0.4–1.2 mmol/l) in 100% of patients. Conclusion. Oral intake of lithium carbonate pills at a dose of 900 mg/day during 2 preoperative days provided an effective and safe plasma lithium concentration in 100% of patients enrolled in the study.

ЦЕЛЬ ИССЛЕДОВАНИЯ Оценить влияние протоколизированно-персонифицированного подхода к управлению гемодинамикой (ППУГ) на 30-дневную летальность и продолжительность пребывания в палате интенсивной терапии (ПИТ) и стационаре пациентов пожилого и старческого возраста, перенесших обширную операцию на органах брюшной полости, определить предикторы летального исхода. МАТЕРИАЛ И МЕТОДЫ Проведено ретроспективно-проспективное клиническое исследование эффективности применения ППУГ в периоперационном периоде хирургических вмешательств на органах брюшной полости у пациентов пожилого и старческого возраста. Исследовано влияние немодифицируемых (пол, возраст, наличие и характер сопутствующих заболеваний) и модифицируемых (сердечный индекс (СИ), уровень NT-proBNP, продолжительность операции, длительность анестезии) факторов на 30-дневную летальность и длительность пребывания в ПИТ и стационаре. РЕЗУЛЬТАТЫ Критериям включения/исключения соответствовали 90 пациентов, пролеченных с применением ППУГ (основная группа), которые ретроспективно сопоставлены с 89 пациентами группы исторического контроля со стандартным ведением в послеоперационном периоде. Статистически значимая взаимосвязь между применением ППУГ и 30-дневной летальностью не выявлена (p=0,813). Длительность пребывания в ПИТ пациентов основной группы (2 (1,0—8,3) сут) меньше по сравнению с длительностью пребывания в ПИТ пациентов контрольной группы (6 (2,0—16,5) сут) (p<0,001), так же как и в стационаре — 12 (10—20) сут и 18 (12—26) сут соответственно (p<0,001). В результате многофакторного регрессионного анализа обеих групп выявлено два независимых предиктора летального исхода: возраст ≥72 года (ОШ корр. 12,37; 95% ДИ 3,38—45,36; p<0,001) и СИ при поступлении ≤2,1 л/мин/м2 (ОШ корр. 4,80; 95% ДИ 1,28—18,06; p=0,02). ЗАКЛЮЧЕНИЕ Старший возраст (≥72 лет) и меньшая величина сердечного индекса при поступлении (≤2,1 л/мин/м2) независимо связаны с бóльшим риском летального исхода. Применение протоколизированно-персонифицированного подхода к управлению гемодинамикой у пациентов, перенесших обширную операцию на органах брюшной полости, не связано с изменением 30-дневной летальности, но независимо ассоциировано с меньшей длительностью пребывания в палате интенсивной терапии и стационаре.

The history of the study of postoperative neurocognitive disorders (PND) looks as a long and thorny path of more than 400 years. Despite all accumulated data on PND risk factors and outcomes, there’s still no complete understanding of the etiology and pathogenesis of this complication. Moreover, current anesthesiologyresuscitation practice still faces challenges and has pending questions in diagnosis and classification of postoperative neurocognitive disorders. The purpose of the review. To contemplate the evolution in the perceptions of the international medical community (IMC) regarding diagnostic approaches and algorithms in PND management. The review covers the history of development of such PND concepts as postoperative delirium, postoperative cognitive dysfunction, emergence agitation and emergence delirium. Also, the pre-existing and current international classifications of postoperative neurocognitive disorders are discussed in chronological order, supplemented by the analysis of their strengths and weaknesses. The paper also delves into current viewpoints concerning the etiology of particular postoperative neurocognitive disorders, and PND potential relevance for postoperative outcomes. Conclusion. Current algorithms and modalities used for PND diagnosis, are novel but yet not ultimate for IMC in the context of continuous progress in medical practice. Early postoperative neurocognitive disorders remain the most poorly studied phenomena with no approved definitions and diagnostic modalities to identify. It is probably the time for IMC to undertake a joint effort to find answers to current unresolved questions regarding postoperative neurocognitive disorders.

The objective: to develop a predictive model for assessing the risk of death in patients with COVID-19 admitted to the intensive care unit (ICU). Subjects and Methods. This was a single-center retrospective cohort study of hospital mortality in patients admitted to ICU of V.P. Demikhov City Clinical Hospital from March 6 to June 3, 2020. Results. Case histories of 403 patients were analyzed. In-hospital 30-day mortality among patients treated in ICU was 44.9% (181/403 patients). A multivariate analysis showed that significant predictors of death in patients with COVID-19 were the age of 60 years or more (adj. OR 3.84; 95% CI 1.56‒9.44, p = 0.003), COPD (adj. OR 2.35; 95% CI 1.12‒4.95, p = 0.024), peripheral artery diseases (adj. OR: 5.08; 95% CI 1.87‒13.76, p = 0.001) and CKD stage 3b and higher (adj. OR 4.58; 95% CI 2.36‒8.90, p < 0.001), LDH 300 IU/l or more (adj. OR 3.05; 95% CI 1.23‒7.58, p = 0.016), and CRP 200 mg/l or more (adj. OR 3.65; 95% CI 1.95‒6.85, p < 0.001). Predictive model quality: AUC = 0.811 [0.733‒0.874], p < 0.001. Conclusions. A nomogram to assess the risk of death in patients with COVID-19 has been developed. It includes the assessment of age, history of COPD, CKD stage 3b and higher, peripheral artery diseases, and monitoring of LDH and CRP.

Introduction and aim. Recent evidence suggests that inhalation anesthesia (IA) is associated with higher cancer mortality than total intravenous anesthesia (TIVA), possibly due to a modulation of the immune response.The aim of this study was to determine the impact of anesthesia techniques on selected parameters of patient immunity considering the evidence of relationship between the anesthesia methods and immune status and, consequently, the incidence of cancer recurrence.Methods. We performed a meta-analysis of clinical studies published in PubMed, Google Scholar, and Cochrane databases, aimed at assessing the impact of anesthesia on the postoperative immune status of patients undergoing breast cancer (BC) surgery. Five randomized and three observational studies were included (a total of 637 patients, of which 320 (50.2%) in the TIVA group). Data on leukocyte counts, matrix metalloproteinases (MMP) 9 and 3, interleukins (IL) 6 and 10 levels, and neutrophil-lymphocyte index (NLI) values were retrieved.Results. Patients after breast cancer surgery who underwent TIVA had significantly lower white blood cell counts (standardized mean difference (SMD)=–0.32; 95% CI: –0.58 to –0.06; I2=58%, P=0.020) and MMP-9 (SMD=–0.35; 95% CI: –0.67 to –0.03; P=0.030; I2=0%) in the postoperative period compared with patients receiving IA. No significant differences in the levels of MMP-3, IL-6, IL-10, and NLI values were found between the two groups.Conclusion. The patients who underwent breast cancer surgery under TIVA had lower blood leukocyte counts and levels of MMP-9, which is involved in the remodeling of extracellular matrix, compared with those operated on under IA, suggesting that the anesthesia method may have an impact on the immunity of breast cancer patients.

There are various data on negative impact of comorbidities on treatment outcomes in patients with novel coronavirus infection (COVID-19). However, the impact of cardiovascular diseases and especially their therapy on the course of infectious process and unfavorable outcomes in COVID-19patients has not been sufficiently studied. Objective. To assess the impact of concomitant cardiovascular diseases and chronic drug intake for their treatment on in-hospi-tal mortality in ICU patients with COVID-19. Material and methods. A single-center retrospective cohort study of ICU patients with COVID-19 was carried out between March 6, 2020 and June 3, 2020 at the Demikhov Moscow City Clinical Hospital. We analyzed the following data: age, gender, previous comorbidities, Charlson comorbidity index, therapy of chronic cardiovascular diseases, severity of COVID-19, NEWS and SOFA scores. Univariate analysis included assessment of relative risk (RR). Multivariate analysis was carried out using regression model. Results. We analyzed medical records of 403 patients (231 (57.3%) men). Mean age of patients was 62.4±15.3 years. Over-all 30-day mortality rate was 44.9% (n=181). Multivariate analysis showed that coronary artery disease (adj. OR 2.459, 95% CI 1.589—3.806, p<0.001) and hypertension (adj. OR 2.893, 95% CI 1.667—5.019, p<0.001) were independent predictors of mortality in ICU patients with COVID-19. Conclusion. Coronary artery disease and hypertension are independent predictors of poor outcomes. Long-term use of angioten-sin-converting enzyme inhibitors, β-blockers, acetylsalicylic acid or statins for cardiovascular diseases does not significantly affect clinical outcomes in ICU patients with COVID-19. © 2022, Media Sphera Publishing Group. All rights reserved.

The objective: to evaluate the prognostic value of Nomogram M for major adverse cardiac events (MACE) and major adverse cardiac and cerebral events (MACCE) after elective cardiac surgery with cardiopulmonary bypass.Subjects and Methods. This is a retrospective cohort study of the Nomogram M prognostic value for MACE and MACCE after elective cardiac surgery with cardiopulmonary bypass. 158 patients were enrolled in the study. The prognostic value was estimated using ROC-analysis.Results. The frequency of MACE and MACCE during hospitalization made 5.7% (9 of 158 patients) and 6.3% (10 of 158 patients), respectively. AUC Nomogram M for MACE was 0.888 [0.825; 0.950] (p < 0.001). Cut-off value made 12.5 points (sensitivity – 88.89%, specificity – 83.89%). Odd ratio was 41.67 [95% CI 4.98; 348.61] (p < 0.001).AUC Nomogram M for MACCE was 0.893 [0.834; 0.951] (p < 0.001). Cut-off value made 12.5 points (sensitivity – 90.00%, specificity – 84.46%). Odd ratio was 48.91 [95% CI 5.91; 404.78] (p < 0.001)Conclusion. Nomogram M has a good prognostic value for the occurrence of MACE and MACCE after elective cardiac surgery with cardiopulmonary bypass. For MACE sensitivity made 88.89%, and specificity – 83.89%. For MACCE sensitivity was 90.00%, specificity – 84.46%.

Aim of the study was to evaluate the feasibility of using a modified nomogram (the M nomogram) to predict the occurrence of new postoperative hemodynamically significant arrhythmias after elective cardiac surgery with cardiopulmonary bypass within 30 days post operation.Materials and methods. This was a retrospective cohort study. The prognostic value of the model using ROC-analysis of the modified nomogram was estimated based on the medical records of 144 patients who underwent elective cardiac surgery with cardiopulmonary bypass.Results. The incidence of new postoperative hemodynamically significant arrhythmias was 13.9% (20 of 144 patients). For the modified nomogram, the AUC was 0.777 [95% CI: 0.661–0.892] (P<0.001); at a cutoff of 12 points, the sensitivity was 60.0% and specificity was 89.52%. The odds ratio was 10.26 (95% CI: 3.63–29.06) (P<0.001). Conclusion. The modified nomogram has an acceptable prognostic value for the occurrence of new hemodynamically significant arrhythmias after elective cardiac operations with cardiopulmonary bypass based on AUC 0.777 [0.661–0.892] (P<0.001), and is currently the best model for predicting the outcome.