[Diagnostic and conservative treatment nuances in patients with obstructive jaundice: in the wake of Russian consensus].

The research was performed at the Loginov Moscow Clinical Scientific Center. It is based on Russian obstructive jaundice (OJ) consensus results, considered at the 45th annual Central Research Institute of Gastroenterology Scientific session Oncological issues in the gastroenterologist practice (1 March 2019). The article objective is to note the diagnostic and conservative treatment current issues in patients with OJ. The increase in the number of patients with OJ of different etiology provides problem actuality. In a large number of cases, medical treatment is delayed due to inadequate diagnostic and management, while correct patients routing today can be provided regardless of medical institution level. In this article the examination steps and conservative treatment role in patients with biliary obstruction management are presented.

[Russian consensus on current issues in the diagnosis and treatment of obstructive jaundice syndrome]. / Rossiiskii konsensus po aktual'nym voprosam diagnostiki i lecheniya sindroma mekhanicheskoi zheltukhi.

The Russian consensus document on topical issues of the diagnosis and treatment of obstructive jaundice syndrome was prepared by a group of experts in various fields of surgery, endoscopy, interventional radiology, radiological diagnosis and intensive care. The goal of this document is to clarify and consolidate the opinions of national experts on the following issues: timing of diagnosis of obstructive jaundice, features of diagnostic measures, the need and possibility of conservative measures for obstructive jaundice, and strategy of biliary decompression depending on the cause and level of biliary block.

[qSOFA score for prediction of outcome in surgical patients in intensive care units. Post hoc analysis of the Russian multi-center trial Rises]. / Ispol'zovanie shkaly qSOFA v prognoze iskhoda lecheniya u khirurgicheskikh patsientov v orit. Subpopulyatsionnyi analiz materialov issledovaniya RISES.

OBJECTIVE: To define the informative value of qSOFA score in the prediction of outcomes in surgical patients admitted to the Intensive Care Units. STUDY DESIGN: Post hoc analysis of multicenter prospective observational study RISES. The following patient information was analyzed: gender, age, diagnosis, presence of infection, SIRS criteria, qSOFA and SOFA scores, outcomes. RESULTS: The study included data of 331 patients with surgical diseases. Infection was not observed in 174 (52.6%) cases, 157 (47.4%) patients had infection. In the group of patients without infection, area under ROC-curve for SIRS criteria was 0.519 (95% CI 0.429-0.610) and similar to that qSOFA (p=0.535). Area under ROC-curve for SOFA scale was 0.619 (95% CI 0.511-0.726) and did not significantly differ from this value for QSOFA (p=0.241). In the group of surgical patients with infection, area under ROC-curve for SIRS was 0.490 (95% CI 0.419-0.561), that was significantly lower than area under ROC-curve for qSOFA (p=0.016). Area under ROC-curve for SOFA scale was 0.803 (95% CI 0.681-0.924), that significantly exceeded area under ROC-curve for qSOFA (p=0.017). CONCLUSION: qSOFA scale is important in surgical patients with infection admitted to ICUs. Increased qSOFA score is associated with augmentation of mortality rate. qSOFA scale significantly exceeds the SIRS criteria, but is inferior to the SOFA in the prognosis of mortality in these patients.

[Diagnostic value of molecular biomarkers of infection in screening by Sepsis-3 criteria]. / Diagnosticheskoe znachenie molekuliarnykh biomarkerov infektsionnogo protsessa pri skrininge po kriteriiam Sepsis-3.

AIM: To compare diagnostic value of molecular biomarkers of sepsis in patients with surgical infection in screening via Sepsis-2 (Surviving Sepsis Campaign 2012, SSC 2012) and Sepsis-3 (The Third International Consensus Definitions for Sepsis and Septic Shock) criteria. MATERIAL AND METHODS: Septic patients according to Sepsis-2 and Sepsis-3 criteria were identified from general population with surgical infection. Logistic regression models quality was the criterion for assessment of diagnostic value of molecular biomarkers. Risk factors importance was estimated via odds ratios (OR) calculation. RESULTS: Sepsis-3 ROC-AUC for procalcitonin increased up to 0.933, cut-off value 2.35 ng/ml (Sepsis-2 AUC 0.768 (p=0.004), cut-off 1.72 ng/ml). Sepsis-3 ROC-AUC for presepsin increased up to 0.932, cut-off value - 772 pg/ml (Sepsis-2 AUC 0.865, cut-off 567 pg/ml). The highest risk of sepsis was observed in systemic response to inflammation combined with organ dysfunction (OR 69.667, S 0.636; 95% CI 20.03-242.4) (Sepsis-2 - OR 9.25, S 0.548; 95% CI 3.2-27.1, p<0.001). Increased levels of both biomarkers significantly increased the risk of sepsis (OR 22.5, S 0.794; 95% CI 4.74-106.6 and OR 20.97, S 0.58; 95% CI 6.705-65.6, respectively). CONCLUSION: Organ dysfunction assessment by Sepsis-3 criteria improves diagnostic possibilities in patients with suspected sepsis. Maximum predictive value is observed for systemic inflammation response combined with organ dysfunction. In these patients procalcitonin and presepsin are characterized by equivalent high diagnostic potential for evidence of infectious nature of the disease. Increased level of these markers can serve as a basis for antimicrobial therapy administration.

Use of an endotoxin adsorber in the treatment of severe abdominal sepsis.

Methods for lipopolysaccharide (LPS) (endotoxin) reduction have been proposed as one way to improve the treatment of Gram-negative sepsis. Here we present a case with severe Gram-negative sepsis, treated with a novel device for LPS adsorption (Alteco LPS Adsorber, Alteco Medical AB, Lund, Sweden). After LPS adsorption, the level of LPS in the patient's bloodstream was almost eliminated: from 1.44 EU/ml before treatment to 0.03 EU/ml post treatment). The procalcitonin level and inflammatory cytokines were concurrently reduced. Also, an obvious improvement in the status of the patient's hemodynamics was seen. Forty-five days after treatment the patient is still alive. In conclusion, LPS adsorption may represent a significant improvement in the treatment of Gram-negative sepsis and further studies are planned.

[Characteristics of protein metabolism changes in oncology patients with surgical and combined treatment]. / Osobennosti izmeneneniia belkovogo obmena u onkologicheskikh bol'nykh s khirurgicheskim i kombinirovannym metodom lecheniia.

Combined approach (surgery and chemotherapy) have been acknowledged as the optimal treatment scheme in oncology. The purpose of this case study was to detect and compare the changes in metabolism emerging in combined treatment method for the purpose of working out, later, a therapeutic correction scheme to correct such changes. Two groups of patients, 20 subjects in each, were examined to establish a basic higher degree of the protein-and-energetic insufficiency and a changed immune response, due to which metabolism in patients with combined treatment normalizes slower than in patient with surgical treatment. Special scheme, worked out for the purpose, are needed to correct the progressing lesions.

[The oxidative modification of blood plasma proteins in patients in critical states]. / Okislitel'naia modifikatsiia belkov plazmy krovi u bol'nykh v kriticheskikh sostoianiiakh.

Current concepts on the formation and biological activity of activated oxygen forms (AOF) in humans are discussed. The main AOF types are produced as a result of consecutive single-electron recovery of molecular oxygen (O2) and are more reactive than O2. AOF are initially normal components of cellular metabolism with certain biological functions. Their reactive aggressiveness is regulated by a potent antioxidant system which is present in any live organism. In disease this balance is distorted towards uncontrolled AOF generation and formation of oxidative stress, when AOF impair all biological structures, including proteins. Unregulated modification of proteins by AOF results in loss of protein biological activities (enzymatic, receptor, transporting function, etc.). Moreover, oxidative modification of proteins generates new antigens and provokes immune response. The authors present experimental data which confirm significant modification of plasma proteins in critical patients. The role of the detrimental effect of AOF on proteins in the formation of critical states deserves special studies.

[Present-day bronchological methods of examination in the diagnosis of adult respiratory distress syndrome]. / Sovremennye bronkhologicheskie metody issledovaniia v sisteme diagnostiki sindroma dykhatel'nykh rasstroistv vzroslykh.

The authors describe the use of the fiber bronchoscopic method in the respiratory distress syndrome of adults (RDSA). The method permits visual assessment of bronchial status and allows obtaining cell elements and mediators which are regarded not merely as a result of bronchoalveolar involvement, but as markers of the degree of this involvement. Special attention is paid to cellular and chemical components of bronchial secretion and to detection of correlation with the identical values of arterial and venous blood. The authors classify the available data on bronchological methods of examination, define their role in the diagnosis and treatment of RDSA, and analyze correlation between these data and clinical stages in the course of the syndrome.