Background Among asymptomatic patients with severe carotid artery stenosis but no recent stroke or transient cerebral ischaemia, either carotid artery stenting (CAS) or carotid endarterectomy (CEA) can restore patency and reduce long-term stroke risks. However, from recent national registry data, each option causes about 1% procedural risk of disabling stroke or death. Comparison of their long-term protective effects requires large-scale randomised evidence.Methods ACST-2 is an international multicentre randomised trial of CAS versus CEA among asymptomatic patients with severe stenosis thought to require intervention, interpreted with all other relevant trials. Patients were eligible if they had severe unilateral or bilateral carotid artery stenosis and both doctor and patient agreed that a carotid procedure should be undertaken, but they were substantially uncertain which one to choose. Patients were randomly allocated to CAS or CEA and followed up at 1 month and then annually, for a mean 5 years. Procedural events were those within 30 days of the intervention. Intention-to-treat analyses are provided. Analyses including procedural hazards use tabular methods. Analyses and meta-analyses of non-procedural strokes use Kaplan-Meier and log-rank methods. The trial is registered with the ISRCTN registry, ISRCTN21144362.

This article describes the successful endovascular treatment of a dural arteriovenous fistula of a rare localization (the area of sphenoid bone lesser region). We examine one report of an unusually located dural arteriovenous fistula successfully treated with Onyx (ev3, Irvine, USA) using a combination of endovascular adjuvant techniques: pressure cooker and remodeling balloon protection of cerebral artery. The article includes previously published observations of such fistulas and discusses anatomic features and venous drainage of dural arteriovenous fistulas in the given location.

INTRODUCTION: Sepsis remains an actual problem of modern medicine. Among other treatment options, timely prescribed optimal nutritional-metabolic support is one of the priority methods of intensive treatment for this category of patients. OBJECTIVE: To study the severity of metabolic dysfunction in sepsis and determine the parameters of optimal substrate supply for this category of patients. MATERIALS AND METHODS: The study included 166 patients with sepsis. We studied the severity of systemic metabolic dysfunction and the impact of various options for energy and protein supply on the course of the disease and its outcome. Energy expenditure and the severity of the catabolic reaction of the body were studied by dynamic evaluation of indicators of indirect calorimetry, actual losses of nitrogen and nitrogen balance. RESULTS: Actual energy expenditure in sepsis reaches its maximum values by the 5-6^th day of the disease (33.5 ± 1.8 kcal/kg/day or 2366 ± 126 kcal/day). The average energy consumption in sepsis is 2226 ± 96 kcal/day or 30.9 ± 1.4 kcal/kg/day. Energy supply in sepsis less than 25 kcal/kg/day leads to a significant increase in mortality. Protein losses in sepsis reach their maximum values by the 5-6^th day of the disease (1.93 ± 0.12 g/kg/day). The average loss of protein in sepsis is 1.68 ± 0.06 g/kg/day. Protein provision of this category of patients with more than 1.5 g/kg/day contributes to a significant decrease in mortality, relative to patients receiving less protein per day. CONCLUSIONS: Energy supply in the range of 25-35 kcal/kg/day, as well as protein supply of more than 1.5 g/kg/day, significantly contribute to better survival of patients with sepsis.

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