Postpericardiotomy syndrome (PCTS) is one of the most frequent cardiac surgery complications seen in 9-65% of patients. Despite its widespread occurrence, the mechanisms of the development of PCTS are still understudied. drug. The use of colchicine in cardiac surgery patients is of particular interest. Due to the ability of this drug the colchicine mechanisms of action are able to inhibit the mobilization of the NLRP3 inflammasome assembly, to suppress the activation of caspase-1. As a result, it can prevent the release of proinflammatory cytokines, namely IL-1β and IL-18. There are conflicting data on the effect of colchicine on the PCTS progression within the systemic inflammatory response after cardiac surgery. In this regard, it was important to study the dynamics of serum levels of IL-6, IL-10, IL-1β, and TNFα in patients before coronary artery bypass grafting (T1), 6 hours (T2), and 10 days (T3) after surgery, and to evaluate the effect of colchicine on the development of PCTS. The results of our research showed a significant increase of IL-10 in both groups 6 hours after surgery. However, on the 10th day, the increase in the level of IL-10, compared with the initial values, was higher in the 1st group – 2 times, compared with the 2nd group. In both groups, showed significant increase in serum concentration of IL-6 after 6 h surgery, with a subsequent decrease in the expression at the stage of T3, while the IL-6 levels in the 2nd group was statistically notably higher than T1. The incidence of pleurisy was lower in the group of patients taking colchicine. Only in the 1st group IL-6 levels were directly associated with IL-10. In patients with pleurisy, the level of released IL-10 and TNFα was significantly higher in the 2nd group. There were no significant intergroup differences in serum levels of IL-1β and TNFα, as well as significant changes in IL-1β between the stages of observation. Analysis of TNFα expression revealed significant differences in TNFα content in the 1st group between the T1-T3 and T2-T3 stages. In both groups, multiple positive associations were found between the studied indicators. Thus, data were obtained indicating the antiinflammatory effect of colchicine in cardiac surgery patients. This was clinically expressed in a tendency to a lower incidence of pleurisy, and was accompanied by increased expression of IL-10, which has an antiinflammatory and immunomodulatory effect against the background of the drug in the postoperative period.

The article describes a clinical case of inhalation therapy with high doses of nitric oxide (NO) in a comorbid patient with a severe course of COVID-19. An air stream containing NO was generated using the PLAZON device. High-dose NO inhalation therapy was administered as a life-saving option due to the lack of effect from treatment delivered in accordance with the current national clinical guidelines for the treatment of COVID-19. The safety and clinical efficacy of the technique was demonstrated.

<p>Acute kidney injury (AKI) and its delayed diagnosis often lead to an increase in the number of patients with chronic kidney disease. There is no denying the importance of studying the pathogenetic mechanisms of AKI, timely predictive identification of patients at high risk of CSA-AKI, as well as the need to search for and improve perioperative strategies to prevent CSA-AKI. The development of new approaches regarding predictive diagnostics of AKI and their widespread introduction into a wide clinical practice will improve the prognosis and survival of these patients.<br />The modern diagnostic continuum of AKI considers risk factors as pre-existing conditions against which adverse factors of the perioperative period are realised. Risk factors for AKI in cardiac surgery are divided into two categories: 1) patient-dependent and 2) operations-associated or modifiable risk factors for the development of AKI, to some extent secondary to iatrogenic effects (adverse factors of the perioperative period). A clear understanding of the significance of these factors regarding the development of AKI in cardiac surgery patients allows us to form risk scales for predicting CSA-AKI in the postoperative period. This review presents the following work, which is a milestone for the predictive diagnosis of AKI in cardiac surgery: model Association of Nephrology and the Association of Anaesthesiologists and Reanimatologists of Russia, the scale EuroSCORE II, the STS Score, Score Mehta, ‘risk index perioperative renal dysfunction/failure’, S. Aronson et al., scale S.Y. Ng et al., model K. Birnie et al.<br />The use of predictive models for the predictive diagnosis of CSA-AKI is an important strategy for identifying high-risk patients. This approach allows active application of preventive strategies regarding AKI in routine clinical practice. It also has distinct advantages regarding conducting cohort clinical studies of new renoprotective technologies. To date, there is no ‘gold standard’ scale for predicting the risk of cardiac AKI. The authors propose consideration of their application as a weighted ‘Solomon’ solution, according to a specific clinical situation.</p><p>Received 10 July 2020. Revised 9 September 2020. Accepted 10 September 2020.</p><p><strong>Funding:</strong> The study did not have sponsorship.</p><p><strong>Conflict of interest:</strong> Authors declare no conflict of interest.</p><p><strong>Author contributions</strong><br />Conception and design: N.O. Kamenshchikov, Yu.K. Podoksenov, M.L. Diakova<br />Drafting the article: N.O. Kamenshchikov, M.L. Diakova, A.M. Boyko<br />Critical revision of the article: M.L. Diakova, Yu.K. Podoksenov<br />Final approval of the version to be published: N.O. Kamenshchikov, Yu.K. Podoksenov, M.L. Diakova, A.M. Boyko, B.N. Kozlov</p>

Objective. To study the structural and functional retinal changes developed in cardiac surgery patients as a consequence of cardiopulmonary bypass and to identify the factors aff ecting the nature and extent of changes observed.Material and Methods. Ten patients who underwent cardiac surgery under cardiopulmonary bypass (CPB) were studied. The ophthalmologic examination was performed before cardiac surgery and 10–14 days after the surgery.Results. On days 10 to 14, after cardiac surgery, visual acuity was restored to the maximum; the perimetry indicators, the level of intraocular pressure, and the structures of the anterior segment of the eyeballs did not change signifi cantly. The ophthalmoscopy revealed the foci of ischemic edema in the fundus along with the fi rst- and second-order arteries in 30% of cases. The thickness of ganglionic and nerve fi ber layers decreased in one patient (10%), which may be associated with the intraoperative ischemia of orbital artery branches feeding the optic nerve. These changes had direct relationships with the level of maximum mean blood pressure (MBP) during CPB and the fl uctuation of absolute MBP values during CPB: MBP ≥ 90 mmHg during CPB was associated with the occurrence of ischemic foci in the retina in 100% of cases. If the diff erence between the maximum and minimum MBP levels during CPB exceeded 20 mmHg, the changes in the retina occurred more frequently (p = 0.0350) than in the cases where MBP fl uctuations during CPB were less than 20 mmHg.Conclusions. The most signifi cant changes in the vision organs of patients undergoing cardiac surgery under CPB occur in the retina. Factors associated with the occurrence of pathological ischemic changes in the retina were fl uctuations in MBP during CPB (≥20 mmHg) and the absolute value of maximum MBP during CPB (>90 mmHg).