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Background: The aim of this study was to obtain the first national estimates of the current prevalence and incidence and death of health care-associated infections (HAIs) of all types in acute care hospitals in Ukraine., Methods: Prospective surveillance was conducted from January 2014 to December 2016 in 17 hospitals. Surveillance case definitions were derived from the Centers for Disease Control and Prevention's National Healthcare Safety Network HAI case definitions. The identification and antimicrobial susceptibility of cultures were determined using a automated microbiology analyzer. Some antimicrobial susceptibility tests used Kirby-Bauer antibiotic testing., Results: Of 97,340 patients, 10,986 (11.3%) HAIs were observed. The most frequently reported HAI types were surgical site infections (60%), respiratory tract infections (pneumonia and lower respiratory tract, 18.4%), bloodstream infections (10.2%), and urinary tract infections (9.5%). Death during hospitalization was reported in 9.7% of HAI cases. The most common organism reported was Escherichia coli, accounting for 21.8% of all organisms, followed by Staphylococcus aureus (18.4%), Enterococcus spp (15.7%), and Pseudomonas aeruginosa (12.4%). Antimicrobial resistance among the isolates associated with HAIs showed that 42.1% and 3.6% of coagulase-negative Staphylococcus spp isolates were β-lactam (oxacillin)- and glycopeptide (teicoplanin)-resistant, respectively. Meticillin resistance was reported in 39.2% of S aureus isolates., Conclusions: HAIs and increasing antimicrobial resistance present a significant burden to the Ukraine hospital system. Infection control priorities in hospitals should include preventing surgical site infections, respiratory tract infections (which also include PNEU and LRTI), bloodstream infections, and urinary tract infections, as well preventing infections due to antimicrobial-resistant pathogens., (Copyright © 2019 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.)

Background Actuality of the problem of infection in critically ill patients remains high. Addition a local infectious processes have a tendency to rapid generalization and sepsis. Neutrophilsfunction failure plays a key role in the patho- genesis of infectious complications and sepsis. The hypothesis about the role of microbial metabolites in the formation of immunosuppression, in particular in the inhibition of phagocytic activity of neutrophils as the first line of defense against bacteria is acquiring more and more supporters. Among the microbial metabolites aromatic compounds, such as phenylcarbinol acid (PCA) are of particular interest. Their concentration in the blood reaches a maximum in case of generalized infection, and correlates with mortality in patients in critical conditions, and PCA biological activity confirmed by earlier researches in vitro. The purpose of the study was to reveal the relationship of the PCA with the severity of bacterial infections and to assess the effect of PCA on neutrophils phagocytic activity., Materials and Methods: At the first stage the levels of PCA (GCh-FID method) in the serum ofpatients (n=57) with a documented bacterial infection of varying severity, confirmed APACHE II and SOFA scales were analyzed comparing with healthy donors (n=72). During the second stage the effect of clinically-relevant concentrations of PCA on neutrophils phagocytic activity ofperipheral blood was analyzed in vitro., Results: The levels ofphenylacetic (PAA), phenyllactic (PLA), hydroxyphenylacetic (p-HPAA) and hydroxyphenyllactic (p-HPLA) acids in patients were significantly higher than in healthy donors, reaching the highest values in severe infection. High direct correlation of PCA levels with the indicators ofscales APACHE II and SOFA was detected. A significant decrease in the number ofphagocytic neutrophils under the influence PAA, p-HPAA and PLA was identified in vitro experiment on average 11%. The most significant influence p-HPAA, PLA and p-HPLA have made on the intensity of the neutrophils absorption capacity reducing this parameter by an average of 26%. Also noted that phenylpropionic acid (PPC) which is in blood of healthy donors, disappears in critical ill patients., Conclusion: Phenolcarbonic acids level in the blood serum shows the severity of bacterial inflammatory process. Ex- periment in vitro shows that the PCA in clinically-relevant concentrations is able to suppress the neutrophilsphagocytic activity.

The role of host genetic variation in pneumonia development and outcome is poorly understood. We studied common polymorphisms in the genes of proinflammatory cytokines (IL6 rs1800795, IL8 rs4073, IL1B rs16944), anti-inflammatory cytokines (IL10 rs1800896, IL4 rs2243250, IL13 rs20541) and toll-like receptors (TLR2 rs5743708 and rs4696480, TLR4 rs4986791, TLR9 rs352139, rs5743836 and rs187084) in patients with community-acquired pneumonia (CAP) (390 cases, 203 controls) and nosocomial pneumonia (355 cases, 216 controls). Experimental data were included in a series of 11 meta-analyses and eight subset analyses related to pneumonia susceptibility and outcome. TLR2 rs5743708 minor genotype appeared to be associated with CAP/Legionnaires' disease/pneumococcal disease. In CAP patients, the IL6 rs1800795-C allele was associated with severe sepsis/septic shock/severe systemic inflammatory response, while the IL10 rs1800896-A allele protected against the development of these critical conditions. To contribute to deciphering of the above results, we performed an in silico analysis and a qualitative synthesis of literature data addressing basal and stimulated genotype-specific expression level. This data together with database information on transcription factors' affinity changes caused by SNPs in putative promoter regions, the results of linkage disequilibrium analysis along with SNPs functional annotations supported assumptions about the complexity underlying the revealed associations.

Investigation was conducted with objective to establish a prognostic significance of the fatty acids content in biliary lipids for the complications occurrence in patients, operated on for an acute cholecystitis, while presence of high operative—anesthesiological risk. A fatty acids content in biliary lipids was analyzed in 64 patients in presence of moderate (grade ІІ) and severe (grade ІІІ) course of the disease. Coefficients К1 and К2 for prognostication of postoperative purulent—inflammatory complications occurrence were elaborated, their threshold level (К1=0.59, К2=1.8) was established. There was established, that excess of the threshold meaning of К1 and К2 in a bile of patients, suffering an acute cholecystitis while presence of high operative—anesthesiological risk, constitutes a prognostic criterion for the postoperative purulent—inflammatory complications occurrence

The aim of this work was to study the effect of microbial metabolites of phenolic nature on the activity of enzymes of the tricarboxylic acid cycle in isolated mitochondria, and determine metabolites of the tricarboxylic acid cycle as potential biomarkers of mitochondrial dysfunction in the blood of patients with sepsis. It is shown that microbial metabolites of phenolic nature have an inhibitory effect on the activity of dehydrogenases, determined by the reduction of dichlorophenolindophenol and nitroblue tetrazolium in liver mitochondria and liver homogenates. This effect is more pronounced in oxidation of the NAD-dependent substrates than succinate oxidation, and at lower concentrations of microbial metabolites than inhibition of respiration. By gas chromatography-mass spectrometry it was found that the content of the tricarboxylic acid cycle metabolites in the blood of patients with sepsis decreased compared to healthy donors. The data obtained show that the microbial phenolic acids can contribute significantly to the dysfunction of mitochondria and suppression of general metabolism, characteristic of these pathologies.

Neurological status was assessed and the numbers of neurons per 1 mm in pyramidal neuronal layer length in CA1 and CA4 hippocampal fields and cerebellar Purkinje cells were evaluated in albino male rats on post-resuscitation day 14 after 12-min cardiac arrest. Intraperitoneal administration of GK-2 (1 mg/kg 30 min after resuscitation and within the next 3 days with an interval of 24 h) accelerated neurological recovery of the animals, sharply reduced the intensity of cerebellar Purkinje cell death, and prevented loss of pyramidal neurons in the hippocampus. These results show the effectiveness of systemic administration of the nerve growth factor mimetic GK-2 in improving structural and functional state of the brain in the post-resuscitation period. This opens new prospects of its use for prevention and correction of post-hypoxic encephalopathy.

Disorders in the erythrocyte morphology and structure of their membranes during long-term storage of erythrocyte suspension (30 days at 4°C) were studied by atomic force microscopy. The morphology and nanostructure of erythrocyte membranes, biochemical parameters, ion exchange parameters, and hemoglobin spectra were recorded. The transformation of erythrocyte morphology and destruction of their membranes were observed throughout the storage period. Irreversible forms of spheroechinocytes and their fragments formed by the end of storage. The concentrations of potassium ions and lactate in solution of the blood preservatiive increased, while pH value decreased. Hemolysis detected by the erythrocyte "leakage" effect was observed starting from days 16-23 of storage.

Nosocomial pneumonia is the most common infection in intensive care units. Currently the problem of resistance of noso-comial pathogens to miost of antibiotics is crucial. Using of inhaled antibiotics in combination with intravenous drugs is eff ective and safe method for treatment of nosocomial pneumonia. The literature review describes current opportunities of ihhaled antibiotic therapy of nosocomial pneumonia, descriptions of drugs, the advantages and disadvantages of this treatment. Special attention is paid for using inhaled aminoglycosides for nosocomial pneumonia.

Host genetic variations may influence a changing profile of biochemical markers and outcome in patients with trauma/injury. The objective of this study was to assess clinical associations of single nucleotide polymorphisms (SNPs) in the genes of cytokines in critically ill patients. A total of 430 patients were genotyped for SNPs in the genes of pro- (IL1B, IL6, IL8) and anti-inflammatory (IL4, IL10, IL13) cytokines. The main end-points were sepsis, mortality and adult respiratory distress syndrome (ARDS). We evaluated the dynamic levels of bilirubin, blood urea nitrogen, creatine kinase, creatinine and lactate dehydrogenase in five points of measurements (between 1 and 14 days after admission) and correlated them with SNPs. High-producing alleles of proinflammatory cytokines protected patients against sepsis (IL1B -511A and IL8 -251A) and mortality (IL1B -511A). High-producing alleles of anti-inflammatory cytokines IL4 -589T and IL13 431A (144Gln) were less frequent in ARDS patients. The carriers of IL6 -174C/C genotypes were prone to the increased levels of biochemical markers and acute kidney and liver insufficiency. Genotype-dependent differences in the levels of biochemical indicators gradually increased to a maximal value on the 14th day after admission. These findings suggest that genetic variability in pro- and anti-inflammatory cytokines may contribute to different clinical phenotypes in patients at high risk of critical illness., (© 2015 British Society for Immunology.)

The Objective: to elucidate an influence of nerve growth factor mimetic GK-2 on the expression of neurotrophic factors and the process of neuronal death after ischemia-reperfusion. Materials and methods. Adult white male rats underwent cardiac arrest for 12 minutes, followed by resuscitation. 10 rats were injected GK-2 (Img/kg i/ρ) at 30 minutes and 48 hours after resuscitation. 10 untreated animals received equivalent doses of saline. The control group consisted of sham-operated animals (n = 10). On the 7th postoperative day the total density of hypoxia-sensitive cerebellar Purkinje cells was determined by morphometric analysis. Immunohistochemical study of proteins FGFb, NT4, BDNF was performed by indirect peroxidase-antiperoxidase method using primary polyclonal antibodies. The number of neurons with different expression levels of the neurotrophic factors was determined., Results: In the post-resuscitation period the neuronal loss was detected in untreated animals. Namely NT4-negative, FGFb-negative and BDNF-negative cells died. GK-2 had no effect on the expression level of FGFb and NT4, however, promoted an increase in the expression level of BDNF. Initiating the expression of BDNF in neurons that were not previously producing this factor, GK-2 prevents the development of post-resuscitation neuronal death. Obtained facts lead to the conclusion that one of the mechanisms of neuroprotective action of nerve growth factor mimetic GK-2 is its ability to activate the expression of BDNF in nerve cells.

Previous studies showed that large amounts of phenylcarboxylic acids (PhCAs) are accumulated in a septic patient's blood due to increased endogenous and microbial phenylalanine and tyrosine biotransformation. Frequently, biochemical aromatic amino acid transformation into PhCAs is considered functionally insignificant for people without monogenetic hereditary diseases. The blood of healthy people contains the same PhCAs that are typical for septic patients as shown in this paper. The overall serum PhCAs level was 6 µM on average as measured by gas chromatography with flame ionization detection. This level is a stable biochemical parameter indicating the normal metabolism of aromatic amino acids. The concentrations of PhCAs in the metabolic profile of healthy people are distributed as follows: phenylacetic ≈ p-hydroxyphenyllactic > p-hydroxyphenylacetic > phenyllactic ≈ phenylpropionic > benzoic. We conclude that maintaining of stable PhCAs level in the serum is provided as the result of integration of human endogenous metabolic pathways and microbiota.

The paper summarizes results of experimental studies and clinical observations of the pathogenesis and effectiveness of respiratory, non-respiratory and pharmacological treatment methods for acute respiratory distress syndrome caused by direct and indirect damaging factors. The article deals with differences and peculiarities of morphological changes and lung functional disorders, clinical, laboratory and instrumental signs of various origins in ARDS and justifies necessity of differential diagnosis and differential treatment of ARDS, depending on the reasons for its development. Furthermore the article discusses an algorithm for differential diagnosis and differential treatment for ARDS caused by direct and indirect damaging factors.

Genetic susceptibility may partially explain the clinical variability observed during the course of similar infections. To establish the contribution of genetic host factors in the susceptibility to critical illness, we genotyped 750 subjects (419 at high risk of critical illness) for 14 single nucleotide polymorphisms (SNPs) in the xenobiotics detoxification/oxidative stress and vascular homeostasis metabolic pathways. In the group of nosocomial pneumonia (NP; 268 patients) the risk of acute respiratory distress syndrome (ARDS) is significantly higher for the carriers of CYP1A1 rs2606345 T/T genotypes and AhR rs2066853 G/A-A/A genotypes. AGTR1 rs5186 allele C is more common among NP non-survivors. The duration of stay in intensive care units (ICU) is higher for NP patients with ABCB1 rs1045642-T allele. The cumulative effect of the risk alleles in the genes comprising two sets of genes partners (xenobiotics detoxification: CYP1A1, AhR and RAS family: ACE, AGT, AGTR1) is associated with the development of both NP and ARDS.

This study was conducted to establish the possible contribution of functional gene polymorphisms in detoxification/oxidative stress and vascular remodeling pathways to community-acquired pneumonia (CAP) susceptibility in the case-control study (350 CAP patients, 432 control subjects) and to predisposition to the development of CAP complications in the prospective study. All subjects were genotyped for 16 polymorphic variants in the 14 genes of xenobiotics detoxification CYP1A1, AhR, GSTM1, GSTT1, ABCB1, redox-status SOD2, CAT, GCLC, and vascular homeostasis ACE, AGT, AGTR1, NOS3, MTHFR, VEGFα. Risk of pulmonary complications (PC) in the single locus analysis was associated with CYP1A1, GCLC and AGTR1 genes. Extra PC (toxic shock syndrome and myocarditis) were not associated with these genes. We evaluated gene-gene interactions using multi-factor dimensionality reduction, and cumulative gene risk score approaches. The final model which included >5 risk alleles in the CYP1A1 (rs2606345, rs4646903, rs1048943), GCLC, AGT, and AGTR1 genes was associated with pleuritis, empyema, acute respiratory distress syndrome, all PC and acute respiratory failure (ARF). We considered CYP1A1, GCLC, AGT, AGTR1 gene set using Set Distiller mode implemented in GeneDecks for discovering gene-set relations via the degree of sharing descriptors within a given gene set. N-acetylcysteine and oxygen were defined by Set Distiller as the best descriptors for the gene set associated in the present study with PC and ARF. Results of the study are in line with literature data and suggest that genetically determined oxidative stress exacerbation may contribute to the progression of lung inflammation.

Absorption and emission spectroscopic investigations and computational predictions have shown that neutral molecules of flavonols and diflavonols can exist in the ground and excited states in one or two tautomeric forms stabilized by intramolecular (in aprotic media) or intermolecular (with solvent molecule(s), in protic media) hydrogen bonds. Electronic excitation creates conditions for the transformation of tautomeric forms, accompanied by proton transfer, reflected in fluorescence spectra. Proton transfer is also probable in monoanions of diflavonols in protic media. The OH groups involved in hydrogen bonds exhibit a proton-donating ability characterized by the respective acidity constants. The electronically excited diflavonols are relatively strong acids if they lose one proton. With increasing basicity of the medium, anionic forms occur, which exhibit spectral characteristics and emission abilities different from those of neutral molecules. These features open up possibilities for the analytical use of these compounds as spectral probes sensitive to the properties of liquid phases--from neutral to strongly basic. The less intensively studied diflavonols seem to be more promising than flavonols for these purposes, since they are more lipophilic, polarizable, polar, and sensitive to basic features of the environment.

Objective of the study was to investigate cerebral and extracerebral insufficiency in survived and died patients after surgical treatment of hemorrhagic stroke for outcome prognosis and decision making on postoperative intensive care. The study included 224 patients after transcranial surgery for hemorrhagic stroke. 119 patients survived and 105 patients died SOFA scale and SIRS criteria were used to assess severity of the patients state. Hemorrhagic stroke before the operation was accompanied with cerebral insufficiency (Glasgow Coma Scale < or = 9) in 19% of patients. Lungs and kidneys dysfunction (SOFA = 1-2) were common. In the early postoperative period 54% of patients had cerebral insufficiency and 36%--organ dysfunction. Acute cerebral insufficiency was closely associated with systemic inflammatory response. Severity of organs (heart, lungs, kidneys) failure and SIRS correlated with GCS score in early postoperative period. There was close correlation between MODS and SIRS scores in survived patients and there wasn't such phenomenon in died patients. This indicates leading role of CNS in homeostasis regulation. SOFA scale using for express diagnosis of perioperative complications is useful for providing adequate intensive therapy.

Objectives: To establish the contribution of genetic host factors to the risk of community-acquired pneumonia (CAP) and nosocomial pneumonia (NP) in the population of the Russian Federation., Methods: A total of 796 subjects (CAP: 334 patients, 134 controls; NP: 216 critically ill patients with NP, 105 critically ill patients without NP) were included in two case-control studies. We analyzed 13 polymorphisms in 11 genes (IL-6, TNF-α, MBL2, CCR5, NOS3, CYP1A1 (three sites), GSTM1, GSTT1, ABCB1, ACE, and MTHFR) using a tetra-primer allele-specific PCR method., Results: Individual single nucleotide polymorphism (SNP) analysis revealed a strong association between CYP1A1 rs2606345 and CAP (p=3.9 × 10(-5), odds ratio (OR) 0.42, 95% confidence interval (CI) 0.27-0.63). Three genes (CYP1A1, ACE, and IL-6) were identified that account for part of the increase in vulnerability to both diseases, CAP and NP. The carriage of three predisposing genotypes versus protective genotypes increased the CAP risk (p=0.001, OR 7.01, 95% CI 1.99-24.70) and NP risk (p=0.028, OR 4.34, 95% CI 1.15-16.45)., Conclusions: Genetic predisposition to CAP and NP is attributed to the cumulative contribution of polymorphisms at the CYP1A1, IL-6, and ACE genes, independently of age, gender, causative pathogen, and the use of mechanical ventilation, in patients in the Russian Federation., (Copyright © 2013 International Society for Infectious Diseases. Published by Elsevier Ltd. All rights reserved.)

This study was conducted to establish the contribution of genetic host factors in the susceptibility to community acquired pneumonia (CAP) in the Russian population. Patients with CAP (n=334), volunteers without a previous history of CAP, constantly exposed to infectious agents, control A group (n=141) and a second control group B consisted of healthy persons (n=314) were included in the study. All subjects were genotyped for 13 polymorphic variants in the genes of xenobiotics detoxification CYP1A1 (rs2606345, rs4646903, and rs1048943), GSTM1 (Ins/del), GSTT1 (Ins/del), ABCB1 rs1045642); immune and inflammation response IL-6 (rs1800795), TNF-a (rs1800629), MBL2 (rs7096206), CCR5 (rs333), NOS3 (rs1799983), angiotensin-converting enzyme ACE (rs4340), and occlusive vascular disease/hyperhomocysteinemia MTHFR (rs1801133). Seven polymorphic variants in genes CYP1A1, GSTM1, ABCB1, NOS3, IL6, CCR5 and ACE were associated with CAP. For two genes CYP1A1 and GSTM1 associations remained significant after correction for multiple comparisons. Multiple analysis by the number of all risk genotypes showed a highly significant association with CAP (P=2.4×10(-7), OR=3.03, 95% CI 1.98-4.64) with the threshold for three risk genotypes. Using the ROC-analysis, the AUC value for multi-locus model was estimated as 68.38., (Copyright © 2012 Elsevier B.V. All rights reserved.)

Atomic force microscopy (AFM) allows a researcher to obtain images of red blood cells (RBC) and their membranes. Various effects on blood lead to surface alterations of cell membranes. Such alterations are estimated by a corrugation of membrane surface. This problem is complicated for statistical analysis because the membrane is the ensemble of structures with different sizes. In the present work we used the space Fourier transform to decompose the complex AFM image of the surface into three simpler ones. The parameters of spectral windows were selected according to the natural structures of RBC membranes. This method allowed us to obtain high resolution images for the corresponding spectral windows, to establish specificity of alterations from each effect, to estimate quantitatively the membrane nanostructures at different space scales and to compare their sizes statistically after actions of different agents. The blood intoxication was modeled by adding hemin, furosemide, chlorpromazine and zinc ions into blood, in vitro., (Copyright © 2012 Elsevier Ltd. All rights reserved.)

Zinc-induced injuries to red blood cell membrane nanostructures at different zinc concentrations were studied by atomic force microscopy. In order to distinguish the intrinsic characteristics of membrane nanostructures, the membrane surfaces were represented by three orders using 3D Fourier transform. Increasing the concentrations of zinc ions modified the pattern of induced injuries: their depths and diameters and their number on the membrane surface test area increased. The injuries and their distribution for each order of membrane surface were analyzed. Albumin restored membrane nanosurface.

In patients with acute respiratory distress syndrome (ARDS) lungs consist of aeration zones and zones of alveolar collapse, which lead to intrapulmonary shunting and hypoxemia. ALV may increase alveolar collaps and potentially lead to lung damage arising out of displacing surfaces tension between aerated and collapsed lung parts and re-closing and opening of the alveoli. Based on the strategy of the "open lung" the recruitment maneuver can be used to achieve the alveolar recruitment, while PEEP prevents alveolar collapse. There are many recrutment types, including a long inflated to a higher pressure, reccuring breath, gradual increase of PEEP, and PIP etc. Data on the use of recruitment in ARDS patients, show varied results with increased efficiency in patients with early ARDS, good complaisance of the chest and extrapulmonary Genesis of lung damage. In this review, we discuss the pathophysiological basis of recruitment use, recent evidence and contradictions of the application of this method.

In this review we provide the definition, goals and objectives of neurocritical care, evaluation of brief history of its development. Mechanical ventilation, intracranial hypertension, neuromonitoring as underlying basics of neurocritical care approaches are discussed. The main types of pathology and specific methods used in neurocritical care units are discussed. The results of our own research on brain death--the development of national criteria; for Guillain-Barre syndrome--a double decrease in the length of mechanical ventilation and in 2.5 times of the recovery time for independent walking ability; on diphteric polyneuropathy--reduced by 11 times mortality compared with nation-wide indicators of nontraumatic persistent vegetative state--the development of diagnostic and predictive neurophysiologic criteria are demonstrated. Research data of multiple organ disfunction syndrome in severe stroke are described. Further development of neurocritical care is being discussed.

The experience of surgical treatment of 10 patients with external intestinal fistulae was analyzed. The plot of the operation was to exlude the duodenum from the digestion by performing the retrocolic gastroenteroanastomosis after Roux or on the ultrashort loop. Early operation prevent septic complications and electrolyte disbalance. Duodenal fistulae, developed on the background of pancreonecrosis or after endoscopic retrograde cholangiopancreaticography, necessitate the external choledochial drainage.

The study included 243 patients with acute community-acquired pneumonia and 173 healthy subjects. The following candidate loci were used to investigate genetic variability: 3 sites of CYP1A1, GSTM1, GSTT1, GSTP1, ACE gene of the rennin-angiotensin system, chemokine receptor gene CCR5. Enhanced predisposition to pneumonia was shown to be characteristic of homozygotes in deletion at the ACE locus (OR = 1.8; p = 0.013), carriers of normal alleles of the GSTM1 locus (OR = 1.7; p = 0.010), and homozygotes in allele 606T of the CYP1A1 gene (OR = 1.6; p = 0.020).

Acute respiratory distress syndrome (ARDS) complicates nosocomial pneumonias (NPn) in 12% to 33% of patients with associated increases in mortality of up to 80%. A timely diagnosis of ARDS with NPn is, however, problematic. The aim of this investigation was to improve the diagnosis and treatment of the early stages of ARDS with NPn. A total of 82 cancer and multiple trauma patients were enrolled in the investigation. Patients were split into 3 groups according to standard ARDS and NPn diagnostic criteria: group 1 ("ARDS + NPn"), group 2 ("NPn"), group 3 ("no ARDS, no NPn"). ARDS was diagnosed using 3 methods: the Murray score, the American-European Consensus Conference criteria, and the V. A. Negovsky Research Institute of General Reanimatology criteria. Elevation of extravascular lung water index along with other ARDS diagnostic criteria (oxygenation index, central hemodynamic indices) was predictive of early stage of ARDS in patients with NPn. The standard diagnostic criteria for ARDS, including the Murray score, oxygenation index, and radiographic data only predicted the later stages of ARDS in NPn. Early diagnosis of ARDS with concomitant NPn in the current study was associated with improved treatment results with decreased duration of artificial ventilation and intensive care unit stay.

The authors studied changes in erythrocyte membrane nanostructure using a rodent model of hemorrhagic hypotension and resuscitation. Both macro- and microstructural elements were examined using atomic force microscopy. Membrane "roughness" was characterized using spatial Fourier transformation and was stratified according to the periodicity of the membrane. Acute hemorrhage resulted in an increase in the diameter and height of erythrocytes, which returned to baseline levels by the end of the hemorrhagic hypotensive period. The effect of hypotension on the erythrocyte surface was nonuniform. In those regions where damage was considerable, the rate of restoration of the membrane microstructure to baseline levels was prolonged. The less damaged surfaces were restored more rapidly to control values after reperfusion. More detailed use of atomic force microscopy in the definition of the erythrocyte membrane microstructure may further define the mechanisms of cellular functional restoration after hemorrhage.

The objective of this study was to measure the efficacy of biphasic positive airway pressure (BIPAP) and synchronized intermittent mandatory ventilation (SIMV) with alveolar recruitment maneuvers (ARMs) in patients with acute lung injury (ALI) and concomitant pneumothorax. Seventy-four patients with ALI and concomitant pneumothorax secondary to blunt thoracic injury were studied. All patients fulfilled criteria for the first stage of acute respiratory distress syndrome, which consisted of acute onset dyspnea, isolated rales, an extravascular lung water index >7 mL/kg, and an oxygenation index <300 mm Hg in the absence of left-ventricular dysfunction. After evacuation of the pneumothorax, ARMs were performed using BIPAP or SIMV 3 to 5 times a day with a peak pressure of 33.4 ± 0.2 cm H(2)O and a positive end-expiratory pressure of 16.1 ± 0.2 cm H(2)O. The use of BIPAP in patients with ALI and concomitant pneumothorax reduced the time to resolution of the air leak allowing application of earlier ARMs. ARMs with peak pressures of 35 to 40 cm H(2)O effectively improved oxygenation and biomechanical properties of the lungs and did not cause pneumothorax relapse. In conclusion, BIPAP allowed for spontaneous ventilation during the breathing cycle and limited P (peak). Its use was associated with more rapid sealing of air leaks with the ability to conduct earlier ARMs. The use of BIPAP compared with SIMV improved outcome in the presence of complex thoracic trauma.

A complex of studies was used in 4 groups of premature babies to study lung tissue morphological changes in hyaline membrane disease, by applying exogenous surfactants during mechanical ventilation. Background diseases, pre- and intranatal risk factors, the babies' longevity, and the specific features of lung tissue and forming hyaline membranes were ascertained. Exogenous surfactants were found to have a blocking effect on the formation of hyaline membranes under mechanical ventilation.

Purpose: After the influence of different actions on the blood, the erythrocytes may change their macrostructure. At the same time, the microstructure of cell membrane will be changed as well. This study provides the results of comparison of red blood cell membrane microstructure after they have been affected by different factors., Materials and Methods: Images and spatial profiles of the cell surface were obtained by atomic force microscope. It was proposed to use spatial Fourier transform to decompose the initial complex profile into series of simple ones. This made it possible to compare surface parameters after exposure of red blood cells to different external actions., Results: Quantitative differences between membrane profile harmonic composition parameters (amplitude and spatial period) after physical impact (impulse electrical field, osmotic swelling) and after chemical impact (the fixing fluid glutaraldehyde and the drug Esmeron) were experimentally confirmed., Conclusions: Such experimental and theoretical approach may lay down the foundations of mechanisms of different factors' effect on red blood cells both in research and in clinics., (Copyright © 2010 Elsevier Inc. All rights reserved.)

The paper presents the results of a clinical trial using the new modified gelatin-based drug hemofusin to correct dyshidria in patients with blood loss and sepsis. Based on the findings, the authors provide evidence for the high clinical efficacy of this drug and the expediency of its incorporation into a complex of infusion therapy in this patient contingent.

The aim of this work was to evaluate contribution of released membrane particles (RMP) to the development of systemic inflammatory response (SIR) after aortocoronary bypass grafting (ACBG). The number of RMP carrying surface adhesion molecules, CD62L, CD62P, CD62E, was shown to increase in the early postoperative period in parallel with the enhancement of lymphocyte plasma membrane blebbing and elevation of cytokine levels in peripheral blood. It is concluded that (1) activation of plasma membrane blebbing in peripheral blood cells underlies the appearance of RMP in circulation; (2) increased number of RMP expressing CD62L, CD62P, CD62E is a marker of intercellular communication associated with the development of SIR and suggests new mechanisms of RMP involvement in the reaction of organism to massive surgical injury.

Atomic force microscopy was used for examination of the surface of human erythrocyte membrane after calibrated electroporation and application of pharmacological agents. Three-order surface inhomogeneities were revealed with various spectral windows of Fourier transform to elaborate the quantitative criteria to assess the state of membrane surface. The size of structural alterations induced in the membranes by electroporation was 100-300 nm, which is comparable to the size of membrane matrix.

The pathogenesis of neuronal dysfunction was evaluated from the viewpoint of cellular disturbances in NAD(+) metabolism and changes in activity of NAD(+)-utilizing enzymes (e.g., ADP-ribosyl cyclase/CD38). S-100B concentration and CD38 expression on peripheral blood lymphocytes were altered in patients after surgery for coronary heart disease with extracorporeal circulation. These changes in patients during the early postoperative period correlated with variations in CD38 expression on neuronal cells from postischemic rats with cognitive dysfunction.

A hundred and one patients (51 males and 50 females) aged 66.2 +/- 5.0 years who had Stages II-III colonic malignancies concurrent with type 2 diabetes mellitus were examined. Two algorithms of postoperative management using the traditional diet and early enteral feeding were comparatively analyzed. The use of an early enteral feeding protocol improves central hemodynamics, oxygen and nutritive status, prevents moderate protein-energy deficiency in the early postoperative period, and reduces the number of complications and deaths in patients with colonic malignancies concurrent with type 2 diabetes mellitus.

Aim: To investigate the anti-ischemic properties of perfluorochemical emulsion "perftoran" in mesenteric region., Methods: Experiments were conducted on 146 nonlinear white male rats weighing 200-350 g. Partial critical intestinal ischemia was induced by thorough atraumatic strangulation of 5-6 cm jejunal loop with its mesentery for 90 min. Global critical intestinal ischemia was made by atraumatic occlusion of the cranial mesenteric artery (CMA) for 90 min also. Perftoran (PF, 0.8-1.0 mL per 100 g) in experimental groups or 0.9% sodium chloride in control groups was injected at 75 min of ischemic period. Mean systemic arterial blood pressure (BP(M)) registration, intravital microscopy and morphological examination of ischemic intestine and its mesentery were performed in both groups., Results: During 90 min of reperfusion, BP(M) progressively decreased to 27.3+/-7.4% after PF administration vs 38.6+/-8.0% in the control group of rats with partial intestinal ischemia (NS) and to 50.3+/-6.9% vs 53.1+/-5.8% in rats after global ischemia (NS). During the reperfusion period, full restoration of microcirculation was never registered; parts with restored blood flow had leukocyte and erythrocyte stasis and intra-vascular clotting, a typical "non-reflow" phenomenon. The reduction of mesenteric 50-400 mum feeding artery diameter was significantly less in the PF group than in the control group (24+/-5.5% vs 45.2+/-3.6%, P<0.05) 5 min after partial intestinal ischemia. This decrease progressed but differences between groups minimized at the 90(th) min of reperfusion (41.5+/-4.2% and 50.3+/-2.8%, respectively). In reperfusion of rat's intestine, a significant mucosal alteration was registered. Villous height decreased 2.5-3 times and the quantity of crypts decreased more than twice. In the group of rats administered PF, intestinal mucosal layer was protected from irreversible post-ischemic derangement during reperfusion. Saved cryptal epithelial cells were the source of regeneration of the epithelium, which began to cover renewing intestinal villi after 24 h of blood flow restoration. View of morphological alterations was more heterogeneous in CMA groups., Conclusion: Systemic administration of perftoran promotes earlier and more complete structural regeneration during reperfusion in rats after partial and global critical intestinal ischemia.

The perioperative period was studied in 50 patients aged 44-79 years who had acute coronary syndrome. The patients underwent aortocoronary bypass surgery at O. M. Filatov Moscow City Clinical Hospital No. 15 in 2002 to 2004. They were divided into 2 groups: 1) 25 patients (21 males and 4 females) who received high thoracic epidural naropine analgesia at least 24 hours before surgery (a study group); 2) 25 patients (19 males and 6 females) who were prepared for surgery through conventional antiischemic therapy. The indication for surgical myocardial revascularization in these patients was not only severe coronary bed lesion, but also frequent resting anginal attacks. The occurrence of resting anginal episodes during the maximally possible antianginal therapy was a criterion for inclusion of patients into this study. The purpose of the study was to improve the results of surgical treatment of patients with acute coronary syndrome, by using high thoracic epidural naropine analgesia.

The influence of prodigiozan on the processes of postirradiation recovery of hemopoiesis in long-term bone morrow cultures of two strain mice, having genetic distinctions in the condition of systems of the reparation DNA was investigated. It was showh, that the irradiation of long-term bone morrow cultures of mice reparation-defective strain 101/H resulted in the greater degree damage of early haemopoietic precursors (GM-CFC), reduction of the amount of the immature and of the mature granulocytes and of the decrease of the number of stromall cells in the comparison with the bone morrow of reparation-capable mice (CBA x C57B1)F1. Under the introduction in cultures of prodigiozan for 24 hours prior to an radiation the distinctions of the speed of postirradiation recovery of hemopoiesis substantially smoothed out, and the protective effect of the drag in bone morrow cultures of mice 101/H was comparable to those, marked in bone morrow cultures of reparation-capable strain mice (CBA x C57B1)F1. It is supposed, that this effect can be caused by the activation of the hematopoietic microenvironment cellular elements and inclusion of the mechanisms of intercellular of interactions, which provide stimulation of the regenerative processes at action radioprotective drags and can in the certain degree to compensate the defect of the systems of the reparation DNA.

Severe diseases of different etiology are generally accompanied by significant neurohumoral stress and catabolism. The use of insulin and insulin-like growth factor 1 (IGF-1) regulates the rate of protein and carbohydrate catabolism, retards increasing azotemia, thus normalizing protein metabolism. By taking into account the physicochemical properties of IGF-1 and the high resolving capacity of the modes of renal replacement therapy (RRT), it cannot be ruled out the possibility that the really significant amount of this polypeptide is eliminated, which may negatively affect the patient's metabolic adaptation. In this connection, the authors studied the levels of IGF-1 in patients with multiple organ dysfunction during hemofiltration/hemodiafiltration (HF/HDF). All the patients were found to have the maximum low content of IGF-1 both before and during RRT. There was a high elimination of this hormone with an effluent during RRT. The clearance of IGF-1, calculated for 24 hours of a procedure was equal to that of the proinflammatory cytokines TNFa and IL-Ibeta during HF/HDF. The results lead to the conclusion that early replacement therapy for hypercatabolism should be performed in patients with multiple organ dysfunction.

The type of open-field behavior (determined in preliminary tests) was preserved after 10-min circulatory arrest. Postresuscitation changes in the bran modified orientation and exploratory activity under conditions of its partial extinction before clinical death. High behavioral activity of rats in the first open-field session after resuscitation was related to the impairment of memory traces, while that in the follow-up period was associated with the formation of a pathological self-maintaining system between components of orientation and exploratory behavior.

The critical states occurring during pregnancy, labor, and early puerperium were analyzed. Seventy puerperas treated at intensive care units (ICU) were examined. The patients were divided into 5 groups: 1) those with preeclampsia (n = 15); 2) eclampsia (n = 22); 3) massive blood loss (n = 17); 4) pyoseptic complications (n = 10); 5) acute respiratory failure (n = 6). The APACHE II scale severity was 22 +/- 5.3 scores. The mean age of puerperas is 29.2 +/- 7.2 years. Total mortality was 14.3%. Parametric and non-parametric statistic methods were used to analyze the reasons for referral of the patients to ICU, their age composition, the association of an outcome to the time of their referral to ICU, the duration of stay there and at hospital, mortality, the time of controlled ventilation, the incidence of multiorgan failure. The common reasons for referral of the puerperas from maternity homes to ICU were eclampsia, preeclampsia, and massive blood loss. Acute respiratory distress syndrome (52.9%), encephalopathy (44.3%), coma (47.1%), and intestinal insufficiency (38.6%) were predominant in the pattern of multiorgan failure in intensive care obstetric patients. When emergencies occurred in puerperas, earlier referral from maternal homes to ICU caused a reduction in mortality from 33.% at referral on day 3 after their occurrence to 23.5% at referral on day 2, and to 11.5 at referral on day 1.

Perftoran (PF) was used within a complex intensive care of 74 patients with purulent-inflammatory urological diseases and with signs of generalized inflammation. Positive effects were found to be made by PF on the parameters of microcirculation, oxygen status, dynamics of the serum content of cytokines, condition of their balance and immune status, which entailed a regression of endogenous intoxication and arrested the inflammatory lesion in the kidneys. PF cut the intensive care time of patients with complicated urological infection by 4.2+/-0.4 days (p < 0.05). The conclusion is that PF is a novel pathogenetic treatment method applicable to patients with purulent-inflammatory urological diseases.

We studied the effects of high-voltage single, double unipolar, and double bipolar electric pulses of exponential or sine shape on erythrocyte membranes. Either single or double (mono- or bipolar) pulses were used. All pulses electroporated the membranes, and the electroporation threshold did not depend on the pulse shape. Two successive pulses decreased erythrocyte number in a nonadditive way. Similar to defibrillation of the whole heart, the effect of two bipolar pulses on erythrocytes was more pronounced than the effect of two unipolar pulses.