Search

Background. Currently, the scientific search for alternative materials and methods for combating pathogens of infectious diseases is an important area of research. Carbon materials are one of the promising types of materials exhibiting antimicrobial and antifungal properties. The aim of the study is to investigate the antibacterial properties of modified carbon sorbents and initial modifiers in relation to some types of pathogenic microorganisms. The objects of the study were carbon sorbent samples before and after modification with biologically active substances with antibacterial properties: salicylic acid, sulfosalicylic acid, tributyrin. The samples of carbon sorbents under study were obtained at the Center of New Chem- ical Technologies BIC. The following strains of gram-positive and gram-negative bacteria were used as experimental models: Staphylococcus aureus АТСС 25923; Pseudomonas aeruginosa АТСС 27853; Klebsiella pneumoniae 418; Esherichia coli АТСС 25922. Results. The highest sensitivity of gram-positive and gram-negative bacteria was established for a carbon sor- bent modified with tributyrin. The absence of growth of the studied test strains of microorganisms was observed after 2 hours of incubation of the «sample-microorganism» mixture.

The majority of asphyxial circulatory arrest (CA) models have a number of disadvantages, such as the lack of uniform criteria for fixing CA and recovery of spontaneous circulation, short duration of CA episode and limited volume of post-resuscitation intensive care, poor similarity with resuscitation measures in current clinical anesthesiology/intensive care settings.The aim of the study: to improve the experimental model of asphyxicial CA by standardizing experimental procedures and using a complex of resuscitation measures replicating current CA management in clinical anesthesiology-intensive care.Materials and methods. The experiments were conducted on 34 male Wistar rats, distributed into 2 groups: Group I included animals subjected to sham procedure (SP, N=12) and Group II – animals subjected to asphyxial circulatory arrest (CA, N=22) and subsequent resuscitation. Asphyxia in anesthetized rats was induced by rocuronium bromide injection, followed by recording of electrocardiogram (ECG), parameters of invasive blood pressure (BP) measurement and laser Doppler fluxmetry (LDF) to assess skin perfusion. CA episode was maintained for 2 min, followed by a series of resuscitation measures and intensive therapy for 2 h. Circulatory parameters (ECG, BP, LDF), gas composition and arterial blood acid-base state (ABS) dynamics were evaluated.Results. Monitored parameters were comparable in both groups at baseline after stabilization period. After exclusion criteria were applied 11 animals from SP group and 18 — from CA were included in the analysis. Tachycardia (heart rate, beats/min–1, SP vs CA) was documented in the CA group: 218 [205; 236] vs 286 [272; 305], P⩽0.0001), as well as recovery of skin perfusion to subnormal parameters in the first minutes after successful resuscitation. At minute 10 in the post-resuscitation period worsening of skin perfusion (M, perfusion units, SP vs CA): 14.7 [12.1; 16.5] vs 10.1 [7.0; 12.5], P=0.0014), and decompensated mixed acidosis (pH, SP vs CA): 7.42 [7.40; 7.43] vs 7.20 [7.13; 7.23], P⩽0.0001) were documented in the CA group, however BP values were comparable (BP, mmHg, SP vs CA): 60 [58; 72] vs 67 [62; 82], P=0.482). At minute 120 post-resuscitation and at the end of intensive care period, both groups demonstrated similar values of the monitored parameters. Three out of 18 animals in the CA group died after resuscitation.Conclusion. Electromechanical dissociation underlies CA in rats subjected to asphyxia. The use of LDF to assess peripheral blood flow makes it possible to standardize the severity of ischemic reperfusion injuries and improve reproducibility of the model. Series of resuscitation measures in experimental setting is justified from a bioethical point of view, and makes it possible to improve repeatability of preclinical research results in clinical practice.

The aim of the study. To identify alterations of motor connectome in patients with varying degrees of hemi-paresis after severe traumatic brain injury (TBI) versus healthy volunteers.Material and methods. The study included 29 patients with TBI aged 18 to 35 years and 23 healthy volunteers aged 20 to 32 years. Participants underwent a comprehensive clinical and neuroimaging study. Motor impairment was evaluated via muscle strength assessment using a five-score scale. The fMRI data were processed using a dedicated CONN software package. Anatomical 3-D connection masks of the whole brain motor functional system in the predetermined regions of interest (ROIs) were used for the assessment. Then the group indicators of functional connectivity (statistical significance of the connection) were computed.Results. It was established that the structure of connections in healthy individuals performing active movement with the right (leading) hand is determined by formation of focus in the cortical and subcortical ROIs in the contralateral hemisphere. With passive movement of the right hand the pale ball becomes functionally active in addition to the activated areas. The striopallidar system structures became active on both sides, and connectivity with the additional motor cortex and the motor cortex of the ipsilateral hemisphere emerged as the paresis increased during active movement. The focus of motor activity during passive movement was determined in the motor cortex and putamen, which makes it possible to use a passive test in patients with gross motor disorders or unconsciousness for a full assessment of the entire structural and functional brain connectome.Conclusion. As hemiparesis increased in patients after severe traumatic brain injury, a decrease in the total number of connection appeared; simultaneous engagement of ancient primordial structures, such as bilateral activation of pale globes, demonstrated neuroplasticity.

The aim of the work was to study the biological activity of modifiers and carbon sorbent samples modified by them in relation to some types of microorganisms.Material and methods. The carbon sorbent under study and the modified samples were obtained at the Center of New Chemical Technologies BIC. Glycolic acid, lactic acid, glycine, and glutamic acid were used as modifiers. Strains of Staphylococcus aureus ATCC 25923, Pseudomonas aeruginosa ATCC 27853, Klebsiella pneumoniae 418, Esherichia coli ATCC 25922, Candida albicans (clinical strain) were used as test cultures. The test sample was placed in the wells of a sterile plate, then a working suspension of the test culture was added in the amount of 2.0 ml until completely wet 1:1. The survival of microorganisms was determined by quantitative inoculation from each well of the «sample — microorganism» mixture on Petri dishes with simple nutrient agar using the sector crop method (Gold). The culture species were confirmed by studying their cultural, morphological, and biochemical properties.Results. The conducted studies have demonstrated high antibacterial and antimycotic activity of carbon sorbent samples modified with hydroxyl acids in relation to the most common opportunistic pathogens of pyoinflammatory diseases of bacterial and fungal nature in comparison with the initial sorbent sample. The carbon sorbent modified with lactic acid oligomer showed the highest antibacterial and antimycotic activity.Conclusion. High antibacterial and antimycotic activity of carbon sorbent samples modified with hydroxy acids and amino acids in relation to the most common opportunistic pathogens of pyoinflammatory diseases of bacterial and fungal nature was established in comparison with the initial sample of the sorbent. The carbon sorbent sample modified with amino acids has a pronounced antibacterial effect against all studied bacterial test strains, but exhibits weak antimycotic properties. The use of modified carbon sorbents is a promising direction for the application therapy of pyoinflammatory infections.

Aim. This review aims to inform physicians of different specialties (anesthesiologists, intensivists, neurologists, neurosurgeons, oncologists) about the diagnostic capabilities of microwave radiothermometry, which enables to identify and analyze features of alterations of cerebral temperature in brain damage.The review displays a critical analysis of 80 recent Russian and foreign open access publications found by keywords.The review presents major clinical features and pathophysiological mechanisms of cerebral thermal balance disruptions in brain lesions. Slow responsiveness and vulnerability of cerebral thermal homeostasis regulation mechanisms that underlie development of different temperature heterogeneity levels in the cerebral cortex in healthy brain and brain lesions are highlighted. The authors postulate their concept about the critical role of hyperthermia in the pathogenesis of brain damage and disruption of interconnections in the global central regulation system. A body of evidence explaining direct association between the depth of consciousness impairment and degree of cerebral cortex temperature heterogeneity manifestation is presented. It is emphasized that a significant increase in temperature heterogeneity with areas of focal hyperthermia accompanies an acute period of ischemic stroke, while in post-comatose state usually associated with prolonged impairment of consciousness, the temperature heterogeneity significantly subsides. It has been suggested that lowering of an increased and rising of the reduced temperature heterogeneity, for example by using temperature exposure, can improve altered level of consciousness in patients with brain damage. The diagnostic capabilities of various technologies used for cerebral temperature measurement, including microwave radiothermometry (MWR), are evaluated. Data on high accuracy of MWR in measurement of the cerebral cortex temperature in comparison with invasive methods are presented.Conclusion. In healthy individuals MWR revealed a distinct daily rhythmic changes of the cerebral cortex temperature, and badly violated circadian rhythms in patients with brain lesions. Since MWR is an easy-toperform, non-invasive and objective diagnostic tool, it is feasible to use this technology to detect latent cerebral hyperthermia and assess the level of temperature heterogeneity disruption, as well as to study the circadian rhythm of temperature changes.

Aim of the study: to reduce cognitive impairment during laparoscopic cholecystectomy by perioperative administration of drugs with antihypoxic and antioxidant effects under the control of stabilography. Materials and methods. We studied the effect of general anesthesia and antioxidants on cognitive, static and locomotor functions during laparoscopic cholecystectomy. We studied 90 patients with acute calculous cholecystitis randomized into three experimental groups (n=30, each group). The control group was composed of 24 healthy individuals. Group 1 patients received no antioxidants, group 2 patients received the combination antioxidant drug (sodium fumarate+sodium chloride+potassium chloride+magnesium chloride) in the post-operative period, and group 3 patients received methylethylpyridinol. The patient groups were comparable in sex, age and type of inflammatory and destructive process in the gallbladder. Surgical intervention was performed under endotracheal anesthesia. Premedication with atropine and promedol was given, and anesthesia induction was carried out with propofol, fentanyl and suxamethonium. Sevoflurane, fentanyl andcisatracurium were employed to maintain anesthesia, analgesia and myorelaxation, respectively. The patients were examined before surgery, 24 and 48 hours after surgery. In the groups of patients who received antioxidant therapy, blood sampling for hematological and biochemical examinations was performed 30 min after the administration of antioxidants. Stabilographic studies and MoCA test (Montreal Scale) were performed before antioxidant administration prior to surgery and after surgery, on days 2 and 3. Results. Neuropsychological testing revealed postoperative cognitive dysfunction on standard therapy which included impaired attention and concentration, executive function, memory, speech, visual constructional skills, abstract thinking, counting, and orientation (21 points on the MoCA scale versus 28–30 points for normal). We found that the pathogenetic factors of cognitive dysfunction included insufficient antioxidant protection, decreased TNF-α and elevated interleukin-18 levels along with an increased level of C-reactive protein in plasma, which manifested as activation of free-radical oxidation processes and reduced antioxidant system and performance of nonspecific resistance. Perioperative use of the combination antioxidant drug and methylethylpyridinol antioxidants reduced the frequency and severity of postoperative cognitive impairment in patients after laparoscopic cholecystectomy. Conclusion. The most important pathogenetic factors of cognitive dysfunction after laparoscopic cholecystectomy include activation of free-radical oxidation, reduction of antioxidant defense system performance and lack of nonspecific resistance factors. Adding the combination antioxidant drug or methylethylpyridinol to the standard therapy reduces the intensity of radical oxygen species generation, maintains the antioxidant potential, activates production and secretion of nonspecific resistance factors, preventing the development and reducing the severity of cognitive disorders in the perioperative period. Neuropsychological testing and stabilographic examination allow identifying the risk of cognitive disorders in patients after laparoscopic cholecystectomy and provide a rationale for the use of antioxidant therapy for their prevention.

The objective is to study the effect of different concentrations of sevoflurane on activation of human neutrophils in an ex vivo model.Subjects and Methods. The cell culture of venous blood neutrophils of 5 healthy men was used in this study. Neutrophil activation by lipopolysaccharide (LPS) and chemotaxis peptide N-formyl-methionine-leucine-phenylalanine (fMLP) as stimulants, was assessed by the expression level of CD11b and CD66b, IL-1β, IL-6 and IL-8, the level of phosphorylation of glycogen synthase β-kinase-3β (GSK-3β). Annexin V and propidium iodide were used to assess apoptosis. Neutrophils were exposed to 0.5, 1 and 1.5 MAC of sevoflurane to assess the effect of the drug on their activation.Results. Incubation of neutrophils with LPS and fMLP statistically significantly increased the expression of these molecules: treatment with LPS at the dose of 200 ng/ml increased CD11b and CD66b expression by 2.3 and 2.2 times (p = 0.002 and p = 0.001, respectively), while treatment with fMLP at 100 nM increased expression by 1.7 and 2.0 times (p = 0.025 and p = 0.03, respectively). When neutrophils were incubated with the same concentration of LPS after exposure to sevoflurane at a dose of 1.5 MAC, the level of CD11b and CD66b expression increased versus intact neutrophils. In this experiment, the change in CD11b expression was statistically insignificant (p = 0.055), the change in CD66b expression was statistically significant (p = 0.007). Thus, sevoflurane exposure at a dose of 1.5 MAC reduces proinflammatory activation of neutrophils induced by LPS.Conclusion. Stimulation of neutrophils by LPS was accompanied by dephosphorylation of GSK-3β, and exposure to 1.5 MAC of sevoflurane resulted in its phosphorylation. Thus, phosphorylation of GSK-3β in neutrophils by sevoflurane reduces the expression of CD11b and CD66b.

The aim is to study the current aspects of resident training in anesthesiology and intensive care. The article focuses on the theoretical training of residents, the importance of a thorough knowledge of pathophysiology, and the formation of clinical thinking. Opportunities for the use of innovative educational computer technologies in residency training are shown. A consistent interdisciplinary pedagogical interaction makes it possible to improve the outcomes of residency training by achieving the main goal of developing a physician who has acquired universal, general and specific professional competences and is capable of providing high-quality medical care.

The aim of the study was to determine experimentally the effect of hemodilution by the 2:1 sterofundin/gelofusine (SG) solution on hemostatic parameters in vitro and in vivo.Material and methods. Experiments were carried out on 75 male Wistar rats weighing 270–380 g and anesthetized with intramuscular tiletamine-zolazepam (40 mg/kg) + xylazine (10 mg/kg). Animals were divided randomly into 4 groups: Group 1 — in vitro 25-percent dilution of carotid blood samples by the SG solution (n=12), Group 2 — in vitro 37.5-percent dilution of similar samples (n=11), Group 3 — in vivo 25-percent dilution (n=10), Group 4 — the controls (n=42) with no dilution. The first stage of the study compared the in vitro dilution groups with the control group and with each other; the second stage compared the in vivo dilution group with the control group. The parameters of low-frequency piezoelectric tromboelastography (LFPTEG), clotting tests and complete blood count were studied to evaluate the effect of hemodilution.Results. At a 25-percent hemodilution with 2:1 CG solution in vitro and in vivo, the hemostatic parameters retained within the reference limits, but a trend to increased intensity of the enzymatic reactions of the coagulation cascade and a significant increase in clot polymerization in vitro due to relative anticoagulant deficiency became evident. In vitro 37.5-percent blood dilution significantly reduced the blood level of fibrinogen and platelet count, inhibited the intensity of the proteolytic stage of coagulation, reduced the clot density at the T3 gelation point, at 5 minutes after reaching it and the maximum amplitude (MA) of the LFPTEG curve, as well as significantly reduced anticoagulant activity of the blood. The observed changes in hemostatic parameters were significantly outside the reference limits, which may affect the interpretation of the experimental results and be clinically important. We found negative correlation between clot density and platelet activity at 25-percent dilution in vivo, whereas at 37.5-percent dilution in vitro an additional positive correlations between platelet count and fibrinogen levels were determined.Conclusion. A 25-percent hemodilution with 2:1 CG solution should be considered «safe» for the in vivo hemostatic system providing minimal effect on the in vitro parameters in the exper-iment.

The aim of the study was to identify the role of cytokine storm in COVID-19, that emerged at the end of 2019, based on the analysis of 80 publications, including 17.4% Russian and 82.6% foreign publications for 2014–2020 with an average impact factor of 11.94 and a maximum of 74.699. This review includes an in-depth discussion of the possible causes and pathogenetic factors of cytokine storm syndrome development caused by COVID-19. The results of research on the use of various principles of cytokine storm correction are provided. It has been established that lung damage and the development of a fatal outcome are caused not by the virus itself, but by the hyperreaction of the body's immune system. The leading role in this process belongs to the cytokine storm, including the action of IL-6.

The aim of the work is to study the antibacterial and antimycotic properties of carbon sorbents modified with biologically active substances in relation to pathogens of purulent-inflammatory diseases. Material and methods. The activity of modifier solutions and modified samples of carbon sorbents was studied in relation to test strains of opportunistic microorganisms in comparison with the initial sample of carbon sorbent. A suspension with a known content of microbial cells was prepared from test strains of microorganisms; it was incubated in wells with test samples for 48 hours. The survival of microorganisms was determined by quantitative inoculation from each well of the sample and microorganism mixture at regular intervals of incubation on Petri dishes with simple agar nutrient, then the number of viable microbial cells in the test mixture was counted. Results. Studies have shown high antibacterial and antimycotic activity of modified carbon sorbents. The best result in comparison with the initial sample was demonstrated by a carbon sorbent modified with lactic acid oligomers and immobilized lysozyme. Studies have shown the promise of using modified carbon sorbent samples for the application therapy in bacterial infections.

The review analyzes possible epidemiological and molecular mechanisms responsible for hyperinflammation in patients with the severe course of COVID-19.Results: it highlights the similarities between this condition and hyperferritinemic syndrome which allows considering pathogenesis of COVID-19 with the direct involvement of iron metabolism. In the case of COVID-19 infection of moderate severity and especially in its severe forms, it is indicated to use of iron chelators and other methods of free iron elimination.

The aim is to study the effectiveness of lithium chloride for preventing damage to the monolayer of endothelial cells in vitro exposed to serum of patients with septic shock.Material and methods. Serum samples prepared from blood of 5 septic shock patients selected according to «Sepsis-3» criteria and 5 healthy volunteers (control serum) were used in the study. Blood for experiments was withdrawn within 2 hours after the diagnosis of septic shock. The Ea.hy926 endothelial cells were incubated with the serum of a patient with septic shock (toxic serum) or control serum for 3 hours at 37°C without or with lithium chloride at final concentrations of 0.01 mmol/l, 0.1 mmol/l, 1 mmol/l, 10 mmol/l. Lithium chloride was added 1 hour before the serum change. After incubation, the expressions of actin, VE-cadherin and claudin were assessed by immunofluorescent microscopy; the level and degree of phosphorylation of glycogen synthase kinase 3/1 (GSK-3/3) were determined using western blotting.Results. Toxic serum significantly inhibited GSK-3/3 phosphorylation, induced cleavage of VE-cadherin and reduced the claudin inendothelial cells. Toxic serum also altered the shape of endothelial cells: they lost their native polygonal shape and became elongated with gaps between them. Incubation of endothelial cells monolayer with lithium chloride at concentrations equal or higher 1.0 mmol/l almost completely prevented cleavage of claudin, actin and VE-cadherin. When studying the in vitro protection of endothelial cells from effects of toxic serum with lithium chloride, pre-incubation with the drug at a concentration of 1 mmol/l for 1 hour prevented inactivation (dephosphorylation) of GSK-3/3 and even to stimulate its phosphorylation in 1-4 hours after exposure to the serum.Conclusion. The study clearly showed the protective effect of lithium chloride on endothelial cell monolayer by activating phosphorylation of GSK-3/3 (enzyme conversion into inactive form). Moreover, the effect of lithium chloride exhibited a distinct dose-dependent character starting with a concentration of 0.01 mmol/l.

Results of the microbiological bench testing of antibacterial and antimycotic activity of the carbon sorbents modified with lactic acid oligomers are presented. It was found that the studied microorganisms - Staphylococcus aureus, Staphylococcus epidermidis, Streptococcus agalactiae, Enterococcus faecalis, Pseudomonas aeruginosa, Streptococcus pyogenes, Klebsiella pneumonia, and Escherichia coli - are resistant to the majority of antimicrobial preparations that are widely used nowadays in clinical practice for treatment of bacterial and mycotic infectious diseases. Antimycotic effect of the modified sorbents toward yeast-like fungi Candida albicans was revealed. It was established for the first time that the modified sorbents have pronounced antimicrobial properties toward associative bacterial-fungal culture S.aureus + C.albicans, especially the carbon sorbent that was modified with a 50% lactic acid solution with subsequent polycondensation.

The aim of the study was to investigate the role of immune disturbances in development of postnecrotic pseudocysts of the pancreas. 94 patients including 74 with postnecrotic pancreatitis and pseudocysts of the pancreas were observed. The adaptive reactions and subpopulation composition of the peripheral blood lymphocytes were assayed. The percentage of the cells in the state of apoptosis in the cyst content was estimated. The disturbances in the subpopulation composition of the lymphocytes and stress adaptive reactions of the blood system were shown to be some of the main pathogenetic factors in development of postnecrotic complications of pancreatitis. The data are useful in differential diagnosis of pseudocysts and choice of the optimal tactics in the operative treatment of such patients.

Purpose — to carry out a comparative assessment of inflammation based on evaluation of intraoperative and early postoperative dynamics of blood serum cytokines in pulmonary malignant neoplasm patients in different anesthesia and analgesia settings.Material and methods. 24 patients of 45 to 50 years of age divided into 2 groups were examined. All patients suffered from verified new onset malignant neoplasms without true signs of metastases. Tumor differentiation by morphology was not undertaken since that was beyond the study design. Patients did not receive radio- or chemotherapy. In Group I (the main group, n=12), a multimodal combined anesthesia [1] followed by extended postoperative epidural analgesia was applied. In Group II (the comparison group, n=12), a combined general anesthesia including mechanical lung ventilation followed by morphine analgesia was used. 4 study points were determined: prior to induction, and one, 12, and 24 hours post-surgery.Results. 12 hours after surgery completion, the concentration of TNFα in the main group was lesser by 57.1% vs. the comparison group; by the end of the first 24 hours, it fell down by 64.3%. Within the same period, in both groups IL-6 turned out to be significantly higher than the upper reference limit. By the end of the first 24 hours, IL-6 tend to decrease in both groups; however, in the comparison group, this parameter was 15% higher than in the main group. Serum IL-10 was within the reference range in both groups. One hour after surgery, concentrationof IL-10 was exponentially growing in both groups and exceeded multifold the upper reference limit, whereas the content of IL-10 in the main group remained reliably higher: the difference amounted to 35.6% percent.Conclusion. During the postoperative period, patients undergone lung resection displayed significant changes in cytokines concentrations demonstrating an inflammation reaction. Inflammation was significant in patients who received epidural analgesia as evidenced by an altered content of anti-inflammatory cytokines.

The purpose is to study antibacterial and antimycotic properties of produced granular carbon sorbents. Material and methods. A VNIITU-1 carbon sorbent was used as a starting material, which was modified with polyvinylpyrrolidone and lactic and glycolic acids oligomers. Microbiological bench tests were carried out to determine the antibacterial and antimycotic activity of these granulated carbon hemosorbents. Antibacterial properties of sorbents were studied in relation to pathogenic and conditionally pathogenic microorganisms: Staphylococcus aureus, Pseudomonas aeroginosa, Klebsiella pneumonia, Escherichia coli, Streptococcus agalactiae as well as their mixtures: mixture No. 1 — S. aureus and E. coli; mixture No. 2 — S. aureus and P. aeruginosa. Results. Presented data demonstrate that the modified VNIITU-1 exhibits significant antibacterial and antimycotic activity against most of the studied microorganisms compared to original sorbent. Conclusion. Modified sorbents as antimicrobial and detoxifying drugs may further be employed in treatment of obstetrical-gynecological and surgical diseases. The carbon sorbents are promising materials for medicine, as they expand the potential of sorption therapy in clinical practice.

Purpose. To evaluate pathogenic factors contributing to the development of delayed complications of newly diagnosed acute destructive pancreatitis (ADP).Materials and methods. A comprehensive examination, treatment and 5-year follow%up of 83 patients who underwent the first attack of ADP have been conducted. The day of admission to the hospital, 24 hours from the beginning of the intensive care, and Days 3 and 5 after the attack were selected as the timepoints of the study. Complete diagnostic procedures were performed once every six months after hospitalization for five years. The patients were followed%up every month. Depending on the further progression of ADP, the patients were divided into four groups. Group I included 27 patients with acute pancreatitis which evolved into pancreatic pseudocysts.Group II (n=43) was comprized of the patients with chronic pancreatitis; group III (n=8) included the patients who presented no pathological processes associated with structural and functional pancreatic changes over the next 5 years; and group IV (n=5) included the patients with pancreatogenic diabetes mellitus.Results. The study confirmed the role of autoimmune mechanisms and abnormal foci localization in pancreas in the development of pancreatogenic diabetes mellitus, contribution of inflammation to formation of post-necrotic pancreatic pseudocysts, as well as the significance of the patient compliance for development of chronic pancreatitis with extensive pancreatic lesions.Conclusion. Statistical analysis of the long-term monitoring of patients allowed to set the odds ratio evolution acute pancreatitis depending on its initial characteristics. At the same time we take into account the parameters and interpretation of the study which is possible in the first few days hospitalization.

Objective. To prove pathogenically the reasonability of multimodal anesthesia in patients with lung cancer to improve the efficacy of pain management.Materials and methods. 74 patients (59 men and 15 women) aged 46 to 60 years with lung cancer were examined and treated. 42 patients (the main group) underwent surgery under multimodal anesthesia accompanied with epidural blockade, and 32 patients (the comparison group) were subjected to a surgical intervention under inhalation and intravenous anesthesia with mechanical ventilation. The surgeries including atypical lung resection, lobectomy and pneumonectomy were performed. In preoperative, intraoperative and early postoperative periods, the systemic hemodynamics parameters were determined; adrenaline, noradrenaline, dopamine, cortisol, insulin and glucose were measured in plasma, and acidbase balance parameters — in arterial blood. Pain intensity was assessed by the visual analog scale. Data processing was carried out using Microsoft Exсel 2000, STATISTICA6.0 and Biostat software. Normality of distribution was assessed by KolmogorovSmirnov test. Since the ordered sample did not follow the normal distribution law, the data are presented as a median (Me) and interquartile amplitude (25 and 75 percentiles).Results. It has been found that the most significant pathogenic factor in patients being operated due to lung cancer under the standard anesthesia is the expressed activation of the sympathoadrenal system due to the impact of surgical stress. This is manifested by disorders of the central hemodynamic parameters, such as metabolism, nociception and oxygen balance. In surgeries carried out under multimodal anesthesia, the minimal changes of basic homeostasis parameters are registered; these changes are shorttermed, compensated and reversible. Pain syndrome upon completion of surgery and in the early postoperative period is either absent or mild.Conclusion. It is more expedient to perform surgeries to remove malignant tumors in the lungs under the multimodal anesthesia, because these interventions are distinguished by high traumatic rate and having a «fine line» between compensation and decompensation of the basic vital functions in the perioperative period.

Objective: to investigate the severity of the stress response of the organism during surgery on the colon because of a tumor by determining the level of stress hormones and glucose depending on various types of anesthesia.Materials and methods. Patients who have undergone resection surgery because of the colon malignancy were divided into two groups: the study group (n=57) and comparison group (n=35). In the study group a multimodal anesthesia was performed that included a shallow sympathetic blockade in combination with surface inhalation anesthesia. In the comparison group inhalationintravenous anesthesia was performed on the basis of systemic administration of fentanyl when accompanied by myoplegia and sevoflurane insufflation. The levels of insulin, epinephrine, norepinephrine, dopamine, cortisol and glucose in serum were eavaluated during three periods of the study: prior to the induction of anesthesia, at the traumatic moment of operation and at the end of the surgery. Statistical hypothesis testing was performed using nonparametric methods and the data were processed with the aid of Statistica 6 software. Results. A significant increase of the level of cortisol and serum catecholamines was observed in comparison group during the 2nd and 3rd stages. In the study group, these indicators did not exceed standard values. Insulin level was higher in the study group during the 1st and 2nd stages compared to the comparison group. Insulin level at the end of the surgery was lower in the study group. The glycemic profiles were almost identical with hyper glycemia trend in the comparison group.Conclusion. Multimodal anesthesia provided most protective effect against stress during traumatic surgeries. The ratio of glucose and insulin values in groups demonstrate the capability of a multimodal anesthesia to prevent postoperative insulin resistance.

Objective is to identify the pathogenic factors for progression of pancreatogenic cardiac failure in the nearest and remote periods.Materials and methods. The study was carried out on 130 male Wistar rats (292±4.0 g) divided into 4 groups. The animals were anesthetized with ethyl ether. Acute destructive pancreatitis was simulated in three experimental groups by infusion of bile (0.15 ml/kg body weight) taken from the bile duct into the pancreatic tissue. The isolated isovolumically contracting rat heart (according to E. L. Fallen et al) was simulated 24 hours, 7 days and 1 month after the bile infusion. The pressure in the left ventricle was measured by electric manometer BMT and registered along with the first derivative at the device N3384P calculating the systolic and diastolic blood pressure, and the speed of contraction and relaxation. At the same time the perfusate samples passed through the coronary arteries were har vested, and aspartate aminotransferase (AST) and glucose were determined by standard methods. To identify the cardiac depression, the high contraction rhythm and hypercalcemic and hypoxic perfusion were applied.Results. It was found that in acute destructive pancreatitis the power and speed parameters of the heart con tractile function were altered that led to lowering the systolic blood pressure and velocity of contraction and relax ation of the left ventricular myocardium and increased diastolic blood pressure as an indicator of cardyomyocyte contracture rate. These abnormalities were evidently manifested in increased heartbits, including hypercalcemic and hypoxic perfusion of the isolated hearts. Glucose consumption was raised per each mmHg generated by the ventricular pressure.Conclusion. the most significant pathogenetic factors of pancreatogenic heart failure include hypoxia, car diomyocyte membrane destruction, inhibition of sarcolemma Capump, sarcoplasmic reticulum, and mitochondrial dysfunction. The maximum depression of myocardial contractility of the left ventricle is detecting during the first day and in a month after simulated pancreatic necrosis.

Objective: to develop a technology for obtaining the molded sorbent VNIITU1, to study its physicochemical and biomedical properties, and to evaluate its efficacy in preventing and treating pyoinflammatory complications in obstetrics.Materials and methods. The molded sorbent VNIITU-1 was designed from the carbon porous material based on nanodispersed carbon by mixing with a vehicle, extruding the mixture, drying the extrudate in an inert atmosphere, thermally treating and activating by steam, followed by washing with distilled water and drying (TU 9398043710698342013). The molded sorbent VNIITU-1 is apyrogenic and nontoxic (Toxicity Study Conclusion No. 1998.013.P dated 14.08.2013; Engineering Testing Assessment No. 12.404 ORTI/2013 dated 26.08.2013), it is destined for single administration, sterile, placed in a removable thread capron mesh container, and used to treat and prevent pyoseptic complications in puerperas at risk for infection, such as acute nonspecific postpartum endometritis. A total of 52 puerperas were examined and treated. They had been divided into 2 groups: a study group (n=37) and a comparison group (n=15). In the study group, the hemosorbent VNIITU1 as a porous carbon applicator was postpartum inserted into the uterine cavity, by concurrently performing traditional antibiotic therapy to prevent infectious complications. The comparison group received only traditional antibiotic therapy. The uterine cavity aspirate was examined for IL1β and IL6 levels, its microbial profile, and microbial growth patterns in culture media. The data were processed using a package of applied STATISTICA6.1 programs and standard mathematical tables in Microsoft Excel. Descriptive and variation statistical methods were applied. The data were presented as Me [low quartilehigh quartile (LQHQ)]; two pre and posttreatment dependent variables were compared using the Wilcoxon and Mann-Whitney tests.Results. The molded carbon sorbent VNIITU1 was found to have pronounced antibacterial activity against S.aureus, P.aeroginosa, K.pneumonia, E.coli and S.agalactiae. Examination of lavages from the surface of the sorbent after its removal from the uterine cavity, by using a transmission electron microscope, revealed castoff epithelial cells, leukocytes, macrophages, and microorganisms, which determines the capacity of the sorbent to eliminate not only soluble toxins, but also microorganisms and disintegrating cell elements. Conclusion. The proposed procedure to postpartum endometritis in puer peras at risk for infection via insertion of the porous carbon applicator VNIITU1 into the uterine cavity is more effective than the traditional approach and it can improve treatment results, by completely eliminating pathogens from the uterus and by reducing the level of local proinflammatory cytokines.

Objective: to estimate the significance of capillary blood oxygen parameters for the prognosis of longstanding hemodynamically significant patent ductus arteriosus (HSPDA) in extremely low birthweight (ELBW) neonates. Subjects and methods. On day 8 of their life, two groups of ELBW newborn infants with and without HSPDA were examined for capillary blood рН, рkО2, %SO2с, O2ct, АkDO2, and RIk, as well as mechanical ventilation (MV) parameters (Pip, MAP, and FiO2). Comparison of two independent samples used nonparametric statistical tests: MannWhitney test, Wald Wolfowitz test, and Kolmogorov-Smirnov test. A logistic regression analysis was used to assess the relationship between the examined parameters and the presence or absence of HSPDA. ROC curves were constructed, by choosing the cut-off point, to estimate the predictive power of the model developed using logistic regression. Results. The developed model has high sensitivity and high specificity (84,6 and 97% respectively). The logistic regression equation takes the form: -0.479•О2сt+0.708•Pip-6.823. Conclusion. Capillary blood oxygen parameters proved suitable for predicting the duration of HSPDA functioning. The resultant good predictive power of the model developed for day 8 of life points to the fact that this period is critical from the viewpoint of resolution of respiratory distress syndrome or development of bronchopulmonary dysplasia, which is crucially significant for MV duration and further prediction. HSPDA is one of the most important factors contributing to the development of bronchopulmonary dysplasia in ELBW neonatal infants.

An analysis of treatment results was made in 26 patients with postnecrotic cysts of different degree of maturity. The laparotomy with trans-gastral cystogastrostomy on the external drainage were performed on 11 patients. A new modified operation underwent 15 patients. This operation was transgastric cystogastrostomy on the external drainage from mini-access, which was developed in 2011. The laparotomy of 4-5 cm was made in pseudocyst projection of the pancreas using a standard set of tools «mini-assistant». Postoperative period have passed without complications in all the patients. The drainage was removed on 30-40 days of postoperative period. The terms of hospital stay reduced from (14,4±0,9) bed/ days to (10,8±0,5) bed/days due to application of proposed method of treatment.

Objective: to reveal aortic structural changes in the recovery period after longterm hemorrhagic hypotension and further blood reinfusion.Material and methods. Two (control and experimental) series of eexperiments were carried out on 10 out bred albino male rats in each. The animals were anesthetized with sodium thiopental (25 mg/kg). Sixtyminute hemorrhagic hypotension (40 mm Hg) was induced by left common carotid artery catheterization, followed by blood reinfusion and wound closure. The animals were observed for 60 days, thereafter thoracic and abdominal aortic fragments were taken. The histological sections were stained with hematoxylin and eosin by the methods of Van Gieson, Verhoeff, and Veigert. Morphometric and histometric parameters, including the percentage of layers in the vascular wall and transmission capac ity coefficients, were determined.Results. The thoracic and abdominal aortic sections have been found to differ in morphometric parameters, which determined their different hemodynamic conditions in critical conditions. Hypertrophy of the media of the abdominal aorta due to thickening of the smooth muscle layers suggests that there are remodeling processes in its wall, which is accompanied by a smaller number of elastic membranes and by the expression of сollagencontaining structures after massive blood loss. For the thoracic aortic segment, such changes are manifested by a decreased medial area, a considerable advential thickening, and a drastic fall in transmission capacity coefficients.Conclusion. The found morphometric characteristics of different aortic segments should be considered as the basis for longlasting adaptation, which can supply blood to the vital organs as efficiently as possible in late recovery periods.

Abstract. Immunological characteristics of phagocytic activity and cellular immunity are presented for 112 patients with acute destructive pancreatitis with suppurative complications (group I), versus non-septic cases. We evaluated lymphocyte subpopulation profiles, phagocytic activity of leukocytes, serum levels of interferon-γ and circulating immune complexes. A mixed-type secondary immune deficiency was shown to develop in pancreatic necrosis. Distinct signs typical to immune deficiency, as well as lack of cellular immune potential were evident as soon as by day 3 of the disease.

Objective: to evaluate the efficiency of therapy for massive obstetric hemorrhage, by applying thromboelastography (TEG). Subjects and methods. Sixty six patients with massive obstetric hemorrhage who were divided into two groups: a study (A; n=37) and comparison (B; n=29) groups were examined. A control group (C; n=30) comprised women with physiological blood loss during labor. The efficiency of TEG was evaluated from the volume of blood loss and the frequency of hysterectomy.Results. Fibrin clot density, MA have the highest prognostic capacity to identify the risk of massive obstetric hemorrhage [AUC=0.83 (95% CI 0.79—0.87); р=0.001]. A therapeutic and diagnostic set for massive obstetric hemorrhage, by applying TEG, can reduce the number of hysterectomies by 3. 1 times (p=0.02), the volume of blood loss by 1.3 times (p=0.03), and the use of fresh frozen plasma by 2.0 times (p=0.01). Conclusion. Rapid evaluation of the blood coagulation system, by using a TEG® 5000 device (Haemoscope Corp., USA) makes it possible to perform timely pathogenetic sound therapy, to prevent a critical condition, and to implement organ-sparing tactics.

Objective: to evaluate the effect of glutamine on functional and morphological changes in the liver and small bowel in the posttraumatic period of cardiac contusion.Material and methods. An experimental model of isolated cardiac contusion was used to investigate the activity of amylase from all small intestinal segments and that of alanine aminotransferase (ALAT), γ-glutamyl transferase (γ-GT), and cholinesterase (CE) in the rat serum over time during the posttraumatic period without correction, as well as during the enteral use of glutamine. Light microscopy (hematoxylin and eosin staining) was employed to evaluate the effect of glutamine on morphological changes in the small bowel (proximal, middle, and distal segments) and liver of experimental animals in the posttraumatic period of cardiac contusion.Results. The injured animals receiving glutamine versus those without correction showed a decrease in the activity of some desorbed γ-amylase fractions, ALAT, and γ-GT and an increase in the activity of CE in different posttraumatic periods of cardiac contusion. The small intestinal morphological pattern was characterized by the absence of signs of stasis, marginal neutrophil standing, and undamaged intramural nerve ganglia. The liver specimens from the animals receiving glutamine exhibited reduced necrotic area sizes and the absence of protein precipitates in the vessels and fatty dystrophy.Conclusion. Small intestinal and liver functional and morphological improvements due to the use of glutamine in experimental cardiac contusion suggest that the amino acid is involved in the metabolism of hepatocytes and enterocytes and give grounds to consider it to be a protector of extrathoracic organs in blunt cardiac injury.

The investigation was dedicated to the exploration of reamberin influence on oxidative stress and metabolic disturbances in 64 patients with abdominal sepsis. The authors used reamberin for correction of oxidative processes and metabolic disturbances for treatment of the patients with abdominal sepsis. The authors registered that reamberin improved the oxygen-transport function of the blood and metabolic processes during the abdominal sepsis via the hybernation condition — a form of adaptive reaction of organs and systems during the endotoxemia for creation of more effective environment for functioning of main organs and the whole organism. The authors show that the main pathogenetic mechanisms for multiorgan dysfunction are metabolic disturbances and energy deficiency in organs and systems with subsequent tissue hypoxia.

Comparative retrospective study of emergency care rendering results for 1200 patients with uncomplicated fibrillation attacks was carried out and their management tactics clinic-economic assessment at a pre-admission stage was done. It has been found that therapy for atrial fibrillation is unproductive in the first hour of observation at a pre-admission stage. Atrial fibrillation attack was eliminated to the end of the first day regardless of used antiarrhythmic preparation in more than 90% of the cases. Proposed management tactics for patients with uncomplicated atrial fibrillation attacks until 24 hours of duration at a pre-admission stage allows by cost lowering and clinical effect of conducting antiarrhythmic therapy maintenance to shorten an emergency team stay time and increase its operative turnover.

Chair of Pathologic Physiology with Clinical Pathophysiology Course of the OmskStateMedicalAcademyhas celebrated its 90th anniversary with the latest achievements in the pathogenesis of postresuscitation disease. Experimental resuscitation model exploited by the staff of the Chair is allowed to extend knowledge in respect to the nature of hemodynamic disorders, endogenous toxemias, functional and metabolic aspects of hypoxia and reoxygenation in terminal and critical states including other significant problems of the pathology. The Chair of Pathologic Physiology is going on with the scientific inquiries in close collaboration with the Clinical Chair of the Academy and Research Units of Russia.

Problem of diagnosis and treatment of patients with necrotizing pancreatitis is an urgent. So it is interesting to study the effectiveness of a multicomponent antihypoxant and antioxidant cytoflavin to reduce violations of the detoxifying properties of the liver in experimental pancreatitis and reduce the severity of pancreatic endotoxemia. Pancreatic modeled by introducing into the pancreas of autobile in a dose of 0,15 ml/kg. Cytoflavin was injected into animals of a comparison group in a dose 0,21 ml/kg in 5 minutes after the model of pancreatic necrosis. We determined the activity of enzymes: alanine transaminase, amylase, and gamma glutamyltransferase, the content of direct bilirubin, glucose, and urea. After modeling of pancreatic necrosis in two days, there are signs of acute liver failure, as evidenced by the differences in the studied parameters of blood and hepatic portal vein: increased alanine transaminase and gamma glutamyltransferase, the change in concentration of metabolic products, such as direct bilirubin and urea. In addition, decreased glucose levels. Introduction of cytoflavin approached the control values the basic biochemical parameters of liver function: decreased hyperenzymemia, exchange function of the liver was restored, which is probably due to antihypoxic, membrane and antioxidant effects of the drug.

Aim. To perform a retrospective comparison of pre-admission emergency care tactics and outcomes in patients with uncomplicated atrial fibrillation (AF) episodes. Material and methods. In total, 1200 cases of pre-admission emergency care in AF patients were analysed, using the ambulance call forms, polyclinics medical cards, and hospital case histories. The emergency care outcomes were compared for the patients who were not hospitalised and those were admitted to the hospital within 1, 12, or 24 hours. Results. The pre-admission emergency care in patients with uncomplicated AF was not effective within the first hour of the follow-up. In over 90% of the cases, AF episode was resolved within 24 hours, regardless of the emergency care tactics or the antiarrhythmic drug used. Inadequate ventricular rate reduction at the preadmission stage was associated with a longer AF episode duration and an increased chance of hospitalisation. Conclusion. The tactics of pre-admission emergency care in uncomplicated AF episodes lasting under 24 hours should primarily address the reduction of ventricular rate. The strategy of obligatory hospitalisation of all ambulanceattended uncomplicated AF episodes which lasted less than 24 hours is not just

The effectiveness of urgent medical care was retrospectively compared in 662 patients with atrial fibrillation (AF) paroxysms, arterial hypertension, and coronary heart disease; in addition, pre-hospital treatment tactics was evaluated. Prehospital AF treatment was minimally effective in the first hour of the follow-up. The majority of the AF paroxysms (>92%) were resolved within the first 24 hours, regardless of the main pathology. The authors propose the pre-hospital treatment tactics for patients with persistent AF paroxysms lasting up to 24 hours. This tactics gives an opportunity to reduce costs and the time spent on urgent medical care visits, therefore, increasing the capacity of urgent medical care service.

The myocardial function has been studied in 30 patients in the acute phase of acute coronary syndrome, ACS (19 and 11 individuals with and without ST segment elevation, respectively). Electrocardiography and tetrapolar integral rheography were performed at Days 1-2, 5-6, and 15-20. It was demonstrated that ACS with ST elevation was associated with reduced myocardial functional reserve and activation of adaptive mechanisms supporting adequate blood flow. ACS without ST elevation, due to the less severe myocardial injury, was characterised by the activation of cardiac compensatory mechanisms preventing heart failure progression. Extracardiac compensatory mechanisms were involved to a lesser extent.

In 263 patients with atrial fibrillation lasting for 0,5–30 hours, pre-hospital antiarrythmic therapy (cordarone 5 mg/kg, verapamil 5–10 mg) was ineffective in the first hour. Sinus rhythm was restored in 8,8% and 11,5% of the patients receiving cordarone and verapamil, respectively. The majority of atrial fibrillation paroxysms were terminated in the first 24 hours (>90%). Cordarone and verapamil were equally effective in pre-hospital treatment of atrial fibrillation. Verapamil reduced ventricular rate more effectively.

To improve the results of conservative treatment of patients with afterburn hypertrophic and keloid cicatrices, 245 patients up to 65 years old having afterburn cicatrices of various area and localization have been examined and treated. In 153 patients, cicatrices were treated using traditional medicines (1% hydrocortisone ointment or Kontraktubex gel), while 92 patients were treated by phonophoresis with verapamil ointment. Clinical-morphological investigations have shown that in patients treated by phonophoresis with verapamil ointment the earlier structural maturation of cicatrix, normalization of pain sensitivity, and more complete removal of afterburn contracture were observed.

Objective: to reveal the mechanisms of changes in the antioxidative defense system of the lymphocytes, spleen and thy-mus in severe brain injury.Materials and methods. Experimental studies were performed on 257 nembutal (40 mg/kg)-anesthetized noninbred male albino rats weighing 200—230 g. Severe mechanical injury was simulated by the Noble-Collip procedure. The activity of superoxide dismutase, catalase, glucose-6-phosphate dehydrogenase, and glutathione reductase and the level of reduced glutathione were determined in the peripheral blood lymphocytes, spleen, and thymus within 30 posttraumatic days.Conclusion. The specific features of changes have been revealed in the activity of antioxidative enzymes in the lymphocytes and organs of immunogenesis: there is a preponderance of discoordination in the antiperox-ide system of peripheral lymphocytes and in the antioxidative defense system of lymphoid organs. The posttraumatic inactivation of the enzymes is associated with their baseline levels: the higher activity of an enzyme is seen in the lymphocytes of a healthy organism and accordingly its implication in the inactivation of excess products of free radicals, the more significant reduction is in its activity in injury. The abnormal changes in the metabolic resource of the lymphocytic antioxidative system, occurring in the early stages of traumatic disease, persisted within 3 weeks and they tended to normalize only by day 30. The impaired enzymatic activity in the lymphoid cell antiradical and antiperoxide defense accounts for the diminished functional capacities of the immune system in the posttraumatic period. The duration of inhibited activity of antioxidative enzymes, which determines the rate of lipid peroxidation processes of lymphocytes and immunogenesis organs, induces prolonged immunodeficiency in the posttraumatic period.

Objective: to study the effects of hypoxen on the myocardial contractility of rats with severe brain injury (BI).Materials and methods. Experiments were made on 69 male albino rats, by using the isolated isovolumetrically contracted heart procedure as described by E. T. Fallen et al. Post-BI cardiac functional reserves were estimated by a hypoxic test, followed by reoxygenation and a high-frequency rhythm load.Results. The intraperitoneal injection of hypoxen in a dose of 60 mg/kg one and 24 hours before severe BI contributed to increases in the rates of left myocardial contraction and relaxation in the injured rats. There was an increase in the resistance of the hearts in the animals receiving the drug before or after injury to hypoxia-reperfusion and high-frequency rhythm loads. The administration of the drug to the animals not only sustained the reserves of antioxidants, but even increased their blood levels.Conclusion. The results of the experiments using hypoxen confirmed the significance of pathogenetic factors, such as hypoxia and oxidative stress, in the development of posttraumatic myocardial contractile changes.

Objective: To evaluate the efficiency of extracorporeal hemocorrection used in the complex therapy in patients with a pyoinflammatory process in the lung.Materials and methods: 62 patients, including 22 patients with lung abscess who underwent routine plasmapheresis and 40 patients with varying pyoinflammatory lung diseases who received modified hemocorrection — plasma exchange combined with laser extracorporeally washed-off cytomass irradiation, were examined and treated. The severity of their general condition was assessed by the SAPS scale and the severity of intoxication was evaluated by the content of low and medium-molecular weight substances (LMMWSs). The hemostatic system was studied by standardized studies.Results. Routine plasmapheresis was established to produce no impact on platelet functional activity within the first 24 hours and, three days later, promoted the progression of disseminated intravascular coagulation. A combination of plasma exchange and laser extracorporeally washed-off cytomass irradiation in patients with pyoinflam-matory lung diseases was attended by a lower blood coagulative activity and plasmin stabilization with attenuated throm-binemia. The plasma and erythrocytic levels of LMMWSs decreased and their urinary concentrations increased, which is indicative of the body’s detoxification block disorders irrespective of the severity of the disease.Conclusion. It is expedient to apply the plasma-exchanging technique in combination with laser extracorporeally washed-off cytomass irradiation to patients with the uncomplicated and complicated course of pulmonary pyoinflammatory processes without the signs of multiple organ dysfunction on admission to a specialized hospital.

Objective: to evaluate the efficiency of hydroxyethyl starch solution (6% refortane, Berlin-Chemie) versus fresh frozen plasma used to correct neonatal hypovolemia.Materials and methods. In 12 neonatal infants with hypoco-agulation, hypovolemia was corrected with fresh frozen plasma (10 ml/kg body weight). In 13 neonates, it was corrected with 6% refortane infusion in a dose of 10 ml/kg. Doppler echocardiography was used to study central hemodynamic parameters and Doppler study was employed to examine regional blood flow in the anterior cerebral and renal arteries.Results. Infusion of 6% refortane and fresh frozen plasma at a rate of 10 ml/hour during an hour was found to normalize the parameters of central hemodynamics and regional blood flow.Conclusion. Comparative analysis of the findings suggests that 6% refortane is the drug of choice in correcting neonatal hypovolemia. Fresh frozen plasma should be infused in hemostatic disorders.

Objective: To determine the regularities of iron metabolic disturbances and their impact on the hemostatic system in critically ill patients due to the severe course of generalized purulent peritonitis, acute pancreatitis, and thermal skin injuries. Materials and methods. In 36 patients with an APACHE II of 22.6±3.4 scores, endogenous iron metabolism was assessed by the level of serum iron, total serum syderopexy power, transferrin iron accumulation, ferritin concentrations, and free hemoglobin levels in blood; the antioxidative protective system, lipid peroxidation activity, and hemostatic parameters are studied. Results. There are general regularities in the hemostatic influence of the high concentrations of free hemoglobin and free radical oxidation products in critically ill patients due to generalized peritonitis, acute pancreatitis, or thermal skin injuries. In these patients, iron metabolism occurs with the overload of transporter proteins, such as transferrin and ferritin. Conclusion. Microcirculatory disorders as intravascular hemolysis and hemoglobin metabolism to ionized iron activate lipid peroxidation in the presence of excess Fe2+, which favors strain of the hemostatic system, by determining a tendency toward hypo- or hypercoagulation via the lowered activity of the platelets dependent on the state of free radical processes. Key words: ionized iron, transferrin, ferritin, lipid peroxidation, intravascular hemolysis, hemostasis.

The purpose of the investigation was to study cardiac contractility in different periods of posttraumatic period and myocardial resistance to oxygen and glucose in severe brain injury (BI).Materials and methods. Experiments were made on 140 male albino rats, by using the isolated isovolumetrically contracted heart procedure, developed by E. T. Fallen et al., 1, 7, and 30 days after injury.Results. Changes in the contractile function of the heart and its metabolism were recorded since day 1 post-BI and they mainly appeared at the stage of reoxygenation after the hypoxic test. The most significant disorders were detected on day 1 after BI in the group of animals with a poor posttraumatic period. Improvement in contractility force and velocity of the isolated hearts following 30 days of injury and in their metabolism was attended by decreased myocar-dial resistance to hypoxia and glucose deficiency.Conclusion. Severe BI is accompanied by depressed cardiac contractility and an increased relationship of the myocardium to the supply with oxygen and glucose, which may be associated with pathogenetic factors, such as hypoxia, impaired bioenergetics, oxidative stress, and Са2+ imbalance.

Experiments have been carried out with two kinds of laboratory animals: 27 rabbits of chinchilla breed with the age of 3—4 months and the weight of the body from 1740 to 2 290 grams (1 993,1 ± 243,2) and 49 white alley male rats with the weight of the body of 180—220 g (195,4 ± 27,3). As an infectious organism, the daily dredge hemolysinogen E. coli with colicinogenic factor Ca 38 was used. Roots of introduction of dredge E. coli were intravenous, transurethral, transcapsular in parenchyma kidneys, enteral and endotracheal (in rats). As the animals were infected through various entrance gates, three variants of acute infections of the uric system were obtained: purulent-destructive defeats, tubular-interstitial infringements and asymptomatic bacteriuria. High virulence of the urostrain E. coli , used in the experiment, is demonstrated. The hypothesis about the universal mechanism of infection of the uric system "from top to down", i.e. hematogenic, has been formulated.

The time course of changes in myocardial lipid peroxidation processes was studied in an experiment on albino male rats that had experienced 4-minute clinical death. There was an alternation of periods of a significant increase (minute 90, hours 3—6, and days 1—3 and 14) and a decrease (days 7, 21, and 30) in the rate of lipoprotein processes and corresponding changes in the content of lipid hydroperoxides and Schiff s bases. Activation of lipid peroxidation processes occurred with deficiency of bioantioxidants and with inhibition of enzymes that made antiradical and antiperoxide protection of cardiomyocytes.acute fatal hemorrhage; resuscitation; heart; lipid peroxidation

Objective: to study the incidence and pattern of cardiac arrhythmias and other abnormalities in the early posttraumatic period of experimental cardiac contusion and to assess their contribution to death and the development of posttraumat-ic myocardial dysfunction.Materials and methods: experiments were carried out on non-inbred albino male rats anesthetized with sodium thiopental. An electrocardiogram, respiration rate, and left carotid blood pressure were recorded in the direct fashion. Cardiac contusion was reproduced by an original device that imitated a blow of the steering wheel to the anterior chest, as that observed when a moving car clashed against an obstacle. Some animals were traumatized after preadministration of atropine sulfate.Results: sinus bradycardia accompanied by bradypnoea or short-term apnoea and lowered blood pressure is a compulsory and persistent ECG abnormality. Preinjection of atropine significantly prevents the occurrence of these changes and points to the likely reflectory mechanism of their development. Other ECG abnormalities (heterotopic rhythms, premature beats, conduction blockade, terminal ventricular complex changes, etc.) are encountered in a variety of combinations, including those among which typical changes that are undetectable, are diverse, short-term, and labile. Among them, there are virtually no hemodynamic and potentially fatal arrhythmias.Conclusion: in experimental isolated cardiac contusion, the pattern of cardiac arrhythmias differs from that observed in the inpatient setting. Cardiac arrhythmias and other ECG abnormalities do not make a considerable contribution to a mortality rate under the conditions of this experiment since there are no hemodynamic ones.

Twenty-four critically ill patients due to generalized purulent peritonitis, pancreatonecrosis, thermal skin injuries, and severe poisoning by acetic acid were examined. The general regularities of the effect of high serum iron concentrations on the health status of patients, on the activity of antioxidative enzymes, and on the initiation of lipid peroxidation (LPO) processes, as supported by the values of Fe2+-induced chemiluminescence, were revealed. In critically ill patients, iron metabolism occurs with the overload of a transport protein, such as transferrin, which is caused by intravascular hemolysis and hemoglobin metabolism to ionized iron. The overload of proteins responsible for iron transport leads to the tissue accumulation of free (ferrous and ferric) iron that is actively involved in the processes of LPO initiation with excess synthesis of cytotoxic radicals, which in turn accounts for the severity of endotoxicosis.

The paper estimates the hypoxic sensitivity of isolated isovolumetrically contracting hearts of non-inbred albino male rats experiencing 4-min clinical death from acute blood loss. In the early postresuscitative period, the inhibited contractility of the myocardium and its increased hypoxic sensitivity has been ascertained to be due to impaired bioenergetics and activated lipid peroxidation processes. A four-fold pO2 reduction in the Krebs-Henseleit solution causes a more rapid and more marked development of myocardial contractures and oxygenized solution-induced reperfusion brings about greater myocardial damages.

The purpose of the present study was to examine the pattern of acute intoxications and to analyze the causes of acute chemical injury in Omsk in the past 5 years. The patients referred for and admitted to the Acute Intoxication Center for acute chemical intoxication were qualitatively and quantitatively analyzed. The study has established that there was an increase in the number of patients referred for and admitted to the Acute Intoxication Center in the period of 2000 to 2004; the main causes of acute chemical injury being unintentional intoxications associated with alcoholization and ingestion of poisonous substances for suicidal purpose and a rise in the incidence of poisonings with narcotics. The study shows it expedient to elaborate a regional programme for the prevention of acute exogenous intoxications in the context of the region’s chemical safety jointly with drug addiction and psychiatric services.

The present study was undertaken to evaluate the informative value of the parameters reflecting the severity of endotoxi-cosis in the early postoperative period in diabetic patients with generalized purulent peritonitis. Sixty-six patients were examined and treated. A follow-up assessment of biochemical, immunological, and hemodynamic parameters has established that the serum level of procalcitonin, the level of leukocytosis, the immunoregulatory index, the content of circulating immune complexes, the scores of the SOFA scale, and minute circulatory volume are the most sensitive and specific markers of the severity of endotoxicosis. They show a low frequency of false-positive results, a high prognostic value of positive results, and a low prognostic value of negative ones.