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The objective was to determine the prognostic value of predictors of early postoperative cognitive disorders in traumatological patients to assess the development of the main clinical outcomes (postoperative delirium and delayed neurocognitive recovery).Materials and methods. A two-center prospective cohort observational study of patients aged 45–74 years after planned traumatological operations (endoprosthetics of large joints of the lower extremities, spinal fusion surgery, transpedicular fixation of vertebrae) under general anesthesia with tracheal intubation was conducted in the period from March 2021 to June 2022. Before the operation, demographic indicators, concomitant diseases, background therapy, laboratory tests and testing (ASA, MoCA, AUDIT, CFS, HADS-A, RASS). At the end of the operation after extubation and in the postoperative period, patients were analyzed according to the scales RUS, CAM- ICU and CAM-ICU-7, NRS and BPS. Statistical analysis was carried out using the software SPSS Statistics 27.0.1.0.Results. The study included 200 patients. Early postoperative cognitive disorders (ePCD) (agitation and emergence delirium (ED)) 61 (30.5%) patients were diagnosed, 139 (69.5%) patients had adequate awakening in the operating room. Independent predictors of the development of ePCD were the age of patients (≥ 60), glucose level ≥ 5.6 and a high score on the Clinical Frailty Scale (≥ 4). The prevalence of postoperative delirium (POD) was 11% (22 patients). The independent risk factors for POD were the duration of hypotension and the presence of hyperactive ED. Delayed neurocognitive recovery after surgery and anesthesia was observed in 115 patients (57.8%). At the same time, a statistically significant predictor of this condition was the duration of hypotension for more than 15 minutes (sensitivity 59.18%, specificity 65.85%).Conclusion. When comparing the influence of the study group (patients with ePCD) with the control group, it was determined that ePCD is an independent risk factor for the development of POD (p < 0.001).

The mortality rate among patients with acute suppurative lung diseases (ASLD) in the ICU reaches 30%. Early, pathogenetically relevant biomarkers are needed to ensure personification and better efficacy of ASLD treatment. Numeric variations in the counts of immune system cells in patient’s blood can be viewed as such candidate biomarkers.The aim of the study. Identification of potential markers predicting ASLD outcome after community-acquired pneumonia and COVID-19.Materials and methods. The study included 216 in-hospital patients aged 18-87 with ASLD after community-acquired pneumonia with (N=81) and without (N=135) COVID-19 history.Results. Patients survival after COVID-19 was linked to lymphocyte count on Day 1 of hospital stay (hazard ratio, HR=5.9 95%CI 0.9–37.4; P=0.0188, log-rank test). In patients who had not have COVID-19, a difference in survival was associated with lymphocyte (HR=2.9 95%CI 1.0–8.4; P=0.0184, log-rank test; N=135), and monocyte counts (HR=2.7 95% CI 0.8–9.5; P=0.0196, log-rank test) on Day 1 of hospital stay. Patients’ survival after COVID-19 infection depended on SII (systemic immune-inflammation index. HR=9.3 95%CI 1.7–49.8; P=0.0124, log-rank test; N=81, SIRI (systemic inflammatory response index, HR=7.2 95%CI 1.4–36.6; P=0.0339, log-rank test; N=81) and NLR (neutrophil-to-lymphocyte ratio, HR=9.6 95%CI 1.8–52.0; P=0.0108; log-rank test; N=81) values on Day 1 of hospital stay. In patients who did not have COVID-19 SII values had no influence on survival.Conclusion. The lymphocyte count makes it possible to predict outcomes of pleural empyema, regardless of patient’s history of COVID-19, i. e. a decrease in the lymphocyte count below 1.2×10⁹ in 1 L is associated with fatal outcome. Monocyte count carries prognostic information for cases of pleural empyema without previous COVID-19 infection. As for the relative indicators, SIRI, SII and NLR values measured on Day 1 in the hospital were predictors of ASLD outcome only in patients after COVID-19 infection, i. e., higher values were associated with increased risk of death, with NLR index being the most informative. Overall severity of illness above 10 scores by CIRS was associated with an unfavorable ASLD outcome, regardless of patient’s history of COVID-19.

High concentration of sepsis-associated aromatic microbial metabolites (AMM) stands as a prognostically unfavorable factor, indicating the progression of multiple organ dysfunction and an increased risk of death in patients with sepsis and septic shock. This study is based on a hypothesis that excess of sepsis-associated AMM in patients with sepsis is caused by metabolic alterations (dysfunction) in the intestinal microbiota.The aim of this study was to compare the potential of normobiota and pathobiota to bio-transform sepsis-associated metabolites of aromatic amino acids tyrosine and phenylalanine, such as phenyllactic acid(PhLA) and 4-hydroxyphenyllactic acid (4-HPhLA).Materials and methods. Samples of intestinal contents of patients with septic shock (N=10, pathobiota) and healthy volunteers (N=9, normobiota) were placed in test tubes with the omnipurpose thioglycol medium. The clinical model of excessive inflow of sepsis-associated AMM into the intestine (for example, from blood or sites of inflammation) was reproduced in the in vitro experiment by adding PhLA or 4-HPhLA in clinically significant concentrations (25 mkM) into each test tube with pathobiota and normobiota. After incubation in a thermostat (37°, 24 hours), AMМ concentrations were measured in the samples with pathobiota and normobiota using GC-MS analysis.Results. Concentration of AMM decreased within 24 hours in the tubes with normobiota after PhLA or 4-HPhLA were added. In the tubes with pathobiota, no decrease in AMM concentrations was documented after loading with PhLA or 4-HPhLA. Concentrations of PhLA (P=0.002) and 4-HPhLA (P0.001) were statistically significantly higher in pathobiota samples compared to normobiota.Conclusion. The in vitro experiment demonstrates that after excessive load with sepsis-associated metabolites (PhLA, 4-HPhLA), the microbiota of healthy people is capable to bio-transform such metabolites to the end products of microbial metabolism, while pathobiota of septic patients exhibits altered biotransformational potential. This data demonstrate that microbiota dysfunction may contribute to the pathogenesis of sepsis.

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 article describes the climate change in the study region for the period 1968-2020. It was specified that over the past fifty-nine years there has been an increase in average annual air temperature by 2,5°C, a decrease in relative humidity by 6,0% and average annual rainfall by 5 mm. According to the analysis, it was determined that during the period 2009-2020 significant damage to pine plantations of Kyiv Polissya is caused by the pests like common pine sawfly (Diprion pini L.), pine bark beetle (Aradus cinnamomeus Panz), pine silkworm (Dendrolimus pini L.), pine weevil (Leucaspis pusilla Loew), and pine star weaver (Acantholyda nemoralis Matsumura). Heterobasidion annosum (Fr.) Bref. has also caused a significant damage to pine forests over the past eleven years; the damaged area is of ​​12,8-15,9 thousand hectares. According to the hydrothermal analysis of the study area, it was determined that 2009 and 2015 were characterized as years of medium drought; 2010, 2016, 2017, 2020 were the years of low drought; 2011–2014, 2018, 2019 were the years of sufficient moisture supply. The analysis of the number W influence found that in the years of increased solar activity the number of phytopests increases, while in the years of minimal solar activity it decreases. Based on the statistical indicators, the analysis of CO2 emissions into the environment for the period 2009-2020 and it was found that since 2012 the amount of carbon dioxide emissions has decreased from 10,2 million tons to 3.7 million tons. Correlation analysis of all indicators showed the interaction between the area of ​​damaged trees by insect pests and the Wolf number, CO2 emissions into the environment, average annual precipitation amounts and hydrothermal moisture coefficient of Selyaninov G.T. There is also a correlation between the area of ​​damaged plantations by pine fungus and the average annual air temperature, relative humidity and CO2 emissions.

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.

Reanimatology (the science of resuscitation) represents the science of critical illness, terminal and postresuscitation conditions, originated within the walls of the V. A. Negovsky Research Institute of General Rean-imatology, Federal Research and Clinical Center of Intensive Care Medicine and Rehabilitology, turns 85 years old on October 19, 2021. This editorial briefly describes the history of the development of the Institute, as well as the current scientific achievements of the Institute staff.

Red blood cells are the most required blood transfusion products worldwide. Safety and efficacy of blood transfusion are still relevant issues. Clarification of the causes and mechanisms of post-transfusion complications requires additional research.Aim of the review is to summarize the data of clinical and research studies on transfusion of red blood cell suspension with various storage times.Material. We selected 76 sources from Web of Science, Scopus, and RSCI databases containing pertinent clinical and scientific research data, as well as blood transfusion guidelines.Results. We reviewed the main stages of preparation and storage of filtered red blood cells, described biochemical and structural alterations occurring during blood storage, summarized clinical data on post-transfusion complications, and analyzed clinical consequences and molecular structure abnormalities of red blood cells in relation to their storage time.Conclusion. During long-term storage, red blood cells undergo significant structural and metabolic changes. The clinical use of relatively «old» red blood cells increases the risk of post-transfusion complications. However, the pathophysiological differences between «young» and «old» erythrocytes remain unclear. Large clinical and molecular research studies may add to our understanding of the complex issues related to blood transfusion.

This paper highlights published hypotheses on the possibility of coronavirus SARS-CoV-2 entry into the bloodstream, its interaction with vascular endothelium, red blood cells, hemoglobin and its fragments. As a result of such interaction, iron ions may be released into the bloodstream and, subsequently, a cytokine storm may occur. In this context, it is important to find a cytoprotective agent capable of blocking such processes. The perfluorocarbon emulsion could be a candidate for this role.The aim of the paper is to show the feasibility of biophysical methods to study the molecular mechanisms of action of SARS-CoV-2 on human red blood cells and hemoglobin as well as the restorative and cytoprotective effect of the perfluorocarbon emulsion during Fe2+ oxidation in heme.Materials and methods. High resolution spectroscopy, atomic force microscopy, atomic force spectroscopy, electroporation were used. Blood was exposed to oxidizing agents of different nature. Perfluorocarbon emulsion was added in various concentrations and its effect at various incubation times was studied. Concentration of hemoglobin derivatives was calculated considering multicollinearity, and statistical analysis of the results was performed.Results. The perfluorocarbon emulsion was shown to have an effective restorative and cytoprotective action in iron ion oxidation in the heme: Fe3+ was restored to Fe2+. The degree of MetHb reduction to HbO2 and Hb depended on the concentration of the oxidizing agent and incubation time. We observed a change in MetHb content from 80-90% to 5-12%. The perfluorocarbon emulsion in clinical concentrations helped eliminate local membrane defects and restored normal erythrocyte morphology.Conclusion. In the light of the studied hypotheses, the use of perfluorocarbon emulsion can become an effective method for blocking the consequences of coronavirus effect on the blood cells and restoring a normal gas exchange.

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.

Мета. Утoчнення пoказань дo ствoрення екстраінтракраніальнoгo мікрoсудиннoгo анастoмoза та oцінка йoгo ефективнoсті при oклюзійнo-стенoтичній патoлoгії брахіoцефальних артерій на підставі кoмплекснoї oцінки церебральнoї гемoдинаміки. Матеріали і метoди. Прoаналізoванo ствoрення екстраінтракраніальнoгo мікрoсудиннoгo анастoмoза 14 пацієнтам з oклюзійнo-стенoтичною патoлoгією брахіoцефальних артерій, яким прoвoдили дуплексне сканування судин гoлoви та шиї, мультиспіральну кoмп’ютерну тoмoграфічну ангіoграфію, церебральну ангіoграфію. Гемoдинамічна oцінка мoзкoвoго крoвoтоку проведена за дoпoмoгoю мультиспіральної кoмп’ютерної тoмoграфічної перфузії. Результати. Дooпераційнo у 71,4% пацієнтів виявленo мнoжинну oклюзійнo-стенoтичну патoлoгію брахіoцефальних артерій з переважнo oднoбічнoю oклюзією або стенoзoм сoнних артерій, у 14,3% - ізoльoване ураження, у 14,3% - пoрушення мoзкoвoї гемoдинаміки. Задoвільна прoхідність екстраінтракраніальнoгo мікрoсудиннoгo анастoмoза, клінічна ефективність, пoкращення перфузії гoлoвнoгo мoзку підтверджені в усіх спостереженнях за результатами нейрoпсихoлoгічнoгo тестування та кoмплекснoгo прoменевoгo oбстеження. У жoднoгo пацієнта не зареєстрoванo пoвтoрнoгo інсульту. Виснoвки. Пoказаннями до формування екстраінтракраніальнoгo анастoмoза при oклюзійнo-стенoтичній патoлoгії брахіoцефальних артерій є симптoматичне ураження сoнних артерій, пoв’язане з пoрушеннями церебральнoї гемoдинаміки в пoєднанні з кoгнітивним дефіцитoм. Створення екстраінтракраніальнoгo мікрoсудиннoгo анастoмoза ефективно для прoфілактики інсульту у пацієнтів з даною судинною патoлoгією.

The purpose of the study — to determine the feasibility of using the succinate-based antioxidant for the in vitro reduction of excessive methemoglobin to oxyhemoglobin in blood.Materials and Methods. Blood sampling was performed in five healthy donors in microvettes containing EDTA during prophylactic examinations. NaNO2 solution was added to blood samples in vitro in order to yield methemoglobin (MetHb). The complex drug containing the following active ingredients: succinic acid, inosine, riboflavin, nicotinamide, was used as an antioxidant. The absorption spectrum of red cell suspensions with different drug content Dι (λι )exper was measured with 1 nm increments. The non-linear regression method was used to calculate concentrations of hemoglobin derivatives in suspensions.Results. In our experiments, when methemoglobin reacted with drug the optical density of peaks typical for oxyhemoglobin increased and the spectral peak of methemoglobin decreased. The greater the concentration of drug, the more was the incubation time, the more efficient was the process of reduction of MetHb to HbO2.Conclusion. We proved experimentally that while the baseline concentration of MetHb was an average of 91—93%, addition of drug decreased its concentration to 25—7%. Without drug, due to autoreduction, the concentration of MetHb decreases only to 84%. The revealed effect provide a potential for practical applications in critical illness, during the storage of donor blood, in blood transfusions, and under the action of physico-chemical factors on blood.

Investigation of mechanical properties of erythrocyte membranes is a pressing issue in practical reanimatology and rehabilitation, because erythrocyte's ability to deform determines the possibility of their passage through capillary network and blood rheology in general.The purpose of the work: to study the process of nonlinear deformation of membranes of normal erythrocytes by the method of atomic force spectroscopy.Materials and Methods. The local stiffness of erythrocyte membranes was studied: that of diskocytes — on the torus and on the depression, that of planocytes — on the cell surface. Аtomic force spectroscopy was used for cell membrane study.Results. The nonlinear deformation process was described by functions h(z), h/z (h), and μ(h). This set of functions describes in full the process of probe incorporation (submergence) into membranes. It has been shown that stepwise dependencies of the stiffness coefficient of membrane segments differ significantly and depend on its condition.Conclusion. The suggested approach may be used in fundamental and clinical studies of blood cells' properties in the norm and different diseases. The method of recording nonlinear deformations may be especially efficient in the reanimatology and rehabilitation practice.

The aim of the study was the assessment of aerosolized colistin (AC) efficacy as adjunctive therapy to systemic antibiotic therapy for nosocomial pneumonia (NP).Materials and methods. This observation study included 90 NP patients under critical care. The primary criterion of therapy efficacy was NP resolution. As the secondary criteria of therapy efficacy, eradication of germs from sputum, the time to patients’ spontaneous breathing, the time in critical care unit, and mortality were evaluated. Patients were split into 2 groups: Gr.1 (n=48) — systemic antibiotics combined with AC; Gr. 2 (n=42) — systemic antibiotics cross over due to sensitivity. The groups were comparable in main characteristics. Aerosolized colistin was dosed 2 mln. U 3 times/day (Xellia Pharmaceuticals ApS, Denmark) in Gr. 1. The regimen of systemic antibiotic therapy was not changed upon AC prescription. Statistical analysis was carried out using Statistica 7.0 (M, σ, Newman—Keuls test; P0.05); in Gr. 1, spontaneous breathing took place earlier than in Gr. 2 — 7.6±1.6 days in Gr. 1 versus 11.7±3.4 days in Gr. 2 (P=0.0000); in Gr. 1, the critical care unit duration was shorter than in Gr. 2 — 12.0±3.4 days in Gr. 1 versus 16.3±3.4 days in Gr. 2 (P=0.0000). Conclusions. Aerosolized colistin 2 mln. U 3 times a day is an effective adjuvant therapy combined with systemic antibiotic therapy for nosocomial pneumonia caused by multidrug-resistant gram-negative germs. This modified treatment assisted faster pneumonia resolution, earlier spontaneous breathing of patients, and shorter time in the intensive care unit. Addition of aerosolized colistin to systemic antibiotics should be regarded as a possible algorithm of treatment in a case of inefficient first-line antibiotic therapy.

Острые и хронические формы нарушения кровообращения головного мозга (ГМ) относят к наиболее распространенным заболеваниям, которые обусловливают инвалидизацию больных и высокую смертность. Диагностические возможности перфузионной мультиспиральной компьютерной томографии (ПМСКТ) при хронической ишемии ГМ недостаточно изучены. Проанализированы показатели ПМСКТ, проведенной у 35 пациентов, в целях отбора для хирургической коррекции по поводу хронической ишемии ГМ, обусловленной стено-окклюзивным поражением артерий плече-головного ствола (ПГС). Все параметры изменяли на стороне стеноза/окклюзии внутренней сонной артерии (ВСА). Данные ПМСКТ могут быть использованы при выборе тактики ведения пациентов и обоснования показаний к хирургическому лечению.

The purpose of the study: to evaluate the effect of Perftoran (PF) on the membrane nanostructure of discocytes and stomatocytes after acute blood loss. Materials and methods. The study was performed in white male rats. Nembutal was administered intraperitoneally at a dose of 25 mg/kg. The study model was as follows: acute blood loss followed by hypotension for 60 min with the BP maintained at the level of 40 mm Hg with subsequent reinfusion of lost blood. Blood samples were collected from the tail artery before the blood loss and 2 hours after reinfusion. PF was administered intraarterially at a dose 3 ml/kg of body mass immediately after the blood loss replacement. Animals who did not receive Perftoran served as a reference group. The RBC membrane structure was studied using the Femtoscan atomic force microscope at ranges with different spatial periods. The ranges were selected using the Fourier transform and spectral windowing. Periods (T) and heights (h) of RBC surface corrugation were calculated for each spectral window according to the isolated profiles of the membrane surface. Results. At a baseline; discocytes and stomatocytes exhibited different structural characteristics of RBC membrane at a spatial range of 600—1200 nm in the form of a higher period of vibration of stomatocytes vs. discocytes. Hypovolemia and subsequent reinfusion of autologous blood affected studied parameters by increasing the period of spatial oscillation both in discocytes and stomatocytes as compared to the initial state. Administration of PF significantly decreased the period of spatial oscillation of the cell membrane both in discocytes and stomatocytes as compared to animal RBCs who underwent hypovolemia and reinfusion without PF administration and baseline parameters. Conclusion. The period of vibration within the range of 600"1200 nm reflecting the state of the bilayer of RBC membrane is not related to the discocyte transformation into the stomatocyte. Data suggest that the PF-induced shortage in vibration within this range was associated with the increased ability of a RBC to deform.

Objective: to analyze the nanostructure of human aortic intima in atherosclerosis and demonstrate the poten tial effect of Niodex on cholesterol plaques.Materials and methods. Samples of intima were taken from those parts of aorta, where different stages of atherosclerotic chages were obvious. Aortic samples were incubated in a solution containing cyclodextrins. A solution of NIODEX, a propylene glycol ester of betacyclodextrin, was used in the study. A layer of aortic intima was formed on the glass slide surface with polylysine. The samples were placed into the working area of an atomicforce microscope (Integra Prima, NTMDT, Russian Federation), and their surfaces were scanned. The number of imaging points was 512; and the imaging regions were as follows: 100100 μm, 20002000 nm.Results. Classification of nanosurface objects was performed and typical fragments (craters, ridges, and trabecular fibers) were identified, and quantitative assessment of their sizes was carried out. 27 fragments were identified as growing cholesterol plaques. 16 of them measuring 900—1200 nm were identified near ridges, and 11 near craters (600—1050 nm). Niodex caused destruction of lipid spots and smoothing of the intima surface. More than a half of the 27 identified objects (15) demostrated a 30% and more decrease in size (median 340—400 nm). A 10—15% decrease was registered in 7 fragments; in the remaining 5 fragments, the decrease in the lesion size was less than 10%.Conclusion. Raw data permit to suppose that the effect of Niodex on the aortic intima results in decceleartion and decreased intensity of atherosclerotic plaque growth on the intima fragments.

The purpose of the study is to evaluate morphological changes in lung vessels of preterm infants with the infant respiratory distress syndrome (IRDS).Material and Methods. Case history records and postmortem examination protocols of 70 preterm infants who died because of severe respiratory compromise as a result of IRDS were analyzed. All newborns were divided into three groups: the IRDS group included 25 (35.7%) infants who died due to IRDS (no surfactant); the Curosurf group was composed of 26 (37.2%) infants who received an exogenous surfactant Curosurf as a part of a complex therapy; the Surfactant BL group included 19 (27.1%) infants receiving Surfactant BL. Histological and morphometric examinations of lung vessels were performed. The Kernogan index calculated as the ratio between the lumen diameter and the wall thickness was determined.Results. The arterial bed of newborns in the IRDS and Curosurf groups was composed of vessels having up to several μm in diameter. Larger arteries (51—100 μm in diameter) and arteries of more than 100 μm in diameter are distributed uniformly and comprise 1/3 of the total number of visualized vessels. The invert correlation of the arterial vascular bed was typical for the infants in the Surfactant BL group: arteries of 50 μm in diameter comprise 30% of all vessels, and arteries of more than 100 μm in diameter prevail. The venous bed of newborns consisted mainly of vessels having less than 50 μm in diameter. The greatest changes in the arterial wall thickness (ТСА) are typical for vessels with a total diameter of more than 51 μm. In babies of the IRDS group, the greatest (ТСА) changes were typical for arteries of 51—100 μm in diameter. Changes in arterial walls (>101 μm) were typical for the Surfactant BL group. Unlike other groups, in the Curosurf group, no significant changes in the parameters under the test were found (P>0.05). In this group (as compared to IRDS and Surfactant BL groups), there were minimal changes in vein characteristics and the minimal venous wall thickness (ТСv) (>100 μm in diameter). The Kernogan index for veins with small diameter was minimal.Conclusion. Evaluation of the microcirculatory bed of lungs in IRDS patients is an urgent problem because the pulmonary gas exchange impairment in preterm infants is primarily caused by circulatory and microcirculatory disorders of various degrees of severity that result from anatomic and functional immaturity of the lung micro circulatory bed. In cases of unfavorable outcomes, dilation of arterial and venous lumen and vascular wall thickening might be considered as principal signs of microcirculatory disorders. Surfactants affect changes in the diameter of lumen of lung vessels, especially those with a diameter more than 50 μm, presumably improving the blood supply of the lungs. Minimal changes of tested parameters were typical for newborns on Curosurf versus IRDS and Surfactant BL groups of infants.

It was shown in the first part of the review that the alterations of systemic hemodynamics and microcirculation in acute blood loss led to the development of metabolic disorders and cell damage. The second part of the review highlights the methods of microcirculation and tissue oxygenation investigation. The focus is on modern biomicroscopy varieties and methods based on the laser technology. In particular, we discuss a method based on the mathematical analysis of microvascular blood flow oscillations (fluxmotion) to evaluate the regulatory mechanisms of microcirculation. The features of regional blood flow and microcirculation in different vascular regions of the body in acute blood loss, as well as during the subsequent reperfusion are considered. It was shown that microcirculatory alterations in a particular organ are largely determined by the structural and functional features of its blood supply, as well as by the role of this organ in the pathogenesis of acute blood loss. These changes can possess both adaptive and pathological significance depending on blood loss stage and severity.

The development of accurate and applicable methods to assess the severity of patient condition is an urgent need in critical care medicine.The goal of the study was to determine whether the quantitave evaluation of phenylcarboxylic acids (PhCAs) concentrations in blood might be employed to assess the severity of patient condition and treatment efficiency intensive care unit.Materials and methods. Clinical and laboratory findings in patients (n=58) with acute surgical diseases of abdominal organs were registered on the day of admission to intensive care unit and during follow-up control including lactate level and blood serum PhCA concentrations of phenyllactic (PhLA), p#hydroxyphenyllactic (p-HPhLA) and phydroxyphenylacetic (p#HPhAA) acids. Patients' condition was assessed using APACHE II and SOFA international scales. PhCA concentrations were determined by gas chromatography. The reference group included healthy blood donors (n=25).Results. PhLA, p-HPhAA, p-HPhLA levels and total concentration of the three PhCAs were shown to be in direct correlation with APACHE II score (rs: 0.624; 0.757; 0.763 and 0.804, respectively; P

Study objective: to improve treatment results of patients with AP complicated by DT by early concomitant use of artificial lung ventilation (ALV) and detoxification by plasmapheresis.Methods of study and treatment. 146 patients with chronic alcoholic intoxication (CAI) and AP development complicated by DT were enrolled to the study. Patients of Group I (reference group, n=45) received «standard» therapy. Group II included patients who received extracorporeal detoxification by plasmapheresis in addition to «standard» therapy (n=51). Group III included patients who underwent oxygenation correction by ALV in addition to «standard» therapy and extracorporeal detoxification by plasmapheresis (n=50).Results. During the evaluation of plasmapheresis efficacy, more rapid normalization of blood biochemistry in patients from Group II was noticed. The following parameters were decreased: blood α#amylase by 73.2%, bilirubin level by 33.3%, AST by 34.1%, ALT by 17.7%; arterial blood lactate level was normalized by 47.6% on Day 3 vs. Group I (p

The aim was to assess the efficacy of mitochondriatargeted antioxidant SkQ1 in prevention of structural and functional abnormalities of brain postresuscitation after cardiac arrest.Materials and methods. Adult male Wistar rats (n=19) underwent cardiac arrest for 7 minutes followed by resuscitation. Nine rats were administered with 500 nmol/kg SkQ1 per os with water for 2 weeks (1 week before and 1 week after resuscitation). A control group consisted of shamoperated animals (n=10). At days 4—6 post operation locomotor activity and anxiety («elevated plus maze» test) and sensorimotor function of limbs («beam walking» test) were examined. Total numbers of neurons per 1 mm of their layer length in vulnerable neuronal populations (cerebellar Purkinje cells and piramidal neurons of hippocampus fields CA1 and CA4) were estimated by histological analysis of the specimens stained with cresyl violet on day 7 postresuscitation. To identify possible mechanisms of SkQ1 action, the immunohistochemical study of a glialderived neurotrophic factor (GDNF) expression in piramidal neurons of hippocampus was performed by indirect peroxidaseantiperoxidase method and antiGDNF primary polyclonal antibodies.Results. Ischemiareperfusion resulted in neuronal loss in all studied brain areas followed by reduction in locomotor activity and development of sensorimotor deficit. SkQ1 prevented development of postresuscitative locomotor and sensorimotor irregularities, significantly reduced Purkinje cells loss, prevented death of piramidal neurons in hippocampal field CA4, but not in CA1. Data demonstrated, that iIn Purkinje cells from resuscitated rats treated with SkQ1 there was a significant increase in number of GDNFpositive neurons, which were more resistant to ischemia (transition of GDNFnegative cells toward the category of cells actively expressing this factor) that promoted their survival postresuscitation.Conclusion. Data confirm the positive effects of SkQ1 on structural and functional status of the brain postre suscitation and suggest possible use of SkQ1 for the prevention or correction of posthypoxic encephalopathies.

The first part of the review highlights the data on the structural and functional organization of the microvas culature; regulation of vascular tone including local (metabolic and myogenic mechanisms, role of endothelium and red blood cells) and systemic (nervous, humoral) factors; general issues of microcirculatory alterations in blood loss and shock. Acute blood loss is considered as a phasic development of compensatory and adaptive processes involving the blood system, cardiovascular, nervous and endocrine systems. Changes in oxygen transport, the pathogenesis of hypoxia and metabolic abnormalities in blood loss and hemorrhagic shock are described. Examples of the vicious circles contributing to acute blood loss pathogenesis are considered as a base for developing decompensated hemorrhagic shock in which the role of hemostasis and blood rheology alterations are also considered.

Purpose of the study. Determine the value of genetic variants of a single nucleotide polymorphic site rs3736309 of intron 3 of aquaporin5 (AQP5) gene in the course of critical illness in patients with documented pulmonary infection. Materials and methods. Patients with critical illness admitted to the intensive care units were examined during the course of treatment (n=86, age 27 to 82 years, mean age 53.20±14.34 years). Main diagnosis included malignancies (15%), peritonitis (16%) and necrotizing pancreatitis (37%). Patients developed nosocomial pneumonia (55%), acute respiratory distress syndrome (ARDS) (54%), septic shock (48%), ARDS combined with septic shock (33%). Bacterial species of Pseudomonas aeruginosa , Klebsiella pneumoniae, Acinetobacter baumannii, and/or Proteus mirabilis alone or in association were revealed in lavage fluid. DNA genotyping DNA was carried out using tetraprimer polymerase chain reaction (PCR). Statistical processing was performed using GraphPad InStat program (GraphPad, USA).Results. The distribution of frequencies of genotypes AA, GA and GG (AQP5, rs3736309) in cohort of patients corresponded to HardyWeinberg equilibrium (P=0.923) and was similar to frequencies of same alleles determined in a conditionally healthy Caucasian individuals (literature data) (P>0.05). In a subgroup of patients with septic shock and AQP5 AA (rs3736309) genotype the lower EVLWI values were found compared to patients with genotypes GG and GA with septic shock in spite of the same approach to treatment. The differences between genetically different subgroups of patients with septic shock were maintained throughout the life of the survey (P

The aim of the study was to demonstrate the effectiveness of the method of selective polygraphy and resonance stimulation of gastrointestinal tract (GIT) in the complex intensive therapy in early postoperative period in a patient with acute intestinal obstruction complicated by peritonitis.Materials and methods. The patient L., female, 52 years old, had numerous operations, because of small intestine obstruction complicated by serousfibrinous peritonitis in early postoperative period (7 days after the first surgery). Patient was performed with a longlasting diagnosis procedure followed by the GIT resonant stimulation to restore the motorevacuation function of GIT. An electrogastroenterography device was employed that was approved for clinical use by the Ministry of Healthcare Industry № 226819, 1998).Results. The amplitude of the oscillations due to resonant effects on the excitable structures gradually increased from 8—22 mkV to 20—44 mkV that indicates the increase of the numbers of passive structures in smooth muscles of the stomach and the jejunum). At the end of three final sessions the amplitudes of the signals (specific reactions) demonstrated the following values: 93 mkV, 88 mkV, 90 mkV, 87 mkV (for the stomach, duodenum, jejunum and ileum, and large intestines, respectively).Conclusion. These values and activity after the stimulation corresponded to the normal GIT motility.

Objective: to provide a rationale for the use of perfluorane to correct erythrocyte morphological changes and blood biochemical indicators in acute blood loss.Material and methods. Experiments were carried out in outbred male rats weighing 250—300 g under nembutal anesthesia. Blood loss was induced by arterial blood exfusion until blood pressure (BP) reached 40 mm Hg, following which this BP level was maintained for 60 minutes. Then the amount of blood withdrawn was reinfused. Perfluorane was injected intraarterially at a dose of 3 ml/kg 45 min before the start of blood loss. On the following day arterial and venous blood samples were harvested. The values of metabolic parameters (acid-base balance (ABB), hemoglobin (Hb), packed cell volume (PCV), and blood biochemistry), the morphological characteristics of erythrocytes (the size of discocytes and the percentage of stomatocytes and echinocytes), and the levels of reticulocytes in peripheral blood were studied. Results. Perfluorane exerted a normalizing effect on the values of blood ABB. Twenty-four hours after blood loss and reinfusion, Group 1 (a non-perfluorane group; n=8) showed reductions in Hb, PCV, and serum iron as compared to Group 3 (intact animals; n=12). In Group 2 (a perfluorane group; n=10), these indicators were decreased to a lesser extent. In these time periods, hypercholesterolemia was less marked in Group 2 than in Group 1. In Group 2, the mean diameter of a discocyte was larger than that in the animals of the two other groups. Group 1 displayed as high as 32% increases in the count of echinocytes with their virtually complete absence in the intact animals. At the same time, the levels of echinocytes in Group 2 animals were similar to those in the intact animals. As compared to Group 3, Group 1 exhibited a 4.5-fold drop in the percentage of reticulocytes (р≤0.05) while Group 2 showed a 2.2-fold rise in this indicator (р≤0.05).Conclusion. The injection of perfluorane at a dose of 3 ml/kg body weight 45 min prior to blood loss causes an increase in the values of Hb, PCV, and serum iron and a reduction in total cholesterol. The administration of perfluorane

Genetic predisposition partially accounts for the clinical variability of the course of an infectious process. A total of 750 people, including 419 (81.1%) male patients aged 42.9±0.9 years, admitted to the clinics of the V. A. Negovsky Research Institute of General Reanimatology (Moscow, Russia), were genotyped to establish the influence of genetic factors on their susceptibility to critical conditions.Materials and methods. Tetra-primer allele-specific polymerase chain reaction was used to investigate single-nucleotide polymorphisms (SNP) in the xenobiotic detoxification and oxidative stress genes (CYP1A1 (three sites), AhR, ABCB1, SOD2, GCLC and CAT) and in the vascular homeostasis genes (ACE, AGT, AGTR1, NOS3, VEGFα and MTHFR).Results. A total of 268 nosocomial pneumonia (NP) cases were registered in a patient group. Individual SNP analysis has shown that among the patients with NP the risk of acute respiratory distress syndrome (ARDS) is associated with the carriage of the following genotypes: CYP1A1 rs2606345-Т/Т (p=0.0027, OR=2.38; 95% CI: 1.35—4.17) and AhRrs2066853-G/A-A/A (p=0.0012, OR=2.94; 95% CI: 1.54—5.60). The frequency of the C allele of the AGTR1 gene (re5186) was much higher among the survivors (in the NP group). The assessment of a multiplicative genetic model of genes that had demonstrated the highest single-locus effects because of a ARDS risk, as well as in-hospital mortality, could establish the complex genotype including a combination of risky alleles of the detoxi- fication and vascular homeostasis genes (CYP1A1 rs2606345-T — AhR rs2066853-A and ACE rs4340-D — AGT rs699-C — AGTR1 rs5186-C), which was associated with the increased risk of both NP and ARDS, as well as with the likelihood of a fatal outcome.Conclusion. An understanding of the risk factors of NP and ARDS will aid in predicting the outcome of the underlying disease and in developing possible preventive measures.

Diagnostic criteria for and approaches to differentiated treatment for acute respiratory distress syndrome (ARDS) in nosocomial pneumonia (NP) have been elaborated, but approaches to preventing this syndrome in the presence of risk factors have not been investigated. Safety-mode mechanical ventilation (MV) (protective MV) is the most probable way of preventing ARDS in NP. Objective: to evaluate the efficiency of MV with safety parameters in preventing ARDS in NP in patients with surgical abdominal infection. Subjects and methods. This retrospective unicentric study was conducted at the clinical bases of the V. A. Negovsky Research Institute of General Reanimatology in 2013—2014. During a retrospective analysis, the patients were divided into two groups: 1) safe MV — after NP was diagnosed, the patients underwent safetymode MV (tidal volume (TV) 6—8 ml/kg); 2) standard MV — after NP was diagnosed, the patients were on MV with traditional parameters (TV 8—10 ml/kg). The incidence of ARDS in the patient groups was taken as a main criterion for the efficiency of safetymode respiratory support. The duration of MV, the length of stay in an intensive care unit, and 30day mortality rates were estimated as secondary criteria for the efficiency of safety-mode respiratory support. The findings were statistically analyzed using a Statistica 7.0 package. The data were expressed as the median (± 25—75 percentiles interquartile range (IQR)). The difference at pResults. Comparison of oxygenation index (OI) and extravascular lung water index (ELWI) showed that there were natural significant differences between the safe MV and standard MV groups in these indicators, beginning from day 2 of the investigation. The standard MV group displayed a significant decrease in OI and an increase in ELWI at 7 days versus at day 1 of the investigation. In the safe MV group, TV was naturally lower than that in the standard MV group on days 1, 3, and 5 of the study. From day 3, the statistical lung compliance was lower in the standard MV group than that in the safe MV group, which was linked to the development of ARDS in the patients in this group. From day 3, the peak airway pressure was higher in the standard MV group than that in the safe MV group. From this time, the plateau airway pressure was higher in the standard MV group than that in the safe MV group. There were significant differences in the incidence rate of ARDS in NP in the patient groups: ARDS developed in 6 (15.0%) and 20 (67.1%) NP patients who underwent safe and standard MV, respectively (p=0.0001, Fisher's exact test). The NP patients who used MV with safety parameters were recorded lower lengths of MV (14.8±6.2 days) and stay in an intensive care unit (19.2±6.0 days) than those who had standard MV (20.0±6.3 and 23.9±7.7 days) (Fig. 9). There were significant differences in mortality rates between the patient groups in the NP patients on safe MV whose mortality was 27.5% (n=11); this in the NP patients on standard MV was 46.7% (n=14) (p=0.0046, Fisher's exact test). Conclusion. MV with safety parameters allows for preventing ARDS in NP in patients with surgical abdominal infection, which improves treatment outcomes.

Nosocomial pneumonia (NP) remains a relevant problem of resuscitation. Molecular biomarkers are significant promises for diagnosing NP. Objective: to estimate the informative value of the plasma levels of Clara cell protein (Club Cell Protein, CCP) as a diagnostic molecular candidate biomarker in NP. Subjects and methods. The investigation was conducted at the Research Institute of General Reanimatology (RIGR), Russian Academy of Medical Sciences (RAMS), in 2010—2013. It included 85 patients in accordance with the criteria of inclusion and exclusion and 30 donors. Acute respiratory distress syndrome and its stages were diagnosed using the criteria of RIGR, RAMS. Plasma Clara cell protein (CCP) levels were measured by the enzyme immunoassay Human Clara Cell Protein ELISA, RD191022200, BioVendor, USA. The findings were statistically analyzed using the package Statistica 7.0. ROC curve analysis was made to determine the sensitivity andspecificity of CCP. The difference at p

Objective. To study the mechanisms of posttraumatic changes in the blood cells, by investigating DNA damages associat ed with hypoxia caused by massive blood loss (BL) in severe injury.Subjects and methods. Ninetyfive patients aged 40.6±16.5 years (from 20 to 79 years) who had sustained severe mechanical injury with different BL volumes (BLV) (from 100 to 4000 ml) and hemodynamic disorders were examined to study DNA damages and white blood cell necrotic and apop totic processes. In terms of the victims' weight, the mean BL was 21.5±16.5 ml/kg (from 1.4 to 61.5 ml/kg). The victimswere divided into 4 groups according to BLV: 1) 26 victims whose BLV was less than 750 ml (5.93±2.41 ml/kg) (grade I BL); 2) 23 victims whose BLV was 750—1500 ml (11.5±1.5 ml/kg) (grade 2 BL); 3) 23 victims whose BLV was 1500—2000 ml (23.8±4.0 ml/kg) (grade 3 BL); 4) 23 victims whose BLV was over 2000 ml (45.6±10.1 ml/kg) (grade 4 BL), according to the type of injury: 1) severe skeletal injury (SSI) (n=17); 2) brain injury (BI) (n=43); 3) a concurrence of SSI and BI (SSI+BI) (n=35); according to the development of infectious complications: 1) 69 victims who developed infectious com plications on days 5—7 postinjury; 2) 26 victims who did not. To evaluate the impact of hypoxia on DNA damages, white blood cell apoptotic and necrotic processes, the victims were divided into 2 groups: 1) hypoxia (18 of the 95 victims who had 4 altered indicators, such as capillary blood pO2, plasma lactate levels, pH, and BE); 2) no hypoxia (10 of the 95 victims whose indicators were within the normal range). DNA damages and necrotic and apoptotic changes in the white blood cells were assessed by the DNA comet assay. The plasma concentration of extracellular DNA was fluorometrically determined using a QuantiTTM HS DNA Assay Kit (Invitrogen, USA). That of 8hydroxy2deoxyguanosine was estimated by enzyme immunoassay employing an 8hydroxy2deoxyGuanosine EIA Kit (Cayman Chemical, USA). The levels of cas pase3, caspase9, superoxide dismutase, and sAPO1/FAS were measured by enzyme immunoassay using test systems(Bender MedSystems, Austria).Results. There were significantly higher plasma levels of free DNA in the victims than in the controls throughout the followup, which is due to its exit from the cells damaged from tissue injury. In the first two weeks after injury, there were increases in DNA damages and white blood cell alteration processes by a necrotic and apoptotic mechanism in the victims with different types of injury, which may be associated with the active participation of leuko cytes in the processes of cellular breakdown product removal in the tissues damaged during injury and the in those of prevention of infectious complications. In the victims, white blood cell alteration in the necrotic pathway does not depend on BLV and hypoxia degree while that in the apoptotic pathway showed a relationship of leukocyte alteration to hypoxia in these patients. The sum of the values of necrotic DNA comets, apoptotic DNA comets, and single and doublestrand breaks on day 3 postinjury may serve as a predictor of the likely development of infectious complications in victims with injury, blood loss, and marked hypoxia. There were differences in the levels of DNA damages and white blood cell apoptosis and necrosis in the victims with BI and SSI. The injury victims showed a threefold decrease in plasma 8hydroxy2 deoxyguanosine concentrations, which was accompanied and, possibly, caused by an increase in the amount of superoxide dismutase.Conclusion. There was a relationship between the degree of DNA damages, apoptosis, and necrosis in the white blood cells of victims with injury and hypoxiainduced blood loss.

Editorial dedicated to the development of the algorithm of diagnosis and prognosis of acute respiratory distress syndrome (ARDS), based on the use of recent data (2012—2014) from the V. A. Negovsky Institute of General reanimatology. Modern approaches to the diagnosis and treatment of ARDS are discussed. Available modern data including results of own recent investigation have clearly demonstrated the potential of quantifying surfactant proteins SPA and SPD, which pro duced by cells of the respiratory epithelium, for the early diagnosis and prognosis of ARDS. A new algorithm for diagnosis and prognosis of ARDS based on a sequential quantification of SPA and SPD molecules in the plasma of patients in crit ical conditions is suggested. Circulating SPA and SPD are considered as valuable candidate biomarkers for developingmultiparametric panel of biomarkers for diagnosis and prognosis of ARDS in patients with lifethreatening critical illness.

Objective: to evaluate the effects of the immunostimulants panavir and derinate on a postresuscitation process in animals of different sexes.Material and methods. The investigation was made on 200—250-g albino rats of both sexes in winter. Circulation was stopped by intrathoracic ligation of the cardiac vascular bundle in ether

The paper considers basic concepts in the design of modern wind energy conversion systems (WECS). The analysis of control methods and systems which are capable to realize operational mode with maximum output power has been presented in the paper. Functional diagrams of systems for different electric generators, mechanical gears and various combinations of electric power supply and control systems have been have been given in the paper. WECS structures that meet the operational requirements in Belarus have been determined in the paper.

Presents investigations on blocking algorithm for transformer current protections during magnetizing inrush current. The investigations have shown that the algorithm has high sensitivity and reliably determines magnetizing inrush current modes.

The paper considers a possibility to use a thermal pump and heat-exchange device in the ventilation system for heat utilization of exhaust air. An influence of air characteristics on energy efficiency of heat-utilizing installations has been shown in the paper. Specific feature of the thermal pump application is the fact hat a source of secondary heat has higher temperature than a consumer. The paper contains results of thermal pump and heat exchange device parameters, hat characterize their efficiency while being applied in a ventilation system.

The surgical treatment results analysis of brain arterial aneurysm ruptures for ten years of clinic of vascular neurosurgery work are presented. Main directions of the indicated pathology surgical treatment and methods of priorities at different localization of brain arterial aneurysm are marked. The perspectives of vascular neurosurgery further development and organization of medical help giving to patients with aneurismal subarachnoid hemorrhage are analyzed.

The modern scales for life quality estimation at patients with cerebrovascular pathology are presented. Standardization of scales application is executed at different types of vascular pathology. Application of the system for stroke severity estimation helps to make objective decision for treatment tactics and strategy. The complex use of scales with balls give a possibility to improve prognosis for period after stroke course, to estimate conservative therapy and surgical treatment efficiency at patients with acute violation of cerebral blood circulation.

Objective: to study the diagnostic and prognostic value of changes in red blood cell electrophoretic mobility (RBCEM) in patients with infectious and noninfectious forms of intoxication.Materials and methods. A cytoferometer (Opton) was used to determine RBCEM; venous blood samples taken on heparin were studied. Thirty patients with peritonitis (infectious intoxication) and 22 patients with a pancreatic tumor and mechanical jaundice (noninfectious intoxication) were examined. All the patients received standard therapy for this disease. Eight out of 30 patients died on days 3—10 postoperatively.Results. On postoperative days 1—2, the values of RBCEM were outside the lower normal range in 90% of the patients with peritonitis (p

Objective: to study the impact of chromium levels on cytogenetic impairments in T lymphocytes in miners from the south of Kuzbass.Subjects and methods. Peripheral blood leukocytes were cultured, as described by P. S. Moorhead (1960), by using the cytogenetic assay of the obtained specimens. Analysis of chromosomes considered changes in the number of chromosomes (hyper-, hypo-, or polyploid sets of chromosomes) and their structural derangement. Ninety-three miners from Novokuznetsk and Mezhdurechensk (Kemerovo Region) were examined. According to the length of underground service, the miners were divided into 2 groups: 1) 32 miners with a service length of 1—5 years; 2) 31 with a service length of 10—15 years. A control group included 30 employees from the mine maintenance departments. The mean age of the miners was 38.6±3.4 years. Previous coal chemical analysis in a number of mines revealed significant concentrations of chromium compounds (as high as 298 mg/kg in the clarke of 83 mg/kg). Lymphocytic chromium was quantified by the atomic emission method using inductively bound plasma. The statistically data were processed using a package of Statistica 5.01 computer programs.Results. Cytogenetic study and measurement of peripheral blood chromium were made in miners with a various underground service length. They were found to have elevated peripheral blood T lymphocytes with cytogenetic disorders, which correlated with the increased blood chromium levels.Conclusion. Thus, the miners with an underground service length of 10—15 years were ascertained to have high blood chromium levels, which was accompanied by increases in the count of both cells with chromosomal structural aberrations and those with poly- and hyperploidy.

Among other negative sequels, hypoxia that is the leading cause of all critical conditions increases the frequency of cell mutations in the patient. Unfortunately, we do not know whether there are available special studies analyzing the frequency of mutations in the germ cells of experimental animals or humans. But those in the somatic cells were reported in various publications more than 30 years ago. Specifically, such phenomena have been described in acute lung injuries and myocardial infarction in both rats and man. But these studies have been sporadic. And the increase in the frequency of somatic mutation affects the incidence of apoptosis, the change in the pattern of immunological processes and, possibly, even the factors of carcinogenesis. Mutagenetic processes can be managed, by modifying their frequency with antimuta-gens.

Objective: to evaluate the immunological responsiveness of various neuronal populations of heat shock proteins of the HSP 70 family and to reveal their association with the magnitude of postresuscitative neuronal morphological changes.Materials and methods. The hypoxia-highly sensitive neuronal populations of pyramidal neurons in the layer of the fifth cerebral sensomotor cortex and hippocampal sectors CA1 and CA4 throughout the postresuscitative period after 12-minute cardiac arrest were subject to a complex immunocytochemical and morphometric study. Their immunological responsiveness to the thermal shock proteins was determined by the indirect peroxidase-antiperoxidase test using the polyclonal antibodies to HSP70. The density and composition of neuronal populations were ascertained by the morphometric assay.Results. The baseline immunological responsiveness of neuronal populations has been demonstrated to be an important factor of its resistance to ischemic lesions. The authors have determined a trend in postresuscitative changes in the immunological responsiveness of neuronal populations to HSP70 and established its association with the development of nerve cell dystrophic changes. They discuss whether complex immunocytochemical and morphometric studies are promising in investigating the mechanisms of postresuscitative brain abnormality.Conclusion. By and large, the findings suggest that the role of HSP70 in maintaining the homeostasis of neuronal populations is more complex and multifactorial, as earlier considered, and it is unlikely to be restricted itself to only merely neuroprotective properties. The high baseline content of HSP70 makes a considerable contribution to the resistance of neuronal populations to ischemia-reperfusion; and the changes in the immunological responsiveness to HSP70 are closely associated with the development of pathological nerve cell changes during a postresuscitative process.

Objective: to study the specific features of pulmonary gas exchange and mechanical properties in various manifestations of respiratory failure in miners with severe concomitant injury, who have a service length of 10 years or more, in order to optimize respiratory support.Subjects and methods. Pulmonary gas exchange and mechanical properties were studied over time in the presence of respiratory failure (acute lung injury/acute respiratory distress syndrome) in 34 miners and 36 victims (a control group) with severe concomitant injury who had no underground service length. Both groups were matched in age, severity and nature of traumatic lesions and surgical interventions. Pulmonary gas exchange and mechanical properties were evaluated by the following indices: oxygen fraction in an inspired gas mixture; hemoglobin saturation and partial arterial blood oxygen and carbon dioxide tension with the alveolar-arterial gradient being calculated by the oxygen level; oxygenation index; intrapulmonary shunting; statistical compliance and airways resistance.Results. The studies demonstrated that the miners, as compared with the controls, had more pronounced gas exchange changes within 5—7 post-traumatic days; later on (days 7—9) the above differences were undetectable. Impaired pulmonary mechanical properties in the miners persisted throughout the study while in the control group, their recovery started just on day 3. The course of respiratory failure in the miners was attributable to the baseline external respiratory function. Their respiratory support was performed during 14.5±1.4 days versus 9.5±1.9 days in the controls. In the miners, the mean bed-days at an intensive care unit were 18.5±2.2 whereas in the controls those were 12.3±2.1.Conclusion. More significant impairments of pulmonary gas exchange and mechanical properties are seen in the miners due to the background changes in external respiratory function in the development of respiratory function after severe concomitant traumatic lesions than in the victims without underground service length, which causes an increase in the duration of respiratory support and intensive care.

Objective: to monitor the efficiency of intensive therapy for brain injury, which presents a great difficulty due to the fact that available noninvasive monitoring techniques for intracranial processes are unavailable. The present study was undertaken to substantiate the monitoring of cerebral hydration by a noninvasive bioimpedance technique.Subjects and methods. Twenty-eight patients with isolated brain injury (BI) and edema verified by computed tomography were examined. A control group consisted of 70 persons without signs of mental confusion and BI in the history. The noninvasive bioimpedance technique was used to evaluate the degree of brain tissue hydration. The hydration coefficient was developed in healthy persons, which reflected the degree of interstitial space hydration in the examined patients with BI. In parallel, cerebral hemodynamic parameters were recorded by rheoencephalography. Cerebral oxygen budget was estimated by jugular oximetry. For correction of cerebral edema, all the patients underwent hyper-ventilation in restored systemic blood circulation and provided pulmonary gas exchange. The study was conducted at 2 stages: before and after 30-minute moderate hyperventilation.Results. According to the effect of hyperventilation, the patients were divided into two groups: 1) 17 patients in whom hyperventilation was attended by the decrease in cerebral liquid volume; 2) 11 patients in whom hyperventilation was accompanied by the accumulation of cerebral interstitial liquid.Conclusion. A noninvasive brain impedance technique may be used as monitoring to evaluate the efficiency of antiedematous therapy for brain injury.

Objective: to comparatively analyze the effect of anesthetics on red blood cell membranes in whole blood and its suspension.Materials and methods. The blood sampled from healthy donors was studied. A total of 260 tests using whole blood and its suspension were carried out. The study has considered the effect of esmerone, listenone, and hexanal on red blood cell membranes and revealed a specific response to each of them.Results. Esmerone given at a concentration of 1 µl and 10 µl of the drug per ml of blood in the suspension impaired the structure of membranes, without showing it worth in the whole blood. Hexenal at a concentration of 2 µl and 20 µl of the drug per ml of blood strengthened the membrane and increased the voltage failure threshold, but this result was more pronounced in the suspension and in the whole blood. The effect of listenone at a concentration of less than 2 µl was slightly noticeable, but the drug strengthened the membrane and induced a pronounced membranous structural derangement when given at a concentration of 20 µl of the drug per ml of blood or higher in the whole blood and in the suspension, respectively.Conclusion. Knowledge about the effects of the agents on blood cells may assist anesthesiologists to prevent possible complications during and after surgical interventions.

Objective: to define the types and specific features of hemodynamic responses in miners with a service length of 10 years or more in the early posttraumatic period after severe mechanical injury.Subjects and methods. Noninvasive central hemody-namic studies using tetrapolar rheography were conducted in 55 injured miners with an underground service length of 10 years or more (a study group) and in 54 victims without underground service (a control group). Major hemodynamic parameters, such as mean blood pressure, heart rate, cardiac index, stroke index, vascular resistance index, were measured over time: on admission and on days 3, 5, and 7. The victims with severe concomitant injury were matched by age and the nature and severity of mechanical injuries.Results. The study has shown that in the early posttraumatic period from days 3 to 7, the miners with an underground service length of 10 years or more had hypodynamic, hyperdynamic, and normodynamic circulations in 37.2, 50.5, and 12.3%, respectively. Unlike the miners, the controls exhibited in this period a hyperdynamic type in 96.0% and only 4.0% were found to have a hypodynamic type.Conclusion. The miners and the victims without underground service were observed to have the similar hemodynamic responses to severe mechanical injuries within the first 24 hours posttraumatically. Beginning with the 3rd-to-7th day, the ratio of hemodynamic circulatory types changed in the miners, by increasing hypodynamic responses. This may be accounted for by the diminished reserve capacities of the circulatory system due to long-term exposure to poor industrial factors.

The authors continue to consider the historical aspects of anesthesiology and reanimatology. Part II deals with the historical development of intravascular anesthesia.

The main mechanisms of thrombolytic drugs’ effects, and their comparative analysis are presented.Advantages and disadvantages of plasminogen activator for acute ischemic stroke treatment, hypertensive intracerebral hematomas, intraventricular hemorrhages are demonstrated.

Objective: on the basis of the data available in the literature to develop a system of criteria for assessing the quality of anesthetic and resuscitative care at aortocoronary bypass surgery (ACBS) in patients with acute coronary syndrome (ACS).Materials and methods: the medical records of patients with different forms of ACS, undergone surgical myocardial revascularization, were analyzed. The current references on the intensive care and surgical treatment of ACS were studied and analyzed.Results: a score system of criteria for assessing the quality of anesthesiological and reanimatological care is presented and warranted for ACS patients. The system characterizes the quality of preoperative preparation, anesthesia, intensive care, postoperative surgical unit stay, and treatment outcome. Possible areas of application of this system are indicated.Conclusion: The elaborated criterion system may be used in evaluating the efficiency of new procedures, surgical techniques and interventions, medical equipment and in comparing the groups of patients selected by a definite sign.