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<article article-type="research-article" dtd-version="1.3" xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" xml:lang="ru"><front><journal-meta><journal-id journal-id-type="publisher-id">rmt</journal-id><journal-title-group><journal-title xml:lang="ru">Общая реаниматология</journal-title><trans-title-group xml:lang="en"><trans-title>General Reanimatology</trans-title></trans-title-group></journal-title-group><issn pub-type="ppub">1813-9779</issn><issn pub-type="epub">2411-7110</issn><publisher><publisher-name>FSBI "SRIGR" RAMS</publisher-name></publisher></journal-meta><article-meta><article-id pub-id-type="doi">10.15360/1813-9779-2015-4-6-13</article-id><article-id custom-type="elpub" pub-id-type="custom">rmt-1472</article-id><article-categories><subj-group subj-group-type="heading"><subject>Research Article</subject></subj-group><subj-group subj-group-type="section-heading" xml:lang="ru"><subject>ОТРАВЛЕНИЯ И ИНТОКСИКАЦИИ</subject></subj-group><subj-group subj-group-type="section-heading" xml:lang="en"><subject>POISONINGS AND INTOXICATIONS</subject></subj-group></article-categories><title-group><article-title>ОЦЕНКА МОРФОЛОГИЧЕСКИХ ИЗМЕНЕНИЙ В ЛЕГКИХ ПРИ ОСТРЫХ ОТРАВЛЕНИЯХ КЛОЗАПИНОМ, ЭТИЛОВЫМ АКОГОЛЕМ И ИХ СОЧЕТАНИЕМ</article-title><trans-title-group xml:lang="en"><trans-title>Assessment of Lung Morphological Changes in Acute Intoxications with Clozapine, Ethanol and Their Combination</trans-title></trans-title-group></title-group><contrib-group><contrib contrib-type="author" corresp="yes"><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Голубев</surname><given-names>А. М.</given-names></name><name name-style="western" xml:lang="en"><surname>Golubev</surname><given-names>A. M.</given-names></name></name-alternatives><bio xml:lang="ru"><p>107031, Москва, ул. Петровка, д. 25, стр. 2;</p><p>117198, Москва, ул. Миклухо-Маклая, д. 6</p></bio><bio xml:lang="en"><p>25, Petrovka St., Build. 2, Moscow 107031;</p><p>6, Miklukho-Maklai St., Moscow 117198</p></bio><xref ref-type="aff" rid="aff-1"/></contrib><contrib contrib-type="author" corresp="yes"><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Сундуков</surname><given-names>Д. В.</given-names></name><name name-style="western" xml:lang="en"><surname>Sundukov</surname><given-names>D. V.</given-names></name></name-alternatives><bio xml:lang="ru"><p>117198, Москва, ул. Миклухо-Маклая, д. 6</p></bio><bio xml:lang="en"><p>6, Miklukho-Maklai St., Moscow 117198</p></bio><xref ref-type="aff" rid="aff-2"/></contrib><contrib contrib-type="author" corresp="yes"><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Романова</surname><given-names>О. Л.</given-names></name><name name-style="western" xml:lang="en"><surname>Romanova</surname><given-names>O. L.</given-names></name></name-alternatives><bio xml:lang="ru"><p>117198, Москва, ул. Миклухо-Маклая, д. 6</p></bio><bio xml:lang="en"><p>6, Miklukho-Maklai St., Moscow 117198</p></bio><email xlink:type="simple">olgpharm@ya.ru</email><xref ref-type="aff" rid="aff-2"/></contrib></contrib-group><aff-alternatives id="aff-1"><aff xml:lang="ru"><institution>НИИ общей реаниматологии им. В. А. Неговского;&#13;
Российский университет дружбы народов</institution><country>Россия</country></aff><aff xml:lang="en"><institution>V. A. Negovsky Research Institute of General Reanimatology;&#13;
Peoples' Friendship University of Russia</institution><country>Russian Federation</country></aff></aff-alternatives><aff-alternatives id="aff-2"><aff xml:lang="ru"><institution>Российский университет дружбы народов</institution><country>Россия</country></aff><aff xml:lang="en"><institution>Peoples' Friendship University of Russia</institution><country>Russian Federation</country></aff></aff-alternatives><pub-date pub-type="collection"><year>2015</year></pub-date><pub-date pub-type="epub"><day>03</day><month>09</month><year>2015</year></pub-date><volume>11</volume><issue>4</issue><fpage>6</fpage><lpage>13</lpage><permissions><copyright-statement>Copyright &amp;#x00A9; Голубев А.М., Сундуков Д.В., Романова О.Л., 2015</copyright-statement><copyright-year>2015</copyright-year><copyright-holder xml:lang="ru">Голубев А.М., Сундуков Д.В., Романова О.Л.</copyright-holder><copyright-holder xml:lang="en">Golubev A.M., Sundukov D.V., Romanova O.L.</copyright-holder><license xml:lang="ru" license-type="creative-commons-attribution" xlink:href="https://creativecommons.org/licenses/by/4.0/" xlink:type="simple"><license-p>Данная работа распространяется под лицензией Creative Commons Attribution 4.0.</license-p></license><license xml:lang="en" license-type="creative-commons-attribution" xlink:href="https://creativecommons.org/licenses/by/4.0/" xlink:type="simple"><license-p>This work is licensed under a Creative Commons Attribution 4.0 License.</license-p></license></permissions><self-uri xlink:href="https://www.reanimatology.com/rmt/article/view/1472">https://www.reanimatology.com/rmt/article/view/1472</self-uri><abstract><sec><title>Цель исследования</title><p>Цель исследования. Выявление морфологических изменений в легких при острых отравлениях клозапином, этанолом и комбинированных отравлениях этанолом и клозапином через 3 и 24 часа после отравления.</p></sec><sec><title>Материалы и методы</title><p>Материалы и методы. Опыты поставлены на беспородных крысах-самцах массой 270—300 гр. Клозапин вводили в дозе 250 миллиграмм на килограмм массы животного под наркозом (хлоролаза). Через 3 и 24 часа животные выведены из эксперимента декапитацией. Исследованы гистологические срезы легких 6 крыс, получивших клозапин перорально в дозе 250 мг/кг, 6 крыс, получивших этанол перорально в дозе 8,6 мл/кг, 6 крыс, получивших этанол и клозапин перорально в вышеуказанных дозах через 3 часа после отравления. Также исследованы гистологические срезы легких крыс (18), получавших аналогичные препараты в вышеуказанных дозах и выведенных из опыта через 24 часа после введения препаратов. Сравнение проводили с гистологическими срезами легких крыс (6), не получавших вышеуказанных веществ. Статистическую обработку проводили непараметрическими методами (критерий χ2 ). Оценивали следующие морфологические признаки: расстройства кровообращения (полнокровие, кровоизлияния), интерстициальный и альвеолярный отек, повреждение бронхиального и альвеолярного эпителия, эндотелия, клеточную реакцию. Различия считали достоверными при р&lt;0,05.</p></sec><sec><title>Результаты исследования</title><p>Результаты исследования. В контрольной группе животных при гистологическом исследовании какиелибо расстройства кровообращения, повреждения бронхиального и альвеолярного эпителия, эндотелия не обнаруживаются. У животных, получавших клозапин через 3 часа после введения препарата наблюдали резкие расстройства кровообращения в легких (полнокровие в системе легочной артерии, очаговое полнокровие капилляров межальвеолярных перегородок, вен), которые усиливались через сутки после введения препарата. В случае смерти че рез 3 часа после введения алкоголя обнаружен выраженный периваскулярный отек, полнокровие и кровоизлияния; в части альвеол содержалась отечная жидкость. Через 24 часа после введения алкоголя наблюдали умеренное венозное полнокровие. Секреторная активность слизистой оболочки бронхов снижалась. Через 3 часа после сочетанного введения клозапина и алкоголя отмечали резкие расстройства кровообращения в легких (выраженное полнокровие, многочисленные кровоизлияния, альвеолярный отек), повреждение (слущивание) бронхиального эпителия, отсутствие окрашивания ядер эндотелиальных клеток. Вокруг вен и артериовенозных анастомозов наблюдали скопление лимфоцитов. Периваскулярный отек отсутствовал. Через 24 часа после сочетанного введения клозапина и алкоголя повреждения усиливались.</p></sec><sec><title>Заключение</title><p>Заключение. Изменения, выявленные при гистологическом исследовании легких у животных, получавших клозапин и комбинацию этанола и клозапина, в совокупности с результатами судебно-химического анализа могут быть использованы для диагностики соответствующих отравлений и для установления их давности.</p></sec></abstract><trans-abstract xml:lang="en"><sec><title>Objective</title><p>Objective:to detect lung morphological changes in acute intoxications with clozapine, ethanol, and their combination 3 and 24 hours after poisoning.</p></sec><sec><title>Materials and methods</title><p>Materials and methods. Experiments were carried out in outbred male rats weighing 270—300 g. Clozapine was given in a dose of 250 mg per kg animal body weight under chloralose anesthesia. Following 3 and 24 hours, the animals were withdrawn from the experiment by decapitation. Lung histological sections from 6 rats that had received oral clozapine 250 mg/kg, 6 rats that had oral ethanol 8.6 ml/kg, and 6 rats that had a combination of ethanol and clozapine orally in the above doses were examined 3 hours after intoxication. Those from 18 rats that had been orally given the similar agents in the above doses and withdrawn from the experiment were also investigated 24 hours after drug administration. The sections were compared with those from 6 rats that had not received the above agents. Nonparametric methods (χ2 test) were used for statistical processing. The investigators assessed the following morphological signs: circulatory disorders (plethora, hemorrhages), interstitial and alveolar edema, damage to the bronchial and alveolar epithelium and to the endothelium, and a cell reaction. The differences were considered significant at p&lt;0.05.</p></sec><sec><title>Results</title><p>Results. In the control animal group, histological examination did not reveal any circulatory disorders and damage to the bronchial and alveolar epithelium and to the endothelium. Three hours after its administration, the animals that had received clozapine were observed to have acute pulmonary circulatory disorders (plethora in the pulmonary artery system, focal plethora of the capillaries of interalveolar septa and that of veins) that increased 24 hours after its ingestion. If death occurred 3 hours after ethanol intake, there was obvious perivascular edema, plethora, and hemorrhage; some alveoli contained transudate. Moderate venous plethora was seen 24 hours following ethanol administration. The secretory activity of the bronchial mucosa decreased. Three hours after coadminis tration of clozapine and ethanol, there were acute pulmonary circulatory disorders (marked plethora, multiple hemorrhages, and alveolar edema), bronchial epithelial lesion (desquamation), and no staining of endothelial cell nuclei. Lymphocyte accumulation was observed around the veins and arteriovenous anastomoses. Perivascular edema was absent. The lesions increased 24 hours after coadministration of clozapine and ethanol.</p></sec><sec><title>Conclusion</title><p>Conclusion. The changes found at lung histological examination of the animals receiving clozapine alone and its combination with ethanol in conjunction with the results of forensic chemical analysis may be used to diag nose relevant intoxications and to establish their duration.</p></sec></trans-abstract><kwd-group xml:lang="ru"><kwd>морфологические изменения в легких</kwd><kwd>криминальные отравления</kwd><kwd>клозапин</kwd><kwd>этанол</kwd></kwd-group><kwd-group xml:lang="en"><kwd>lung morphological changes</kwd><kwd>criminal intoxications</kwd><kwd>clozapine</kwd><kwd>ethanol</kwd></kwd-group></article-meta></front><back><ref-list><title>References</title><ref id="cit1"><label>1</label><citation-alternatives><mixed-citation xml:lang="ru">Стопницкий А.А., Акалаев Р.Н. Интенсивная терапия больных с отравлением уксусной кислотой, осложненным развитием шока. Общая реаниматология. 2014; 10 (2): 1822. http://dx.doi.org/10.15360/1813-9779-2014-2-18-22</mixed-citation><mixed-citation xml:lang="en">Stopnitsky A.A., Akalaev R.N. Intensivnaya terapiya bolnykh c otravleniem uksusnoi kislotoi, oslozhnennym razvitiem shoka. Obshchaya Reanimatologiya. [Intensive therapy of patients with acetic acidpoison ing complicated by shock. General Reanimatology]. 2014; 10 (2): 1822. http://dx.doi.org/10.15360/1813-9779-2014-2-18-22. [In Russ.]</mixed-citation></citation-alternatives></ref><ref id="cit2"><label>2</label><citation-alternatives><mixed-citation xml:lang="ru">Батоцыренов Б.В., Ливанов Г.А., Андрианов А.Ю., Васильев С.А., Кузнецов О.А. Особенности клинического течения и коррекция метаболических расстройств у больных с тяжелыми отравлениями метадоном. Общая реаниматология. 2013; 9 (2): 1822. http://dx.doi.org/10.15360/1813-9779-2013-2-18</mixed-citation><mixed-citation xml:lang="en">Batotsyrenov B.V., Livanov G.A., Andrianov A.Yu., Vasilyev S.A., Kuznetsov O.A. Osobennosti klinicheskogo techeniya i korrektsiya metabolicheskikh rasstroistv u bolnykh s tyazhelymi otravleniyami metadonom. Obshchaya Reanimatologiya. [The clinical course and correction of metabolic disturbances in patients with severe methadone poisoning. General Reanimatology]. 2013; 9 (2): 1822. http://dx.doi.org/10.15360/1813-9779-2013-2-18. [In Russ.]</mixed-citation></citation-alternatives></ref><ref id="cit3"><label>3</label><citation-alternatives><mixed-citation xml:lang="ru">Ливанов Г.А., Батоцыренов Б.В., Васильев С.А., Андрианов А.Ю., Баранов Д.В., Неженцева И.В. Окислительный дистресс и его коррекция реамберином у больных с острым отравлением смесью психотропных веществ. Общая реаниматология. 2013; 9 (5): 1823. http://dx.doi.org/10.15360/1813-9779-2013-5-18</mixed-citation><mixed-citation xml:lang="en">Livanov G.A., Batotsyrenov B.V., Vasilyev S.A., Andrianov A.Yu., Baranov D.V., Nezhentseva I.V. Okislitelnyi distress i ego korrektsiya reamberinom u bolnykh s ostrym otravleniem smesyu psikhotropnykh veshchestv. Obshchaya Reanimatologiya. [Oxidative distress and its correction with reamberin in patients with acute poisoning by a mixture of psychotropic substances. General Reanimatology]. 2013; 9 (5): 1823. http://dx.doi.org/10.15360/1813-9779-2013-5-18. [In Russ.]</mixed-citation></citation-alternatives></ref><ref id="cit4"><label>4</label><citation-alternatives><mixed-citation xml:lang="ru">Ливанов Г.А., Батоцыренов Б.В., Остапенко Ю.Н., Шестова Г.В., Рутковский Г. В., Малыгин А.Ю. Особенности ранней диагностики и лечения острых отравлений соединениями таллия. Общая реаниматология. 2013; 9 (3): 3540. http://dx.doi.org/10.15360/1813-9779-2013-3-35</mixed-citation><mixed-citation xml:lang="en">Livanov G.A., Batotsyrenov B.V., Ostapenko Yu.N., Shestova G.V., Rutkovsk G.V., Malygin A.Yu. Osobennosti rannei diagnostiki i lecheniya ostrykh otravlenii soedineniyami talliya. Obshchaya Reanimatologiya. [Acute severe thallium poisoning: early diagnosis and treatment. General Reanimatology]. 2013; 9 (3): 3540. http://dx.doi.org/10.15360/1813-9779-2013-3-35. [In Russ.]</mixed-citation></citation-alternatives></ref><ref id="cit5"><label>5</label><citation-alternatives><mixed-citation xml:lang="ru">Слюндин Д.Г., Ливанов А.С., Анучин В.В., Бобринская И.Г., ГутоваЕ.В. Криминальные отравления клозапином. Анестезиология и реаниматология. 2007; 4: 6164. PMID: 17929492</mixed-citation><mixed-citation xml:lang="en">Slyundin D.G., Livanov A.S., Anuchin V.V., Bobrinskaya I.G., Gutova E.V. Kriminalnye otravleniya klozapinom. [Criminal clozapine intoxications]. Anesteziologiya i Reanimatologiya. 2007; 4: 6164. PMID: 17929492. [In Russ.]</mixed-citation></citation-alternatives></ref><ref id="cit6"><label>6</label><citation-alternatives><mixed-citation xml:lang="ru">Flanagan R.J. Fatal toxicity of drugs used in psychiatry. Hum. Psychopharmacol. 2008; 23 (Suppl 1): 4351. http://dx.doi.org/10.1192/bjp.bp.109.070219. PMID: 18098225</mixed-citation><mixed-citation xml:lang="en">Flanagan R.J. Fatal toxicity of drugs used in psychiatry. Hum. Psychopharmacol. 2008; 23 (Suppl 1): 4351. http://dx.doi.org/10.1192/bjp.bp.109.070219. PMID: 18098225</mixed-citation></citation-alternatives></ref><ref id="cit7"><label>7</label><citation-alternatives><mixed-citation xml:lang="ru">Справочник Видаль. Лекарственные препараты в России. 21е изд. М.: Астрафармсервис; 2014: 8.</mixed-citation><mixed-citation xml:lang="en">Spravochnik Vidal. Lekarstvennye preparaty v Rossii. 21e izd. [Vidal Directory. Drugs in Russia. 21st ed.]. Moscow: Astrafarmservis; 2014: 8. [In Russ.]</mixed-citation></citation-alternatives></ref><ref id="cit8"><label>8</label><citation-alternatives><mixed-citation xml:lang="ru">Ермохина Т.В., Лужников Е.А., Ильяшенко К.К. Гериатрические аспекты диагностики и лечения отравлений психотропными веществами. Анестезиология и реаниматология. 2008; 6: 3739. PMID: 19227292</mixed-citation><mixed-citation xml:lang="en">Ermokhina T.V., Luzhnikov E.A., Ilyashenko K.K. Geriatricheskie aspekty diagnostiki i lecheniya otravlenii psikhotropnymi veshchestvami. [Geriatric aspects of diagnosis and treatment of psythotropic agent poisonings]. Anesteziologiya i Reanimatologiya. 2008; 6: 3739. PMID: 19227292. [In Russ.]</mixed-citation></citation-alternatives></ref><ref id="cit9"><label>9</label><citation-alternatives><mixed-citation xml:lang="ru">Машковский М.Д. Лекарственные средства. В 2х частях. 16е изд. М.: Новая волна; 2014: 7374.</mixed-citation><mixed-citation xml:lang="en">Mashkovsky M.D. Lekarstvennye sredstva. V 2kh chastyakh. 16e izd. [Drugs. In 2 parts. 16th ed.]. Moscow: Novaya Volna; 2014: 7374. [In Russ.]</mixed-citation></citation-alternatives></ref><ref id="cit10"><label>10</label><citation-alternatives><mixed-citation xml:lang="ru">Kervin R.W. Clozapine: back to future for sсhizopbrenia research. Lancet. 1995; 345 (8957): 10631064. PMID: 7715333</mixed-citation><mixed-citation xml:lang="en">Kervin R.W. Clozapine: back to future for sсhizopbrenia research. Lancet. 1995; 345 (8957): 10631064. PMID: 7715333</mixed-citation></citation-alternatives></ref><ref id="cit11"><label>11</label><citation-alternatives><mixed-citation xml:lang="ru">Whitney Z.I., Procyshyn R.M., Fredrikson D.H., Barr A.M. Treatment of clozapineassociated weight gain: a systematic review. Eur. J. Clin. Pharmacol. 2015; 71 (4): 389401.http://dx.doi.org/10.1007/s0022801518071. PMID: 25627831</mixed-citation><mixed-citation xml:lang="en">Whitney Z.I., Procyshyn R.M., Fredrikson D.H., Barr A.M. Treatment of clozapineassociated weight gain: a systematic review. Eur. J. Clin. Pharmacol. 2015; 71 (4): 389401. http://dx.doi.org/10.1007/s0022801518071. PMID: 25627831</mixed-citation></citation-alternatives></ref><ref id="cit12"><label>12</label><citation-alternatives><mixed-citation xml:lang="ru">Musil R., Obermeier M., Russ P., Hamerle M. Weight gain and antipsychotics: a drug safety review. Expert. Opin. Drug Saf. 2015; 14 (1): 7396. http://dx.doi.org/10.1517/14740338.2015.974549. PMID: 25400109</mixed-citation><mixed-citation xml:lang="en">Musil R., Obermeier M., Russ P., Hamerle M. Weight gain and antipsychotics: a drug safety review. Expert. Opin. Drug Saf. 2015; 14 (1): 7396. http://dx.doi.org/10.1517/1474-0338.2015.974549. PMID: 25400109</mixed-citation></citation-alternatives></ref><ref id="cit13"><label>13</label><citation-alternatives><mixed-citation xml:lang="ru">Aneja J., Sharma N., Mahajan S., Chakrabarti S., Grover S. Eosinophilia induced by clozapine: a report of two cases and review of the literature. J. Family Med. Prim. Care. 2015; 4 (1): 127129. http://dx.doi.org/10.4103/2249-4863.152269. PMID: 25811003</mixed-citation><mixed-citation xml:lang="en">Aneja J., Sharma N., Mahajan S., Chakrabarti S., Grover S. Eosinophilia induced by clozapine: a report of two cases and review of the literature. J. Family Med. Prim. Care. 2015; 4 (1): 127129. http://dx.doi.org/10.4103/22494863.152269. PMID: 25811003</mixed-citation></citation-alternatives></ref><ref id="cit14"><label>14</label><citation-alternatives><mixed-citation xml:lang="ru">Velayudhan R., Kakkan S. Late onset clozapine induced agranulocy to sis. Indian J. Psychol. Med. 2014; 36 (4): 425427.http://dx.doi.org/10.4103/0253-7176.140738. PMID: 25336778</mixed-citation><mixed-citation xml:lang="en">Velayudhan R., Kakkan S. Late onset clozapine induced agranulocytosis. Indian J. Psychol. Med. 2014; 36 (4): 425427. http://dx.doi.org/10.4103/0253-7176.140738. PMID: 25336778</mixed-citation></citation-alternatives></ref><ref id="cit15"><label>15</label><citation-alternatives><mixed-citation xml:lang="ru">Кирюхина Н.А., Шигеев С.В. Острая интоксикация клозапином – актуальная судебномедицинская проблема. Матлы науч.практ. конф. с междунар. участием, посвященной памяти проф. Г.А.Пашиняна. М.; 2011.</mixed-citation><mixed-citation xml:lang="en">Kiryukhina N.A., Shigeyev S.V. Ostraya intoksikatsiya klozapinom – aktualnaya sudebnomeditsinskaya problema. Materialy nauchno-prakticheskoi konferentsii s mezhdunarodnym uchastiem, posvyashchennoi pamyati professora G.A.Pashinyana. [Acute intoxication with clozapine is a topical forensic medical problem. Proceeding of the ScientificandPractical Conference dedicated to the memory of Prof. G.A. Pashinyan]. Мoscow; 2011. [In Russ.]</mixed-citation></citation-alternatives></ref><ref id="cit16"><label>16</label><citation-alternatives><mixed-citation xml:lang="ru">Мурхазанов Р.А. Клинические аспекты отравления клозапином. Акт. вопр. внутренних болезней. 2000; 24: 252.</mixed-citation><mixed-citation xml:lang="en">Murkhazanov R.A. Klinicheskie aspekty otravleniya klozapinom. [Clinical aspects of clozapine poisoning]. Aktualnye Voprosy Vnutrennikh Boleznei. 2000; 24: 252. [In Russ.]</mixed-citation></citation-alternatives></ref><ref id="cit17"><label>17</label><citation-alternatives><mixed-citation xml:lang="ru">Matsuda K.T., Cho M.C., Lin K.M., Smith M.W., Young A.S., Adams J.A. Clozapine dosage, serum levels, efficacy and sideeffect profiles: a comparison of Korean-American and Caucasian patients. Psychopharmacol. Bull. 1998; 32 (2): 253257. PMID: 8783895</mixed-citation><mixed-citation xml:lang="en">Matsuda K.T., Cho M.C., Lin K.M., Smith M.W., Young A.S., Adams J.A. Clozapine dosage, serum levels, efficacy and sideeffect profiles: a comparison of KoreanAmerican and Caucasian patients. Psychopharmacol. Bull. 1998; 32 (2): 253257. PMID: 8783895</mixed-citation></citation-alternatives></ref><ref id="cit18"><label>18</label><citation-alternatives><mixed-citation xml:lang="ru">Ackenheil М. Clozapine pharmacokinetic investigations and biological effects in man. Psychopharmacology (Berl.). 1989; 99 (Suppl): S32S37. PMID: 2682731</mixed-citation><mixed-citation xml:lang="en">Ackenheil М. Clozapine pharmacokinetic investigations and biological effects in man. Psychopharmacology (Berl.). 1989; 99 (Suppl): S32S37. PMID: 2682731</mixed-citation></citation-alternatives></ref><ref id="cit19"><label>19</label><citation-alternatives><mixed-citation xml:lang="ru">Christians U. The future of therapeutic drug monitoring pharmacodynamic and toxicodynamic monitoring. Ther. Drug Monit. 2004; 30 (2): 151158. http://dx.doi.org/10.1097/FTD.0b013e31816b9063</mixed-citation><mixed-citation xml:lang="en">Christians U. The future of therapeutic drug monitoring pharmacodynamic and toxicodynamic monitoring. Ther. Drug Monit. 2004; 30 (2): 151158. http://dx.doi.org/10.1097/FTD.0b013e31816b9063</mixed-citation></citation-alternatives></ref><ref id="cit20"><label>20</label><citation-alternatives><mixed-citation xml:lang="ru">Gardiner T.H., Lewis J.M., Shore P.A. Distribution of clozapine in the rat: localization in lung. J. Pharmacol. Exp. Ther. 1978; 206 (1): 151157. PMID: 660545</mixed-citation><mixed-citation xml:lang="en">Gardiner T.H., Lewis J.M., Shore P.A. Distribution of clozapine in the rat: localization in lung. J. Pharmacol. Exp. Ther. 1978; 206 (1): 151157.              PMID: 660545</mixed-citation></citation-alternatives></ref><ref id="cit21"><label>21</label><citation-alternatives><mixed-citation xml:lang="ru">Зимина Л.Н., Михайлова Г.В., Баринова М.В., Павленко Е.Ю., Полозов М.А., Попов С.В., Розумный П.А., Ильяшенко К.К., Ермохина Т.В. Морфологические аспекты острых отравлений азалептином. Суд. мед. экспертиза. 2008; 51 (3): 810. PMID: 18589664</mixed-citation><mixed-citation xml:lang="en">Zimina L.N., Mikhailova G.V., Barinova M.V., Pavlenko E.Yu., Polozov M.A., Popov S.V., Rozumnyi P.A., Ilyashenko K.K., Ermokhina T.V. Morfologicheskie aspekty ostrykh otravlenii azaleptinom. [Morphological aspects of acute intoxication with azaleptin]. Sudebno Meditsinskaya Ekspertiza. 2008; 51 (3): 810. PMID: 18589664. [In Russ.]</mixed-citation></citation-alternatives></ref><ref id="cit22"><label>22</label><citation-alternatives><mixed-citation xml:lang="ru">Winckel K., Siskind D., Hollingworth S., Wheeler A. Clozapineinduced myocarditis: separating the wheat from the chaff. Aust. N. Z. J. Psychiatry. 2015; 49 (2): 188. http://dx.doi.org/10.1177/0004867414554269. PMID: 25296630</mixed-citation><mixed-citation xml:lang="en">Winckel K., Siskind D., Hollingworth S., Wheeler A. Clozapineinduced myocarditis: separating the wheat from the chaff. Aust. N. Z. J. Psychiatry. 2015; 49 (2): 188. http://dx.doi.org/10.1177/0004867414554269. PMID: 25296630</mixed-citation></citation-alternatives></ref><ref id="cit23"><label>23</label><citation-alternatives><mixed-citation xml:lang="ru">Haas S.J., Hill R., Krum H., Liew D., Tonkin A., Demos L., Stephan K., McNeil J. Clozapineassociated myocarditis: a review of 116 cases of suspected myocarditis associated with the use of clozapine in Australia during 19932003. Drug Saf. 2007; 30 (1): 4757. PMID: 17194170</mixed-citation><mixed-citation xml:lang="en">Haas S.J., Hill R., Krum H., Liew D., Tonkin A., Demos L., Stephan K., McNeil J. Clozapineassociated myocarditis: a review of 116 cases of suspected myocarditis associated with the use of clozapine in Australia during 19932003. Drug Saf. 2007; 30 (1): 4757. PMID: 17194170</mixed-citation></citation-alternatives></ref><ref id="cit24"><label>24</label><citation-alternatives><mixed-citation xml:lang="ru">Garcia G.J., Chagas M.H., Silva C.H., MachadodeSousa J.P., Crippa J.A., Hallak J.E. Structural and functional neuroimaging findings associated with the use of clozapine in schizophrenia: a systematic review. Rev. Bras. Psiquiatr. 2015; 37 (1): 7179. http://dx.doi.org/10.1590/1516444620141387. PMID: 25806554</mixed-citation><mixed-citation xml:lang="en">Garcia G.J., Chagas M.H., Silva C.H., MachadodeSousa J.P., Crippa J.A., Hallak J.E. Structural and functional neuroimaging findings associated with the use of clozapine in schizophrenia: a systematic review. Rev. Bras. Psiquiatr. 2015; 37 (1): 7179. http://dx.doi.org/10.1590/1516444620141387. PMID: 25806554</mixed-citation></citation-alternatives></ref><ref id="cit25"><label>25</label><citation-alternatives><mixed-citation xml:lang="ru">Elmorsy E., Elzalabany L.M., Elsheikha H.M., Smith P.A. Adverse effects of antipsychotics on microvascular endothelial cells of the human bloodbrain barrier. Brain Res. 2014; 1583: 255268. http://dx.doi.org/10.1016/j.brainres.2014.08.011. PMID: 25139421</mixed-citation><mixed-citation xml:lang="en">Elmorsy E., Elzalabany L.M., Elsheikha H.M., Smith P.A. Adverse effects of antipsychotics on microvascular endothelial cells of the human bloodbrain barrier. Brain Res. 2014; 1583: 255268. http://dx.doi.org/10.1016/j.brainres.2014.08.011. PMID: 25139421</mixed-citation></citation-alternatives></ref><ref id="cit26"><label>26</label><citation-alternatives><mixed-citation xml:lang="ru">Баширова А.Р., Сундуков Д.В., Голубев А.М. Морфофункциональные патологические изменения головного мозга при смертельных отравлениях азалептином и этиловым алкоголем. Мед. экспертиза и право. 2013; 4: 3536.</mixed-citation><mixed-citation xml:lang="en">Bashirova A.R., Sundukov D.V., Golubev A.M. Morfofunktsionalnye patologicheskie izmeneniya golovnogo mozga pri smertelnykh otravleniyakh azaleptinom i etilovym alkogolem. [Pathological mor phofunctional changes in the brain during fatal intoxications with azaleptin and ethanol]. Meditsinskaya Ekspertiza i Pravo. 2013; 4: 3536. [In Russ.]</mixed-citation></citation-alternatives></ref><ref id="cit27"><label>27</label><citation-alternatives><mixed-citation xml:lang="ru">Arias S.A., Cohen P., Kwon J.S. Clozapineinduced lymphocytic alveolitis. Am. J. Psychiatry. 2011; 168 (2): 210211. http://dx.doi.org/10.1176/appi.ajp.2010.10101494. PMID: 21297049</mixed-citation><mixed-citation xml:lang="en">Arias S.A., Cohen P., Kwon J.S. Clozapineinduced lymphocytic alveolitis. Am. J. Psychiatry. 2011; 168 (2): 210211. http://dx.doi.org/10.1176/appi.ajp.2010.10101494. PMID: 21297049</mixed-citation></citation-alternatives></ref><ref id="cit28"><label>28</label><citation-alternatives><mixed-citation xml:lang="ru">Lewis A., Gibbs A., HopeGill B. Probable occupational pneumonitis caused by inhalation of crushed clozapine. Occup. Med. (Lond.). 2012; 62 (5): 385387. http://dx.doi.org/10.1093/occmed/kqs041. PMID: 22638645</mixed-citation><mixed-citation xml:lang="en">Lewis A., Gibbs A., HopeGill B. Probable occupational pneumonitis caused by inhalation of crushed clozapine. Occup. Med. (Lond.). 2012; 62 (5): 385387. http://dx.doi.org/10.1093/occmed/kqs041. PMID: 22638645</mixed-citation></citation-alternatives></ref><ref id="cit29"><label>29</label><citation-alternatives><mixed-citation xml:lang="ru">Ильяшенко К.К., Лужников Е.А. Токсическое поражение дыхательной системы при острых отравлениях. М.: МЕДПРАКТИКА; 2004: 175.</mixed-citation><mixed-citation xml:lang="en">Ilyashenko K.K., Luzhnikov E.A. Toksicheskoe porazhenie dykhatelnoi sistemy pri ostrykh otravleniyakh. [Toxic lesion of the respiratory system in acute poisonings]. Мoscow: MEDPRAKTIKA; 2004: 175. [In Russ.]</mixed-citation></citation-alternatives></ref><ref id="cit30"><label>30</label><citation-alternatives><mixed-citation xml:lang="ru">Каган В.Е., Орлов В.Н., Прилипко Л.И. Проблема анализа эндогенных продуктов перекисного окисления липидов. М.; 1986: 136.</mixed-citation><mixed-citation xml:lang="en">Kagan V.E., Orlov V.N., Prilipko L.I. Problema analiza endogennykh produktov perekisnogo okisleniya lipidov. [A problem in the analysis of endogenous lipid peroxidation products]. Moscow; 1986: 136. [In Russ.]</mixed-citation></citation-alternatives></ref><ref id="cit31"><label>31</label><citation-alternatives><mixed-citation xml:lang="ru">Oyewumi L.K., Cernovsky Z.Z., Freeman D.J., Streiner D.L. Relation of blood counts during clozapine treatment to serum concentrations of clozapine and norclozapine. Can. J. Psychiatry. 2002; 47 (3): 257261. PMID: 11987477</mixed-citation><mixed-citation xml:lang="en">Oyewumi L.K., Cernovsky Z.Z., Freeman D.J., Streiner D.L. Relation of blood counts during clozapine treatment to serum concentrations of clozapine and norclozapine. Can. J. Psychiatry. 2002; 47 (3): 257261.PMID: 11987477</mixed-citation></citation-alternatives></ref></ref-list><fn-group><fn fn-type="conflict"><p>The authors declare that there are no conflicts of interest present.</p></fn></fn-group></back></article>
