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 developing
multiparametric panel of biomarkers for diagnosis and prognosis of ARDS in patients with lifethreatening critical illness.

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 victims
were 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 deter
mined 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.

Objective: to reveal aortic structural changes in the recovery period after longterm hemorrhagic hypotension and further blood reinfusion.

Material and methods. Two (control and experimental) series of eexperiments were carried out on 10 out bred albino male rats in each. The animals were anesthetized with sodium thiopental (25 mg/kg). Sixtyminute hemorrhagic hypotension (40 mm Hg) was induced by left common carotid artery catheterization, followed by blood reinfusion and wound closure. The animals were observed for 60 days, thereafter thoracic and abdominal aortic fragments were taken. The histological sections were stained with hematoxylin and eosin by the methods of Van Gieson, Verhoeff, and Veigert. Morphometric and histometric parameters, including the percentage of layers in the vascular wall and transmission capac ity coefficients, were determined.

Results. The thoracic and abdominal aortic sections have been found to differ in morphometric parameters, which determined their different hemodynamic conditions in critical conditions. Hypertrophy of the media of the abdominal aorta due to thickening of the smooth muscle layers suggests that there are remodeling processes in its wall, which is accompanied by a smaller number of elastic membranes and by the expression of сollagencontaining structures after massive blood loss. For the thoracic aortic segment, such changes are manifested by a decreased medial area, a considerable advential thickening, and a drastic fall in transmission capacity coefficients.

Conclusion. The found morphometric characteristics of different aortic segments should be considered as the basis for longlasting adaptation, which can supply blood to the vital organs as efficiently as possible in late recovery periods.

Objective: to comparatively evaluate the perioperative clinical period in patients operated on via miniinvasive access and median sternotomy.

Subjects and methods. A retrospective analysis included all patients who had undergone correction of mitral valve defect with or without tricuspid valve correction and atrial ablation. 121 and 112 patients were operated on through miniinvasive access (a study group) and median sternothomy (a control group), respectively.

Results. The duration (median [25; 75 percentiles] of aortic occlusion in the study group (89 [71; 120] min) was significantly longer than that in the control group (65 [52; 84] min); р<0.01. Acute heart failure complicated the clinical course in 28 (23.1%) and 15 (13.4%) cases in the study and control groups, respectively; р=0.06. In the miniinvasive
access group, two deaths were caused by intraoperative aortic dissection. There was no significant difference in the length of stay in the intensive care unit and in that of hospitalization between the groups.

Conclusion. The findings are generally correlated with the world data obtained while implementing the procedure. The frequency and pattern of complications due to miniinvasive correction of mitral valve defect require additional financial expenditures and human resources. It is necessary to analyze the longterm results of treatment for the reasonable evaluation of the efficiency and expediency of using this procedure.

Part 1 of the review gives information on the composition and properties of a pulmonary surfactant and quantitative and qual itative impairments in the pulmonary surfactant system in different neonatal and adult abnormalities and describes the composition of commercial synthetic and natural surfactants. The results of surfactant therapy for respiratory distress syndrome and other lung diseases with secondary surfactant deficiency in the newborns are analyzed.

Objective: to evaluate the efficacy of alveofact in neonatal infants with respiratory distress syndrome (RDS).

Subjects and methods. The trial enrolled 5 premature neonatal infants. Their mean gestational age was 30.2±2.3 weeks; the birth weight was 1422±604 g. All the premature neonates needed mechanical ventilation (MV) because the leading clinical sign was severe respiratory failure. The surfactant alveofact was injected endotracheally in all the neonates at 3—5 minutes of life, by taking into account their gestational age and birth MV. The mean dose of the agent was 50 mg/kg).

Results. The pilot study indicated the efficacy of alveofact. There was normalization of lung gasexchange function parameters after alveofact
injection within the first 24 hours of life. Alveofact administration allows MV with the parameters close to physiological ones.