Part 2 of the review considers the problem of surfactant therapy for acute respiratory distress syndrome (ARDS) in adults and young and old children. It gives information on the results of surfactant therapy and prevention of ARDS in patients with severe concurrent trauma, inhalation injuries, complications due to complex expanded chest surgery, or severe pneumonias, including bilateral pneumonia in the presence of A/H1N1 influenza. There are data on the use of a surfactant in obstetric care and prevention of primary graft dysfunction during lung transplantation. The results of longterm use of surfactant therapy in Russia, suggesting that death rates from ARDS may be substantially reduced (to 20%) are discussed. Examples of surfactant therapy for other noncritical lung diseases, such as permanent athelectasis, chronic obstructive pulmonary diseases, and asthma, as well tuberculosis, are also considered.

Objective: to determine the significance of the expression of GDNF protein for developing a cerebellar Purkinje cell death process after ischemiareperfusion.

Materials and methods. Rats of both sexes were subjected to 10 minutes of systemic circulatory arrest caused by cardiac vascular fascicle ligation. The status of a highly hypoxiasensitive neuronal population of cerebellar Purkinje cells was investigated in different postresuscitation periods. The total number of Purkinje cells per mm
of their layer length was estimated by a histological analysis of the specimens stained with cresyl violet after the Nissl procedure. An immunocytochemical analysis was made to determine the number of GDNFpositive (weakly and strongly stained) and GDNFnegative neurons per mm of their layer length and the total population density.

Results. The histological and immunocytochemical studies of resuscitated male and female rats have determined a trend in the development of a neuron death process in the population of cerebellar Purkinje cells and revealed postresuscitation changes in the level of GDNF protein expression. Homogeneous and unidirectional postresuscitation changes have been ascertained to develop in the Purkinje cell population of the animals of both sexes. The initial rise in the expression of GDNF protein in the neuronal pop
ulation can prevent the development of a nerve cell death process. The subsequent decrease in GDNF expression is accom panied by neuronal fallout (death). At the same time, GDNFnegative cells may undergo death. There are gender specific features; the male rats show changes in GDNF expression in the Purkinje cell population and develop neuronal death processes earlier than the female rats.

Conclusion. There was an association between the changes in GDNF protein expression and the development of a neuronal death process in the postresuscitation period. The GDNF protein expression was shown to be an important factor influencing the resistance of neurons to death in the postresuscitation period. This determines prospects for using GDNF to elaborate approaches to protecting the brain in ischemiareperfusion.

Objective: to study the specific features of skin blood flow changes in blood loss and after its replacement.

Material and methods. Experiments were carried out on 22 outbred male rats weighing 400—550 g, anesthetized with nembutal or chloralhydrate. The caudal artery was catheterized to measure blood pressure (BP), to sample and reinfuse blood. Skin blood flow in the area of the right ear was recorded by laser Doppler flowmetry. Onehour hypovolemic hypotension followed by autoblood reinfusion served as a model. Blood loss volume necessitated maintenance of BP at about 50 mm Hg by 60 minutes of hypotension. The investigators deter mined the following indicators of skin blood flow: microcirculatory index (MI) and relative perfusion units (pf. u); a wavelet method was used to estimate the maximum amplitudes of blood flow fluctuations (flux motions) in the ranges accepted to be correlated with active and passive mechanisms to regulate microcirculation. The data were statistically processed by applying the Statistica 7.0 program. The results were presented as Me (25%; 75%).

Results. The animals were divided into groups according to blood loss volume: lower (L) and higher (H) than average. At 60 minutes of hypotension, BP in both groups averaged 53 mm Hg, but the L group showed a tendency (p<0.1) towards a greater MI and a longer  mplitude of flux motions in the neurogenic (An) and additional (Aa) frequency ranges (p<0.05) than in the H group. At 60 minutes of blood reinfusion, all the analyzed indicators returned to the base
line values (except a tendency (p<0.1) towards a lower MI) in the H group while BP remained below the baseline value in the L group. In the same followup period, the amplitudes of flux motions in the An and Aa ranges were higher and MI and BP were lower in the L group than in the H group (p<0.05).

Conclusion. During hypovolemic hypotension and reinfusion, the increased amplitude of flux motions involves an animal's individual and typological capacity to compensate blood loss and to maintain blood flow under tissue hypoperfusion.

Objective: to estimate the clinical and prognostic value of the blood levels of lipopolysaharidebinding protein (LPSBP) and lactate in critically ill polytrauma patients.

Subjects and methods. An analysis was made of the results of an examination in critical ly ill polytrauma victims who were retrospectively classified in accordance with the 1992 ACCP/SCCM criteria: systemic inflammatory response syndrome (n=18), local infection (n=36), sepsis (n=27), severe sepsis (n=12), and septic shock (n=6). A case was regarded as infection when the source of the latter was established and it was microbiologically verified. The investigators determined serum LPSBP levels by an immunochemiluminescence analyzer (IMMULITE ONE, USA) and venous whole blood lactate concentrations by a Roche Omni S analyzer (Germany).

Results. The development of infectious complications was noted
in 81% of the polytrauma patients by days 5—7; by days 8—10, 45% were diagnosed as having sepsis whose severe course was characterized by the addition of polyresistant gramnegative microorganisms. An early increase in the concentration and frequency of diagnostic levels of serum LPSBP was ascertained in the polytrauma patients before infection was microbiologically verified. There was a strong direct correlation between lactate and LPSBP levels.

Conclusion. The findings suggest that LPS BP and lactate are of diagnostic and prognostic value and may be used as early markers of pyoseptic complications.

Blood loss is a complex pathological process with the mechanism that has not been fully unstudied. Blood rheology is a particular link that is involved in blood losses. Objective: to perform a comprehensive study of blood rheological proper ties, such as erythrocyte aggregability, erythrocyte deformability, plasma viscosity, and packed cell volume, in different degrees of experimental blood loss.

Materials and methods. Blood loss of different stages was simulated in anesthetized animals. The Georgian technique, membrane filtration, a capillary method, and a standard centrifugation method were used to study blood rheological properties. The data were analyzed applying the statistical programs Origin 4.1 (Microcat.Software.Inc) and Microsoft Excel.

Results. In stages 1, 2, and 3 blood losses, erythrocyte aggregability was significantly increased by 10, 25, and 44% and erythrocyte deformability was decreased by 12, 13, and 15%, respectively, as compared to the controls. The delta viscosity was insignificant (both in the subgroups in different blood loss degrees
versus the control group); the packed cell volume in blood loss was increased insignificantly as compared to the control.

Conclusion. Comprehensive assessment of the degree of blood loss requires a minimum set of blood rheological indices, such as erythrocyte aggregability and deformability, blood viscosity, and packed cell volume. The basis for monitoring the rheological indices of massive blood loss is the specific features of erythrocyte aggregation.

Objective: to test the hypothesis that the perioperative use of omega3 polyunsaturated fatty acids (ω3PUFA) as intravenous infusion will reduce the risk of postoperative atrial fibrillation (POAF) in patients with coronary heart disease operated on under extracorporeal circulation.

Subjects and methods. A doubleblind prospective controlled study was conducted in 39 patients who were randomized into two groups: 1) 18 patients were infused with ω3PUFA (Omegaven, Fresenius Kabi, Germany), beginning before inducing anesthesia in a dose of 200 mg/kg/day within the first 24 hours and 100 mg/kg/day on days 2 to 7 postsurgery; 2) 21 received placebo (Intralipid, Fresenius Kabi, Germany) in the equivalent dose. The primary end point was freedom from POAF during 2 months after surgery. POAF was examined using a subcutaneously implanted continuous cardiac rhythm monitoring device (Reveal XT, Medtronic, USA). Monitoring readings were taken on day 10 at 3, 6, 12, and 24 months following surgery.

Results. POAF was observed in 4 (19%) patients in the placebo group and in 5 (27.8%) in the ω3PUFA group on days 10 postsurgery (p=0.88). During 2year followup, POAF was revealed in 5 (27.8%) patients in the control group and in 6 (35.3%) in the ω3PUFA group (p=0.9). The duration of POAF was associated with the risk of rehospitalizations for decompensated heart failure (regression coefficient, 0.24; standard error, 0.02; p<0.0001; R2=0.74).

Conclusion. The results of the study do not support the efficiency of perioperatively using ω3PUFA to prevent POAF

Objective: to evaluate the efficiency of inhaled surfactant therapy in neonatal infants with respiratory failure.

Subjects and methods. The trial enrolled 13 premature neonatal infants; their mean gestational age was 31.8±2.8 weeks and the birth weight was 1825±600.9 g. They had a oneminute Apgar score of 4.3±1.4. All the neonates needed mechanical ventilation (MV) at
birth because the leading clinical sign was respiratory failure caused by acute intranatal hypoxia, neonatal amniotic fluid aspiration, respiratory distress syndrome (RDS), and cerebral ischemia. Curosurf was injected in a dose of 174.7±21 mg/kg in the infants with neonatal RDS at 35 minutes of life. All the babies included in the study were noted to have severe disease and prolonged MV. After stabilization of their status, the neonates received combination therapy involving surfactantBL inhalation to reduce the duration of MV. The dose of the agent was 75 mg.

Results. After surfactantBL inhalation, effective spon
taneous respiration occurred in 69.2% of the newborn infants; successful extubation was carried out. The median duration of
MV after surfactant BL inhalation was 22 hours (4—68 hours). There were no reintubated cases after inhalation therapy. Following surfactantBL inhalation, 4 (30.8%) patients remained to be on MV as a control regimen; 3 of them had highfre quency MV. SurfactantBL inhalation made it possible to change the respiratory support regimen and to reduce MV parame ters in these babies. 

Objective: to evaluate the laboratory and clinical effects of combined intravenous laser therapy in young children with thermal
injuries in the acute period of burn disease.

Subjects and methods. Forty children whose mean age was 2.67±0.35 years were examined; thermal injuries accounted for 25.05±1.01% of the total body surface area; of them degrees IIIaIIIb was 19.04±0.85%. A comparison group (n=15) received conventional therapy without taking into account and correcting baseline and current hemostasiological disorders. On day 1, a study group (n=25) had programmed anticoagulant therapy and intravenous laser therapy at different radiation frequencies with a Mustang 20002+ laser therapy apparatus (patent for invention No. 2482894) in addition to the conventional therapy. The laser therapy cycle was 6 to 16 sessions. The investigators estimated and compared the following examined parameters: white blood cell count; leukocytic index of intoxication; plasma average mass molecules at a wavelength of 254 nm; toxogenic granularity of neutrophils; wound exudate discharge time; surgical plasty area; and hospitalization time.

Results. The positive laboratory and clinical effects of the performed combined intravenous laser therapy in the combined therapy of burn disease in young children were comparatively shown in the study group patients. The significant decrease in the level of an inflammatory response and endogenous intoxication led to a rapider burn wound cleansing, active epithelization, and reduced surgical plasty volumes.

Conclusion. Combined intravenous laser therapy signif icantly exerts antiinflammatory and detoxifying effects in young children with 40% thermal injuries in the acute period of burn disease. Abolishing a systemic inflammatory response by combined intravenous laser therapy initiated early regenerative processes in the burn wound and caused reductions in surgical plasty volumes and hospitalization time, which optimizes ther apy for burn disease.