Objective: to assess the specific features of central hemodynamics (CH), extravascular lung water index (EVLWI), and pulmonary oxygenizing function in patients with different outcomes of treatment for severe communityacquired pneumonia (CAP).

Subjects and methods. The retrospective study enrolled 57 patients with CAP. According to its outcome, there were 2 groups: 1) 44 patients (33 men and 11 women), whose disease ended in recovery; 2) 13 patients (8 men and 5 women), whose CAP resulted in a fatal out come. The groups did not differ in age (48.1±2.3 and 55.3±4.1 years) and overall disease severity according to the APACHE II (21.5±0.8 and 25.2±2.1 scores) and SOFA (8.7±0.2 and 9.7±1.0 scores) scales (p<0.05). CAP was more severe in Group 2: 3.5±0.1 and 4.4±0.27 CURB65 scores (p>0.05). All the patients received identical antibiotic therapy. They underwent transpulmonary thermodilution according to the standard procedure. The indicators were daily recorded. The data were statistically processed. A corre lation analysis was made calculating the correlation coefficients (r). The significance of differences was estimated by the Student's ttest or Mann-Whitney test.

Results. On day 1 of followup, the patients in both groups were prone to arterial hypotension, had tachycardia, lower or nearnormal central venous pressure (CVP). Group 1 versus Group 2 had higher cardiac index (CI) (2.9±0.2 and 2.1±0.1 l/min/m2 ) and global ejection fraction (GEF) (22.5±1 and 15.8±1.7%) (p<0.05) and lower CVP (4.1±0.2 and 5.6±0.4 mm Hg) (p<0.05). On day 3, Group 2 versus Group 1 had higher CVP (p<0.05) and lower CI, GEF, and some other cardiac pump function indicators. Admission EVLWI was virtually equally elevated in both groups. In Group 1, the indicator decreased later on and approached the normal values at 67 days of treatment. In Group 2, EVLWI remained high and did not virtually decrease. The indicator was ascertained to be inversely correlated with GEF on treatment days 1—2 (r=0.35 to 0.58; p<0.01) and 6—7 (r=0.67 to 0.43; p<0.001).

Conclusion. In the first 24 hours of treatment, the patients with the unfavorable course of severe CAP are diag nosed as having signs of acute respiratory distress syndrome (ARDS) and impaired CH, which can be interpreted as progressive right ventricular dysfunction. The pivotal role of ARDS in the pathogenesis of CH disorders is borne out by the inverse correlation between EVLWI and integral cardiac systolic function indicator and GEF.

Objective: to analyze the efficiency of prescribed antibiotic therapy in patients with viral and bacterial pneumonia of variable severity in the epidemic and postpandemic periods (October 2009 to February 2011).

Subjects and methods. Case histories of 85 patients (mean age, 35.92±13.3 years) were retrospectively analyzed; out of them 31 patients were followed up and treated in intensive care units (ICU). The patients were grouped according to PaO2/FiO2: 1) PaO2/FiO2 >300 (n=54); 2) PaO2/FiO2 <300 (n=26); 3) PaO2/FiO2< 200 (n=5).

Results. Regression analysis proved the importance of antimicrobial therapy used in admitted patients hav ing risk factors and PaO2/FiO2 > 300. Bacteriological followup revealed that all the patients who had PaO2/FiO2 <200 and died in ICU had been nosocomially reinfected with polyresistant microorganisms and targeted antimicrobial therapy could not be per formed.

Conclusion. Early antibiotic therapy in patients with PaO2/FiO2 >300 and risk factors improves the prognosis of the dis ease. All the patients who have PaO2/FiO2 >300 and are ineffectively treated for antibacterial pneumonia should undergo follow up analysis of bronchoalveolar lavage to be switched to targeted antibiotic therapy. The patients who have PaO2/FiO2< 200 are at the highest risk for nosocomial reinfection and pose difficulties in choosing adequate antibiotic therapy. There is a significant relationship between the detection of polyresistant microorganisms and ICU mortality rates.

Objective: to develop a technology for obtaining the molded sorbent VNIITU1, to study its physicochemical and biomedical properties, and to evaluate its efficacy in preventing and treating pyoinflammatory complications in obstetrics.

Materials and methods. The molded sorbent VNIITU-1 was designed from the carbon porous material based on nanodispersed carbon by mixing with a vehicle, extruding the mixture, drying the extrudate in an inert atmosphere, thermally treating and activating by steam, followed by washing with distilled water and drying (TU 9398043710698342013). The molded sorbent VNIITU-1 is apyrogenic and nontoxic (Toxicity Study Conclusion No. 1998.013.P dated 14.08.2013; Engineering Testing Assessment No. 12.404 ORTI/2013 dated 26.08.2013), it is destined for single administration, sterile, placed in a removable thread capron mesh container, and used to treat and prevent pyoseptic complications in puerperas at risk for infection, such as acute nonspecific postpartum endometritis. A total of 52 puerperas were examined and treated. They had been divided into 2 groups: a study group (n=37) and a comparison group (n=15). In the study group, the hemosorbent VNIITU1 as a porous carbon applicator was postpartum inserted into the uterine cavity, by concurrently performing traditional antibiotic therapy to prevent infectious complications. The comparison group received only traditional antibiotic therapy. The uterine cavity aspirate was examined for IL1β and IL6 levels, its microbial profile, and microbial growth patterns in culture media. The data were processed using a package of applied STATISTICA6.1 programs and standard mathematical tables in Microsoft Excel. Descriptive and variation statistical methods were applied. The data were presented as Me [low quartilehigh quartile (LQHQ)]; two pre and posttreatment dependent variables were compared using the Wilcoxon and Mann-Whitney tests.

Results. The molded carbon sorbent VNIITU1 was found to have pronounced antibacterial activity against S.aureus, P.aeroginosa, K.pneumonia, E.coli and S.agalactiae. Examination of lavages from the surface of the sorbent after its removal from the uterine cavity, by using a transmission electron microscope, revealed castoff epithelial cells, leukocytes, macrophages, and microorganisms, which determines the capacity of the sorbent to eliminate not only soluble toxins, but also microorganisms and disintegrating cell elements.

Conclusion. The proposed procedure to  postpartum endometritis in puer peras at risk for infection via insertion of the porous carbon applicator VNIITU1 into the uterine cavity is more effective than the traditional approach and it can improve treatment results, by completely eliminating pathogens from the uterus and by reducing the level of local proinflammatory cytokines.

Objective: to use laser Doppler flowmetry (LDF) to investigate the effect of perfluorane on the time course of microhemocirculato ry changes in the rat pial vessels in acute blood loss and after autohemotransfusion.

Material and methods. Experiments were car ried out on 31 outbred male rats weighing 300—400 g under anesthesia with intraperitoneal Nembutal 45 mg/kg. The caudal artery was catheterized to measure blood pressure (BP), to sample and reinfuse blood, and to administer infusion solutions. LDF (ЛАКК 02 device, LAZMA, Russia) was used to record blood flow in the pial vessels of the left parietal region (the center coordinates were 3 mm caudal to bregma and 2 mm left of the sagittal suture. A volumefixed acute blood loss model was applied. The goal amount of blood loss was 30% of the circulating blood volume. At 10 minutes after blood sampling, the animals were administered 0.9% NaCl solution (physiologic saline (PS), n=15) or perfluorane (PF), n=16)) in a dose of 3 ml/kg body weight. At 60 minutes following blood sampling, autohemotransfusion was used, after which there was a 60min reperfusion period. The investigators analyzed LDF readings and determined the following indicators: microcirculation index; the maximum amplitudes of blood flow fluctuations in the endothelial, neurogenic, and myogenic frequency ranges by a wavelet analysis. The data were statistically processed using Statistica 7.0 software.

Results. Hypovolemia caused a more than 50% reduction in BP; moreover, blood flow in the pial vessels decreased by less than 20% of its baseline level (p<0.05). In the same period, there was an increase in the amplitude of flux motions mainly in the neurogenic (NA) frequency. The differences in microcirculatory parameters between the PS or PF groups were in the retention of higher NA in the PS group throughout hypovolemia; at the same time the groups did not differ in the arterial blood levels of the index of perfusion (IP), рСО2, and lactate. After blood reinfusion and BP elevation, the examined microcirculatory parameters did not dif fer between the groups and were similar to the baseline values, suggesting that there were compensatory changes in the amplitude of flux motions in response to evolving blood loss.

Conclusion. The findings suggest that PF versus PS leads to the reduced tension of compensatory mechanisms for cerebral blood flow regulation at a risk for hypoxia during hypovolemia.

Systemic therapeutic hypothermia has gained a negative reputation in treating multiple trauma patients and is regarded as one of the factors in the lethal triad of shock, acidosis, and hypothermia. This fact owes to no relationship between acidosis and hypothermia; the effects of the latter on coagulation are evident and complexly reversible in the presence of acidosis.

Objective: to determine the impact of noninvasive local brain cooling on the metabolic and blood coagulation indicators of a patient with acute cerebral ischemia.

Subjects and methods. The subjects of the study were 113 patients with severe brain injury, including that complicated by the involvement of stem structures, who underwent brain cooling in different modifications. In so doing, the val ues of acidbase balance and coagulation system in arterial and venous blood were investigated.

Results. Local brain hypother mia was not found to affect coagulation while the baseline negative values of excess buffer bases showed positive values (a right shift) by the end of cooling. Recommendations were given to prevent metabolic shifts.

Conclusion. Patients at very high risk for bleeding may be safely cooled to a brain temperature of 32—34°C even in the presence of moderatetosevere acidosis. This is a great advantage of local hypothermia over systemic one.

Objective: to reveal early changes in the hemostatic system during warfarin therapy in cardiac surgical patients, by comprehensively evaluating their hemostatic status.

Subjects and methods. Seventyfive patients receiving cardiac surgical treatment were examined. All the patients took warfarin for 5±1.5 days. Laboratory studies involving the determination of routine coagulogram readings and thrombodynamic indicators (lag time (Tlag) and rate (Vs) of clot growth, and concentrations of individual Factors II, VI, IX, and X) were used to evaluate the patients' hemostatic status.

Results. 28% of the patients were found to have an international normalized ratio (INR) of above 3.0. There was a correlation of Tlag with INR (R2=0.66). Both indicators were  comparatively highly correlated with Factor II and Factor X concentrations (R2=0.50 and 0.40 for Tlag; R2=0.53 and 0.48 for INR) and were uncorrelated with Factor IX levels (R2=0.20 for Tlag and 0.34 for INR). However, there was a difference in Factor VII concentrations: no correlation for Tlag (R2=0.20) whereas it for INR was rather high (R2=0.42). The index Vs was uncorrelated with INR (R2=0.24) and the concentration of blood coagulation factors (R2<0.1). There was a high correlation between Factor II and Factor X concentrations (R2=0.87); the correlation between the concentrations of all other pairs of coagulation factors was substantially lower (R20.45). The lack of correlation of a thrombodynamic indicator, such as clot growth rate, with the concentration of coagulation factors points to the fact that warfarin acts mainly on the phase of coagulation activation rather than that of clot propagation.

Conclusion. The weak correlation between coagulation factors (except that of a pair of Factor II and Factor X) is indicative of the individual response of the patients to warfarin treatment and the need to monitor the hemostatic status by global hemostatic tests rather than by individual proteins. The thrombodynamic indicator Tlag reflects the effect of warfarin in proportion to INR. Warfarin virtually fails to affect the rate of clot growth so this indicator may be used to evaluate the patient's procoagulant status uncompensated for with warfarin intake. 

Objective:to detect lung morphological changes in acute intoxications with clozapine, ethanol, and their combination 3 and 24 hours after poisoning.

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<0.05.

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.

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.