Pneumonia is one of the most common infections with high mortality rates. The gene polymorphism of Toll-like receptors that belong to the first line of defense of the immune system can make a considerable contribution to individual variability due to the risk of pneumonia. Today this issue has not been adequately explored and the data available in the literature are conflicting.

Objective: to carry out a meta-analysis of the association between Toll-like receptor gene polymorphic variants and the risk of pneumonias and its coinfections.

Methods. A meta-analysis was carried out to detect a possible association of the risk of pneumonia and coinfections with single nucleotide polymorphisms (SNP) in the TLR2 (rs5743708 (2258 G>A; Arg753Gln) and TLR4 (rs4986790 (896A>G; Asp299Gly) genes. The investigation enrolled 2312 (682 patients/1630 control individuals) and 3075 (910/2165) Caucasians for each SNP, respectively. As the rate of minor alleles of both polymorphic variants was less than 5%; the analysis was made only for a dominant genetic model.

Results. Analysis of the study group showed that the A allele of TLR2 rs5743708 was associated with the risk of pneumonia (OR = 1.90; 95% CI: 1.02—3.54; P=0.042) while TLR4 rs4986790 was not associated with pneumonia. Analysis of subgroups (children/adults and community-acquired/nosocomial pneumonia) revealed no significant effects.

Conclusion. The A allele of TLR2 rs5743708 may be a risk factor for susceptibility to pneumonia. These results have promises for their clinical application; however, due to the high heterogeneity and insufficient sizes of samples, these results need to be confirmed by further investigations.

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

Materials and methods. Experiments were carried 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. The LDF (ЛАКК-02 device, LAZMA, Russia) method was used to record blood flow in the microvessels of the internal surface of the right ear. A volume-fixed 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 with 0.9% NaCl solution (physiologic saline (PS), n=15) or perfluorane, PF, n=16 at in a dose of 3 ml/kg body weight. At 60 minutes following blood sampling, autohemotransfusion was carried out, after which there was a 60 min reperfusion period. The investigators ana lyzed LDF readings and determined the following indicators: microcirculation index (MI); the maximum ampli tudes of blood flow fluctuations in the endothelial (Ae), neurogenic (An), and myogenic (AM) frequency ranges by a wavelet analysis. The data were statistically processed using Statistica 7.0 software. Results. At baseline, no differences were found between the PF and PS groups in the examined indicators. At 1—10 min of hypovolemia (before drug administration), as compared with the baseline values, both groups showed equal changes as reductions in blood pressure (BP) (by 58.3 and 62.2% in the PS and PF groups) and MI (by 63.3 and 69.2% in the PS and PF groups) and an increase in An (P<0.05). After drug injections, BP and MI were increased in both groups, but to a greater extent in the PF group (P<0.05); Ae also rose in both groups, and An continued to remain higher. During hypovolemia, BP values were thereafter similar in both groups and An remained elevated as compared to its baseline values, at the same time Ae remained increased in the PF group only. During reperfusion, MI, Ae, and An returned to their baseline values in both groups. BP returned to its baseline values and was kept constant in the PS group and decreased in the PF group at 50—60 min versus 1—10 min of reperfusion and outcome. The differences in BP had no impact on the microcirculatory parameters examined.

Conclusion. The administration of PF versus PS in acute blood loss causes a more pronounced increase in BP and MI. The Ae increase persisting in the PF group throughout hypovolemia may point to the stimulating effect of PF on the endothelium-dependent mechanisms of flux motions in the rat ear skin under hypovolemic conditions.

Objective. Investigate the impact of the course of pregnancy and labor on some lipid metabolic disturbances in newborn infants.

Subjects and methods. The anamnestic data of the course of pregnancy, which were used to identify a high risk for intranatal hypoxia and the birth of a critically ill baby, were analyzed in 217 pregnant women. In addition to assessment of a baby's status at birth, the newborn infants underwent measurements of cholesterol and triglyc-erides in their central venous blood just after birth and on day 5 of life Results. The low levels of triglycerides and cholesterol are an inherent feature in the newborns born via an emergency cesarean section due to bleeding-complicated placental presentation or abruption and other obstetric causes. The most critical plasma level of triglycerides in extremely premature infants born at 22—29 weeks' gestation and in those having extremely low birth weight was no more than 0.01—0.2 mmol/l. Gestational age and birth weight have an impact on the production of triglycerides. Acute intranatal hypoxia affects the perinatal concen-tration of cholesterol in the newborns; the severer is hypoxia, the lower are blood cholesterol levels.

Conclusion. Varying perinatal triglyceride and cholesterol metabolic disturbances are specific in newborn infants with respiratory failure who were born via an emergency cesarean section due to placental abruption or discoordinated labor activity. The low blood levels of the test substances are detectable in babies at birth. Gestational age and birth weight are another factors that influence blood triglyceride concentrations. The lowest triglyceride levels are a characteristic feature in newborn infants at 22—29 weeks' gestation and in those having extremely low birth weight.

The need for emergency cessation of ventricular fibrillation is one of the problems of modern reanimatology. In spite of searches for novel methods, there is the only effective method — electrical cardiac defibrillation.

Objective: to investigate the effect of different forms of pulses on cell membranes in a model experiment and to assess their use for effective cardiac defibrillation.

Materials and methods. The Maxwell model was used for theoretical analysis of the spatial distribution of an electric field in the red blood cell membrane. The electric effect on a single cell was calculated using the experimental findings and the equivalent electrical circuit of the myocardial structure during a defibrillation procedure. The cardiomyocyte membrane potential upon exposure to defibrillator discharge was estimated. Exposure of the red blood cell membrane to single, two unipolar and two heteropolar pulses was examined.

Results. There is non-additivity of speeds upon double exposure as compared to single one. Single pulse causes a lower effect of electroporation than two double pulses. Hyperpolarization and depolarization processes in the cardiomyocyte membranes occur successively during electrical cardiac defibrillation.

Conclusion. Two heteropolar pulses cause an effect of biological membrane electroporation with a greater probability than two unipolar ones.

Objective: to show the problems of differential diagnosis and treatment of atypical hemolytic-uremic syndrome in a 23-year-old patient.

Results. Eculizumab (Soliris), (Alexon Pharmaceuticals Inc., USA) that is a glycosylated humanized monoclonal antibody to immunoglobulins (IgG2/4k) is shown to be effective in treating this disease.

Conclusion. Atypical hemolytical-uremic syndrome in pregnancy is a disease, whose treatment difficulties are largely associated with the problem of differential diagnosis with thrombotic thrombocytopenic purpura and man-ifestations of multiple organ dysfunction. The treatment for this disease gives a key role to Eculizumab.

Objective: to enhance the efficiency of medical rehabilitation in patients who have undergone mechanical ventilation (MV) and tracheostomy in an intensive care unit through dynamic clinical, laboratory, endoscopic control and adequate therapy for detected pathology. A total of 120 intensive care unit patients who had undergone tracheostomy in different MV periods were examined.

Subjects and methods. A total of 120 patients (76 men and 44 women) aged 15 to 78 years were examined in different MV periods. All the patients were operated on in intensive care units. The surgical techniques of tracheostomy were described; the clinical and endoscopic pattern of the laryngeal and tracheal mucosa in patients on MV was presented. The bacteria isolated from the patients on MV were typed; the cartilages of the anterior tracheal wall were pathomorphologically studied in different MV periods.

Results. Microbiological examination indicated the predominance of the mixed microflora: Staphylococcus, Pseudomonas aeruginosa and Proteus. Intraoperative postmortem examination of the cartilages of the anterior tracheal wall was made in 30 patients in different MV periods who were noted to develop pathological changes in the laryngeal and tracheal mucosa and destructive and dystrophic alterations in the tracheal cartilage even if their intubation lasted as long as 3 days. Morphological examination of tracheal cartilages in patients who were on MV for 4 to 7 days revealed progressive destructive and dystrophic processes in peretracheal connective tissue, leukocyte accumulation, and focal bleeding. During intubation for more 7 days, there was partial death of the cartilage, its replacement by granulation tissue, and appearance of regions of sequestration of the dead cartilage. Endoscopic examination showed varying degrees of postintubation laryngeal and tracheal changes in all (n=120) the examinees.

Conclusion. The performed treatment permitted decannulation of 111 patients; 16 patients underwent endoscopic intervention into the larynx and trachea; reconstructive operations followed by decannulaton were performed in 4 patients with postintubation laryngeal and tracheal stenosis; 5 patients with severe comorbidity remained to be chronic cannula carriers.

The review deals with basic fibroblast growth factor (bFGF), one of the most known representatives of the family of neutrotrophic factors. It discusses its function in the central nervous system in health and disease, some mechanisms of neuroprotective action, the therapeutic potential of bFGF for the treatment of functional and structural disorders of the nervous system in brain ischemia of different etiologies, and in neurodegenerative diseases. Alternative routes for delivery of this protein to injured cerebral regions are considered.