The purpose of this study is to determine and evaluate if the preconditioning with desflurane depends on level of phosphoGSK3β.

Material and methods. White outbred male rats (56) were randomly allocated to 6 groups. Ischemia/reperfusion modeling was performed using V. G.Korpachev's technique. The reference group consisted of sham (falselyoperated) animals. The second group underwent global ischemia/reperfusion after anesthesia with chloral hydrate. The next two groups were treated with either sevoflurane or desflurane at 1 MAC. In the final two groups, the use of same anes thetics was followed by global ischemia/reperfusion. The concentration of phosphoGSK3β in brain homogenate was determined using western blotting. A statistical analysis was performed using the MannWhitney Utest, and the difference was considered significant at P<0.05. A threeminute ischemia with subsequent reperfusion resulted in a significant increase in the concentration of phosphoGSK3β vs. the reference group (620437 relative units vs. 304574 relative units, respectively, P<0.05). Similar results were observed in groups where animals received inhaled sevoflurane (743166 relative units) and desflurane (667119 relative units) alone (P<0.05). In the ischemia/reperfusion group, the concentration of phosphoGSK3β was equal to 922231 relative units after inhalation of sevoflurane (P<0.05 vs. the reference group). In the group with a combination of desflurane and ischemia/reperfusion, the enzyme concentration increased up to 677084 relative units (P<0.05 vs. reference group). No difference in concentrations of the enzyme between groups receiving inhaled anesthetics with and without ischemia/perfusion was found. In addition, the concentration of this enzyme was comparable with that in the ischemia/reperfusion group.

Conclusion. Two anesthetics under testing possess similarly increased concentration of phosphoGSK3β in rat brain homogenates.

The purpose of this review is to present the most significant modifications and transformations of a hemoglobin molecule potentially related to developing a strategy of resuscitation and treatment of lifethreatening forms of anemia. Hemoglobin is one of the wellstudied proteins. The paper reviews the history of hemoglobin studies from 1839 untill present. Methodically, the hemoglobin studies included electrophoresis, spectrophotometric method, Xray diffraction method, atomicforce microscopy. The basic forms of hemoglobin include oxyhemoglobin, deoxyhemoglobin and methemoglobin. Data on protein crystallization and polymerization are discussed. Many forms of hemoglobin have the ability to form crystals or polymers in vitro, some pathological forms can be modified in vivo. The studies of structural features of various hemoglobin forms represent a contemporary task for fundamental researches.

This review presents current data on the mechanism of action, selective toxicity, toxicokinetics and toxicodynamics of diacetylmorphine (heroin). Acute diacetylmorphine poisoning is considered under taking into account the developing a critical state, in which the poisoning severity is determined by severe metabolic disorders associated with the progression of hypoxia. The main lifethreatening complications of acute diacetyl morphine poisoning are described including those associated with the nervous system, respiratory, circulatory and urinary systems. Since hypoxia is the principal damaging factor, the the mechanisms of oxygen transport disorders and the pathogenesis of activation of free radical oxidation in acute diacetylmorphine poisoning are discussed. The improvement of intensive care strategy for severe forms of acute diacetylmorphine poisoning by the inclusion of a substrate antihypoxant Reamberin into the list of routine critical care prescriptions is emphesized.

The review devoted to sorbents and sorbentbased medical devices used in clinical practice for extracorporeal detoxification using a hemoperfusion technique. Clinical data have confirmed the effectiveness of this approach for removal of bacterial endotoxins, lowdensity lipoproteins, and bilirubin. Other studies demonstrated successful application of sorbents to treat autoimmune diseases. Special attention is paid to hemoperfusion in as a possible treatment for severe sepsis and septic shock. The review justifies importance of development and application of novel multimodal sorbents, which combine both properties of selective and nonselective sorbents. The review discusses clinical efficacy of hemoperfusion and key molecular interactions between the sorbent and circulating molecules pathogenetically relevant to developing critical illness and severe diseases. The reference list: 137.

The survival of patients after the sudden circulatory arrest (SCA) depends not only on immediate onset of resuscitative measures, but also on their quality.

The purpose of the study. The purpose is to assess the compliance of basic and expanded resuscitative measures carried out by healthcare providers in hospitals with modern national and international guidelines within the frames of a stimulation course.

Materials and Methods. The research was perfomed in a multifield hospital in Moscow, in 2016. It consisted of two phases. During the first phase, within the frames of a simulation course, providers' skills in the cardiopul monary resuscitation (CPR) and chest compression (CC) technique mastership were evaluated. During the second stage, their skills in expanded CPR and ability to work as a part of resuscitation teams were assessed. During the simulation, all team activities were recorded (both audio and video); CC parameters were also registered using a CC pressure control sensor (hereinafter referred to as a sensor) and audiovisual tips. The European Resuscitation Council Guidelines for Resuscitation 2015 were used as reference criteria. The analysis was performed using the ZOLL RescueNet Code Review® software. A statistical analysis was performed using the Statistica 7.0 software (MannWhitney Utest). The data were presented as a mean, median ± 25—75 percentiles (25—75 IQR), minimum and maximum values. The difference was considered significant at P<0.05.

Results. Test results of most healthcare providers were unsatisfactory when the CPR was performed without sensors and audiovisual tips: the percentage of target CCs was not more than 10% in 72% of providers (n=18). When the CPR was performed with sensors and audiovisual tips regulating the CC quality, the percentage of target CCs was 65.7%. i.e. it was significantly higher than that during the CPR without the sensor and the tips (P=0.0000). While only one provider was able to perform the target CC without the sensor and the tips (4%), 12 providers were able to do it with the sensor (48%) (P=0.0000). In all resuscitation teams, there was a lack in compliance with the ECR 2015 guidelines for expanded CPR, as well as ineffective team work was revealed. Chest compressions did not comply with recommended parameters; pauses before and after defibrillator discharge were too long. In most cases, there was hyperventilation during the artificial lung ventilation. The safety principle was not followed by one of resuscitation teams during the defibrillation procedure.

Conclusion. The obtained data demonstrate that healthcare providers have poor skills in basic and expanded CPR. Therefore, it is important to train and retrain healthcare providers in basic and expanded CPR within the frames of simulation training courses on a regular basis (in accordance with European Resuscitation Council Guidelines for Resuscitation 2015 and National Resuscitation Council). During training, the use of technical means of monitoring of the chest compression quality control in CPR should be warranted. It is important to arrange regular retraining in order to keep the skills uptodate, as well as regular debriefings on the CPR quality after each case of resuscitation measures in a hospital.

The purpose of the study is to assess the possibility of managing the antibiotic resistance level and consumption of antimicrobial agents in a hospital based on the analysis of the drug resistance index.

Material and methods. The antibiotic consumption planning system was employed at the multidisciplinary surgical hospital based on the unified Registry of microorganisms (ROM). ROM included data on 25.581 strains obtained from patients with infections admitted to the intensive care units (ICU) and specialized departments. Protocols of empiric antimicrobial therapy and perioperative antibiotic prevention were developed. The ROMbased system allowed automated calculation of drug resistance indices for nosocomial microor ganisms. Data obtained during the preintervention period (2012) and intervention period, (2014—2015) were compared.

Results. Decreases in the drug resistance indices for Pseudomonas aeruginosa from 0.721 in 2012 to 0.596 in 2015, Acinetobacter baumannii from 0.96 in 2012 to 0.889 in 2015, Klebsiella pneumoniae from 0.728 in 2012 to 0.595 in 2015 were achieved due to reduction of antimicrobial resistance, reduced consumption of III—IV generation cephalosporins and antipseudomonal carbapenems, and more frequent use of ertapenem for treatment of infections caused by Klebsiella pneumoniae. There was an increase in the drug resistance index of Escherichia coli from 0.325 in 2012 to 0.382 in 2015 due to increased consumption of protected penicillins and first generation cephalosporins for prevention in abdominal surgery and urology and increased pathogen resistance to these antibiotics.

Conclusion. A development of a unified hospital ROM and application of the drug resistance index for math ematical modeling of the pathogens resistance level allows to perform timely monitoring of changes in antibiotic resistance of nosocomial microorganisms in ICU setting and other hospital departments and proper managinge the antibiotics prescription.

The purpose of the study is to evaluate morphological changes in lung vessels of preterm infants with the infant respiratory distress syndrome (IRDS).

Material and Methods. Case history records and postmortem examination protocols of 70 preterm infants who died because of severe respiratory compromise as a result of IRDS were analyzed. All newborns were divided into three groups: the IRDS group included 25 (35.7%) infants who died due to IRDS (no surfactant); the Curosurf group was composed of 26 (37.2%) infants who received an exogenous surfactant Curosurf as a part of a complex therapy; the Surfactant BL group included 19 (27.1%) infants receiving Surfactant BL. Histological and morphometric examinations of lung vessels were performed. The Kernogan index calculated as the ratio between the lumen diameter and the wall thickness was determined.

Results. The arterial bed of newborns in the IRDS and Curosurf groups was composed of vessels having up to several μm in diameter. Larger arteries (51—100 μm in diameter) and arteries of more than 100 μm in diameter are distributed uniformly and comprise 1/3 of the total number of visualized vessels. The invert correlation of the arterial vascular bed was typical for the infants in the Surfactant BL group: arteries of 50 μm in diameter comprise 30% of all vessels, and arteries of more than 100 μm in diameter prevail. The venous bed of newborns consisted mainly of vessels having less than 50 μm in diameter. The greatest changes in the arterial wall thickness (ТСА) are typical for vessels with a total diameter of more than 51 μm. In babies of the IRDS group, the greatest (ТСА) changes were typical for arteries of 51—100 μm in diameter. Changes in arterial walls (>101 μm) were typical for the Surfactant BL group. Unlike other groups, in the Curosurf group, no significant changes in the parameters under the test were found (P>0.05). In this group (as compared to IRDS and Surfactant BL groups), there were minimal changes in vein characteristics and the minimal venous wall thickness (ТСv) (>100 μm in diameter). The Kernogan index for veins with small diameter was minimal.

Conclusion. Evaluation of the microcirculatory bed of lungs in IRDS patients is an urgent problem because the pulmonary gas exchange impairment in preterm infants is primarily caused by circulatory and microcirculatory disorders of various degrees of severity that result from anatomic and functional immaturity of the lung micro circulatory bed. In cases of unfavorable outcomes, dilation of arterial and venous lumen and vascular wall thickening might be considered as principal signs of microcirculatory disorders. Surfactants affect changes in the diameter of lumen of lung vessels, especially those with a diameter more than 50 μm, presumably improving the blood supply of the lungs. Minimal changes of tested parameters were typical for newborns on Curosurf versus IRDS and Surfactant BL groups of infants.