In newborns with severe intranatal asphyxia, the hemostasis system adaptation is impaired, thus increasing the risk of bleeding during the first day of life.
The purpose of the work was to evaluate the effect of severe birth asphyxia and metabolic acidosis on the newborns' hemostasis system, based on the thromboelastography (TEG) findings.
Materials and methods. A retrospective analysis of medical records of 40 severely asphyxiated newborns (group 1) and 20 healthy newborns (group 2) was performed. The study was carried out during the first hour of life of the newborns.
Results. Infants in group 1 demonstrated a reduced activity of platelets and enzymatic components of the coagulation. The enzymatic phase of the coagulation hemostasis (P<0.001) and the kinetics of clot strength growth significantly decreased in group 1 newborns, as compared to the second group (P<0.001 and P<0.01, respectively). The fibrin network growth rate and its structurization in group 1 newborns was lower than that in group 2 newborns (P<0.05). The platelet activity in group 1 infants was reduced as compared to group 2 (P< 0.05).
Fibrinolysis in newborns did not differ at the 30th minute of the study. The correlation analysis demonstrated that decreased pH and Be values and hyperlactacidemia correlated; platelet and coagulation hemostasis parameters were altered with a shift to hypocoagulation. Conclusion. Thromboelastographic study of whole blood samples demonstrated a shift of the hemostatic system to hypocoagulation for both platelet and enzymatic components of hemostasis, without any changes in the clot lysis in severely asphyxiated newborns.

The purpose of the study is to examine the effect of anesthesia and respiratory support parameters on central and peripheral hemodynamics in patients with morbid obesity undergoing an endoscopic gastric resection.
Materials and methods. A randomized study of 43 patients with a body weight index of >40 kg/m2 who underwent an endoscopic longitudinal gastric resection (sleeve gastrectomy) was performed. Patients were divided into two groups. In Group 1 (n=22), combined anesthesia based on the low%flow desflurane inhalation was applied along with the mechanical ventilation in the VC%CMV mode with a constant PEEP level. In Group 2 (n=21), combined anesthesia based on the low-flow desflurane inhalation was applied along with the prolonged epidural analgesia (PEA) with 0.2% ropivacaine solution and VC%CMV respiratory pattern, with PEEP dose escalation using titration, inverted respiratory cycle, and a gradual increase in the respiratory rate. The intraoperative monitoring included central and peripheral hemodynamics, blood gases, and ABB.Results. The study demonstrated that there was more stable central and peripheral hemodynamics in Group 2 during the intraoperative period as compared to Group 1, where increased systolic BP, median NMBP, diastolic BP, HR, CI, SVI, and SVRI levels were registered. In addition, in Group 2, РаO2 levels were significantly higher
and РCO2 levels were lower during pneumoperitoneum; no significant changes in ABB were recorded.
Conclusion. Thoracic epidural analgesia with pneumoperitoneum, increased intraabdominal pressure, and PEEP escalation mode provide stable intraoperative central and peripheral hemodynamics during endoscopic gastric resection in patients with morbid obesity.

Outbreaks of viral infections have become a global healthcare challenge over the last decade. The 2009—2010 flu A (H1N1) outbreak resulted in global pandemia, associated with high morbidity and mortality reaching 31%. Another flu A (H1N1) outbreak occurred in 2015—2016. There is a strong probability that it may be repeated in the future. This infection is associated with its high incidence among pregnant women. There are some published reports describing the efficacy and safety of veno%venous extracorporeal membrane oxygenation (ECMO) in patients with severe acute respiratory distress syndrome that is refractory to standard therapeutic options. The article presents a clinical case of a successful use of extracorporeal membrane oxygenation and intermittent renal replacement therapy in a puerpera with acute respiratory distress syndrome caused by flu A (H1N1)-related severe viral and bacterial pneumonia. The positive effects of the combination of veno%venous extracorporeal membrane oxygenation and modern detoxification techniques have been demonstrated. Revealed organizational problems
were related to selection criteria for prescription of extracorporeal gas exchange, as well as to carrying out the procedure in an institution in the deficiency of the experienced staff and corresponding equipment.

Purpose. To evaluate pathogenic factors contributing to the development of delayed complications of newly diagnosed acute destructive pancreatitis (ADP).
Materials and methods. A comprehensive examination, treatment and 5-year follow%up of 83 patients who underwent the first attack of ADP have been conducted. The day of admission to the hospital, 24 hours from the beginning of the intensive care, and Days 3 and 5 after the attack were selected as the timepoints of the study.
Complete diagnostic procedures were performed once every six months after hospitalization for five years. The patients were followed%up every month. Depending on the further progression of ADP, the patients were divided into four groups. Group I included 27 patients with acute pancreatitis which evolved into pancreatic pseudocysts.
Group II (n=43) was comprized of the patients with chronic pancreatitis; group III (n=8) included the patients who presented no pathological processes associated with structural and functional pancreatic changes over the next 5 years; and group IV (n=5) included the patients with pancreatogenic diabetes mellitus.
Results. The study confirmed the role of autoimmune mechanisms and abnormal foci localization in pancreas in the development of pancreatogenic diabetes mellitus, contribution of inflammation to formation of post-necrotic pancreatic pseudocysts, as well as the significance of the patient compliance for development of chronic pancreatitis with extensive pancreatic lesions.
Conclusion. Statistical analysis of the long-term monitoring of patients allowed to set the odds ratio evolution acute pancreatitis depending on its initial characteristics. At the same time we take into account the parameters and interpretation of the study which is possible in the first few days hospitalization.

Purpose. To study glutamate metabolism characteristics in phylogenetically different parts of the mammalian brain in experimentally induced hemorrhagic shock (HS) in cats.
Material and methods. Experiments were performed on 76 cats. HS was induced by intermittent bloodletting from femoral artery at a rate of 10ml/kg•10 minutes, with the average volume of 24±0.8 ml/kg. The bloodletting was discontinued after arterial pressure (BP) drop to 60.0±1.5 mmHg. We studied ammonia, glutamate (Gt), and α-ketoglutarate (α-KG) levels and glutaminase (GS) and glutamate dehydrogenase (GDG) activity in specimens harvested from phylogenetically different parts of the brain (cortex, limbic system, diencephalon, and medulla oblongata).
Results. In intact animals, the peak GDG activity was found in the medulla oblongata (phylogenetically the oldest part of the brain) and the peak GS activity was registered in the sensorimotor cortex (phylogenetically the youngest part of the brain); the glutaminase activity did not depend on the phylogenetic age of brain structures.
In the case of HS, Gt metabolism changes began in the sensorimotor cortex manifested by decreased GS activity, which progresses by the 70th minute of the post%hemorrhagic period (PHP) accompanied by delayed increase in the GDG and glutaminase activity, as well as Gt accumulation. In the limbic system and diencephalon the Gt metabolism was changing (impaired glutamine synthesis, stimuled Gt synthesis with glutamine desamidization and α%KG amination) when developed by the 70th minute of the PHP. Similarly to sensorimotor cortex, changes were associated with Gt accumulation. During the agony, α%KG deficiency developed in all parts of the brain as a result of its increased contribution to Gt synthesis. At the same period of time, in the sensorimotor cortex, limbic system and diencephalon the Gt synthesis from glutamine was stimulated, however, the Gt contribution tothe formation of glutamine was decreased. The accumulation of ammonia regardless of the HS stage was detected only in
the sensorimotor cortex, limbic system and diencephalon; in the medulla oblongata ammonium increase was found only during the agony.
Сonclusion. HS creates conditions for glutamate accumulation in nerve cells by impairing the metabolism of glutamate in the brain structures. The nature and scope of these disorders depend both on the intensity of glutamate metabolism in phylogenetically different brain structures in acute blood loss and HS.

The literature review presents an analysis of publications describing the use of a glucose%insulin mixture as a cardioprotective agent in acute myocardial infarction and in cardiac surgeries with extracorporeal circulation (ECC). It summarizes historical aspects of implementation of the glucose%insulin therapy in cardiology and car%
diac surgery. Possible mechanisms of action of the glucose-insulin-potassium mixture in acute ischemia and myocardial infarction were analyzed (normalization of electrical processes on the cardiomyocyte membrane, replenishment of metabolic substrates and increased production rate of adenosine triphosphoric acid due to glycolysis, decreased intensity of non%esterified fatty acid oxidation, decreased apoptosis, etc.). It discusses results of clinical studies evaluating prescription of the mixture for acute myocardial infarction, including data from metaanalyses. It demonstrated that the role and the clinical efficacy of the preventive and therapeutic measure under consideration in acute myocardial infarction are still the subject of discussion and require further research. It also analyzed modern concepts explaining the cardioprotective effects of insulin and glucose during surgeries with ECC (decreased insulin resistance, activation of anaplerosis, stimulation of intracellular signaling pathways maintaining the viability of cells, reduction of the severity of systemic inflammatory response, immunomodulating
effect, etc.). Review discusses results of clinical studies including data from randomized clinical trials and metaanalyses performed over the last 5 years that demonstrated the absence of the effect of the glucose%insulin therapy on the hospital mortality. Various studies demonstrated its positive effects including decreased incidence of peri%
operative myocardial infarctions and intensity of inotropic support, increased values of postoperative cardiac index, decreased duration of postoperative mechanical ventilation and ICU stay, etc. Review concludes that the interest to the therapeutic and preventive use of the glucose%-nsulin mixture in both emergency cardiology and cardiac surgery has been revived recently.