Aim. To study the red blood cell (RBC) morphology in newborn infants with a history of perinatal hypoxia using the atomic-force microscopy. Material and methods. The state of RBC membranes of 10 newborns with a history of perinatal hypoxia was studied. All infants were born with low Apgar scoring; the following resuscitative measures were carried out at birth: tracheal intubation, mechanical ventilation (MV). The study group newborns were transferred from the delivery room to the ICU, where MV was started. To obtain images of normal red blood cells in the field of the atomic force microscope (AFM), 14 full-term newborns delivered after a favorable course of pregnancy and normal term labor were enrolled in a reference group. Results. Discocytes and planocytes comprised 36% of the total red blood cell count in the residual umbilical cord blood of newborns with a history of perinatal hypoxia; there was a decreased amount of normal RBC forms, thus demonstrating an unfavorable effect of hypoxia on newborn's RBC membrane. Poikilocytosis was typical for infants exposed to perinatal hypoxia; transitional forms of RBCs (stomatocytes and echynocytes) were visualized. Stomatocytosis and echynocytosis were typical for 80% of newborns. Stomatocytosis persisted in full-term newborns exposed to hypoxia complicated with aspiration of neonatal meconium. The analysis of RBC membrane nanostructure demonstrated that the first-order height (h₁) experienced the greatest alterations at birth in newborns with perinatal hypoxia; it was 4.2 times as much as the similar parameter in healthy newborns. Estimations of second-order height (h₂) parameter values demonstrated a two-fold increase showing that the spectrin matrix also changed under the effect of hypoxia. The third order value (h₃) was significantly higher in newborns with perinatal hypoxia, than that in healthy infants. Therefore, perinatal hypoxia causes antenatal complete damage of nanostructures of RBC membranes. Conclusion. Perinatal hypoxia alters RBC morphology and impairs the nanostructure of membranes. These changes confirmed the effect of the hypoxia degree on all nanostructures of RBC membranes: phospholipid bilayer, protein elements of the membrane, spectrin matrix. Changes in heights and spatial periods of the red blood cell membrane surfaces h₁ and h₃ associated with hypoxia apparently are aimed at a compensatory increase in the red blood cell membrane surface contributing to the increase of the gas exchange area. These changes may represent adaptive responses to hypoxia aimed to preserve the functional capabilities of red blood cells. The course of an early adaptation period (post-hypoxic period) is characterized by the instability of all nanostructures of red blood cell membranes and a greater variability of morphological forms. Effects of perinatal hypoxia on the red blood cell membrane persist for some time and go beyond the early neonatal period.

The purpose of the investigation was to study the effect of the ethylmethylhydroxypyridine succinate (EMHPS) infusion on the dynamics of cerebral blood flow patterns in patients during the acute phase of severe concomitant traumatic brain injury. Materials and methods. The study involved two groups of patients, each of 25 persons aged 41.5 (29; 51) years on average, with a severe concomitant traumatic brain injury. The patients of the 1^st (control) group were cured with a standard intensive care while in the 2^nd (study) group the EMHPS infusion was added to the said standard treatment in a dose of 100 mg per hour through an infusion pump within 10 days. By transcranial dopplerography (TDG) testing the following cerebral macrocirculation parameters (CMP) were studied: systolic blood flow velocity (V_max), diastolic blood flow velocity (Vmin), pulsation index (PI) and resistance index (RI). Results. The most frequent type of the cerebral blood flow (CBF) disorder noted in the both groups during the initial examination was a hindered perfusion pattern noticed in 15 and 16 patients from 1st and 2^nd groups, respectively. Mild vasospasm was recorded in four patients in the 1st group and in three cases in the 2^nd group. Signs of gross vasospasm were noted in two patients from each group. In two patients of each group patterns of hypoperfusion and hyperperfusion were noted. In the patients of the 1^st group the CMP normalization was observed in six cases on the third day, in eight cases on the fifth day, in 12 cases on the seventh day, in 18 cases on the 10th day, while in the patients of the 2nd group the CMP normalization was observed on the 3^rd day in 12 cases, on the 5^th day in 15 cases, on the 7^th day in 16 cases and on the 10^th day in 20 cases. Conclusion. The most common patterns identified during the initial examination included hindered perfusion and vasospasm, which were transformed into a normoperfusion pattern through the hyperperfusion stage (reactive hyperemia). The EMHPS infusion in a dose of 100 mg per hour usually aids to normalize parameters within 3—5 days.

The purpose of the study: to evaluate the effect of Perftoran (PF) on the membrane nanostructure of discocytes and stomatocytes after acute blood loss. Materials and methods. The study was performed in white male rats. Nembutal was administered intraperitoneally at a dose of 25 mg/kg. The study model was as follows: acute blood loss followed by hypotension for 60 min with the BP maintained at the level of 40 mm Hg with subsequent reinfusion of lost blood. Blood samples were collected from the tail artery before the blood loss and 2 hours after reinfusion. PF was administered intraarterially at a dose 3 ml/kg of body mass immediately after the blood loss replacement. Animals who did not receive Perftoran served as a reference group. The RBC membrane structure was studied using the Femtoscan atomic force microscope at ranges with different spatial periods. The ranges were selected using the Fourier transform and spectral windowing. Periods (T) and heights (h) of RBC surface corrugation were calculated for each spectral window according to the isolated profiles of the membrane surface. Results. At a baseline; discocytes and stomatocytes exhibited different structural characteristics of RBC membrane at a spatial range of 600—1200 nm in the form of a higher period of vibration of stomatocytes vs. discocytes. Hypovolemia and subsequent reinfusion of autologous blood affected studied parameters by increasing the period of spatial oscillation both in discocytes and stomatocytes as compared to the initial state. Administration of PF significantly decreased the period of spatial oscillation of the cell membrane both in discocytes and stomatocytes as compared to animal RBCs who underwent hypovolemia and reinfusion without PF administration and baseline parameters. Conclusion. The period of vibration within the range of 600"1200 nm reflecting the state of the bilayer of RBC membrane is not related to the discocyte transformation into the stomatocyte. Data suggest that the PF-induced shortage in vibration within this range was associated with the increased ability of a RBC to deform.

Objective: to identify histomorphological changes in the heart for acute poisoning with clozapine and combined poisonings with ethanol and clozapine 3 and 24 hours after poisoning. Materials and methods: the experiments were performed in mongrel male rats weighing 290—350 g. Clozapine was administered at a dose of 150 mg/kg animal weight under anesthesia with chlorolase. After 3 hours and 24 hours the animals were sacrificed by decapitation. Histological sections of the heart of 5 rats that had received clozapine orally at a dose of 150 mg/kg and of 5 rats that had received ethanol and clozapine orally in the above doses 3 hours after the poisoning were examined. There was also a study of histological sections of the heart of rats (n=10) that had received similar preparations in the above doses and were withdrawn from the experiment 24 hours after the administration of the preparations. The comparison was performed by evaluating the histological sections of the heart of rats (n=5) that had not received the above substances. The presence of following morphological signs was evaluated: circulatory disorders (plethora, hemorrhages), eosinophilia, fragmentation of cardiomyocytes, cell reaction, and homogeneity of the cytoplasm. The evaluation was carried out using the Fisher criterion. The presence of a sign was considered reliable when it appeared in 4—5 cases in one group and was completely absent in another. Results: in the control group of animals the histological examination of the heart showed no circulatory disorders, eosinophilia, fragmentation of cardiomyocytes, or homogeneity of the cytoplasm. The earliest change in the heart with the effect of clozapine was blood circulation disorders that appeared already 3 hours after the administration of the medicine and increased by 24 hours. Eosinophilia of the myocardium, which is specific for clozapine poisoning, was observed in all experimental groups. In the clozapine and ethanol group, homogenization of the cytoplasm was observed after 3 hours, indicating cell death. In the group receiving clozapine as a monopreparation, similar changes were not observed. Perhaps, the appearance of such changes is associated with the influence of ethanol. In the group affected by clozapine and ethanol there were circulatory disorders (plethora of veins and venules, small pericapillary hemorrhages) after 3 hours. By 24 hours these disorders intensified. Arterial and venous plethora, periarterial and pericapillary hemorrhages were observed. Conclusion. The changes revealed by histological examination of the heart in animals receiving clozapine and a combination of ethanol and clozapine, together with the results of forensic analysis, can be used to diagnose relevant poisonings and to establish their prescription.

Closed chest cardiopulmonary resuscitation (CPR), having been so successful after its introduction in the operating room for saving lives of anesthetized patients, was adopted for use in the intensive care units, then hospital-wide, and finally to out of hospital patients. This has lead to ethical dilemmas involving patients who must themselves request discontinuation of artificial organ function devices and treatments, or placing family members in the difficult positions of having to make those decisions for their unconscious and suffering relatives. In this review, the Ethical principles on which physicians, hospitals, patients, and surrogate decision makers rely in order to apply their perceived moral obligations to provide patient safety, comfort, and treatment are examined with particular emphasis on do not resuscitate orders (DNR). It is clear that DNR does not equate with do not treat.

A complex effect of thermal trauma on the immune system triggers the tendency to develop and generalize infection in patients with severe thermal trauma. The phagocytic system, which is represented, first of all, by neutrophilic granulocytes, is significantly altered. Objective: to determine the dynamics of changes in the functional activity of neutrophils in patients with thermal trauma, as well as its prognostic significance in the development of purulent-septic complications of a burn disease. Materials and methods. The functional activity of neutrophils was assessed by spontaneous and induced chemiluminescence responses of whole blood sequentially stimulated with phorbol-12-myristate"13-acetate(PMA) and N-formyl-methionyl-leucyl-phenylalanine (fMLP). 34 patients with a burn disease of different severity were dynamically examined during observation. Results. The newly developed technique was applied to study the responses of whole blood of patients with burn disease to stimuli; data on the functional activity of neutrophils depending on various severities of the disease and response dynamics were obtained. Analysis of chemiluminescent curves of the development of respiratory explosion of neutrophils helped to reveal parameters of the immune system state, namely: a one— or two-phase response to a stimulus, a «rapid phase» neutrophil specific activity, and a «slow phase» neutrophil specific activity. Conclusion. The results revealed trends in alterations of functional activity of neutrophils in burn disease. Diagnostic and prognostic indices of the functional activity of neutrophils for assessing the severity of the disease and the prognosis of the septic process were suggested.

Aim of the study: the effectiveness of concomitant use of antioxidant therapy with antioxidant 2-ethyl-6- methyl-3-hydroxypyridine succinate (mexidol) and intensive nutritional support with glutamine in patients with abdominal sepsis (AS). Materials and methods. 170 patients with abdominal sepsis (AS) involved in the study were separated into two groups. Patients of group 1 (control group, n=70) received basic treatment. Patients from group 2 (n=100) were divided into 2 subgroups. Patients from the subgroup 21 (n=70), in additon to the basic treatment, received intravenously, by drop infusion, mexidol (2000 mg per day) and dipeptiven (27.5 g per day), patients from subgroup 22 (n=30) additionally to that received per os glutamine. Survival analysis was carried out according to the Kaplan-Meier method with using of the Cox's F-test and Mantel-Cox test for testing of statistical hypotheses. Results. Treatment outcomes analysis showed that in the basic group 2, mortality was lower than in the control group 1. A statistically significant increase of cumulative part in the survivors was revealed using mexidol and glutamine. Conclusion. Concomitant intravenous administration of medications had positive effects on treatment outcomes. Following on from the analysis results, we may suggest that the pair mexidol + dipeptiven interrupts the cascade of development of abdominal sepsis and contributes to avoiding a critical condition during sepsis.