Objective: to evaluate the efficacy of exogenous phosphocreatine (EPCr) application in elderly and senile patients operated for colorectal cancer.

Material and methods. 80 patients with routine perioperative management (Group 1) and 56 patients in whom routine perioperative management was supplemented with EPCr administration (Group 2). Postoperative morbidity and duration of hospitalization after surgery have been assessed in both groups.

Results. Postoperative morbidity was lower in Group 2: 7.2% vs. 35% (P=0.001; OR=0.18; 95% CI: 0.07—0.49), mainly due to decreasing the incidence of acute coronary syndrome and anastomotic leakage. The duration of hospi% talization after surgery was lower in Group 2 as well.

Conclusions. Application of EPCr might be an effective measure to decrease the postoperative morbidity in elderly and senile patients with colorectal cancer. 

The literature review presents an analysis of publications on the use of a selective α2-adrenergic receptor agonist (α2-AR) dexmedetomidine as a cardioprotector in cardiosurgical interventions. It summarizes historical aspects of the introduction of α2-AR agonists in the intensive care practice. It analyzes possible mechanisms of the cardioprotective effect of dexmedetomidine (central sympatholysis, favorable effects on the coronary circulation and relief of the coronary steal syndrome in originally ischemized areas of the myocardium, antiinflammatory and antioxidant effects, and prevention of apoptosis activation). Data from experimental studies of dexmedetomidine cardioprotection were analyzed. Results of clinical studies, including data of metanalyses, were discussed. It dwells on data on the favorable effect of dexmedetomidine on various parameters of the postoperative period, including a decreased risk of delirium, general complications of cardiosurgical interventions, and the mortality rate in patients. It presents data on cardioprotective properties of dexmedetomidine in surgical patients who undergo noncardiac interventions, particularly vascular ones, including high risk surgeries in the aorta. A comparative analysis of results of clinical trials studying the dexmedetomidine cardioprotection during surgeries with extracorporeal circulation was performed. A range of pharmacological effects of dexmedetomidine during anesthesiological support of cardiac surgeries, including those in elderly and senile patients, was described. It has been concluded that the dexmedetomidine cardioprotection in the various fields of surgery is obviously very promising.

Aim of the study: to evaluate expression level of BDNF and its association with the postresuscitative neuronal death in highly hypoxia-sensitive brain regions.

Materials and methods. Cardiac arrest in adult albino male rats was evoked by intrathoracic clamping of supracardiac bundle of vessels for 10 min. Pyramidal neurons of the hippocampus and Purkinje cells of the cerebellum were analyzed at various time points after resuscitation (days 1, 4, 7, 14). Shame-operated rats served as controls. The expression of BDNF protein was immunohistochemically determined. The BDNF expression level was determined by evalution on the base of the average optical density. The number of neurons with different BDNF expression levels and the total number of neurons per 1 mm of the layer length were computed. Image analysis systems (Intel personal computer, Olympus BX-41 microscope, ImageScopeM, ImageJ 1,48v and MS Excel 2007 software packages) were used in the study. Data statistical processing was performed with the aid of Statistica 7.0 program and Kolmogorov-Smirnov λ-test, Mann-Whitney U-test and Student's t-test.

Results. The dynamics of postresuscitative shifts of BDNF immunoreactivity in neuronal populations of hippocampal pyramidal cells and cerebellar Purkinje cells was established. It was shown that the level of BDNF expression within the two neuronal populations decreased, that was accompanied by neuronal death. In the Purkinje cell population the neuronal death occurred by the 4th day after resuscitation, while in the hippocampus, it occurs only by the 7th day. Notably, only BDNF-negative neurons or neurons with low level of BDNF expression died in both neuronal populations.

Conclusion. The results of the study indicate the existence of an interrelation between the shifts in BDNF expression and the postresuscitative neuronal death. It was shown that only the cells with none or poor BDNF expression underwent death in highly hypoxia-sensitive neuronal populations. The results suggest that the level of BDNF expression is one of factors that have a significant effect on neuronal resistance to ischemia-reperfusion. A possibility of induction of the endogenous BDNF expression in order to prevent neuronal death is discussed. 

The aim of the study: to study general pathological processes in the lungs in different time after acute clozapine and combined clozapine+ethanol poisonings.

Materials and methods. The experiments were performed on 25 outbreed male rats. The animals were divided into 5 groups: 1) reference (intact rats); 2) clozapine poisoning, 3 hours; 3) clozapine poisoning, 24 hours; 4) combined clozapine and ethanol poisoning, 3 hours; 5) combined clozapine and ethanol poisoning, 24 hours. Clozapine was administered orally at a dosage of 150 milligrams per kilogram of the animal weight under anesthesia (chlorolase); alcohol was administered with clozapine orally at a dosage of 5 milliliters per kilogram of the animal weight. Animals of all these groups sacrificed by decapitation. Lung tissue samples were examined by light microscopy using a microscope Nikon Eclipse E-400 with a video system based on camera Watec 221S (Japan) at a 400X magnification. We evaluated the presence of the following signs: circulatory disturbances (hyperemia, hemorrhage), presence of atelectasis and dystelectasis, emphysema, cellular response (increased white blood cells count), desquamation of epithelium into the lumen of the bronchi, sludge. A morphometric analysis was performed using a grid developed by G. G. Avtandilov. The following signs were evaluated (volume percent, vol.%): the area of the alveoli, intraalveolar septi, vessels, white blood cells, the percentage of white blood cells in the intraalveolar septi , the area of the edema and dystelectasis.

Results. the following histologic signs were found 3 hours after clozapine poisoning: desquamation of epithelium into the lumen of the bronchi; cellular response (increased white blood cells count); presence of atelectasis and dystelectasis; thickening of intraaveolar septi due to edema; infiltration of intraalveolar septi by WBCs. Atelectasis and dystelectasis in pulmonary parenchyma and infiltration with WBC were observed 24 hours after clozapine poisoning. In the group of animals treated with ethanol and clozapine and decapitated 3 hours after the poisoning the following histological signs were detected: desquamation of epithelium into the lumen of the bronchi, the secret in the lumen of the bronchi, cellular response, atelectasis and dystelectasis, perivenular hemorrhages, hemorrhages into the alveoli, hemorrhages into intraalveolar septi, dilation of the lumen of the bronchi, the presence of sludge, thickening of intraalveolar septi (due to infiltration with WBCs, detachment of the endothelium in blood vessels. Arterial hyperemia, cellular response (increased of WBC count), atelectasis and dystelectasis, and thickening of intraalveolar septi were found 24 hours after combined ethanol and clozapine poisoning. In all study groups the lumen of the alveoli was significantly smaller as compared to the reference group, but the area of the intraalveolar tissue, on the contrary, was significantly greater. The total area of pulmonary microvessels did not differ significantly from the reference group 3 hours after clozapine poisoning. It became significantly higher 24 hours after the poisoning. A significant increase in this parameter vs. the reference group was found both 3 and 24 hours after the administration of the combination of clozapine with ethanol by animals.

Conclusion. In clozapine and clozapine + ethanol poisoning, a certain complex of general pathological processes in lungs develops. There are alteration of bronchial epithelium and the vascular endothelium, circulatory disorder, increased vascular permeability, infiltration of intraaveolar septis. Morphological and immunoreactive changes can be used for valuation of severity of general pathological process in acute clozapine and clozapine + ethanol poisonings and determination of the exact time of the poisonings. 

The problem of unintentional hypothermia in the postoperative period is still an urgent one.

The purpose of the work: to assess the effect of the in vitro temperature on the morphology and nanostructure of erythrocyte membranes.

Material and methods. 4 containers with erythrocyte suspensions with different blood groups were used; the suspension was packed in sealed containers (400 mL) with CPD blood preservative. The erythrocyte suspension was kept at 4°С. Samples (15 ml) were placed in a thermostat at 20°C and 37°C; then they were placed on the BioRS-24 Mini-Rotator Bioscan (EU) rotator (6—8 rpm). The analysis of the acid-base balance was carried out using the I-510 ionometric converter (Russian Federation). The morphology and nanostructure of erythrocyte membranes were analyzed using an atomic force microscope (AFM) «NTEGRA Prima» (NT-MDT, Russian Federation), in a contact mode, on monolayers prepared using a method of sedimentation in liquid and air.

Results. Discocytes were present in monolayers of blood after 1-hour and 12-hour rotation (12±3%) on Day 19 of ES storage at temperature 20°С. The number of echinocytes was 14±2% after a 1-hour rotation and 40±7% after a 12%hour rotation. The number of spheroechinocytes was 74±2% after a 1-hour rotation and 42± 8% after a 12-hour rotation. At a temperature of 37°С, after a 1-hour rotation, four forms of erythrocytes were present in a monolayer: discocytes, echinocytes, spheroechinocytes, and ovalocytes. The distribution of cell forms changed after a 12-hour rotation, and the cells recovered their shapes to discocytes (97±2%).

Conclusion. The obtained findings confirm the effect of cooling during erythrocyte preservation. The shape of erythrocytes was changed. The morphological structure of frozen erythrocytes recovers slowly, within 12 hours. It means that the transfusion of red blood cells whose temperature is below 37°C may not be effective for at least 12 hours and the transfusion medium should be warmed to reduce the risk of transfusion of blood products. 

The purpose of the research: to analyze insufficiency of medical care for patients with acute respiratory failure in the ICU.

Materials and methods. It was a retrospective study of 160 patients' medical records (age from 15 to 84 years) with acute respiratory failure (ARF) hospitalized in the ICUs of 24 regional and municipal hospitals of the Irkutsk Oblast. Medical records were provided by the Territorial Fund of Compulsory Medical Insurance of citizens of Irkutsk region.

The results. The basic defects in conducting mechanical ventilation were associated with improper lung function evaluation, microbiological tests of sputum and radiology. ARF was not diagnosed in 32 of 160 ICU patients (20%). In 23% of cases the causes of ARF were not diagnosed. The greatest part of the defects in the treatment of patients with acute respiratory failure was found during the treatment of hypoxemia: no recovery of the respiratory tract patency, no prescription of oxygen for hypoxemia, no mechanical ventilation for persistent hypoxemia on the background of maximum oxygen supply and late switching to mechanical ventilation at the stage of hypoxic cardiac arrest.

Conclusions. The use of pulse oximetry alone in the absence of arterial blood gas analysis in 98% of patients with acute respiratory failure and failure to perform the lung X-ray and/or MSCT imaging in 21% of patients were accompanied by a high level of undiagnosed acute respiratory distress syndrome (78%), lung contusion (60%), pulmonary embolism (40%), cardiogenic pulmonary edema (33%), and nosocomial pneumonia (28%). Defects of treatment of patients with ARF in 46% of cases were caused by inadequate management of hypoxemia associated with the recovery of the respiratory tract patency, prescription of oxygen, and mechanical ventilation. 

The purpose of the study: to identify a legally justified possibility for a patient (patient's relatives) to purchase a drug product (DP), which has not been purchased by a healthcare institution but is recommended by the doctor in charge «by lifesaving indication» as the most effective one.

Materials and methods. Federal Law N 323-FZ «On the Fundamentals of Health Protection in the Russian Federation» as of 11/21/2011 and a number of current normative legal acts (NLA) regulating medical activities were analyzed.

Results. The analysis demonstrated the absence of a concept of «lifesaving indications» in the normative legal acts. It demonstrated that the patient's illness that may require the prescription of DP by the «lifesaving indications» should be diagnosed by medical consultants' board of the healthcare institution. It also prescribes DPs «for lifesaving indications» not included in the standard of care (SC) and in the List of Essential Medicines (LEM) and not payable «outpocket of» (personal) funds.

Conclusion. The use of DPs «for lifesaving indications» in urgent and emergency medical care should not be arranged on a feepaying basis. If a patient (or patient's relatives) would demand compensation for material damage (cost of purchased drug) by applying to a Obligatory Medical Insurance Company or bringing the case before the court, this demand should be satisfied.