The purpose of the study — assessment of the level of consciousness in patients with a brain damage on the basis of electrophysiological examination of the functional state of the autonomous nervous system by recording parameters of the heart rate variability (HRV).

Materials and Methods. The study included 77 patients on Day 20—50 after a traumatic brain injury, anoxic injury, consequences of acute cerebral circulation disorders. The following parameters of the HRV for a 5-minute recording were accepted as criteria of norm and pathology of the autonomous nervous system (ANS) activity: (1) parasympathetic hyperactivity (hypervagal state) values with 95% confidence intervals were recorded within the accepted values for (a) SDNN (standard deviation of normal to normal R-R intervals), [41.5 —149.3 ms]; (b) rMSSD (root-mean-square of the successive normal sinus R—R interval difference in ms), [42.4—175.0 ms];(c) pNN50% (percentage of successive normal sinus RR intervals >50 ms), [8.14—54.66%]; (d) SI (Baevsky stress index), [0—80 normalized units, n. u.]; (2) the sympathetic hyperactivity recordered within the range of values for (a) SDNN [4.54—13.30 ms]; (b) rMSSD [2.25— 5.77 ms]; (c) pNN50% [0—0.109%]; (d) SI >900 n. u.; (3) the normal value of ANS parameters were recordered within the range of values for (a) SDNN [13.31—41.4 ms]; (b) rMSSD [5.78—42.3 ms]; (c) pNN50% [0.110—8.1%]; (d) SI [80—900 n. u.]. For verification of the hypervagal state, sympathetic hyperactivity or normal state, at least 3 of 4 parameters should be within the specified limits.

Results. In 40 (51.9%) of 77 patients examined after a brain damage, ANS functional activity parameters were within the range of pathological values. The sympathetic hyperactivity was identified in 34 patients, and in 6 cases the hypervagal state was diagnosed. Pathological parameters of HRV were found in 80% of patients with severe forms of unconsciousness (vegetative state, coma), and only in 20% of patients with normal consciousness.

Conclusion.The computer analysis of the HRV is a necessary element of examination of patients with different levels of consciousness after a brain damage of a traumatic and non-traumatic genesis. The frequency of pathological changes in the functional state of the autonomous nervous system increases significantly in groups of patients from the normal level of consciousness to the state of minimal consciousness, vegetative state, and coma. The sympathetic hyperactivity is the main type of ANS pathology in the groups of patients with minimal consciousness, in the vegetative state, and coma. 

The purpose of the study. To study parameters of the lipid metabolism in newborn infants to identify general patterns depending on the gestational age.

Materials and methods. The course of pregnancy and its outcome was analyzed in 286 women who gave birth to 323 infants; 89 of them were born in multiple pregnancies. The infants were divided into 4 groups depending on the gestational age. Levels of cholesterol (C), triglycerides (TG), low-density lipoproteins (LDL) and high-density lipoproteins (HDL) were tested in the central venous blood immediately after birth and on the 5th day of life.

Results. Hypotriglyceridemia below 0.2 mmol/l was typical for 31.3% of the newborns; a TG level within the range of 0.21—0.5 mmol/l was found in 43.3% of infants, i.e. the perinatal production of TG was decreased in 76.6% of infants. The perinatal TG production depended on the infant's gestational age: the smaller it was, the lower TG blood level was in infants at birth. At the gestational age of 25—33 weeks, the perinatal TG production was low in most newborns. The perinatal production of the lipid metabolism parameter was increased with the increase of the gestational age. The TG blood level increased rapidly at the gestational age of 37 weeks. The postnatal TG production in the blood of newborn babies had no dependence on the gestational age strating from the gestational age of 31 weeks and more. Hypercholesterolemia and lower both LDL and HDL levels were found in newborns of all groups at birth; no significant intergroup differences in concentration of C, HDL or LDL were observed (P>0.01).

Conclusion. The state of the lipid metabolism in the newborns in the perinatal period depends on the gestational age and the birth weight. Low TG production is typical for small premature infants with a low and extremely low birth weight due to physiological immaturity of organs and systems. The peculiarities of the prenatal morphogenesis make an adequate lipid metabolism possible by the full-term gestational age only. An abnormal course of pregnancy impairs normal triglyceride, C, LDL and HDL production. The greatest changes of the tested parameters are typical for small immature infants with a gestational age of 25—31 weeks. This age is associated with a high incidence of the respiratory distress syndrome. Deficiency of buffer bases affects the TG production at birth; the pH value and blood oxygen tension at birth affect the C level. The production of lipid metabolism parameters increases with the increase of the gestational age. There are certain individual characteristics in newborns who may have perinatal disorders of the lipid metabolism at the full-term gestational age. 

The purpose of the study — to determine the feasibility of using the succinate-based antioxidant for the in vitro reduction of excessive methemoglobin to oxyhemoglobin in blood.

Materials and Methods. Blood sampling was performed in five healthy donors in microvettes containing EDTA during prophylactic examinations. NaNO2 solution was added to blood samples in vitro in order to yield methemoglobin (MetHb). The complex drug containing the following active ingredients: succinic acid, inosine, riboflavin, nicotinamide, was used as an antioxidant. The absorption spectrum of red cell suspensions with different drug content Dι (λι )exper was measured with 1 nm increments. The non-linear regression method was used to calculate concentrations of hemoglobin derivatives in suspensions.

Results. In our experiments, when methemoglobin reacted with drug the optical density of peaks typical for oxyhemoglobin increased and the spectral peak of methemoglobin decreased. The greater the concentration of drug, the more was the incubation time, the more efficient was the process of reduction of MetHb to HbO2.

Conclusion. We proved experimentally that while the baseline concentration of MetHb was an average of 91—93%, addition of drug decreased its concentration to 25—7%. Without drug, due to autoreduction, the concentration of MetHb decreases only to 84%. The revealed effect provide a potential for practical applications in critical illness, during the storage of donor blood, in blood transfusions, and under the action of physico-chemical factors on blood. 

The purpose of the study was to determine the efficacy of a synthetic leu-enkephalin stabilized analogue to prevent damage of endothelial cells monolayer in vitro caused by serum samples from septic shock patients.

Materials and methods. The experiments were performed using the EaHy.926 endothelial cells monolayer. We studied the in vitro effect of synthetic leu-enkephalin analogue on the cell damage caused by serum samples from five septic shock patients. The status of endothelial intercellular junctions was estimated by immunofluorescence microscopy and western blot with antibodies against adherens junction protein, VE-cadherin, and against the tight junctions protein, claudin. Cell viability was determined by staining with propidium iodide.

Results. Preconditioning with a synthetic leu-enkephalin analogue (10, 50 and 100 μg/ml) of endothelial cells in vitro prevented the destruction of both tight and adherens junction and partially prevented endothelial cell death.

Conclusion. Preconditioning with a synthetic leu-enkephalin analogue partially prevents endothelial cell damage caused by exposure to septic patients’ sera in vitro. These data ensure the need for clinical trials on the effectiveness of a synthetic leu-enkephalin analogue for prevention of sepsis-associated endothelial dysfunction in clinics. 

Chronic wounds with impared wound healing that require prolong time for healing remain unsolved problem of modern medicine. Excessive oxidative stress plays an important role in the pathogenesis of chronic wounds caused by aging, diabetes and other pathologies. This review is aimed at the role of mitochondria in oxidative stress and to the future prospects for using the innovative mitochondria targeted antioxidants for treatment of impaired wounds. Recent studies in old mice and mice with type 2 diabetes showed that the mitochondrial antioxidant SkQ1 [10- (6'- plastoquinonyl) decyltriphenylphosphonium] stimulates healing of full-thickness dermal wounds. SkQ1 accelerates inflammatory stage of wound healing, maturation of granulation tissue, angiogenesis and epithelization of wounds. The anti-inflammatory effect of SkQ1 is possibly connected to decreased inflammatory activation of the vascular endothelium, which is typical for aging, diabetes and other pathologies. Local administration of SkQ1 also accelerates wound healing and provides strong anti-inflammatory effect in the model of acute aseptic inflammation. In addition, SkQ1 to stimulate apoptosis of neutrophils and suppresses their activation, as well as suppresses inflammatory activation of mast cells. In the wound model in vitro, SkQ1 accelerates movement of epithelial cells and fibroblasts into the «wound» and stimulates differentiation of human subcutaneous fibroblasts to myofibroblasts. Reviewed data suggest that SkQ1-based topical drugs have a great potential to treat wounds that exhibit impaired healing also in patients suffering from chronic critical illness.

The purpose is to evaluate the detoxification effects of the polymyxin sorption columns and filtration detoxification using polymethyl methacrylate membranes in abdominal sepsis in cancer patients.

Materials and Methods. We examined 226 patients with oncological diseases of abdominal organs complicated by abdominal sepsis postsurgery. In 50 cases, septic shock was reported. In 173 patients an acute renal injury (ARI) was diagnosed in the structure of organ failures, of which a combination with acute respiratory distress syndrome (ARDS) was diagnosed in 61 patients. The severity was 26.3±3.3 points (APACHE-II scale), 10.2±2.5 points (SOFA scale), and 4.3±1.8 points (qSOFA scale). Microbiological identification was obtained in 155 (68.6%) cases. The polymyxin column sorption was used in 86 patients 2–6 hours after sepsis was diagnosed with the EAA greater than 0.5. The blood flow rate was 80–150 mL/min; the duration was 120–240 min; the sorption frequency was 2–3 sessions at a 24-hour interval. If ARI and ARDS were developed, detoxification by filtration using a dialyzer with a BK-1.6F polymethylmethacrylate membrane was included in the complex treatment of 144 patients. The detoxification was carried out for 8–12 hours changing the dialyzer every 4 hours.

Results. A statistically significant decreases of hyperthermia, leukocytosis, neutrophilia, procalcitonin, and the EAA test values were revealed after the completion of the sorption treatment. Normalization of hemodynamic parameters, increase of the oxygenation index, and SOFA scoring decrease by 5.6±2.1 points (P<0.05) were found. PCT and IL-6 blood levels decreased from 6.7±2.7 ng/mL to 2.3±0.6 ng/mL and from 7300±7700 pg/mL to 860±180 pg/mL, respectively, as determined 60 minutes after completion of filtration detoxification procedure (P<0.05). The SOFA index decreased by 4.1±1.1 points (P<0.05).

Conclusion. The use of polymyxin column sorption and filtration detoxification using a polymethyl metacrylate membrane improves the results of treatment of abdominal sepsis in cancer patients.

Clozapine is an atypical antipsychotic agent with a confirmed effectiveness which is widely used in the clinical practice. However, its administration is associated with a high risk of serious adverse events. Life-threatening conditions related to administration of clozapine may be a result of idiosyncrasy, acute poisoning resulting from unintentional overdose of the prescribed dug, suicidal behavior, and criminal actions. The review presents current data on the mechanism of therapeutic and toxic effect of clozapine. It describes the effect of clozapine on cell receptors and ultracellular structures. It dwells on the contribution of major and intermediate metabolites of this medicinal agent to the development of toxic effects.