Purpose. To develop a method of producing tissue-engineered constructs (TECs) on the basis of resident mesenchymal progenitor cells (MPC) of the human heart and to assess the effect of TECs transplantation on regenerative processes in the heart using a model of myocardial infarction in rats.
Materials and methods. Human resident MPCs were isolated from the right atrial auricle of CAD patients. A similar protocol was used to obtain MPCs from Wistar rats. The MPC immunophenotype was determined by cytofluorometry. Corresponding TECs were obtained on the basis of MPC sheets of human and rats' hearts. Myocardial infarction in rats was induced by ligation of the anterior descending coronary artery followed by TEC transplantation. Euthanasia was performed 30 days after the transplantation. Histological examination of the implant and vascularization cells, morphometric analysis, tracking of the MPC differentiation ability, determination of the content of growth factors by solid-phase ELISA were carried out. Statistical evaluation of the significance of differences was performed using the Statistica 8.0 software package.
Results. The analysis of the obtained cell constructs showed that they consisted of several layers of cells interacting with each other by means of connexin 43 and were characterized by good cell viability as a part TECs. The number of vessels in the peri-infarction area under the transplant from the MPC was significantly higher than that in the reference group with signs of differentiation of cardiac MPCs transplanted into endothelial vascular cells.
The increased vascularization was combined with an increase in the area of viable myocardial sites and a decrease in LV cavity dilation. Analysis of the cardiac MPC secretion products showed that they produce the most important growth factors and cytokines that regulate angiogenesis and migration of stem cells.
Conclusion. The strategy of using epicardial TEC transplantation based on MPC sheets seems to be a rational approach for effective delivery of viable stem/progenitor cells to the damaged myocardium. The use of TEC helps to reduce or temporarily eliminate the effect of factors that contribute to progressive heart dysfunction by local paracrine exposure and activation of the revascularization processes in the affected zone.

The purpose of the study: to assess the content of BDNF and its TrkB receptor in the populations of hippocampal pyramidal neurons in the post-resuscitation period and to identify the contribution of these factors to the neuron resistance to ischemia.
Material and methods. The condition of populations of pyramidal neurons of the CA1 and CA4 hippocampus fields was investigated in white mature male rats that underwent a 10-minute cardiac arrest at different periods of the post-resuscitation period (1st, 4th, 7th, 14th day). Animals after a sham surgery served as a reference group. Immunocytochemical methods were used to determine immunoreactivity to BDNF and TrkB proteins. Based on the visual inspection and analysis of the optical density, the following types of neurons with different color intensity were distinguished: weak (BDNF–, TrkB–), moderate (BDNF+, TrkB+) and strong (BDNF++, TrkB++). The total density of neurons and the number of cells with different immunoreactivity to the studied proteins per 1 mm of length were determined. We used the Olympus BX-41 microscope and Image Scope M, ImageJ 1.48 v, MS Excel software. Statistical data processing was performed using Statistica 7.0 software.
Results. There was a decrease in the overall density of the population of pyramidal neurons in both studied fields of the hippocampus of the resuscitated animals as compared to the reference group: in the CA1field, on the 4th day after cardiac arrest (26%); in the CA4 field, on the 7th day (38.5%). It was found that the number of BDNF+ neurons doubled in the CA4 field on the 4th day, and the number of BDNF++ neurons decreased. On the 7th day, the number of BDNF– cells decreased sharply, the number of BDNF+ cells decreased to the reference level, and the number of BDNF++ neurons remained reduced vs. the reference group. There was a decrease in the number of BDNF– and BDNF+ cells in the CA1 field on the 4th day, while the number of BDNF++ neurons remained the same. The observed changes remained on Day 14.
The analysis TrkB protein expression in the CA4 field on the 7th day of the post-resuscitation period as revealed by reactivity with anti-TrkB antibody demonstrated a decrease in the number of TrkB– cells as compared to the reference group. By the 14th day, the number of not only TrkB– neurons, but also TrkB+ cells was reduced, while the number of TrkB++ neurons remained at the level of the reference group. There was a decrease in the number of TrkB+ neurons was observed in the CA1 field on the 4th day after resuscitation. On day 7, there was a decreased numbers of both TrkB+ and TrkB–-neurones. The number of TrkB–-neurones remained decreased up to day 14. At that, the number of TrkB++ neurons persisted at the reference level throughout the observation period.
Conclusion. The obtained results demonstrate that the resistance of neurons to ischemia-reperfusion is associated with the intracellular expression of BDNF and TrkB proteins. The reduction of the overall density of neurons in the post-resuscitation period was obsereved both in hippocampal fields CA1 and СА4; only cells with minimal and moderate content of the studied proteins died. Neurons with the highest BDNF and TrkB protein content survived.

The purpose of the study is to evaluate the in vitro and ex vivo effectiveness and safety of a new device for extracorporeal blood purification.
Materials and methods. The sorption properties and safety of hemoperfusion using the LPS sorption column that employs hypercrosslinked styrene-divinylbenzene copolymer.
were studied using three different models:
1) Escherichia coli endotoxin solution in aqueous 0.9% NaCl solution with an assessment of the efficacy of endotoxin elimination,
2) donor erythrocyte suspension with assessment of the hemoperfusion column safety for blood cells,
3) whole donor blood with assessment of hemosorption efficacy and hemoperfusion safety of the new column.
Results. There was a 18.5-fold decrease in the endotoxin concentration in 0.9% sodium chloride solution over
2 hours of perfusion vs. the baseline, while maintaining the residual sorption capacity of the column. Perfusion of RBC suspension and freshly prepared donor blood through the new LPS column did not demonstrate the emergence and growth of cytolytic markers; on the contrary, a two-fold decrease in the concentration of free hemoglobin containing in the RBC suspension was observed. There was a two-fold decrease in the vitamin B12 concentration, a 3.54-fold decrease in β2-microglobulin and a 2.5-fold decrease in creatinine levels. The atomic force microscopy did not find critical impairment of the morphology of erythrocyte membranes.
Conclusion. In vitro and ex vivo tests demonstrated reliable experimental data on the effectiveness and safety of the device that employs a hypercrosslinked styrene-divinylbenzene copolymer for LPS-selective hemosorption, which was not inferior to one of analogues for hemosorption currently employed in clinical practice.

The multifunctional urokinase-type plasminogen activator system (uPA-system) includes serine proteinase — uPA or urokinase, its receptor (uPAR) and two inhibitors (PAI-1 and PAI-2). The review discusses the structural features and involvement of the system components in the development of life-threatening processes including carcinogenesis, inflammation, neurogenesis and fibrinolysis, in regulation of which the destruction of extracellular matrix (ECM), cell mobility and signaling inside and outside the cell play a decisive role. uPA triggers the processes by activating the plasminogen and its convertion into plasmin involved in the activation of matrix metalloproteinases (MMPs) in addition to the regulation of fibrinolysis. MMPs can hydrolyze all the major ECM components and therefore play a key role in invasion, metastasis, and cell mobility. MMPs activates a cassette of biologically active regulatory molecules and release them from ECM. uPAR, PAI-1 and PAI-2 are responsible for regulation of the uPA activity. In addition, being a signaling receptor, uPAR along with MMPs lead to the stimulation of a number of signaling pathways that are associated with the regulation of proliferation, apoptosis, adhesion, growth and migration of cells contributing to tumor progression, inflammation, chemotaxis, and angiogenesis. Effective participation of the uPA system components in ECM destruction and regulation of intracellular and extracellular signaling pathways demonstrates that the system significantly contributes to the regulation of various physiological and pathological processes.

Medical imaging deals with physical examination and visual monitoring the organs and tissues. The main advantage of the imaging is capability to get quick and informative diagnostic data on the state of the main body systems in real time. In addition, imaging system using can reduce the risk of complications during manipulations. In this review, the potential of various imaging techniques, their advantages and disadvantages, and features of their application in anesthesiology are discussed.

The article summarizes the international experience of using different types of anesthesia for the surgical treatment of carotid artery lesions. The anesthesiology support of surgery on the carotid basin includes general and combined anesthesia of various types. The regional anesthesia is a separate field in the carotid surgery. The paper presents the advantages and disadvantages of each anesthetic technique. The recent publications show the superiority of regional anesthesia in terms of its cost-effectiveness, less frequent use of temporary intraluminal shunt, the possibility to constant monitoring of patient’s neurological status throughout the operation, and lower incidence of neurologic and cardiac complications. Complications of the regional anesthesia and the methods of their correction are described in detail. There is still no consensus about the choice of the optimal type of anesthesia for carotid endarterectomy, hence further large-scale randomized trials are needed.

The review dwells on the analysis of anesthetic techniques for pediatric eye surgery, including the use of drugs used and methods of anesthesia. While preparing the paper, Cyberleninka (www.cyberleninka.ru), PubMed, Medline databases were used with the targeted search using the following keywords: propofol, sevoflurane, paracetamol, regional anesthesia, ophthalmology, children. The search was not restricted by the date of paper publishing; the focus was made on papers published within the last 10 years. The purpose of the review was to assess the scope of various anesthetic techniques (general anesthesia and regional blockades), anesthetics (sevoflurane, propofol, paracetamol, local anesthetics) in pediatric eye surgery.

Purpose of the study: to evaluate the parameters of cognitive potential and systemic proinflammatory response during direct myocardial revascularization surgery on a beating heart and under conditions of various types of extracorporeal circulation (classical cardiopulmonary bypass and minimized extracorporeal circuit).
Materials and methods. A total of 205 patients aged 41–76 years (56.16±2.91 years) were examined. All patients were screened by the Montreal Cognitive Assessment and underwent contrast-enhanced CT perfusion imaging of the brain. The concentrations of tumor necrosis factor, interleukins-6 and 8, and neuron specific enolase were measured in the perioperative period. Surgery in all patients was performed under general balanced anesthesia based on sevoflurane. All patients were randomly divided into three groups: the patients after off-pump surgery; the patients after surgery with classical cardiopulmonary bypass; the patients after surgery with a minimized extracorporeal circuit. Off-pump surgery was performed using a tissue stabilizer. Cardiopulmonary bypass using membrane oxygenators was performed in a nonpulsatile regimen with a perfusion index of 2.4 l/(min•m2) under moderate hypothermia (34–35°C). Protection of the myocardium during the period of aortic cross-clamping was carried out by pharmacological cold cardioplegia.
Results. Seven days after surgery, the lowest Montreal Cognitive Assessment scoring was found in a group of patients operated using the classical cardiopulmonary bypass. In this group, the decline was almost 23 % (P=0.0202) compared with the baseline. In the same group, the increase in the level of neuron specific enolase reached 43.19% (P=0.0047). One day after surgery, the highest values (P<0.05) of tumor necrosis factor, interleukin-6 and interleukin-8 were found in the group of patients who underwent surgery with the classical cardiopulmonary bypass. Cortisol levels 24 hours after surgery also increased in all groups, but the smallest increase was recorded in the group of patients undergoing the off-pump surgery.
Conclusion. Off-pump surgery or the use of the minimized extracorporeal circuit with biocompatible coating, centrifugal pump in the absence of blood contact with air minimally affects the cognitive potential of patients, reduces manifestations of the systemic inflammatory response, which, in turn, reduces a number of postoperative complications and improves the results of treatment.

The purpose of the study: to study hemodynamic parameters and the degree of its orthostatic stability during verticalization in patients with long-term impairment of consciousness in post-comatose period of brain damage.
Materials and methods. This study included 30 patients with long-term impairment of consciousness caused by severe brain damage (Group 1), 10 of whom were in a vegetative state (VS) and 20 patients had a minimally conscious state (MCS). A severe traumatic brain injury was the most frequent cause of long-term disorders of consciousness (53.3%), other causes were associated with severe disorders of cerebral circulation (13.4%) and following consequences: rupture of cerebral aneurysms (10%), or post-hypoxic brain damage (10%), or removal of brain tumors (13.3%). The second group was comprised of 24 patients with local neurological symptoms after cerebral circulation disorders. The third group included 40 healthy volunteers. Systemic hemodynamic parameters were monitored using a multifunctional monitor TFM 3040i (CNSystem Austria) . Blood pressure (BP), heart rate (HR), stroke volume (SV), cardiac output (CO), and total peripheral resistance (TPR) were measured in real time. The statistical analysis was carried out using the Statistica-10 software package.
Results. 26 patients of the first group (86%) demonstrated satisfactory hemodynamic stability in the tilt test at 30° and 60°; 3 patients of this group presented signs of orthostatic hypotension and 1 patient developed postural orthostatic tachycardia syndrome (SPOT) when tilted by 30°. A comparative analysis of hemodynamic parameters in patients of the first and second groups did not demonstrate significant differences, except for significantly higher HR values and lower SV values in the first group. Parameters of systemic hemodynamics in the horizontal position were significantly different in healthy volunteers, and were characterized by higher SV and CO values and lower BP, HR and TPR values as compared to patients of groups 1 and 2.
Conclusion. This study demonstrated a hypokinetic type of blood circulation in all patients with brain lesions; it was more severe in patients with long-term impaired consciousness after severe brain damage. The majority of patients in this group presented satisfactory orthostatic hemodynamic stability; different types of orthostatic disorders were found in 14% of cases. A passive orthostatic test (0—30—60°) applied in this study allowed to diagnose orthostatic disorders at a slight tilt up to the onset of clinical symptoms of brain hypoperfusion. This indicates the need for hemodynamic monitoring in the early stages of patients' verticalization.

The problem of iatrogenesis in the medical practice is still urgent: according to published data, in healthcare institutions of the Ministry of Public Health of the Russian Federation, about 50.0% of errors in medical care are made by surgeons; among these errors, diagnostic errors prevail (80.0 %) due to improper examination of patients and lack of follow up. Together with surgeons, anesthesiologists and intensivists are in the top five of physicians who demonstrated the greatest number of defects in medical care (about 30.0%).
The purpose of our study is prevention of iatrogenesis in the intensive care unit (ICU).
Materials and methods. We analyzed findings of the forensic examination and evaluation of medical care of a patient with knife wounds.
Results. We determined the immediate cause of death, and describe the causal link between the outcome and identified defects in the medical care.
Conclusion. Preventing the iatrogenesis in ICU is right strategy to improvemethe medical care quality.