Objective: to evaluate the cytoprotective effect of perfluoran when pre-administered in massive blood loss. Material and methods. Experiments were performed on 21 nembutal-anesthetized rats. Acute blood loss from the rat caudal artery served as a model for a terminal state. Perfluoran had been injected 45 minutes prior to blood loss. Morphological and morphome-tric analyses of monolayer dried unstained blood smear slides were made using an Olympus BX-50 light microscope at a magnification of 1000 (10X100). Cytometry was carried out using Image scope color software. Results. In the control group of experiments, i. e. without perfluoran preadministration, at 5 minutes of blood loss, the circulating blood showed only 20% of discoid forms; the other forms of the red blood cells were grades 1-to-3 transformation stomatocytes. By 60 minutes of hypotension, there was a decrease in stomatocyte counts to 5.2% and a change in the ratio of circulating red blood cell populations. The number of smaller, i.e. senescent, cells was increased and that of large cells was reduced. The preventive administration of perfluoran in small amounts playing no prominent role in the delivery of oxygen and the alteration of circulating blood volume, substantially changed the ratio of different shapes and sizes of erythrocytes, increased their average diameter, and stabilized the membrane of a red blood cell. Conclusion. The preadministration of low-dose perfluoran before blood loss prevents deformational stress, increases the surface of a red blood cell, and stabilizes its membrane. Key words: blood loss, perfluoran, red blood cell, stomatocyte, deformation stress, rheology.

Background. The posttraumatic period in victims with severe concomitant injury is frequently complicated by nosocomial pneumonia, resulting in high mortality rates and longer time and increased cost of treatment in intensive care unit unit patients. Procalcitonin (PCT) is considered to be a marker for infectious complications due to different critical conditions; however, its prognostic value for different patient categories and periods after injury remains unclear; elevated PCT levels maybe related to the development of pneumonia in view of the severity of injury and the duration of mechanical ventilation (MV). Objective: to establish a correlation between the time course of changes in PCT levels and the development of nosocomial pneumonia and sepsis in victims with severe concomitant injury in relation to its severity and the duration of MV. Subjects and methods. The case histories of 271 victims with severe concomitant injury treated in the Intensive Care Unit, N. V. Sklifosovsky Research Institute of Emergency Care, in 2008—2012 were retro- and prospectively analyzed. The admission PCT level and its changes were analyzed in relation to the severity of injury and secondary infectious complications. Severe concomitant injury was ascertained to be accompanied by elevated serum PCT levels. A correlation was found between injury severity, mortality, the development of infectious pulmonary complications, sepsis, and mean PCT levels. The more severe the injury, the higher serum PCT level was revealed. In the first 12 hours, a group of victims without pneumonia exhibited the highest PCT levels (1.91±0.51 ng/ml). Later on there was its smooth fall and normalization by days 3—5. In the group of victims with pneumonia, but without sepsis, the PCT level averaged 1.71±0.64 ng/ml just in the first 6 hours, then its concentration continued to rise and its maximum level (3.93±1.26 ng/ml) was recorded in the first 48 hours. Later on, its decrease and normalization were observed by day 6 if the course of disease was favorable. A distinct pattern was seen in the group of victims with pneumonia and sepsis. Just in the first 6 hours, the mean level of PCT was 6.98±1.3 ng/ml and then its concentration continued to increase to 22.7±7.8 ng/ml in the first 48 hours. ROC analysis revealed the most prognostic effect of PCT at risk for pneumonia in the range from 12 to 24 hours since the ROC curve area was 0.753, which was good, as estimated by experts, and the cut-off was 1.79 ng/ml; moreover, sensitivity was 69.7% and specificity was also 69.7%. Conclusion. It is shown that it is expedient to monitor PCT levels in patients with severe concomitant injury from the admission of victims to hospital. The PCT concentration of more than 1.79 ng/ml during the first 12 hours after injury can serve as an early predictor for nosocomial pneumonia with a risk for further generalization of the process in victims with severe concomitant injury. Key words: severe concomitant injury, procalcitonin, infectious complications, pneumonia, sepsis, biomarker, predictor, mortality, ISS, mechanical ventilation.

Objective: to provide a rationale for the efficiency of sevoflurane-induced cardiac preconditioning (CPC), by assessing the pattern of recovery of heart rate and by estimating troponin I levels and changes in NT-proBNP concentrations in patients undergoing aortocoronary bypass surgery (ACBS) under extracorporeal circulation (EC). Subjects and methods. Sixty patients aged 60.6±8 years (M±&) were examined after elective ACBS using EC and divided into two groups of 30 patients each: 1) inhalation induction and maintenance of anesthesia (IIMA) with sevoflurane and fentanyl, with CPC being simulated; 2) total intravenous anesthesia (TIA) with propofol and fentanyl. Inhalation induction of sevoflurane anesthesia was performed in the IIMA group. Ten minutes before aortic ligation, the dose of the anesthetic was increased up to 2 MAC for CPC. Inhaled anesthetics were not used in the TIA group. The authors assessed the pattern of cardiac performance recovery and estimated the level of NT-proBNP 24 and 48 hours after tracheal intubation and that of troponin I following 24 hours of the intubation. Results. Defibrillation was required in one patient from the TIA group who developed ventricular fibrillation. The baseline levels of NT-proBNP were comparable in both groups. Following 24 hours, its level was more than thrice higher in the TIA group than that in the IIMA one (p<0.05). By the end of 2 days, the concentration of NT-proBNP continued to rise (up to 480% of the baseline level) in the TIA group and returned to the preoperative values in the IIMA group (p=0.05). Twenty-four hours after tracheal intubation the level of troponin I was insignificantly higher in the TIA group than that in the IIMA group (p=0.1). Conclusion. Sevoflurane has cardioprotective properties in preventing and/or reducing the degree of heart failure after ACBS using EC. There is a need to continue the study in increased cohort to provide evidence that sevoflurane-induced CPC can lower cardiomyocyte damage due to ischemia/perfusion. Key words: anesthetic preconditioning, sevoflurane, NT-proBNP, troponin I, heart failure.

Objective: to evaluate the safety of using 7.2% NaCl/6% hydroxyethyl starch 200/0.5 solution to develop acute renal injury (ARI) in patients after aortocoronary bypass surgery (ACBS) under extracorporeal circulation (EC). Subjects and methods. This was a single-center prospective, randomized, single-blind clinical trial. The patients singly received either 7.2% NaCl/6% hydroxyethyl starch 200/0.5 solution (a NC/HES group, n=20) or 0.9% NaCl (a control group, n=20) in a dose of 4 ml/kg for 30 min after induction of anesthesia. The primary endpoint was the rate of ARI diagnosed according to the recommendations of the International Organization KRIGO (Kidney Disease: Improving Global Outcomes). The secondary endpoints were serum cystatin C (sCys С), and urinary neutrophil gelatinase-associated lipocalin (uNGAL). Results. The rate of ARI was comparable in both patient groups. Thus, ARI was found in 4 (20%) patients in the NC/HES group and in 6 (30%) cases in the control group (p=0.72). During the first two postoperative days, the peak concentration of creatinine was significantly lower in the NC/HES group (101 (range 94—107) ^l/l) than in the control one (117 (range 100—127) ^l/l) (p=0.02). That of sCys C was substantially lower in the NC/HES group (0.83 (range 0.73—0.89) mg/l) than in the control one (1.02 (range 0.88—1.15) mg/l) (p=0.001). The patients of the NC/HES group had comparable peak of uNGAL concentrations (33 (range 5—38) ng/ml) versus the controls (30 (range 21—50) ng/ml). Conclusion. The use of NC/HES does not cause any increase in the rate of ARI, increased renal injury, or a more significant decrease in glomerular filtration in patients after ACBS under EC. Key words: hypertonic solution, hydroxyethyl starch, acute renal injury, aortocoronary bypass surgery.

Objective: to determine the impact of reamberin incorporation into intensive care on the antioxidant defense system and the activity of lipid peroxidation in patients with toxic-hypoxic encephalopathy. Subjects and methods. The investigation enrolled 84 patients with acute severe poisoning by a mixture of psychotropic substances (hypnotics, neuroleptics, antidepressants, 1,4-benzodiazepine derivatives, ethanol). Oxygen balance parameters (oxygen consumption, oxygen utilization quotient, and arteriovenous oxygen difference) were calculated. The antiradical defense system was evaluated determining the levels of reduced glutathione and free sulfhydryl groups of proteins activity of the antiradical enzymes glutathione peroxidase, glutathione-S-transferase, and catalase in red blood cells. Lipid peroxidation rate in red blood cells was determined by measuring the concentration of malondialdehyde. Results. The incorporation of reamberin into intensive care was found to be accompanied by a reduction in tissue hypoxia, more rapid recovery of the antioxidant defense system, and a decrease in the activity of lipid peroxidation processes. Сorrection of metabolic disturbances in its turn leads to the improved clinical course of acute poisoning, which manifests itself as a reduction in the duration of coma, the length of stay in the intensive care unit, and mortality. Conclusion. The reduction in the severity of metabolic disturbances associated with the development of hypoxia and free radical disorders leads to substantial improvement of the clinical course and outcomes of toxic-hypoxic encephalopathy. Key words: toxic-hypoxic encephalopathy, hypoxia, antioxidant system, lipid peroxida-tion, reamberin.

Objective: to study the immune status in a group of children with acute chemical injury and to define the role of integral hematological parameters in the rapid evaluation of the functional state of the immune system. Subjects and methods. Ten patients aged 1 to 3 years with acute chemical poisoning were examined. They underwent immune status examination and clinical blood analysis with calculation of integral hematological parameters, by using the conventional formulas. Results. Within the first 24 hours of the disease, the children were found to have higher neutrophils, lower lymphocytes, and moderate monocytosis. Immunological studies revealed a reduction in total lymphocyte counts due to a decreased T-cell ratios. The level of B lymphocytes did not differ from the normal values, but at the same time there was impaired B-lymphocyte production of immunoglobulins. The absorbing capacity of neutrophils remained unchanged and oxygen-dependent cellular metabolism was enhanced. Conclusion. Immunological findings and integral hematological indices point to immune system functional changes forming in children via a systemic response to acute chemical poisoning. Key words: children, acute chemical injury, hematological indices, immune status.

Objective: to analyze changes in the electrical activity (EA) of the gastrointestinal tract (GIT) in critically ill patients and to evaluate its impact in clinics by using the effect of glutamine as an example. Subjects and methods. Examinations were made in 249 critically ill patients (131 men and 118 women at the age of 68±17 years), including 97 and 152 therapeutic and surgical patients, respectively. Two patient groups were identified: these included a control group (n=186) treated without glutamine therapy and a study group (n=63) additionally receiving glutamine 0.5 g/kg/day for 5 to 10 days (enterally or intravenously in relation to the magnitude of intestinal failure (IF)). The patients were automatically classified according to the values of GIT EA. The authors studied a relationship of the changes in the latter to APACHE II, SAPS II, SOFA, LOD, IF, and 28-day survival in the intensive care unit (ICU). The accuracy of probabilistic prediction was estimated, by simultaneously considering the status of seven organ systems and 28-day survival rates during the use of glutamine in relation to the scores of APACHE II and the type of GIT EA. Results. Two types of GIT EA were identified; these were moderate (type 1) and significant (type 2) changes as compared to the normal values. With an increase in the total severity of the condition and in the magnitude of IF regardless of the disease profile, there were unilateral GIT EA changes, their moderate and rather high correlation with APACHE II, SAPS II, SOFA, LOD scores, IF stage — with 28-day survival rates. The use of glutamine provided an increase in 28-day survival rates in patients with an APACHE II score of > 15 scores and type 2 GIT EA. Conclusion. The impairments of GIT EA in critical care patients possess specific pathological patterns an their account increases the accuracy of prediction and the efficacy of glutamine used in CCP. Key words: critical care, gastrointestinal tract, peripheral electrogastroenterography, glutamine.

Objective: to study the impact of liver resection (LR) and a hyperbaric oxygenation (HBO) session and their combination on blood antistaphylococcal activity. Material and methods. Experiments were carried out on 77 outbred albino rats (females) exposed to LR (15—20% of the liver weight) and HBO at 3 ata as a 50-min session once daily, which was used in the operated rats in the first 3 days after LR. Serum bactericidal activity against opportunistic (No. 1726) and pathogenic (No. 209) S.aureus strains and the ability of neutrophils and monocytes to absorb S.aureus 209 were studied. Results. restoring the serum bactericidal activity against S.aureus 1726, HBO used after LR enhances its activity against pathogenic S.aureus 209. By decreasing the inhibitory effect of LR on the ability of the liver to enrich blood with the neutrophils that actively phagocy-tize the staphylococcus, HBO eliminates the retention of the monocytes actively phagocytizing S.aureus 209 in the operated organ, by concurrently increasing the count of these cells in the arterial blood. HBO stimulates the rate of uptake of S.aureus 209 by neutrophils in the operated organism when the blood passes through the vessels of the portal system with the partial retention of these cells in the liver portion left after its resection. By selectively suppressing the humoral component of blood antistaphylococcal defense, HBO in healthy unoperated animals stimulates the ability of the liver to enrich the blood with the monocytes that actively phagocytize the staphylococcus. At the same time the rate of uptake of S.aureus 209 by neutrophils is stimulated by hyperoxia. Conclusion. HBO regulates blood antistaphylococcal activity changes in response to LR by exerting a selective effect on the bactericidal activity of the blood against the staphylococcus in rats. Key words: liver, resection, hyperoxia, bactericidal activity, blood, staphylococcus.

Transition from micron to nanometric image sizes creates many problems associated with the emergence of non-uniform scale heterogeneities of objects. To recognize the structural units of membrane heterogeneities is a complex pathophysiological and biophysical task. Objection: to show main methodological approaches to analyzing the heterogeneities of membrane nanostructures when using microscopy and to demonstrate the need for an expert evaluation when investigating red blood cell membranes in health and the influence of exogenous and physicochemical factors on blood. The paper discusses the limits of applicability of optical and atomic force microscopy. It shows the heterogeneities of cell distribution over the ensemble, surface of an individual cell, by the pattern and extent of local membrane damages and by a number of others. To take into account all the types of heterogeneities, to form the qualitative monolayers of cells, and to choose scanning nanoscales adequately with the tasks may contribute to the successful implementation of the research goals set. Key words: membranes, heterogeneities, local defects, optical, atomic force microscopy.

On August 5, 2013 Igor Viktorovich Venin was 75 years old and devoted about 50 years of his life to medical electronic instrumentation engineering. In 1966 to 2012, sixteen defibrillator models including one with an unipolar pulse and 15 with bipolar pulses, out of them 6 current models with three (quasi-sinusoidal, trapezoidal, and quasi-sinusoidal step-functional) types of bipolar pulses were designed and put into serial production under the direction of I. V. Venin. The key achievement of I.V. Venin is that he developed the world’s first defibrillators with a bipolar pulse 24 years earlier than in the USA. This all amounts to about one half of the total number of defibrillators designed and transferred to production in the USSR, Russia, and Ukraine in 1952 to 2012. Key words: I.V. Venin, defibrillator, bipolar pulses.