Objective: to reveal the patterns of blood biochemical changes, a trend in poikylocytosis, and impairment in the ultra-structure of red blood cells of the whole blood stored in citrate-phosphate-dextrose-adenine-1 during long-term storage. Material and methods. The whole blood that had been obtained from 5 donors aged 25±3 years of different sexes and stored at +2 to +4°С was examined. On storage days 1, 7, 14, 21, and 30, the morphological composition of a red blood cell population was assessed in monolayer blood smears (1000 cells per smear), by using an Olympus BX-500 microscope, computer, and ImageScopeM program. The surface of the red blood cell membranes was analyzed using an IntegraPrima NT-MDT atomic force microscope (AFM). Blood biochemical composition was examined using an i-stat 1® analyzer M: 300. Statistical processing was made with a STATISTICA 7 program. Results. A change in the biochemical composition of the whole blood was revealed within just the first 24 hours of storage. Morphological changes were observed in the red blood cells 3 days later. At 21 days, discocytes were 31.3±3.27% as compared to the control (in the first 24 hours) (p<0.0001). After 30 days of storage, altered red blood cells amounted to more than 80%, among them echinocytes prevailed as compared to the control (79.6±2.74%; p<0.0001). The examinations using AFM illustrated that the nanostructure of the red blood cell membranes tangibly changed with storage, they showed local lesions (excrescences of different sizes) growing into large spicules. Conclusion. The performed studies of the biochemical parameters of the blood, the morphological characteristics of the red blood cells and their membranes suggest that their changes evolved in just the first 24 hours of blood storage. The findings are essential for the development of new methods for storing blood and its components.

Objective: to study the average local tension of a membrane upon exposure to its modifiers. Materials and methods. Blood from 3 healthy donors was sampled into ethylene diamine tetraacetate-containing microvettes (Sarstedt AG and Co., Germany) during prophylactic examinations. In this series of experiments, the red blood cells were exposed to the membrane nanosurface modifier hemin (muriatic hematin). Hemin disrupts the conformation of spectrin, a band 4.1 protein, and weakens their bond [19]. Hemin was added to blood in vitro. Its blood concentration was 1.8 mM. The images of cells and their membranes were obtained on a NTEGRA Prima atomic force microscope (NT-MDT, Russia) [16]. The membrane tension was estimated by atomic force spectroscopy. Results. After exposure to hemin, 68% of cases showed a 2.1-fold increase in the average tension as compared to the mean control value (p<0.05), which could reduce ID by «30 %. Subsequent exposure to perftoran returned the membrane tension to the baseline values in 85% of cases. The membrane tension of other 15% of the areas on the cells remained high — 2.3 times higher than the control values (p<0.05) even despite the action of perftoran. Conclusion. Thus, atomic force spectroscopy was used to measure the average local tension of the membrane, which depended on exposure to its modifiers, such as hemin. Key words: red blood cell, membrane tension, atomic force spectroscopy, hemin.

Objective: to compare central hemodynamic and microcirculatory changes in critical conditions caused by different factors and to reveal their possible differences for a further differentiated approach to intensive therapy. Subjects and methods. The study covered 16 subjects with severe concomitant injury (mean age 41.96±2.83 years) and 19 patients with general purulent peritonitis (mean age 45.34±2.16 years). Their follow-up was 7 days. The central hemodynamics was estimated by transpulmonary thermodilution using a Pulsion PiCCO Plus system (Pulsion Medical Systems, Germany). The microcirculatory bed was evaluated by cutaneous laser Doppler flowmetry using a LAKK-02 capillary blood flow laser analyzer (LAZMA Research-and-Production Association, Russian Federation). Results. The pattern of central hemodynamic and microcirculatory disorders varies with the trigger that has led to a critical condition. Central hemodynamics should be stabilized to ensure the average level of tissue perfusion in victims with severe concomitant injury. In general purulent peritonitis, microcirculatory disorders may persist even if the macrohemodynamic parameters are normal. Conclusion. The macrohemodynamic and microcirculatory differences obtained during the study suggest that a complex of intensive therapy should be differentiated and, if the latter is used, it is necessary not only to be based on the central hemodynamics, but also to take into consideration functional changes in microcirculation. Key words: severe concomitant injury, general purulent peritonitis, micro-circulation, central hemodynamics, type of circulation.

Objective: to determine the efficiency of bronchofibroscopy (BFS) and cytology of bronchoalveolar lavage fluid (BALF) for the diagnosis of pulmonary complications in resuscitation patients with varying acute therapeutic and surgical diseases. Subjects and methods. Twenty-seven patients treated at the intensive care unit of the Meditsina Clinic (the clinical basis of the Department of Therapy and Family Medicine, N. I. Pirogov Russian National Research Medical University) were examined. Sanitation BFSs were performed, by taking BALF for cytological examination. Results. BALF hyperneutrophil-ia is characteristic of the patients who are critically ill (an APPACHE-II score of more than 21). All the patients were diagnosed as having Grades 1 and 2 inflammatory changes in the airway mucosa. Conclusion. The introduction of cytological examination of BALF into the practice of intensive care units of multidisciplinary health care facilities considerably increases the quality and efficiency of resuscitative measures and promotes shorter treatment duration. Key words: bronchofi-broscopy, pulmonary complications, diagnosis, bronchoalveolar lavage fluid, cytology.

This paper validates the PHBQ test that has been thrice translated from English into Russian; then its three variants translated into English again. The variant whose meaning was the most significant was taken for further patient testing and researches. To confirm that the translated variant was a systemic tool for work with patients, it was compared with modified PHBQ and CBCL tests for 3—7-year-old children. The latter has been translated into Russian and is commercial. The statistical significance of each of these tests was estimated using different statistical data processing methods, such as a factor analysis, a reliability analysis (Cronbach’s alpha), a correlation and regression statistical analysis that is used to test the validity of different mathematical models. The findings may suggest that the Russian language-adapted test may be employed as a reliable tool for patient testing in detecting post-hospitalization disorders; the correlation observed in the comparison of the three tests being rather high. Key words: post-hospitalization syndrome, surgical interventions, fear, distress, PHBQ test.

Objective: to develop technology for the transmembrane mass transfer of fat-soluble substances with emulsified solution of the essential lipids exposed to dialysis. Materialaadmethods. The pharmacopoeia lipofundin MCT/LCT (20% intravenous fat emulsion) (B. Braun, Germany) was used at all study stages. Coaclusioa. Bicarbonate hemodialysis-modified lipofundin solution contains no triglycerides; its osmolarity is normalized and the solution is ready to use for lipid on-line hemodiafiltration, which allows fat-soluble substances that accumulate in acute liver failure to be removed. Key words: lipid hemodi-afiltration, lipofundin, acute liver failure.

Objective: to compare the informative value of four nutritional screening scales in patients operated on the heart under extracorporeal circulation (EC). Subjects and methods. A prospective cohort study was conducted to examine the results of treatment in 894 adult patients operated on under EC. Nutritional screening was carried out using four scales: Nutritional Risk Screening 2002 (NRS-2002), Malnutrition Universal Screening Tool (MUST), Mini Nutritional Assessment (MNA), and Short Nutritional Assessment Questionnaire (SNAQ). Their nutritional status was assessed by the Subjective Global Assessment (SGA) scale. Mortality and postoperative complications were analyzed. Results. The MUST scale had the highest sensitivity (97.9%) in identifying malnutrition (MN). Univariate analysis of postoperative complications indicated that all the scales had a similar prognostic value: MUST [OR 2 (95% CI, 1.4—2.8); р = 0.0001], SNAQ [OR 1.8 (1.2—2.5); р=0.002], NRS-2002 [OR 1.8 (1.1—3.1); р=0.03], MNA [OR 1.8 (1.3—2.4); р=0.0007] and lower sensitivity (21.2, 23.3, 8.5, and 25.7% for SNAQ, MUST, NRS-2002, and MNA, respectively). However, multivariate analysis along with the commonly known risk factors (age, gender, EC duration) confirmed the prognostic value of the MUST [OR 1.6 (1.1—2.4); р=0.01] and MNA [OR 1.5 (1.1—2.1); р=0.02] scales. Conclusion. The MUST scale is of the most informative value in terms of its sensitivity in detecting MN and of independent prognostic value as to postoperative complications. All the scales have a poor prognostic value regarding the postoperative complications, which determines the urgency of developing a special cardiac screening scale for the nutritional status. Key words: cardiac surgery, nutritional screening, nutritional assessment, malnutrition.

Objective: to analyze the informative value of new methods for the early diagnosis of acute kidney injury (AKI) to determine treatment policy after heart surgery under extracorporeal circulation (EC). Subjects and methods. Patients of both sexes were examined before and after heart surgery under EC. A perfusion index of 2.5±0.4 l/min/m2, moderate hypothermia, and a mean blood pressure of 60—100 mm Hg were maintained throughout EC. Urine samples were taken 4—6 and 16—18 hours after termination of EC and centrifuged. Urinary neutrophil gelatinase associated lipocalin (NGAL) was determined using an Abbott Architect i1000sr analyzer. The cutoff level proposed by the Abbott Diagnostics was 132 ng/ml. NonResults. Two groups were formed. Group 1 included 14 patients with AKI according to the 2004 RIFLE classification. Stage 1 AKI was seen in 5 cases; there was no disease progression or urinary NGAL elevation. Four to six hours after EC, 8 of 9 patients with Stages 2—3 AKI had a urinary NGAL level of 200 ng/ml. Two patients required renal replacement therapy (RRT), their renal function recovery was observed. Other two patients died from respiratory and cardiac failure. Group 2 comprised 61 patients without AKI: in 59 and 2 patients, urinary NGAL levels were lower and higher than the accepted cutoff levels, respectively. No deaths were observed. AKI developed in patients who had more prolonged EC, transverse aortic ligation, low hemoglobin levels and received more doses of donor blood. In Stages 1—3 AKI, the sensitivity was 57.1% (95% confidence interval (CI), 28.9—82.2) and specificity was 96.7% (95% CI, 88.6—99.5); in Stages 2—3 AKI, these were 88.9% (95% CI, 51.7—98.2) and 97% (95% CI, 89.5—99.5), respectively. Conclusion. Urinary NGAL levels should be determined by using the laboratory platforms 4—6 hours after long EC, as well as aortic ligation, and transfusion of two or more blood doses. Elevated urinary NGAL levels are highly sensitive to Stages 2—3 AKI and useful in assessing indications by the beginning of RRT. Key words: cardiac surgery under extracorporeal circulation, acute kidney injury, urinary NGAL, urinary albumin to creatinine ratio.

Objective: to improve the results of spontaneous labor in female patients with diabetes mellitus (DM). Subjects and methods. The results of physiological labor analgesia were analyzed in 140 patients. The parturients were divided into 3 groups: 1) 40 parturients in whom analgesia was performed by the intravenous administration of promedol; 2) 40 parturients in whom analgesia was done by the fractional administration of 0.2% ropivacaine hydrochloride into the epidural space; 3) 40 parturients in whom analgesia was carried out with intravenous paracetamol 2000—3000 mg. In all the patients, the investigators estimated central hemodynamic parameters by echocardiography, the efficiency of labor analgesia according to the scale described by N. N. Rasstrigina and B. V. Shnaider, as well as blood glucose levels, fetal status by a cardiotocographic technique, and neonatal status by Apgar scores at 1 and 5 minutes of life. Results. Analgesia quality assessment established that the best analgesic effect was achieved in the patients in Group 2 where 75.0% of the parturients had 8—10 scores. A comparative analysis of carbohydrate metabolic parameters also ascertained that the most steady-state and physiological glycemic level was recorded in Group 2 patients throughout the study. In addition, epidural analgesia versus other analgesic techniques provides the most steady-state hemodynamic parameters during labor, which promotes improved labor and has a beneficial effect on fetal and neonatal states. Conclusion. Glycemic levels during labor and delivery can be optimized in patients with DM only if adequate analgesia is achieved. By ensuring adequate labor analgesia, epidural analgesia normalizes glycemic and central hemodynamic parameters, favors elimination of delivery abnormalities, and has a beneficial effect on fetal and neonatal states. Key words: epidural analgesia, diabetes mellitus, spontaneous labor.

Pharmaceuticals based on lithium ions have been already used in clinical practice for over 60 years for the treatment of bipolar disorders and remain a basic pharmacological therapy for patients with this disease. In spite of this, the therapeutic mechanisms of action of lithium ions have not been fully investigated. In the past decade, in vitro and in vivo experiments have provided a good deal of data suggesting that lithium ions have previously undescribed neuro-, cardio-, and nephro-protective properties. Numerous investigations have demonstrated that glycogen synthase kinase-3/3, the key enzyme of different pathological and protective signaling pathways, is the target of lithium ions in displaying these effects. This review deals with just these new properties of lithium ions, which make them utterly promising for clinical use in circulatory arrest-associated conditions, which is particularly relevant for anesthesiology and resuscitation. Key words: lithium ions, brain, heart, kidney, postresuscitation disease.