General Reanimatology (E-Journal) / Общая реаниматология
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Наноструктура мембран эритроцитов недоношенных новорожденных с респираторным дистресс-синдромом
No full textObjective: to study the nanostructure of red blood cell membranes in premature babies with neonatal respiratory distress syndrome (NRDS), by applying atomic force microscopy. Subjects and methods. The investigation included 27 newborn infants, of them 13 premature babies with NRDS formed a study group. The mean gestational age was 33.1±2.3 weeks; their birth weight was 1800±299.3 g. A comparison group consisted of 14 full-term babies with favorable pregnancy and term labor. The mean gestational age of the babies was 39.4±0.5 weeks; their birth weight was 3131.7±588.8 g; the infants had a one minute Apgar score of 8±0.4. Their red blood cells were examined using an atomic force microscope. The objects to be examined were residual umbilical cord blood (RUCB) from the premature infants; central venous blood after 7 hours of birth and neonatal venous blood taken on day 7 of life. Results. RUCB from full-term babies contained planocytes that were a major morphological type of red blood cells. In physiological pregnancy and acute fetal hypoxia, the morphological composition of red blood cells in premature neonates with NRDS was close to that in full-term babies. The planocytes are also a major morphological type of red blood cells in the premature infants; the frequency of their occurrence varies. Stomatocytes are typical of all the neonates in the NRDS group; their frequency levels vary greatly: from 8 to 65% of the total number of erythrocytes. The examination revealed that the premature infants of 31—36 weeks gestation were characterized by abnormal erythrocyte shapes that showed a high variability. At birth, the premature babies were found to have changes in the nanostructure of red blood cell membranes, which were influenced by intrauterine hypoxia. The first-order value reflecting flickering in the red blood cell membrane varies to the most extent. Conclusion. Atomic force microscopy showed that the greatest changes in the structure of red blood cell membranes were found in RUCB. The premature babies with NRDS had intrauterine poikilocytosis caused by unfavorable factors, as confirmed by the presence of multiple correlations. Analysis of the nanostructure of red blood cell membranes revealed that the first-order value reflecting flickering in the red blood cell membrane was most sensitive; this indicator showed a slow normalization. Correspondence to: Key words: red blood cell membrane, nanostructure, planocytes, stomatocytes, premature newborn infants, respiratory distress syndrome
Нормотермический или гипотермический режимы искусственного кровообращения у пациентов с приобретенными пороками сердца
Get PDFBackground. Hypothermal extracorporeal circulation has been used in cardiosurgery over 50 years. However, recent trials have not shown its predominant effect on the protection of the brain, lung, and myocardium in patients during surgery. We have presumed that when normothermal extracorporeal circulation used in patients with acquired heart disease, its pathophysiological effect on the body is comparable with that of hypothermal extracorporeal circulation. Subjects and methods. One hundred and forty patients who were to undergo acquired heart disease correction were randomized into two equal groups: that using hypothermal or normothermal extracorporeal circulation. Perioperative troponin I and NT-proBNP concentrations, postoperative clinical course, and hospital morbidity and mortality rates were estimated. Results. There were no significant differences in the concentrations of troponin I and NT-proBNP at the study stages. In the normothermal extracorporeal circulation group patients with isolated aortic stenosis, the concentration of troponin I was higher than that in the hypothermal extracorporeal circulation group. Analyzing the postoperative course indicated that the duration of mechanical ventilation was significantly lower in the hypothermal extracorporeal circulation group than in the normothermal extracorporeal circulation group. There were no differences in hospital complications and mortality rates. Conclusion. Hypothermal versus normothermal extracorporeal circulation in the correction of acquired heart diseases has no predominant effect on tro-ponin I and NT-proBNP concentrations, postoperative clinical course, and hospital complications and mortality rates. Key words: extracorporeal circulation, hypothermia, acquired heart disease, troponin I, NT-proBNP
Особенности гемодинамики и свертывающей системы крови у больных, оперированных по поводу кровотечений язвенной болезни
Get PDFObjective: to evaluate the clinical efficacy of hypoxen and nutrients used in the combination therapy of patients operated for bleeding gastroduodenal ulcer. Subjects and methods. Seventy-four patients were examined and treated. All the patients were divided into 3 groups: 1) standard therapy + hypoxen in a daily dose of 1 g for a week; 2) standard therapy + hypox-en and nutrients; 3) standard therapy only. Hypoxen and nutrients were administered on postoperative day 1 via an enter-al feeding tube. Systemic hemodynamic and hemostatic parameters were determined using MICAR-RHEO hardware-software rheographic unit APG2-01 analyzer, respectively. Results. It was established that the hyper- and eukinetic hemodynamic types were predominant before surgery and the eukinetic type was prevalent in the early postoperative period. Hypoxen and nutrients were observed to positively affect central hemodynamic parameters, such as blood pressure, cardiac output, circulating blood volume, and heart rate. Hypercoagulation changes (shorter blood clotting time in a study group and elevated serum fibrinogen levels in a comparison group) on postoperative day 10 suggest that the hemostatic parameters should be monitored and corrected as soon as possible. Key words: ulcer disease, hypoxen, nutritional support, blood circulation, hemostatic system
Влияние гипербарической оксигенации на антистафилококковую активность крови при экспериментальной резекции печени
Get PDFObjective: 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
Изменения наноструктуры мембран красных клеток крови при кровопотере на этапах хирургического лечения у больных при операциях на спинном мозге
Get PDFObjective: to study impairments in the nanostructure of red blood cells in blood loss during spinal cord surgery. Subjects and methods. The study enrolled 17 patients operated on at the Center of Neurosurgery, City Clinical Hospital Nineteen, for spinal cord pathology. Examinations were made in 3 patient groups: 1) a blood loss of less than 300 ml; 2) 600±200 ml; 3) 1500±200 ml. Images of fragments of the surface structure of red blood cell membranes were obtained using an atomic force microscope (NT-MDT). Results. The study showed the time course of changes in the index hi for the three patient groups. 24 hours after surgery, the first-order height h1 increased in all the patients. The time course of changes in h1, h2, and h3 was shown to have distinguishing characteristics in each of the above groups. In Group 1, the second- and first-order heights maximally rose on days 1 and 3, respectively. In Group 2, the first-order height maximally increased on day 1; in Group 3, there was a rise in all three orders on day 3. In Groups 1 and 2, the values of the nanostructure were close to the control ones on day 5 and in the 1500±200-ml blood loss group, hi was 5 times greater than the control on the same day. Conclusion. Spinal cord surgical blood losses give rise to systemic changes that directly affect red blood cells: they alter their membrane nanostructure, shape, and size. The membrane flicker increases and the characteristics of the spectrin matrix and aggregation of protein clusters change
Динамика морфологических изменений эритроцитов и биохимических показателей консервированной цельной крови в различные сроки хранения
Get PDFObjective: 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
Раствор 7,2% NaCl / 6% ГЭК 200/0,5 не ухудшает почечную функцию у кардиохирургисческих пациентов, оперированных в условиях искусственного кровообращения
Get PDFObjective: 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
Динамика уровня прокальцитонина при развитии нозокомиальной пневмонии у пострадавших с тяжелой сочетанной травмой в отделении реанимации
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Биомаркеры прокальцитонин и белок S100β в клинико-лабораторном мониторинге при критических состояниях новорожденных
No full textObjective: to determine quantitative changes in procalcitonin (PCT) and S100β protein in serum from newborn infants under the long-term intensive care in an intensive care unit in order to optimize managing the care. Subjects and methods. A study group prospectively included 69 critically ill neonates of more than 2 days of birth admitted to the neonatal intensive care unit. The levels of PCT (normal values Results. In critically ill neonates, both biomarkers were shown to be increased in most cases. The level of PCT varied from the normal values up to 72 ng/ml [mean 1.03 (range 0.36—3.92 ng)]. Mean level of S100β protein was 0.339 (range 0.234—0.481) ^g/l. Levels of PCT and S100β positively correlated (r=0.47; p<0.05). The infants with the increased baseline levels of PCT demonstrated significant reduction of the biomarker over time that was considered as the adequacy of performed antibiotic therapy. The highest S100β levels were recorded in premature babies with sepsis including those without significant perinatal lesion of the central nervous system (CNS). Unidirectional reduction was typical for both S100β and PCT levels. Combination of increased S100β serum concentration decreased PCT was a pattern of developing the periventricular leukomalacia. There was evidence for a direct relation of biomarker S100β? to the presence of convulsive syndrome (Kendal’s coefficient 0.36; p<0.05). Conclusion. Similarly to newborn infants with traumatic, hypoxic, and hemorrhagic CNS lesions, patients with infectious and septic pathology exhibited elevated S100β levels. Both biomarkers PCT and S100β are suggested to be included in a battery of clinical and monitoring tests to optimize treatment of high-risk neonates in the intensive care unit. Key words: newborn infants, premature infants, critical conditions, biomarkers, procalcitonin, S100β protein, laboratory monitoring, perinatal pathology, antibacterial therapy