[By the 200th anniversary of friedrich von esmarch (1823-1908)]. / K 200-letiyu so dnya rozhdeniya Fridrikha fon Esmarkha (1823­1908).

The world fame of Friedrich von Esmarch (1823-1908) is based on his universal effectiveness as a surgeon and innovative physician. He was primarily a military surgeon, and some ones call him the «Ambroise Pare of Germany¼. He owns numerous ideas in optimizing care for wounded and innovative developments in surgery. Friedrich von Esmarch improved methods of asepsis and antisepsis, anesthesia and sanitation in German hospitals. He is also considered as one of the pioneers in primary care. Friedrich von Esmarch is an author of more than 80 publications including a first aid textbook.

[Re-operations in patients with heart wounds]. / Povtornye operatsii u postradavshikh s raneniiami serdtsa i perikarda.

AIM: To define the risk factors of complications which are followed by re-operations in patients with cardiac and pericardial wounds and to prevent these complications. MATERIAL AND METHODS: Retrospective and prospective analysis of 1072 victims with cardiac and pericardial injuries for 35 years was performed. Overall mortality was 17.2%. 98 patients died during surgery. Postoperative bleeding was observed in 38 (3.9%) cases. RESULTS: In 28 cases re-operations were performed for bleeding-related complications. Indications for re-thoracotomy were one-time drainage from pleural cavity over 500 ml or bleeding rate over 100 ml per hour for 4 hours. Prevention of postoperative bleeding in case of cardiac and pericardial wounds was developed on basis of analysis of these observations. CONCLUSION: Risk factors of complications requiring re-operation are cardiomyopathy of different etiology, technical and tactical errors during primary intervention and hypocoagulation with massive blood loss. Prevention of these complications includes careful heart wound closure, comprehensive intraoperative control, correction of hemostatic system.

[Use of thrombolytic therapy and rheolytic thrombectomy in treatment of pulmonary artery thromboembolism].

The article deals with the results of combined treatment of patients with pulmonary thromboembolism by means of systemic thrombolytic therapy, anticoagulant therapy, and rheolytic thrombectomy during the period from 2012 to 2013. Thrombolytic therapy was used in 78 of 187 patients with the confirmed diagnosis of pulmonary thromboembolism (Group 1). The diagnosis was verified and therapeutic results were controlled by means of contrast-enhanced spiral computed tomography and perfusion scintigraphy. Thrombolysis was carried out using: tissue plasminogen activator - alteplase (61 cases) with administration of the full dose during 2 hours, streptokinase (14 cases) at a dose of 1.5 million IU in the mode of prolonged infusion during 24 hours and urokinase (3 cases) at a dose of 4400 IU/kg during 12 hours. 109 patients were subjected to anticoagulant therapy (Group 2). Five patients were subjected to rheolytic thrombectomy for desobstruction of the pulmonary artery. The method was used in patients with previously performed ineffective or partially effective thrombolytic therapy, as well as in patients with contraindications to thrombolysis. The lethality rate for TLT amounted to 5.4% and that for anticoagulant therapy 26.6%. Probability of a lethal outcome in Group 2 (anticoagulant therapy) turned out to be 6.71 times higher as compared with Group 1 (thrombolytic therapy). In all cases of using rheolytic thrombectomy we managed to achieve a decrease of the Miller index and systolic pressure in the pulmonary artery. Desobstruction of the pulmonary artery was complete in 3 cases. In two cases rheolytic thrombectomy was partially effective and the patients underwent repeat thrombolysis with a good clinical outcome. Using systemic thrombolysis in patients with pulmonary artery thromboembolism demonstrated a positive effect on the prognosis of survival. Rheolytic thrombectomy contributed to improvement of the results of thrombolytic therapy and may be used as an alternative method of treatment.

[Postoperative complications of heart and pericardial injuries].

The 31-year experience of 839 cases of heart and pericardial injuries was analyzed. The complicated course was registered in 36%. Such factors as patient's age, blood loss, severity of injury and patient's condition on admission, defined the possibility of complications. No less important were the characteristics of postoperative treatment and early diagnostics of the injury. The thorough analysis of reasons of the complications' development allowed to work out some prophylactic measures and to decrease the frequency of postoperative lethality from 13.8 to 6.8%, whereas the complications rate was decreased from 43.8 to 32.3%.

[Assessment of the diagnostic value of perfusion scintigraphy in diagnosis of pulmonary artery thromboembolism].

The present work was aimed at specifying the place of perfusion scintigraphy of the lungs in the diagnostic algorithm of pulmonary artery thromboembolism (PATE) and at determining sensitivity, specificity, and accuracy of the method concerned. The authors analysed the data regarding a total of 211 patients divided into two groups (Group One with an arbitrary algorithm of investigation, comprising 108 patients and Group Two with the suggested algorithm of «pulmonary roentgenography Doppler ultrasonography perfusion scintigraphy of the lungs¼) in clinically suspected pulmonary artery thromboembolism and scintigraphy-revealed defects of perfusion. The diagnostic complex included ECG, Doppler ultrasonography of the veins, roentgenography, perfusion scintigraphy of the lungs, and in a series of doubtful cases Echo-CG and CT angiography of the lungs. We revealed reliable signs of pulmonary artery thromboembolism (PATE) by the findings of instrumental diagnostic methods, having demonstrated a considerable increase in specificity and accuracy of perfusion scintigraphy in diagnosing PATE using the proposed diagnostic algorithm, when scintigraphy stands on the third position (specificity increased by 78% and accuracy by 22%). The following recommendations were made: the findings of scintigraphy should be interpreted with due regard for the data of roentgenography and Doppler ultrasonography of the veins; if the patient s condition is severe, the examination may be limited to roentgenography alone prior to performing perfusion scintigraphy of the lungs.

[Pattern dynamics of bacteriemia and sepsis pathogens in ICU patients of emergency service].

The results of microbiological tests of 2382 blood specimens from 698 patients of three ICUs of the N. V. Sklifosovsky Research Institute of Emergency Service were analysed for a period of 2009 to 2012. No microbial growth was detected in 1160 specimens (48.7%). In the subsequent tests 816 isolates were used. The quota of grampositive isolates in the pathogen pattern decreased from 51.68 to 35.9% and that of gramnegative isolates increased from 38.26 to 48.1%. The number of the Candida isolates increased from 7.38 to 15.2%. The frequency of the S. aureus and Enterococcus spp. isolates lowered from 26.2 to 13.3% and from 15.4 to 11.5% respectively. The quota of K. pneumoniae isolates and Acinetobacter spp. increased from 8.1 to 18.9% and from 14.1 to 17.4% respectively. Most of the S. aureus isolates were methicillin resistant. All the staphylococcal isolates were susceptible to vancomycin and linezolid. All the strains of K. pneumoniae isolated in 2009-2012 produced extended spectrum beta-lactamases. In 2012 7.8% the K. pneumoniae isolates were resistant to carbapenems. In 2012 25.5% of the Acinetobacter spp. isolates were susceptible to carbapenems and 70.2% were susceptible to cefoperazon/sulbactam.

[Features of immunity in tobacco smoking among adolescents].

The work is devoted to the study of indicators of systemic and local immunity in the respiratory tract in healthy adolescent tobacco use. The aim of the work is to characterize indices of general and local immunity of the respiratory tract during smoking in healthy adolescents. The study of local immunity was performed in induced sputum with the use of 0.1% solution of dithiothreitol. The study used tests assessing immune status I and II level. Active smoking in healthy adolescents induces a local and general immunological signs of inflammation: in sputum--elevation of IL-1alpha level and number of cells with activation markers (SD45 and HLA-DR); in the peripheral blood--the rise of levels of IL-6, IL-8, TNF CD19 (+) - cells, IgE and IL-4 in combination with a reduction in the number of CCD3(+)-, CD4(+)-, CD8(-)-lymphocytes and depression of the phagocytic activity of neutrophils.

[Results of preclinical studies of live monovalent influenza vaccine Influvir].

AIM: To perform preclinical assessment of new live monovalent vaccine Influvir against pandemic influenza virus A/H1N1 [strainA/17/California/2009/38 (H1N1)]. MATERIALS AND METHODS: Preclinical studies of acute toxicity and effect of Influvir vaccine on systems and organs of laboratory animals (rats and outbred white mice) was performed according to modern requirements of Institute of Toxicology. RESULTS: According to results of toxicometry and necroscopy, live monovalent influenza vaccine Influvir during intransal application was safe and had good tolerability during 14 days of observation for experimental animals after acute application. Performed preclinical studies allow to label the studied vaccine as class V virtually nontoxic drugs. CONCLUSION: According to results of preclinical studies, clinical trials of live monovalent intranasal influenza vaccine Influvir can be permitted.

[Early application of plasmapheresis for complex treatment of purulent mediastinitis].

Acute purulent mediastinitis (APM) is one of the most difficult forms of surgical infection with severe clinical course and lethality from 17 to 80%. Overall 80 patients with APM were treated; plasmapheresis in postoperative period was used at 66 of them. The main criteria of negative prognosis at the patients with APM were elderly age, high score on APACHE-2, SAPS-2 and SOFA scales, higher level of creatinine and urea serum concentration, hyperglycemia, leucopenia. Early application of plasmapheresis was associated with lower lethality (12.5% at the group with early beginning of plasmapheresis, 35.3% at the group with late beginning, 36.2% at the control group). Plasmapheresis promotes normalization of hemostasis, microcirculation and immune parameters, reduction of intoxication and systemic inflammation syndrome.

Purification and characterization of alcohol oxidase from a genetically constructed over-producing strain of the methylotrophic yeast Hansenula polymorpha.

Alcohol oxidase (AOX) has been purified 8-fold from a genetically constructed over-producing strain of the methylotrophic yeast Hansenula polymorpha C-105 (gcr1 catX) with impaired glucose-induced catabolite repression and completely devoid of catalase. The final enzyme preparation was homogeneous as judged by polyacrylamide gel electrophoresis and HPLC. Some physicochemical and biochemical properties of AOX were studied in detail: molecular weight (approximately 620 kD), isoelectric point (pI 6.1), and UV-VIS, circular dichroism (CD), and fluorescence spectra. The content of different secondary structure motifs of the enzyme has been calculated from the CD spectra using a computer program. It was found that the native protein contains about 50% alpha-helix, 25% beta-sheet, and about 20% random structures. The kinetic parameters for different substrates, such as methanol, ethanol, and formaldehyde, were measured using a Clark oxygen electrode. The rate of enzymatic oxidation of formaldehyde by alcohol oxidase from H. polymorpha is only twice lower compared to the best substrate of the enzyme, methanol.

Isolation and Purification of enzymes from ligninolytic complex of the basidial fungus Trametes pubescens (Schumach.) Pilát and study of their properties.

A method for purification of enzymes from the ligninolityc complex of the basidiomycete Trametes pubescens (Schumach.) Pilat has been elaborated. Two homogeneous isoforms of laccases (laccase 1 and laccase 2) as well as a homogeneous preparation of lignin peroxidase were isolated. Basic biochemical parameters of the enzymes were determined, such as the molecular weights (67, 67, and 45 kD, respectively), isoelectric points (5.3, 5.1, and 4.2, respectively), as well as content and composition of the carbohydrate moiety of the laccases (N-acetylglucosamine, mannose, and xylose). The pH dependences and thermal stabilities of the laccases were investigated. The kinetic parameters of the enzymatic reactions catalyzed by the laccases were determined using different substrates, such as catechol, hydroquinone, 2,2 -azinobis-(3-ethylbenzthiazoline-6-sulfonate), and K4Fe(CN)6. The structure of the active sites of both laccases and the lignin peroxidase were studied by EPR, CD, and UV-VIS spectroscopy, as well as using fluorescence analysis. Our studies showed similarity of the spectral characteristics of the two laccases, whereas their kinetic properties were found to be different.

[Characteristics of hemodynamic and external respiratory function in patients with concomitant wounds of the heart and lung during early postoperative period].

The parameters of intracardiac hemodynamics and external respiratory function (ERF) were studied by echocardiography and computed spirography with pneumotachometry in 123 patients with punctured and lacerated wounds of the chest in the early postoperative period. All the patients were divided into 6 groups according to the pattern of injuries. Group 1 included 25 patients with chest wound without organ damages; Group 2 comprised 42 patients with wound of the lung; Group 3 consisted of 22 patients with wound of the left ventricle (LV); in Group 4 there were 11 persons with wound of LV and the lung; Group 5 included 8 victims with wound of the right ventricle (RV); and Group 6 comprised 15 patients with wounds of the lung and RV. One- and five-day follow-ups revealed the most pronounced disorders of intracardiac hemodynamics and ERF in patients with concomitant wound of the lung and RV (Group 6). At the same time it was found that when wounds of the lung were concomitant with those of the heart, there was discoordination of RV and LV work with decreased volumetric blood flow along the pulmonary artery. These impairments also persisted by day 5 of the moment of wound. By that time there were positive hemodynamic and ERF changes in the other groups.

Comparison of physico-chemical characteristics of four laccases from different basidiomycetes.

New strains of basidiomycetes producing extracellular laccases (Trametes ochracea 92-78, and Trametes hirsuta 56) have been found by screening of isolates of Trametes fungi. The laccases from T. hirsuta 56 and T. ochracea 92-78 as well as two laccases from previously found and described strains of basidiomycetes, namely Cerrena maxima and Coriolopsis fulvocinerea, were purified to homogeneity. The standard redox potentials of type 1 copper in the enzymes were determined and found to be 780, 790, 750, and 780 mV, respectively. The spectral and biochemical studies showed that the enzymes had no significant differences between the structures of their active sites (T1, T2, and T3). In spite of this fact, the basic biochemical properties as well as the redox potentials of the T1 sites of the enzymes were found to be different. The molecular weights of the laccases range from 64 to 70 kDa, and their pI values range from 3.5 to 4.7. The pH-optima are in the range 3.5-5.2. The temperature optimum for activity is about 50 degrees C. The thermal stabilities of the enzymes were studied. The catalytic and Michaelis constants for catechol, guaiacol, hydroquinone, sinapinic acid, and K(4)Fe(CN)(6) were determined. Based on these results as well as results obtained by comparing with published properties of several laccases, it could be concluded that T. hirsuta and Cerrena maxima laccases have some superior characteristics such as high stability, high activity, and low carbohydrate content, making them attractive objects for further investigations as well as for application in different areas of biotechnology.

Solubility of chrysotile asbestos and basalt fibers in relation to their fibrogenic and carcinogenic action.

Fiber length and persistence are thought to be determinants for the development of toxic, fibrogenic, and carcinogenic effects of fibrous dusts. When the solubilities of chrysotile asbestos (CA) and basalt fibers (BF) were compared by measuring the loss of silica and magnesium in Leineweber's solution, CA was shown to be the more soluble. In a 6-month inhalation experiment, chrysotile at a mean concentration of 25 mg/m3 had a higher clearance rate than other comparable dusts. In acute toxicity studies, chrysotile and basalt fibers were administered intraperitoneally. At a dose of 1.7 g/kg body weight of CA, one third of the animals died. A dose of 2.7 g/kg body weight killed all the animals. With BF, even at a dose of 10 g/kg body weight all the animals survived. When the two fibers were administered over a 6-month period, either intratracheally or by inhalation, fibrotic lesions were more common in the group that received CA. Intraperitoneal administration of CA led to three times as many deaths from peritoneal mesothelioma as administration of BF. It appears, therefore, that in spite of its higher solubility and lower persistence, CA was the more toxic, fibrogenic and carcinogenic fiber, which gives rise to the hypothesis that the surface chemistry of the fibers is the determinant for biological activity.

[Asbestosis (review of the literature)]. / Problemy asbestoza (obzor literatury).

The proposed review of medical literature on the influence of asbestos on the health conditions of workers, consists of 5 parts: 1. occupational hygiene in some industries in which asbestos is used; 2. new data on the peculiarities of the action of asbestos-containing dusts; 3. the epidemiology of tumours among the workers dealing with asbestos, in particular, in construction materials production and in construction proper; 4. problems of an early diagnosis of asbestosis; 5. prevention of asbestos-induced diseases, and health legislation on the safety of working conditions with regard to asbestos adopted in different countries.

[Hygienic aspects of the production of asbestos substitutes]. / Gigienicheskie aspekty proizvodstva zamenitelei asbesta.

Due to the high level aggressiveness of asbestos, more attempts have been made in the recent years to replace asbestos by other artificial mineral fibres. In this connection, the labour conditions were studied in the basalt and carbon fibres processing sites. The major occupational hazards of these sites included basalt and carbon fibres dusts, heating microclimate in some working zones and physical overload. An intratracheal experiment revealed a lower degree of fibrinogenicity of the basalt and carbon fibres as compared to chrysotile asbestos. The number of the induced mesothelioma in the intraperitoneal introduction of basalt and carbon fibres was markedly lower than in case with chrysotile asbestos. Hygienically, asbestos should be replaced wherever possible, and the dust control measures should by no means be inferior to those with asbestos.