Radioprotective Properties of Neomitilan in Experimental Radiation Pneumonia.

The efficiency of neomitilan, a polysaccharide isolated from Crenomytilus grayanus mussels, was studied in experimental model of radiation pneumonia (irradiation of the animal lungs with a total dose of 14 and 28 Gy). Histological study showed that an increase in the number of nucleated components in the lungs of animals subjected to neomitilan inhalation prior to irradiation. Proliferation of bronchial epitheliocytes and the formation of additional lymphoid structures were also revealed in these animals. The absence of a tendency to lung tissue recovery in animals irradiated with 28 Gy is due to extreme radiation toxicity.

[Modern approaches to the study of sanitary and irretrievable losses of surgical nrofile in military].

The article presents a comparative characteristics of domestic and foreign approaches to the static analysis of losses of surgical profile in military conflicts. The ways of improvements of statistical materials on military losses for improvement of surgical aid delivery are mapped out. The authors proved the need to establish the register of combat trauma.

[Battle-field surgery in the beginning of 21st century].

The authors underwent an analysis of doctrine changes of battle-field surgery. The terminology is specified, the ways of improvement of effectiveness and quality of medical care for the wounded, taking into account the new doctrine, are formulated. In accordance with Federal law No 323-FZ of 2011.11.21 the term < is suggested for description of medical care at medical forward treatment unit instead of equalfied aid>.

Improving retinal imaging by corneal refractive index matching.

Imaging the retina at high resolution requires a dilated pupil, which in turn exposes more corneal irregularities. We diminish the optical errors of the cornea by refractive index matching. Lens-fitted goggles were used for corneal immersion, to reduce its aberrations, while keeping the ocular power. An additional aspheric plate reduced the residual ocular spherical aberration. A comparison of the index-matching-based retinal images with those acquired directly shows resolution improvement for subjects with normal extent of ocular aberrations. A simulation of the point spread function, obtained from an averaged ocular and corneal wavefront error, also reveals substantial improvement when using corneal index matching. The demonstrated improvement using index matching may enable further improvement of current retinal imaging techniques or relaxing requirements for active ocular aberration correction.

[Peculiarities of delivery of specific surgical assistance to wounded during counter-terrorist and peacemaking operations on North Caucasia].

The organization of surgical care for the wounded in various local wars and armed conflict has its own characteristics, the study of which is necessary to optimize the planning of medical evacuation support of troops. It is based on the concept on an early specialized surgical care. The paper discusses the problematic issues of medical care to the wounded in past peacekeeping operations, and analyze features of specialized surgical care.

[Injury to the liver in patients with severe combined traumas].

Experience with treatment of 220 patients with a severe combined trauma who were subjected to surgical intervention on abdominal organs was analyzed. In 164 of them (74.8%) there was a closed trauma, in 56 (26.2%) abdominal wounds were diagnosed. Injuries of the liver resulting from the closed trauma of the abdomen were revealed in 41 (25.6%) patients. For the assessment of severity of the injury and determination of the strategy of treatment the authors have developed a classification of liver injuries.

[An anesthesiologist-resuscitator's differential tactics in acute traumatic disease].

The detection of four forms of the course of acute traumatic disease (traumatic shock, acute respiratory failure, acute heart failure, and traumatic coma) leads to the conclusion that the multi pathogenic mechanism responsible for progression of the disease generates a need for differentiating the tactics of an anesthesiologist-resuscitator, beginning from the first hours after injury. Therapeutic tactics may be standardized within each specific form of an acute period of traumatic disease. Implementation of specific tactic programs for anesthesiological and resuscitative care in acute traumatic disease has promoted a reduction in mortality from 8.2 to 3.2% in this period.

[Pathogenetical features of the first period of trauma disease with acute respiratory insufficiency].

The pathogenetical features of acute respiratory insufficiency (ARI) were studied as a clinical form of the first period of the trauma disease (TD)--the period of acute impairments of the important for life functions (the first 8-12 h after trauma). In 17 casualties with a severe combined trauma the severity of the first period of the disease depended on the ARI caused by a serious injury of the chest not accompanied by a direct injury of the heart. It was shown that ARI is an independent clinical form of the first period of TD. The indices of the systemic hemodynamics in ARI are within the limits of the normal values. ARI resulting from the "primary" injury of the lungs results in a decreased delivery of oxygen to the tissues and of its consumption. When ARI takes place during the first period of TD the metabolic function of the lungs is sharply suppressed and pronounced endotoxemia is observed.

Laboratory MCAO Test-Bed for Developing Wavefront Sensing Concepts.

An experimental optical bench test-bed for developing new wavefront sensing concepts for Multi-Conjugate Adaptive Optics (MCAO) systems is described. The main objective is to resolve imaging problems associated with wavefront sensing of the atmospheric turbulence for future MCAO systems on Extremely Large Telescopes (ELTs). The test-bed incorporates five reference sources, two deformable mirrors (DMs) and atmospheric phase screens to simulate a scaled version of a 10-m adaptive telescope operating at the K band. A recently proposed compact tomographic wavefront sensor is employed for star-oriented DMs control in the MCAO system. The MCAO test-bed is used to verify the feasibility of the wavefront sensing concept utilizing a field lenslet array for multi-pupil imaging on a single detector. First experimental results of MCAO correction with the proposed tomographic wavefront sensor are presented and compared to the theoretical prediction based on the characteristics of the phase screens, actuator density of the DMs and the guide star configuration.

[Pathogenetical peculiarities of the first period of trauma disease in acute heart failure].

Under observation there were 29 casualties with severe combined trauma complicated by acute heart failure (AGF) caused by a direct injury of the heart, without severely disturbed consciousness and valuable blood loss. In 65% of the patients the trauma was severe, in 35%--extremely severe. Higher ST wave was registered in ECG of 40% of the patients in standard leads, in 30% there was no wave R in chest leads. Disturbed rhythm was noted 2-2.5 times more often than in other kinds of injuries. Ventricular extrasystoles, paroxysmal ciliary arrhythmia, atrioventricular and ideoventricular rhythm were determined since the first day after trauma. The results of the investigation have shown that the primary injury of the myocardium was followed by a decreased heart work. Circulatory insufficiency of blood circulation was developed. The impaired systemic hemodynamics led to inadequate delivery of oxygen to the tissues and of oxygen consumption, to the development of tissue hypoxia and respiratory disorders closely connected with it. The circulation disturbances caused also a suppression of detoxication mechanisms of organism, the development of disseminated intravascular coagulation and endotoxicosis.

[The severe combined cerebro-cranial trauma. Pathobiochemical characterization]. / Tiazhelaia sochetannaia cherepno-mozgovaia travma. Patobiokhimicheskaia kharakteristika.

The indices of the endocrine system, systemic transport and consumption of oxygen, metabolism, hemostasis in the femoral artery, central and internal jugular veins were investigated in 144 patients with severe combined cerebro-cranial traumas (CCT) during the first 7 days after trauma. In 15 of them liquor was investigated. The results of the investigation have shown that in not severe CCT (FS-II: 0.50+/-0.25 scores) the ACTH level in blood was 1.9 times higher and cortisol 5.6 times higher than normal. In the cerebral tissue aerobic oxygenation of glucose prevailed (aerobic index: 90+/-2%): metabolic disorders were caused by extracranial injuries--the content of lactate, malon dialdehyde (MDA), middle molecular peptides (MCM238-302) was higher in the central vein than in the jugular vein. In patients with the superior truncal form of severe contusion of the brain (Field Surgery-II: 11.8+/-0.2 scores) in the cerebral tissue there was prevalence of anaerobic glycolysis (aerobic index: 60.1+/-3.5%), lactate oxygen index grew to 0.160+/-0.018. The inferior truncal form of brain contusion (FS-II: 18.8+/-0.2 scores) had sharply decreased both aerobic and anaerobic oxidation of glucose in the cerebral tissue. In cases of severe and extremely severe CCT there was a suppression of central regulatory mechanisms--in response to the trauma the elevation of the level of ACTH and cortisol in blood was insignificant. Thrombinemia and prevailing endotoxemia were noted in the jugular vein. Great concentrations of lactate, MDA, MCM were determined in the liquor. So, liquor sorption is thought to be expedient. Lower index of oxygenation (1.9+/-0.3), higher respiratory index (1.5+/-0.1) and alveolar dead space (37.7+/-7.2%) evidenced secondary injury of the lungs in cases of severe and extremely severe combined CCT.

[Pathogenetical features of the acute period of traumatic disease. Traumatic shock as a special manifestation of the acute period]. / Patogeneticheskie osobennosti ostrogo perioda travmaticheskoi bolezni. Travmaticheskii shok -- chastnoe proiavlenie ostrogo perioda.

Clinico-pathogenetical features of the acute period of trauma disease due to a severe combined injury were studied in 644 patients. An analysis of clinical indices was made in 428 of them, clinico-laboratory indices--in 216 patients. The results have shown that the main form of the acute period of the trauma disease are traumatic shock (62.8%), traumatic coma (18.3%), acute respiratory insufficiency (5.7%). Dramatically decreased delivery and consumption of oxygen lower than the metabolic requirements of the tissues accompany the traumatic shock which results in the suppression of tissue metabolism. Pronounced endotoxicosis developing along with the traumatic shock results not from the degree of injured tissues only, but from the centralization of blood circulation. It is also supported by the insufficient detoxicating function of the kidneys. A severe degree of the traumatic shock causes disseminated intravascular coagulation (DIC) of the II-III degree. After helping out from shock the patient has normocoagulation or the I degree DIC. Traumatic shock with marked hypotension and metabolic acidosis is a significant factor of high risk of the development of acute lesion of the lungs.

[State of central hemodynamics in traumatic disease]. / Sostoianie tsentral'noi gemodinamiki pri travmaticheskoi bolezni.

The state of central hemodynamics was determined by the method of integral rheography of the body in 389 patients with severe combined traumas admitted to the clinic of field surgery of the Medical Military Academy. Under study was the dependence of the main indices of hemodynamics on severity of the state and character of the trauma. Changes to the parameters of hemodynamics in patients with sharply pronounced insufficiency of circulation were studied. It was shown that one of its mechanisms was an impairment of intrasystemic relationships between the minute volume and the forming indices: stroke output, heart rate, work of the left ventricle. The decisive rule was developed for the diagnosis of a small cardiac output.

[Metabolic bases of the pathogenesis of severe multiple trauma]. / Metabolicheskie osnovy patogeneza tiazheloi sochetannoi travmy.

Under analysis there were data of hormonal activity of the hypothalamo-hypohysis-adrenocortical system and the incretory apparatus of the pancreas, metabolism (of proteins, lipids, carbohydrates) and concentration of microelements (iron, zinc), lipid peroxidation (content of malonic dialdehyde and diene conjugates, on the one hand, and total oxidative activity of blood, superoxide dismutase (SOD), ceruloplasmin, catalase, SH-group, on the other hand) and results of its therapeutic correction (with superoxide dismutase, ionole, extracorporeal laser irradiation and laser irradiation of the wounds), content of the inflammatory reaction markers (tumor necrosis factor and IL-1) in patients with a severe combined trauma in the dynamics of traumatic disease. The results obtained and literature data allow a conclusion to be made that the basis of metabolic changes in severe combined traumas are formed by a developing adaptation reaction of organism immediately after trauma integrated with the systemic aseptic inflammatory response caused by vast necrosis of tissues, hypo- and reperfusion processes. The intensity of these reactions depends on severity of the trauma, determines its clinical course and outcome. The therapeutic correction of higher activity of the lipid peroxidation system (caused by a systemic inflammatory response) ionol, extracorporeal laser irradiation of blood, laser therapy of the wounds increase the antioxidative volume of blood and decrease the production of lipid peroxidation. Early intrabronchial instillation of homogenic SOD increases the total antioxidative activity, the level of SOD and catalase, decreases the content of malonic dialdehyde in the sediment of broncho-alveolar lavage and in blood.

[Organization and volume of work in the department of anesthesiology and resuscitation in a central district hospital]. / Organizatsiia i ob"em raboty otdeleniia anesteziologii i reanimatsii tsentral'noi raionnoi bol'nitsy.

The experience accumulated during organization and functioning of an anesthesiology and intensive care unit in a central district hospital is described. The efficacy of anesthesiological aid and intensive care has been demonstrated in conditions of a rural region. The authors believe advisable the establishment of anesthesiology and intensive care units in large central district hospitals.