Relevance The large number of atypical antipsychotic drugs on the market , the breadth of their medical and non-medical use, and their relative affordability make atypical antipsychotics common causes of overdose, suicidal actions or non-medical use of drugs. At the same time, they remain insufficiently studied from the chemical and toxicological point of veiw.

Aim od study: creation of available express method of detection of clozapine, olanzapine, quetiapine and risperidone in the urine of patients with acute poisoning.

Material and methods Thin layer chromatography (TLC), gas chromatography with mass selective detection (GC-MS), and high performance liquid chromatography with mass selective detection (HPLC-MS/MS) were used. The preparation of intact urine samples with addition of standard solutions of clozapine, olanzapine, quetiapine, risperidone and urine samples of patients with symptoms of acute poisoning with given drugs was carried out by methods of liquid-liquid extraction at alkaline pH values for TLC chloroform, a mixture of ethyl acetate-diethyl ether (1:1) for GC-MS and acetonitrile for HPLC-MS/MS.

Results A TLC method has been developed to detect clozapine, olanzapine, quetiapine and risperidone, which allows its the presence to be quickly revealed in the patient’s urine at the preliminary examination stage and also distinguish them from each other in case of the same type of symptoms of poisoning. For confirmatory analysis, it is advisable to use the methods of HPLC-MS/MS and GC-MS. Compared to confirmatory methods, the developed TLC-screening technique is expressive, does not require the use of expensive high-tech equipment and allows clozapine, olanzapine, quetiapine and risperidone to be differentiated from other toxicologically significant psychoactive substances found in general screening.

Background Today, one of the problems of modern society in the health are the high rates of mortality from cardiovascular disease.

Aim of study Study of physico-mechanical properties of the vascular implants and aortic wall to support an adequate choice of the plastic material when performing reconstructive surgeries in patients of various age groups.

Material and methods As an object of study, sections of the anterior wall of the thoracic and abdominal aorta were taken from 30 corpses. Study groups: Group 1 - from 33 to 60 years, Group 2 - from 60 to 92 years. We also evaluated the physical and mechanical properties (finite length, plastic strain ratio, tensileuniaxial load (longitudinal)) of the three vascular implants made of polyethylene terephthalate and polytetrafluoroethylene. Kruskal–Wallis H test was used to determine the significance of differences.

Results The finite length of the aortic wall varies slightly in the study groups, while plastic strain rate of the abdominal aorta in Group 1 was 1.3 times higher than that in the chest. When assessing physical and mechanical properties of thoracic and abdominal aorta, values of “finite length” (1.4 times) and “plastic strain ratio” (1.5 times) were higher in Group 1, and the value of the tensile load indicator is higher in Group 2 compared to Group 1 (1.47 times). The tensile load of the thoracic aorta in Group 1 is 14 H and 27 H lower than the samples of Groups 1 and 3, respectively, but 1.6 times higher than the sample of Group 2. The tensile  load of the abdominal aorta of Group 1 is 13 H higher compared to the sample of Group 1 and twice higher compared to the sample of Group 2. The study Group 2 values of tensile load for thoracic aorta are 1.3 times, 2.4 times and 1.16 times higher than respective implant values (sample 1, 2 and 3, respectively).

Conclusion We used samples of Group 3 vascular implants for replacement of abdominal aorta and Group 1 implants for thoracic aorta. In study Group 2 vascular implants of Group 3 may be used for abdominal and thoracic aorta replacement due to the proximity of the values of the evaluated characteristics.

Background Sepsis and septic shock are formidable and complications in surgery with mortality 20–50%. In the pathogenesis of sepsis, a significant role belongs to bacterial endotoxin (LPS - liposaccharide).

Aim of study Assessment of the efficacy of selective lipopolysaccharides hemosorption (SLH) in treatment of sepsis.

Material and methods We examined 65 patients with developed sepsis or suspected presence of gram-negative infection. Patients were retrospectively divided into two groups. In Group 1, 27 patients received Polymyxin B hemoperfusion using Toraymyxin cartridges. In Group 2 (38 patients), adsorber Alteco (LPSA) was used.

Results It was established that 28-day mortality was 11.1% in Polymyxin group and 28.9% in LPS group A, p = 0.091, 60-day mortality was 33.3 and 55.3%, respectively (p=0.065). The use of SLH contributed to a decrease in the activity of endotoxin (EAA) from 0.52 (0.39; 0.65) to 0.40 (0.36; 0.57) EU (p=0.330) in Polymyxin group and from 0.59 ( 0.42; 0.72) to 0.54 (0.40; 0.81) EU ( p = 0.981) in the LPS-A group. At the same time, the level of procalcitonin (PCT) in the blood statistically significantly decreased from 8.4 (3.6; 29.0) to 4.8 (1.9; 36.3) ng/ml (p=0.0117) only in the LPS-A group. The level of C-reactive protein (CRB) in the blood statistically significantly decreased only in the Polymyxin group, from 205 (154; 264) to 162 (106; 202) mg/L (p<0.001). After SPH procedures, there was a tendency to a decrease in the level of blood cytokines in both groups. 

Conclusion 1. The trend of better survival among patients was noted during hemoperfusion when using Polymyxin B in comparison with the results of adsorption of lipopolysaccharide with Alteco cartridges: so, 28-day mortality was 11.1 and 28.9%, respectively (statistically not significant).

2. As a result, the procedure of selective lipopolysaccharides hemosorbtion on hemosorbents with Polymyxin B in blood significantly decreased level of C-reactive protein (21%), there was statistically insignificant decrease in the level of endotoxin activity (23.1%), lipopolysaccharide binding protein (21.6%), procalcitonin (2.4 times), presepsin (20%), as well as the level of interleukin-6 (3.4 times) and interleukin-10 (1.6 times) . Adsorption of lipopolysaccharide with Alteco cartridges leads to a statistically significant reduction of procalcitonin in blood (1.8 times), and statistically insignificant decrease of: endotoxin activity (9.3%), lipopolysaccharide binding protein (28.6%), interleukin-6 (3.8 times), interleukin-10 (7.1 times) and soluble receptor to interleukin-2 (2.2 times).

Abstract In 21 male patients aged 20 to 40 years, metabolic disorders in post-toxic delirious syndrome caused by gamma-hydroxybutyric acid poisoning and its precursors were studied. In the examined group of patients, hyperammonemia was detected in 71.4% of cases, metabolic lactic acidosis was revealed in 76.2%. The direct correlation between the severity of metabolic disorders and delirious syndrome according to DRS-R-98 scale was established. The statistically significant increase in capillary blood levels of lactate on day 3 of psychotic period was 4.9 mlmol/L and ammonia on day 5 was 187.0 mmol/L. The greatest severity of metabolic disorders was found in patients over the age of 27 years who systematically use the studied substances with narcotic effects for 7 months or more and combine their intake with other psychoactive substances.

Abstract The issues of providing medical care to patients with mental disorders are of exceptional medical and social importance. The aim of the study was to analyze the current state of medical care for psychiatric patients under emergency medical care (EMC) conditions. We used regulatory, statistical and analytical methods. The gaps of the normative legal support of the activities of the teams in the provision of ambulance care for patients with mental disorders and behavioral disorders are considered. In order to improve legislation in the field of ambulance care, it was proposed to amend the Procedure for the provision of emergency, including specialized medical care, approved by the Order of the Ministry of Health of Russian Federation dated 06.06.2013 No. 388n “On the Approval of the Procedure for the Provision of Emergency Care, Including Specialized Medical Care”.

Abstract Placenta accreta (PAS-disorders) is one of the most serious complications of pregnancy, associated with the risk of massive uterine bleeding, massive hemotransfusion and maternal mortality. Peripartum hysterectomy is a common treatment strategy for patients with placenta accreta. Currently, there is a clear trend of changing surgical tactics in favor of organ-saving operations, but there are no studies devoted to anesthesiological support of such operations.

The aim of the study is to substantiate an effective and safe method of anaesthesia in organ-saving operations for placenta accreta spectrum disorders.

Materia l and methods The study involved 80 patients with a diagnosis of placenta accreta spectrum disorders, confirmed intraoperatively, who underwent organ-saving operations. The patients were randomized depending on the method of anesthesia into 3 groups: general anesthesia, spinal anesthesia with planned conversion to general after fetal extraction and epidural anesthesia with planned conversion to general also after fetal extraction. The comparison of intraoperative hemodynamics, efficiency of tissue perfusion, efficiency of antinociceptive protection at the stages of surgery was performed. A comparative analysis of the volume of blood loss and blood transfusion, time of patients activation in the postoperative period, severity of pain on the first day after surgery, duration of hospital stay before discharge and comparison of the assessment of the newborn according to Apgar score at first and fifth minute after extraction.

Conclusion The study shows that the optimal method of anesthesia in organ-saving operations for placenta accreta spectrum disorders is epidural anesthesia with its planned conversion to general anesthesia with an artificial lung ventilation after fetal extraction. Such an approach to anesthesia allows to maintain stable hemodynamic profile with minimal vasopressor support, sufficient heart performance, providing effective tissue perfusion and a high level of antinociceptive protection at the intraoperative stage and reduce the volume of intraoperative blood loss and hemotransfusion. In the current study there were no differences in neonatal outcomes and duration of hospitalization depending on the method of anesthesia. The advantage of epidural anesthesia with its conversion to general anesthesia was earlier activation after surgery and lower intensity of postoperative pain syndrome.

Background The use of neuroimaging methods is an integral part of the process of assisting patients with acute cerebrovascular events (ACVE), and computed tomography (CT) is the «gold standard» for examining this category of patients. The capabilities of the analysis of CT images may be significantly expanded with modern methods of machine learning including the application of the principles of radiomics. However, since the use of these methods requires large arrays of DICOM (Digital Imaging and Communications in Medicine)-images, their implementation into clinical practice is limited by the lack of representative sample sets. Inaddition, at present, collections (datasets) of CT images of stroke patients, that are suitable for machine learning, are practically not available in the public domain.

Aim of study Regarding the aforesaid, the aim of this work was to create a DICOM images dataset of native CT and CT-angiography of patients with different types of stroke. Material and meth ods The collection was based on the medical cases of patients hospitalized in the Regional Vascular Center of the N.V. Sklifosovsky Research Institute for Emergency Medicine. We used a previously developed specialized platform to enter clinical data on the stroke cases, to attach CT DICOMimages to each case, to contour 3D areas of interest, and to tag (label) them. A dictionary was developed for tagging, where elements describe the type of lesion, location, and vascular territory.

Results A dataset of clinical cases and images was formed in the course of the work. It included anonymous information about 220 patients, 130 of them with ischemic stroke, 40 with hemorrhagic stroke, and 50 patients without cerebrovascular disorders. Clinical data included information about type of stroke, presence of concomitant diseases and complications, length of hospital stay, methods of treatment, and outcome. The results of 370 studies of native CT and 102 studies of CT-angiography were entered for all patients. The areas of interest corresponding to direct and indirect signs of stroke were contoured and tagged by radiologists on each series of images.

Conclusion The resulting collection of images will enable the use of various methods of data analysis and machine learning in solving the most important practical problems including diagnosis of the stroke type, assessment of lesion volume, and prediction of the degree of neurological deficit.

Background In more than half of cases of chronic pancreatitis (CP), enlargement of the pancreatic head is diagnosed with the presence of complications that serve as an indication for organ resection. The development of an optimal method for the surgical treatment of CP with damage to the pancreatic head (PH) is one of the tasks of surgical pancreatology.

Aim of study To perform comparative evaluation of immediate and late results of different types of PH resection in CP.

Material and methods A prospective controlled study was conducted with a comparative analysis of the results of surgical treatment of 131 patients with CP with pancreatic head enlargement. In 29% (n=38) cases inflammatory complications were revealed, in 86.3% (n=113), they have been associated with compression of adjacent organs, jaundice also developed (n=60), as well as duodenal obstruction at the level of duodenum (n=43), regional portal hypertension (n=10). A total of 47 pancreatoduodenal, 58 subtotal, and 26 partial resections of the pancreas were performed.

Results Duodenum preserving pancreatic head resections had significantly better short-term results compared to pancreatoduodenal resections. Subtotal PH resection in the Bern’s version was superior to all other resections in terms of average duration of surgery, postoperative inpatient treatment, and intraoperative blood loss. The frequency of relaparotomy for intraperitoneal complications of hemorrhagic etiology was 8.2% (n=4). The frequency of the adverse effect according to pain preservation 5 years after duodenum preserving resection tract was 0.125; after pancreatoduodenal resection - 0.357 with a statistically significant relative risk (RR) of 0.350 (CI95% = 0.13–0.98). According to other indicators of clinical long-term surgical treatment depending on the various methods of PH resection, there were no statistically significant differences (p>0.05). The quality of life of patients 5 years after the operation according to the EORTC QLQ-C30 questionnaire was statistically significant (p=0.0228) by only two indicators: dyspnea (DY:8.3) and insomnia (SL:16.67; 27.4) with higher values after operations of Beger and the Bern’s version of the subtotal PH resection, respectively.

Aim of study The study is devoted to a morphometric assessment of the manifestations of edema-swelling of the somatosensory cortex (SSC) of the brain of white rats after severe traumatic brain injury (TBI) without using L-lysine escinate and when using it as a therapeutic effect.

Material and methods We stained sections with hematoxylin-eosin and performed morphometric methods. On thin (4 μm) serial frontal sections of SSC, neurons and microvessels in the control (intact animals, n=5) were examined in 1 (n= 5), 3 (n=5), 5 (n=5), 7 (n=5) and 14 (n=5) days after injury without treatment (n=25, comparison group) and with treatment (n=25, main group). In color raster images (lens x100), using the plug-in filter “Find Maxima”, maximum brightness areas (MBA) were determined , which were then analyzed using the “Analyze Particles” program from ImageJ 1.52 s. MBA corresponded to SSC sites with a high degree of hydration of nerve tissue - edema-swelling. Statistical hypotheses were tested using nonparametric criteria.

Results and discussion In control animals, a low degree of hydration of SSC tissue was noted (relative area 3-8%). In the comparison group, 1 and 3 days after STBI, foci of edema-swelling covered up to 30% of SSC, in 5 days - up to 15%, in 7 days - up to 20%, in 15 - up to 18%. Significant heteromorphism and heterogeneity of changes in the neuropil around neurons and blood vessels was noted. In the dynamics of the post-traumatic period, the proportion of large foci of edema-swelling (intra- and perineuronal, perivascular) decreased. In the main group, one day after STBI, there was a statistically significantly smaller number of foci of edema-swelling and their total relative area. The values range of these variables significantly decreased. L-lysine escinat affected the water balance most effectively in the acute post-traumatic period (day 1 and 3). The drug “smoothed out” the manifestation peaks (number, focal area) of edema-swelling: the values of the studied morphometric indicators were statistically significantly different. Consequently, morphometric signs of hydropic dystrophy after STBI were detected in both studied groups during the 15 days of observation.

Conclusion The degree of SSC nervous tissue hydration increased after STBI. L-lysine escinate statistically significantly reduced manifestations of hydropic dystrophy. The drug significantly affected the degree of hydration of neural tissue observed in the early post-traumatic period.

Background The development and implementation of widespread training for rules, techniques and methods of providing first aid to the widest possible range of people will significantly reduce the level of disability and mortality among victims of road traffic accidents (RTAs).

Aim of study To study the organization of first aid for the victims in the Arkhangelsk region.

Material and methods Part 1. The journals of registration of attendance at classes with a trained contingent in the educational-methodical department of the School of Disaster Medicine of the Territorial Center for Disaster Medicine of the Arkhangelsk Region for the period from 01.01.2012 to 12.31.2018 are analyzed. Part 2. We selected 906 medical records of patients (003/u) affected by an accident on the federal highway M-8 “Kholmogory” and treated in hospitals of Arkhangelsk region, admitted acutely in period from 01.01.2012 till 31.12.2018. The study was conducted according to the criteria of retrospective continuous documentary observation. As a criterion of statistical significance, the probability of a random error of less than 5% (p<0.05) was applied using the correction for multiple comparisons (Bonferroni correction).

Conclusion 1. The educational activities of the TCDH of the Arkhangelsk Region over a seven-year period are characterized by a significant increase in the total number of trained cadets (p<0.001); 2-fold increase in the number of trained motor vehicle drivers (p<0.001) and employees of Ministry of Emergency Situations and Russian Interior Ministry (p<0.001). 2. The first aid to injured in an accident on the federal highway M-8 Kholmogory in the Arkhangelsk Region was provided in 65 cases (7.2%); in almost 90% of cases, first aid was recorded in the Arkhangelsk and Severodvinsk medical districts of the Arkhangelsk region (p<0.001).

Abstract The review presents the main aspects of the cardioprotective properties of the xenon inhalation anesthetic. Based on the analysis of publications, the article discusses modern views on the mechanisms of the protective action of xenon, realized using pre- and post-conditioning mechanisms, shows major molecular targets and their effects. The article presents the results of experimental studies in vivo and in vitro, which showed the protective effect of xenon on the myocardium and the results of recent randomized clinical trials. The analysis of studies demonstrates the ability of xenon to increase myocardial resistance to ischemia and reperfusion and opens up good prospects for its use in clinical practice in patients with a high risk of cardiac complications.

SUMMARY Uterine arteries embolization (UAE) is one of the modern trends in the treatment of uterine bleeding caused by uterine leiomyomas (UL). However, unfavourable results of this method of treatment are observed in 10–15% of cases. This is primarily concerned with the emerging ischemia of ovarian tissue after embolization.

Material and methods Complex examination and treatment was performed in 48 patients admitted with UL complicated by the development of uterine bleeding. Patients with UL were divided into two groups. In the Group I of patients (n=29) standard embolization was performed, while the patients of the Group II (n=19) with diagnosed interarterial utero-ovarian anastomosis underwent separating technique of UA occlusion using different types of emboli.

Results and discussion The features of the uterine blood supply in patients with UL were analyzed from the perspective of the effecacy and safety of endovascular intervention. A methodology of staged EUA was developed, which involved the staged aortography of the infrarenal aorta (for visualization of the ovarian arteries); pelvic arteriography (for evaluating the vascular anatomy of the pelvis and identifying utero-ovarian intearterial anastomoses); selective arteriography followed by UAE first with cylindrical emboli, and then with standard emboli in the form of microspheres. The application of the developed technique did not show dysfunction of the ovaries in both the short and long-term follow-up period up to 18 months in the Group II.

Conclusion The separating UA occlusion is a safe and effective way of preventing ischemic damage in the presence of signoficant utero-ovarian inter-arterial nastomoses.

Abstract Small bowel obstruction (SBO) is 3-4% of all abdominal acute diseases. Small bowel obstruction due to bezoars is rare (2-4%), and is detected mainly in patients with predisposing risk factors: gastrointestinal motility disorders, psychiatric diseases, enzymatic insufficiency, previous bariatric surgery, diabetes mellitus and hypothyroidism complicated by gastroparesis. The leading role in the verification of small bowel obstruction in patients without surgical interventions on the abdominal organs should be given to computed tomography. According to the literature, the mortality from SBO due to bezoar may reach 30%. We present an unusual clinical case of recurrent small bowel obstruction with severe intestinal disease and septic shock induced by multiple phytobezoars and complicated with severe pseudomembranous colitis. Moreover, in our opinion, laparoscopic access can be used both for diagnostic and therapeutic purposes in patients with acute small bowel obstruction.

Abstract This article will discuss the causes of Wernicke encephalopathy, diagnosis, treatment and clinical examples of this disease.