The 16 reference contexts in paper V. Moroz V., A. Golubev M., В. Мороз В, А. Голубев М (2013) “Сепсис: принципы диагностики // Sepsis: Principles of Diagnosis” / spz:neicon:reanimatology:y:2013:i:6:p:5

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    According to the present criteria many of them are regarded as sepsis.The results of the analysis of mortality in England for the period of 2001-2010 showed that 5.1% of deaths in the country were associated with sepsis
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    , which is one of the most serious health problems according to the authors. In the United States sepsis is on the 11th position [2] in the list of the most frequent causes of death. A retrospective analysis was used to identify the incidence of sepsis among 150410 patients for 6-year period (2005—2010).
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    According to the present criteria many of them are regarded as sepsis.The results of the analysis of mortality in England for the period of 2001-2010 showed that 5.1% of deaths in the country were associated with sepsis [1], which is one of the most serious health problems according to the authors. In the United States sepsis is on the 11th position
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    [2]
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    in the list of the most frequent causes of death. A retrospective analysis was used to identify the incidence of sepsis among 150410 patients for 6-year period (2005—2010). In the countries of Western Europe the number of patients with sepsis annually exceeds 500 000.
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    A retrospective analysis was used to identify the incidence of sepsis among 150410 patients for 6-year period (2005—2010). In the countries of Western Europe the number of patients with sepsis annually exceeds 500 000. Mortality in sepsis reaches 28.6% and increases up to 38.4% with age.
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    . At the same time, the clinical diagnosis of sepsis in deceased patients is not always confirmed by the results of postmortem studies. We analyzed the medical cards and protocols of autopsies of 134 patients who had died in intensive care units.
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    2843
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    We analyzed the medical cards and protocols of autopsies of 134 patients who had died in intensive care units. Infectious complications were registered in 129 patients, in 16 of whom sepsis was diagnosed. At postmortem examination only one case of sepsis was confirmed
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    . This shows us the significant overdiagnosics of sepsis, that is just as dangerous as those cases, when the pathological process is not identified. Recently there have been some encouraging reports of more cautious and careful evaluation of developing infectious complications that can be regarded as sepsis.
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    Recently there have been some encouraging reports of more cautious and careful evaluation of developing infectious complications that can be regarded as sepsis. At the international forum in Beijing (2011), it was noticed
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    that the point in the understanding and definition of the term «sepsis» is different among doctors of different specialties. The process of determination of sepsis was based on the concept of systemic inflammatory response (SIR) adopted in 1991, which seemed to be simple before it turned out to be come much more complicated.
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    According to the authors, the term of «sepsis» should be reviewed to meet the clinical realities and pathogenetic processes, developing in cases of sepsis. The determination of sepsis on the basis of this concept has three main problems
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    [7]
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    . First, the high sensitivity of the SIR causes almost 90% of patients in intensive care units meet the criteria of sepsis. Second, the fact that there is an inflammatory process in all patients with sepsis, which is widely recognized, but, obviously, not all patients with infectious process have sepsis, is also contradictory.
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    In 2013, the Committee of agreement, composed of 68 international experts representing 30 international organizations, offered the updated program of treatment of sepsis and septic shock
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    [8]
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    . Attention was paid to the importance of conformation of bacterial infection and potential sources of infection. Sepsis was defined as the presence of confirmed or probable infection along with its systemic manifestations.
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    Attention was paid to methods of treatment of severe sepsis and septic shock. There is a need in a more detailed randomization of patients with sepsis diagnosis when including them in investigations
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    [9]
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    . The majority (61) of clinical reviews (102) were excluded from consideration because, when conducting addiSepsis: Principles of Diagnosis V. V. Moroz, A. M. Golubev V. A. Negovsky Research Institute of General Reanimatology, Russian Academy of Medical Sciences, Moscow Correspondence to: Golubev A.
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    At postmortem examinations purulent thrombophlebitis and multiple isolated septic foci with the involvement of small veins situated in the proximal direction are seen. That can be regarded as metastasis of purulent process
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    . In all cases of postmortem examinations the primary metastatic focus that can be localized in the area of the penetration of the infection or metastatic purulent foci should be identified. The hyperplasia of lymphoid tissue also occurs.
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    The main morphologic criteria for sepsis include formation of a septic focus, metastatic foci of purulent inflammation in various organs and tissues, and a significant spleen enlargement
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    [11]
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    . Thus an important task of the diagnostic of sepsis is the development of methods of intravital visualization of morphological changes that characterize the infectious process. Intravital visualization of structural changes developing in different diseases is widely used for diagnostics of various diseases and is performed by various methods: computer tomography, magnetic reso
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    Recently have been published some encouraging messages showing the possibility of in vivo detection of inflammation in internal organs using perfluorocarbon emulsions. Russian perfluorcarbonic emulsion «Perftoran» has been successfully used in clinical practice
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    [12—14]
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    . Experimental data demonstrating the possibilities of in vivo detection of the inflammation in the lungs have been obtained [15]. Pneumonia in mice was caused by intratrcheal exposition of lipopolysaccharide (LPS).
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    Russian perfluorcarbonic emulsion «Perftoran» has been successfully used in clinical practice [12—14]. Experimental data demonstrating the possibilities of in vivo detection of the inflammation in the lungs have been obtained
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    [15]
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    . Pneumonia in mice was caused by intratrcheal exposition of lipopolysaccharide (LPS). Perfluorcarbonic emulsion containing fluorine-19 was injected intravenously to detect inflammative focci in the lungs by the method of magnetic resonance.
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    The accumulation of perfluorcarbonic emulsion by macrophages in the focci of inflammation was confirmed by histological methods. It was shown that macrophages in the area of inflammation engulf particles of perfluorcarbonic emulsion, which works as a contrast agent when using magnetic resonance method
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    . The authors concluded that the use of perfluorocarbon emulsions containing fluorine-19 was a highly specific prognostic test that allowed to quantify the distribution of inflammation in the lungs in vivo.
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    The results of the study of phagocytes detectionin vivousing perfluorcarbonic emulsion by the method of magnetic resonance in experimental ischemic damage of myocardium and brain have been published
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    [18]
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    . The model of acute ischemia of a myocardium and brain in mice with subsequent intravenous injection of perfluorcarbonic emulsion has been employed in the study. Histological studies show that particles of the emulsion are engulfed by macrophages and accumulated in the area of the myocardial and brain ischemia.
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    The fact is that perfluorcarbonic emulsions are nontoxic and can be used for diagnostics of various inflammations and the observation of biological processes at the cellular level. Bi-colour fluorescent perfluorcarbonic nano-emulsions that increases the efficiency of their detection and emloys the method of magnetic resonance were proposed
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    [19]
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    . There have been numerous recent studies of molecular markers in critical conditions, including various infectious complications, for example sepsis [20—24]. However, the specific molecular markers for sepsis have not been found so far.
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    Bi-colour fluorescent perfluorcarbonic nano-emulsions that increases the efficiency of their detection and emloys the method of magnetic resonance were proposed [19]. There have been numerous recent studies of molecular markers in critical conditions, including various infectious complications, for example sepsis
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    [20—24]
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    . However, the specific molecular markers for sepsis have not been found so far. Apparently, the dynamics of different molecular markers (cytokines, procalcitonin and others) concentration in inflammatory diseases, including sepsis, reflects the processes of regulation and of adaptation and, first of all, the condition of immunoreactivity of the human body.
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