[Craniocerebral hypothermia in the acute period of ischemic stroke]

OBJECTIVE

To determine the effect of craniocerebral hypothermia (CCH) on neurological deficit regression, hemodynamics, fever and functional outcome of therapy in patients with moderate ischemic stroke (IS).

MATERIAL AND METHODS

This study included 60 patients with IS (the first day). The main group consisted of 30 patients who underwent CCH, and the comparison (control) group consisted of 30 patients without CCH. The National Institutes of Health Stroke Scale (NIHSS), the Glasgow Coma Scale (GCS), the modified Rankin Scale (mRs) were used. Recorded parameters were mortality, heart rate (HR), blood pressure (BP), axial temperature, cerebral temperature of the frontal cortex. Cerebral temperature was obtained noninvasively by using a RTM-01-RES radiothermometer (Russia). CCH (for 24 hours) in the main group was implemented by ATG-01 device (Russia). Results were recorded on the day of admission, after 24 hours and at discharge. In both groups, basic neuroprotective, hypotensive, antiplatelet and antiedemic therapy was administered.

RESULTS

No fatal outcomes were reported in both groups. Side-effects and complications of CCH were not recorded. In the main group, neurological deficit assessed by NIHSS decreased by 75% after the CCH procedure and by 93.75% at the time of discharge from the hospital. In patients of the comparison group, regression of neurological deficit was 35% on the second day and 55% at the day of discharge. The use of CCH suppressed systemic and cerebral hyperthermia. Functional outcome of therapy in the main group was higher compared to the comparison one. The dynamics in blood pressure and heart rate didn't differ in both groups.

CONCLUSION

A pronounced positive effect of CCH on the course of the acute period and therapy results in patients with IS was demonstrated.

[Rehabilitation of patients with post-stroke cognitive impairment using the P300-based brain-computer interface: results of a randomized controlled trial]

OBJECTIVE

To study the effects of a 10-day cognitive training using the brain-computer interface (BCI) technology at the P300 wavelength on the recovery of cognitive functions in poststroke patients.

MATERIAL AND METHODS

The study included 30 patients, aged 22-82 years, with ischemic stroke less than 3 months old and moderate cognitive impairment (<26 points on the Montreal Cognitive Assessment Scale (MoCA)). All patients underwent neuropsychological testing, assessment of the presence of depression, assessment of activity in daily life. Patients were randomized into two groups: patients of group 1 (main) underwent a 10-day course of cognitive rehabilitation in the form of daily exercises in the BCI environment at the P300 wave equipped with a headset for recording an electroencephalogram (EEG). Patients of group 2 (control) received a standard set of rehabilitation measures.

RESULTS

There was an increase in the mean score of the MoCA «Attention» domain in the main group of patients (2.3±1.24 to 5.2±1.16 points) compared with the control group (5.9±1.00 to 4.2±0.94 points, p<0.05). The results of covariance analysis with repeated measures, taking into account the factors «Visit» and «Group», the covariate «Depression» and «Number of training sessions» revealed significant effects for the MoCA domains «Naming» (p<0.05), «Attention» (p<0.05), «Abstraction» (p<0.05). By the end of the 10-day cognitive training using BCI, patients of the main group showed a significant increase in the number of entered letters (20.8±2.01 to 25.9±1.7 characters (p=0.02) compared with the control group (21.9±1.9 to 23.1±1.8, p=0.06). When comparing the number of words entered by patients after 10 days, a significant difference was found between the main and control groups (p<0.05).

CONCLUSION

Rehabilitation of patients with post-stroke cognitive impairment using P300 BCI has a significant positive effect on the restoration of cognitive functions, primarily attention.

[A two-year prospective longitudinal study of the dynamics of cognitive functions in different periods of stroke]

OBJECTIVE

To examine the dynamics of cognitive functions 3, 6, 12, and 24 months after ischemic stroke (IS).

MATERIAL AND METHODS

The study included 32 patients (women 21.4%), aged 40-71 years (mean age 58.7 years), with IS less than 3 months old and a moderately pronounced decrease in activity in everyday life. At four visits (baseline, after 12, 36, 84 weeks), a neuropsychological examination of cognitive functions was carried out using a 10-point system (1 point - maximum impairment, 10 points - no impairment), testing according to the Barthel scale, the National Institutes of Health Stroke Scale (NIHSS), the modified Rankin scale (mRs). During the study, patients received unified basic therapy and underwent multimodal rehabilitation courses.

RESULTS

When assessing cognitive functions in the period 3-6 months after IS, there was a significant (p<0.05) improvement in memory (6.5±0.62 to 8.0±0.74 points), attention (5.7±0.58 to 7.2±0.73 points), praxis (7.9±0.78 to 9.1±0.85 points), speech (6.5±0.67 to 7.5±0.87 points); a significant increase in the average Barthel score (65.8±5.4 to 89.2±8.6) was accompanied by a significant decrease in neurological deficit (7.7±0.51 to 5.3±0.33 NIHSS points and 3.9±0.28 to 2.6±0.15 mRs points). In the period 6-12 months after IS, significant disturbances were detected in the areas of memory, attention and thinking. Cognitive function continued to deteriorate 12-24 months after IS. In the period 6-24 months after IS, no significant changes in the average values on the Barthel, NIHSS, and mRs were detected.

CONCLUSION

The most favorable interval for the recovery of cognitive functions in patients after IS is the early recovery period. As the time after a stroke increases, the ability to recovery cognitive functions decreases.

[The repeated disability because of thyroid cancer in adult population]

The article presents the results of analysis of repeated disability because of thyroid cancer in adult population of Moscow in 2015-2019. The study established negative dynamics of increasing of the number of individuals with repeated disability because of thyroid cancer in all essential age contingents (young, middle and elderly age) of adult population. The similar trend was revealed in gender contingents of individuals with repeated disability because of thyroid cancer (in males, increase was made up to 112.5% and in females up to 196.3%). In the gender and age structure of repeated disability because of thyroid cancer, predominated females and the elderly. The study established dynamics of decreasing of percentage of individuals with repeated disability because of thyroid cancer of the disability groups I and III and corresponding increasing in disability group II. The percentage of individuals with repeated disability because of thyroid cancer in disability groups I and II was higher in males as compared with females. Most individuals with disabilities because of thyroid cancer don't work. The study results make available spectrum of disorders of main functions of organism, their degree and types and intensity of limitations in vital activity of individuals with repeated disability because of thyroid cancer. The organized database of characteristics of repeated disability because of thyroid cancer in adult population can be used in implementation of personalized approach to medical social rehabilitation of increasing number of disabled individuals with malignant damage of the most important organ of endocrine system.

[Noninvasive magnetic stimulation with endoscopic navigation for the treatment of cricopharyngeal failure in chronic critical illness]

OBJECTIVE

To assess the efficacy of treatment of cricopharyngeal insufficiency in chronic critical illness caused by severe brain injury using non-invasive magnetic stimulation with endoscopic navigation.

MATERIAL AND METHODS

Thirty patients (19 men and 11 women, mean age 50±12 years) were studied. The exposure was carried out by a bipolar alternating magnetic field using an inductor located in the projection of the hyoid bone. The study compared the standard therapy and the complex of therapeutic measures, in which the proposed non-invasive magnetic stimulation method with endoscopic navigation was included. The procedure was carried out daily without regime changes, with objective control 1 time in 10 days. The duration of the first course was 10 days, followed by a decision to extend the course for another 10 days, depending on the objective dynamics. Evaluation was performed with the Rosenbek Penetration and Aspiration Scale (PAS), the Fiberoptic Endoscopic Dysphagia Severity Scale (FEDSS), The Mann assessment of swallowing ability (MASA) and the Functional oral intake scale (FOIS).

RESULTS AND CONCLUSION

Improvements of swallowing function were observed in both groups, but qualitative changes were more pronounced in the main group. The use of the proposed method made it possible to obtain a more stable and predictable result.

[The particular medical social problems of individuals of elderly and senile age as exemplified by the Rostov Oblast]

The article analyzes dynamics of main indices of disability in population older than able-bodied age in the Rostov Oblast. The trend of decreasing of scope of examinations of individuals of the mentioned age group, including decreasing the number of first and iteratively recognized as the disabled, against the background of increasing in the population structure of percentage of individuals older than able-bodied age. At the same time, increasing of accumulated disability was established in the studied category of population.

[Age-related aspects and gender differentiation of primary disability due to thyroid cancer in the adults population of Moscow.]

The results of the analysis of primary disability due to thyroid cancer of the adult population of Moscow in the period 2015-2019 are presented. An increase in the number of peaple newly recognized as disabled (PNRD) due to this pathology was revealed. In the age structure of primary disability elderly people was dominated. The predominant gender contingent of the PNRD were women. It was found that the predominant number of PNRD had a moderate impairment (II degree) of the basic functions of the body. At the same time, gender differentiation in the severity of persistent impairment of the body functions among disabled was revealed. In the contingent of disabled men the proportion of persons with severe (III degree) and complete (IV degree) impairment of the function of the blood system and the immune system and with a severe impairment of the function of the endocrine system and metabolism was higher compared to the contingent of disabled women. It was determined that the main types of capacity limitations were self-care, work, moving and communicate limitations (the first degree of difficulties in life areas prevailed (p<0,05). Thyroid cancer, due to the rapid growth of morbidity and disability, is an important public health concern. The study of disability indicators of the population is necessary for the development of rational measures of medical and social rehabilitation of patients suffering from thyroid cancer, and for the implementation of medical and social prevention of disability.

[New perspectives of motor rehabilitation of patients after focal brain lesions]

Rehabilitation of patients after focal brain lesions is one of the topical issues of modern medicine. Motor disorders are known to develop in more than 80% of survivors of stroke and traumatic brain injury and be one of the main causes of disability, which necessitates an active search for new effective techniques for correction of motor disorders. Modern rehabilitation includes both traditional techniques for recovery of patients with motor deficit (exercise therapy and physiotherapy) and botulinum therapy, kinesiotherapy, mechanotherapy, etc., which have been developed in recent years. Robotic technologies have been developed, improved, and implemented. Currently, due to progress in computerization, virtual reality-based rehabilitation of patients is of particular interest. The article reviews the key studies in this field. We describe various visualization methods and means of immersion in a virtual environment for recovery of upper and lower extremity function in patients with focal brain lesions. The study provides an assessment of the effectiveness and safety of various virtual reality-based rehabilitation programs in patients with motor disorders after stroke and traumatic brain injury.

Diagnostics and Therapy of Human Diseases - Focus on Sialidases

Sialic acid residues that make part of the cell surface repertoire of carbohydrate residues are implicated in various physiological processes and human pathologies. Sialidases, or neuraminidases, are the enzymes that are able to cleave and release the sialic acid residues, while trans-sialidases can transfer the residues from donor to acceptor molecules. They are important for processing the surface glycolipids and glycoproteins. Therapeutic potential of pharmacological sialidases inhibition is currently actively studied. Knowledge and expertise gained from genetic defects leading to human sialidase deficiency can be used for designing such drugs. In this review, we discuss the current progress in studying sialidases and their inhibitors and the relevance of these studies to developing novel therapeutic approaches. In vitro studies suggest that some sialidase inhibitors might be useful therapeutics for treating sialidosis, cancer, infections, immune diseases, atherosclerosis and other pathologies. Consequently, there is a field for further research and development. A thorough investigation of human sialidases is therefore crucial to human health.

ЧРЕСКОЖНАЯ ЭНДОСКОПИЧЕСКАЯ ГАСТРОСТОМИЯ С УЗ-НАВИГАЦИЕЙ, КАК МЕТОД ВЫБОРА ДЛЯ ОБЕСПЕЧЕНИЯ ЭНТЕРАЛЬНОГО ПИТАНИЯ У ПАЦИЕНТОВ В ХРОНИЧЕСКОМ КРИТИЧЕСКОМ СОСТОЯНИИ

Цель. Анализ эффективности УЗ-навигации при чрескожной эндоскопической гастростомии для повышения безопасности метода обеспечения пути доставки энтерального питания.Материалы и методы. Чрескожная эндоскопическая гастростомия методикой «на себя» (pull), дополненная УЗ навигацией, была выполнена 115 пациентам с последствиями тяжелой черепно-мозговой травмы (ЧМТ) и церебральными инсультами, находящимся в длительном (хроническом) критическом состоянии и имеющим стойкую дисфагию в период их реабилитации в ФНКЦ РР. Результаты. Все пациенты перенесли операцию удовлетворительно и уже через сутки могли получать энтеральное питание. У двух пациентов (1,7%) наблюдалось осложнение в виде пневмоперитонеума, которое потребовало дополнительного назначения антибактериальной терапии и благополучно разрешилось через 7–10 дней, без дополнительных хирургических вмешательств. Добавление в методику УЗИ области, определенной по диафаноскопии, оправдало себя в 15-ти случаях (13,0%): из них с частотой 73,0% в определенной для пункции точки выявлен край печени, и с частотой 27,0% выявлена поперечно-ободочная кишка. Выводы. 1. Чрескожная эндоскопическая гастростомия по методике «pull» с добавлением УЗ-навигации является адекватным способом обеспечения пути энтерального питания у пациентов в длительном (хроническом) критическом состоянии.2. Проведение УЗ-навигации области, определенной диафаноскопией, непосредственно перед пункцией желудка, особенно у пациентов с гепатомегалией, избыточной массой тела и у пациентов, имеющих в анамнезе оперативные вмешательства на брюшной полости, позволило избежать послеоперационных тяжелых осложнений в 13,0% случаев, что доказывает целесообразность применения исследования, как часть чрескожной эндоскопической гастростомии.3. Выполняя чрескожную эндоскопическую гастростомию под УЗ-навигацией, удалось снизить число осложнений.

Sialidases: Therapeutic and Antiatherogenic Potential

This review focuses on the biological role and clinical relevance of relatively poor studied enzymes known as sialidases. We describe structure and function of sialic acid, in particular as a component of gangliosides and plasma lipoproteins. Several types of sialidases are known in mammals, of which trans-sialidase is of special interest, since it is capable of removing sialic acid from low density lipoprotein (LDL) particles and transferring it to different acceptors in blood plasma. Desialylation of LDL, in turn, endows it a capacity to accumulate in the smooth muscle cells of human aortic intima, and therefore is important for atherogenesis. Moreover, sialidases appear to be involved in a variety of pathological processes, including viral infections and cancer, which makes these enzymes an attractive therapeutic target.

[Protection of the access to medicines right among disabled people.]

Disabled people remain one of the most vulnerable categories of population. Access to safe, quality and effective medicines as a key element of social well-being among people with disabilities remains of the priorities at the international agenda and national policy. The right of access to medicines among disabled people is not directly specified in any international document on the protection of the rights of persons with disabilities, which certainly affects the availability of medicines for this population in various regions of the world. The article examines the main international legal documents in the field of protecting the rights of people with disabilities for access to health care services, analyzes the practice of implementing programs for drug provision for people with disabilities in the US and Russia, and outlines the main directions for improving public policy in this area.

Phytoestrogen-Rich Natural Preparation for Treatment of Climacteric Syndrome and Atherosclerosis Prevention in Perimenopausal Women

The present study evaluated the risks and benefits of phytoestrogen treatment in healthy perimenopausal women in relation to the dynamics of climacteric syndrome and progression of atherosclerosis. Study participants were treated with placebo or phytoestrogen-rich natural preparation Karinat based on grape (Vitis vinifera) seeds, green tea (Camellia sinensis) leaves, hop (Hunulus lupulus) cone powder and garlic (Allium sativum) powder. The dynamics of climacteric syndrome was evaluated by Kupperman Index and Utian Quality of Life Scale. Atherosclerosis progression was evaluated by measuring carotid intima-media thickness. Significant changes of climacteric syndrome's severity in both Karinat and placebo groups (p = 0.005 and p = 0.001) were obtained after 24 months of follow-up. Detailed analysis of Kupperman Index suggested that Karinat possessed a significant effect on nervousness (p = 0.010), weakness (p = 0.020) and formication (p = 0.010). A significant improvement of medical (p = 0.070) and emotional (p = 0.060) components of Kupperman Index and Utian Quality of Life Scale was also observed in Karinat group. However, difference in carotid intima-media thickness between the two groups was not statistically significant at follow-up. A slight positive effect of phytoestrogens on climacteric syndrome manifestations was demonstrated in this study. Karinat can be used for alleviation of climacteric syndrome and cardiovascular disease prevention in perimenopausal women. Copyright © 2017 John Wiley & Sons, Ltd.

Relationship between Morphofunctional Changes in Open Traumatic Brain Injury and the Severity of Brain Damage in Rats

A correlation between the severity of morphofunctional disturbances and the volume of brain tissue injury determined by MRT was demonstrated on the model of open traumatic brain injury in rats. A relationship between the studied parameters (limb placing and beam walking tests and histological changes) and impact force (the height of load fell onto exposed brain surface) was revealed.

Heat shock protein HSP40 family chaperone DNAJB6/MRJ expression analysis in blood cells obtained from patients with atopic dermatitis in different phases

Heat shock protein HSP40 family molecular chaperone DNAJB6/MRJ expression has been analyzed in blood cells of patients with atopic dermatitis compared with healthy donors. Severity of disease was estimated according index SCORAD.

METHODS

Peripheral blood cells were separated using Percoll density gradient. Purified neutrophils and lymphocytes have been stained with antibodies to the heat shock protein DNAJB6/MRJ. Cells were analyzed using flow cytometry. Real time PCR method has been used to verify the bacterial contamination of the skin of patients with atopic dermatitis. Statistical analysis was performed by ANOVA.

RESULTS

Expression of DNAJB6/MRJ protein has been found to be elevated in all samples of cells obtained from patients with atopic dermatitis. The highest level of the DNAJB6/MRJ protein expression was shown in neutrophils at the acute phase of severe atopic dermatitis. DNAJB6/MRJ protein expression in lymphocytes of patients with atopic patients was less extensive compared with neutrophil level and was shown to be higher at subacute phase of disease. The DNAJB6/MRJ protein expression was found to be statistically significant higher in lymphocytes from atopic patients compared with healthy donors. The bacterial contamination of skin (verified by PCR) was shown to influence the DNAJB6/MRJ protein level in lymphocytes of atopic dermatitis patients.

CONCLUSION

Expression of the heat shock protein DNAJB6/MRJ was elevated in neutrophils and lymphocytes of patients with atopic dermatitis compared with healthy donors. The highest level of the DNAJB6/MRJ protein was found to be in neutrophils at acute phase of severe atopic dermatitis and gradually decline as continue to the disease.

[Vegetative State: Difficulty in Identifying Consciousness and Predicting Outcome]

Article consists of literature review, authors experience of the application of neurovisualization and neurophysiological research methods to predict the recovery of consciousness in patients in vegetative state (VS). According to the literature data PET with FDG has higher sensitivity in the detection of signs of consciousness, then functional MRI (fMRI). The method fMRI allows assessing the functional activity of the brain in a state of rest and in response to stimulation with different modalities ― visual, auditory, etc (with the application of active and passive paradigm). A higher specificity in the detection of signs of consciousness have the methodology of fMRI with the active paradigm, at the same time, the absence of signs of consciousness according to the fMRI can not be charged as a basis for the conclusion of a poor prognosis in a particular patient. Neurophysiological tests (EEG, TMS, EP, etc) are more readily available and quite effective. Based on the literature analysis, the authors comes to the conclusion that neurovisualization and neurophysiological tests used in the prediction of the outcome of VS reflects the residual functional activity of different brain areas, in a context of diffuse brain damage, and the recovery of consciousness is usually combined with the restoring of the functional activity off the thalamocortical tracts, which activity, indirectly, is evaluated using these methods. In the authors' opinions, the main disadvantage in the interpretation of the is the lack of a common pathophysiological concept of the organization of brain functions in VS patients. The authors offer for the discussion their concept of stable pathological states of the brain, which is based on the works of Russian pathophysiologists.

[Risk for environment-induced diseases due to air pollution from motor vehicles in road-patrol officers]

The paper describes risk factors for environment-induced diseases in road-patrol (RP) officers under the existing working conditions: noise and chemical ambient air pollution from motor vehicles. There is evidence for a significant increase in the incidence of diseases of the cardiovascular and nervous system, sense organs, digestive and endocrine metabolic systems in the State Road Safety Inspectorate officers who are directly engaged in traffic management. Potential and real risks from motor transport to the health of RP roads have been estimated. Recommendations on optimizing the working conditions are given.

[Organization of mobile medical care for the rural population]

Mobile medical care for people in rural areas well developed in the 1980s has lost its initial meaning and become only formal in a number of areas. The paper gives different organizational forms of medical care for rural population in some areas (the Nizhni Novgorod and Rostov Regions, the Republic of Komi, the Jewish Autonomous Region) of the Russian Federation.