Tissue-Engineered Constructions in Biophysics, Neurology and Other Fields and Branches of Medicine

This paper describes the gangliopexy method, a method for creating a new center of local neurohumoral regulation, based on the formation of new connections discovered between the nervous system and the vascular system. The prospects for the development of this method are studied. At the same time, novel concepts about the cycles of nitric oxide and the superoxide anion radical are introduced. A possible role of these cycles is examined in the protection of cells and the body as a whole against oxidative and nitrosative stress, which develops when (in 5-30% of cases) destructive changes in the displaced ganglion lead to vascular complications and an increased risk of mortality. Mechanisms that can protect nerve cells, prevent the development of destructive changes in these cells and reduce the risk of mortality are also investigated.

[Neurological and neurodevelopmental disorders in preterm-born children (with extremely low, very low or low body weight)]

AIM

To evaluate the incidence of neurological diseases and neurodevelopmental disorders in preterm-born children, aged 5-8 years, with extremely low (ELBW), very low (VLBW) or low body weight (LBW) at birth.

MATERIAL AND METHODS

One hundred and twenty-two preterm-born children, including 36 born with ELBW, 36 born with VLBW and 50 born with LBW, were examined in the age from 5 years 0 months to 8 years 0 months. Presenting complaints were assessed by means of the structured parents' questionnaire. Diagnosis of the nervous system diseases was based on the criteria of ICD-10 and DSM-V.

RESULTS AND CONCLUSION

Based on the assessment results, there was no any neurological or neurodevelopmental disorder in 8.3% (n=3) of children with ELBW, 16.7% (n=6) with VLBW, 22.0% (n=11) with LBW at birth. Compared to the general pediatric population, more preterm-born children with ELBW, VLBW or LBW, aged 5-8 years, had developmental dyspraxia, chronic motor tics, tension type headaches and enuresis. Moreover, the higher incidence was found for neurodevelopmental disorders, including attention deficit hyperactivity disorder, autism spectrum disorders, specific learning disabilities, compared with population rates. All conditions were more prevalent in boys than in girls, with the exception of tension type headaches. The frequency of disorders was inversely correlated with gestational age and body weight. However, the results demonstrate reserve capacities of the developing brain in children born preterm and suffered early brain damage.

[Potential of peptidergic nootropic therapy in developmental dysphasia in children]

AIM

To study the therapeutic efficacy of peptidergic nootropic medication Cortexin during two-month follow-up in children with developmental dysphasia aged 3-4 years.

MATERIAL AND METHODS

Fifty-four children with developmental dysphasia were randomized into two equal groups. The cortexin group received the drug once daily intramuscularly during 10 days. After this course, children did not receive any pharmacotherapy and were examined two months after the beginning of treatment. The control group did not receive pharmacotherapy and was examined twice in two months interval. All the parents were provided with recommendations for the stimulation of speech development in dysphasic children. Before treatment and two months later, speech development was assessed by special scales and questionnaires for parents.

RESULTS AND CONCLUSION

After treatment with Cortexin, a significant improvement was achieved not only on the 'expressive language' scale but also on the 'attention to speech' and 'impressive language' scales. The volume of active vocabulary was increased by 2.3 times, the number of articulated phrases by 3.6 times. The evaluation of parents' questionnaires demonstrated the decrease of cerebrasthenic, psychosomatic problems, motor clumsiness, hyperactivity, attention deficit and problems with emotional control in children. The therapy contributed to the reduction of difficulties in communication and social adaptation. The positive effect of Cortexin was observed after the completion of treatment (the protracted effect).

[Pharmacotherapy of psychomotor developmental delay in 6-12 months preterm infants with hypoxic-ischemic encephalopathy (the double-blind comparative multicenter placebo-controlled study)]

AIM

To evaluate the efficacy and safety of hopantenic acid (Pantogam) in the complex treatment of prematurely born infants, aged 6-12 months, with psychomotor developmental delay due to hypoxic-ischemic encephalopathy.

MATERIAL AND METHODS

Eighty-seven patients were randomized into two groups: 44 received standardized treatment and pantogam for two months, 43 standardized treatment and placebo. Pantogam (syrup 100 mg/ml) or placebo were prescribed orally 15-30 minutes after feeding, twice a day, in a daily dosage of 30-50 mg/kg body weight. The assessment of psychomotor development from birth to two years was performed with the Griffiths Mental Development Scales (GMDS-ER) twice (before and after completion of therapy).

RESULTS

The response to two month therapy determined as the reduction of developmental delay for more than 6% of the initial GMDS-ER general quotient (GQ) score was significantly better in the group I after pantogam treatment (63.6% of patients) compared to group II (36.4%, p=0.021). Group I demonstrated the significant decrease of the developmental delay in two domains ('Personal-Social' and 'Performance') and a trend to overcome the delay in three other domains: 'Locomotor', 'Hearing and Speech', 'Eye and Hand Coordination'. The improvement after pantogam treatment was more obvious in the subgroup of infants born late preterm (gestational age 34-36 weeks) compared to infants born moderate preterm (gestational age 32-33 weeks). The favorable safety profile of pantogam was confirmed, comparable to that of placebo.

CONCLUSION

Pantogam is efficient and safe medication in the complex treatment of psychomotor developmental delay in preterm infants, aged 6-12 months.

[Neurodevelopment of children born very preterm with extremely low and very low body weight]

AIM

To evaluate the characteristics of neurodevelopment by the age of 5-8 years in children who were born very preterm with extremely low body weight (ELBW) and very low body weight (VLBW).

MATERIAL AND METHODS

Seventy-two patients, aged from 5 years to 8 years were examined. Patients were divided into group I (36 patients born preterm with ELBW (16 boys, 20 girls)) and group II (36 patients born with VLBW (16 boys, 20 girls)). The control group included 30 healthy peers (16 boys, 14 girls). All children were assessed by means of the Griffiths Mental Development Scales, Extended Revised: 2 to 8 years (GMDS-ER 2-8).

RESULTS

The value of general quotient (GQ) in patients born with ELBW (73.4±2.1) was significantly lower compared to their healthy peers (80.9±2.1; p=0.036). The same tendency was found in patients born with VLBW who's GQ was decreased by 73.1±3.0 (p=0.101). Concurrently the patients demonstrated lower scores on all six scales, which achieved significant difference with the controls for the 'Locomotor' and 'Performance' scales in group I, and for the 'Performance' and 'Practical reasoning' scales in group II. The boys born with ELBW tended to demonstrate lower results on all six scales and received significantly lower scores on the 'Locomotor' and 'Language' scales. The boys born with VLBW demonstrated significantly lower scores on the 'Language', 'Eye and hand co-ordination' and 'Practical reasoning' scales. In girls significantly lower score on the 'Performance' scale only was shown for those, who were born with ELBW.

CONCLUSION

Early diagnosis and characterization of developmental delays in children born very preterm determine the effectiveness of therapeutic measures based on the individual approach and comprehensive medical-psychological-pedagogical support.

[Clinical effectiveness of the infusion therapy under control of the transesophageal dopplerography in acute period of severe combined trauma]

In 72 patients with combined trauma the impact of volume and consistence of infusion therapy on severity of the disease, frequency and severity of infectious complications, duration of MV and ICU stay was assessed. The patients were divided into 2 groups depending on the volemic status control method and infusion algorithm. The main group (35 patients) was controlled by transesophageal dopplerography Cardio Q apparatus ("Deltex Medical", GB) and the infusion therapy was carried out under the control of stroke volume and Ftc. In the control group (37 patients) the volemic status was assessed clinically: BP, CVP, HR, diuresis. The volume of the infusion therapy during the first 12 hours in the main group was significantly higher than in the control group which proved that patients were suffering from hypovolemia, which was not diagnosed by traditional clinical criteria. The ICU stay in the main group was significantly shorter compared to the control group 15.3 +/- 8.2 and 29.5 +/- 10.4 days respectively. Infectious complications occurred in 12 patients out of 35 in main group and 25 out of 37 in the control group. The conclusion of this study is that infusion therapy control with central hemodynamic parameters can shorten the MV time and ICU stay an lower the rate of infectious complications in patients with combined trauma. A mortality decrease in patients with transesophageal dopplerography controlled infusion is not shown.

[Current technologies and changing the medical paradigm in aortic ruptures (analysis of clinical cases)]

The paper describes two clinical cases of aortic rupture of traumatic and nontraumatic genesis, which was difficult to diagnose due to evident neurological symptoms. The analysis of these cases and the data available in the literature leads to the conclusion that aortic rupture is not a nosological entity with a known fatal outcome. Timely diagnosis based on widely practiced up-to-date ultrasound and radiological methods allows one to perform surgical or endovascular treatment in good time, by showing good long-term outcomes.

[Effect of hyperosmolar solutions on partial pressure of oxygen in arterial blood]

The study was undertaken to define the effect of hyperosmolar solutions on arterial blood oxygen levels. Analysis of arterial blood oxygenation after hyperosmolar solution infusions revealed a drop in partial pressure of oxygen (132.14 +/- 70.36, 120.0 +/- 66.48, and 119.24 +/- 70.10 mm Hg). At the same time there was a reduction in the extravascular lung water index (p < 0.05) as compared with the baseline values (7.93 +/- 2.17, 7.31 +/- 1.7), and Z62 +/- 1.99 ml/kg), respectively. This effect is particularly marked in a group of patients in whom the arterial blood content of oxygen is in the lower normal range. To evaluate and eliminate the above effect in reducing the arterial blood level, it is necessary to estimate respiratory indices during hyperosmolar solution infusion.

[Use of albumin in infusion-transfusion therapy for acute brain injury]

The investigation is aimed at determining whether it is necessary to include 20% albumin preparations into infusion-transfusion therapy for acute intracranial hemorrhage. An insignificant improvement of central hemodynamic parameters was shown in a group wherein 20% albumin solution was used. At the same time there was a significant increase in the pulmonary extravascular water index as compared with a control group (10.1 +/- 0.5 and 9.0 +/- 0.22 ml/kg, respectively; with no differences in the severity of lung injury, LIS was 0.71 +/- 0.23 scores; while in the group receiving no albumin solution it was 0.65 +/- 0.06 scores. Thus, the routine use of 20% albumin preparation as part of infusion-transfusion therapy for acute intracranial hemorrhage is not effective and rather safe.

[Information analysis of spinal ganglia]

Information parameters (entropia and redundancy) of cervical and thoracic spinal ganglia of albino rat foetuses, mature animals (cat and dog) and human subjects were analysed. Information characteristics of spinal ganglia were shown to be level-specified and to depend on their functional peculiarities. Information parameters of thoracic spinal ganglia of man and different animals are specie specified and may be used in assessment of morphological structures as information systems.