[Stroke risk stratification in elderly patients with comorbid sarcopenia and atherosclerosis]

OBJECTIVE

The study was to investigate the features of carotid arteries atherosclerosis as the leading risk factor for atherothrombotic stroke in elderly patients depending on the presence of sarcopenia.

MATERIAL AND METHODS

2 groups of patients above the working age were examined: 110 patients with normal muscle mass and 24 suffering sarcopenia. Ultrasound examination of carotid and vertebral arteries extracranial segments was performed with an assessment of atherosclerotic changes severity, atherosclerotic plaques instability, 10-year risk of stroke (according to Framingham risk score) and a 10-year risk of fatal cardiovascular disease (SCORE risk scale).

RESULTS

10-year risk of fatal cardiovascular disease was 3 [2; 5] points for patients without sarcopenia, 3 [2; 3] points for patients with sarcopenia (p=0.81). The 10-year risk of stroke was 16 [12; 18] for patients without sarcopenia, 18 [15; 22] points for patients with sarcopenia (p=0.1). Due to the ultrasound examination data the incidence of carotid arteries atherosclerotic lesions in patients without sarcopenia was 50 (46.3%), in patients with sarcopenia - 18 (75.0%) (p=0.01). Statistically significant (p<0.05) increase in the atherosclerotic plaques instability signs was revealed in patients suffering sarcopenia compared to those without it: heterogeneous echotexture - 66.7% cases versus 38.2% (p=0.01), presence of hypoechoic masses - 41.7% patients vs 12.7% (p=0.02).

CONCLUSION

It is important to take into account not only traditional risk factors in the overall assessment of cardiovascular risk as well as therapeutic and preventive measures planning in elderly patients, but also pay attention to body composition since modern diagnostic systems may be not sensitive enough to identify high-risk patients with comorbid atherosclerosis and sarcopenia.

[Paradoxical air embolism of intracerebral arteries as a complication of tooth extraction]

The article describes the rare clinical case, demonstrating sudden onset of neurological manifestations (seizures and consequent formation of ischemic stroke foci) in a 29 year-old female patient during tooth extraction (right lower third molar) using the high-speed dental drill. Air injection through damaged tissues caused subcutaneous emphysema in the buccal area that caused air embolism. Presence of asymptomatic congenital heart defect in the patient (atrial septal defect) allowed the bubbles of air to move paradoxically from right to left with consequent embolization of small cerebral arteries. Treatment in specialized department was successful and had beneficial effect on patient's condition.

[Effect of the intercellular adhesion molecule E-cadherin on the prognosis of non-small cell lung cancer]

The effect of E-cadherin on the prognosis of Stage I-II non-small cell lung cancer (NSCLC) was investigated. Tumor E-cadherin expression and its correlation with the clinical and morphological characteristics of a patient, as well as the prognostic role of this marker were studied. It was ascertained that the E-cadherin expression did not depend on patient gender and age, tumor histological pattern, location, grade, and pT category, but it was significantly related to the pN1 category (p < 0.0001). Univariate analysis revealed that the histological pattern of a tumor, nodal status, resection type (lobectomy/pulmonectomy), and E-cadherin expression level were significantly correlated with patient survival. Multivariate analysis showed that the important predictors were tumor histological pattern and resection type (p = 0.01 and p = 0.00004, respectively). A more complete study of the prognostic and predictive role of E-cadherin expression in patients with Stage I-II NSCLC will help identify a prognostically unfavorable group of patients who may be given additional treatment in the postoperative period.

[The influence of microvessel density in the tumor on the prognosis in patients with stage I-II non-small cell lung cancer after surgical treatment]

A study of the prognostic role of microvessel density in tumors of patients with stage I-II non-small cell lung cancer (NSCLC) was performed from June 2008 to June 2011. Determination of microvessel density using the marker CD31 was conducted in 114 patients. Microvessel density was significantly correlated with tumor size: so at greater than 3 cm in diameter, the content of microvessels was 68.7 +/- 3.1, with a smaller tumor size--48.6 +/- 4.5. Independent prognostic markers in patients with stage I-II NSCLC after surgery are histological type (HR = 2.97), tumor size (HR = 4.5), and the number of microvessels in tumor (HR = 3.2).

[Laser information technologies in oncosurgery]

The introduction of laser information technologies to medical practice has improved the results of reconstructive and plastic operations in oncology thanks to a possibility to plan the surgery beforehand. Sixty-eight patients were operated on at Gertsen Moscow Research Oncology Institute between 2001 and 2006; 99 stereolithographic models were used to plan different stages of the surgical intervention. The tasks fulfilled with an individual stereolithographic model, may be relatively divided into three groups: 1) planning the resection stage; 2) planning the reconstructive surgery; 3) assessing the necessity to correct the complex autograft after the reconstructive surgery. The use of laser stereolithographic modelling in surgical treatment of patients with locally advanced malignancies made it possible to complete the reconstructive operation successfully in 98.4% of the patients, and rehabilitate functionally 88.6% of the patients.

[Antihypoxant effect of zinc(II) bis(N-acetyl-L-cysteinato)sulfate octahydrate in acute normobaric hypoxia]

Using two models of the acute normobaric hypercapnic hypoxia (ANHH) and acute normobaric hypoxia without hypercapnia (ANWH), some parameters of the impulse activity of somatosensory cortex neurons were studied in experiments on cats. A new antihypoxant drug--aminothiol complex substance composed of zinc(II) and N-acetyl-L-cysteine (piQ-1104, 50 mg/kg)--was used for the brain protection. The substance studied showed a high antihypoxant activity in the brain neurons during all stages of both ANHH and AHWH. The average active survival time during hypoxic state was increased 2-2.5 times in comparison to the control group. The neuron activity dynamics under ANHH and AHWH conditions and after piQ-1104 injection was observed.

Complex N-acetyl-L-cysteine compounds with biometals as self-defense factors of biological system

We studied the effects of complex N-acetyl-L-cysteine compounds with transitional biometals on the inflammatory and adaptation reactions. Some compounds were superior to known antihypoxants and actoprotectors and exhibited significant antiinflammatory activity.

Laser stereolithography and supercritical fluid processing for custom-designed implant fabrication

This paper describes the laser photopolymerization of a liquid mixture of polyfunctional acrylic monomers, photoinitiator and hydroxyapatite (HA). Pure polymeric and composite materials of specific shape and structure were fabricated by laser stereolithography based on images derived from three-dimensional (3D) computer modeling. The polymeric objects then were treated with supercritical carbon dioxide to remove potentially toxic residues (monomers, low molecular weight oligomers, etc.) and to provide interconnective microporosity. Finally, samples were implanted into white rats (diastolic epiphysis of femoral bone) to study living tissue response and processes of osteointegration and osteoinduction. It was shown that incorporation of HA into the composite implant structure encouraged periosteal as well as endosteal osteogenesis and improved their osteointegrative characteristics in particular. Supercritical carbon dioxide treatment significantly enhanced the biocompatibility of the materials, increasing the area of direct contact of the implant surface with regenerated bone tissue.

[Potentialities of spiral computed tomography in the diagnosis and treatment of traumatic injuries of the midface]

The paper summarizes the results of examination of 169 patients referred to the surgeon in the period from 1 till 47 days after medial facial (MF) trauma by using spiral computed tomography (SCT) and the method of laser stereolitography (LSLG). The actual aspects of diagnosis and treatment are marked; the methods for the analysis of injuries of soft tissue structures and adjacent areas while orbit trauma are developed together with the methods for determination of degree of enophthalmos. Also discussed are the possibilities of SCT and LSLG in visualization of MF injuries and planning patient treatment.

[Perspective of skull reparative surgery using three-dimensional computed tomography and stereolithography]

The review presents the stages of the development and use of virtual three-dimensional CT images. A possibility to get a 3D-based real skull model and an implant for reconstruction using a 3D-prototype technique (stereolithography) is a new step to the development of reconstructive surgery.

[The possibility of using a laser stereolithography method in forensic medicine]

The data of computer-aided tomography are proposed to be used in forensic medical diagnostic and identification studies. The technology of making hard copies of objects by laser stereolithography on the basis of tomography data is described.

[The pharmacological correction of the activity of lipid peroxidation processes in the dynamics of craniocerebral trauma]

Rat experiments have shown that free radical oxidation processes are activated in the cerebral mitochondrial fraction in the dynamics of craniocerebral injury, which appears as accumulation of malonic dialdehyde and disturbed functional interaction of antiradical protection enzymes. These changes are most marked 24 hours after injury. Some GABA-positive drugs and opioid receptor agonists prevent lipid peroxidation activation. The highest efficiency is displayed by piracetam (1 g/kg) and the synthetic enkephalin analogue DSLET (0.1 mg/kg).

[Comparison of the antioxidative activity of fenibut, fentolamin and ionol]

Phenibut and phentolamine were found to exhibit the properties of the true antioxidants in the hen egg yolk suspension and in the rat brain homogenate. The antioxidative activities of the drugs were significantly higher in the brain homogenate, while the antioxidative activity of the known antioxidant ionol was unchanged.