Influence of the Synthesis Scheme of Nanocrystalline Cerium Oxide and Its Concentration on the Biological Activity of Cells Providing Wound Regeneration

In the ongoing search for practical uses of rare-earth metal nanoparticles, cerium dioxide nanoparticles (nanoceria) have received special attention. The purpose of this research was to study the biomedical effects of nanocrystalline forms of cerium oxide obtained by different synthesis schemes and to evaluate the effect of different concentrations of nanoceria (from 10-2 to 10-6 M) on cells involved in the regeneration of skin cell structures such as fibroblasts, mesenchymal stem cells, and keratinocytes. Two different methods of nanoceria preparation were investigated: (1) CeO-NPs-1 by precipitation from aqueous solutions of cerium (III) nitrate hexahydrate and citric acid and (2) CeO-NPs-2 by hydrolysis of ammonium hexanitratocerate (IV) under conditions of thermal autoclaving. According to the X-ray diffraction, transmission electron microscopy, and dynamic light scattering data, CeO2-1 consists of individual particles of cerium dioxide (3-5 nm) and their aggregates with diameters of 60-130 nm. CeO2-2 comprises small aggregates of 8-20 nm in diameter, which consist of particles of 2-3 nm in size. Cell cultures of human fibroblasts, human mesenchymal stem cells, and human keratinocytes were cocultured with different concentrations of nanoceria sols (10-2, 10-3, 10-4, 10-5, and 10-6 mol/L). The metabolic activity of all cell types was investigated by MTT test after 48 and 72 h, whereas proliferative activity and cytotoxicity were determined by quantitative cell culture counting and live/dead test. A dependence of biological effects on the method of nanoceria preparation and concentration was revealed. Data were obtained with respect to the optimal concentration of sol to achieve the highest metabolic effect in the used cell cultures. Hypotheses about the mechanisms of the obtained effects and the structure of a fundamentally new medical device for accelerated healing of skin wounds were formulated. The method of nanoceria synthesis and concentration fundamentally and significantly change the biological activity of cell cultures of different types-from suppression to pronounced stimulation. The best biological activity of cell cultures was determined through cocultivation with sols of citrate nanoceria (CeO-NPs-1) at a concentration of 10-3-10-4 M.

The Role of Trace Elements and Minerals in Osteoporosis: A Review of Epidemiological and Laboratory Findings

The objective of the present study was to review recent epidemiological and clinical data on the association between selected minerals and trace elements and osteoporosis, as well as to discuss the molecular mechanisms underlying these associations. We have performed a search in the PubMed-Medline and Google Scholar databases using the MeSH terms "osteoporosis", "osteogenesis", "osteoblast", "osteoclast", and "osteocyte" in association with the names of particular trace elements and minerals through 21 March 2023. The data demonstrate that physiological and nutritional levels of trace elements and minerals promote osteogenic differentiation through the up-regulation of BMP-2 and Wnt/β-catenin signaling, as well as other pathways. miRNA and epigenetic effects were also involved in the regulation of the osteogenic effects of trace minerals. The antiresorptive effect of trace elements and minerals was associated with the inhibition of osteoclastogenesis. At the same time, the effect of trace elements and minerals on bone health appeared to be dose-dependent with low doses promoting an osteogenic effect, whereas high doses exerted opposite effects which promoted bone resorption and impaired bone formation. Concomitant with the results of the laboratory studies, several clinical trials and epidemiological studies demonstrated that supplementation with Zn, Mg, F, and Sr may improve bone quality, thus inducing antiosteoporotic effects.

AOX1a Expression in Arabidopsis thaliana Affects the State of Chloroplast Photoprotective Systems under Moderately High Light Conditions

Alternative oxidase (AOX) in the mitochondrial electron transport chain is considered important for sustaining photosynthesis under high light conditions. Here, we examined the effects of the AOX pathway on the state of chloroplast photoprotective systems. Arabidopsis thaliana plants (4 weeks old), comprising three genotypes (wild type [WT], overexpressing [XX-2] and antisense [AS-12] lines for AOX1a), were exposed to moderately high light conditions (MHL, 400 μmol m^-2 s^-1) in a short-term experiment (8 h). After 8 h of MHL, the WT and XX-2 plants showed stable non-photochemical quenching (qN) and violaxanthin cycle activity. Antisense plants displayed the lowest level of qN and a lower de-epoxidation state (DEPS) relative to plants of the same line after 4-6 h MHL, as well as compared to WT and XX-2 plants after 8 h MHL. The decline in DEPS in AS-12 plants was attributed to an insufficient violaxanthin de-epoxidase activity, which in turn was associated with a decrease in reduced ascorbate levels in the chloroplasts and leaves. Simultaneously, gene expression and the activity of ascorbate peroxidase in the antisense line increased after 8 h of MHL, supporting the compensatory effect of the antioxidant system when AOX1a expression is suppressed. This study emphasizes the role played by AOX in modulating the photoprotection processes and in the maintenance of relationships between mitochondria and chloroplasts by influencing ascorbate content.

Early predictive blood markers of hemorrhagic stroke - influence of cytoflavin therapy

Examination of the patterns of free-radical processes (FRP) and changes of the early screening markers to predict the course of hemorrhagic stroke (HS) and applied pathophysiologically based therapy can be of great practical importance. This study aimed to determine early changes in the parameters of oxidative stress and routine biochemistry blood tests in patients with HS and to assess their relationship with clinical outcome. The effects of early applied cytoflavin were also investigated. The prospective study included 151 patients with HS. Forty-eight percent of patients in the standard conservative therapy were given cytoflavin antioxidant energy therapy from the first day of hospitalization. The neurological status, neuroimaging, biochemical blood tests and FRP were assessed on days 1, 5, 10, and 20 of hospitalization. In patients with HS, an imbalance of all stages of FRP was detected proportionately to the severity of HS. The malondialdehyde concentration above 5.3 μmol/L, the number of leukocytes above 15 800, glucose above 11.9 mmol/L, lactate dehydrogenase above 574 IU/L, and lactate above 2.5 mmol/L, detected on the first day, predetermined a high risk of death. Additional cytoflavin treatment allowed stabilizing the clinical laboratory picture of HS, improved the treatment results, and reduced hospital mortality rate.

[Treatment of influenza and other acute respiratory viral infections in patients with diabetes mellitus]

PURPOSE OF THE STUDY

The study of the influenza and ARVI clinical performance, the development of patients with diabetes mellitus, evaluation of the effectiveness and safety application of antiviral therapy, carried out in the framework of routine clinical practice.

MATERIALS AND METHODS

126 patients aged from 22 to 83 years (27.8% of men) with ARVI or influenza that occurred with medical care during the first 5 days of the disease (60.3% in the first 48 hours) are included. All patients suffer from diabetes, for the treatment of which oral hypoglycemic agents or insulins were constantly taken. The patients were divided into two groups: the first group received standard symptomatic treatment of ARVI; antiviral drug Kagocel.

RESULTS AND CONCLUSION

Diabetes and other acute respiratory viral infections. There is an increase in the incidence of bacterial complications - 2.2 times, an increase in the frequency of systemic antibiotics - 2.3 times. The purpose of the drug prescription led to a more rapid regression of all the symptoms of influenza and ARVI, but the most striking positive dynamics was observed in the symptoms of general weakness and headache. The prescription of Kagocel was accompanied by a 58% reduction in the number of bacterial complications and a 53% reduction in the use of antibiotics, which led to a reduction in the number of cases of the disease and an improvement in initial diseases, with an frequency increase in 1.8 times. The most significant effect achieved with early treatment and early initiation of antiviral therapy (in the first 48 hours of the disease).

[Treatment of ARVI and influenza in patients with arterial hypertension]

AIM

to study the flow phenomena of influenza and ARVI in patients with arterial hypertension, as well as the effectiveness of antiviral therapy.

MATERIALS AND METHODS

Analyzed data was collected during the international multicenter prospective observational FLU-EE study "Treatment of ARVI and influenza in routine clinical practice". The study included 18946 patients with established diagnosis of influenza or ARVI of varying severity. 577 patients 51-70 years old who have a history of arterial hypertension (70% of women) were selected from this cohort. These patients regularly received angiotensin - converting enzyme inhibitors for treatment in monotherapy or in combination with other drugs, used to heal diseases of the cardiovascular system. Patients were divided into two groups depending on the therapy. The first group received symptomatic treatment of influenza and ARVI (comparison group, n=86); the second group received the antiviral drug Kagocel in the complex treatment (n=491).

RESULTS

Persons with arterial hypertension and other diseases of the cardiovascular system are at risk for severe flu. The administration of the antiviral drug Kagocel as part of the complex therapy of influenza and ARVI makes it possible to speed up the regression of the intoxication syndrome, reduce the incidence of bacterial complications by 36% and the need for antibiotic therapy by 38%. Moreover, a positive effect was registered both with the early treatment of patients for medical help (by 45%) and with delayed treatment, on the 3rd day and later (by 35%).

CONCLUSION

The use of the antiviral drug Kagocel as part of complex therapy for influenza and other acute respiratory viral infections has shown its effectiveness for different groups of patients, including hypertension, despite the fact that cardiovascular pathology, often combined with comorbid diseases, significantly worsens the course and outcome of ARVI.

Regularities of free radical processes and involutional changes of face and neck skin in different age groups

Aim

The purpose of this study was to examine the role of free radical oxygen and peroxide– lipid processes along with conducting the study of blood flow level and oxygen saturation of facial tissues in patients of different ages with varying degrees of involutional changes in the skin of the face and neck.

Materials and methods

One hundred and fifty-three people (84.3% women and 15.7% men) aged from 26 to 78 years with varying degrees of involutional changes in facial skin were examined. The clinical and laboratory evaluation was carried out dynamically and included various indicators of free radical processes, objective and subjective clinical visualization, and laser Doppler flowmetry (LDF) of the facial skin and transcutaneous oximetry (TcpO₂) performed at 10 points on the face. To assess the state of free radical processes, the authors investigated the basal indicator of chemiluminescence intensity (ICb), the intensity of chemiluminescence stimulated (ICs) by zymosan, the activity coefficient (AC) of chemiluminescence, antiperoxide activity of plasma, and malondialdehyde (MDA).

Results

With aging, the imbalance of the oxygen constituents of free radical processes grows with the increase in ROS. Proportional to age, the ICs increased 2.1 times on average in people older than 55 years compared to that in people younger than 30 years and ICb decreased by 1.8 times. As a result, the AC increased by 5.6 times. This correlates with involuntary skin changes and with regression of microcirculation and TcpO₂. According to LDF, it was established that average total blood flow in people younger than 30 years and people older than 55 years was 8.1 and 6.4 mL/min, respectively The difference between the indicators of TcpO₂ in people younger than 30 years and people older than 55 years was 1.6 times (average 56 vs 35 mm Hg). The stability of the indicators of the peroxide–lipid link of oxidative stress in different age groups demonstrated that the activation of ROS formation in mitochondria is not a cause but a consequence of microcirculation and metabolic processes in the face and neck and aging in general.

Conclusion

The tissue metabolism and microcirculation parameters naturally regress with aging, which is associated with the increase of ROS. The excess of species leads to the intensification of peroxide processes. This, in turn, is reflected in the aesthetic appearance manifested by aging.

Influence of pharmacological preconditioning on the results of lifting operations efficiency

The main aim of the study is to determine the effectiveness and safety of lifting operations in women with varying degrees of involuntary changes of facial skin, in particular when applying pharmacological conditioning, with the objectification of the role of the latter.

Materials and methods

A research and surgical treatment were conducted to eliminate involutional changes of various degrees in the facial skin of 461 women aged 35–75 years. Surface lifting was performed in 20.2% of patients, SMAS-lifting – 49.0%, SMAS-lifting with a three-level endoscopic assist lift of the lower face zone was performed in 30.8% of women. Before the surgery in 13.2% of cases, I degree of involutional changes in facial skin was registered, 47.9% – grade II, 38.9% – grade III. Patients were divided into two comparable groups. With the standard preparation without additional drug correction, 299 women (64.9%) were operated on in the preoperative period, they made up a comparison group. The main group included 162 (35.1%) women who underwent therapeutic conditioning before the lifting operation (Cytoflavin, n = 86; Actovegin n = 23; Ethylmethylhydroxypyridine succinate, n = 32; Meldonium, n = 21; Pentoxifylline, n = 31; Vinpocetine n = 27). Instrumental evaluation of the skin dermal microcirculation was performed using laser Doppler flowmetry and estimation of transcutaneous oxygen tension. In the blood plasma, the parameters of free radical processes (FRP) were studied. FRP were studied in terms of generation of active oxygen forms by leukocytes – intensity of chemiluminescence basal and intensity of chemiluminescence stimulated, as well as antiperoxide plasma activity and malondialdehyde. Early postoperative complications were analyzed, the number of repeated lifting surgical corrections on the face was studied for 5 years.

Results

The role of FRP in the pathogenesis of involuntary changes in the facial skin has been established. The imbalance of FRP was expressed in the intensification of the reactive oxygen species generation and products of lipid peroxidation. This correlated with disorders of cutaneous microcirculation and a decrease in the saturation of the facial tissues with oxygen, manifested by an increasing energy deficit and the severity of involutional skin changes. The obtained data justify the expediency of using pharmacological conditioning with energy correcting antioxidant medicine. Preoperative conditioning allowed to reduce the number of early postlifting complications associated with tissue trophism in a quarter, especially during surface lifting. In addition, in the preconditioning group, the scar was more cosmetic already at the seventh day after the operation. Based on the study of postoperative catamnesis, self-assessment data and laboratory-instrumental methods of skin system examination in people of different ages, it was revealed that while using SMAS-lifting with a three-level endoscopic-assisted lifting of the lower part of the face, the lowest frequency of complications and the best 5-year effectiveness were established.

[Expression of genes for neurotransmitter transporters in astrocytes in different brain regions in experiment]

AIM

To investigate the expression of transporters of different neurotransmitters (glutamate, aspartate, lactate, choline) in the culture of astrocytes isolated from different regions of the brain (cortex, hippocampus and brainstem) in 3- and 11-day rats.

MATERIAL AND METHODS

An experimental study was performed on 24 3- (n=12) and 11-days (n=12) old rats (Rattus norvegicus). The results of high-performance sequencing were analyzed.

RESULTS

The expression of glutamate and aspartate transporters in the brainstem of 3-day rats was higher than in other regions, however, an opposite effect was observed in 11-day rats. The expression of lactate transporters with age became identical to those of the cortex.

CONCLUSION

The data demonstrate the particular qualities of neuro-astrocytic connections and the important role of astrocytes in signal transmission. Results of the study performed by using genetic methods developed by the authors for the study of neurotransmitter transporters make it possible to recommend these methods to control the neurogenesis and neurohomeostasis, including in cerebrovascular and neurodegenerative diseases.

Lifestyle Risk Factors in the Development of Kidney Cancer: A Russian Experience

The objective of our study was the evaluation of major lifestyle risk factors for the development of renal cell carcinoma (RCC) and the assessment of chances of developing this disease among inhabitants in the region, in the presence of and with combinations of the studied risk factors. Risk factors for developing RCC that are associated with lifestyle (smoking, obesity and hypertension) were observed in 500 patients with RCC aged 30-64 years who were investigated at the Krasnoyarsk Oncology Dispensary (study group) and 858 participants in the Krai (control group). The results of our study showed that smoking increases the risk of developing RCC 2.9 times and arterial hypertension 3.3 times in men; in women, obesity and hypertension increased these risks 2.6 and 3.2 times, respectively. All three risk factors were combined in 13.6% of men and in 8.4% of women with RCC. Our data may be useful for the prevention, development of screening programmes and early diagnosis of RCC.

[Efficacy and safety of collagen biomaterial local application in complex treatment of the diabetic foot syndrome (final results of the multicenter randomised study)]

AIM

To evaluate the efficacy and safety of collagen biomaterial application during the 4-week follow-up of patients with diabetic foot syndrome.

MATERIAL AND METHODS

75 patients with diabetic foot (Wagner II (69.3%) and III (30.7%)) aged 30-80 years were included in the multicenter study, among them were 50.7% with the wound unhealed for 1.5-6 months and 49.3% over 6-48 months. Patients were randomized into 2 groups: 1) standard therapy (n=37), 2) the additional use of the collagen material Collost (n=38). Observation period was at least 4 weeks for each patient. The size of ulcers, results of general and biochemical blood tests, oximetry, microbiological testing, ultrasound of lower extremities vessels as well as a detailed medical history, social and functional status, level of cardiovascular comorbidity and ongoing therapy were estimated.

RESULTS

Additional use of a collagen biomaterial has led to a significant reduction ulcers of all sizes from 13.5 to 2.1 cm² (in the comparison group - from 12.5 to 7 cm²). The best dynamics have been registered in Wagner II (4.4-fold average wound area regress in Collost group, from 8.8 to 2.0 cm²; average wound area regress by 1.8 times, from 10 to 5.6 cm² in the comparison group) than in Wagner III group (in the main group from 55 to 21.3 cm²; in the control group from 36 to 32.4 cm²) and in ulcers existing less than 6 months. Treatment with biological material Collost within standard therapy after 4 weeks led to increase of complete epithelialization by 2.6% (21.1% as compared to 14.7%), while decreasing the frequency of ineffective treatment by 4.1 (7.9% in primary and 32.4% in the comparison group).

CONCLUSION

We have proved the efficacy and safety of collagen biomaterial topical application in a diabetic foot syndrome treatment.

[Assessment of changes in the lesions sizes and the incidence of complete epithelialization during the treatment of diabetic foot syndrome over a period of 4 weeks (multicenter study)]

AIM

To assess the effectiveness of the collagen biomaterial in treatment process in patients with DFS.

MATERIAL AND METHODS

71 patients 30-80 y.o. with diabetic foot syndrome of varying severity were included in prospective multicenter study. Patients were randomized into two homogeneous groups: control group (n=35) - standard therapy, other 36 patients (main group) were additionally treated with medical device (MD) Collost in accordance with the instructions for use.

RESULTS

Biomaterial Collost using in complex treatment of diabetic foot syndrome resulted in more rapid and effective healing of the ulcer. The treatment success increased from 43% to 72%. Complete epithelialization was achieved by 2.6 times more rapidly in conjunction with reduction the incidence of unsuccessful treatment results by 4.1 times.

Treatment for acute respiratory viral infection and influenza in daily clinical practice: Results of the multicenter international observational FLU-EE study

Purpose: To study the clinical aspects of influenza and acute respiratory viral infection (ARVI) in routine clinical practice, with efficacy and safety of the antiviral therapy evaluation. Subjects and methods: In the large multicenter prospective observational study were enrolled 18,946 patients aged 18 to 93 years with previously determined diagnosis of influenza or ARVI from 262 outpatient sites in Russia, Armenia, Moldova and Georgia. According to study design, 3 visits were evaluated. On each visit the detailed medical examination, determination of individual symptoms’ severity and course of disease were made. The dynamic evaluation of prescribed in routine clinical practice therapy of influenza and ARVI and cases of disease exacerbations with antibiotics concomitant therapy were assessed. Results: For the first time in outpatient practice on a large population of adult patients the objective data were obtained and analyzed. This data relating to the timing of access to medical care of patients with influenza and ARVI depending on the age and the disease severity, dynamics of clinical picture of the disease, their outcomes, timing recovery, as well as ongoing drug therapy of ARVI and influenza, allowed to identify patterns of development and course of these diseases. The effectiveness and safety of antiviral drug Kagocel for treatment of ARVI and influenza was shown. This is reflected in the improvement of the clinical picture of the disease; reducing the number of patients with exacerbations, requiring the prescription of systemic antibiotics up to 1.5 times; the acceleration of regression of symptoms and recovery periods. Conclusion: This study allows increase the level of objective assessment of the beginning and course of influenza and other ARVIs in outpatient practice, to predict their course and outcome, and to improve the treatment

The Effect of Antiviral Therapy on the Incidence of Bacterial Aggravations and Administration of Systemic Antibiotics in Patients with Acute Respiratory Viral Infections and Influenza (Results of International Cohort Observational Study)

OBJECTIVE

to evaluate the incidence of bacterial aggravations and antibiotics administration with analysis of effectiveness of antiviral therapy in ambulatory patients with acute viral respiratory infection (ARVI) and influenza.

MATERIAL AND METHODS

International cohort open non-interventional .study <<Treatment of ARVI and influenza in routine clinical practice? was conducted. The data analysis covers treatment results of 18946 ambulatory patients aged 18-93 years with clinical diagnosis of ARVI or influenza in 262 centers in Russia, Moldova, Armenia and Georgia. One group of patients received treatment in accordance with approved and applicable in their country schemes of complex treatment of ARVI and influenza; other group included patients treated with the complex treatment including antiviral drug Kagocel@ (Russia). On each of 3 visits were evaluated clinical symptoms (in scores), the presence of bacterial aggravations, and the effectiveness of drug treatment including antibacterial therapy.

RESULTS

Bacterial aggravations were recorded in 8.3% cases, and-systemic antibiotics were prescribed by doctors in 9.3% cases. The incidence of bacterial aggravations and administration of systemic antibiotics increased proportionally to the age of patients, severity of disease, times of first visit to the doctor and the start of treatment. Prescription of Kagocel@ in the complex treatment of ARVI and influenza contributes to reduction of number of bacterial aggravations in 1.65 times (p<0.01) and decreases necessity of systemic antibiotic therapy in 1.51 times (p<0.01), which leads to better disease outcome at various therapy start times. Maximum efficiency and fewer treatment aggravations were recorded for working age patients.

CONCLUSIONS

Antiviral therapy has shown its effectiveness in the treatment of ARVI and influenza, its implementation leads to decrease of bacterial aggravations incidence.

[Performance evaluation of integrated cytoprotective therapy of different duration in patients with cerebral infarction]

The paper reviews the preliminary results of a multicenter randomized clinical research. The aim of the study was to determine the optimal duration of different types of energy-correction therapy. 99 case report forms of patients with cerebral infarction were reviewed with their prior envelope randomization into three groups. Patients in the first group (experimental group), consisting of 32 patients, as part of combined therapy received ascorbic acid (5% solution twice a day in a recommended dosage of 20 ml/day for 20 days); the second group (37 patients) received 10 ml of cytoflavin intravenously by drop infusion twice a day for 10 days; the third group received cytoflavin for 20 days (from day 1 to day 10 - 20 ml a day, from day 11 to day 20 - 10 ml a day). The average NIH scale score on admission was 14.9 ± 2.6. Prescription of cytoflavin came with average 1.7 - 1.8 time regression (p < 0.05) of the volumes of cerebral ischemia in the of cases of the 10- and 20-day courses of treatment, while there were no significant morphologic changes in the ascorbic acid group. These results correlated with the best dynamics and outcomes of the neurological and performance status of patients receiving cytoflavin. Despite the lack of significant general differences in the clinical and morphological data of the second and third groups, the patients with underlying grave medical condition in the 20-day cytoflavin group (with NIH score of 14-20 points on admission) tended to have improved neurologic status parameters in comparison with the experimental group and the 10-day cytoflavin group. These results attest to the advantages of personalized antioxidant energy-correction therapy.

[Clinical and Pathophysiological Correlations in Acute Stroke, CT Visualized at Different Times]

Two hundred twenty one patients aged 32-93 years with brain infarction, admitted to a Vascular Neurology Center in the first 3-48 hours (mean 6 hours) after the onset of the symptoms of stroke with computed tomography (CT) verified diagnosis were enrolled in the study. According to the timing of the CT-verification the patients were divided into 2 groups: "early" visualization (EV 50.2%) and "late" visualization (LV, 49.8%). In the EV group the lesion was visualized by CT on the admission (3-6 hours after the admission), in the LV group it was visualized only when CT was repeated 2-3 days after the admission. The patients in the LV group demonstrated increased severity of the underlying pathology, increased mortality and unfavourable functional outcomes correlating with the stroke lesion volume vs. the EV group. There was observed pathophysiological correlation of the blood enzymatic spectrum and acid-base balance parameters, explaining the late lesion visualization by delayed and more pronounced intracellular energy synthesis stabilization mechanisms failure in the aerobic and anaerobic glycolysis cycles.

[Modern methods of energy homeostasis correction in elderly patients]

In the multicenter randomized clinical-instrumental prospective study 185 patients aged 55-75 years (mean age 68 years) with 94 men and 91 women with cerebral infarction were included. All the patients were hospitalized in the period from 6 to 24 hours from the time of the debut of clinical symptoms, 42,2% of patients scored 14 and above on NIH scale on admission. Patients were randomized into 3 groups: 1st group consisted of 64 patients treated as an antioxidant by 5% solution of ascorbic acid 2 times a day the recommended dose (20 ml/day) for 20 days; 2nd group consisted of 72 patients who received energy monitor Cytoflavin in a daily dose of 20 ml (10.0 ml/drip 2 times a day for 10 days); 3rd group consisted of 49 patients with Cytoflavin therapy extended to 20 days, moreover from 11th to 20th day the dose was 10 ml/day. Cytoflavin treatment was more efficient than ascorbic acid, which can be explained by different pharmacologic mechanisms. Treatment with Cytoflavin for 10 days resulted in a significant decrease of ischemia zone volume by 25% in average, treatment with Cytoflavin for 20 days--by 29%, which manifested in better outcomes in neurologic and functional status. Ascorbic acid demonstrated no effect on morphologic parameters. Patients having at the time of admission 18-20 points according to the NIH and treated with Cytoflavin for 20 days demonstrated significant trend towards improvement of the parameters of the neurological status.

[Efficacy of antioxidant energocorreсtion in brain infarction (results of a multicenter randomized trial)]

OBJECTIVE

To determine the optimal duration of energy corrective treatment of ischemic stroke (II) with cytoflavin or ascorbic acid.

MATERIAL AND METHODS

A multicenter randomized clinical trial included 185 patients, aged 40-75 years. Patients were randomized into 3 groups: the control group (n=64) received ascorbic acid; cytoflavin group 1 (n=72) was treated for 10 days and cytoflavin group 2 (n=49) for 20 days. In all groups, mean NIHSS score was 13, 42.2% of patients scored ≥14 and on admission, 42.2% of patients had consciousness impairment of different severity.

RESULTS

Cytoflavin treatment was more efficient than ascorbic acid that can be explained by different pharmacologic mechanisms. Treatment with cytoflavin for 10 days resulted in a significant decrease of ischemia zone volume by 25.2%, treatment with cytoflavin for 20 days - by 29.0%, which was associated with better outcomes in neurologic and functional status. Ascorbic acid demonstrated no effect on morphologic parameters. Prolonged treatment with cytoflavin in critically ill patients led to significant improvement in clinical and morphologic variables compared to the 10-day course. In patients with less severe condition comparable results were obtained.

CONCLUSION

Our data justify the need for personalized integrated antioxidant and energy correction therapy.

[Medical and organizational issues of pre- and post-stroke disablement]

Authors examined 400 patients in the acute stage of ischemic and hemorrhagic stroke, including 140 patients who were followed-up for 6 months after the discharge. The dynamics of neurological and functional status, degree of disability and 6 month mortality were evaluated. It was shown that before hospitalization, 45.3% patients had disability pensions group I (14 or 7.7%), group II (136 or 75.1%) and group III (31 or 17.1%). The proportion of disabled people among able-bodied citizens younger than 60 years was 17.5% and it was 77.4% among those older than 80 years. Disability was caused by the cardiovascular pathology (48.1%), previous stroke (30.9%), diabetes mellitus type 2 and its complications (21%). The group of disability assigned before stroke, degree of comorbidity and severity of main disease were positively correlated with the severity of patient's condition on admission to and at discharge from the hospital. During 6 months after discharge, 15.7% of patients died, the rate of mortality was higher by a factor of 1.5 (21.4%) for secondary stroke compared to the first one. The rate of disability increased during 6 months. A number of people with disability group I increased by 12%, group II - by 20% , group III - by 5% and was estimated as 15, 55.7 and 15%, respectively.

[Investigation of risk factors of cardiovascular events by the interregional assistance fund of relatives of stroke patients]

We have analyzed the results of the clinical and laboratory study of 1070 people in 7 regions of the Russian Federation, including 222 (20.7%) men and 848 (79.3%) women aged from 19 to 94 years (mean age 57.15±13.39 years). It has been shown that 6.8% were smokers and 31.5% were alcohol abusers. Regular physical training (>30 min/day) was noted in 45.7%. Symptoms of asthenia were found in 73.3%. The level of knowledge on risk factors of stroke was estimated as: arterial hypertension (68.6%), ischemic heart disease (47.5%), heart rhythm disorders (27.0%), thrombosis of low extremities (26.8%). Mean values of arterial pressure were 140/80 mm Hg, heartbeat rate -- 74 per min. Mean value of BMI was 28.67 kg/m(2), BMI was higher than 30 in 41%. Hyperglycemia >6.2 mmol/l was recorded in 28%, hypercholesterolemia >6.2 mmol/l in 26%. Stenoses of inner carotid arteries were found in 49.2%: less than 50% diameter stenosis was in 32.8%, 50--70% in 11.8% and >70% in 4.6%. Antihypertensive drugs were used by 66.8%, antiaggregants - by 31.2% and statins by 31.2%. Knowledge about stroke was demonstrated by 81.8%, about stroke symptoms -- 58.5%, about the appropriate actions to be taken in the case of a stroke -- 48.5%. The low risk of stroke was observed in 33.2%, moderate risk in 37.3%, high-risk in 24.6% and critical risk in 4.9%.

[Energokorrektion of hemorrhagic stroke in the elderly]

The study included 102 elderly patients with hemorrhagic stroke of different size, location, and severity; the treatment was conservative. The results of the study demonstrate the important pathogenetic significance of free radical processes for hemorrhagic stroke. Severity of oxidative stress being a direct reflection of the energy deficiency correlates with the severity of the patients, with the volume of intracerebral hematoma, hyperglycemia, and determines the outcome. Assignment Cytoflavin leads to the elimination of free radical imbalance, a more rapid recovery of the impaired consciousness and focal neurological deficiency with the improvement of the functional outcome of the disease, and disability also decreased.

[Free radical processes in the pathogenesis of involutional skin changes]

AIM

To study the role of free radical processes (FRP) in the development of involutional skin changes and their correction.

SUBJECTS AND METHODS

One hundred and twenty patients aged 18 to 74 years with various degrees of involutional facial and cervical skin changes were examined. Clinical and laboratory assessments were made over time. The oxygen and lipid peroxidase parameters of FRP were estimated; objective and subjective visualization, Doppler flowmetry of the facial skin, and colorimetric study of the skin color spectrum were done.

RESULTS

The imbalance between oxygen and lipid peroxide components of FRP was found to increase with advancing age. These processes correlate with the severity of involutional skin changes and objectify the early use of energy-correcting therapy (ECT). The incorporation of ECT with cytoflavin positively affects FRP values and clinical and instrumental findings of involutional facial and cervical skin changes, by improving microcirculation. The patients with first-second degree involutional skin changes achieved the best results.

CONCLUSION

The findings permit cytoflavin to be recommended as one of the components of therapy aimed to stabilize intradermal exchange processes as part cosmetic manipulations in aesthetic medicine.

[Oxidative stress and combined antioxidant energy correction in the treatment of periodontitis]

Experimental-clinical study with inclusion of 50 Wistar rats with modeled parodontitis and 71 patients with chronic generalized parodontitis of different severity degree was conducted. Significance of oxidation stress in disease development and running was established in the course of the study. Disbalance of free-radical processes (FRP) in case of periodontal diseases affects oxygen stage of the oxidation stress in bigger degree and continues for a long time. In the course of experiment positive influence of cytoflavine preparation as energy-correction and antioxidant was confirmed as well as its combination with calcium-D3. In the course of comprehensive clinical study the efficacy of cytoflavine use was verified by the example of FRP correction that was accompanied by clinical picture and treatment results improvement.

[Free radical processes in patients with the acute calculous cholecystitis]

The role of the free radical processes (FRP) is shown and objectified in the development of the acute calculous cholecystitis (ACC). It is revealed on the first day of hospitalization already. In catarrhal and phlegmonic ACC free radical processes changes apply mostly to the oxygen part of the oxidation process. The greatest imbalance of the FRP is registered in the gangrenous ACC. It appeared like decrease of the oxygen and activation of the lipid FRP disregulation. On the first day FRP changes refer to the oxygen part of the oxidation process only. Starts with a second day from the disease début changes in the lipid component of the oxidative stress join the disregulation process. It is proved by the decrease of the antiperoxidant activity of plasma and increase of malondialdehyde. Malondialdehyde level and its rate of rise serve as prognostic criteria of the course and outcome of disease. FRP changes correlate with the clinical presentations of disease. They last till the patient's discharge. The high efficiency of the energetic corrector reamberin in a dose of 400-800 ml was shown in patients with ACC.

[The complex energy correction of chronic brain ischemia]

Considerable disturbance of all quality of life domains that worsens social adaptation and daily living and results in an asthenic-neurotic syndrome, along with neurologic and mnestic-intellectual disturbances, was revealed in patients with chronic brain ischemia (stages I, II, III). Based on the results of the double blind placebo-controlled trial, the high clinical efficacy of cytoflavin in patients with chronic brain ischemia has been shown. The treatment with cytoflavin decreases the severity of subjective symptoms and complaints thus increasing the working ability of patients, improves balance and gait, decreases the severity of asthenic and neurotic syndromes, improves cognitive and memory functions (information storage, reasoning and attention), positively effects on quality of sleep and all aspects of quality of life, in particular, on physical activity, self-rating of health and viability as well as social activity, mental health and emotional lability.

[Current conceptions of neurocytoprotective therapy]

The review is devoted to pharmacological effects and clinical effectiveness of one of the "oldest" neurocytoprotective drugs cerebrolysin. Experimental data that have revealed molecular mechanisms of the drug action as well as the results of clinical trials demonstrating the efficacy of cerebrolysin in the treatment of acute and chronic brain ischemia, Alzheimer's disease, moderate and mild cognitive disorders are described in details. It has been concluded that the efficacy o this drug has been supported by fundamental research, using animal models and cell cultures, and multiple clinical trials in patients with different pathologies.

[Free radical processes in patients with the gastro-intestinal bleedings]

The role of the free radical processes (FRP) is shown and objectified in the development of the ulcer gastro-intestinal bleedings (UGIB). It is revealed on the first day of hospitalization already. The greatest imbalance of the FRP is registered in heavy patients with acute UGIB. It appeared like decrease of the oxygen and activation of the lipid FRP disregulation. Unheavy patients have FRP changes refer to the oxygen part of the oxidation process only. Intensification FRP in process of increase of weight disease consists in decrease activity oxygen and increase a lipid disbalance. FRP disbalance has long time proceeds, last till the patient's discharge. Results of the research prove as much as possible early inclusion in a complex of medical actions antoixidant therapy. The high efficiency of the energetic corrector reamberin in a dose of 400-800 ml was shown in patients with UGIB.

[Oxidative stress in patients with mechanical jaundice of different origin and severity]

This randomized clinical study included 118 patients with mechanical jaundice (MJ) of different origin and severity. It highlighted the role of free radical-generation processes (FRP) in the development of the disease within 1 day after its onset. Disbalance of FRP affects oxygen and lipid components of oxidative stress and is especially well pronounced in severe cases and in patients with tumours. It becomes increasingly apparent with time from the onset of jaundice and endotoxicosis. FRP disbalance precedes clinical manifestation of jaundice and persists for a long time even after alleviation of its clinical symptoms. Certain signs have a prognostic values. Therapy with reamberin at a daily dose of 400 ml is shown to effectively correct oxidative stress associated with MJ of tumorous and non-tumorous origin regardless of the severity of the disease. Positive effect of antioxidative therapy is accompanied by the improvement of laboratory characteristics, clinical picture, and outcome of the disease.

[Course of free radical processes and prognosis of ischemic and hemorrhagic stroke]

A study of free radical processes (FRP) markers in 381 patients with ischemic and hemorrhagic stroke revealed the importance of oxidant stress that was most severe in patients with large volumes of stroke. Intensification of FRP consists in the reduction or inversion of oxygen FRP activity and increase in lipid free radical FRP that last till the patient discharge from a hospital. FRP indicators are early prognostic markers of stroke course and outcome. An inverse correlation between the level of anti peroxide plasma activity (APA) and the dynamics of the increase in stroke lesion from 1 to 20 days, and direct correlation between malondialdehyde (MDA) titer and the risk of hemorrhagic transformation and growth of the lesion from 5 to 20 days of disease were revealed. The results indicate that inclusion of antoixidant therapy should be conducted as early as possible after stroke using high doses of drugs in severe cases. The high efficacy of antioxidant cytoflavin in a daily dose of 20 ml in patients with stroke of different character and severity was shown. The positive effect of cytoflavin on FRP markers was accompanied by the improvement of clinical and morphological presentations and stroke outcome.

[Free radical processes at patients with pathologies of biliary ducts and methods of their correction]

The main objective of a research in the early diagnostics of a functional condition of a liver, is to estimate the degree of the level of its expressiveness and timely pathogenetic correction on the basis of the free radical system processes of studying of patients with mechanical jaundice. Results were carried out among 61 patients with pathologies of bile tracts( biliary ducts) which proved the essential role of free radical processes with strengthening of peroxidation of membrane lipids against the absolute or relative insufficiency of endogenic antioxidants in the mechanism of development of hepatic insufficiency at the given category of patients with the highest degree expressed at the serious conditions of the patients with malignant diseases. It is revealed that the inclusion of energy corrector antioxidants of reamberin to the therapy as a part of standard schemes of treatment promoted positive regressing dynamics of parameters of free radical processes that are correlated with positive clinical symptoms and outcome of diseases.

[Effect of early correction of energy and free-radical homeostasis on the clinical-morphological presentation of cerebral infarction]

A randomized comparative prospective 35-day clinical-instrumental trial of 30 patients with an ischemic hemispheric stroke hospitalized on the first day of disease was carried out. In addition to basic therapy, 16 patients of the main group were treated with the antioxidant power-normalizing drug cytoflavin used in dosage 20 ml/day intravenous in drops from the 1st to 10th day and 2 tablets twice a day from the 11th to 35th day. Fourteen patients of the comparison group received basic therapy only. Patient's state was assessed at 0-24 h and 5, 11, 21, 35 days of stroke. Assessment of neurological status (the Glasgow Coma Scale, the NIH stroke scale, a short version of MMSE), brain MRI (brain lesion volume), a study of antioxidant stress markers, assessment of functional outcome (the Barthel index and the modified Rankin scale) were conducted. The early active correction of power and free radical homeostasis by cytoflavin improved the dynamics of brain morphological changes and free-radical changes that was correlated with the activation of consciousness and reduction of neurologic deficit that resulted in the decrease of disability.