Mexidol, Cytoflavin, and succinic acid derivatives as antihypoxic, anti-ischemic metabolic modulators, and ergogenic aids in athletes and consideration of their potential as performance enhancing drugs

Emoxypine (ethylmethylhydroxypyridine) is a synthetic derivative of vitamin B6 . Emoxypine succinate is a registered drug in Russia and Ukraine under various trade names including Mexidol, Mexicor, and Armadin Long. Mexidol demonstrates antihypoxic and anti-ischemic effects and also modulates metabolism. The use of Mexidol by Russian athletes has been confirmed in the past. Current use by athletes is unknown as this drug is not monitored or included in drug testing protocol. Metabotropic and antihypoxic effects of Mexidol were compared to the effects of meldonium or trimetazidine, both of which are included on the World Anti-Doping Agency (WADA) Prohibited List in category S4.4. Metabolic Modulators. The conjugation of emoxypine with succinate elevates the therapeutic effectiveness of the Mexidol formulation as succinic acid itself has important impacts to consider despite being a common food additive and drug excipient. Other succinic acid salts like ammonium succinate, found as dietary supplement, have been patented as performance enhancers. Available research on healthy subjects suggests that combinations of selected 3-substituted pyridine derivatives with succinate including Mexidol and a related drug Cytoflavin can enhance the performance of athletes. Cytoflavin is a multi-component formula containing meglumine sodium succinate, nicotinamide (vitamin B3 ), inosine (riboxin), and riboflavin. Other related succinate-based drugs include Remaxol, Reamberin, and Cogitum. Mexidol and Cytoflavin and related substances exhibit similar biological effects as drugs on the WADA Prohibited List, and if they are used for performance enhancement by athletes, they could be worthy of consideration as prohibited substances in sport.

[Factors of the hemostasis system as biomarkers of severe course of acute viral infections]

The authors give literature review of hemostasis and immune system factors intraction as main biomarkers of a severe cause of viral infectious diseases. Pro-inflamatory cytokines as the main markers of inflammation, can serve both as biomarkers of the clinical severity of the infectious process and reflect the state of the hemostatic and fibrinolytic systems, since components of these systems are present in various structures of the central nervous system and affect the development of neurons and synaptic plasticity. An inverse correlation has been proven between the concentration of D-dimer and the oxygenation index, and the development of DIC is not associated with the presence of respiratory failure in patients with influenza type A, while the ferritin concentration directly reflects the severity of the disease. One of the markers of endothelial damage may be soluble thrombomodulin, which, however, is rarely used in routine clinical practice. Cytoflavin is a highly effective pathogenetic drug that affects various parts of the hemostasis system, has anti-ischemic, antioxidant, antihypoxic, immunocorrective effect, which is indicated for any generalized infectious disease since its debut.

[FIRES Syndrome in a Preschool Child]

Severe epileptic syndromes of childhood are an urgent problem for pediatric neurologists and neuroresuscitators. The article presents a clinical observation of FIRES syndrome in a pediatric patient, which is a form of severe drug-resistant epilepsy in children of preschool and school age, the development of which is caused by hyperthermia, probably associated with herpesvirus (human herpesvirus type 6) infection. The features of the progressive course and the difficulties of diagnostic search are reflected. An empirical approach to etiotropic therapy is described, since the disease manifested itself with respiratory manifestations and fever. The tactic of pathogenetic treatment is described, in which drugs of polyfunctional action, such as Cytoflavin, have a priority, many years of experience in the use of which allows the authors to recommend it as a starting intensive therapy.

Metabolic and Body Composition Changes in Ice Hockey Players Using an Ergogenic Drug (Cytoflavin)

BACKGROUND AND OBJECTIVES

In ice hockey, the major physical workload comes from acceleration in all planes of motion and transitions between skating trajectories. Hockey players' anthropometric characteristics correlate with performance. In team sports, the use of ergogenic drugs for recovery is relevant to avoid athletes' overtraining. It is very important to protect athletes' health and allow them to maintain high-performance levels. Cytoflavin is an ergogenic drug whose action is based on the combined effects of its active ingredients (succinic acid, inosine, nicotinamide and riboflavin), which are naturally occurring metabolites that stimulate tissue respiration. The study aimed to assess the 6-week Cytoflavin consumption effects on body composition (body weight, body mass index, body fat percentage and bioimpedance phase angle) and aerobic performance.

METHODS

This study included 60 male professional hockey players (aged 19 to 36 years) divided into two groups of 30 subjects: group I (body weight 87.90 ± 7.44 kg, BMI 25.86 ± 2.04 kg/m²) and group II (body weight 87.04 ± 6.22 kg, BMI 25.52 ± 2.38 kg/m²). Athletes in group I received Cytoflavin, whereas athletes in group II did not.

RESULTS

In group I, statistically significant reductions in body weight and body mass index were not observed until 14 and 35 days, respectively. In contrast, in group II, both body weight and BMI significantly decreased both times. Aerobic performance significantly increased in both groups, with significantly greater increases in group I.

CONCLUSIONS

Cytoflavin can be considered an ergogenic drug that improves body composition parameters, especially in the control of weight reduction and improvement in aerobic performance.

[Evaluation of the effectiveness of the drug Cytoflavin in patients with dyscirculatory encephalopathy who have undergone a new coronavirus infection]

OBJECTIVE

To evaluate the effectiveness of the Cytoflavin in patients with dyscirculatory encephalopathy (DE) who had a new coronavirus infection.

MATERIAL AND METHODS

82 patients were examined: 16 (19.5%) men and 66 (80.5%) women aged 58 to 80 years, mean age 69±6 years and 70±6 years, respectively. All patients had moderate vascular cognitive impairment (less than 26 points according to the MoCA test), a history of COVID-19 in the period from 3 to 12 months before the start of the study. Patients before COVID-19 were registered with a neurologist with chronic cerebrovascular diseases with non-demented cognitive impairment of vascular origin. Patients of the main group (MG) received the Cytoflavin from the 1st to the 25^th day of observation, inclusive, 2 tablets 2 times a day against the background of standard basic therapy. Patients in the comparison group received only standard basic therapy.

RESULTS

It was found that during therapy with Cytoflavin, patients noted a positive trend in the form of a decrease in the symptoms of cognitive impairment, improved orientation and working memory, concentration of attention and counting. Also, patients in MG noted a decrease in fatigue and depressive disorders, an increase in motivation and a positive attitude, the emergence of interest in life, an improvement in the emotional background of mood, an increase in physical activity and working capacity. Comparing the mechanisms of development of vascular dysfunction, a pathogenetic commonality between DE and the development of consequences in the form of cognitive impairment caused by COVID-19 was noted.

CONCLUSION

Cytoflavin therapy at a dosage of 2 tablets 2 times a day for 25 days can be recommended as part of complex therapy for patients with DE and a COVID-19.

[The role of inflammation in the development of diabetic polyneuropathy and the possibility of its correction]

OBJECTIVE

To study the effect of the combined drug Cytoflavin on the mechanisms of nonspecific inflammation in the treatment of diabetic polyneuropathy (DPN) with an assessment of the dynamics of the TNF-α index.

MATERIAL AND METHODS

An open comparative prospective observation of patients with a history of DPN for more than 5 years and a high level of TNF-α was carried out. All patients underwent basic oral combined hypoglycemic therapy, the main group used the combined drug Cytoflavin 10 ml (per 200 ml 0.9% NaCl) for 10 days, followed by the transition to the enteral form of the drug, 2 tablets 2 times a day for 1 months The main indication for the appointment of Cytoflavin was the presence of comorbid pathology in the form of cerebrovascular disease in all studied patients. The severity of clinical symptoms of DPN, the quality of life (QOL) of patients, as well as the dynamics of the level of TNF-α as an indicator reflecting the process of inflammation were assessed.

RESULTS

As a result of the treatment in the study group, there was an improvement in QoL, a decrease in the severity of sensory complaints and a decrease in the level of TNF-α, which may indicate a possible anti-inflammatory mechanism of the combined drug Cytoflavin.

CONCLUSION

Cytoflavin can inhibit inflammation and reduce the severity of sensitive disorders in patients with DPN.

[Results of a clinical and experimental study of the safety and efficacy of Cytoflavin in combination with reperfusion therapy for ischemic stroke]

OBJECTIVE

To study the efficacy and safety of Cytoflavin in combination with thrombolytic therapy.

MATERIAL AND METHODS

At the first preclinical stage, the effect of Cytoflavin, solution for intravenous administration, on the fibrinolytic activity of alteplase (Actilyse) was studied in vitro. At the second, clinical stage, the safety and efficacy of Cytoflavin treatment, initiated within in the first 24 hours from the stroke onset and continued for 10 days, was evaluated in patients with acute stroke who received reperfusion therapy. At the clinical stage of the study, 200 patients were examined: 100 subjects of the main group who received reperfusion therapy in combination with Cytoflavin; 100 control subjects who received reperfusion therapy in combination with other drugs from the neuroprotective group as part of routine clinical practice.

RESULTS

The preclinical study has demonstrated that alteplase in the studied concentrations debulks the mass of a thrombus by 2131%. There were no statistically significant differences in the reduction of thrombus weight with addition of Cytoflavin at various concentrations combined with alteplase to the incubation medium. The addition of Cytoflavin to the incubation medium with alteplase had no effect on the concentration of D-dimer in the rat's plasma. In the clinical study, there were no statistically significant differences in the frequencies of intracranial hemorrhages of various types between the study groups. In the multivariable analysis, significant predictors of intracranial hemorrhage were baseline NIHSS score, systolic blood pressure, history of diabetes and anticoagulant use, baseline CT ASPECTS score, but not the treatment group.

CONCLUSION

The use of Cytoflavin in combination with thrombolytic therapy is safe. Up-to-date treatment of stroke which includes timely reperfusion and neurometabolic support of recovery leads to the rapid manifest regression of the neurological deficit and to the improvement in functioning and activity of patients with cerebral infarction.

[Difficulties in diagnosing the chronic course of tick-borne encephalitis in children]

Infections transmitted by ixodic ticks in childhood account for about 20%, and tick-borne encephalitis accounts for up to 25% of cases. A feature of the course of tick-borne encephalitis is unpredictability and the possibility of chronization in 1-3% of cases with late diagnosis and inadequate therapy. The article presents a clinical observation of the disease in a child whose chronically progressive course of amyotrophic form was diagnosed 1 year and 8 months after the onset of the disease. The presence of anamnestic data, features of clinical manifestations in the dynamics and typical neurovirualization picture of the disease, even with negative results of serological and molecular genetic studies of blood and cerebrospinal fluid, allowed to make a diagnosis, prescribe etio-pathogenetic therapy and thereby stabilize the patient's condition. The use of complex drugs in the treatment, such as Cytoflavin, allows to optimize the course of the disease.

[Therapeutic possibilities of stimulating reparative neurogenesis in patients with glaucoma who have recovered from a coronavirus infection]

In patients with glaucoma, the neuroplasticity of retinal cells, their axons and neuroglial elements is pathogenetically reduced, including due to a decrease in the concentration of neurotrophic factors. Coronavirus infections contribute to the damage processes, causing apoptosis of retinal and optic nerve cells. In this regard, the possibility of pharmacological stimulation of the production of these peptides through energy potentiation of the cell mitochondria function, reduction of oxidative stress severity and activation of interneuronal transduction system becomes relevant.

PURPOSE

This study aimed to conduct a comprehensive diagnosis of the severity of oxidative stress, identify changes in the neuroplasticity and reparative ability of the retina in patients with primary open-angle glaucoma (POAG) who have recovered after a coronavirus infection, and are undergoing therapy with the complex drug Cytoflavin.

MATERIAL AND METHODS

The study included 40 patients (mean age 57.2±3.6 years) with advanced POAG compensated by hypotensive agents; all of them recovered from moderate Covid-19 30 to 90 days prior to inclusion in the study. Twenty patients of the main group received therapy with the complex drug Cytoflavin, 20 other patients comprised the control group. In the comparison groups, the concentration of BDNF and CNTF in blood serum (SC) was determined by enzyme-linked immunosorbent assay (ELISA). Overall assessment of oxidative stress was done by high performance liquid chromatography. Studies of the functional activity of the retina were performed using the Tomey EP 1000 electroretinograph according to the standard method.

RESULTS AND DISCUSSION

Retinal photosensitivity significantly improved in patients of the main group taking the complex drug Cytoflavin (mD mean after treatment increased from -7.34±0.62 dB to -4.52±0.12 dB (p>0.001), PSD mean decreased from 6.23±0.21dB to 4.27±0.13 dB (p>0.001)); the neural activity of the retina improved according to PERG (the amplitudes of the P50 and N95 components increased from 0.92±0.04 µv to 1.65±0.01 µv and from 1.83±0.06 µv to 2.68±0.01 µv, respectively (p>0.001), the latency of the P50 and N95 components decreased from 53.40±2.51 ms to 49.37±2.22 ms and from 112.40±5.23 ms to 107.4±8.11ms, respectively (p>0.001); the concentration of BDNF increased (from 18.65±5.32 ng/ml to 20.23±4.05 ng/ml (p>0.001)) and the concentration of CNTF in the blood serum decreased (from 3.99±0.37 pg/ml to 1.85±0.02pg/ml (p>0.001)), the severity of oxidative stress decreased (the indicator of oxidative stress decreased by 1.4 times after treatment p>0.001) and the content of antioxidant protection indicators increased: the indicator of antioxidant protection of blood serum increased by 1.4 times, the concentration of superoxide dismutase - by 1.9 times (p>0.001), glutathione peroxidase - by 1.4 times (p>0.001), coenzyme Q10 - by 4.5 times (p>0.001).

CONCLUSION

The obtained data can be used to determine the risk of progression of glaucomatous optic neuropathy in patients with glaucoma who have had a coronavirus infection.

[The successful use of Cytoflavin in the patient with postaveny syndrome]

A clinical observation of the use of Cytoflavin according to a two-stage scheme (10.0 ml intravenously drip per 200 ml of 0.9% sodium chloride solution for 10 days, followed by a transition to a tablet form of 2 tablets 2 times/day for 25 days) in a patient with postcovid syndrome with pronounced vegetative and neurocognitive disorders. The effectiveness of therapy was confirmed by an improvement in heart rate variability and a decrease in the severity of depression, anxiety (on the HADS scale) and the level of autonomic dysfunction (on the COMPASS-31 scale). The significant changes in levels of fatigue (on a scale MFI) is not marked. The obtained results can serve as a basis for further research.

[Enzymatic activity of paraoxonase depending on polymorphism Q192R of the PON1 gene in patients with primary open-angle glaucoma]

It is believed that one of the main blood enzymes that hydrolyzes oxidized lipids incorporated in lipoproteins is the calcium-dependent hydrolase of paraoxonase 1, which has a significant antioxidant effect depending on the polymorphism of the PON1 gene.

PURPOSE

To genotype patients with primary open-angle glaucoma (POAG) by the Q192R polymorphism of the PON1 gene in order to identify their genetic predisposition to dyslipidemia and atherosclerosis, as well as to determe the possibility of correcting the reduced activity of the PON1 enzyme in the examined individuals by the complex drug Cytoflavin.

MATERIAL AND METHODS

The study included 25 men with advanced POAG, IOP compensated by hypotonic agents, and 20 volunteers without POAG (mean age 63.0±5.4 years). All subjects underwent genotyping by the Q192R polymorphism of the PON1 gene using an analyzer. PON1 activity was assessed by the rate of nitrophenol formation when paraoxone diluted in acetone was added to the blood plasma. At the second stage, patients (of different phenotypes) were prescribed the complex drug Cytoflavin.

RESULTS

Homozygous carriers of the 192R allele were found to have significantly lower levels of PON1 activity than homozygous carriers of the Q192 allele. Carriage of the 192R allele may determine an increased risk of atherosclerotic injury in patients with POAG, especially in cases with high levels of atherogenic blood lipoproteins, low levels of high-density lipoproteins, or high levels of peroxidized lipids in the blood. The drug Cytoflavin showed a positive therapeutic effect on oxidative stress and hypercholesterinemia in POAG patients.

CONCLUSION

These findings can be used to determine the atherogenicity of lipoproteins and the progression of glaucomatous optic neuropathy and to optimize the therapy of PAHO.

[The result of prospective randomized study CITADEL - the efficacy and safety of drug cytoflavin in postcovid rehabilitation]

OBJECTIVE

To investigate the structure of postcovid syndrome, age and gender characteristics of its course, and to assess the effect of Cytoflavin on the clinical course of neurological disorders in patients who have undergone COVID-19.

MATERIAL AND METHODS

The study included 100 patients, the average age was 40.4±11.7 years, there were statistically more men than women. The duration of the transferred SARS-CoV-2 days is from 30 to 90 days from the date of recovery). By random sampling, the patients were divided into two groups, the main group, received Cytoflavin tablets, a course of 25 days, 2 tablets 2 times a day. Comparison group - other drugs (vitamins, nootropic drugs). All patients were examined on the day of treatment and 25-30 days after the end of therapy. The status was assessed using Asthenia Assessment Scale (MFI-20), Brief Mental Status Assessment Scale (MMSE), Quality-of-Life Questionnaire (EQ-5D), General Health Assessment Scale, and Pittsburgh Sleep Quality Index (PSQI). The analysis of laboratory parameters was carried out retrospectively.

RESULTS AND CONCLUSION

Postcovid syndrome was more common in men, among comorbid conditions arterial hypertension and atherosclerosis prevailed, neurocognitive and autonomic disorders predominated. Appointment of Cytoflavin made it possible to achieve a pronounced anti-asthenic effect with the correction of cognitive impairments, which was reflected in a significantly more significant positive dynamics of indicators of all scales. An additional effect of Cytoflavin was revealed - a decrease in the severity of thrombocytopenia. During the observation period, no patient had any serious adverse events or side effects associated with taking the drug. Prescription of the drug does not require age-related dose adjustment and is well combined with basic therapy for concomitant pathology.

[Biofeed back therapy and Cytoflavin in the system of medical support of the training process of elderly hockey players.]

One of the ways to improve the condition of the elderly body is the method of auto-training with biofeedback, as a means of correcting deviations in the functioning of the regulatory apparatus, as well as improving antioxidant protection and eliminating the effects of oxidative stress using Cytoflavin therapy. These methods seem to be a simple and effective means of correcting negative changes in the FS of elderly hockey players after a training cycle and ensuring the possibility of a more complete recovery of their body. The difference in the points of application made it possible to combine the intake of Cytoflavin and biofeedback training into a single complex correctional and restorative technique. Purpose of the research: to consider the organizational and methodological aspects of introducing a comprehensive methodology for correcting the functional state of elderly hockey players into the system of support of their training process. Based on the results of the study, we have obtained convincing data on the positive effect of the inclusion of Cytoflavin and biofeedback training in the system of medical support for the training process of elderly hockey players. The organizational and methodological aspects of introducing a comprehensive methodology for correcting the functional state of older hockey players into the system of support for their training process considered in this article make it possible to solve a number of problems facing medical workers regarding continuous monitoring of the functional state of older hockey players, proactive diagnosis of their negative deviations, as well as a system of reabilitation.

[Development of an algorithm for the appointment of biofeed-back therapy and Cytoflavin for the treatment of osteochondrosis in elderly patients.]

Continuous improvement of protocols for the treatment of various ailments, in particular, osteochondrosis, is one of the important tasks of providing medical care to elderly patients. Supplementation of treatment with Cytoflavin and biofeed-back therapy seems to be a promising solution, however, it is necessary to develop an algorithm to predict it effectiveness in patients taking into account their initial clinical and psychophysiological status. As a result of the treatment, predictors of the effectiveness of the use of Cytoflavin and biofeed-back therapy have been identified and an algorithm for their administration has been developed.

[Structural and functional features of peripheral vasculature in patients with glaucoma]

PURPOSE

To study the reactivity of the vascular endothelium and the elastic properties of the upper and lower extremities, and assess the vascular innervation effect of Cytoflavin in patients with stable and rapidly progressive primary open-angle glaucoma (POAG).

MATERIAL AND METHODS

The study included 67 patients with POAG (mean age 66.3±1.5 years), among them 31 with stable and 36 with rapidly progressive glaucoma. During the first stage of the study, the reactivity of the vascular endothelium was assessed with reactive hyperemia test; the viscoelastic properties of the upper and lower extremities were evaluated using volumetric sphygmomanometry. For the second stage of the study, patients were divided into the main group (n=20) that received intravenous injections of 10 ml Cytoflavin with 200 ml of 5% glucose solution for 10 days and then 2 tablets twice a day for 60 days, and the control group (n=16).

RESULTS

The function of the vascular endothelium was significantly reduced in patients with rapidly progressive POAG. Correlation analysis revealed a negative correlation between the flow-dependent vasodilation (FDV), and the duration of POAG and initial diameter of the brachial artery (r=0.5, p<0.05 and r=0.6, p<0.05, respectively). Pathological response of vessel endothelium was detected in 88% of patients with stable and 96% of patients with rapidly progressive POAG. Cytoflavin was found to have positive effects on the endothelium in patients with POAG.

CONCLUSION

The obtained data can be used for identification of risk factors for rapid POAG progression and optimization of its treatment.

[Functional rehabilitation of patients after endovitreal surgery of rhegmatogenous retinal detachment with complete retinal attachment]

Rhegmatogenous retinal detachment (RRD) is one of the most severe eye diseases typically occurring in people of working age. The annual rates of primary vision disability in patients with RRD is 2-9%.

PURPOSE

To increase the functional effectiveness of endovitreal surgery in patients with RRD by including Cytoflavin in the system of postoperative rehabilitation.

MATERIAL AND METHODS

The study involved 68 patients with RRD aged 37 to 65 years. Patients underwent vitrectomy using the 25 Gauge technology with endolaser coagulation of rupture zones and silicone oil tamponade in the vitreous cavity. Three months after the surgery, silicone oil was removed from the vitreous cavity. Patients were divided into 2 groups: the main - 34 people who received Cytoflavin in addition to standard therapy, and the control - 34 people receiving only standard postoperative treatment. The time course of the treatment's functional effectiveness was analyzed using best corrected visual acuity (BCVA) and macular photosensitivity. Laser Doppler flowmetry (LDF) was used to register the microcirculation and microcirculation efficiency indices. Morphological signs of macular ischemia were registered by optical coherence tomography angiography (OCT-A).

RESULTS

Patients of the main group showed higher level of restoration of macular function compared with the control group. The increase in functional activity of the macular area correlated with postoperative dynamics of restoration of central retinal thickness. Analysis of LDF and OCT-A indices showed that improvement of visual functions in patients treated with Cytoflavin is directly related to restoration of chorioretinal blood flow.

CONCLUSION

The use of Cytoflavin in patients after endovitreal surgery of RRD led to improvement of BCVA by an average of 2.6 times and photosensitivity of the macula by 2 times. The visual functions of patients improved after using Cytoflavin due to its positive effect on chorioretinal microcirculation and the density of macular capillary plexuses.

[Possibilities of using Cytoflavin in the treatment of cognitive and emotional disorders in patients with tension headaches]

OBJECTIVE

To evaluate the efficacy and safety of Сytoflavin in the treatment of cognitive and emotional disorders in patients with tension headache.

MATERIAL AND METHODS

Fifty patients with tension headache, aged from 18 to 50 years, were studied. The following methods and tests were used: neurological examination, NPRS, STAI, CFQ, RAVLT, TOVA, electroencephalography (routine and spectral analysis). The patients were treated with Сytoflavin.

RESULTS

After the treatment, clinical improvement was observed in 62.0% of the patients. A significant decrease in trait anxiety and inattention, as well as an improvement of memory performance were observed. A comparative analysis of neurophysiological results before and after the treatment showed a decrease in the manifestations of dysfunction of nonspecific regulation of the brain.

CONCLUSION

The results of this study demonstrate the efficacy of Cytoflavin in the treatment of tension headache and associated emotional and cognitive impairments.

[Possibilities for optimizing the pathogenetic therapy of purulent meningitis in children]

AIM

To assess an effect of the combined use of Cytoflavin and Sulodexide on the course and outcomes of purulent meningitis in children.

MATERIAL AND METHODS

Fifty children with purulent meningitis, aged from 5 to 17 years 11 month, were studied. Thirty patients of the treatment group (n=30; mean age 6,8 ± 2,2 years) received Cytoflavin (0,6 mcg/kg once a day) during 5 days with the following treatment with Sulodexide (250 LSU/day in children 5-12 years, 500 LSU/day in children above 12 years). Patients of the comparison group (n=20), aged 5,9±1,8 years, received standard antibacterial treatment. Duration and persistent of fever, cerebral, meningeal symptoms, the recovery period of CSF, the normalization of the number of desquamated epithelial cells (DEC), D-dimer were estimated. Outcomes of purulent meningitis were assessed using a working scale representing a modification of Rankin's, Fisher's, and Glasgow scales.

RESULTS AND CONCLUSION

The combination of drugs reduces the duration of cerebral and meningeal symptoms, leads to the normalization of hematological parameters (the level of leukocytes, desquamous epithelial cells, D-dimer) and improves outcomes.

[Approaches to psychopharmacological correction of the functional state of elderly people in playing with game sports.]

The observed increase number of elderly actively employed persons. This indicates the need to study both classical geriatric aspects and new ways to maintain the proper level of their functional states. The current level of knowledge about the methods of adjusting functional states provides ample opportunity to correct violations in systems that are the most susceptible to factors of intense sports activity. According to the results of a comprehensive survey of a group of elderly ice hockey players, the most pronounced changes in the functioning of the central nervous system and antioxidant defense were determined. In this target group it is rationally to combine the use of the complex metabolic drug Cytoflavin with neurotropic antioxidant activity and the biological feedback method, as one of the most effective and safe ways to increase efficiency, having an extensive evidence base.

[Effectiveness of metabolic therapy in elderly patients with discirculatory encephalopathy and moderate cognitive disorders.]

The effectiveness of neurometabolic therapy in patients with various stages of discirculatory encephalopathy was assessed according to the severity of cognitive impairment. Using a number of studies [clock drawing test, MMSE, Spielberger-Hanin, Bourdon test and cognitive evoked potentials (P300 peak)], cognitive functions of 60 elderly patients (mean age - 61,3±12,4 years) with various degrees of chronic head ischemia were analyzed brain and discirculatory encephalopathy of the I-III stages. Depending on the treatment regimen, patients were divided into 2 groups: 34 (the main group) received Cytoflavin in the treatment regimen: 2 tablets 2 times/day for 2 months. The comparison group consisted of 26 patients who received basic therapy without Cytoflavin. The majority (81,7%) of patients revealed cognitive disorders of varying severity. The inclusion of Cytoflavin in the treatment regimen improved the performance of neuropsychological tests (concentration and stability of attention, memory indicators, decreased reactive anxiety and smoothing signs of dementia), as evidenced by the positive dynamics of the CVP test (shortening the latency period and increasing the amplitude of the P300 peak, and as a result, reducing the coefficient latency / amplitude ratios).

[Cytoflavin effect on locomotor and psychoemotional status in physiological and pathological aging.]

Currently, the actual problem is the correction of motor, cognitive and psychoemotional disorders in physiological aging, as well as in various pathological processes that accompany aging and accelerate it. In this regard, it became necessary to search for drugs that can restore age-related disorders of the brain. The aim of the study was to evaluate the possibility of Cytoflavin as a pharmacological corrector of age-dependent disorders of the functions of the cerebral cortex during physiological and pathological, accelerated aging. The mouse sensorimotor cortex of the brain was the material for study. The transgenic male mice with HER2/neu overexpression at the age of 2 and 10 months were used as an experimental model, male wild-type FBV/N mice at the age of 2 and 18 months served as a control. We studied locomotor activity, orientational research behavior and the psychoemotional status of animals using the «open field» test and the Suok test. It was found that in old FBV/N mice, after the cytoflavin treatment, recovery of locomotor functions and orientational-research behavior is observed. Under conditions of HER2/neu overexpression after the Cytoflavin treatment, an improvement in motor functions occurs. It was also shown that the studied drug has an anxiolytic effect on both wild-type FBV/N mice and transgenic HER2/neu mice during aging. Thus, the positive effect of Cytoflavin on the dynamics of the behavior of experimental mice during physiological and pathological accelerated aging allow to suggest that in the late stages of ontogenesis, Cytoflavin restores the cerebral cortex functions and prevents neurodegeneration.

[Current possibilities of complex diagnosis and treatment of the consequences of traumatic brain injury]

Article is devoted to topical issues of complex diagnosis and treatment of the consequences of traumatic brain injury (TBI) in children, adolescents and adults. Craniocerebral trauma is one of the most important problems of modern neurology, due to the high frequency and severity of disability. In recent years, there has been a steady increase in effects of TBI, a significant part of which are asthenic, autonomic, cognitive, emotional and motor disorders. Factors affecting the severity of the consequences of TBI are: the severity of the injury, the age, at which the injury occurred, the time elapsed since the injury, the localization of the lesion. After mild TBI, the structure of cognitive impairment is dominated by memory and attention disorders (75%), visual-motor coordination, as well as asthenic disorders (88%), chronic headaches (95%). After moderate and severe TBI, there are more pronounced impairment of cognitive and motor functions accompanied by pathological neurological symptoms in 94-100% of children, which leads to difficulties in learning, self-service and has a negative impact on social adaptation. The article describes in detail the modern methods of complex diagnosis, as well as pathogenetically justified methods of drug therapy of cognitive disorders in patients with the consequences of TBI. The high efficacy of the modern cytoprotective drug Cytoflavin in the treatment of the effects of TBI is shown.

[Substantiation of the drug «Cytoflavin» application and cognitive-behavioral therapy in complex treatment of deforming coxarthrosis in elderly patients.]

The article presents the results of a study of the effectiveness of the addition of a standard course of conservative therapy to 104 patients of the older age group with coxarthrosis deforming the drug «Cytoflavin» and cognitive-behavioral therapy courses. It was found that such scheme increases the effectiveness of therapeutic interventions, which manifests itself as the improvement of the mental and physical components of quality of life by reducing pain and increasing the functionality of some of the affected hip. At the heart of positive clinical effect is a decrease in processes of inflammation and reduction of tension of regulatory processes in the organism.

[About the prognostic role of fibulin-5 protein in the progression of pathological vascular remodeling in patients with isolated sistolic arterial hypertension.]

Today, arterial hypertension (AH) is often associated with accelerated aging. In the structure of AH in persons over 65 years of age, the most common form is isolated systolic hypertension (ISAH), the mechanisms of development of which remain unexplained. Molecular regulation of remodeling of smooth muscle cells of vessels, changes in which, along with perivascular fibrosis and endothelial dysfunction, lead to increased sensitivity to procontractile mediators and calcification, forms the basis of mechanisms of vascular aging and rigidity. Clinically, this process is manifested in ISAH in individuals of an early period of old age and senile age. The search for new diagnostic molecular markers and the development of pharmacological correction of mechanisms of vascular wall aging in ISAH is an urgent and timely task. The review presents an analysis of current data from medical literature about the participation of fibulin-5 protein in the process of elastogenesis in the vascular wall, as well as in molecular pathological pathways of inflammation and aging of the vascular wall in ISAH. The role of multifunctional signal molecule fibulin-5 in the age-related loss of elasticity of the vascular wall is shown. Presented is the perspective of creating a drug from the group of senolitics based on fibulin-5 molecule, as well as modern application possibilities for preventing aging of the vascular wall of the drug Cytoflavin (active ingredients in 1 ml of solution: succinic acid, 100 mg; nicotinamide, 10 mg; riboxin, 20 mg riboflavin mononucleotide, 2 mg).

[Variants of postoperative delirium suppression in elderly patients.]

To study the effectiveness of the inclusion of Cytoflavin in the management of postoperative delirium treating in elderly patients. Analyzed the results of treatment of 89 elderly patients (65-74 years) who, according to similar emergency indications, underwent surgery and postoperatively showed signs of delirium (according to the DDS scale ≥8 points). Depending on the treatment regimen, the patients were divided into three groups: in the first (n=32) group, bromodihydrochlorophenylbenzodiazepine was administered intravenously (1-5 min) in a dose of 1 mg in the 1st group (n=32) to the group (patients of the 2nd group (n=28) with the same purpose and at the same time cytoflavin was injected: 10 ml of the drug in dilution per 200 ml of 10% glucose solution intravenously at a rate of 140 drops (7 ml) per minute. Patients of 3rd group (n=29) were injected with ethylmethylhydroxypyridine succinate intravenous (within 5-7 min) at a dose of 200 mg. The condition was assessed using the SOFA, DDS and RASS scales. The inclusion of drugs with antioxidant/membrane-protective action (Cytoflavin and ethylmethylhydroxypyridine succinate) in the treatment regimen of postoperative delirium in the elderly increases the effectiveness of treatment, which is manifested in more rapid relief of the condition. When comparing the efficacy of Cytoflavin and ethylmethylhydroxypyridine succinate, it was noted that in a number of indicators (restoration of spontaneous breathing, improvement after the first dose and complete relief of signs of delirium) both drugs showed comparable results, however, when assessing the depth of sedation (on the RASS scale), Cytoflavin was more effective (p=0,001).The obtained results of the effectiveness of cytoflavin in combination with good patient tolerance allows us to recommend the inclusion of the drug in the treatment regimens of this pathology.

[Evaluation of bio-inverse communication and Cytoflavin effects on the dynamics of the clinical and psychophysiological condition of elderly patients with osteochondrosis]

We conducted a study of 150 patients on the basis of polyclinic № 91 in St. Petersburg. The effect of Cytoflavin and bio-inverse communication therapy on the dynamics of the condition of elderly patients with osteochondrosis was evaluated. A number of positive effects from such an addition to existing therapy, potentiating the nominal effect, were revealed.

[Peculiarities of clinical and psychophysiological status of elderly patients with osteochondrosis.]

We conducted a study of 220 patients in polyclinic № 91 in St. Petersburg. It was revealed that elderly patients with osteochondrosis are characterized by a high prevalence and severity of osteochondrosis against the background of metabolic disorders in the structures of the spine. At the same time, the actual condition of the spine does not always determine the severity of the pain syndrome. The effect of osteochondrosis on the development of comorbid pathology has been clarified. The ways of correction of the clinical and psychophysiological status of elderly patients with osteochondrosis such as appointment of Cytoflavin, behavioral therapy and biofeed back therapy are suggested.

[Behavioral psychotherapy and citoftavin in the treatment of deforming coxarthrosis in elderly patients]

The authors studied the efficiency of the expansion of the standard course of conservative therapy of deforming coxarthrosis by appointment Cytoflavin and behavioral therapy. The study was performed on 104 elderly patients. It was found that the addition of the existing scheme increases the effectiveness of therapeutic interventions, which manifests itself as the improvement of the mental and physical components of quality of life by reducing pain and increasing the functionality of some of the affected hip. At the heart of positive clinical effect is a decrease in processes of inflammation and reduction of tension of regulatory processes in the organism. Positive quality extra medical appointments was the absence of significant side effects when taken orally Cytoflavin requiring discontinuation of the drug, as well as the absence of failure patients from further sessions of behavioral therapy.

[Optimization of treatment of elderly patientswith diabetic foot syndrome and mediakaltsinozom arteries]

The objective of the research was to study the effectiveness of the drug Cytoflavin in the comprehensive treatment of mixed form diabetic foot syndrome with media calcification arteries in 75 elderly patients with type 2 diabetes. Depending on the regimen, patients were divided into two groups: control received basic therapy; main group in addition to the base, received the drug Cytoflavin 10 ml 0,9 % NaCl 200 ml for 10 days, followed by a transition to the tablet form of the drug - 2 tablets 2 times per day orally for one month. The inclusion of the drug Cytoflavin in the treatment regimen increased the effectiveness of treatment, which was shown to improve tissue oxygenation due to the normalization of the basal oxygen tension, restoring the activity of antioxidant enzymes and, consequently, in an authentic decrease in the average time of hospital treatment and a decrease in the number of repeated surgical interventions and reamputatsy over the next year.

[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.