[Guillain-Bare syndrome in a patient with tuberculous]. / Sindrom Giiena­Barre u bol'noi tuberkulezom.

The article reports on the rarest case of Guillain-Barré syndrome in the form of acute motor-sensory polyneuropathy in a female patient with tuberculous meningitis, disseminated pulmonary tuberculosis, and tuberculous pleurisy. In the neurological status at the exit from the coma, the patient was diagnosed with tetraplegia, bulbar syndrome, and respiratory disorders. Further, within a week, pronounced muscle atrophy appeared. Active etiotropic, pathogenetic therapy, including plasmapheresis, gave a dramatic effect with a significant improvement in the condition and a gradual regression of neurological disorders. The differential diagnosis was carried out primarily with critical illness polyneuropathy. The authors emphasize the rarity of the presented case: to date, such a combination of pathologies has never been described in the literature.

[Treatment of neurological postoperative disorders after surgical intervention for head and neck tumors using low-intensity laser radiation]. / Korrektsiya nevrologicheskikh posleoperatsionnykh narushenii u bol'nykh s opukholyami golovy i shei s ispol'zovaniem nizkointensivnogo lazernogo izlucheniya.

OBJECTIVE: To evaluate the efficacy of low-intensity laser radiation in rehabilitation treatment of patients undergoing radical treatment for head and neck tumors. MATERIAL AND METHODS: The study included 134 patients (39 (29.1%) men, 95 (70, 9%) women), aged from 23 to 78 years old, with an average age of 54.24±12.7 years. Three groups were formed: Group 1 - 45 patients who received the traditional complex of rehabilitation treatment, which includes physical exercise, massage, and drug therapy, without using low-intensity laser radiation; Group 2 - 45 patients who received the traditional complex of rehabilitation treatment in combination with low-intensity laser radiation; Group 3 - 44 patients who underwent only a few low-intensity laser irradiation courses as a rehabilitation treatment. The impact on the tissues of the shoulder joint and cervico-supraclavicular region was carried out by radiation with a wavelength of 660 nm and 970 nm using a matrix radiation source. The course of treatment was 10 treatment sessions lasting 10 minutes. During the first year after radical treatment, the course of laser therapy was repeated every 3 months. In the course of the study, indicators of the patient's subjective assessment of changes occurring with them were studied, depending on the method of rehabilitation used, as well as the restoration of range of motion in the shoulder joint on the side of the operation and the function of soft tissues in the shoulder joint on the radical treatment side. RESULTS: Against the background of the treatment, an improvement in the condition of patients was recorded in the form of a decrease in the severity of motor and sensory disorders. CONCLUSION: Complex rehabilitation treatment with the obligatory use of low-intensity laser radiation provides an improvement in the function of the peripheral nervous system and blood circulation, which, in turn, allows not only to restore the function of these organs, but also to generally improve the quality of life of patients.

[Neurohumoral response and Fas-ligand-induced apoptosis in peripheral blood of patients with acute ischemic stroke]. / Neirogumoral'nyi otvet i aktivnost' Fas-liganda perifericheskoi krovi v ostrom periode ishemicheskogo insul'ta.

OBJECTIVE: To identify an effect of the neurohumoral response on the severity and orientation of Fas-ligand-initiated processes in the acute period of IS. MATERIAL AND METHODS: The study included 155 patients with IS in the territory of the left and right middle cerebral arteries, the control group consisted of 28 people. The National Institutes of Health Stroke Scale (NIHSS), the Hospital Anxiety and Depression Scale (HADS), and the Daily Life Stress scale were used. Concentrations of sFas, sFasL, cortisol (K), adrenaline (A), norepinephrine (NE), adrenocorticotropic hormone (ACTH) in the blood plasma of patients with IS were measured by enzyme-linked immunosorbent assay on days 1, 7 and 21 and once in the control group. CD3CD95+ lymphocytes phenotyping was performed using flow cytometry. RESULTS AND CONCLUSION: The hypothalamic-pituitary-adrenal axis dominance is associated with the activation of the apoptosis-inducing properties of peripheral blood in the first week after the IS onset and their decrease towards the end of the acute period, which is clinically represented by the increased levels of anxiety and depression, an unfavorable outcome of the acute period of IS.

[Arterial stiffness in patients with acute cerebrovascular accident]. / Zhestkost' arterial'noi stenki u bol'nykh s ishemicheskimi narusheniyami mozgovogo krovoobrashcheniya.

OBJECTIVE: To identify correlations between parameters of vascular stiffness and characteristics of the clinical course of acute cerebrovascular accident (stroke). MATERIAL AND METHODS: Two hundred and seven patients with stroke (mean age 64.6±10.9 years; 115 men) treated in a neurological department of «Municipal Clinical Hospital Br. Bakhrushins of the Health Care Department of Moscow¼ were studied. All patients underwent a standard neurological and clinical-instrumental examination, including assessment of arterial stiffness by sphygmography. Analysis of the data was carried out depending on the severity of stroke and the pathogenetic subtype of stroke. RESULTS: The pathological value of the CAVI was detected in all patients with cerebral infarction. The highest values were noted in patients with an atherothrombotic subtype of stroke. A positive correlation was revealed between CAVI and the age of patients (r=0.57; p=0.0001), left ventricular myocardial mass index (r=0.55; p=0.0001), NIHSS score (r=0.6; p=0.0001) The inverse correlation was found between CAVI and glomerular filtration rate (r= -0.4; p=0.02). CONCLUSIONS: The factors determining the severity of stroke are age, arterial hypertension, type 2 diabetes, carotid atherosclerosis, left ventricular remodeling, and decreased glomerular filtration rate. The CAV and the toe-brachial index, rather than the ankle-brachial index, significantly distinguished patients with ischemic stroke from patients with transient ischemic attack.

[Clinical pathomorphology and tanatogenesis of various forms of alcoholic intoxication]. / Klinicheskaia patomorfologiia i tanatogenez razlichnykh form alkogol'noi intoksikatsii.

The objective of the present study was to identify the clinical and pathomorphological changes in the internal organs for the elucidation of the cause of death associated with various forms of alcoholic intoxication (chronic alcoholic intoxication, poisoning with surrogate alcohols, etc.). The analysis of the clinical conditions resulting from alcohol abuse has demonstrated that the principal pathology underlying the fatal outcome is complemented by a variety of non-lethal somatic disorders aggravating the patients' condition and enhancing its severity. The clinicians are known to give more attention to the accompanying somatic complications than to the cause underlying the main pathology (alcoholism). Such attitude in the absence of the adequate treatment of the alcohol dependency is neither clinically efficient nor economically appropriate. Poisoning with surrogate alcohols is characterized by the pulmonary-cerebral variant of tanatogenesis in the combination with hypercoagulation and the erosive processes in the gastrointestinal tract whereas death from alcoholic intoxication is usually associated with heart tanatogenesis.

[Apoptosis as a systemic adaptive mechanism in ischemic stroke]. / Apoptoz kak sistemnyi adaptivnyi mekhanizm pri ishemicheskom insul'te.

This paper presents a literature review considering the role and mechanism of apoptosis in the pathogenesis of ischemic stroke (IS). The authors introduce a new concept: the functional request of the patient as a set of external (the nature and intensity of rehabilitation measures, characteristics of everyday life, diet, etc.) and internal (genetic factors, internal picture of the disease, availability of rental and other psychological facilities and etc.) attributes. This concept allows a new angle in understanding the pathogenesis of IS and creates fundamental and clinical potential for more successful approaches to therapy and rehabilitation after IS.

[The brain after ischemic stroke: a clinical/histological study]. / Golovnoi mozg posle ishemicheskogo insul'ta: kliniko-gistologicheskoe issledovanie.

AIM: To analyze the histological features of changes in the brain tissue after ischemic stroke. MATERIAL AND METHODS: Brain tissue samples obtained in autopsy from 9 people died as a result of a left middle cerebral artery ischemic stroke from 3 to 7 days after admission were studied. Tissue samples were taken from 3 areas of the brain: 1) contiguous to the tissue necrotic damage site zone, 2) 5-10 cm distant from the previous one, 3) the contralateral hemisphere zone symmetrical to damage site. Samples were Nissl and hematoxylin-eosin stained. Detection of p53 protein, NSE, GFAP was performed by indirect immunoperoxidase immunohistochemistry. RESULTS: A decrease in the total number of neurons and glial elements, their spatial redistribution, change in cell structure and their functional activity was found. The changes of the artery wall and impaired regional blood flow were detected. The more intense NSE reactivity; p53-positive neurons, reduced neuron-astrocytes distance were identified in zones 2 and 3. CONCLUSION: Ischemic stroke is accompanied by severe histological changes. These changes with varying degrees of severity occur both in the areas adjacent to necrotic core, and in remote areas, and it is a substrate for neuroplasticity.

[A case report of central pontine and extrapontine myelinolysis in the combination with spinal cord damage in a patient with tuberculosis in the lung]. / Sluchai tsentral'nogo pontinnogo i ekstrapontinnogo mielinoliza v sochetanii s porazheniem spinnogo mozga u bol'nogo tuberkulezom legkikh.

A case report of central pontine and extrapontine myelinolysis in the combination with spinal cord damage is presented. The authors analyze literature data on this problem and discuss the pathogenesis and diagnostic issues of myelinolysis.

[A role of the Fas system in the pathogenesis of ischemic stroke]. / Rol' sistemy Fas v patogeneze ishemicheskogo insul'ta.

The Fas system can promote several biological effects due to their activation after ischemic stroke: apoptosis, inflammation, proliferation, differentiation. Fas interacts with adapter proteins activating a number of signaling pathways, including MAPK, NFKB, JNK, ERK, phosphorylation of cytoskeletal proteins, and caspase-dependent apoptosis. Fas expressed by neuronal progenitor cells from the subventricular zone does not induce apoptosis in healthy adult humans. During motion and differentiation of these cells, Fas regulates their morphological structure by the phosphorylation/dephosphorylation of cytoskeletal elements. An increase in the Fas and Fas ligand expression is observed in response to stroke injury. Fas responsible not only for cell death and inflammation but also for neuronal plasticity which occupies a central place in the processes of sanogenesis.

[The experience of application of test system "TB-Biochip" in the Tambov oblast].

The analysis was implemented concerning application of biological chips technique developed by the V A. Engelgardt institute of molecular biology--"TB-Biochip" designed for detecting DNA agent of tuberculosis in diagnostic samples of human respiratory organs and establishing its medicinal sensitivity to rifampicin and isoniazid. It is demonstrated that "TB-Biochip" is a sensitive and highly specific method of detecting medicinal sensitivity to main anti-tuberculosis pharmaceuticals. At that, analysis time amount to less than 72 hours. The comparative analysis was carried out concerning results of detection of medicinal sensitivity of mycobacteria by two express techniques--TB-Biochip (Biochip-IMB) and BACTECTM MGITTM 960 ("Becton Dickonson"). The data obtained by two techniques matched in 97.6%for rifampicin and in 92.1% for isoniazid.

[The role of surrogate alcoholic beverages in the development of hemorrhage in the patients presenting with Mallory-Weiss syndrome].

The objective of the present work was to study the pathological changes in various organs and tanatogenesis associated with Mallory-Weiss syndrome making use of the forensic medical and clinical materials. It was shown that the main cause of unrestrained vomiting resulting from alcoholic intoxication and leading to perfusive bleeding is not only the direct action of ethanol and surrogate alcohol on gastroesophageal mucosa and induced thrombocytopenia. Another cause may be brain oedema with subsequent cerebral herniation and irritation of the pseudobulbar centres responsible for the initiation of the vomiting reflex. The authors propose recommendations for forensic medical diagnostics of the cases of such hemorrhage.

[To the Fas-induced neurons apoptosis mechanisms in stroke pathogenesis].

The goal of the present study was to investigate the plasma levels of proteins regulating Fas-induced apoptosis in acute stroke and to relate ones to brain damage and clinical features. By means of ELISA soluble Fas receptor (sFas) and soluble Fas ligand (sFasL) plasma levels were detected. Fas protein (CD95) expression on CD3 lymphocytes surfaces was detected using flow cytometry. It is summarized, that Fas-induced apoptosis play significant role in stroke pathogenesis. As the result, prognostic significance of sFasL plasma level is showed. Fas induced apoptosis mechanisms seems to be perspective target for search new therapy stroke patients.

[The tuberculous meningoencephalitis in patients with later stages of HIV infection].

Based on the examination and treatment of 120 patients with tuberculous meningoencephalitis (TM) in the later stages of HIV infection, the differences between these patients and patients without HIV infection were found. HIV-infected patients with TM had a more acute disease onset, more clinical symptoms of encephalitis confirmed by magnetic resonance imaging of the brain, more frequent presence of mycobacterium tuberculosis in the cerebrospinal fluid and higher level of resistance to tuberculosis drugs. The morphologic study demonstrated the domination of necrotic and exudative reactions over productive inflammation with destructive abscess-type lesions in the brain matter. The mortality was more than 2 times higher than that in the control group.

[The effect of ozone therapy on the activity of the autonomic nervous system].

We studied 48 patients, mean age 57 years, 14 men, 34 women, with chronic cerebrovascular disease and autonomic dysfunction. Patients had different types of autonomic response (sympathicotonic or normotonic). Autonomic tone at baseline, autonomic reactivity and autonomic supply of activity were determined. Patients were divided into 2 groups. Patients of the main group received ozone therapy along with standard medications. Patients of the control group received standard medications. Disturbances of vascular-autonomic regulation with the domination of ergotropic sympathetic effects were identified in 69.7% of patients with chronic cerebrovascular disease. Ozone therapy caused a shift of the autonomic balance towards the parasympathetic activity as well as the decrease in the activity of the vasomotor center and the central regulation circuit that indicates the increase in the power of defense mechanisms associated with the normalization of autonomic balance.

[Postural stability during static strain before and after submaximal aerobic bycycle test in athletes].

The aim of study was to investigate static balance control in wrestlers (n = 31) and effects of fatigue on postural regulation in two position: bipedal stance and squat position with open eyes prior to and 2 min after bicycle PWC(170) test. A force platform ("Ritm". Russia) was used to determine static balance control. We found a minimum difference in postural control between wrestlers and controls prior to exercise in bipedal stance. In squat position linear and angular (all p < 0.001) sway velocity of centre of pressure were lower in wrestlers and were negatively correlated to PWC(170) index (r = 0.454 and r = 455, p < 0.001 with linear and angular sway velocities respectively) indicating that 20% dispersion of sway velocities in static strain position may be determined to physical working capacity. After PWC(170) test all parameters of sway were increased in both groups both in bipedal stance (p < 0.01) and squat position (p < 0.001) indicating an important role of muscular fatigue in the decrease of postural stability in both groups. Linear velocity after PWC(170) in bipedal stance increased to an equal extent in both groups but the increases of velocities of sway of centre of pressure in squat position were lower in athletes (ANOVA, p = 0.037 for linear and p = 0.008 for angular sway velocities respectively) and were negatively correlated to an extent of recovery of heart rate after PWC(170) indicating some contribution (6.5-14.2% of dispersion of linear and angular sway velocities) of an recovery rate to maintenance of a high level of postural stability in an static strain position in wrestlers during physical fatigue.

[Comparative analysis of the regulation of vertical posture in athletes of different sports qualifications].

The goal of study was to investigate the regulation of balance in athletes with different sports qualifications: masters of sport (MS, n=18) and candidates for master of sports (CMS, n=13). Balance examined by means of stabilographic complex ("Rhythm". Russia) in the static tests: in simple bipedal stance (BS) and squat positions (SQ), as well as in the dynamic tests: "Involute", evaluating the tracking movement and "Step input", assessing the reaction of the whole body on the visual-motor task. It was found that the MS with the same anthropometric data, PWC 170 and trunk power did not differ in linear and angular velocity of oscillations of the center of pressure (CP) in BS and SQ positions. MS had a relative dominance of low-frequency oscillations in the spectral analysis in the BS test with eyes open. In the test "Step input" MS had a lower latent period of reaction, a greater speed and an accuracy of the body motion forward and back in response to the step input signals, while they had a relative dominance of high frequency oscillations. Thus, the results showed that the masters of sport have improved postural regulation, which manifested itself mainly in the dynamic test on the speed and accuracy of the vertical body reaction to input visual signals.

[Mechanisms of formation of chronic low back pain relapse and their correction in patients with dorsopathy].

A clinical-neurological, psychological, biochemical and electromyographic study of 40 operated and 40 non-operated patients with chronic low back pain syndrome was conducted before and after treatment. The authors used various modes of administration of xydifonum, a chelate from the group of bisphosphonates, including electrophoretic, peroral and administration in the form of ointment, administered in turn with heparin one to improve the antiplatelet effect, using photopheresis the with the help of the state-of-the art photomatrix LED equipment. The application of Ca2+-modulating properties of xydifonum demonstrate its universality in achieving of analgesic, muscle-relaxing, anxiolytic and antidepressant effects thus allowing to exclude polypragmasy. This is a main difference between this drug and other medications with limited effects. Based on the results obtained, the authors propose a scheme of development of chronic low back pain.

[Acute toxic encephalopathy in patients with tuberculosis]. / Ostraia toksicheskaia éntsefalopatiia u bol'nykh tuberkulezom.

A hundred and thirty five patients admitted to Moscow Tuberculosis Hospital No. 7 for disseminated and progressive forms of tuberculosis were examined. Among neurological disorders in tuberculosis, acute toxic encephalopathy (ATE) should be placed in the first place in terms of their severity, problems of diagnosis and treatment. In patients with acutely progressive forms of tuberculosis, the development of ATE is brought about by two factors: 1) significant tuberculous toxemia concurrent, in 37% of cases, with severe alcoholic intoxication that leads to generalized toxic and allergic vasculitis and as a result DIC syndrome; 2) cerebral hypoxia with dyscirculatory disorders due to progressive cardiopulmonary failure. The status of patients with tuberculosis and ATE is generally critical or extremely critical. These are actually resuscitative patients. Most patients have disseminated bilateral lung lesions with multiple decay cavities, with massive bacterial isolation found at sputum bacterioscopy. With this, mycobacterial resistance to at least one antituberculous drug was found in 83% of cases. Primary multidrug resistance was detected in 29.6% of patients. The diagnosis of ATE in patients with tuberculosis is difficult and requires that tuberculous meningitis shall be excluded. Acute progression, no spinal fluid changes, significant signs of cooagulopathy and thrombcytopathy with multiorgan failure and progressive DIC syndrome may diagnose ATE in patients with acutely progressive tuberculosis. The specific features of treatment in patients with tuberculosis and ATE are intensive antituberculous therapy with predominantly parenteral administration of drugs and intensive therapy for the DIC syndrome. Despite the treatment, 48 (35.6%) patients died from progressive tuberculosis and ATE, in 40 (29.6%), therapeutic efficiency was low due to multidrug myobacterial resistance.