[The efficiency of X-Ray endovascular care in decreasing of population mortality from acute coronary syndrome and acute disorder of cerebral circulation].

The article considers results of assessment of dynamics of mortality from cardiovascular diseases and the most important nosologic forms - acute cerebrovascular disorders and coronary heart disease with acute coronary syndrome and development of accessibility of X-Ray endovascular care of patients in the Oblast. The results of analysis of changes in mortality after implementation of new model of care of patients with acute vascular diseases are presented. The relationship between accessibility of X-Ray endovascular interventions and decrease of mortality was analyzed. The reliable significantly strong connection was found for cerebrovascular diseases, and medium negative connection for coronary heart disease with acute coronary syndrome.

[Variants of the clinical course of the acute period of ischemic stroke in young and middle-aged patients]. / Varianty klinicheskogo techeniya ostrogo perioda ishemicheskogo insul'ta u patsientov molodogo i srednego vozrasta.

OBJECTIVE: To identify and study variants of the clinical course of the acute period of ischemic stroke (IS) in young and middle-aged patients, to establish their dependence on the presence of the main risk factors for cardiovascular diseases. MATERIAL AND METHODS: The study included 145 patients (111 men and 34 women) with IS in its acute period, including 22 young (15.2%) and 123 middle-aged people (84.8%). The main risk factors of cardiovascular diseases were analyzed. Five variants of the clinical course of the acute period of IS were identified: regredient, regredient with residual mild focal neurological symptoms, stable, slowly progressive, and rapidly progressive. The regredient course and the regredient course with residual mild focal neurological symptoms are attributed to the favorable course of the acute period of IS; stable, progressive, and rapidly progressive predicted unfavorable course. RESULTS: Regredient course was observed in 43 (29.7%) patients; regredient with residual mild focal neurological symptoms in 78 (53.8%) patients; stable course was established in 4 (2.8%) patients; slow progressive course in 15 (10.3%) patients and fast progressive course in 5 (3.4%) patients. The following risk factors significantly contributed to the favorable course: less pronounced motor, sensory and speech disorders at the time of admission of the patient to the hospital and at the end of the acute period of IS, timely hospitalization in the neurological department for the treatment of patients with acute disorders of cerebral circulation within the «therapeutic¼ window, intravenous thrombolytic therapy, mild severity of IS on the NIHSS, a lesion of the vertebral-basilar brain basin, absence of overweight and ischemic heart disease in the patient's anamnesis (p<0.05). CONCLUSION: Determining the clinical course of the acute period of IS in young and middle-aged patients will make it possible to predict the rehabilitation potential of a particular patient and increase the effectiveness of individual neurorehabilitation measures at the stages of early and late rehabilitation treatment.

[Dynamics of the mortality indicator of the population of the Irkutsk region from cerebrovascular diseases in age and gender aspect]. / Dinamika pokazatelya smertnosti naseleniya Irkutskoi oblasti ot tserebrovaskulyarnykh boleznei v vozrastno-polovom aspekte.

OBJECTIVE: To study and analyze the dynamics of the mortality rate of the population of the Irkutsk region from cerebrovascular diseases (CVD) in 2010 and 2020 in terms of age and gender. MATERIAL AND METHODS: The study included all registered deaths among the population of the Irkutsk region in 2010 and 2020 years in age and gender groups from CVD. The grouping of the material was carried out by distributing the deceased by sex and five-year age intervals (from 15 to 85+ years) with the subsequent calculation of mortality tables. The method of analysis of the time series was used with the calculation of indicators of absolute increase, rate of increase, growth rate, the content of 1% increase in the mortality rate in cases. RESULTS: A significant increase in the 1% increase in mortality among males both in 2010 and in 2020 years was observed starting with the age group 55-59 years. The 1% increase in mortality was 1.24 and 1.69 deaths, respectively. Among females, a significant increase in the 1% increase in mortality was recorded in the 60-64 age group in 2010 year and in the 65-69 age group (1.25 and 1.31 deaths, respectively). In 2020 year, compared to 2010 year, both among females and males in almost all age groups, there was a decrease in the intensity of the 1% increase in mortality cases, except for the 55-59 age group among males. gender and except for age groups 40-44 years old and 55-59 years old among females. CONCLUSION: In the Irkutsk region, among males, the decrease in the mortality rate from CVD compared with females from 2010 to 2020 years was less pronounced. During the study period of observation, the intensity of the ratio of the increase in the mortality rate from CVD in men to women increased. So, in 2010 year, the maximum ratio was 2.1:1, in 2020 year - 5.0:1. The exponent 1% increase in deaths in males was higher than in females.

[Indicators of stroke morbidity and mortality from stroke in the territories included in the Federal program of caring for patients with stroke]. / Pokazateli zabolevaemosti insul'tom i smertnosti ot nego na territoriyakh, voshedshikh v Federal'nuyu programmu reorganizatsii pomoshchi patsientam s insul'tomm.

OBJECTIVE: To study and analyze the dynamics of stroke morbidity and mortality rates among men and women in the territories included in the Federal program for the reorganization of care for stroke patients. MATERIAL AND METHODS: The study was based on data from the territorial-population register of strokes. The study included the following territories: Ivanovo region, Stavropol territory, the Republic of Bashkortostan, Sverdlovsk region, Irkutsk region, Sakhalin region, and the Republic of Tatarstan. Research period was from 2009 to 2016. A total of 29 779 stroke cases were analyzed. The age of the examined people was 25 years and older. RESULTS AND CONCLUSION: In the study areas, a 2.2 - fold decrease in stroke mortality among men and a 3-fold decrease among women was found. The values of morbidity and mortality from stroke over the entire study period were higher among men. It was also revealed that in 2015-2016, the mortality rate was in a narrow range of values, which demonstrates the impact of comprehensive measures to reduce stroke mortality in all the studied territories. The results of cluster analysis of stroke incidence rates obtained from seven territories over an 8-year period indicate similar measures for primary stroke prevention among men. Among women, there are also similarities in primary stroke prevention measures, with the exception of two regions - the Stavropol territory (4.8 cases per 1000 population) and the Republic of Tatarstan (4.5 cases per 1000 population), where the highest values of the stroke incidence rate were found. The results of cluster analysis of stroke mortality rates among men indicate a fairly large variation in the indicator values. The dominant value of the stroke mortality rate among men was found in the Sakhalin region (1.61 per 1000 population). The significance of stroke mortality rates among women in the regions was similar: six territories with similar levels of values were identified. The exception was the Stavropol territory (2.48 cases per 1000 population), where the highest death rate from stroke was revealed.

[Cellex in the therapy of patients with complex and central apnea in the early recovery period of ischemic stroke]. / Opyt primeneniya polipeptidnogo preparata Tselleks u patsientov s kompleksnym i tsentral'nym apnoe sna v rannem vosstanovitel'nom periode ishemicheskogo insul'ta.

A variety of structural and functional post-stroke disturbances demands an integrated clinical/diagnostic approach. Persistent hypoxemia due to disturbance of a saturation of blood oxygen in sleep can decrease the effectiveness of neurorehabilitation. In some cases of sleep apnea, the efficiency of continuous positive airway pressure therapy is insufficient and it should be combined with course neuroprotective therapy. Modern approaches to neuroprotective and neuroreparative therapy are considered as the independent direction for treatment of the central sleep apnea syndromes in patients with stroke consequences that is obviously important aspect of secondary prevention of a stroke.

[Differentiated complex treatment of Parkinson's disease considering atrophic changes of the brain]. / Differentsirovannoe kompleksnoe lechenie patsientov, stradayushchikh bolezn'yu Parkinsona, s uchetom stepeni atroficheskikh izmenenii veshchestva golovnogo mozga.

OBJECTIVE: To develop and implement the tactics of the differentiated complex (medication in combination with surgery) treatment of the form of Parkinson's disease (PD) associated with dyskinesias, according to the severity of atrophic changes in the brain. MATERIAL AND METHODS: The study included 40 patients with PD associated with dyskinesias and motor fluctuations. Patients of the main group received medication and surgical treatment, patients of the comparison group received only medication. The patient's health was assessed every 3 months during 1.5 years. Three atrophy indices were proposed to describe atrophic changes in the brain. RESULTS: We have determined the values of the indices when the complex treatment was optimal for patients. CONCLUSION: The results of the study are supposed to be used in the practice of neurologists and neurosurgeons.

[Analysis of carrying clinically significant allelic variants of TPMT and DPYD genes associated with the response to drug therapy in cancer practice among 9 ethnic groups of the Russian Federation].

AIM: To study the peculiarities of carrying clinically significant allelic variants of TPMT and DPYD genes associated with the response to drug therapy in cancer practice among 9 ethnic groups of the Russian Federation. MATERIALS AND METHODS: The study included 1446 conditionally healthy volunteers from 9 ethnic groups. Carriage of polymorphic TPMT and DPYD gene markers was detected by the Real-Time PCR (polymerase chain reaction) method. RESULTS: In all ethnic groups, the distribution of genotypes and alleles matched the equilibrium of Hardy-Weinberg. TPMT*3A (rs1800460) and TPMT*3C (rs1142345) were observed in heterozygous state in all investigated ethnic groups. In the Kabardinian group (n=204) the frequency of the TPMT*3A minor allele (MAF, %) was 2.94%; Balkars (n=200) 1.25%; Ossetians (n=239) 1.67%; Chuvashes (n=238) 1.89%: Mari (n=206) 1.21%; Tatars (n=141) 1.77%; Russians (n=134) 4.85%. The frequency of the TPMT*3C minor allele (MAF, %) in the Kabardinian group (n=204) MAF was 4.90%; Balkars (n=200) 1. 75%; Buryats (n=114) 0.44%; Ossetians (n=239) 1.88%; Chuvashes (n=238) 1.68%: Mari (n=206) 1.21%; Tatars (n=141) 1.42%; Russians (n=134) 4.48%. The results of the analysis of DPYD*2A polymorphism (rs3918290) demonstrated ethnic peculiarities of distribution. In the heterozygous state it was found only in the groups of Kabardins (n=204, MAF 1.22%), Balkars (n=200, MAF 2.00%), and Ossetians (n=239, MAF 0.63%). CONCLUSION: The results obtained in the study will be useful for developing personalized algorithms of antitumor therapy in cancer practice, including those aimed at increasing the safety of chemotherapy.

[Cytoflavin in patients with vertigo and dizziness in a distant period of mild traumatic brain injury]. / Primenenie Tsitoflavina u bol'nykh s golovokruzheniem v otdalennom periode legkoi cherepno-mozgovoi travmy.

OBJECTIVE: To study the efficacy and safety of the complex metabolic neuroprotective medicine cytoflavin in tablet form in patients with vertigo and dizziness in a distant period of mild traumatic brain injury. MATERIAL AND METHODS: Forty patients, aged 20-55 years, with a mild traumatic brain injury were studied for 3 months to 1 year. Cytoflavin was used as monotherapy in a dose of 2 tablets 2 times a day for 25 days. Otoneurological and stabilometric examinations were performed before and after treatment. The Dizziness Handicap Inventory, a visual-analogous scale and HADS were administered. RESULTS AND CONCLUSION: Cytoflavin decreases the severity of vertigo and dizziness, improves stabilometric indicators and reduces emotional disorders in patients with vertigo in the distant period of mild traumatic brain injury. No significant adverse reactions are observed.

[An analysis of the long-term stroke morbidity and mortality in the regions of the Russian Federation included in the Federal patient assistance reorganization program]. / Analiz srednemnogoletnei zabolevaemosti i smertnosti ot insul'ta v regionakh Rossiiskoi Federatsii, voshedshikh v federal'nuyu programmu reorganizatsii pomoshchi patsientam s insul'tom.

OBJECTIVE: To analyze the average long-term incidence of stroke and mortality in the regions of Russia in the territories included in the Federal program for the reorganization of care for stroke patients from 2009 to 2016. MATERIAL AND METHODS: The study is based on data from the territorial population register for an eight-year period for seven territories in the regions of Russia included in the Federal program for the reorganization of care for stroke patients. The study included the following territories: Stavropol krai, the Republic of Bashkortostan, Sverdlovsk region, Irkutsk region, Sakhalin region, and the Republic of Tatarstan. The total number of stroke cases in the study areas was 29 779. RESULTS: The highest average incidence was shown in the Republic of Tatarstan, which had significant differences with all regions (p<0.001). The level of mean annual mortality was identified in Stavropol krai, which had significant differences with all regions (p=0.008-p<0.001). Significant differences in the average long-term stroke incidence were typical for nine pairs of territories out of 21 of the territories, and the average long-term stroke mortality was typical for six pairs of territories. CONCLUSION: The incidence of stroke does not depend on the geographical location of the region, its economic development and ethnic composition of the population. The quality and effectiveness of primary prevention of cardiovascular diseases comes to the fore. In regions where it is not carried out at the proper level, the incidence of stroke is the highest. Only high-quality implementation of appropriate preventive measures will significantly reduce these indicators. Stroke mortality rates depend primarily on the quality of diagnosis and specialized medical care provided to stroke patients. The decrease in the mortality rate of these patients is possible only with the mandatory implementation of the approved clinical guidelines and protocols for treatment.

[Genetic and non-genetic factors of laboratory resistance to clopidogrel in patients with ischemic stroke]. / Geneticheskie i negeneticheskie faktory laboratornoi rezistentnosti k klopidogrelu u bol'nykh s ishemicheskim insul'tom.

To identify clinical and pharmacogenetic predictors of the efficacy of clopidogrel in patients with AI based on CYP2C19 and ABCB1 genotyping. MATERIAL AND METHODS: Clinical and laboratory examinations were performed in 121 patients with AI, and CYP2C19 polymorphisms (CYP2C19*2 (G681A, rs4244285), CYP2C19*3 (G363A, rs4986893), CYP2C19*17 (C806T, rs12248560), ABCB1 (C3435T, rs1045642), associated with a disturbance of antiplatelet action of clopidogrel. The carriage of polymorphic markers of the studied genes was determined by the method of polymerase chain reaction in real time. RESULTS AND CONCLUSION: In the group with laboratory resistance to clopidogrel, women prevailed (p<0.0001), atherothrombotic subtype was 80% (p=0.0384), the frequency of obesity ischemic stroke was 60% (p<0.0001). Univariate analysis of variance of CYP2C19 polymorphisms CYP2C19 (CYP2C19*2 (G681A, rs4244285), CYP2C19*3 (G363A, rs4986893), CYP2C19*17 (C806T, rs12248560), ABCB1 (C3435T, rs1045642) in patients with ischemic stroke, demonstrated a significant effect of CYP2C19 genotypes on the indicators of residual reactivity of platelets.

[Dynamics of mortality rates in different types of stroke in the territories included in the Federal program of reorganization of care for stroke patients]. / Dinamika pokazatelei letal'nosti pri raznykh tipakh insul'ta na territoriiakh, voshedshikh v Federal'nuiu programmu reorganizatsii pomoshchi patsientam s insul'tom.

AIM: To study and analyze the dynamics of one-day, 7-day and 28-day mortality rates in different types of stroke. MATERIAL AND METHODS: The retrospective study was based on the data of the territorial population register for 2009-2016 from seven territories of the Russian Federation in which the Federal program of reorganization of care for stroke patients came into force in 2009. The study population included men and women, aged 25 years and older, registered in the study area. A total of 29.779 stroke cases were identified. The mortality rate was calculated as the ratio of the number of stroke cases that ended fatally to the number of stroke cases per year. The dynamics of the mortality rate of the following types of stroke was analyzed: subarachnoid hemorrhage (SAH), intracerebral hemorrhage (ICH) and ischemic stroke (IS). RESULTS: Between 2009 and 2010, there was an increase in SAH one-day, 7-day and 28-day mortality rates and in ICH one-day, 7-day mortality rates. In the period from 2009 to 2010, the increased ICH 28-day mortality rates tended to increase, while the IS one-day, 7-day and 28-day mortality rates decreased. One-day, 7-day and 28-day mortality rates in SAH, ICH, IS had a declining trend from 2010 to 2016. A slight increase in SAH one-day mortality rate in 2014 and 2015 and SAH 7-day mortality rate in 2013 was observed. The same trend was noted for ICH mortality rates in 2013 and 2016 and in 2013, respectively. The IS one-day, 7-day and 28-day mortality rates slightly increased in 2014. CONCLUSION: According to the territorial-population register from 2009 to 2016, a significant decrease in one-day, 7-day and 28-day mortality rates in all types of stroke in the studied territories was registered. There is no doubt that this is due to the successful implementation of the Federal program of reorganization of care for stroke patients carried out in this period in the territories included in the study.

[Variantsand types of clinical course of different forms of early neurosyphilis in patients with HIV infection]. / Varianty i tipy techeniia rannego neirosifilisa u patsientov, infitsirovannykh virusom immunodefitsita.

AIM: To study and compare the frequency and types of clinical course of different forms of early neurosyphilis (NS) in patients with HIV infection. MATERIAL AND METHODS: The results of clinical, laboratory and neuropsychological examinations of two groups of patients: with early NS in combination with HIV infection (n=62) and with early NS without HIV (n=62) were analyzed. RESULTS AND CONCLUSION: The variants (regressive, stationary, slowly progressive, rapidly progressive) and types (favorable, unfavorable) of clinical course of different forms of early NS were identified in these groups. In the group of HIV-positive patients, an unfavorable course of early NS was observed in 75.8% of patients, with stationary and slowly progressive course being most frequent. Patients with early NS without HIV infection had a favorable course of the disease in 95.2% of cases.

[Prognostic methods of postoperative cognitive dysfunction in patients with ischemic heart disease after coronary bypass surgery under extracorporeal circulation]. / Prognozirovanie posleoperatsionnoi kognitivnoi disfunktsii u bol'nykh ishemicheskoi bolezn'iu serdtsa, perenesshikh operatsiiu koronarnogo shuntirovaniia v usloviiakh iskusstvennogo krovoobrashcheniia.

AIM: To work out the techniques of forecasting the development of postoperative cognitive dysfunction in early and late periods after coronary bypass surgery using fully connected multilayer neural networks. MATERIAL AND METHODS: Based on the study of 264 patients with stroke, 9 neural network models for prognosis of cognitive dysfunction after coronary bypass surgery and 7 models for prognosis of cognitive dysfunction 12 months after surgery were built. Fully connected multilayer neural networks of direct propagation were used for working-out the prognostic techniques. RESULTS AND CONCLUSION: The high prognostic significance of neural networks in relation to cognitive disorders in early and late periods after coronary bypass surgery under extracorporeal circulation was demonstrated. Possibilities of creating neural networks make their application in cardiac surgery clinics available and promising.

[Epidemiology of stroke in Irkutsk: the data of the territorial population register (2009-2013)]. / Epidemiologiya insul'ta v Irkutske (po dannym territorial'no-populyatsionnogo registra 2009­2013 gg.).

AIM: To study the changes in the main epidemiological induces of stroke in Irkutsk over 2009-2013. MATERIAL AND METHODS: To obtain significant epidemiological data, a unified method of territorial/population register was used. Stroke morbidity and mortality among persons aged over 25 years is presented. RESULTS: The highest indices of morbidity among men (5,6 per 1000 population) were recorded in 2010, among women (3,9 per 1000 population) in 2009. Stroke morbidity decreased by 28% in women of Irkutsk over the 5-year period. Indices of morbidity among men did not change during the period of the study and were higher compared to nationwide RESULTS: Mortality indices demonstrated a trend to a reduction: the mortality from stroke decreased by 2-fold over the 5 years. CONCLUSION: The decrease in stroke mortality among men and women (both in Irkutsk and Russia in whole) is a logical consequence of a complex approach to the problem as well as opening of specialized vascular centers and secondary prevention of stroke.

[Cytoflavin in the treatment of preschool and early school age children with the consequences of perinatal hypoxic brain damages]. / Primenenie tsitoflavina u detei doshkol'nogo i rannego shkol'nogo vozrasta s posledstviyami perinatal'nykh gipoksicheskikh porazhenii tsentral'noi nervnoi sistemy.

AIM: To study the efficacy and safety of the complex metabolic neuroprotector cytoflavin in children with the consequences of perinatal hypoxic brain damages. MATERIAL AND METHODS: Patients, aged 4-8 years, were stratified into three groups: 35 with infant cerebral palsy, 64 with the minimal brain dysfunction and 47 with sensorineural hearing loss. The control group consisted of 30 children. Monotherapy with cytoflavin was carried out in the dose of one tablet twice a day for 25 days. Neurologic status, neurophysiological examination andneuropsychophysiological testing were performed before and after treatment. RESULTS AND CONCLUSION: The efficacy of cytoflavin in children of preschool and early school agewas demonstrated. A complex neuroprotective action, including vasoactive, nootropic and antiasthenic effects, was revealed. Side-effects of cytoflavin were not observed.

[Clinical presentations of neurological forms of hepatolenticular degeneration in Primorsky Krai]. / Klinicheskie proyavleniya nevrologicheskikh form gepatolentikulyarnoi degeneratsii v Primorskom krae.

Clinical characteristics of neurological forms of hepatolenticular degeneration (HLD) were studied in one of the regions of Russia (Primorsky Krai) in the sample of 111 patients at the wide age range (average 35.6 years); mean time since the diagnosis was 13.7 years. According to N.V. Konovalov's classification, 4 groups of patients were identified: I arrhythmic-hyperkinetic form (n=61), II extra-pyramidal cortical form (n=30), III tremulous form (n=15), IV tremulous-rigid form (n=6). A main body of clinical manifestations of the pathology at the stage of cerebral signal of HLD manifestation was determined; three degrees of the severity of its course were established. Correlation between clinical HLD manifestation severityand the time since the diagnosis of neurological stage of the disease and its form was noted. Age parameters of the development of different extra-pyramidal disturbances and predictors of the severity of the course were specified.

[Stroke epidemiology in Irkutsk according to the territorial population register]. / Épidemiologiia insul'ta v Irkutske po dannym territorial'no-populiatsionnogo registra.

AIM: To study the dynamics of main epidemiological indices of stroke in Irkutsk in 2009-2013 and to compare the results with those in Russia. MATERIAL AND METHODS: The study was based on the data of the clinical/epidemiological analysis of stroke in open population of men and women in Irkutsk, the data analysis was performed using SAS 8.0. RESULTS: The territorial population register showed changes in disease and death rates for all stroke cases in the group of 25-74 years old both in men and women. The morbidity in men did not significantly exceed that in Russia. In the period of 5 years, the morbidity in women decreased by 28%. The stable trend towards the decrease in deaths from stroke in men and women was observed. During the observational period it decreased two-fold.

[The results of the multicenter pharmaco-epidemiological observational project on the use of mydocalm in the treatment of pain syndromes with the muscle spasm].

The prospective multicenter open noncomparative pharmaco-epidemiological observational project on the use of mydocalm in real clinical practice has been completed in 2013. The project has been performed in 2090 clinical/rehabilitation settings in 284 cities of 13 countries using the results of 35,383 patients. The project aimed to assess the safety of treatment (percentage of patients with adverse-effects) and pain relieving efficacy as well as patient's satisfaction with the treatment. In total, 6603 (19%) adverse-effects were recorded. Their severity was evaluated as mild in 84,48%, no serious adverse-effects were noted. The high efficacy of mydocalm in the treatment of pain syndromes with the muscle spasm has been demonstrated. The high level of tolerability and absence of the clinically significant increase of adverse effects in the combination with nonsteroidal anti-inflammatory drugs have been confirmed.

[THROMBOLYTIC THERAPY OF ACUTE VASCULAR DISEASES IN IRKUTSK REGION].

Cardiovascular diseases rank first as the cause of mortality, morbidity, and disability. This paper concerns evolution of thrombolytic therapy for acute coronary syndrome and ischemic stroke in the Irkutsk region characterized by low population density.

[A case of the cerebral vasculitis at the late stage of Kawasaki disease].

A description of the clinical observation of the child at the late stage of Kawasaki disease is presented. In our observation, an aneurysm of the circumflex branch of the left coronary artery was discovered on the echocardiography of the child. MRI results of the brain with vascular program revealed a picture of vasculitis, fusiform expansion of the A1 segment of the right anterior cerebral artery, M1 segment of the left middle cerebral artery. Systemic vasculitis was diagnosed at the late stage of disease. This case shows the importance of better awareness of pediatricians, cardiologists, neurologists about Kawasaki disease, its manifestations at the early stage and possible long-term complications, as well as modern approaches to treatment.