[Neurological manifestations of hypoparathyroidism: diagnostic difficulties. Case report].

Hypoparathyroidism is a rare condition characterized by reduced production of parathyroid hormone or tissue resistance which leads to hypocalcemia and hyperphosphatemia. Neurological manifestations often occur as the first symptoms of hypoparathyroidism and are characterized by a wide variety of symptoms of both the central and peripheral nervous systems dysfunction, which requires a differential diagnosis with a wide range of neurological diseases. Two clinical cases illustrating the features of subacute and chronic hypoparathyroidism are presented. In the case of subacute hypoparathyroidism, a young woman presented with severe tetany involving the oculomotor muscles (paroxysmal strabismus), laryngeal muscles (respiratory stridor), body muscles (opisthotonus, «obstetrician's hand¼) and the development of secondary myopathy. In another case with a long-term chronic course of postoperative hypoparathyroidism, the patient's adaptation to severe hypocalcemia was noted; the clinical features were dominated by cerebral syndromes due to brain structures calcification (Fahr's syndrome). Possible reasons for late diagnosis of hypoparathyroidism, the importance of active detection of symptoms of neuromuscular hyperexcitability and laboratory testing of phosphorus and calcium metabolism are discussed.

[Type 2 diabetes and cognitive functions in patients with chronic cerebrovascular diseases].

BACKGROUND: Type 2 diabetes (Т2DM) both directly and indirectly impacts the development of morphological and functional changes of the central nervous system. AIM: The study was to determine clinical and neurophysiological patterns of cognitive impairment (CI) in patients with chronic cerebrovascular diseases (CCD) and Т2DM. MATERIALS AND METHODS: We examined 132 patients with CCD. First group included 58 patients without Т2DM aged 64.5 [58; 72], second group 74 patients with CCD and Т2DM 63 [57; 70]. Clinical, neurological, neuropsychological, neurophysiological (cognitive evoked potentials (EP) and neurovisualisation (brain MRI) examination was carried out to all patients. RESULTS: Somatic and neurological characteristics of the patients were similar in both groups with the exception of more distinct metabolic changes in Т2DM patients. Neurovisualisation study of the brain MRI in Т2DM patients revealed more distinct changes in the form of white matter hyperintensity and subarachnoidal spaces enlargement. Neuropsychological examination in patients revealed the reduction of intellectual flexibility, constructive praxis disruption, optical spatial dysfunction and deteoration of delayed word recall. Significant disorders in the way of overall cognitive impairment, lobar dysfunction and impaired verbal associative productivity, proved by statistically lower amplitude and higher latency of P300 EP peak were noted in Т2DM patients. Correlation links were detected: for P300 amplitude and direct and inverse number listing test (r=0.366 and r=0.520; p=0.006 and p0.001 respectively); P300 latency and HbA1c (r=0.32; р0.05) in group 2 and glucose levels in both groups (r=0.30; p0.05); inverse relationship of latency with control functions evaluation (r=-0.34; p=0.008). CONCLUSION: CCD especially with Т2DM manifests with neurocognitive imbalance, including control functions disruption and are accompanied by neurophysiological and neurovisualistion changes.

Putative Trace-Amine Associated Receptor 5 (TAAR5) Agonist α-NETA Increases Electrocorticogram Gamma-Rhythm in Freely Moving Rats.

Cortical gamma rhythm is involved in transmission of information (communication) between brain areas that are believed to be involved in the pathogenesis of cognitive dysfunctions. Trace amines represent a group of endogenous biogenic amines that are known to be involved in modulation of function of classical monoamines, such as dopamine. To evaluate potential modulatory influence of a specific receptor for trace amines Trace Amine-Associated Receptor 5 (TAAR5) on the dopamine system, we used HPLC measurements of dopamine and its metabolites in the mouse striatum following administration of the putative TAAR5 agonist α-NETA. Administration of α-NETA caused significant modulation of dopaminergic system as evidenced by an altered dopamine turnover rate in the striatum. Then, to evaluate potential modulatory influence of TAAR5 on the rat brain gamma rhythm, we investigated the changes of electrocorticogram (ECoG) spectral power in the gamma-frequency range (40-50 Hz) following administration of the putative TAAR5 agonist α-NETA. In addition, we analyzed the changes of spatial synchronization of gamma oscillations of rat ECoG by multichannel recording. Significant complex changes were observed in the ECoG spectrum, including an increase in the spectral power in the ranges of delta (1 Hz), theta (7 Hz), and gamma rhythms (40-50 Hz) after the introduction of α-NETA. Furthermore, a decrease in the spatial synchronization of gamma oscillations of 40-50 Hz and its increase for theta oscillations of 7 Hz were detected after the introduction of α-NETA. In conclusion, putative TAAR5 agonist α-NETA can modulate striatal dopamine transmission and cause significant alterations of gamma rhythm of brain activity in a manner consistent with schizophrenia-related deficits described in humans and experimental animals. These observations suggest a role of TAAR5 in the modulation of cognitive functions affected in brain pathologies.

[Carotid revascularization in type 2 diabetes mellitus. Significance of chronic hyperglycaemia]. / Karotidnaia revaskuliarizatsiia u bol'nykh sakharnym diabetom 2 tipa. Znachenie khronicheskoi giperglikemii.

Patients with type 2 diabetes mellitus (type 2 DM) are typically prone to the development of cerebral atherosclerosis. Presented herein are the results of examination of patients suffering from ischaemic cerebrovascular diseases on the background of type 2 DM subjected to open surgical or endovascular interventions. In patients with cerebrovascular pathology and type 2 DM, atherosclerosis progresses on the background of chronic hyperglycaemia combined with dyslipidaemia, leading to increased incidence of the development of cerebral circulatory impairments and detection of the indications for carrying out angioreconstructive operations on the internal carotid arteries. The presence of type 2 DM is associated with increased risk for the development of ischaemic lesions of the brain matter while performing carotid endarterectomy and endovascular interventions which are associated with higher values of glycaemia (8.0 mmol/l) and glycated haemoglobin (7.8-8 %) prior to the operation.

DH(*) in chiral smectics under electric field.

The behavior of double helices (DH(*) formed in the temperature interval N(*) -SmA(*) in compounds of non-chiral liquid crystals doped with chiral molecules was investigated. Two different systems presenting left-handed and right-handed chirality were studied. A statistics of the handedness of the DH(*) revealed a correlation with the mixture chirality, as predicted theoretically in C. Meyer, Yu. A. Nastishin, M. Kleman, Phys. Rev. E 82, 031704 (2010). By applying a gradually increasing AC electric field, one can observe the shrinking of the cylinder circumscribing the DH(*) . This shrink is accompanied by a reduction of the DH(*) 's pitch. This effect was similar to the one produced by the decrease of temperature in the absence of the field.

[Painful diabetic polyneuropathy: focus on life quality improvement of patients]. / Bolevaia forma diabeticheskoi polineiropatii: fokus na uluchshenie kachestva zhizni patsienta.

AIM: To evaluate the efficacy and safety of cytoflavin as an additional agent in the treatment of painful diabetic polyneuropathy and to analyze changes in the life quality of the patients studied. MATERIAL AND METHODS: An analysis of treatment data was carried out in 61 patients with verified painful diabetic polyneuropathy, who were divided into 2 groups depending on the therapy regimen. Patients of the main group (n=36) at the start of the therapy with gabapentin additionally received cytoflavin: intravenously, slowly, 10 ml diluted in 0.9% NaCl 200 ml for 10 days, followed by switching to per os 2 tablets 2 times a day for 25 days. Patients of the comparison group used gabapentin in comparable doses as an analgesic symptomatic therapy. Clinical neurological and anamnestic methods were used to monitor and assess the condition of patients. RESULTS AND CONCLUSION: Cytoflavin inclusion in the standard symptomatic treatment of patients with painful diabetic polyneuropathy contributed to a more pronounced decrease in the subjective assessment of pain (VAS scale) by the 10th day (42.8±2.4 mm versus 58.2±2.1 mm in the comparison group) and its maximum level of decline to 21-25 days. The achieved result was maintained by the 35th day (21.4±1.1 mm against 22.4±1.7 mm in the comparison group). At the same time, the quality of life of patients as assessed by SF-36 was significantly increased after treatment. The results obtained, along with the safety of the drug, allow us to recommend its inclusion in the treatment regimens for patients with this pathology.

Membrane tubulation from giant lipid vesicles in alternating electric fields.

We report on the formation of tubular membrane protrusions from giant unilamellar vesicles in alternating electric fields. The construction of the experimental chamber permitted the application of external AC fields with strength of dozens of V/mm and kHz frequency during relatively long time periods (several minutes). Besides the vesicle electrodeformation from quasispherical to prolate ellipsoidal shape, the formation of long tubular membrane protrusions with length of up to several vesicle diameters, arising from the vesicular surface in the field direction, was registered and analyzed. The threshold electric field at which the electro-induced protrusions appeared was lower than the field strengths inducing membrane electroporation.

[Chronic cerebrovascular diseases and metabolic syndrome: approaches to pathogenic therapy of cognitive dysfunction]. / Khronicheskie tserebrovaskuliarnye zabolevaniia i metabolicheskii sindrom: podkhody k patogeneticheskoi terapii kognitivnykh narushenii.

Cognitive decline comprises one of the most important symptoms of chronic cerebral hypoperfusion. It leads not only to social disability of the patients with a subsequent decline in life quality but also to a decrease in adequate control of the course of both vascular pathology and comorbid states. Pathogenetic therapy and prevention of cerebrovascular disease progression, along with general medical measures, should include the drugs normalizing different symptoms of metabolic syndrome (arterial hypertension, diabetes mellitus etc) as well as complex drugs with multiple actions (hemangioma correction, antithrombotic, antioxidant and vasoactive) actions.

[Cerebrovascular diseases: perspectives of pathogenetic metabolic haemangiocorrective treatment].

Metabolic syndrome is a serious risk factor for acute and chronic cerebrovascular disease, which are a leading cause of disabling conditions. The association of proatherogenic effects of the main components of metabolic syndrome--hyperinsulinemia, arterial hypertension, dyslipidemia and obesity--leads to prominent haemorheological and hemostasis changes, which in turn play a pivotal role in the initiation, course and outcome of cerebrovascular pathology. Metabolic syndrome also influences the efficacy of the main pathogenetic therapy of cerebrovascular diseases--antithrombotic therapy. Thus, primary and secondary prevention of cerebrovascular disease in patients with metabolic syndrome should include haemangiocorrective, antithrombotic, antioxidant and endothelium-protective treatment, as well as therapy of the main components of metabolic syndrome.

[Chronic cerebrovascular diseases associated with metabolic syndrome: new treatment approaches].

Metabolic syndrome is a risk factor for acute and chronic cerebrovascular diseases. The development of oxidative stress promotes the progression of cerebral ischemia and treatment of the biochemical disturbances is needed. Use of antioxidants in patients with cerebrovascular diseases and metabolic syndrome reduce such symptoms as insulin resistance, hyperglyceridemia, hyperglycemia. The authors present results of a clinical study of mexidol in 40 patients, aged from 50 to 70 years, with chronic cerebrovascular pathology. Perspectives of using this group of drugs as universal neuroprotectors are discussed.

Electric-field-induced perfect anti-nematic order in isotropic aqueous suspensions of a natural beidellite clay.

We study the electric-field-induced birefringence and orientational order in the isotropic phase of aqueous suspensions of exfoliated natural beidellite clay particles, thin (L = 0.65 nm) flat charged sheets with high aspect ratio, D/L ≈ 300. Our electric birefringence experiment is optimized for aqueous suspensions of colloidal particles, with a high frequency a.c. electric field, ν ≈ 1 MHz, applied by two external electrodes to a thin flat sample, sealed in an optical capillary. In isotropic and biphasic samples, we observed strong field-induced birefringence Δn(E), saturating at moderate E(sat) field to a plateau Δn(sat) proportional to the volume fraction ϕ. The field-induced order parameter S(E) is negative and saturates to S(sat) = -0.5 above E(sat). This corresponds to a perfect "anti-nematic" order, i.e. the normals of the beidellite particles are perpendicular to the field, without any preferred azimuthal direction. The measured specific excess polarizability ΔA(sp) is among the highest data reported for other strongly anisometric dielectric and metal particles. We explain the high ΔA(sp) value with the strong induced polarization of the electric double layer of counterions at the charged particle/electrolyte interface. The estimated equivalent conductivity of the beidellite particle K(eq) = 2 K(σ)/L is several orders of magnitude larger than the bulk conductivity of the electrolyte K(e), resulting in a metal-like behavior of the beidellite disks under field. In the isotropic regions of biphasic nematic/isotropic samples, the excess polarizability is further enhanced by an order of magnitude, indicating collective reorientation of the particles. We propose that this enhancement might be due to pretransitional fluctuations of the spontaneous nematic order S(N) of the colloidal suspension and/or formation of chains of particles, with antinematic order of the beidellite disks in the chains.

Liquid-crystalline nematic phase in aqueous suspensions of a disk-shaped natural beidellite clay.

After size-selection and osmotic pressure measurements at fixed ionic strength, the behavior of aqueous colloidal suspensions of anisotropic disklike beidellite clay particles has been investigated by combining optical observations under polarized light, rheological, and small angle X-ray scattering (SAXS) experiments. The obtained phase diagrams (volume fraction/ionic strength) reveal, for ionic strength below 10(-3) M/L, a first-order isotropic/nematic (I/N) phase transition before gel formation at low volume fractions, typically around 0.5%. This I/N transition line displays a positive slope for increasing ionic strength and shifts toward lower volume fraction with increasing particle size, confirming that the system is controlled by repulsive interactions. The swelling laws, derived from the interparticle distances obtained by SAXS, display a transition from isotropic swelling at low volume fractions to lamellar swelling at higher volume fractions. The liquid-crystal properties have then been investigated in detail. Highly aligned nematic samples can be obtained in three different ways, by applying a magnetic field, an ac electric field, and by spontaneous homeotropic anchoring on surfaces. The birefringence of the fluid nematic phase is negative with typical values around 5 x 10(-4) at a volume fraction of about 0.6%. High nematic order parameters have been obtained as expected for well-aligned samples. The nematic director is aligned parallel to the magnetic field and perpendicular to the electric field.

[Effect of metformin on the magnitude of oxidative stress in patients with type 2 diabetes mellitus].

The final glycated products forming in diabetes contribute to the higher atherogenic oxidative modification of low-density lipoproteins (LDL). The impact of glycemic control on the parameters of free radical oxidation was comparatively studied in patients with type 2 diabetes who received metformin (Glucophage, Nycomed) (Group 1, n = 40) and sulfanylurea preparations (Group 2, n - 30, out of them 15 patients took maninil and 15 had diabeton) good glycemic control caused the magnitude of oxidative stress to reduce, which appeared as the decreased levels of primary (lipid hydroperoxides) and secondary (malonic dialdehyde) products of free radical oxidation in LDL and as the enhanced activity of antioxidative defense enzymes. However, with the identical degree of glycemic control, which was determined by the level concentrations of HbA1c and lipids in both groups, the plasma levels of lipid peroxides decreased by more than 5 times in Group 1 patients receiving metformin than in Group 2 patients and the rate of LDL oxidability reduced by 4.5 times. Such a marked effect of metformin on the attenuated manifestations of oxidative stress is indicative of its antioxidative effect independent of the hypoglycemic effect of the drug.

The ALS/MND prevalence in Sweden estimated by riluzole sales statistics.

OBJECTIVES: To determine whether sales statistics for riluzole can be used as a marker for the prevalence of amyotrophic lateral sclerosis (ALS)/motor neuron disease (MND) in Sweden. MATERIALS AND METHODS: A questionnaire was sent to all neurological units in Sweden asking about the numbers of patients with ALS/MND and whether these patients were treated with riluzole. Sales statistics for riluzole were obtained from the 906 public pharmacies and 89 hospital pharmacies in Sweden. RESULTS: Eighty percent of the neurological units answered the questionnaire. The estimated prevalence in September 2003 from the questionnaire was 5.4/100,000 inhabitants. The sales expressed in defined daily dose/100,000 inhabitants/day was 3.8. For the counties the correlation between these two parameters was 0.83. CONCLUSION: Estimated prevalence is highly correlated with sales statistics for riluzole. Riluzole sales statistics could be used as a crude marker for the prevalence of ALS/MND in Sweden.

Interrelation between compensation of carbohydrate metabolism and severity of manifestations of oxidative stress in type II diabetes mellitus.

Glycosylation end-products formed during diabetes mellitus promoted atherogenic oxidative modification of low-density lipoproteins. We evaluated the effects of compensation of carbohydrate metabolism and therapy with antioxidant probucol on parameters of free radical oxidation in patients with type II diabetes mellitus. Compensation of carbohydrate metabolism reduced manifestations of oxidative stress, which was manifested in accelerated enzymatic utilization of reactive oxygen species and lipid peroxides and decreased content of free radical oxidation products in low-density lipoproteins. In patients with type II diabetes mellitus combination therapy with antioxidant probucol decreased the severity of oxidative stress and stabilized carbohydrate metabolism without increasing the dose of hypoglycemic preparations.