[COMPASS study results as a foundation for new treatment approach for neurological patients. Opinion of the expert council of december 18, 2021]. / Znachenie rezul'tatov issledovaniya COMPASS v izmenenii podkhodov k lecheniyu patsientov nevrologicheskogo profilya. Zaklyuchenie soveta ekspertov ot 18 dekabrya 2021 g.

The resolution of the Council of Experts devoted to the discussion of the effectiveness of the use of a combination of rivaroxaban 2.5 mg 2 times a day and acetylsalicylic acid 100 mg per day to prevent recurrent non-coronary ischemic stroke results of the COMPASS study is presented. The advantages of this combination and the safety of its use are considered. Recommendations for the implementation of the results of the study in clinical practice are given.

[Peripheral neurostimulation in headache treatment]. / Perifericheskaia neirostimuliatsiia v terapii golovnykh bolei.

According to rough estimates, at least one third of the population in developed countries suffers, to varying degrees, from certain forms of primary headache, the modern pharmacotherapy of which is not always effective and has a number of limitations. The non-pharmacological treatment of headache can be an alternative to the prescription of pharmacological agents and the only possible assistance option for patients developing drug-resistant cephalalgias. This review describes various methods of electrical neuromodulation that are used for the management of primary headaches. The authors provide information on current stages in implementation of implantable and non-invasive equipment into clinical practice, which makes possible electrical stimulations of peripheral nerves and of the sphenopalatine ganglion, as well as allows transcranial magnetic stimulation. Also the appearance and usage of portable electrical devices available on the world market are described, and mechanisms that can underlie anticephalgic action of neuromodulation therapy are discussed. Special attention is paid to the methods that are applied for electrostimulation of the vagus nerve and occipital nerves.

[The diagnostic significance of vestibular evoked myogenic potentials in different types of vertigo]. / Diagnosticheskoe znachenie vestibuliarnykh miogennykh vyzvannykh potentsialov pri raznykh tipakh golovokruzheniia.

AIM: To study the parameters of vestibular evoked myogenic potentials (VEMPs) in different types of vertigo. MATERIAL AND METHODS: Seventy-seven patients, 35 men and 42 women, aged 43.7±12.5 years, with vestibular vertigo and unsteadiness were examined. The activity of the stemocleidomastoid muscle in response to auditory stimulation of the ipsilateral ear was recorded using surface electromyography. RESULTS: There were a trend towards the increase in the N2 latency, the significant reduction of the P1-N2 amplitude (p<0,005) on both sides and significant changes in the coefficient of asymmetry. Compared to healthy people, the P1 latency and asymmetry in P1 latency were significantly increased in patients with peripheral type of vertigo (p<0,005 and р=0,0007, respectively). There were no differences in the P1 latency and N2 in patients with unsteadiness. CONCLUSION: In patients with peripheral vertigo, central vertigo and unsteadiness, vestibular-spinal reflex was disturbed at different levels of vestibular analyzer.

[Fluvoxamine, amitriptyline and transcranial electrostimulation of the brain in the treatment of chronic daily headache].

Efficacy of antidepressants fluvoxamine, amitriptyline and transcranial electrostimulation of the brain in the treatment of chronic daily headache has been studied. Amitriptyline had the highest effect in dosage 50 mg daily but was not well tolerated by patients that resulted in that only 50% of them finished the study. Fluvoxamine had high efficacy and good tolerability in the treatment of chronic daily headache and medication overuse headache. Small dosages of amitriptyline and fluvoxamine potentiated the analgesic effect of transcranial electrostimulation of the brain. The combination of antidepressants with transcranial electrostimulation of the brain alleviated the negative effect of the withdrawal of overused analgesics and may be recommended for out-patient use.

[The role of ozone therapy in prevention of pyoinflammatory complications after transurethral resection of prostatic adenoma].

The study of efficacy of ozone therapy (OT) in preparation of patients with prostatic adenoma (PA) and cystostoma for transurethral resection (TUR) of PA included 20 PA patients with cystostomic drainage who had undergone PA TUR and preoperative preparation with OT sessions. The control group consisted of similar patients but without ozone pretreatment. OT efficacy was assessed by the rate of pyoinflammatory complications (PIC), results of immunological examination, positive changes in prostatic secretion, urine analysis, total blood count, degree ofbacteriuria. In the study group PIC (acute urethritis) developed in 1 patient, in the control--in 6 patients (3 cases of acute urethritis, 2 cases of acute prostatitis and 1 case of acute epididymitis). OT led to lowering of mean values of leukocyturia from 18.1 +/- 0.6 to 14.3 +/- 0.7 on the day of operation, to 10.9 +/- 0.7 after 4 days and to 8.7 +/- 0.6 on postoperative day 8 versus from 18.8 +/- 0.8 to 15.4 +/- 0.7, to 15.8 +/- 0.6 and 13.5 +/- 0.6, respectively. Mean control count of leukocytes in prostatic secretion fell in both groups. OT reduced bacteriuria. Number of bacteria to the day of operation decreased in both groups, but complete elimination of the agent from urine on day 8 was not achieved in the controls. The study group exhibited a rise in the absolute count of blood leukocytes, lymphocytes and ESR diminishing. OT raised significantly the phagocytic count and activity, concentration of mature T-lymphocytes (CD3), T-helpers (CD4), cytotoxic T-lymphocytes (CD8), B-lymphocytes (CD20), T-NK-cells (CD16), T-lymphocyte activation markers (CD3+, CD16+, CD56+, CD3+, CD25+, HLADR+, CD3+. The concentration of IgG, IgM, IgA remained high. Thus, the results of ozone application before PA TUR appeared promising in prevention of postoperative PIC.

[Endoscopic treatment of bladder diverticula]. / Endoskopicheskoe lechenie divertikulov mochevogo puzyria.

Transurethral endoscopic incision of the urinary bladder's diverticular neck has been performed in 29 patients aged 44 to 90 years (mean age 65 years). 25(86.2%) patients had verified concomitant diseases and high anesthesia risk prohibiting radical surgery. According to preoperative diagnosis, the volume of the diverticula ranged from 20 to 700 ml, the diameter of the neck--from 0.3 to 2.0 cm. 10 patients had multiple diverticula. Uroflowmetry registered the maximal urinary flow rate (Qmax) within 2.1-5.3 ml/s. In all the patients surgery was performed under epidural anesthesia, simaltaneously with transurethral resection (TUR) of benign prostatic hyperplasia in 18 patients, with TUR of the urinary bladder neck or incision of the prostate because of its sclerosis in 11 patients. In 2 cases there was also TUR of the bladder for papillary cancer involving the bladder wall and the diverticulum, in 6 cases one-stage pneumatic or mechanical cystolithotripsy was performed. No intraoperative complications occurred. After the operation all the patients resumed normal micturition. Control examination after 6-48-month follow-up Qmax rose to 14.1-23.0 ml/s. Neither ultrasound investigation nor cystography detected diverticulum in 13 patients. The size of the diverticulum diminished in size in 16 patients. Residual urine in large diverticula (14 patients) was 50 ml maximum. 12 months after the operation 1 patient developed recurrent sclerosis of the prostate with reappearance of residual urine. He was reoperated (TUR of the prostate) without incision of the neck of the diverticulum. Postoperative complications were the following: mild electric burn of the thigh (1 case), acute epididimitis treated conservatively (1 case) and early postoperative bleeding which required endoscopic revision of the bladder and coagulation of the bleeding vessel from the cut neck of the diverticulum (1 case). Thus, transurethral incision of the bladder's diverticular neck is effective and low-traumatic intervention which in patients with severe somatic pathology is an alternative to the open surgery, while in patients without such pathology it does not complicate open operation (diverticulectomy) if it becomes necessary.

[The effect of tropoxin on the neurogenic and vasogenic inflammation of the dura mater vessels]. / Vliianie tropoksina na neirogennoe i vazogennoe vospalenie sosudov tverdoi mozgovoi obolochki.

Subchronic administration of tropoxin (in doses of 7.5 and 10 mg/kg) caused dose-dependent blocking of 131I-albumin plasma transudation from the dura mater vessels, induced by electrical stimulation of the trigeminal ganglion and intravenous infusion of the agonist of 5-HT2B/2C receptors metachlorophenylpiperazine. The antimigraine agent metisergid produced a similar effect. A single injection of metisergid and tropoxin did not block albumin transudation. A 3 mg/kg dose of mianserin prevented the blocking effect of tropoxin and metisergid on plasma exudation into the dura mater. It is suggested that the mechanism of the tropoxin antimigraine effect is realized through the presynaptic 5-HT1 receptors of afferent endings of the trigeminal nerve and the postsynaptic 5-HT2B/2C receptors of the dura mater vessels.

[Study of mechanisms of action of amitriptyline and acupuncture using nociceptive flexor reflex in patients with chronic forms of headache]. / Izuchenie mekhanizmov deistviia amitriptilina i akupunktury s pomoshch'iu notsitseptivnogo sgibatel'nogo refleksa u patsientov s khronicheskimi formami golovnykh bolei.

The nociceptive flexor reflex (NFR, R3) was tried for quantitative assessment of pain in patients with various forms of primary and secondary headaches. Amitriptyline and acupuncture elevated the threshold of R3-reflex emergence, though the threshold of subjective pain sensitivity increased only in response to amitriptyline. NFR is adequate for assessing anesthesia efficacy and investigating the mechanisms of action of analgesics in patients with headache.

[The combined use of acupuncture and antidepressants for managing the spondylogenic lumbosacral pain syndrome]. / Sochetannoe primenenie akupunktury i antidepressantov dlia kupirovaniia spondilogennogo poiasnichno-kresttsovogo bolevogo sindroma.

The effects of antidepressants amitriptyline and pyrazidol on the analgesic action of acupuncture in patients with lumbosacral radiculitis was studied by the double blind control method. The combined use of acupuncture with antidepressants was shown to enhance the effectiveness of the treatment, to increase on the average by 5-6 hours the duration of analgesia within 24 hours after each procedure, to reduce the duration of the treatment on the average by 4-5 days, that indicates the expediency of clinical use of the proposed combination.

[The analgetic activity of antidepressants and their influence on the pain-relieving effect of acupuncture]. / Issledovanie anal'geticheskoi aktivnosti antidepressantov i ikh vliianiia na boleutoliaiushchii éffekt akupunktury.

The analgesic properties of new Soviet-made antidepressants pyrasidol, incazan, tetrindol as compared with amitriptyline and their influence on the analgesic effect of acupuncture were studied in experiments on rats by using the method of electrical stimulation of the tail root with stimuli of the increasing intensity. All the studied drugs at single and subchronic (6 days) administration possessed the analgesic actions. Pyrasidol exerted the most pronounced effect. The antidepressants enhanced the analgesic effect of electroacupuncture, in particular during activation of the points of general action and this effect showed up to the greatest degree under medication with pyrasidol.