Integral estimation of systemic inflammatory response under sepsis.

Currently, the most significant mediators of the systemic inflammatory response (SIR), specific to the development of critical states in sepsis, have the chaotic changes of concentrations in the blood. The solution to the problem is using integral indicators. A scoring scale of the SIR (0-16 points) is proposed based on the determination in the blood plasma of CRP, TNF-α, IL-6, IL-8 and IL-10. The scale was used in the survey of 167 patients with a diagnosis of sepsis (43 patients with sepsis according to definitions of "Sepsis-1 or 2" and 124 patients with sepsis according to the criteria of "Sepsis-3"); septic shock was verified in 31 cases and in 48 cases lethal outcomes were recorded. The association of SIR with critical complications of sepsis was revealed, especially under acute septic shock and in cases of a "second wave" (days 5-7) of critical complications. In contrast, prolonged/subacute sepsis (more than 14 days) under tertiary peritonitis is characterised by a lesser dependence of the criticality of the state on the severity of SIR. The proposed scale is an open system and allows you to modify the range of used particular indicators that are compatible by pathogenetic and diagnostic significance.

Health-related quality of life in Russian adults with epilepsy: the effect of socio-demographic and clinical factors.

OBJECTIVE: The aim of this study was to evaluate socio-demographic and clinical factors influencing the health-related quality of life (HRQOL) of adult patients with epilepsy in a naturalistic treatment setting in Russia. METHODS: The QOLIE-31 questionnaire and the Beck Depression Inventory (BDI) were completed by 208 patients with a broad clinical spectrum of epilepsy (the mean age was 31.49±13.20 years and ranged from 18 to 74 years). RESULTS: In Russian adult patients with epilepsy, lower mean QOLIE-31 scores were obtained compared with previously published international data for overall HRQOL, emotional well-being, and cognitive functioning and social functioning subscales (p<0.001). Univariate analysis revealed that duration of epilepsy negatively correlated with all QOLIE-31 subscores (p<0.05), except for emotional well-being (p=0.1). In multivariate regression analysis, BDI depression score was the predictor of overall score and all QOLIE-31 domains, except for emotional well-being. Age could be considered as a predictor of cognitive and social functioning, medical effects, and the total QOLIE -31 score. Seizure frequency was a factor associated with all HRQOL domains, except for medication effects and emotional well-being, whereas gender, education, family status, seizure type, employment, lateralization of epileptic foci, number of antiepileptic drugs, and the reported adverse events did not significantly affect HRQOL. CONCLUSION: The present study has revealed that longer duration of epilepsy, older age, higher seizure frequency, and depression are the potential predictors of worse HRQOL in adult Russian patients with epilepsy.

Cellular Stress and General Pathological Processes.

From the viewpoint of the general pathology, most of the human diseases are associated with a limited number of pathogenic processes such as inflammation, tumor growth, thrombosis, necrosis, fibrosis, atrophy, pathological hypertrophy, dysplasia and metaplasia. The phenomenon of chronic low-grade inflammation could be attributed to non-classical forms of inflammation, which include many neurodegenerative processes, pathological variants of insulin resistance, atherosclerosis, and other manifestations of the endothelial dysfunction. Individual and universal manifestations of cellular stress could be considered as a basic element of all these pathologies, which has both physiological and pathophysiological significance. The review examines the causes, main phenomena, developmental directions and outcomes of cellular stress using a phylogenetically conservative set of genes and their activation pathways, as well as tissue stress and its role in inflammatory and para-inflammatory processes. The main ways towards the realization of cellular stress and its functional blocks were outlined. The main stages of tissue stress and the classification of its typical manifestations, as well as its participation in the development of the classical and non-classical variants of the inflammatory process, were also described. The mechanisms of cellular and tissue stress are structured into the complex systems, which include networks that enable the exchange of information with multidirectional signaling pathways which together make these systems internally contradictory, and the result of their effects is often unpredictable. However, the possible solutions require new theoretical and methodological approaches, one of which includes the transition to integral criteria, which plausibly reflect the holistic image of these processes.

Factors influencing on quality of life in people with epilepsy.

OBJECTIVES: To assess the influence of different factors on health-related QOL in adults with epilepsy in Moscow, Russia. METHOD: We evaluated quality of life in 242 patients (98 de novo and 144 previously inadequately treated) by using QOLIE-31. Partial cryptogenic or symptomatic epilepsy was diagnosed in 214 patients, in 28-idiopathic generalized epilepsy. Stepwise regression analysis was performed to assess the influence of different factors on QOL. RESULTS: In patients with epilepsy in Russia the total score of QOLIE-31 was rather low-42.13+/-4.14. Relationship of quality of life (total score) and frequency of seizures and duration of disease was analyzed. Frequency of seizures was the most significant parameter related to QOL (R=0.46 with total score). Duration of disease also correlated with QOL score (R=0.24 with total score). Significant but rather weak association (link) between frequency of seizures and almost all of subscales of quality of life was noticed. Duration of epilepsy correlated with less number of subscales: Energy/fatigue, Medication effects, Social functioning, Overall QOL subscales. When factors influencing on QOL were separately analyzed in newly diagnosed and previously treated patients frequency of seizures was the most important parameter in both groups. CONCLUSIONS: Frequency of seizures is the most important factor influencing on QOL in adults with epilepsy (newly diagnosed and previously treated).

Current knowledge on the neuroprotective and neuroregenerative properties of citicoline in acute ischemic stroke.

Ischemic stroke is one of the leading causes of long-lasting disability and death. Two main strategies have been proposed for the treatment of ischemic stroke: restoration of blood flow by thrombolysis or mechanical thrombus extraction during the first few hours of ischemic stroke, which is one of the most effective treatments and leads to a better functional and clinical outcome. The other direction of treatment, which is potentially applicable to most of the patients with ischemic stroke, is neuroprotection. Initially, neuroprotection was mainly targeted at protecting gray matter, but during the past few years there has been a transition from a neuron-oriented approach toward salvaging the whole neurovascular unit using multimodal drugs. Citicoline is a multimodal drug that exhibits neuroprotective and neuroregenerative effects in a variety of experimental and clinical disorders of the central nervous system, including acute and chronic cerebral ischemia, intracerebral hemorrhage, and global cerebral hypoxia. Citicoline has a prolonged therapeutic window and is active at various temporal and biochemical stages of the ischemic cascade. In acute ischemic stroke, citicoline provides neuroprotection by attenuating glutamate exitotoxicity, oxidative stress, apoptosis, and blood-brain barrier dysfunction. In the subacute and chronic phases of ischemic stroke, citicoline exhibits neuroregenerative effects and activates neurogenesis, synaptogenesis, and angiogenesis and enhances neurotransmitter metabolism. Acute and long-term treatment with citicoline is safe and in most clinical studies is effective and improves functional outcome.