[Toxoplasmosis in the practice of a neurologist]. / Toksoplazmoz v praktike nevrologa.

Toxoplasmosis is a zoonotic protozoal disease characterized by a chronic course, polymorphism of clinical manifestations, predominant damage to the central nervous system, organs of vision, liver and lungs. The causative agent of the disease is the obligate intracellular parasite Toxoplasma gondii, which circulates widely in the external environment and has a large circle of intermediate hosts. Toxoplasmosis is classified by the method of infection (congenital or acquired), by pathogenesis (acute or chronic), by manifestation (latent or with the manifestation of symptoms). According to the state of the human immune system, the disease can occur without immunodeficiency, while the patient has a chronic lifelong carrier, and with immunodeficiency. People with HIV most commonly present with cerebral toxoplasmosis. The article presents a case of the development of toxoplasmosis in a patient in the absence of a burdened history.

[Nonimmunogenic staphylokinase in the treatment of acute ischemic stroke (FRIDA trial results)]. / Neimmunogennaya stafilokinaza ­ novyi tromboliticheskii preparat v lechenii ishemicheskogo insul'ta (rezul'taty issledovaniya FRIDA).

AIM OF THE STUDY: To investigate the efficacy and safety of non-immunogenic staphylokinase (NS) compared with alteplase (A) in patients with acute ischemic stroke (AIS) within 4.5 h after symptom onset. MATERIAL AND METHODS: 336 patients with IS within 4.5 h after symptom onset were included in a randomized, open-label, multicenter, parallel-group, non-inferiority comparative trial of NS vs A (168 patients in each group). NS was administered as an intravenous bolus in a dose of 10 mg, regardless of body weight, over 10 s, A was administered as a bolus infusion in a dose of 0.9 mg/kg, maximum 90 mg over 1 hour. The primary efficacy endpoint was a favorable outcome, defined as a modified Rankin scale (mRS) score of 0-1 on day 90. Safety endpoints included all-cause mortality on day 90, symptomatic intracranial haemorrhage, and other serious adverse events (SAEs). RESULTS: At day 90, 84 (50%) patients reached the primary endpoint (mRS 0-1) in the NS group, 68 (41%) patients - in the A group (p=0.10, OR=1.47, 95% CI=0.93-2.32). The difference between groups NS and A was 9.5% (95% CI= -1.7-20.7) and the lower limit of the 95% CI did not cross the margin of non-inferiority (pnon-inferiority<0.0001). There were no significant differences in the frequency of deaths between the groups: on day 90, 17 (10%) patients in the NS group and 24 (14%) in the A group had died (p=0.32). There was a trend towards significant differences in the frequency of symptomatic intracranial haemorrhage: NS group - 5 (3%) patients, A group - 13 (8%) patients (p=0.087, OR=0.37, 95% CI=0.1-1.13). There were significant differences in the number of patients with SAEs: in the NS group - 22 (13%) patients, in the A group - 37 (22%) patients (p=0.044, OR=0.53, 95% CI=0.28-0.98). CONCLUSION: The presented results of the FRIDA trial are the first in the world to use a drug based on NS in patients with IS. It has been shown that a single bolus (within 10 s) administration of NS at a standard dose of 10 mg, regardless of body weight, allows to conduct fast, effective and safe thrombolytic therapy in patients with IS within 4.5 h after symptom onset. In further clinical tials of NS, it is planned to expand the therapeutic window beyond 4.5 h after symptom onset in patients with IS.

[Thrombolytic therapy of ischemic stroke]. / Tromboliticheskaia terapiia ishemicheskogo insul'ta.

Reperfusion therapy is one of the main treatment strategies of ischemic stroke. The first studies of the efficacy of thrombolytic medications started form the use of streptokinase and fibrinolysin in patients with ischemic stroke in late 50 - early 60 of the XX century in the United States, Soviet Union, and Western Europe. After the development of recombinant tissue plasminogen activator, thrombolysis became one of the main methods of reperfusion in patients with acute ischemic stroke, acute myocardial infarction, or other acute vascular thrombotic events. Later, modified variants of tissue plasminogen activator with prolonged clearance time, high fibrin-selectivity, and bolus delivery were introduced. Another group of thrombolytic agents includes derivatives of flora and fauna - external plasminogen activators, of which streptokinase, staphylokinase, and desmoteplase are most common drugs. These medications are not a structural part of the human organism, and overcoming of immunogenicity while preserving fibrinolytic activity and fibrin specificity is one of the main tasks in applying them in clinical practice.

[Trace elements in the nervous tissue and ischemic stroke].

Disbalance of the trace elements increases the risk of cerebrovascular disease and, first of all, of ischemic stroke (IS). This is due to the fact that certain trace elements are necessary for maintaining various aspects of the metabolism of neurons and glia. Energetic and plastic processes in the nervous tissue have an extremely active dynamics and their dependence on the availability of brain macro-and micronutrients makes it necessary to take into account the trace element status of patients with IS. This paper presents the results of clinical and basic research which revealed the association between the content of certain trace elements in different biological substrates and the course of stroke. The importance of magnesium, zinc, manganese, copper and selenium for the support of the function of the nervous tissue was shown. The study of the trace element profile in various regions of the brain in patients with IS is a very promising area of modern neurological research.

Magnetic excitations in EuCu2(Si(x)Ge(1-x))2: from mixed valence towards magnetism.

We report the inelastic neutron scattering study of spin dynamics in EuCu(2)(Si(x)Ge(1-x))(2) (x = 1, 0.9, 0.75, 0.6), performed in a wide temperature range. At x = 1 the magnetic excitation spectrum was found to be represented by the double-peak structure well below the energy range of the Eu(3+) spin-orbit (SO) excitation (7)F(0)→(7)F(1), so that at least the high-energy spectral component can be assigned to the renormalized SO transition. Change of the Eu valence towards 2 + with increased temperature and/or Ge concentration results in further renormalization (lowering the energy) and gradual suppression of both inelastic peaks in the spectrum, along with developing sizeable quasielastic signal. The origin of the spectral structure and its evolution is discussed in terms of excitonic model for the mixed valence state.

[Analysis of a disturbance of trace element balance in patients with ischemic stroke with arterial hypertension].

Disturbance of trace element balance increases the risk of cerebrovascular disease and, above all, ischemic stroke (IS). A comparative analysis of clinical and demographic parameters and trace element composition of hair was performed in the group of 30 ischemic stroke patients with arterial hypertension (AH) and 30 stroke patients without hypertension (mean age 55±7 years). The stroke patients with hypertension were characterized by the elevated body mass index (28.5±4.1 kg/m2, AI, 26.0±2.9 kg/m2, p=0.006), higher incidence of coronary heart disease (p=0.04). Alcohol consumption more than 3 drinks a week was associated with a 5-fold increase of the risk of stroke with hypertension (95% CI 1.0-27, p=0.035). The results revealed a number of statistically significant differences in trace element profile in the studied groups of patients: deficits of essential magnesium, manganese, cobalt, copper, zinc, a statistically significant increase in sodium levels, toxic and conditionally toxic trace elements (cadmium, mercury, bismuth, barium, etc.). One of the probable factors that lead to the accumulation of toxic trace elements in stroke patients is the increased consumption of alcohol including that of substandard quality. The data obtained also show the feasibility of implementing screening programs to assess micronutrient status (including trace elements) for early detection of pathological abnormalities in the elemental homeostasis that might lead to an increased risk of ischemic stroke and hypertension.

[Recurrent choledocholithiasis. Diagnosis, prevention and treatment].

For the period of 6 years we have 110 patients with recurrent bile duct stones (BDS). Were evaluated the changes of the bile duct and bile papilla (BP), predisposing to the recurrence of BDS; the causes of recurrent BDS after endoscopic papillosphincterotomy (EPST). To improve the treatment results in patients with recurrent BDS is necessary: at the primary operation to estimate the changes of the BP and periampulyarnuyu area, in patients with completed EPST to prescribe litolitic therapy; in patients with a complex BDS after unsuccessful attempt of EPST to do holedoholitotomy with a blind stitch or in combination with the drainage of Pikovsky.

[A multicenter program on assessment of efficacy and safety of a new therapeutic scheme for patients with chronic cerebrovascular insufficiency].

An assessment of the complex multicenter prospective non-comparative program aimed at studying of efficacy and safety of a new scheme of therapy with cavinton in patients with chronic cerebrovascular insufficiency has been conducted. One hundred and forty-nine patients (46 male, 113 female), aged from 35 to 65 years, have been examined. The treatment started from intravenous infusions of the drug during 7 days as follows: 20, 30, 40, 50, 50, 50 and 50 mg of cavinton solution diluted in 500 ml of physiologic solution with the following peroral taking of cavinton forte in dose 10 mg 3 times daily during 11 weeks. Efficacy of drug was primarily assessed with MMSE and then by SF-36 and CGIC-PGIC. There were significant differences in scores on MMSE and SF-36 before and after treatment and on CGIC-PGIC on the 8th and 90th days of the study. The parenteral and peroral use of cavinton is well-tolerated and has a favorable safety profile.

[Cerebrolysin alleviates perinatal CNS disorders through the autoimmune modulation and antioxidant protection].

We investigated the effects of the neuroprotective drug cerebrolysin on the autoimmune parameters (FasL, Fas and metallotionein-1) in 20 newborns with perinatal ischemic CNS damage and 20 healthy newborns. The treatment with cerebrolysin in dosage of 0,1 ml per 1 kg of body mass, 10 injections every other day, resulted in the normalization (p<0,001) of the T-lymphocyte apoptosis (the increase of Fas and decrease of FasL) and activation of antioxidant protection through the increase of metallotionein-1 expression. The normalization of the autoimmunity was found to reduce edema and improve the circulation of the brain sites affected with ischemia.

[Neurobiology of lithium].

In addition to well-documented mood-stabilizing effects, lithium can be used in the treatment of acute brain injuries (ischemia) and chronic (neurodegenerative) diseases. Recent in vitro and in vivo studies reveal that the long-term treatment with lithium up-regulates cell survival molecules (Bcl-2, cAMP-responsive element binding protein, GRP 78, brain-derived neurotrophic factor, Hsp70) and down-regulates pro-apoptotic activities (e.g., excitotoxicity, p53, Bax, caspase, cytochrome C release, beta-amyloid peptide production and tau hyperphosphorylation) thus preventing or even reversing the neuronal cell death and neurogenesis retardation.

[The circadian changes of plasma and blood viscosity and hematocrit in patients with ischemic stroke].

We studied the blood and plasma viscosity and hematocrit in patients with ischemic stroke and in a control group. Patients with ischemic stroke had a marked hyperviscosity and elevated hematocrit levels which were correlated with arterial hypertension, alcohol consumption and tobacco smoking. In women aged 45-55 years, viscosity and hematocrit were correlated with age that may be explained by the hormonal changes. People with ischemic stroke had three variants of circadian patterns of viscosity and hematocrit with peaks at 9 am, 3 pm and 9 pm. In some patents a strong correlation between the time of stroke onset and circadian pattern was observed.

[Quality of histological diagnosis and methods of its assessment].

Two aspects of histological diagnosis quality are considered: sufficiency and significance of clinical information. The sufficiency is determined as correspondence to relevant standards, significance or validity is judged by comis on of detectability and incidence rate, by comparison of the conclusions of different pathologists.