[Comorbidity of neuromyelitis optica spectrum disorder and systemic lupus erythematosus]. / Komorbidnost' zabolevaniya spektra optikoneiromielita i sistemnoi krasnoi volchanki.

The comorbidity of neuromyelitis optica spectrum disorder (NMOSD) and systemic lupus erythematosus (SLE) is a poorly studied problem. The issues of the pathogenetic relationship between these diseases, timely diagnosis of their co-existence in one patient, disease course and therapeutic approaches are the most relevant. The authors summarize current views on the state of the problem and analyze three clinical cases of NMOSD and SLE comorbidity including the diagnostic issues and therapeutic approaches.

[Diagnostic value of immunoglobulin free light chains at the debut of multiple sclerosis]. / Rol' opredeleniia svobodnykh legkikh tsepei immunoglobulinov v diagnostike debiuta rasseiannogo skleroza.

AIM: To evaluate the diagnostic value of determination of free immunoglobulin light chains (IgG) in the debut of multiple sclerosis (MS). MATERIAL AND METHODS: Data from 226 patients, including 111 patients with clinically isolated syndrome with conversion to multiple sclerosis within the first 2 years of the disease (group 1), 49 patients with clinically isolated syndrome who did not develop multiple sclerosis within the first 2 years of the disease (group 2), 20 patients with other inflammatory diseases of the central nervous system (group 3) were analyzed. The control group consisted of 46 patients with non-inflammatory diseases of the central nervous system. The clonality of immunoglobulins in the CSF, concentration of kappa and lambda free light chains and their ratio were studied. RESULTS: Concentrations of free light chains were significantly higher in the first group in comparison with group 2 and the control group, but didn't differ from group 3. In group 3, concentrations of free light chains were significantly higher compared to group 2 and controls. In oligoclonal-positive patients with clinically isolated syndrome (groups 1 and 2), concentrations of kappa and lambda free light chains were significantly higher than in oligoclonal-negative patients. The production of free light chains in patients from the first group was considerably higher than in group 2 regardless of the oligoclonal status. The concentration of kappa chains and quotient of kappa free light chains in the CSF had the best diagnostic characteristics. Their use, along with the evaluation of IgG clonality, reduced the risk of false-negative results by 50%. Regardless of other factors, elevated concentrations of kappa chains increase the likelihood of MS diagnosis by 9.718 times. CONCLUSION: The use of free light chains as a laboratory marker can increase the accuracy of MS diagnosis. These markers can help indirectly assess the risk of transformation of a clinically isolated syndrome into definite multiple sclerosis within the first 2 years of disease.

[The biomarkers of cerebral ischemia as a new method for the validation of the efficacy of cytoprotective therapy]. / Biomarkery ishemii golovnogo mozga kak novyi metod dokazatel'stva éffektivnosti neirotsitoprotektorov.

AIM: To study blood plasma concentrations of NR2-peptide in patients with ischemic stroke (IS) to assess its diagnostic value as a biomarker of cerebral ischemia and determine the dynamics of the biomarker during treatment with cortexin. MATERIAL AND METHODS: One hundred and twenty patients, aged from 18 to 70 years, including 36 with transient ischemic attack (TIA) and 84 with IS in the carotid territory (n=70) and vertebral/basilar territory with the Wallenberg-Zakharchenko syndrome (n=14), were enrolled. The National Institute of Health Stroke scale (NIHSS) was used to assess neurological status. Blood plasma concentration of NR2-peptide was measured in all patients at admission and after treatment. All laboratory results were compared with neuroimaging (MRI, CT) data. RESULTS: Concentrations of NR2-peptide detected in all patients were higher than in controls (>1.5 ng/ml), p<0.0001. The direct correlation between NR2-peptide (from 3.38 ng/ml to 15.6 ng/ml) and ischemic lesion (from few to 80 mm) was observed. A decrease in NR2-peptide concentration (from 8.5 to 5,.9 ng/ml, p<0.0001) was noted in patients treated with cortexin after 10-day treatment course. CONCLUSION: NR2-peptide blood assay is a reliable hemotest of brain ischemia. Cortexin has a sufficient therapeutic efficacy.

[The association of intrathecal production of immunoglobulin free light chains and progression of multiple sclerosis]. / Sviaz' intratekal'noi produktsii svobodnykh legkikh tsepei immunoglobulinov s progressirovaniem rasseiannogo skleroza.

AIM: To assess an impact of immunoglobulin free light chains (FLC) on short-term and long-term prognosis of clinical and radiological activity and progression of disability in multiple sclerosis (MS). MATERIAL AND METHODS: A sample of 381 patients with definite MS was divided into 2 groups. In group 1, lumbar puncture was performed at the time of clinically isolated syndrome, and patients were prospectively followed up to 2 years (short-term prognosis group, n=97). In group 2, MS was diagnosed immediately after lumbar puncture, and retrospective analysis of the disease course with the duration not less than 5 years was performed (long-term prognosis group, n=284). The Expanded Disability Status Scale (EDSS) and the Multiple Sclerosis Severity Score (MSSS) were used to assess patient's status. Concentrations of kappa and lambda FLC in the CSF (K-FLCCSF, L-FLCCSF) and serum (K-FLCSERUM, L-FLCSERUM) as well as quotients of concentrations (Q-K and Q-L) were determined. Patients were stratified into subgroups with high and low concentrations of K-FLC and L-FLC using cut-offs from our previous studies: K-FLCCSF=0.595 mcg/l and L-FLCCSF=0.127 mcg/l. RESULTS: In group 1, significant correlations were found only between EDSS score and concentrations of K-FLCCSF (r=0.377, p=0.00019) and Q-K (r=0.366, p=0.0012). FLC concentrations did not correlate with the number of relapses and new T2 lesions. The age and EDSS score at the disease onset didn't differ between patients with high and low K-FLC and L-FLC (K-FLCCSF: р=0.2658; L-FLCCSF: р=0.5502). A significant decrease of EDSS score after the disease onset was observed in all groups except for patients with high concentrations of K-FLCCSF (p=0.1844), so the EDSS score after 2 years was significantly higher in this subgroup of patients (p=0.0006). In group 2, significant correlations of K-FLC with EDSS score (r=0.181, p=0.002) and MSSS score (r=0.121, р=0.044) for long-term prognosis (median (IQR) = 8 (6-13) years) were found. No correlations of FLC concentrations with the number of relapses during the first 5 years were found. Survival analysis showed that high concentrations of K-FLCCSF were associated with the high risk of progression to EDSS 6 (HR=2.055, p=0.026) but not with EDSS 4 (HR=2.388, p=0.08). CONCLUSION: Concentrations of kappa FLC can help to define the prognosis of MS early at the disease course. Although low concentrations of FLC do not exclude a severe disease phenotype, patients with high K-FLCCSF concentrations are at greater risk for faster MS progression, probably, due to impaired reparation of neural tissue. Measurement of FLC concentrations can be used to determine a therapeutic tactics in patients with MS.

[The improvement of treatment efficacy in newborn full-term infants with severe birth asphyxia]. / Povyshenie effektivnosti terapii novorozhdennykh donoshennykh detei s tyazheloi asfiksiei v rodakh.

AIM: To investigate the efficacy of cytoflavin as add-on to moderate controlled hypothermia in the treatment of newborn full-term infants with severe birth asphyxia. MATERIAL AND METHODS: Sixty full-term underweight children diagnosed with severe birth asphyxia (Apgar score 4-5) underwent moderate hypothermia for 72 hours. Depending on the regimen, the children were divided into two equal groups: the basic group received cytoflavin in dose of 2 ml/kg / day and the control group received the traditional scheme of therapy. RESULTS: The inclusion of cytoflavin increases the efficacy of therapy by reducing the severity of depression of consciousness (the increase in the average total score on the modified Glasgow Coma Scale pediatric/Saint Petersburg by 47.1% in children of the basic group compared with 27.9% in the control group, p=0.04) and more rapid recovery of vital functions (early extubation by 20.3%, p=0.03, and transition to enteral feeding earlier by 16.7% compared with the control group). The use of cytoflavin in newborns with severe asphyxia reduces lactic acidosis in the blood serum and normalizes EEG parameters as compared to the control group (p=0.02). CONCLUSION: Cytoflavin can be recommended as adjunctive therapy in full-term infants with severe intrapartum asphyxia.

[Role and place of biochemical markers in diagnosis of cerebral ischemic stroke].

In recent years neurologists pay special attention to biochemical markers of instrumental diagnosis of brain ischemia in its acute phase. Determination of specific biomarkers in the blood of patients at early stages of cerebral blood circulation disorders may be helpful in screening patients at high risk of stroke in the short-term period. We present a review of literature and an analysis of own data (over 200 patients) with chronic and acute cerebral blood circulation disorders on the possibility of using brain biomarkers in clinical practice. The diagnostic value of NR2-antibodies in stroke with ischemic volume 5-70 cm3 is approximately 95,9% and in transitory ischemic attacks--98%.

[Short- and long-term effects of internal carotid arteries stenting in high-risk patients].

The efficacy of endovascular treatment of internal carotid arteries (ICA) stenosis (20 patients) has been compared to that of conventional carotid endarterectomy (25 control cases). ICA stenting was performed in case of stenosis, narrowing arteries to > or = 60% in "symptomatic" patients and to > or = 80% in "asymptomatic" ones. Angiographic indices revealed favorable outcome after stenting in 100%. Mean extent of residual stenosis was 8.3 +/- 0.8%. Significant complications (stroke/fatal outcome) after 22 procedures developed in 3 (13.6%) cases. Mortality was estimated as 4.5%. Taking stroke and fatal cases into account, the interventions were successful in 86.4% cases. The duration of follow-up study was from 1 to 48 months, with 1 case resulting in death and 2--in development of acute disturbance of cerebral blood circulation of contralateral ICA. Short- and long-term results of the intervention did not significantly differ between the study and control groups thus indicating ICA stenting as an alternative to carotid endarterectomy procedure.

[Arterial and venous blood flow at different stages of vascular cognitive impairment].

Sixty-nine patients with vascular cognitive impairment (VCI) have been studied using complex assessment of clinical, cognitive, imaging and sonographic characteristics at different stages of the disease. The ratio of venous return from the brain to arterial inflow, an integral parameter of cerebral hemodynamics, has been also investigated. The results revealed that the most severe clinical, cognitive and imaging changes were typical for cases with disturbances of both arterial and venous cerebral blood flow. VCI progression was followed by the deterioration of cognitive and imaging characteristics. The advanced stage of VCI was featured by the most significant clinical, cognitive and imaging changes, on one hand, and moderate sonographic characteristics, on the other. Disorders of both arterial and venous cerebral blood flow components contribute to VCI pathogenesis.

[A case of successful one-stage correction of abdominal aortic aneurysm and stenosis of the internal carotid artery in a 78-year-old patient]. / Sluchai uspeshnoi odnomementnoi korrektsii anevrizmy briushnoi aorty i stenoza vnutrennei sonnoi arterii u patsienta v vozraste 78 let.

Presented herein are the results of successful one-stage revascularization of the brain and reconstruction of the abdominal aorta in a 78-year old patient with infrarenal abdominal aortic aneurysm, the signs of rupture, stenosis of the left renal artery and multiple aortic arch lesions -- stenoses of both internal carotid arteries and both vertebral arteries. The sequence and technology of surgical intervention are described.