[Dynamics of platelet hemostasis indices in patients with cardioembolic stroke against the background of atrial fibrillation]. / Dinamika pokazatelei trombotsitarnogo gemostaza u patsientov s kardioembolicheskim insul'tom.

OBJECTIVE: To study the parameters of platelet hemostasis in patients with cardioembolic ischemic stroke on the background of atrial fibrillation and taking warfarin to assess the effectiveness of antiplatelet drugs in the prevention of recurrent ischemic strokes. MATERIAL AND METHODS: 93 patients with ischemic stroke on the background of atrial fibrillation were examined, of which the main group consisted of 43 patients who took warfarin and 50 patients from the reference group without warfarin. The study of the platelet link of hemostasis using inductors (adrenaline, ristomycin, arachidonic acid, collagen, ADP) in patients of both groups was carried out. In the group of patients taking warfarin there was a significant increase in platelet aggregation for adrenaline up to 57.15 [29.51; 62.61] (p=0.0315), spontaneous aggregation 2.46 [1.39; 6.75] (p=0.047), reduction of platelet aggregation for collagen 14.45 [4.80; 43.63] (p=0.008). In 35 patients of the study group (n=93), laboratory resistance to aspirin was also revealed in terms of platelet aggregation to arachidonic acid, which is a criterion for evaluating the effectiveness of preventive measures for recurrent ischemic strokes with antiplatelet drugs. CONCLUSION: The obtained data are additional risk factors for recurrent strokes. It is also recommended to study platelet aggregation for arachidonic acid to assess the effectiveness of antiplatelet drugs prophylaxis of recurrent ischemic strokes.

[A clinical and genetic analysis of risk factors for the development of acute and chronic cerebral ischemia]. / Kliniko-geneticheskii analiz faktorov riska razvitiia ostroi i khronicheskoi ishemii golovnogo mozga.

To study the association between polymorphic markers in the ACE, SERPINE1, FGB, F5, F7, F12, GP1BA, GPIIIa, MTHFR, CYP11B2, PON1, PON2, NOS2, NOS2, HIFla, LTA, ALOX5AP genes and clinical characteristics of acute and chronic forms of circulatory disorders of the brain. MATERIAL AND METHODS: The analysis of polymorphic variants in ACE, FGB, F5, F7, F12, GP1BA, GPIIIa, SERPINE1, MTHFR, CYP11B2, PON1, PON2, NOS2, NOS3, PDE4D, HIF1a, LTA, ALOX5AP in 81 patients with chronic cerebral ischemia (CCI) and 69 patients with ischemic stroke (IS), and their interrelation with clinical manifestations of disease were investigated. RESULTS AND CONCLUSION: The association between the T/T genotype of the PDE4D SNP 83C>T polymorphism and a rapid progression of hypertensive disease (GB) was revealed (OR=6.22, CI=1.86-20.79, p=0.0036) in the group of patients with CCI. The association of the allele D and the DD genotype of the ACE (I>D, rs1799752) with cardioembolic stroke (OR=2.67, 95% CI=1.23-5.8, p=0.02 and OR=7.14, 95% CI=1.72-29.69, p=0.0057) was found. When comparing subgroups of patients with different degrees of stenosis of brachiocephalic arteries (BCA), the association of the allele C and the TC genotype of the GP1BA (rs2243093, -5T/C) with BCA occlusion and expressed hemodynamically significant stenosis (>75%) was revealed (OR=3.39, 95% CI=1.12-10.25, p=0.03 and OR=4.44, 95% CI=1.27-15.54, p=0.023, respectively). Thus, polymorphic markers in PDE4D, ACE, GP1BA in combination with certain clinical characteristics are risk factors for the progression of CCI and development of IS.

[The state of microcirculation and platelet hemostasis in patients with ischemic stroke after systemic thrombolytic therapy]. / Sostoianie mikrotsirkuliatsii i trombotsitarnogo zvena gemostaza u patsientov s ishemicheskim insul'tom posle provedeniia sistemnoi tromboliticheskoi terapii.

AIM: The state of microcirculation and platelet hemostasis in patients with ischemic stroke after systemic thrombolytic therapy. MATERIAL AND METHODS: Forty-two patients after systemic thrombolytic therapy (TLT) (mean age 64.26 [60.58; 68.06]) and 47 patients without TLT (54.52 [47.48; 60.83]) were studied. The study of platelet hemostasis was conducted with the determination of platelet aggregation (AT) on adrenaline, ADP, ristomycin, spontaneous aggregation on days 1, 7 and 14. Studies of the state of microcirculation of cerebral vessels were carried out using the laser Doppler flowmetry (LDF). RESULTS AND CONCLUSION: Characteristics of changes in induced AT and parameters of the microcirculation system in patients after systemic TLT at 1, 7 and 14 days in comparison with the indices of patients without TLT were revealed that allowed to expand the understanding of pathological mechanisms of the microcirculatory bed, their connection with violations of central hemodynamics and to obtain additional markers of disease course and prognosis.

[The frequency of cerebrovascular disorders in patients with different forms of atrial fibrillation]. / Chastota perenesennykh narushenii mozgovogo krovoobrashcheniia u patsientov s razlichnymi formami fibrilliatsii predserdii.

AIM: To study the frequency of blood circulation disorders (BCD) in patients with different forms of atrial fibrillation (AF) and its relationship with AF duration and treatment with anticoagulants. MATERIAL AND METHODS: Medical records and medical history of 1626 patients with non-valvural AF were analyzed in Moscow from 2009 to 2015. RESULTS: Patients with persistent AF were older and had a higher risk of thromboembolic and hemorrhagic complications. In the group of patients with paroxysmal and persistent AF, percentage of patients with BCD (including recurrent ones) was decreased by 13.1 and 28.9% compared to the patients with persistent form. There was no correlation between AF duration and BCD frequency. The frequency of using anticoagulants was 10.8% in outpatients and 42.8% in inpatients. Patients with persistent AF received anticoagulants less frequently than patients with less persistent forms. CONCLUSION: Persistent AF is associated with the higher risk of BCD. The prevention of BCD in patients with persistent AF was insufficient compared to that in patients with less persistent forms.

[Platelet hemostasis in patients with ischemic stroke after systemic thrombolytic therapy]. / Osobennosti trombotsitarnogo gemostaza u patsientov s ishemicheskim insul'tom posle provedennoi sistemnoi tromboliticheskoi terapii.

AIM: To study the platelet aggregation (PA) in patients with ischemic stroke (IS) after systemic thrombolytic therapy (TLT). MATERIAL AND METHODS: Twenty-four patients, including 13 with atherothrombotic IS and 11 with cardioembolic IS, have been examined after systemic TLT. Spontaneous and adrenaline-induced PA, international normalized ratio, activated partial thromboplastin time, fibrinogen, neurological deficit severity on the NIHSS (2nd, 6-7th, 12-14th and 21st days after TLT), computed tomography (CT) of the brain (at baseline and 2nd day after TLT) were assessed. RESULTS: The correlation between TLT outcomes and characteristics of spontaneous and adrenaline-induced PA was shown. Patients with initially elevated PA (group 1, n=7) had the lowest NIHSS score in the 21st day. A group of patients with initially reduced PA (group 2, n=17) included a subgroup with no spontaneous aggregation (n=9) and a subgroup with hemostasis system dysregulation manifested with increased spontaneous PA and fibrinogen (n=8), in which the recovery of neurological functions was lower compared to group 1. CONCLUSION: The results of the study can be used for individualization of preventive antiaggregative and anticoagulative therapy after TLT.

[Characteristics of microcirculation in patients with acute ischemic stroke and chronic cerebral ischemia]. / Osobennosti sostoianiia mikrotsirkuliatsii u patsientov s ostrym ishemicheskim insul'tom i khronicheskoi ishemiei golovnogo mozga.

OBJECTIVE: To study microcirculation in patients with acute ischemic stroke (IS) using the method of laser Doppler fluorimetry (LDF). MATERIAL AND METHODS: We examined 19 patients with acute carotid IS, including 12 patients who received thrombolytic therapy. The reference group included 22 patients with chronic cerebral ischemia without a history of IS. Computed and magnetic resonance tomography of the brain, ultrasound diagnosis of head and neck vessels, the study of the changes in neurological status, emotional sphere, cognitive functions and laboratory methods were used. RESULTS: An index of total blood flow in the microcirculatory bed on the side of stroke was lower compared to that in patients with chronic cerebral ischemia. The study of parameters of microcirculatory bed regulation revealed an increase of blood inflow into the microcirculatory bed with the augmentation of the myogenic activity of arterioles and primarily the nutritional regimen of microhemocirculation. A decrease in the myogenic activity in the microcirculation system and nutritional direction of microhemodynamics were noted in patients with large IS. In some cases, non-nutritional regimen and/or venule congestion were observed. CONCLUSION: The study of the microcirculation system with the LDF method can be used as the method of early diagnosis of unfavorable variants of cerebral microcirculation that is necessary for outcome prognosis and its correction.

[Tactics of antihypertensive therapy in patients with hypertonic crisis complicated with hemorrhagic stroke]. / Taktika antigipertenzivnoi terapii u patsientov s gipertonicheskim krizom, oslozhnennym gemorragicheskim insul'tom.

OBJECTIVE: To determine an optimal tactics of antihypertensive therapy in patients with hypertonic crisis complicated with hemorrhagic stroke. MATERIAL AND METHODS: We examined 86 inpatients, 42 men and 44 women, aged 46-87 years, with hypertonic crisis complicated with hemorrhagic stroke. The severity of neurological deficit, parameters of cardiac output and Kaplan-Meier survival curve based on the level of arterial pressure (AP) were assessed. RESULTS: The best survival rate of the patients with systolic blood pressure >162 mm Hg to the 20th min from the beginning of treatment with the greater rate of its increase was established. The efficacy of antihypertensive therapy did not depend on the baseline neurological deficit. The remote survival rate did not depend on such factors as sex, age, baseline AP level, AP, frequency of heart contractions, hematoma's volume.

[Neuroprotective treatment of chronic cerebrovascular insufficiency].

OBJECTIVE: To study the efficacy of cerebrolysin in 300 patients with chronic brain ischemia (CBI), I and II stages. MATERIAL AND METHODS: The main group consisted of 195 patients with CBI, I stage and 105 patients with CBI, II stage. Patients of the control group (45 patients) did not receive cerebrolysin. Changes in neurological and emotional status, cognitive functions, indicators of platelet and erythrocyte aggregation, their deformity and morpho-densitometric parameters were studied. RESULTS AND CONCLUSION: Authors found the additional mechanisms of cerebrolysin action resulted in the improvement of morpho-densitometric characteristics of erythrocytes and hemorheological properties important for capillary blood flow.

[An impact of neuroprotective therapy on blood rheological and morphodensitometric parameters in patients with chronic cerebral ischemia].

OBJECTIVE: To explore the dynamics of aggregation of platelets and erythrocytes, their deformity and computed morphodensitometric parameters in patients with chronic cerebral ischemia, stages I and II, treated with cerebrolysin. MATERIAL AND METHODS: We examined 300 patients, including 87 men and 213 women, aged from 30 to 55 years. Patients were randomized by disease stage and treatment (standard treatment with or without cerebrolysin). The dynamics of neurological and emotional status as well as cognitive functions and results of laboratory studies were assessed. RESULTS AND CONCLUSION: Along with the total positive effect of cerebrolysin on the clinical picture, additional mechanisms of its action (antiaggregant, antihypoxic and membranotropic) improved the erythrocyte morphodensitometric parameters, hemostatic, hemorheological and blood gas transport characteristics, in particular on the microcirculatory level.

[Prevention of stroke in patients with atrial fibrillation: a role of modern anticoagulants].

The review addresses the primary and secondary prevention of cardioembolic ischemic stroke, in particular, in patients with non-valvular atrial fibrillation. Indications and schemes of anticoagulation treatment, advantages in stroke prevention and difficulties in using of the common oral anticoagulant warfarin are discussed. The authors compare the mechanism of action, efficacy and safety of the peroral anticoagulant rivaroxaban with warfarin. Based on the results of large meta-analyses, it has been concluded that the efficacy of rivaroxaban is rather superior to warfarin, this drug has the same safety profile and is more convenient in use. During treatment, no laboratory monitoring of hemostasis indicators is needed. This drug can be recommended for prevention of cardioembolic stroke in patients with atrial fibrillation.

[Ischemic stroke with sinus rhythm in patients with arterial hypertension].

We studied 71 patients with hypertensive disease and sinus rhythm on the ECG without clinical signs of heart failure in the acute stage of ischemic stroke compared to 36 patients with arterial hypertension without complications. A retrospective analysis including 91 patients with uncomplicated arterial hypertension examined previously (3-8 years ago) using the same protocol was carried out. The results of this examination were extracted from our database. The greater hypertrophy of the left ventricular, signs of diastolic dysfunction of the both ventricles and a statistically significant decrease in the blood flow through the right auricle were identified in the patients with the acute cerebral blood flow disturbances. The retrospective analysis of patients with arterial hypertension demonstrated the predictive value of the decrease in the peak velocity of transmitral diastolic flow in the phase of rapid filling Ve in the development of cerebral vascular complications of the disease and lethal outcome.

[Prognostic value of hemorheologic and morphodensitometric parameters of blood cells for the progression of cerebrovascular insufficiency].

Authors have studied 484 patients, aged from 35 to 55 years (mean - 41.0+/-1.4 years), in the early stages of cerebrovascular insufficiency. Computed morphodensitometry of erythrocytes, the study of their deformation and aggregation capacity have been used. It have studied the subpopulation content of erythrocytes and determined their morphometric parameters. The morphodensitometric changes in erythrocytes were correlated with disturbances of their functions (aggregation properties, deformation, gas transfer ability) that had the most impact on the hemodynamics of the microcirculation stream. Clinical and laboratory studies revealed that the morphofunctional changes in erythrocytes appeared earlier and played a key pathogenetic role in the formation and progression of cerebral ischemic hypoxia.

[A compensated form of chronic cerebral ischemia in elderly patients].

The study and treatment of 65-78 year old patients during 10 years allowed the investigators to identify a compensated (stabilized) form of the disease. By the results of clinical and laboratory examination patients of this group occupied the interim position between patients of middle age (45-55 years old) with a stabilized course of chronic cerebral ischemia, stage I, and patients of the same age with the progressive form of stage II of the disease. Some medical and social anti-risk factors for progression and development of chronic cerebral ischemia complications were singled out. The range from the age of 30-32 to 50-55 years old is crucial in future development of cerebrovascular process.

[Psychological characteristics of the personality of the sanitary service physician and his job satisfaction]. / Psikhologicheskaia kharakteristika lichnosti sanitarnogo vracha i ego udovletvorennost' trudom.

The contributors propose the results of a psychological study in the personal peculiarities of sanitary service physicians depending on their qualification and duration of work. The study was based on testing 65 persons attending postgraduate courses on occupational, communal and radiation hygiene. Particular attention was focused on the communicative skills of high qualified physicians. The proposed technique provides valuable information which would facilitate physicians' professional skills, and provide guidance in teaching them. The technique can also be used in charting systems of professional incentives for this group of medical staff.