[Progressive multifocal leukoencephalopathy in HIV-positive individuals]. / Progressiruyushchaya mul'tifokal'naya leikoentsefalopatiya u VICh-pozitivnykh patsientov.

The article discusses the historical aspect and modern ideas about the etiology and pathogenesis of progressive multifocal leukoencephalopathy in patients with HIV infection. An analysis and synthesis of literature data on the clinical presentation of this pathology was carried out. The possibilities and limitations of laboratory and instrumental diagnostic methods, including neuroimaging methods, are discussed in detail. The pathomorphological signs of the disease in HIV-positive individuals are covered.

The Effects of Human Chorionic Gonadotropin and Gonadotropin-Releasing Hormone Receptor Antagonist on Testicular Steroidogenesis in Normal and Obese Rats.

We studied the effect of a high-fat, high-carbohydrate diet (HFHCD) on basal testosterone levels in the blood and testosterone, its precursors, and expression of steroidogenic genes in the testes of rats treated with human chorionic gonadotropin (hCG, 10 IU/rat, subcutaneously, once), gonadotropin-releasing hormone receptor antagonist cetrorelix (75 µg/kg, subcutaneously, 3 days), and their combination. In HFHCD rats, no obvious signs of androgen deficiency were observed and the response of the testes to hCG stimulation was preserved. Unlike control rats (normal diet), the expression of the luteinizing hormone receptor gene in these rats did not change in response to hCG stimulation and cetrorelix administration; they also showed a paradoxical, more pronounced response to hCG administration under conditions of suppression of the gonadotropin secretion by cetrorelix. This suggests that the etiology and pathogenesis of obesity may have different effects on the hormonal status of the male reproductive system.

[The structure of stroke and the effect of somatic and addiction diseases on its appearance and course in patients with HIV infection]. / Struktura insul'ta i vliyanie somaticheskikh i narkologicheskikh zabolevanii na ego vozniknovenie i techenie u bol'nykh VICh-infektsiei.

OBJECTIVE: To study the contribution of somatic and addiction diseases to the formation and course of acute cerebrovascular accidents in people with HIV infection. MATERIAL AND METHODS: The study included 123 patients with HIV infection, aged 27 to 86 years, who were treated in the primary vascular departments of hospitals in the Tyumen region in the period from 2013 to 2019. The patients were divided into two groups corresponding to the typology of stroke. All patients underwent a comprehensive neurological examination, laboratory and instrumental studies, including neuroimaging methods. RESULTS: In the group of patients with ischemic stroke, arterial hypertension was observed in 91.1% of cases, and with intracranial hemorrhages - in 66.7%. This risk factor was associated with a fatal outcome in 59.0% of patients with hemorrhages. Among those who died from cerebral infarction, 8.0% of patients suffered from hypertension, and 67.0% of them were men. Concomitant bronchopulmonary pathology in the vast majority of cases increased the risk of ischemic stroke in patients (93.0% of cases), and the presence of pneumonia in the acute period of a stroke significantly increases the risk of death. In addition, 45.5% of patients had comorbid viral hepatitis C (HCV). In this group of patients, 64.0% had an ischemic type of stroke, and 36% had hemorrhage. There were no deaths in patients with ischemic stroke, HIV and HCV, and among patients with hemorrhages and the same viral diseases, the mortality rate was 50.0%. CONCLUSION: The study showed a greater effect of hypertension on the risk of ischemic stroke than on the risk of intracranial hemorrhage in the study group of patients, which is an inverse relationship than the effect of this factor on the risk of stroke in HIV-negative patients. The presence of hepatitis C in an HIV-infected patient with a stroke increases the likelihood of death from intracranial hemorrhage.

Stimulation of Ovulation in Immature Female Rats Using Orthosteric and Allosteric Luteinizing Hormone Receptor Agonists.

Human chorionic gonadotropin (hCG) and luteinizing hormone (LH) are widely used for the treatment of reproductive disorders and for controlled ovulation induction, but their use is limited by side effects. Allosteric agonists of the LH/hCG receptor, including thieno[2,3-d]thienopyrimidine TP03 developed by us, can become an alternative. TP03 (50 mg/rat, i.p.) when administered to immature female rats treated 48 h before with Follimag has been shown to increase progesterone levels (maximum 8 h post-treatment) and induce ovulation, as indicated by the appearance at 24 h corpus luteum (8.6 ± 0.5 per ovary). In terms of its activity, TP03 is comparable to hCG, although it acts more moderately. In the ovaries, unlike hCG, TP03 does not lead to an increase in the expression of vascular endothelial growth factor, which can cause ovarian hyperstimulation syndrome. Thus, TP03 is a promising drug as an ovulation inducer and ovarian steroidogenesis stimulator.

[Experience in the management of patients with genetic epilepsies and epileptic encephalopathies in the outpatient practice]. / Opyt vedeniya patsientov s geneticheskimi epilepsiyami i epilepticheskimi entsefalopatiyami v ambulatornoi praktike.

OBJECTIVE: To describe the spectrum of being detected gene mutations in patients with epilepsy in clinical practice of neurologists specializing in epilepsy with an analysis of diagnosed epileptic syndromes, the characteristics of seizures, the timing of a genetic diagnosis, options and treatment effectiveness. PATIENTS AND METHODS: The study included 100 patients (40 boys, 60 girls) with epilepsy and/or epileptic encephalopathy and a gene mutation identified. The average age was 6.9±5.1 years. Through remote access, epilepsy specialists filled out a specially designed unified table containing information from outpatient case history. RESULTS AND DISCUSSION: There are patients with a wide range of gene mutations, the leading of which is a mutation in the SCN1A gene (15%). The main method (85%) of detection remains the sequencing of the last generation in the «Hereditary Epilepsy¼ panel. Years pass from the onset of the disease to the genetic diagnosis (Me - 3 years). In most cases, patients with severe (52% have epileptic encephalopathy, 88% have developmental disorders) and pharmacoresistant (mean amount of anti-epileptic drugs - 3.8±2.2, multitherapy - 70%) syndromes have undergone genetic testing. In the treatment of these patients epileptologists are increasingly (52%) use alternative methods: steroids, ketogenic diet and others. The absence of seizures was observed only in 46% of patients. CONCLUSION: Thus, in the outpatient practice of epileptologists, patients with a wide range of gene mutations are found. As a rule, these are patients with severe, therapy-resistant epileptic syndromes.

[Secondary spondylogenic epidural abscess]. / Vtorichnyi spondilogennyi épidural'nyi abstsess.

The article presents the results of a retrospective analysis of 200 patients with hematogenous osteomyelitis of the spine who were treated in the Tyumen Regional Clinical Hospital #2. Neurological disorders were present in 37 patients (group I); 163 patients (group II) had no neurological disorders; according to CT and MRI, secondary spondylogenic epidural abscess was diagnosed in 24 patients. At admission, the severity of neurological deficit assessed using the Frankel scale was as follows: Grade A - 6 cases, Grade B - 7 cases, Grade C - 17 cases, Grade D - 5 cases, and Grade E - 2 cases (epidural abscess without neurological deficit). At discharge, the severity of neurological deficit was as follows: Grade A - 3 cases, Grade B - 2 cases, Grade C - 13 cases, Grade D - 11 cases, and Grade E - 8 cases. In group I, 35 out of 37 patients underwent surgery; of these, 21 patients had improvements. There were no statistically significant differences in neurological deficit changes between patients with and without epidural abscess. In 12 patients, the neurological status remained unchanged. Two patients died. We present an analysis of the severity of neurological symptoms, depending on the spinal lesion level, and the results of microbiological tests. Changes in neurological symptoms in lesions of various spinal parts are described. Cervical spine lesions and the process caused by S. aureus are shown to significantly increase the risk of neurological disorders. An active surgical approach for complicated forms of spinal osteomyelitis provided partial or complete regression of neurological disorders in 62.2% of cases.

[Modern problems of stroke at different hospitalization stages based on the data of the Regional Vascular Center of Tyumen]. / Sovremennye problemy tserebral'nogo insul'ta na étapakh gospitalizatsii, po dannym Regional'nogo sosudistogo tsentra Tiumeni.

AIM: To analyze clinical and organizational aspects of stroke patients care and factors affecting the outcomes of the disease at the prehospital and inpatient stages. MATERIAL AND METHODS: The medical documentation of patients with acute vascular lesions of the brain who were admitted and were subsequently treated at the Regional Vascular Center in Tyumen in 2016-2018 was studied retrospectively. At the first stage, factors affecting the delay in admission of patients (n=173) to the hospital were identified. At the second stage, the frequency and nature of discrepancies in diagnoses were determined, as well as the main factors affecting mortality at each stage of hospitalization of patients. For this purpose, 1330 accompanying documents and 508 case histories of patients with transient ischemic attacks and cerebral infarction were studied. RESULTS AND CONCLUSION: The main factor affecting the transfer of patients to the hospital outside the 'therapeutic window' was living alone (58.8%, p=0.01). There was a significant number of discrepancies in the diagnoses of the referring institution (73.7% in out-patient clinics and 61.9% in other referring hospitals (p<0.001)), the emergency department and the specialized vascular department of the inpatient department which were significantly correlated with the mortality rate. In cases when all three diagnoses differed, the probability of a fatal outcome increased from 18.9 to 80.0% (p<0.001).

[Intrathecal administration of drugs]. / Intratekal'noe vvedenie lekarstvennykh preparatov.

The article summarizes the introduction of drugs into the cerebrospinal fluid. Indications and contraindications for the administration of pharmaceuticals in the cerebrospinal fluid spaces are presented. Main groups of pharmacological agents used for endolumbar introduction and conditions under which they are used, as well as advantages and disadvantages of this treatment are considered. The authors describe a method of administration of antibiotics for bacterial and fungal infections of the central nervous system. The need to assess the intracranial pressure prior to cisternal puncture and exclude blocking of cerebrospinal fluid pathways is emphasized. Information about intrathecal administration of anticancer and cytostatic drugs in primary and metastatic brain lesions as well as data on the significant positive effect of oxygen-ozone mixture in the treatment of victims of traumatic brain injury in its acute period are presented. Of interest are the results of the study, which showed a statistically significant reduction in the severity of neurological deficit after the introduction of cerebrolysin in the lumbar space in the first days after the onset of cerebral infarction. Possible complications of the described method of drug delivery, measures taken against them and methods of preventionare described.

[Meteorological risk factors of stroke].

Based on correlation analysis of stroke, recorded in Khanty-Mansiysk during 5 years, and standard meteorological factors, we found the significant relationship between the frequency of stroke and daily temperature amplitude. The positive correlation between the frequency of stroke and between-day changes in air temperature in the combination with changes in atmospheric pressure during 3 h was identified. A maximal number of strokes was recorded in December, April, May and July and a minimal number was in January, June, August and September. The frequency of stroke and fatal outcomes did not depend on the season.

[Clinical and epidemiological characteristics of stroke in the Khanty-Mansi autonomous region].

A study of registry data revealed that morbidity, mortality, early lethality and frequency of secondary cases of stroke were significantly lower compared to those in the Russian Federation that could be explained by the younger mean age of the population in the Khanty-Mansi autonomous okrug (KMAO). Annual frequency of new cases of stroke among men was higher than among women though the prevalence of risk factors was lower in men. The levels of morbidity in men and women differed significantly than in the country as a whole. Changes in the clinical course of stroke were noted over the period of the study that was supported by the data on the significant reduction of the morbidity with the absence of the dynamics in the mortality and early lethality. The structure of stroke forms was similar to that in the Russian Federation but significant differences were found between men and women. The ratio between the number of cases of stroke of the carotid artery territory and that of stroke of the vertebral-basilar system was similar to the ratio recorded in the Russian Federation.

[Disturbances of blood lipid content after acute disorders of brain blood flow].

The parameters of blood lipid spectrum have been analyzed in 421 patients who survived cerebral stroke and transitory ischemic attacks in 2004-2008. The study included people of Khanty-Mansiysk and Khanty-Mansi autonomous okrug and watchmen. The statistical analysis did not reveal differences between mean concentrations of total cholesterol, high and low density lipoproteins and triglycerides in the settled population and in watchmen. Mean values of all parameters, with the exception of high-density lipoprotein, were higher compared to normative values. The highest frequency of deviations was found for low-density lipoproteins (63.5% of cases). The highest concentrations of total cholesterol and low-density proteins were seen in patients after transitory ischemic attacks regardless of their sex. The comparison of blood lipid spectrum parameters in different age groups revealed significant differences only for total cholesterol.

[Prevalence and risk factor structure of cerebral stroke in people of the Khanty-Mansi autonomous okrug].

Based on the data of cerebral stroke register carried out in the Khanty-Mansi autonomous okrug in 2004-2007, the information on the prevalence of main risk factors has been obtained. Arterial hypertension is the most significant risk factor for all forms of acute cerebral blood flow disturbance. Comparison of prevalence of main risk factors of stroke in residents of this region and people of other regions of the Russian Federation has revealed significant differences for all factors, with the exception of alcohol abuse. The structure of risk factor prevalence in the autonomous okrug differs from that in Russia. The statistically significant differences in the prevalence of all factors for ischemic stroke and non-traumatic intracranial hemorrhages studied were found in men and women living in the okrug as well as in the settled population and in watchmen. Highly significant direct correlations (p<0.0005) between the number of risk factors and the level of early 28 day mortality were revealed.

[Epidemiology and risk factors of cerebral stroke in Khanty-Mansiysk autonomic region: population register data].

Based on register data, epidemiologic indicators of cerebral stroke for the population of Khanty-Mansiysk autonomic okrug and values of early mortality and mean ages of patients have been obtained. The structure of acute disturbances of brain blood circulation has been studied. It has been shown that morbidity and mortality from cerebral stroke in the population of autonomic okrug is significantly lower compared to the same indicators in the Russian Federation in whole. Morbidity among men is higher than among women. An analysis of stroke risk factors revealed that the prevalence of some factors is significantly higher in the population of the okrug compared to other the Russian regions.

[Dynamics of the rythm of the isolated and intact frog heart]. / Dinamika ritma izolirovannogo i intaktnogo serdtsa liagushki.

This study was designed to examine the changes of the isolated frog's heart rate as a function of the time in the two time intervals: 20-95 min and 95-170 min after hearts were prepared. The heart rate decreased in these intervals quite linear but average slope between 20-75 min was significantly steeper than in the time interval 95-170 min. It was shown that the difference in the heart rate response induced by the increasing temperature in intact animals and isolated hearts partly might be explored by this decrease in the isolated frog's heart rate with time.

[Terminal vascular bed of the connective tissue membrane in hypoxic hypoxia]. / Terminal'noe sosudistoe ruslo soedinitel'notkannykh obolochek pri gipoksicheskoi gipoksii

Morphological changes of all links of the terminal vascular bed during acute hypoxic hypoxia were studied in experiment and in postmortem material. A complex of methods was used including microdissection, injection with India ink - gelatin, clearing, silver nitrate impregnation after V. V. Kuprijanov, staining after Van Gieson and with hematoxylin-eosin, biomicroscopy and reoencephalography. Signs of desorganization of the vascular bed were revealed which manifested themselves as changes in microangioarchitectonics and diameters of vascular lumens, increased permiability of their walls with saturation of them with white and escape of its forming elements of the blood outside the limits of the vessels, as well as in destruction of the aggregate state of the blood. It considerably enlarges our knowledge of the state and changes in the vascular bed during hypoxic hypoxia.