[Upper limb motor and functional recovery in patients with tetraplegia]. / Vosstanovlenie dvigatel'nykh funktsii verkhnei konechnosti u patsientov s travmoi sheinogo otdela spinnogo mozga.

OBJECTIVE: To study the recovery of the upper limb motor function and functional independence in patients with cervical spinal cord injury. MATERIAL AND METHODS: The study included 49 patients with subacute tetraplegia, mean age 33±14.8 years, 42 men and 7 women, admitted to the Preodolenie Rehabilitation Center. The follow-up was up to 2 years. The clinical and functional states were assessed after 3, 6, 12 and more than 12 months after spinal injury, using the ASIA neurological standard scale, the motor subscale of Functional Independence Scale (FIM) and short form of Van Lieshout Test (VLT). All patients received continuous rehabilitation courses that included physiotherapy, occupational therapy, social support, psychological rehabilitation. RESULTS: Upper limb motor recovery occurred in the first 6 months after spinal cord injury at 5±3.9 points (ASIA), while in 49% patients motor level decreased by one segment of the spinal cord, in 8% patients completeness of spinal cord injury improved. The improvement of functional independence was found during the first 12 months: according to FIM, in the period of 3-6 months by 18±11.1 points, in the period of 6-12 months by 8±8.1 points; according to VLT in the period of 3-6 months by 19±14.4 points, in the period of 6-12 months by 5.6±6.02 points. CONCLUSIONS: Upper limb motor recovery mostly occurs in the first 6 months while the functional independence improvement lasts during the first 12 months after a spinal cord injury.

[Comparative analysis of functional independence predictors in patients with cervical tetraplegia]. / Sravnitel'nyi analiz prediktorov funktsional'noi nezavisimosti u patsientov s tservikal'noi tetraplegiei.

Purpose of the study was to investigate clinical predictors of functional independence in patients with cervical tetraplegia at different periods after a spinal cord injury (SCI). MATERIAL AND METHODS: 190 patients (151 men and 39 women) with an SCI from 3 months to 6 years old were included in a retrospective study. The average age was 27 years. The examination was carried out using the international standard for neurological classification of spinal cord injury (ASIA) with the definition of motor score ASIA for the upper extremity (ASIA upper extremity), neurological (NL) and motor levels (ML), and the completeness of spinal cord injury (AIS). Functional assessment was performed using the FIM motor subscale. The study of neuromuscular conduction of the median nerves - according to stimulation electroneuromyography (SENMG). The degree of functional independence was assessed as a severe disability with FIM less than 42 points, mild and moderate - FIM 42 points or more. RESULTS: Using logistic regression analysis, it was found that in the first 6 months after SCI, the main predictors are ASIAupper extremity (AUC=0.84; X2=3.32; p=0.06) and NL (AUC=0.80; X2=2.96; p=0.09). When observed in the first 12 months, ASIAupper extremity (AUC=0.86) remains the leading predictor. Moreover, pronounced functional limitations can be predicted using predictors of ASIAupper extremity in 84.4% and completeness of injury (AIS) in 81.2% of cases, moderate and mild limitations - ASIAupper extremity in 81.4%, NL in 86.0% and functional tenodesis (FT) in 100% of cases. In the long-term period (more than 12 months), the exceptional predictive power of the predictor ASIAupper extremity (AUC=0.92) is noted both in the prediction of severe (82.5%) cases and moderate and mild functional disorders (91.8% of cases). In addition, in the SCI long-term period, the predictor AIS plays a significant role in severe disorders (in 82.5% of cases), and NL (88.2%) and FT (100%) - in moderate and mild disorders. The boundaries between functional groups according to functional independence in groups of 12 months and more than 12 months after SMT are presented: ASIAupper extremity 22.4 and 22.6 points, ML more than 6.5 and the presence of FT with a ML of more than 5.6, respectively. At the same time, the results of SENMG showed low predictive significance. CONCLUSION: Motor score ASIAupper extremity is a leading predictor in all periods after SCI, while completeness of spinal cord injury (AIS) more accurately predicts pronounced functional limitations, and ML and FT predict moderate functional limitations. The FT, a neurological level of C6 and higher, a motor score ASIA upper extremity of more than 22 points are criteria for achieving moderate functional independence.

[Funtional tenodesis as a predictor of functional outcome in patients with cervical tetraplegia]. / Funktsional'nyi tenodez kak prediktor funktsional'nogo iskhoda u patsientov s tservikal'noi tetraplegiei.

AIM: To determine the value of functional tenodesis (FT) of the hand as a predictor of the degree of disability in patients with cervical tetraplegia (CT) at different periods after a spinal injury. MATERIAL AND METHODS: We examined 190 patients (79% - men) with CT (92.5% of cases of traumatic origin) at the age of 27 [21.0; 36.0] years with a neurological level of CІІІ-DІ, and a share of complete motor damage (A - B according to AIS) 70%. The examination included determination of neurological, motor levels and completeness of spinal cord injury (according to ISNSCI), assessment of functional independence (FIM motor domain), FT of the hand, and the severity of contractures of the joints of the hand. Using logit-regression analysis, creation of contingency tables, ROC analysis, depending on the timing of spinal injury, 4 classification models were studied: Disease duration less than 6 months, assessment of the functional outcome 6 months after spinal injury (model A); disease duration less than 6 months, assessment after 12 months (model B); disease duration less than 12 months, assessment after 12 months (model C); disease duration more than 12 months, evaluation after more than 12 months (model D, primary one). RESULTS: FT developed in the first 6 months after spinal injury in 12 (24%) patients, in 6-12 months - in 15 patients (20%), in more than 12 months - in 1 (less than 1%) patient. The incidence of joint contractures of the hand in group A (20%) and C (24%) did not have a statistical difference (χ2=0.22; p=0.64). Hand contractures in the first 6 months were observed in 20% of patients, in the first 12 months - in 24%, more than 12 months after spinal injury - in 28% of patients. In model A, the FT sensitivity was 80%, specificity was 64%, AUC - 0.65; in model B - 85%, 36%, 0.36, respectively; in model C (log-regression χ2=19.1; p was not determined) - 69%, 100%, 0.59, respectively; in model D (log-regression χ2=55.3; p was not determined) - 65%, 100%, 0.71, respectively. CONCLUSION: FT and contracture of the joints of the hand form during the first year after the debut of CT. As a predictor of a pronounced limitation of self-care, the sensitivity of FT in the first 6 months after spinal injury was 80-85%, in the later period, the specificity of FT was 100%, and sensitivity was 65-69%; in general, the predictive power of FT was low (AUC 0.36-0.71) and increased with the assessment of the functional outcome in the period of more than 12 months after the injury.

[Study of conformational mobility of insulin, proinsulin, and insulin-like growth factors].

In this work, by method of molecular dynamics there was performed comparative analysis of conformational mobility of evolutionary related peptides--insulin, proinsulin, IGF1, and IGF2. The highest mobility has been shown to be characteristic of the proinsulin molecule, while the lower mobility--IGF1 and proinsulin. The rotation radius (Rg) of insulin, IGF1, and IGF2 changes insignificantly. The proinsulin Rg decreases with leaving to plateau after 6000 ps. Graphs of the mean square deviations (RMSD) from initial positions for A- and B-domains are practically identical, which indicates integrity of the carcass formed by A- and B-domains. The proinsulin C-domain behaves sufficiently chaotically. The IGF1 and IGF2 C-domains form the ordered structures reminding horseshoe and elongated hairpin. The particularly major contribution to the IGF2 mobility is made by D-domain by remaining practically immobile in IGF1, which can be the cause of the high stability of IGF1. The obtained data can be used at development of novel effective drugs for treatment of diabetes mellitus, based on principle of evolutionary relationship of peptides.