[Portable telemedical complex usage perspectives for medical care of elderly and senile patients with cerebrovascular pathology.]

The article discusses perspectives of medical care in elderly and senile patients with cerebrovascular pathology with portable telemedical complex use. Analysis of telemedical cooperation physician-consultant-patient and discussion of medical equipment criteria for telemedical complex selection and organizational together with legal issues of medical data transfer, storage and access were performed. The important clinical features of cerebrovascular pathology in elderly patients were presented, which determined necessity of highly qualified medical specialist involvement in management of such patients. The opportunities of portable medical complex usage were discussed.

[Prevention of cognitive disorders in elderly and senile patients.]

The aim of the study was to evaluate the effect of vitamin D on the cognitive functions and quality of life in elderly and senile patients with cerebrovascular disease. 100 elderly and senile patients with cerebrovascular disease were examined: 60 people - level 25 (OH)D in blood serum <20 ng/ml (deficiency, pronounced deficiency), in 40 people this indicator was ≥30 ng/ml (within the normal range). Cognitive functions were evaluated according to neuropsychological scales (MMSE, MoCA, FAB, «clock drawing test¼, Schulte tables). To study the quality of life, all patients filled out a general questionnaire SF-36. The body's vitamin D supply was judged by the content of 25 (OH)D in the blood serum. Patients with low vitamin D levels (25 (OH)D <20 ng / ml) were divided into two subgroups: 30 people were prescribed cholecalciferol at a dosage of 8 000 IU/day for three months and 30 people who were not treated with cholecalciferol. The study showed that patients with low levels of vitamin D [25 (OH)D <20 ng/ml] had significantly worse indicators when assessing both cognitive functions and quality of life. The work proved that cognitive functions affect the quality of life. In patients with extremely low levels of vitamin D [25 (OH)D <20 ng/ml], after taking cholecalciferol at a dosage of 8000 IU/day for three months, there was a normalization of the level of 25 (OH)D (the average level of which was 34,10±7,42 ng/ml) in the blood serum and there was a significantly significant positive dynamics in assessing cognitive functions and quality of life.

[The role of polypeptide compounds in mechanism of CNS plasticity in patients with hereditary pathology of peripheral motor neuron]. / Rol' rostovykh polipeptidnykh soedinenii v mekhanizme plastichnosti TsNS u bol'nykh nasledstvennoi patologiei perifericheskogo dvigatel'nogo neirona.

Synaptic pruning is a physiological mechanism of neuroplasticity, which is regulated through synthesis of growth polypeptides, neurotrophins. The role of neurotrophins in the mechanism of synaptic pruning in patients with hereditary pathology of peripheral motor neuron was studied in a clinical experimental trial. It was found that patients had elevated levels of regulatory growth polypeptides, which led to the axon growth inhibition effect in organotypic tissue cultures. Thus, neurotrophin overexpression can be considered as a factor preventing synaptic pruning and contributing to further process of neurological degeneration in nerve tissue in patients with hereditary pathology of peripheral motor neuron.

[Pathogenesis of cognitive disorders in patients with Duchenne muscular dystrophy]. / Patogenez kognitivnykh rasstroistv pri myshechnoi distrofii Diushenna.

AIM: Clarification of the pathogenesis of cognitive disorders in patients with Duchenne muscular dystrophy in the clinical laboratory and molecular genetic study. MATERIAL AND METHODS: Thirty-six male patients with Duchenne muscular dystrophy (DMD), aged from 5 to 22 years (mean age 13.7 years), were examined. The control group consisted of 30 healthy people (7-22 years old, mean age 13.8). The clinical, molecular-genetic and laboratory study was conducted. The search for mutations in the dystrophin gene was carried out using multiplex PCR and multiplex ligation-dependent probe amplification. The laboratory study included determination of neurotrophins: brain-derived neurotrophic factor (BDNF), nerve growth factor (NGF) and ciliary neurotrophic factor (CNTF) using immunoenzyme method in serum. RESULTS AND CONCLUSION: Severe cognitive impairment was found in 33% of patients with DMD. The distribution of mutations in the DMD gene was not uniform, most often the mutations were found in the region from exon 43 to exon 50. Serum concentration of NGF in patients with DMD was higher than in the control group (2391 pg/ml [1587; 4136] and 553 pg / ml [314; 864], respectively (p<0.001)). In the group of patients with cognitive disorders, there was a decreased concentration of BGF (23 670 [21 700; 30 720] pg/ml (p<0.001)). In patients with BGF concentration less than 31 000 pg/ml, the chances of cognitive disorders were more than 10 times higher (p<0.001, odds ratio OR=12.0, 95% CI [1.9-76.4]). Thus, biochemical mechanisms, such as NGF overexpression and BGF deficiency, are involved in the development of cognitive disorders in patients with DMD.

[Significance of sleep deprivation in the development of local epilepsy from neuroplasticity opinion]. / Znachenie deprivatsii sna v razvitii lokal'no obuslovlennoi epilepsii s pozitsii kontseptsii neiroplastichnosti.

AIM: Learning cycle «sleep-wake¼ is of great theoretical and practical importance because it allows to understand the general patterns of adaptive mechanisms of human interaction with the environment (neuroplasticity), violations of which are the basis of many diseases of the CNS, including epilepsy. MATERIAL AND METHODS: Complex clinical and electroencephalographic (video-EEG monitoring with mandatory recording of sleep) study was carried out before and after prolonged sleep deprivation (for at least 1 day) of 178 patients with locally due to epilepsy (LEi). 45 healthy volunteers were examined in the control group as well as the patients with epilepsy. The work was carried out to compare the results of clinical and neurological and electrophysiological studies during sleep deprivation (SD) in patients with LEi and in healthy individuals with neurohistological and electron microscopic patterns of changes in the brain of rats in an experiment with 48-hour SD. RESULTS AND CONCLUSION: Discovered in the CNS of rats after SD morphological changes such as pleyokoniya of mitochondria, damage in the blood-brain barrier, signs of exhaustion astrocytes, glial cells and the change of the nuclei of gliocytes and some neurons of the type of apoptosis and karyorrhexis and destruction of synapses reveal a violation of the fundamental mechanisms of neuroplasticity. The results allow us to consider the SD patients as a damaging factor for the central nervous system, provoking the development of epileptic seizures and epilepsy, and the SD in laboratory animals can be used as a model for further study of the mechanisms of neuroplasticity. In addition the findings greatly complement current understanding of the mechanisms of neuroplasticity and pathogenesis of epilepsy, and justify the need for the study of therapeutic efficacy of modulators of neuroplasticity (transcranial magnetic stimulation, ipidacrin etc.) in the complexe treatment of patients with the this specified profile.

[Omaron in the treatment of vertebrobasilar insufficiency].

The study aimed at evaluation of tolerability, safety and clinical efficacy of omaron in the treatment of vertebrobasilar insufficiency (VBI). Forty patients with different stages of VBI have been examined. A diagnosis of VBI was based on the results of neurological study, ultrasonic dopplerography, electroencephalography, electrocardiography, brain MRI and CT examination. Neurological scales were used for assessment of neurological status and further data processing. The treatment with omaron resulted in significant clinical improvement and stabilization of the pathological process. The drug is well-tolerated by patients including those of older age groups.

[The analysis of structural changes and functional characteristics in condition of vascular cerebral lesions].

To 61 patient with vascular diseases of a brain the analysis of structurally functional changes and degrees of conformity to their clinical manifestations is conducted. For 53 patients the correlative connection between clinicotopical and neurophysiological data was detected. In 8 cases the outcomes under the clinical data corresponded to topical consept about localization of the lesion focus. However, the signs of discrepancy were detected by comparison them with neurovisualization methods. Taking into consideration the obtained data the assumption about a capability of secondary neurodynamic focuses formation is permissible in patients with cerebral vessel lesions.