[Prediction of myocardial contractility after coronary bypass surgery according to preoperative contrast-enhanced magnetic resonance imaging and echocardiography]. / Prognozirovanie dinamiki sokratitel'noi funktsii miokarda u patsientov posle koronarnogo shuntirovaniya po dannym predoperatsionnykh magnitno-rezonansnoi tomografii serdtsa s kontrastnym usileniem i ekhokardiografii.

OBJECTIVE: To establish the criteria for reversibility of myocardial contractility in patients with coronary artery disease (CAD) after coronary artery bypass grafting considering data of cardiac magnetic resonance imaging (MRI) and echocardiography. MATERIAL AND METHODS: We studied the results of coronary artery bypass grafting in 186 patients with CAD complicated by reduced left ventricular ejection fraction (<30%). All patients underwent cardiac MRI and echocardiography before surgery. Immediate and long-term results were evaluated according to echocardiography and MRI data. RESULTS: We confirmed the previously established predictors of improvement in left ventricular contractility: diastolic IVST ≥10.5 mm and PWT ≥9.5 mm, score of LV myocardium damage according to MRI with delayed contrast enhancement (p<0.05). Multivariate analysis makes it possible to calculate prognostic index and obtain information about further myocardial contractility after revascularization with an error of 6%. CONCLUSION: Echocardiography and contrast-enhanced cardiac MRI are valuable to assess morphological and functional state of the left ventricle in patients with ischemic cardiomyopathy and preoperatively determine functional reserve of the myocardium.

Dual wavelength Talbot self-imaging using facet patterned nonlinear crystals.

A method for functional patterning of facets of a nonlinear crystal using focused ion beam milling has been developed. The near-field diffraction on periodic gratings has been experimentally and theoretically studied. The periodicity of the structure enables Talbot self-imaging at the fundamental and second-harmonic frequencies simultaneously. Spatial interference patterns for both harmonic frequencies are individual ones, which can enable the higher-accuracy optical testing, coupling the radiation at both frequencies, and wavelength-division demultiplexing. The impact of the aperture effect on a Talbot carpet is discussed.

[Dome-shaped macula: features of differential diagnostics with clinical examples]. / Fenomen kupoloobraznoi makuly: osobennosti differentsial'noi diagnostiki (klinicheskie nabliudeniia).

The phenomenon of dome-shaped macula (DSM) constitutes protrusion of membranes of the posterior pole of the eye toward the vitreous body due to local thickening of sclera layers. The phenomenon was detected using enhanced depth imaging optical coherence tomography (EDI-OCT). In uncomplicated forms of DSM, all layers of the retina are contiguous, but the setting of DSM can involve a number of pathological conditions causing decrease in vision. One of the most often described concurrent conditions in DSM is serous retinal detachment (SRD). Such complicated forms of DSM are often masked as a non-pigmented neoplasm of the choroid, in particular hemangioma (HC). PURPOSE: To demonstrate the possibilities of differential diagnostics of DSM with HC using modern instrumental diagnostic methods. MATERIAL AND METHODS: The study involved two clinical cases of patients with DSM and HC, who underwent comprehensive ophthalmological examination including EDI-OCT and OCT angiography, fluorescent angiography (FA), indocyanine-green angiography (ICG) and magnetic resonance imaging of brain and orbits (MRI). RESULTS: The most simple and highly informative method for differential diagnostic of DSM with HC is currently EDI-OCT. In difficult differential diagnostic cases, it is recommended to use FA and MRI. Additionally, for identification of the cause of SRD in DSM, OCT-angiography and ICG-angiography can be used. Thus, diagnostics of DSM is difficult today primarily because of the low awareness of ophthalmologists about the presence of such macula pathology. Detection of this anatomical feature by means of ophthalmoscopy alone can be difficult and requires special skills and experience. The use of EDI-OCT, as well as FA and MRI in difficult differential diagnostic cases, and correct interpretation of the obtained data can help avoid diagnostic errors.

A Method for Quantitative Evaluation of the Results of Postural Tests.

A method for quantitative evaluation of the results of postural tests is proposed. The method is based on contact-free measurements of 3D coordinates of body point movements. The result can serve as an integral test based on the Mahalanobis distance.

[Methodological approaches to the substantiation of a harmonized mean year maximum permissible nickel concentration in ambient air].

In the article there are presented the results of the substantiation of a harmonized mean year maximum permissible nickel concentrations (MPNC) in ambient air according to the results of epidemiological studies and mathematical modeling of the evolution of risk Data of the analysis of hygienic standards of the nickel content in the air used both in Russia and abroad, as well as the results of the own research allow us to recommend as a harmonized mean year MPNC-0.00005 mg/m3, and as critical effects--disorders of the respiratory organs.

[Brain metabolism in multiple sclerosis: effects of neurotrophic therapy].

We studied 15 patients with relapsing-remitting multiple sclerosis (MS) in the state of remission (disease duration 1-5 years, EDSS scores 2.5-5.5) treated with сerebrolysin (Cere) to investigate the rate of brain metabolism changes. All patients continued to receive their disease modified treatment therapy (copaxon or interferons). Patients of the main group (n=10) received i.v. 20 ml of Cere (diluted in 200 ml NaCl 0.9%) for 10 days and vitamins B (pentovit) in tablets. Patients in the control group (n=5) were treated only with pentovit in tablets. All the patients underwent magnetic resonance spectroscopy (MRS) (Siemens Symphony 1.5T) prior to the beginning of treatment and 1-3 days after the end of therapy. Five patients of the main group who had best results according to the data obtained from the 2nd MRS underwent a third MRS investigation after 3 months. After 10 days of Cere treatment, the level of N-acetylaspartate in MS lesions had increased from 2.12 to 2.39 (p<0.001) and the level of lactate had decreased by 4 times (from 0.21 to 0.05; p<0.001). In perifocal lesion areas, the level of lactate had significantly decreased from 0.22 to 0.1 (p<0.05). We have also found the trend towards NAA increase in morphologically intact brain tissues. The positive metabolic changes after Cere therapy remained in some patients for 3 months. In the control group, there was the increase of creatine level in intact brain tissues from 1.16 to 1.30 (p<0.05) without significant changes in other areas. All the patients in the main group reported subjective improvement and one patient had the improvement in EDSS scores by 1.0 point.

[Comparative analysis of possibilities of radiological methods in diagnosis and characterization of osseous structures damages of the knee joint in patients with tibial condyles fractures].

73 patients with intracapsular fracture of lateral condyle of thibia were explored by MRI and X-ray imaging. Computer tomography was prescribed for 56 patients. The most frequent fractures were--Schatzker II (n = 23; 31,5%) and II (n = 18; 24,7%) types of fractures. A comparative expert analysis of the results of radiographic, MRI and CT was performed in 56 patients. CT was "the golden standart". X-ray sensitivity in identifying the type of fracture was 80,3%, specificity--66,7%, accuracy--79,6%. In identifying the displacement of bone fragments X-ray sensitivity was 70,4%, specificity--81,2%, accuracy--73,3%. Sensitivity of radiography in detecting depth of impressions was 72,3%, specificity--80%, accuracy--74,1%. CT and MRI have the same results.

[Surgical resection in combination with stereotaxic cryodestruction in patients with supratentorial gliomas in functionally significant areas of the brain: possibilities of using combined surgical treatment and its results].

A combined method of surgical treatment of glial tumors of the brain is proposed for decreasing risk of complications. The method includes microsurgical ablation of the main volume of the neoplasm and stereotaxic cryodestruction of the residual part of the tumor. Combined surgical treatment was used in 12 patients. The results obtained show that the proposed method elevates the efficacy of surgical method, facilitates increased indices of survival rate and maintenance of quality of life of the patients at the tolerant level.

[The possibilities of electronic-social network in services for old citizens].

The article is dedicated to analysis of using the potentials of electronic nets in social-gerontological work. Modern technologies are described and a review of most perspective directions of electronic net of social work in caring of old population is given.

[Choice of approach trajectories in stereotaxic surgery in patients with intracerebral tumors].

An analysis of factors was made which influence the choice of approach trajectories in preoperative planning the diagnostic and medical stereotaxic interventions in patients with intracerebral tumors. Stereotaxic operations were planned and fulfilled on 124 patients with glial tumors of different supratentorial localizations. In planning trajectories with using MRI the passage of stereotaxic cannula through the pial folds and functionally significant zones of the brain were avoided. At the postoperative period no parenchymatous hemorrhages were noted in the approach zone, even with great number of trajectories. It was also noted that in passing the stereotaxic instrument through the lateral venticles of the brain the risk of complications was minimal.

[MRI features of space-occupying lesions in the breast].

Our study evaluates the correlation between benign and malignant breast masses contrast enhancement, on the one hand, and the type of the vascular net and histological prognosis, on the other. We reviewed the preoperative images of 298 breast masses (benign--95 (32%), malignant--203 (68%)) after dynamic contrast enhancement as well as on the basis of pathomorphological data. Due to use of high-concentration paramagnetic contrast agents in ultra-fast sequences, benign and malignant tumors could be differentiated. The quantitative data on both intensive contrast and ring-shaped enhancement corresponded to the low capillary density in the center of carcinoma which correlated with poor prognosis.

[Technique of stereotactic cryodestruction in management of patients with cerebral gliomas].

Aim of the study was to evaluate the safety and efficiency of stereotactic cryodestruction of supratentorial astrocytomas that were located deeply in the brain and/or within eloquent areas.We examined 74 patients aged 18-64 years with supratentorial gliomas of different grade located in deep or eloquent brain areas. All the patients underwent stereotactically guided cryodestruction of the tumor. The survival rate was evaluated by the Kaplan-Meier method. The chi-square method was used for comparative analysis of results of this study with available data from the literature. For the analysis of the prognostic importance of various factors the Cox proportional hazards model was applied. The average survival period was 12.4 months for glioblastoma (control group--6.4 months, p=0.04), and 46.9 months for anaplastic astrocytoma (control group--18 months, p=0.006). For patients with fibrillar-protoplastic astrocytoma the 5-year survival rate was 95.7%. The frequencies of complications did not exceed those of the routine surgical interventions in patients with brain tumors. We found that stereotactic cryodestruction as well the Karnofsky performance score were statistically reliable prognostic factors (p=0.0377 and p=0.0006, respectively), while the extent of cryodestruction and the residual tumor mass did not influence the survival rate. Stereotactic cryodestruction is a safe surgical procedure, which results in statistically significant improvement of survival in patients with supratentorial gliomas located within deep and/or eloquent areas of brain.

[The course of the postoperative period in patients with cerebral gliomas after different volumes and kinds of surgery].

The investigation included 340 patients with cerebral gliomas. Under analysis there were age, gender, neurological status and Karnovsky status before and after operation, localization of the tumor, type and volume of surgical intervention, postoperative complications. It was shown that radical extirpation of glial formations facilitated more favorable course of the postoperative period. Partial ablation of gliomas is associated with greater risk of the development of postoperative complications and neurological dysfunctions. As the main method of surgical treatment of patients with gliomas located in the functionally significant and deep areas of the brain stereotaxic cryotomy is thought to be indicated.

Localization of human cortical areas activated on perception of ordered and chaotic images.

The aims of this study were to identify the locations of areas in the human cortex responsible for describing fragmented test images of different degrees of ordering and to identify the areas taking decisions regarding stimuli of this type. The locations of higher visual functions were determined by functional magnetic resonance imaging (fMRI) using a scanner fitted with a superconducting magnet and a field strength of 1.5 T. The blood oxygen level-dependent (BOLD) method was based on measurements of the level of hemoglobin oxygenation in the blood supplied to the brain. This level was taken to be proportional to the extent of neuron activation in the corresponding part of the gray matter. Stimuli were matrixes consisting of Gabor elements of different orientations. The measure of matrix ordering was the ratio of the number of Gabor elements with identical orientations to the total number of elements in the image. Brain neurons were activated by simultaneous changes in the orientations of all the elements, leading to substitution of one matrix by another. Substitution of the orientation was perceived by observers as rotation of the elements in the matrix. Stimulation by matrixes with a high level of ordering was found to activate the occipital areas of the cortex, V1 and V2 (BA17-BA18), while presentation of matrixes with random element orientations also activated the parietal-temporal cortex, V3, V4, V5 (BA19), and the parietal area (BA7). Brain zones responsible for taking decisions regarding the level of order or chaos in the organization of the stimuli are located in different but close areas of the prefrontal and frontal cortex of the brain, including BA6, BA9, and BA10. The results are assessed in terms of concepts of the roles and interactions of different areas of the human brain during recognition of fragmented images of different degrees of complexity.

[The structural and functional neurovisualization in patients with epileptic seizures in cerebro-vascular diseases].

The results of the dynamic study of patients with epileptic seizures in chronic and acute cerebral vascular pathology are presented. Various methods of structural and functional neurovisualization--magnetic resonance tomography using perfusion- and diffusion-weighted imaging, proton magnetic resonance spectroscopy, positron emission tomography, single photon emission computed tomography were used. Based on the results obtained in the study, the authors discuss etiopathogenetic variants of the development of these seizures and new possible approaches to the complex treatment besides the administration of antiepileptic medications.

[Localization of human brain areas activated for chaotic and ordered pattern perception].

The aim of our work was to localize cortical areas involved in the processing of incomplete figures using functional MRI (fMRI) for 8 healthy volunteers (18-30 year old) with the did of anatomical and fMRI fast imaging technique: echo planar imaging (EPI), whole brain scan (36 slices) matrix 64 x 64, 3.7 second. We used 1.5 T MR-scanner and BOLD-method (Blood Oxygenation Level Dependent), based on distinctions of magnetic properties of hemoglobin. Fast imaging technique on modern MR-scanners with > or = 1.5 T provides precise statistical maps of oxygenation increase with high spatial resolution. For test stimuli we used matrix of Gabor grating. We used two types of 10 x 10 matrices with chaotic and ordered orientation of Gabor gratings. The size, brightness and contrast of the stimuli were identical. The chaotic and ordered patterns activated different brain areas. We establish that ordered patterns activated only primary visual cortex - V1 and V2, (BA17-18), wheareas chaotic patterns activated in addition primary visual cortex, the V3,V4,V5 (BA19) of the occipital cortex and the area 7 of parietal area (BA7) classification. Decision making for that task is localized in prefrontal and frontal cortex, including (BA 6, 9, 10).

[Arrangement of specialized public health care and the work experience of the gastroenterological center]. / Organizatsiia spetsializirovannoi pomoshchi naseleniiu i opyt raboty gastroénterologicheskogo tsentra.

Arrangement of consulting gastroenterological centers at multi-type clinical hospitals makes it possible to render highly qualified medical care for adults, establish schools for training patients, render significant methodical assistance to medical staff on a permanent basis, especially during the period of the public health care system reorganization.

Typical changes of reversible erythrocyte aggregation in various pathological processes.

Examinations of patients with malignant tumors of different location (lung cancer, stomach, colorectal cancer, and head and neck tumors), patients with paranoid schizophrenia and neurotic disorders revealed enhanced reversible erythrocyte aggregation. It was found that enhancement of erythrocyte aggregation is associated with structural modification of their membrane and appearance of transformed cells (echinocytes, stomatocytes, etc.). The phenomenon of enhanced reversible erythrocyte aggregation in somatic and mental diseases can be regarded as a typical pathological process.