[Efficacy and safety of collagen biomaterial local application in complex treatment of the diabetic foot syndrome (final results of the multicenter randomised study)]. / Éffektivnost' i bezopasnost' mestnogo primeneniia kollagenovogo biomateriala v kompleksnom lechenii sindroma diabeticheskoi stopy (itogi mnogotsentrovogo randomizirovannogo klinicheskogo issledovaniia).

AIM: To evaluate the efficacy and safety of collagen biomaterial application during the 4-week follow-up of patients with diabetic foot syndrome. MATERIAL AND METHODS: 75 patients with diabetic foot (Wagner II (69.3%) and III (30.7%)) aged 30-80 years were included in the multicenter study, among them were 50.7% with the wound unhealed for 1.5-6 months and 49.3% over 6-48 months. Patients were randomized into 2 groups: 1) standard therapy (n=37), 2) the additional use of the collagen material Collost (n=38). Observation period was at least 4 weeks for each patient. The size of ulcers, results of general and biochemical blood tests, oximetry, microbiological testing, ultrasound of lower extremities vessels as well as a detailed medical history, social and functional status, level of cardiovascular comorbidity and ongoing therapy were estimated. RESULTS: Additional use of a collagen biomaterial has led to a significant reduction ulcers of all sizes from 13.5 to 2.1 cm2 (in the comparison group - from 12.5 to 7 cm2). The best dynamics have been registered in Wagner II (4.4-fold average wound area regress in Collost group, from 8.8 to 2.0 cm2; average wound area regress by 1.8 times, from 10 to 5.6 cm2 in the comparison group) than in Wagner III group (in the main group from 55 to 21.3 cm2; in the control group from 36 to 32.4 cm2) and in ulcers existing less than 6 months. Treatment with biological material Collost within standard therapy after 4 weeks led to increase of complete epithelialization by 2.6% (21.1% as compared to 14.7%), while decreasing the frequency of ineffective treatment by 4.1 (7.9% in primary and 32.4% in the comparison group). CONCLUSION: We have proved the efficacy and safety of collagen biomaterial topical application in a diabetic foot syndrome treatment.

[Postoperative applications of the fast track technology in patients with herniated intervertebral discs of the lumbosacral spine]. / Primenenie tekhnologii bystrogo vosstanovleniya posle khirurgicheskikh vmeshatel'stv u patsientov s gryzhami mezhpozvonkovykh diskov poyasnichno-kresttsovogo otdela pozvonochnika.

TOPICALITY: The fast track technology means a complex of targeted measures involving rational preoperative preparation, minimally invasive surgery, regional anesthesia and short-acting anesthetics, and early postoperative rehabilitation. Elucidating the possibility of applying the fast track technology in neurosurgery, in particular in spinal surgery, is extremely topical. This is associated with the epidemiological data and the fact that minimally invasive techniques used in neurosurgery are highly expensive. AIM: The study objective was implementation of the fast track technology and subsequent analysis of its use after surgery in patients with herniated intervertebral discs of the lumbosacral spine. MATERIAL AND METHODS: The fast track technology following spinal surgery was implemented at the Clinical Hospital of the Presidential Administration of the Russian Federation and the Neurosurgical Department of the Clinical Hospital № 1 of the Presidential Administration of the Russian Federation using an algorithm of technology application. The study included 48 patients who underwent surgical treatment for herniated intervertebral discs of the lumbosacral spine between January and July 2015. RESULTS: An analysis of pain severity using the Visual Analog Scale demonstrated a slight decrease (10%) in a group of patients who were subjected to the fast track technology, at discharge and at 1 month after surgery; there was no difference in longer follow-up. An analysis of the functional status using the Oswestry index and Roland-Morris scale demonstrated that patients of the study group had faster and more efficient recovery and an improvement of the functional activity by 20% (p<0.05) compared to those in the control group. An analysis of patient-reported assessment of treatment quality revealed that indicators, such as awareness and pain control, in the study group were highest and amounted to 95% and higher. An analysis of the hospital stay duration showed a decrease in the number of bed-days in an integrated group by 39%, which saved 34 bed-days. CONCLUSION: The fast track technology reduces the degree of surgical aggression, increases surgery safety, and decreases the number of intraoperative complications and hospital stay duration.

[Medical and organizational issues of pre- and post-stroke disablement].

Authors examined 400 patients in the acute stage of ischemic and hemorrhagic stroke, including 140 patients who were followed-up for 6 months after the discharge. The dynamics of neurological and functional status, degree of disability and 6 month mortality were evaluated. It was shown that before hospitalization, 45.3% patients had disability pensions group I (14 or 7.7%), group II (136 or 75.1%) and group III (31 or 17.1%). The proportion of disabled people among able-bodied citizens younger than 60 years was 17.5% and it was 77.4% among those older than 80 years. Disability was caused by the cardiovascular pathology (48.1%), previous stroke (30.9%), diabetes mellitus type 2 and its complications (21%). The group of disability assigned before stroke, degree of comorbidity and severity of main disease were positively correlated with the severity of patient's condition on admission to and at discharge from the hospital. During 6 months after discharge, 15.7% of patients died, the rate of mortality was higher by a factor of 1.5 (21.4%) for secondary stroke compared to the first one. The rate of disability increased during 6 months. A number of people with disability group I increased by 12%, group II - by 20% , group III - by 5% and was estimated as 15, 55.7 and 15%, respectively.

[Investigation of risk factors of cardiovascular events by the interregional assistance fund of relatives of stroke patients].

We have analyzed the results of the clinical and laboratory study of 1070 people in 7 regions of the Russian Federation, including 222 (20.7%) men and 848 (79.3%) women aged from 19 to 94 years (mean age 57.15±13.39 years). It has been shown that 6.8% were smokers and 31.5% were alcohol abusers. Regular physical training (>30 min/day) was noted in 45.7%. Symptoms of asthenia were found in 73.3%. The level of knowledge on risk factors of stroke was estimated as: arterial hypertension (68.6%), ischemic heart disease (47.5%), heart rhythm disorders (27.0%), thrombosis of low extremities (26.8%). Mean values of arterial pressure were 140/80 mm Hg, heartbeat rate -- 74 per min. Mean value of BMI was 28.67 kg/m(2), BMI was higher than 30 in 41%. Hyperglycemia >6.2 mmol/l was recorded in 28%, hypercholesterolemia >6.2 mmol/l in 26%. Stenoses of inner carotid arteries were found in 49.2%: less than 50% diameter stenosis was in 32.8%, 50--70% in 11.8% and >70% in 4.6%. Antihypertensive drugs were used by 66.8%, antiaggregants - by 31.2% and statins by 31.2%. Knowledge about stroke was demonstrated by 81.8%, about stroke symptoms -- 58.5%, about the appropriate actions to be taken in the case of a stroke -- 48.5%. The low risk of stroke was observed in 33.2%, moderate risk in 37.3%, high-risk in 24.6% and critical risk in 4.9%.

[Energokorrektion of hemorrhagic stroke in the elderly].

The study included 102 elderly patients with hemorrhagic stroke of different size, location, and severity; the treatment was conservative. The results of the study demonstrate the important pathogenetic significance of free radical processes for hemorrhagic stroke. Severity of oxidative stress being a direct reflection of the energy deficiency correlates with the severity of the patients, with the volume of intracerebral hematoma, hyperglycemia, and determines the outcome. Assignment Cytoflavin leads to the elimination of free radical imbalance, a more rapid recovery of the impaired consciousness and focal neurological deficiency with the improvement of the functional outcome of the disease, and disability also decreased.

[Cryoglobulins in patients with ischemic stroke].

The composition of circulating immune complexes with cryo-properties (cryo-IC) were determined in 70 patients on days 1, 2, 3, 7, 14 and 21 after ischemic carotid stroke. The quantitative and qualitative assessments of cryo-IC content were conducted on a spectrophotometer and on a vertical electrophoresis, respectively. Concentrations of immunoglobulins (Ig) M, A and C, fibronectin, percentage of IgM with rheumatoid factor activity, IgG isotypes (IgG1, IgG2, IgG3, IgG4) were measured with ELISA. The control group included 15 healthy age- and sex-matched people. Compared to the controls, the cryo-IC content was higher in 100% of patients studied, it was higher in atherothrombotic variant than in cardioembolic one. The cryo-IC level was directly correlated with the clinical state severity (p < 0.01). IgG, IgM and fibronectin were observed in 100%, IgA--in 11% and IgM with rheumatoid factor activity--in 6% of patients. The percentage of IgG1 and IgG2 was not less than 90% of the total amount, with the IgG1 percentage about 50%. Cryo-IC changing in the time in dependence on ischemic variant were formed on different stages of development of acute brain ischemia. Dependence of concentrations of fibronectin and IgG, IgA, IgM on the time of observation was similar for both variants of ischemic stroke, but with a time axis shift, running faster and with a smaller range of changes of parameters studied in cardioembolic than in atherothrombotic stroke.

[Dynamics of blood fibronectin and its correlation with the phenomenon of cryoglobulinemia in patients with ischemic stroke].

Seventy patients with carotid ischemic stroke (38 with atherothrombotic and 32 with cardioembolic variants) were examined. The dynamics of fibronectin level and its correlation with blood cryoglobulins concentrations were evaluated in the 1st, 2nd, 3rd, 7th, 14th and 21st days after disease onset. The quantitative assessment of cryoglobulins content was carried out using spectrophotometric method; fibronectin concentration was measured by ELISA. In patients with atherothrombotic variant of stroke, the level of fibronectin in the blood serum and in the cryocomplex was higher compared to patients with cardioembolic variant in the 1st day (p < 0.001) and during all the period of the study (p < 0.05). The concentration of cryocomplexes in the blood serum of patients with ischemic stroke was in reverse correlation with percentage of fibronectin in their content and with the pathogenetic variant of ischemia (r = -0.94; p < 0.05 and r = -0.87; p < 0.05 or atherothrombotic and cardioembolic variants, respectively).

Effect of routine therapy and selective plasmapheresis on electrical properties of cryoglobulins during ischemic stroke.

The charge properties of cryoglobulins were examined during the first 21 days of ischemic stroke (atherothrombotic and cardioembolic). Routine drug therapy produced no effect on the charge of cryoglobulins. Plasmapheresis significantly modified the electrokinetic parameters of cryoglobulins during atherothrombotic stroke and produced less pronounced effect on these proteins during cardioembolic stroke.

The use of statistical methods for predicting the status of patients with acute cerebral and coronary ischemia.

The most significant informative clinical laboratory parameters were determined and the exceptional value of cryoglobulin concentrations for predicting the clinical status was demonstrated. The efficiency of the proposed protocol of selective plasmapheresis for patients with atherothrombotic variant of stroke is confirmed, mathematical models describing and predicting the patient status are plotted.

Cryoglobulin level in patients with ischemic stroke and effect of selective plasmapheresis on this parameter.

Serum concentrations of cryoglobulins were measured in patients with ischemic stroke; inadequate changes in these concentrations over the course of the entire acute period of the disease were shown. Positive effect of selective plasmapheresis on the decrease in cryoglobulin concentration and recovery of patients was confirmed.

[Involvement of autoimmune mechanisms in development of ischemic brain damage].

Autoimmune processes take place during an acute phase of brain injury as well as during chronic vascular diseases. Cryoglobulinemia is a nonspecific marker of long-term stimulation of the immune system which reflects duration of autoimmune sensitization. It is characterized by production of abnormal temperature-dependent immunoglobulins named cryoglobulins. The highest cryoglobulinemia was found in patients with atherothrombotic stroke that corresponds to the results of previous studies reporting the greatest level of neurospecific antibodies during slow atherothrombosis development. It is shown that cryoglobulinemia is an important factor in pathogenesis of stroke which contributes to microcirculatory and hemorheological disorders, increases blood viscosity and results in the development of immunocomplex endovasculitis of small brain blood vessels in the ischemic lesion.

[Crioglobulinemia in cerebral and coronal atherothrombosis].

Forty-seven patients: group A--17 patients with acute ischemic atherothrombotic stroke and group B--30 patients with acute Q-formation myocardial infarction. The levels of dynamics and comparative clinical relevance of crioglobulinemia in patients of the both groups have been evaluated. Crioglobulines (CG) in the peripheral blood serum were determined at 1, 2, 3, 7th and 14th days after the disease development. On the 1st day, the elevated CG level similar in the both groups as well as similarity of crioglobulinemia dynamics in whole was observed. In the group A, but not in the group B, the CG level was directly correlated with disease severity (p<0,05). In the group B, there was a trend, which depended on the blood CG level on the 1st day of the disease and on the presence of previous stenocardia (p<0,1).

[Cryoglobulinemia and extracorporal plasma therapy in severe ischemic stroke]. / Krioglobulinemiia i ee korrektsiia pri ostrom ishemicheskom insul'te.

Forty-five patients with carotid ischemic stroke have been examined within the first 24 hours from the disease onset. The Orgogozo and NIH scales were used to objectify a severity of the patient's state and the Barthel scale--to evaluate a degree of functional rehabilitation. Cryoglobulins (CG) were measured in blood serum by spectrophotometric method on the 1st, 2nd, 3rd, 7th and 21st days. Selective plasmapheresis was included in the therapeutic complex for 22 randomly selected patients. In both groups, a level of CG positively correlated with a severity of the patient's state on the 1st day of the monitoring (r=-0.5; p<0.01). The study of hemostasis indicated the presence of a direct correlation between an increase of platelet aggregation, blood hyperviscosity and CG concentration (r=0.46; p<0.05 and r=0.74; p<0.01, respectively). Higher scoring on the Orgogozo scale and Barthel scale prevailed in the group treated with plasmapheresis that significantly correlated with a decrease in CG concentration in blood serum (r=-0.6; p<0.05 and r=0.5; p<0.05 respectively). An evaluation of platelet aggregation, blood viscosity and a coagulogram on the 21st day of the disease revealed a significant improvement of blood rheology in the group of patients switched to efferent therapy.

[The participation of the cAMP intracellular signal system in the olfactory transduction of camphor and amyl alcohol]. / Issledovanie uchastiia vnutrikletochnoi signal'noi sistemy tsAMF v oboniatel'noi transduktsii kamfary i amilovogo spirta.

In the frog isolated olfactory epithelium, the cAMP intracellular signal system was shown to take part in olfactory transduction of amyl alcohol but not camphor.