[Optimizing the diagnosis and treatment of dorsalgia in real-world clinical practice: the secondary endpoint of the DORISS multicenter observational study]. / Optimizatsiya diagnostiki i lecheniya dorsalgii v usloviyakh real'noi klinicheskoi praktiki: vtorichnaya konechnaya tochka mnogotsentrovogo nablyudatel'nogo issledovaniya DORISS.

OBJECTIVE: To evaluate the efficacy of Ipigrix in the complex treatment of patients with dorsalgia (DA) of the lumbosacral spine based on the results of the DORISS observational non-interventional multicenter study. MATERIAL AND METHODS: Overall 3563 patients with verified diagnoses of DA at 200 clinical centers within the Russian Federation who received comparable baseline therapy according to nosological standards were examined, some of them additionally received oral or staggered treatment with Ipigrix. Baseline therapy for DA was given to 376 patients (treatment group 1), combination of baseline with oral Ipigrix was given to 1026 patients (group 2), and combination with staggered prescription of ipidacrine - to 2161 (group 3). Secondary endpoint of the study included analysis of the improvement of clinical symptoms, values of pain NRS and DN4 scales together with Roland-Morris questionnaire during the period of observation depending on the therapy with an assessment of its safety. RESULTS: The results of the analysis of covariance allowed to exclude the influence of confounders (age and initial indicators of the utilized scales) on DA outcomes and demonstrated the greatest pain reduction in patients who additionally received Ipigrix via the staggered scheme. The inter-group comparison aligned by pseudorandomization showed statistically significant benefits of combined therapy regardless of the type of Ipigrix administration concerning main vertebral syndrome manifestations, sensory and motor disturbances, relief of pain, as well as neuropathic symptoms, improvement of neurophysiological parameters and restoration of life functioning without serious drug related adverse events. CONCLUSION: Ipigrix (ipidacrine) can be considered an effective and safe adjuvant analgesic in the treatment of DA.

[Compression of nerves and senses: ipidacrine as the light at the end of the tunnel]. / Kompressiya nervov i chuvstv: ipidakrin kak svet v kontse tunnelya.

OBJECTIVE: To evaluate the efficacy of the AChE inhibitor ipidacrine when added to traditional therapy in outpatients with tunnel syndromes (TS) based on clinical, neurophysiological and psycho-emotional indicators. MATERIAL AND METHODS: Ninety-two patients with a verified diagnosis of TS were randomized into a main group (MG), in which ipidacrine was added to the therapy (n=50), and a control group (CG), which received conventional therapy (n=42). Clinical neurological examination, provocative (Tinel, Falen, Goldberg finger compression, elevator and tourniquet) tests, pain questionnaires (VAS, DN4, PainDetect, Pain Disability Index), Beck's depression scale, the Spielberger Trait and State Anxiety Inventory, electroneuromyography (ENMG) were used. RESULTS: Most of the examined subjects were patients with mild TS without muscle weakness or amyotrophy (80%). In the main group, there was a significant decrease in hypoesthesia, normalization of provocative tests, the increase of SNAP amplitudes, as well as nerve conduction velocities over motor and sensory fibers of the studied nerves (p<0.05). Besides, the regression of neuropathic pain syndrome was objectified according to VAS, DN4 and PainDetect scales, which indexes decreased significantly (p<0.01) in the course of therapy combined with ipidacrine. The positive dynamics, in its turn, contributed to the reduction of depression according to Beck's depression scale, comorbid chronic pain syndrome and improvement of patients' quality of life according to Pain Disability Index (p<0.05). There was no significant improvement of clinical and neurophysiological parameters in the CG (p>0.05). There were no significant differences in the assessment of pain, depression and quality of life (p>0.05), except for a decrease in VAS scores (p=0.03). CONCLUSION: In patients treated with traditional therapy in combination with ipidacrine, the follow-up study after 4 weeks showed the reliable positive dynamics of clinical, neurophysiological and psycho-emotional indicators without application of psychoactive drugs.

[Optimizing the diagnosis and treatment of dorsalgia in real-world clinical practice: the primary endpoint of the DORISS multicenter observational study]. / Optimizatsiya diagnostiki i lecheniya dorsalgii v usloviyakh real'noi klinicheskoi praktiki: pervichnaya konechnaya tochka mnogotsentrovogo nablyudatel'nogo issledovaniya DORISS.

OBJECTIVE: To evaluate the impact of treatment with Ipigrix on the dynamics of clinical symptoms, neurological status, and quality of life in patients with dorsalgia of the lumbosacral spine based on the DORISS non-interventional multicenter observational study. MATERIAL AND METHODS: A total of 3563 patients with verified diagnoses of low back pain in 200 clinical centers across the Russian Federation who received comparable baseline therapy according to nosological standards were examined, some of whom additionally received oral or staged administration of Ipigrix. The primary endpoint of the study was the description of clinical and sociodemographic parameters, the consumption of medical resources, and the search for optimization of dorsalgia diagnosis in contemporary Russian outpatient neurological practice. RESULTS: The population of patients included in the study represents a homogeneous group of educated, overweight people of working age with average severity of low back pain and related dysfunction. In 91.6% of cases nonspecific mechanisms of pain syndrome development with a moderate neuropathic component prevail in the genesis of back pain, being a reason for seeking medical advice once every 2 months on average. The overdiagnosis of lumbar radiculopathies is discussed, which most probably is of combined nature due to overuse and straightforward interpretation of neuroimaging results, nonsyndromological diagnosis, and classification defects. CONCLUSION: Improving the methods of diagnosis and treatment of patients with PB will reduce the incidence and the number of relapses of pain syndrome.

[Disturbances of Autonomic Regulation of Cardiovascular System at Different Working Regimes with Night Shifts].

Aim        To study temporal and spectral characteristics of heart rhythm variability (HRV) in night shift workers.Materials and methods       Along with traditional risk factors, conditions of labor contribute to development of cardiovascular morbidity, including night shift work, which can be associated with disorders of the autonomic regulation detected by analysis of HRV. This study included 100 healthy men. 74 of them were engaged in shift work, including 53 men with rotating shift work, 21 men with fixed night shifts, and 26 men with day-time work. HRV was analyzed by data of 5-min electrocardiogram recording (background recording and orthostatic test).Results   Night-shift workers had decreases in total power of regulation (ТР, SDNN) and in the parasympathetic branch (HF, pNN50). Rotating night-shift workers displayed significant decreases in SDNN and pNN50 and pronounced changes in the VLF / LF / HF ratio in the orthostatic test.Conclusion            In work with night shifts, the type of autonomic regulation differs from the "standard" functioning of the autonomic nervous system (ANS). This study showed different effects of night work regimens on HRV indexes. With the rotating shift work, the ANS dysregulation was more profound and was evident by a significant decrease in the ANS total tone and parasympathetic activity (SDNN, pNN50) compared to night shifts with fixed working hours. The excessive weakening of the parasympathetic component in the passive orthostatic test can be considered as an early marker for ANS maladaptation.

[An outpatient with hand numbness: old prejudices, new strategies of differential diagnosis and treatment]. / Patsient s onemeniem v rukakh na ambulatornom prieme nevrologa: starye predrassudki, novye strategii differentsial'noi diagnostiki i lecheniia.

AIM: To search for 'diagnostic masks' of tunnel syndrome (TS) of the upper limbs and evaluate the efficacy of the antiacetylcholinesterase agent ipidakrine in the treatment of TS in a polyclinic. MATERIAL AND METHODS: An analysis of outpatient cards showed that 597 people had complaints of numbness in their hands (23.9% of all neurological pathology). After exclusion of patients with vascular, demyelinating pathology, somatoform disorders, 92 people, who previously had the diagnosis of osteochondrosis, were first-time diagnosed with TS of upper limbs with mild to moderate severity. Kruskal-Wallis' nonparametric analysis of variance revealed homogeneity of clinical and instrumental manifestations in all patients. Patients were divided into 2 comparable groups: the control group (n=42), which received traditional therapy and the main group (n=50), which additionally received ipidacrine. The follow-up clinical-neurophysiological examination was carried out 4 weeks after treatment. RESULTS: A significant improvement was revealed during the use of ipidacrine in addition to the traditional therapy, despite the short period of drug administration. Positive dynamics was also observed in the group receiving traditional therapy, but no significant differences were recorded between baseline and after treatment. CONCLUSION: The key 'diagnostic masks' of TS are various syndromes caused by spinal osteochondrosis. The high efficacy of ipidacrine in the complex treatment of patients with mild to moderate TS is confirmed.

[A clinical efficacy of electrode pharmaphoresis in treatment of railway workers with low-back pain].

OBJECTIVE: To evaluate clinical efficacy and tolerability of electrode pharmaphoresis using preparations xefocam and mydocalm-richter in railway workers with low-back pain. MATERIAL AND METHODS: Authors carried out an open prospective noncomparative study of 16 patients, aged 21-82 years, with spinal osteochondrosis with root syndrome and radiculopathia of the lumbar/sacral spine with pain syndrome regardless of its duration. Treatment efficacy was assessed by the dynamics of pain syndrome severity based on the scores of a self-rated scale completed by the patient and the McGill Pain Questionnaire. Quality-of-life was assessed with the Oswestry Disability Index before and in the end of treatment. Clinical outcome was evaluated with the modified Nurick scale. Electrode pharmaphoresis (the "Farma T.E.B. Trans Epidermal Barrier Physio" apparatus) was administered to all patients using xefocam (solution for injections 8 mg, 2 ml per procedure) and mydocalm-richter (solution for injections 100 mg, 2 ml per injection) in the lumbar/sacral spine. RESULTS AND CONCLUSION: The high clinical efficacy of electrode pharmaphoresis using xefocam and mydocalm-richter was shown. The complex restoration study resulted in the reduction of pain syndrome in all patients. Pain severity was reduced to mild grade in 68.8% to the middle of treatment and in 93.8% patients in the end of treatment. As a consequence of pain reduction, the functional activity (quality of self-service, daily activities) increased significantly in 68.8% of patients. Positive treatment effect was noted in 100% of patients, good tolerability of this medication in 87.5%.

[POEMS-syndrome: a literature review and case reports].

POEMS-syndrome (Polyneuropathy, Organomegaly, Endocrinopathy, M-protein, and Skin Changes) is a rare nosological form occurred in patients with paraproteinemic hemoblastosis. Chronic progressive sensory-motor polyneuropathy is a key syndrome of the disease and it is a common reason for referral to neurologist. The paper presents data about POEMS-syndrome and own case reports with the analysis of disease features and results of examination.

[Peculiarity of autonomic functions regulation remodeling in human adaptation to extreme conditions in labor activities].

In modem society, professional activity in conditions of extreme factors occupies a growing place. Of particular note is the work related to night shifts involving up to 20% of the population. In some cases, this work may lead to a breach of the adaptation processes of the body and increase the risk of diseases. The necessity to search criteria of dysregulation changes in the human body during adaptation to extreme conditions in labor activities is the actual problem from the standpoint of preventive health care of the working population health and providing safety in professional activities conditions. In our work, we attempted to identify early signs of autonomic function's dysregulation by analyzing the heart rhythm variability in locomotive operators and doctors on duty. It was revealed that these groups of people with different levels of intensity of professional activities may be the model for observation of the stages of dysregulation process. It is also shown that the earliest markers of autonomic regulation remodeling are indicators of the spectral analysis of heart rhythm variability, reflecting the activity of the total power regulation (TP) and parasympathetic part (HF).

[Piascledin in the treatment of chronic dorsalgia].

Piascledine is a plant drug which positively influences the metabolism of cartilage and bone tissues. The authors studied the therapeutic effect of the drug in outpatients with chronic nonspecific dorsalgia. Piascledine was administered in dose 300 mg daily during two months. In the first month, it was used in the combination with artrosilene (320 mg daily). A comparison group included patients receiving monotherapy with NSAIDs (artrosilene). The study confirmed the high analgesic efficacy of piascledine in the treatment of patients with chronic nonspecific dorsalgia with controlled using of NSAIDs. The positive effect of piascledine was demonstrated after one month of treatment. The authors suggest that further clinical trials and placebo-control studies are needed to confirm these results.

[Work with night shift as a factor dysregulation of autonomic nervous system of locomotive drivers].

Work with night shift is an obligate necessity of modem industrial urban society. In developed countries in the work on the night shift use up to 20%. These categories of workers are definitely the locomotive drivers. The consequence of a regular work with night shifts is a violation of human circadian rhythms, which, through dysregulation of the autonomic nervous system, is reflected in a greater risk of disease and transport accidents. The need to find ways and criteria of preventive monitoring dysregulatory changes in the human body is an urgent and challenging issue in terms of the health of the working population, disease prevention, and transportation security.

[Pathophysiological features of dorsalgia development among railway workers, connected with railway communication].

Dorsalgia's is an actual medical and social problem. It gains prominent significance among railway workers, connected with railway communication. Pain syndromes among this group of patients have different complex pathogenetic mechanisms of the development. In a great number of cases it is usually seen the worsening of the condition in connection to concomitant anxiety and depression. There are also concomitant osteoporosis and autonomic trophical disturbances.

[Axonopathy in the pathogenesis of multiple sclerosis, peripheral diffuse and local motor neuropathies and motor neuron disease].

Two hundreds and seventy-six patients including 43 patients with multiple sclerosis, 24 - with acute inflammatory demyelinating polyneuropathy (AIDP), 144 - with chronic inflammatory demyelinating polyneuropathy (CIDP), 27 - with motor multifocal neuropathy (MMN), 38 - with lateral amyotrophic sclerosis (LAS) have been examined. Symptoms of axonal degeneration, manifested in denervation phenomena in both clinical and instrumental studies (electromyography, transcranial magnetic stimulation, MRT), were revealed in all groups of patients. The formation of excitation conduction blocks is an universal pathophysiological mechanism of the axonopathy development in AIDP, CIDP, MMN and LAS. Symptoms of axonopathy and peripheral demyelinization in patients with multiple sclerosis and LAS suggest the possibility of transformation of immunopathological process from the central nervous system to the peripheral one.

[Differential diagnosis of multifocal motor neuropathy and related diseases].

Multifocal motor neuropathy (MMN) is a rare disease of the peripheral nervous system pathogenetically related to local demyelinization and formation of excitation conduction blocks. MMN affect only those nerves and their segments that comprise excitation conduction blocks. Such blocks have a persistent character and show a mosaic pattern over motor fibres which accounts for the specific clinical picture of MMN.

The role of axonopathy in the mechanisms of development of demyelination processes in the central and peripheral nervous system.

The role of axonopathy in the development of demyelinating processes in the CNS and peripheral nervous system was addressed in studies of 43 patients with multiple sclerosis (MS) and 144 patients with chronic inflammatory demyelinating polyneuropathy (CIDPN). Patients with MS were found to have foci of reduced MRI intensity in the T1 regime ("black holes," present in 28%) and regional atrophy of the cerebral cortex (in 46%), which showed a significant association with the degree of invalidity on the EDSS (Kendall tau = 0.38 and 0.43; p = 0.038 and 0.021, respectively). The mean fatigue score on the FSS was 4.9 (3.6; 5.4). A significant increase in the central conduction time on the background of fatigue (p = 0.016), along with an absence of signs of impaired reliability of neuromuscular transmission and an absence of past-activation phenomena, suggested that central mechanisms were predominant in the formation of fatigue phenomena in MS. In addition, 34.9% of patients with MS showed signs of peripheral nervous system involvement, while the clinical-electrophysiological pattern in 12.5% of patients with CIDPN showed signs of CNS involvement. These data widen existing concepts of the mechanisms of formation of axonopathy in the CNS, based on evidence for the development of axon-demyelinating processes in CIDPN, which is the most accessible model of demyelination for study using contemporary neurophysiological methods.

[Mechanisms of development of secondary axonal failure in diffuse and local demyelinating neuropathies].

To estimate a qualitative and quantitative effects of axonal failure on the clinical and electromyographic (EMG) picture of diffuse and local demyelination, 24 patients with Guillain-Barre syndrome (GBS), 144 with chronic inflammatory demyelinating polyneuropathy (CIDP) and 27 patients with multifocal motor neuropathy (MMN) have been studied. All the patients underwent a complex clinical neurological and EMG examination. Along with significant association between muscular hypotrophies and weakness in the majority of patients (tau=0,51; p<0,001), in some cases weakness in extremities was found in the absence of amyotrophic syndrome specifying a "functional" axonopathy due to the disturbance of ionic transport and the blockade of potassium channels. The formation of persisting conduction block in 100% of MMN cases and in up to 75% of GBS and CIDP cases revealed the additional special mechanism of axonopathy. The primary autoimmune affection of axonal membrane in a case of acute motor axonal neuropathy is described. The data obtained suggest that secondary axonal pathology underlies formation of the pathological system manifesting with failure of neurotrophic influence of the affected axons in relation to muscles and leading to neurological plastic deficiency at a level of self-supporting dysregulation pathology.

[Therapeutic effect of dexalgin on disturbances of vertebrogenic and nonvertebrogenic mechanisms in back pain].

To evaluate the effect of Dexalgin on dysregulation mechanisms in the complex therapy of dorsalgia, 39 patients have been studied. They were divided into 2 groups: with vertebrogenic (23 patients) and without vertebrogenic (16 patients) pain syndrome. Dexalgin was prescribed in dosage 75 mg daily during 5 days. Its efficacy was measured using the Visual Analogue Scale (VAS), Mc Gill Pain Questionnaire, OBPDQ in case of low back pain. Electromyographic (EMG) and magnetic resonance imaging (MRI) examination was performed in radiculopathic patients receiving dexalgin. The results revealed a statistically significant decrease of the VAS values at the control examination in both groups of patients (p<0,001) with background RI values being 18,4 +/- 9,7 and 21,2 +/- 11,7, respectively. The considerable reduction of RI to 14,6 +/- 9,2 was observed in the second group (p=0,044) on day 5. Dynamic examination showed the predominant decrease of OBPDQ percentage values in patients with myofascial back pain (p=0,038). The EMG data demonstrated a tendency to reduction of spontaneous activity in muscular fibers and normalization of the H-reflex latency during the tibial nerve conduction study in patients with vertebrogenic dorsalgia (p=0,058 and p=0,064, respectively). Dexalgin is the new generation of nonsteroid analgesics possessing potential in treatment of both, acute and exacerbations of chronic dorsalgias. No significant between-group differences were found in the MRI study. The study revealed dexalgin efficacy in patients with myofascial low back syndrome.

[Surgical treatment of thymomas in patients with generalized myasthenia gravis]. / Khirurgicheskoe lechenie timom u bol'nykh generalizovannoi miasteniei.

Experience in surgical treatment of 2977 patients with generalized myasthenia is presented, 386 (13%) of them have undergone surgeries for thymus tumors. Organo-specific tumors (thymoma) were diagnosed in 370 (95.9%) of them. Computed and magnetic-resonance tomography has the highest sensitivity and specificity in diagnosis of thymus tumors. Thymomthymectomy was performed in 317 patients including extended one in 117 (36.9%). Postoperative lethality in thymic tumor in the last years was 0.5%, general lethality over all period--5.1%. According to used classification (WHO, 1999) types of thymoma were the following: type A--2.1%, type B--86.3%, type AB--9.6%. Prognosis of surgical treatment depends of tumor type (it is worse in type B than in types A and AB), duration of the disease and severity of myasthenia.

[Disorders of autonomic fibers of the peripheral nerves in polyneuropathies]. / Porazhenie vegetativnykh volokon perifericheskikh nervov pri polinevropatiiakh.

The conditions of postganglionic fibers and parasympathetic fibers of vagus nerve were studied in 102 patients with varioustypes of polyneuritis and in 43 healthy individuals. In the control group the amplitude of evoked cutaneous sympathetic potential (ECSP) on the hand was 330 +/- 102 microV with 1.42 +/- 0.12 s latency, on the foot 230 +/- 81.7 microV with 2.04 +/- 0.17 s latency. Respiration arrhythmia at rest amounted to 45 +/- 14.7 ms and in forced ventilation 80.6 +/- 28.5 ms. Substantial changes of ECSP parameters and heart periods are characteristics of polyneuropathies. The disorders are especially severe in axonal polyneuropathies of various genesis: hand ECSP amplitude decreased to M + 107.5 +/- 118.3 microV, foot ECSP M-61.9 +/- 79.2 microV. Latencies increased on hand to M-1.8 +/- 0.55 s and on foot to M-2.29 +/- 0.71 s. Heart periods are also changed: M-27.9 +/- 1.1 ms at rest, M-66.9 +/- 56.4 ms in forced ventilation. Demyelinating polynephropathies elicit less pronounced changes in ECSP and respiratory arrhythmia. No clear correlations were detected between heart periods or ECSP parameters and clinical signs.