[Variants of the clinical course of the acute period of ischemic stroke in young and middle-aged patients]. / Varianty klinicheskogo techeniya ostrogo perioda ishemicheskogo insul'ta u patsientov molodogo i srednego vozrasta.

OBJECTIVE: To identify and study variants of the clinical course of the acute period of ischemic stroke (IS) in young and middle-aged patients, to establish their dependence on the presence of the main risk factors for cardiovascular diseases. MATERIAL AND METHODS: The study included 145 patients (111 men and 34 women) with IS in its acute period, including 22 young (15.2%) and 123 middle-aged people (84.8%). The main risk factors of cardiovascular diseases were analyzed. Five variants of the clinical course of the acute period of IS were identified: regredient, regredient with residual mild focal neurological symptoms, stable, slowly progressive, and rapidly progressive. The regredient course and the regredient course with residual mild focal neurological symptoms are attributed to the favorable course of the acute period of IS; stable, progressive, and rapidly progressive predicted unfavorable course. RESULTS: Regredient course was observed in 43 (29.7%) patients; regredient with residual mild focal neurological symptoms in 78 (53.8%) patients; stable course was established in 4 (2.8%) patients; slow progressive course in 15 (10.3%) patients and fast progressive course in 5 (3.4%) patients. The following risk factors significantly contributed to the favorable course: less pronounced motor, sensory and speech disorders at the time of admission of the patient to the hospital and at the end of the acute period of IS, timely hospitalization in the neurological department for the treatment of patients with acute disorders of cerebral circulation within the «therapeutic¼ window, intravenous thrombolytic therapy, mild severity of IS on the NIHSS, a lesion of the vertebral-basilar brain basin, absence of overweight and ischemic heart disease in the patient's anamnesis (p<0.05). CONCLUSION: Determining the clinical course of the acute period of IS in young and middle-aged patients will make it possible to predict the rehabilitation potential of a particular patient and increase the effectiveness of individual neurorehabilitation measures at the stages of early and late rehabilitation treatment.

[Predicting the results of rehabilitation treatment of patients with acute myocardial infarction who underwent coronary artery stenting: focus on the rehabilitation potential]. / Prognozirovanie rezul'tatov vosstanovitel'nogo lecheniya bol'nykh s ostrym infarktom miokarda, perenesshikh stentirovanie koronarnykh arterii: fokus na reabilitatsionnyi potentsial.

The search for ways to assess the rehabilitation potential (RP) in patients with acute myocardial infarction (AMI) who have undergone stenting remains relevant, which will allow personalizing approaches to prescribing treatment complexes necessary for a particular patient, increasing their effectiveness and reducing the likelihood of complications. OBJECTIVE: To develop a method for assessing RP in patients in the acute period of myocardial infarction and to evaluate its role in predicting the effectiveness of therapeutic measures in the early recovery period. MATERIAL AND METHODS: The study consisted of two parts. In the first part, a method for assessing the RP of patients with AMI was created using mathematical modeling methods. For this purpose, the analysis of discharge epicrisis of 137 patients (training sample) with AMI aged from 34 to 85 years (average age 59.4±2.1 years) was carried out. In the second part of the study, the results of rehabilitation measures were analyzed in these patients who, after the intensive care unit and intensive care unit, were transferred to the cardiology department of Angara Clinical Resort JSC. At the end of the II stage of rehabilitation, a multidisciplinary team evaluated the effectiveness of treatment of patients using integral indicators characterizing the clinical condition of a patient who has undergone acute coronary syndrome and stenting. RESULTS: In the first part of the study, devoted to the development of a mathematical model for assessing the RP of patients with AMI, an algorithm of methodology was created: a formalized patient map was formed, the evidence base was represented by 109 indicators; certain indicators were assigned the values of coefficients of linear classification functions, depending on which the patient fell into one of three groups: group 1 - high RP; group 2 - medium RP; group 3 - low RP. The second part of the study was devoted to determining the value of RP for predicting the effectiveness of therapeutic measures in the early recovery period (stage II of medical rehabilitation). When testing patients at the end of treatment at the resort, it was found that the greatest effect was observed in group 1 patients with high RP. A lesser effect was observed in patients of group 2 and, especially, group 3. CONCLUSION: The use of a method for assessing RP based on mathematical modeling in AMI patients who have undergone stenting allows predicting the results of medical rehabilitation of patients at stage II in the conditions of the resort.

Biochemical Status of Obese Male Adolescents of Different Ethnicity: Discriminant Analysis in the Identification of the Most Informative Indicators.

Parameters of the lipid metabolism and lipid peroxidation-antioxidant defense system in male adolescents with obesity, representatives of European and Mongoloid ethnicity were evaluated. Discriminant analysis revealed the most informative biochemical parameters for obese male adolescents: glutathione-S-transferase, VLDL cholesterol, glutathione peroxidase, reduced glutathione, and SOD activity for obese male Caucasian adolescents and glutathione-S-transferase, VLDL cholesterol, α-tocopherol, and glutathione peroxidase for Mongoloids obese male adolescents. The use of discriminant analysis allows implementing a differentiated ethnicity-oriented approach to prescribing antioxidant drugs in the complex therapy of obesity.

[Rehabilitation potential of patients with ischemic stroke: the possibility of predicting the course of the disease and the results of rehabilitation treatment]. / Reabilitatsionnyi potentsial bol'nykh s ishemicheskim insul'tom: vozmozhnosti prognozirovaniya techeniya zabolevaniya i rezul'tatov vosstanovitel'nogo lecheniya.

The search for ways to assess the rehabilitation potential (RP) in patients with ischemic stroke (IS) remains relevant, which will allow personalizing approaches to prescribing the treatment complexes necessary for a particular patient, increasing their effectiveness and reducing the likelihood of complications. OBJECTIVE: To develop a method for assessing RP in patients in the acute period of IS and to evaluate its role in predicting the effectiveness of therapeutic measures in the early recovery period. MATERIAL AND METHODS: The study consisted of two parts. In the first part, using mathematical modeling methods, a method was created for assessing the RP of patients with acute IS. For this, we analyzed the discharge records of 102 patients (training sample) with IS aged 42 to 80 years (mean age 64.0±2.6 years). In the second part of the study, the results of rehabilitation measures were analyzed in these patients, who were transferred from the primary vascular department to the neurological department of Angara Clinical Resort. At the end of stage II of rehabilitation, a multidisciplinary team assessed the effectiveness of treatment of patients using integral indicators characterizing the clinical condition of a patient who had a stroke. RESULTS: In the first part of the study, devoted to the development of a mathematical model for assessing the RP of patients with IS, a methodology algorithm was created: a formalized patient card was created, the evidence base is represented by 85 indicators; certain indicators were assigned the values of the coefficients of linear classification functions, depending on which the patient fell into one of 4 groups: group 1 - satisfactory RP with limitations in rehabilitation measures; group 2 - satisfactory RP; group 3 - low RP; 4th group - high RP. The second part of the study was devoted to determining the value of RP for predicting the effectiveness of therapeutic measures in the early recovery period (stage II of medical rehabilitation). When testing patients at the end of treatment at the resort, it was found that the greatest effect was observed in patients of the 4th group with a high RP. A lesser effect was noted in patients of the 2nd group. The worst results were registered in the 1st and especially in the 3rd groups. CONCLUSION: The use of the method for assessing the RP of patients who have undergone IS, based on mathematical modeling, makes it possible to predict the results of medical rehabilitation of patients with IS at the II stage of rehabilitation in a resort.

[Differentiated complex treatment of Parkinson's disease considering atrophic changes of the brain]. / Differentsirovannoe kompleksnoe lechenie patsientov, stradayushchikh bolezn'yu Parkinsona, s uchetom stepeni atroficheskikh izmenenii veshchestva golovnogo mozga.

OBJECTIVE: To develop and implement the tactics of the differentiated complex (medication in combination with surgery) treatment of the form of Parkinson's disease (PD) associated with dyskinesias, according to the severity of atrophic changes in the brain. MATERIAL AND METHODS: The study included 40 patients with PD associated with dyskinesias and motor fluctuations. Patients of the main group received medication and surgical treatment, patients of the comparison group received only medication. The patient's health was assessed every 3 months during 1.5 years. Three atrophy indices were proposed to describe atrophic changes in the brain. RESULTS: We have determined the values of the indices when the complex treatment was optimal for patients. CONCLUSION: The results of the study are supposed to be used in the practice of neurologists and neurosurgeons.

Morphofunctional State of the Periodontal Tissues in Humans and Rats with Arterial Hypertension.

We performed comparative analysis of hemodynamic in the periodontal microcirculatory bed in adolescents with arterial hypertension (AH) and morphological changes in the periodontal tissues of in hypertensive ISIAH rats of comparable biological age. In the periodontal tissues of adolescents with hypertension, the blood flow velocity and index of peripheral resistance increased, while pulse pressure decreased. In ISIAH rats, the mean area of periodontal and pulp vessels increased and the area of the connective tissue decreased. These results can be used in the complex assessment of morphofunctional state periodontium during hypertension development.

[Cytoflavin in patients with vertigo and dizziness in a distant period of mild traumatic brain injury]. / Primenenie Tsitoflavina u bol'nykh s golovokruzheniem v otdalennom periode legkoi cherepno-mozgovoi travmy.

OBJECTIVE: To study the efficacy and safety of the complex metabolic neuroprotective medicine cytoflavin in tablet form in patients with vertigo and dizziness in a distant period of mild traumatic brain injury. MATERIAL AND METHODS: Forty patients, aged 20-55 years, with a mild traumatic brain injury were studied for 3 months to 1 year. Cytoflavin was used as monotherapy in a dose of 2 tablets 2 times a day for 25 days. Otoneurological and stabilometric examinations were performed before and after treatment. The Dizziness Handicap Inventory, a visual-analogous scale and HADS were administered. RESULTS AND CONCLUSION: Cytoflavin decreases the severity of vertigo and dizziness, improves stabilometric indicators and reduces emotional disorders in patients with vertigo in the distant period of mild traumatic brain injury. No significant adverse reactions are observed.

Comparative Analysis of the Morphology of Dentition in Normotensive and Hypertensive Rats Exposed to Chronic Stress.

The peculiarities of the histological structure and morphometrical parameters of the dentition in ISIAH rats (inherited stress-induced arterial hypertension) before stress and after modeling of everyday life stress regimen (chronic stress) were compared with those in WAG rats. The area of blood vessels of the periodontium, the thickness of the endothelium in the periodontal and pulp vessels, and the number of fibroblasts were increased, while the level of odontoblasts was reduced in ISIAH rats both before and after exposure to chronic stress, which can reflect more pronounced reaction to stress in hypertensive animals.

Changes in the Periodontium and Pulp in ISIAH Rats Caused by Stress Exposures in Different Modes.

It was shown that the intensity of morphological changes in the dental system tissues (periodontium and pulp) of ISIAH rats depends on the mode of stress exposure. Acute stress was associated with a significant increase in the area of periodontal and pulp vessels, a decrease in the area of connective tissue of these components, and an increase in the thickness of the vascular endothelium. Chronic stress in these animals induced an increase in the thickness of the endothelial layer of the periodontal and pulp vessels, fibromatosis (increase in the number of fibroblasts), and a sharp decrease in the level of odontoblasts.

[Role of immunological factors in the development of myopic choroidal neovascularization]. / Vliyanie immunologicheskikh faktorov na mekhanizmy formirovaniya miopicheskoi khorioidal'noi neovaskulyarizatsii.

AIM: To study the concentration of cytokines in the aqueous humor of the anterior chamber in patients with myopic choroidal neovascularization (mCNV) and to compare the results to their ophthalmic status. MATERIAL AND METHODS: A total of 19 patients (19 eyes) with mCNV treated with intravitreal ranibizumab were included in the study. The control group consisted of 15 patients (15 eyes) with myopia who had cataract surgery. Age, sex, and refractive error distribution were similar to that in the study group. All patients underwent a detailed ophthalmic examination as well as immunological study of the aqueous humor for cytokines concentrations using flow fluorometry (Bio-Plex Pro Human Cytokine Panel, 27-Plex, Bio-Rad Laboratories, USA). RESULTS: Significant differences in concentrations of 10 cytokines were found between the mCNV and study groups. Vascular endothelial growth factor (VEGF) level was twice as low in patients with mCNV as that in the controls (191.15±142.3 pg/ml and 320.06±170.05 pg/ml, respectively) (p<0.05). The other 9 cytokines were higher in mCNV, namely, platelet-derived growth factor (PDGF-BB), inflammatory and anti-inflammatory cytokines (IL-2, IL-15, IL-17А and IL-5, IL-13, respectively), tumor necrosis factor (TNFα), and chemokines (IL-8, RANTES). The degree of myopia as well as morphological and functional changes in the macular zone were shown to be in close correlation with cytokines involved in inflammation and VEGF. VEGF level appeared to be negatively related to axial eye length, refractive error, and three cytokines: IL-13, INF-γ, and RANTES. At the same time, numerous (6, 8 and more) close correlations were established between inflammatory and anti-inflammatory cytokines, chemokines, and growth factors. CONCLUSION: Patients with mCNV have been found to have higher than usual levels of inflammatory and anti-inflammatory cytokines, chemokines, and growth factors as well as a significantly decreased VEGF concentration. Immunological status of these patients differs from that in other ocular neovascular diseases suggesting possible involvement of alternative pathogenetic mechanisms.

[Molecular genetic markers of predisposition to thrombosis in adolescents with essential hypertension ].

AIM: To estimate the spread and distribution of genotypes and alleles of thrombosis predisposition gene polymorphisms in adolescents with essential hypertension (EH). SUBJECTS AND METHODS: One hundred and thirty-seven 14- to 17-year-old adolescents were examined. There were 3 examined groups: 1) 37 EH patients with prothrombotic changes (PTC); 2) 60 EH patients without PTC; 3) 40 healthy adolescents. Prothrombin time, activated partial thromboplastin time, and the levels of fibrinogen and soluble fibrin monomer complexes were determined. The adolescents were assigned to a PTC group if they had changes by one or several above indicators. Polymerase chain reaction assay was used to type coagulation factor II (FII) and factor V (FV), plasminogen activator inhibitor type 1 (PAI-7), 5,10-methylenetetrahydrofolate reductase (MTHFR), and methionine syntase reductase (MTRR) gene polymorphisms. Group differences were determined by qualitative signs, by using.the χ2test and Yates' correction for continuity and Fisher's exact test if one of the groups had at least 5 individuals. All differences were considered statistically significant at p < 0.05. RESULTS: FV R506Q, FII G20210A, PAI1-675 4G/5G, MTHFR A1298C, and MTRR A66G polymorphisms have not been found to affect the hemostatic system in adolescents with EH. MTHFR C677T may act as a risk factor of PTC in adolescents with EH, by increasing the risk of thrombotic events at an old age. CONCLUSION: It is recommended that the determination of molecular genetic markers for predisposition to thrombosis be actively used in adolescents with EA to form a risk group for thrombotic events and to implement preventive measures..

[Comprehensive assessment of risk factors for retinal vein occlusion and derivation of classification criteria for retinal ischemia].

OBJECTIVE: to perform a complex ophthalmological and general examination of patients with retinal vein occlusion (RVO) and to derive classification criteria for retinal ischemia. MATERIALS AND METHODS: A total of 44 patients with RVO and macular edema and 20 controls were enrolled. All patients underwent a thorough ophthalmological and general examination and clinical laboratory testing. RESULTS: Cardinal risk factors of RVO development were derived from among somatic illnesses and laboratory results. Regional hemodynamics assessment helped identify the most significant systolic and diastolic blood flow disturbances in the central retinal vein and central retinal artery circulation systems. Profound changes in electrophysiological parameters were found. Statistical analysis of the collected data allowed to identify 3 stages of retinal ischemia. CONCLUSION: The established risk factors of RVO development, regional blood flow impairment and original classification criteria for retinal ischemia make it possible to predict the course of the disease and treatment effect.

[Regularities and mechanisms of visual perception transformation in presbyopia development].

66 healthy subjects were divided into 2 groups (mean age in the 1st group 18,6+/-0,4 years and 51,7+/-6,5 years in the 2nd group) to study regularities and mechanisms of presbyopia development. Visual pattern characteristics and anatomico-physiological parameters were studied using ultrasound biomicroscopy, electroretinography, ISCEV and visual evoked potentials. The most informative parameters for division of 2 groups are near visual point, fusion capacity in convergence, range of relative accommodation, binocular visual acuity, intraocular pressure, astigmatism, ciliary body thickness, A-wave amplitude on maximal ERG. Presbyopia development is accompanied with significant reorganization of visual analyzer activity, including binocular interaction. Surgical treatment of presbyopia should be supplemented with methods aimed to recover binocular interaction.

[Method for the determination of the biological age and aging rate in man].

Multiple linear regression was used to develop a mathematical model of biological age in healthy subjects. Aging rate was found to slow down in elderly persons compared with young and middle-aged ones. In men below 60 years, it was lower than in women. The aging rate increased in patients with coronary heart disease and hypertensive disease.

[Human biological age, cardiovascular system, and its aging rate]. / Biologicheskii vozrast chekovek, serdechno-sosudistaia sistema i skorost' ee stareniia.

Mathematical model of biological age of the cardiovascular system was determined by multiple linear regression analysis in 100 normal subjects aged 30-74 years on the basis of central hemodynamic, microcirculation, and vascular reactivity parameters. The rate of cardiovascular aging is decreased in elderly subjects. Before 60 years of age the rate of aging is higher in men than in women.

[The prediction of the development of circulatory encephalopathy in hypertension patients with the initial manifestations of brain blood supply insufficiency]. / Prognozirovanie razvitiia distsirkuliatornoi éntsefalopatii u bol'nykh gipertonicheskoi bolezn'iu s nachal'nymi proiavleniiami nedostatochnosti krovosnabzheniia mozga.

The principal risk factors conducive to the development of cardiovascular diseases in young and middle-aged subjects with chronic cerebrovascular insufficiency due to Stage I or II essential hypertension were under study. Thirty-four male patients with the initial manifestations of inadequate blood supply to the brain (IMIBS), 35 male patients with stages I or II dyscirculatory encephalopathy (DE), and 32 and 33 female patients with the same conditions, respectively, were examined. Hypertensive cerebral crises were significantly more frequent in DE patients of both sexes than in IMIBS patients, and a tendency to a longer standing of arterial hypertension was observed in DE patients as against those with IMIBS. The results of the examinations evidence that excessive body mass, hypokinesia and psychoemotional stress, as well as an 'accumulation' of risk factors were conducive to the development of DE in essential hypertension patients with IMIBS. Basing on the discriminant analysis of risk factors, the authors have developed a method for predicting the development of DE in patients with IMIBS of a hypertensive origin. Use of this method will essentially improve the efficacy of prophylactic and therapeutic measures in IMIBS patients.

[Variants of the clinical course of circulatory encephalopathy and the significance of certain risk factors]. / Varianty klinicheskogo techeniia distsirkuliatornoi éntsefalopatii i znachenie nekotorykh faktorov riska.

Based on the results of a many-year dynamic follow-up of 151 patients with dyscirculatory encephalopathy (DE), the authors distinguish six variants of its clinical course: stable, slowly progressing without paroxysms or transient disorders of brain circulation (TDBC), slowly progressing with paroxysms, that with TDBC, intermittent, rapidly progressing. The two former variants are referred to the favorable type of DE course, the rest are considered unfavorable. The major risk factors in the patients with the favorable and unfavorable patterns of DE were studied, as well as the contribution of these factors to the development of DE. In male patients the factors conductive to the development of an unfavorable DE course were psychoemotional stress, hypokinesia, alcohol abuse, the presence of two or more concomitant somatic diseases and the absence of regular therapy; in women such factors were psychoemotional stress, excessive body mass, arterial hypertension, the presence of two or more concomitant somatic diseases, and a family history of cardiovascular diseases. A method for predicting the DE course, based on a discriminant analysis of the risk factors, has been developed, that will essentially improve the efficacy of therapeutic and prophylactic measures in such patients.