Prevalence of high affinity naturally occurring IgG2 antibodies against human chorionic gonadotropin and its subunits in patients with ovarian cyst.

Naturally occurring antibodies to tumour antigens are gaining interest as clinically important cancer biomarkers for early diagnosis, prognosis and for the development of anti-cancer therapeutics. The glycoprotein αß heterodimer hormone human chorionic gonadotropin (hCG) and its ß subunit (hCGß) are produced by various cancers, and their increased serum levels correlate with poor prognosis. We have previously reported that patients with benign ovarian cysts, but not the malignant tumours, were characterized by augmented serum levels of naturally-occurring IgG antibodies to hCG and hCGß. Here we further characterise these antibodies in patients with ovarian cysts. IgG and IgM antibody binding to whole hCG, hCGß, hCGα, hCGß C-terminal peptide (hCGßCTP), and the hCGß core fragment (hCGßCF) were measured in the sera from 36 patients with ovarian cysts and 12 healthy non-pregnant women using a standard ELISA. IgG subclass usage and affinity was also determined together with cross-binding to whole hCG and its subunits of four selected commercial monoclonal antibodies generated against ovarian cyst mucins. Our results showed that 91.7% of the sera tested contained elevated IgG, but not IgM antibodies to one or several antigens, with an overwhelming prevalence of high affinity IgG2 indicating their binding to carbohydrate epitopes and possibly ovarian cyst mucins. Anti-mucin commercial antibody ab212418 (Abcam) produced against Gal1-3GalNAc, exhibited strong cross-binding to hCGαß, hCGß, hCGα and hCGßCTP. The protective anti-cancer potential of these antibodies will be further investigated and could lead to the development of novel treatment strategies for ovarian cancer.

EVALUATION OF COGNITIVE IMPAIRMENT IN PATIENTS WITH MULTIPLE SCLEROSIS USING GEORGIAN LANGUAGE MONTREAL COGNITIVE ASSESSMENT.

The main objective of the study was to evaluate the prevalence and risk factors of cognitive impairment in patients with multiple sclerosis. Fifty-three patients with multiple sclerosis were enrolled in this cross-sectional study. Study participants underwent neurological status examination and cognitive screening with Montreal Cognitive Assessment. Beck Depression Inventory was used to assess mental health. Statistical analysis was performed using SPSS software, version 26.0. The overall prevalence of cognitive impairment in our group was 42%. We found that higher physical disability and progressive disease course are main risk-factors for cognitive decline in patients with multiple sclerosis.

EVALUATION OF NOVEL PORCINE PERICARDIAL BIOMATERIAL FOR VENTRAL AND INGUINAL HERNIA REPAIR. THE RESULTS OF A NON-RANDOMIZED CLINICAL TRIAL.

Using the mesh for hernia repair is the most common type of hernia surgery. There are many types of meshes made of various synthetic materials, but all of these meshes have their own respective disadvantages. The aim of this study was to provide preliminary results of a non-randomized clinical trial evaluation of novel porcine grafts XI-S+® (Colorado Therapeutics LLC. USA) for ventral and inguinal hernia repair. All patients underwent a standardized surgical procedure. Onlay surgical repair technique has been performed in ten patients with ventral hernia and Lichtenstein tension-free method has been used for ten patients with inguinal hernia repair. The XI-S+® mesh fixation was performed with multiple simple interrupted sutures using prolene thread. The average age of the patients with ventral hernia was 54±14 years, and 30% of patients were female and 70% of patients were male. The average age of the patients with inguinal hernia was 62.5±9.4 years, and 10% of patients were female and 90% of patients were male. The average hospitalization length was 2 days. During three years of observation, no recurrence of hernia was observed in patients. The XI-S + ® mesh has anti-adhesive properties, is extremely resistant to infections, provides favorable conditions for engraftment, early activity and patient rehabilitation. The clinical studies of the patients that underwent ventral and inguinal hernia repair using XI-S+® mesh have shown that the post-operative pain was minimal and easily controlled by the use of analgesics. As for the sensation of the mesh, in some patients it has been present up until 1 month from surgery, but it fully disappeared by the end of the 3rd month.

NATURALLY-OCCURRING AUTOANTIBODIES TO HUMAN CHORIONIC GONADOTROPIN AND ITS SUBUNITS IN OVARIAN CYST PATIENTS.

Growing evidence supports the existence of immune-surveillance mechanisms in ovarian tumour patients, including autoantibodies to tumour associated and tumour specific antigens, tumour growth factors. Glycoprotein hormone human chorionic gonadotropin (hCG) and its hormone-specific hCGß subunit have been associated with epithelial tumours such as bladder, lung, oral/facial, breast, cervical, ovarian, vaginal, prostate, renal and pancreatic carcinomas. It is believed that hCG plays a role of an autocrine growth factor for tumor cells. Here we have demonstrated that sera of patients with ovarian cyst contain naturally-occurring autoantibodies, predominantly of IgG2 isotype, that bind to hCG and its subunits with high affinity. Titration of blood sera from 36 female patients, aged 22-61 after ethical permission and informed consent, diagnosed with ovarian cyst and healthy age-matched controls (n=12) was performed using a classical enzyme-linked immunosorbent assay (ELISA). Binding of the sera to the following antigens was tested: hCGαß, hCGß, hCGα, hCGß C-terminal peptide (hCGßCTP) and hCGß core fragment (hCGßCF). The same type of ELISA (with necessary modifications) was used for further investigation of subclass usage and assessment of binding affinity of the detected autoantibodies. Our data indicates that the sera of the majority of patients with ovarian cyst contain significantly higher levels of the natural IgG antibodies binding to hCGαß, hCGß, hCGα, hCGßCTP and hCGßCF, than those of the healthy controls. Natural IgG antibodies to hCGαß heterodimer were detected in 78% of cases, to hCGß in 61% of cases, to hCGα in 78% of cases, to hCGßCTP in 69% of cases, to hCGßCF in 83% of cases. These autoantibodies predominantly belonged to the IgG2 subclass and were characterized by the high binding affinity. It is plausible that they cross- bind to sugar side chains of hCG and its subunits. Our data demonstrated that sera of patients with the ovarian cyst contains elevated levels of naturally-occurring IgG antibodies, which bind to hCG and/or its subunits. The overwhelming majority of these autoantibodies belong to the IgG2 isotype thus indicating that they might be directed against carbohydrate antigens within highly glycosylated hCG.

Use of the universal pain assessment tool for evaluating pain associated with temporomandibular disorders in youngsters.

AIM: Determine, whether the UPAT could be used as an extra tool to collect data on functional TMJ pain and to assess orofacial pain levels related to temporomandibular disorder(s) (TMD) in youngsters. METHODS: Patients were screened at the N1 Dental Clinic of Tbilisi State Medical University. The clinical scores of possible functional jaw pain were collected using the UPAT, to indicate pain severity on a visual scale during different jaw movements (opening, closing and lateral). STATISTICS: Comparisons of categorised data have been performed by chi-square test and Fisher's Exact test (where expected values were less than 5). The P value less than 0.05 was considered as statistically significant. RESULTS: Two hundred and ninety-one youngsters were screened by calibrated dentists. The majority (59%) of participants were male; age distribution ranged from 8 to 15 years (mean 11.46 ± 2.11). The results of the UPAT demonstrated the existence of functional TMJ pain in 15.46% (n=45) of the patients without significant prevalence (P > 0.05) in this survey group. CONCLUSION: According to the results of the present study, the UPAT demonstrated that it could be an additional tool to detect the existence of functional jaw pain possibly associated with TMD and also a valid instrument to score pain intensity associated with TMD in youngster patients.

Use of the universal pain assessment tool for evaluating pain associated with TMD in youngsters with an intellectual disability.

BACKGROUND: The Universal Pain Assessment Tool (UPAT) was used to assess the level of pain in people with limited communication skills. The UPAT enables clinicians to consult a specialized pain management team more often and lead to earlier interventions. The purpose of this study was to determine, whether the UPAT could be used as an extra tool to collect data on functional TMJ pain and to assess orofacial pain levels related to temporomandibular disorder(s) (TMD) in people with intellectual disabilities (ID). MATERIAL AND METHODS: Non-down syndrome ID Athletes were screened during the Special Olympics European games in 2014. The clinical scores of possible functional jaw pain were collected using the UPAT, to indicate pain severity on a visual scale during different jaw movements (opening, closing and lateral). RESULTS: Two hundred and four youngsters were screened by calibrated dentists. The majority (65%) of participants were male (133 male and 71 female athletes); age distribution ranged from 15 to 23 years (mean 19.25 ± 2.53). The results of the UPAT have shown the existence of functional TMJ pain in 32% (n=65) of the athletes without significant prevalence (P > 0.05) in this survey group. CONCLUSIONS: According to the results of the present study, the UPAT demonstrated that it could be a useful tool to detect the existence of functional jaw pain possibly associated with TMD and also a valid instrument to score pain intensity associated with TMD in people with ID.

Application of sonography for evaluation of posterior circulation disorders.

Posterior circulation disorders (PCD) include a) vertebrobasilar insufficiency (VBI), which has a wide clinical manifestation such as vestibulocerebellar syndrome, cephalalgia, cochlear syndrome, vegetovascular dystonia, visual disturbances, "syndrome of vertebral artery compression" etc, b) vertebrobasilar TIA and c) stroke. All of them are caused by blood flow disturbances in vertebral (VA), basilar (BAS) and posterior cerebral arteries (PCA). Aim - evaluation of role of extracranial duplex-sonography (EDS), transcranial color-coded duplex-sonography (TCCD) and rotational functional tests (RFT) in PCD. 88 patients (age range 18-62y) with PCD and 20 healthy controls with relevant age range were examined using EDS, TCCD and RFT with measurement of vertebral arteries (VA) diameter, mean flow velocities (MFV) and pulsatility index (PI) in VA, basilar artery (BAS) and posterior cerebral arteries (PCA). For statistical analysis SPSS software (Version 11.5) was used. In 48 (54,5%) patients revealed unilateral narrowing (less than 2.5 mm in diameter) and deformation of vertebral artery associated with osteochondrosis or primary hypoplasia. In 11 (12,5%) patients revealed bilateral narrowing (less than 2.8 mm in diameter) and deformation of vertebral arteries. Ultrasound investigation showed a decrease of MFV (23 ± 1.4 cm/sec) in the intracranial length of vertebral artery and an increase of PI (3,2 ±0,3 p=0,002) in the extracranial segments (V1- V3). In 52 cases (59%) revealed decrease of MFV in BAS by 32.6 ± 4.7% and in 41 cases (46.5%) decrease of MFV in both PCA by 24.8 ± 5.2% (P<0.002). In 21 cases (23.8%) revealed concurrent development of vertebrogenic reflex vasoconstriction. In 18 patients (20.4%) exposed only deformation of vertebral arteries with local increase of MFV and normal values in intracranial segments. Rotational tests were positive in 42 (47.7%) patients and manifested high correlation with clinical data. EDS and TCCD are important tools for estimation of high hemodynamic risk in patients with PCD. Rotation induced vertebrobasilar ischemia with temporary impairment of cerebral blood flow to the brainstem, thalamus, and occipital lobes predicts possible posterior circulation TIA or stroke and helps with proper selection of further treatment strategy.

Temporomandibular joint disorder (review).

Etiopathogenesis and clinical management of TMJD integrates a number of medical disciplines. In particular, dentistry, oral - facial surgery, neurology, rheumatology and so on. Nowadays there is no unified strategy for the management of this disease. Most cases of temporomandibular disorder (TMD) respond to simple treatment and the prognosis is good. Symptoms usually remit with simple care. In cases of secondary involvement of temporomandibular joint (TMJ), the prognosis depends on the primary disease. A comprehensive, chronological history and physical and examination of the patient, including dental history and examination, is essential to diagnose the specific condition to decide further investigations, if any, and to provide specific treatment. in severe cases, a joint consultation of a dentist, neurologist and rheumatologist is needed.

Quantitative electroencephalography coherence and dipole source index during various cognitive tasks in children with attention deficit hyperactivity disorder.

Attention deficit hyperactivity disorder (ADHD) is one of the most important disorder of childhood and adolescence. Debates about diagnostic approaches requiring for the precise assessment of ADHD remains actual till nowadays. The role of neurophysiological methods for this purpose is controversial. Thus the aim of our study was to observe QEEG changes by means of the most modern software analysis systems- coherence and brainwave activity dipole source localization. We have assessed 39 children- 18 of them from control group (Age range 9-12 years). QEEG was registered during Raven test and adding of one digit numbers. The results were analyzed by means of coherence measures and brainwave bilateral synchronous activity dipole source generator localization detection system (BrainLoc. 6). As a result we observed high coherence measures for ADHD compared to controls. As for dipole source generator we have detected higher dipole equivalent index in control group compared with ADHD children. Thus according to our results it is obvious that QEEG can serve as a valid neurometric tool in the diagnosis of Attention deficit hyperactivity disorder.

Quantative EEG during baseline and various cognitive tasks in children with attention deficit/hyperactivity disorder.

It is known that attention deficit/hyperactivity disorder is a widely spread condition in school aged childhood population. Making of precise diagnosis is a serious problem of modern pediatric neurology. In spite of large amount of guidelines and questionnaires the unified consensus of diagnosis is still absent. Thus it is important to search additional diagnostic criteria which can help physicians to confirm ADHD. For this purposes we have used quantative EEG (QEEG) parameters. There are numerous papers regarding QEEG changes of ADHD children during baseline (resting with closed eyes, resting with opened eyes, photic stimulation, hyperventilation).But information concerning QEEG evidences during cognitive tasks is insufficient. For this purposes we have used QEEG during Raven test, reading and calculation in children with ADHD and control group. QEEG was carried out according to standard 10-20 electrode placement rule from the following derivations: F3, F4, C3, C4, P3, P4, O1, O2. We have observed that in controls fulfilling of Raven test is more difficult than reading. Thus they are eulectic but in ADHD children reading is more difficult than Raven test. Thus they are dyslexic. By means of alpha and delta bands analysis it became apparent that alpha band is inversely proportional to mental effort and delta band is directly proportional to mental activity.

Primary headache disorders in the Republic of Georgia: prevalence and risk factors.

OBJECTIVE: To estimate the 1-year prevalences of migraine and tension-type headache (TTH), and identify their principal risk factors, in the general population of the Republic of Georgia. METHODS: In a community-based door-to-door survey, 4 medical residents interviewed all biologically unrelated adult members (>/=16 years) of 500 adjacent households in Tbilisi, the capital city, and 300 in rural Kakheti in eastern Georgia, using a previously validated questionnaire based on International Headache Society diagnostic criteria. RESULTS: The target population included 1,145 respondents, 690 (60%) women, mean age 45.4 +/- 12.0 years. The 1-year prevalences were as follows: migraine 6.5% (95% confidence interval 5.0-7.9), probable migraine 9.2% (7.5-10.8), all migraine 15.6% (13.5%-17.7%), TTH 10.0% (8.2-11.7), probable TTH 27.3% (24.8-29.9), all TTH 37.3% (34.5%-40.1%). Female gender and low socioeconomic status were risk factors for migraine but not for TTH. Headache on >/=15 days/month was reported by 87 respondents, a prevalence of 7.6% (6.1-9.1). Female gender, low socioeconomic status, and frequent use (>/=10 days/month) of acute headache drugs were risk factors. The likely prevalence of medication overuse headache was 0.9% (0.3-1.4), of chronic migraine 1.4% (0.7-2.1), and of chronic TTH 3.3% (2.3-4.4), but caution is needed in interpreting these estimates. CONCLUSIONS: While the prevalences of migraine and tension-type headache are comparable with those in Europe and the United States, a remarkably high percentage of the population of Georgia have headache on >/=15 days/month. This study demonstrates the importance of socioeconomic factors in a developing country and unmasks the unmet needs of people with headache disorders.

Prevalence of cluster headache in the Republic of Georgia: results of a population-based study and methodological considerations.

We present a study of the general-population prevalence of cluster headache in the Republic of Georgia and discuss the advantages and challenges of different methodological approaches. In a community-based survey, specially trained medical residents visited 500 adjacent households in the capital city, Tbilisi, and 300 households in the eastern rural area of Kakheti. They interviewed all (n = 1145) biologically unrelated adult occupants using a previously validated questionnaire. The household responses rates were 92% in Tbilisi and 100% in Kakheti. The survey identified 32 persons with possible cluster headache, who were then personally interviewed by one of two headache-experienced neurologists. Cluster headache was confirmed in one subject. The prevalence of cluster headache was therefore estimated to be 87/100,000 (95% confidence interval < 258/100,000). We used a conservative approach, which has an obvious advantage of high-quality data collection, but is very demanding of manpower and time.

Riluzole suppresses post-sigh, but not spontaneous apnoeas during sleep in rats.

We conducted this experiment to determine the role of glutamate in the mechanism of sleep apnoeas by administering riluzole, a glutamate release inhibitor, to freely moving rats in which sleep-related apnoeas are physiological phenomena. Adult Sprague-Dawley rats were implanted with electrodes for electroencephalogram (EEG) and electromyogram (EMG) recording to monitor sleep and were placed inside a single-chamber plethysmograph to monitor respiration. Sleep and respiration were recorded for 6 h following intraperitoneal administration of 0.5, 5.0 and 10.0 mg kg(-1) riluzole. Riluzole dose-dependently suppressed post-sigh apnoeas during rapid eye movement (REM) sleep but had no effect on sleep-related spontaneous apnoeas. The drug (5.0 and 10.0 mg kg(-1)) also dose-dependently reduced wakefulness and increased sleep. It appears that glutamate, an excitatory neurotransmitter, plays a role in the genesis of the post-sigh apnoeas during REM sleep.

Cognitive correlates of leukoaraiosis in the early stages of Alzheimer's disease.

To reveal cognitive correlates of leukoaraiosis (LA) in the early stages of Alzheimer's disease (AD) and to exclude confounding effects of aging, brain atrophy, education and dementive illness on cognition, we carefully selected a sample of 37 probable AD patients (NINCDS-ADRDA criteria, Hachinski ischemic score < 5) with similar indices of age, educational level, degree of brain atrophy and dementia severity (CDR 0.5, CDR 1 and MMSE score no lower than 20), and compared the results of neuropsychological testing of patients with and without LA. All patients underwent magnetic resonance imaging. LA was detected in 17 out of 37 cases. There were no significant differences between subjects with and without LA (Student's t-test, p>0.05) in tests that evaluate language, verbal intelligence and visuospatial functions, while the patients with LA showed poorer performance (p<0.05) in the tests evaluating verbal memory, attention/concentration and executive functions. The results obtained suggest that the patients with LA in the early stages of AD revealed dorsolateral prefrontal dysfunction syndrome due to disconnection of cortico-subcortical circuits. We found this syndrome to be more prenounced than it has been described in the non-demented elderly with LA. It may be that in patients suffering from degenerative illness, the brain has fewer compensatory reserves than in cases of "normal" aging, and it is more sensitive to ischemic damage caused by cerebral amyloid, arteriosclerotic or fibro-hyalinotic angiopathy. This typical neuropsychological syndrome is revealed only in the initial stage of AD in patients with LA. The follow-up progress of the atrophic-degenerative illness leads to overlapping of the specific neuropsychological syndrome by global cognitive impairment.