Radiomic-based nonlinear supervised learning classifiers on non-contrast CT to predict functional prognosis in patients with spontaneous intracerebral hematoma.

PURPOSE: To evaluate if nonlinear supervised learning classifiers based on non-contrast CT can predict functional prognosis at discharge in patients with spontaneous intracerebral hematoma. METHODS: Retrospective, single-center, observational analysis of patients with a diagnosis of spontaneous intracerebral hematoma confirmed by non-contrast CT between January 2016 and April 2018. Patients with HIE > 18 years and with TCCSC performed within the first 24 h of symptom onset were included. Patients with secondary spontaneous intracerebral hematoma and in whom radiomic variables were not available were excluded. Clinical, demographic and admission variables were collected. Patients were classified according to the Modified Rankin Scale (mRS) at discharge into good (mRS 0-2) and poor prognosis (mRS 3-6). After manual segmentation of each spontaneous intracerebral hematoma, the radiomics variables were obtained. The sample was divided into a training and testing cohort and a validation cohort (70-30% respectively). Different methods of variable selection and dimensionality reduction were used, and different algorithms were used for model construction. Stratified 10-fold cross-validation were performed on the training and testing cohort and the mean area under the curve (AUC) were calculated. Once the models were trained, the sensitivity of each was calculated to predict functional prognosis at discharge in the validation cohort. RESULTS: 105 patients with spontaneous intracerebral hematoma were analyzed. 105 radiomic variables were evaluated for each patient. P-SVM, KNN-E and RF-10 algorithms, in combination with the ANOVA variable selection method, were the best performing classifiers in the training and testing cohort (AUC 0.798, 0.752 and 0.742 respectively). The predictions of these models, in the validation cohort, had a sensitivity of 0.897 (0.778-1;95%CI), with a false-negative rate of 0% for predicting poor functional prognosis at discharge. CONCLUSION: The use of radiomics-based nonlinear supervised learning classifiers are a promising diagnostic tool for predicting functional outcome at discharge in HIE patients, with a low false negative rate, although larger and balanced samples are still needed to develop and improve their performance.

Clasificadores de aprendizaje supervisado no lineales basados en radiómica de la TC cerebral sin contraste para predecir el pronóstico funcional en pacientes con hematoma intracerebral espontáneo / Radiomic-based nonlinear supervised learning classifiers on non-contrast CT to predict functional prognosis in patients with spontaneous intracerebral hematoma

Objetivo: Evaluar si clasificadores de aprendizaje supervisado no lineales basados en radiómica de la TC cerebral sin contraste (TCCSC) pueden predecir el pronóstico funcional al alta en pacientes con hematoma intracerebral espontáneo (HIE). Material y método: Análisis observacional retrospectivo y unicéntrico de pacientes con diagnóstico de HIE confirmado por TCCSC entre enero de 2016 y abril de 2018. Se incluyeron pacientes con HIE >18años y con TCCSC realizado dentro de las primeras 24horas del inicio de los síntomas. Se excluyeron los HIE secundarios y en los que no se disponía de las variables de radiómica. Se recogieron datos clínicos, demográficos y variables al ingreso. Los pacientes se clasificaron según la Escala Modificada de Rankin (mRS) al alta en buen (mRS0-2) y mal pronóstico (mRS3-6). Tras la segmentación manual de la TCCSC de cada HIE se obtuvieron las variables de radiómica. La muestra se dividió en una cohorte de entrenamiento y prueba y otra cohorte de validación (70-30%, respectivamente). Se usaron diferentes métodos de selección de variables y reducción de dimensionalidad, así como diferentes algoritmos para la construcción del modelo. Se realizaron 10 iteraciones de validación cruzada estratificada en la cohorte de entrenamiento y prueba y se calculó la media de los valores de área bajo la curva (AUC). Una vez entrenados los modelos, se calculó la sensibilidad de cada uno para predecir el pronóstico funcional al alta en la cohorte de validación. Resultados: Se analizaron 105 pacientes con HIE. Se evaluaron 105 variables de radiómica de cada paciente. Los algoritmos P-SVM, KNN-E y RF-10, en combinación con el método de selección de variables ANOVA, fueron los clasificadores con mejor rendimiento en la cohorte de entrenamiento y prueba (AUC: 0,798, 0,752 y 0,742, respectivamente)...(AU)

Purpose: To evaluate if nonlinear supervised learning classifiers based on non-contrast cerebral CT can predict functional prognosis at discharge in patients with spontaneous intracerebral hematoma (HIE). Methods: Retrospective, single-center, observational analysis of patients with a diagnosis of spontaneous intracerebral hematoma confirmed by non-contrast CT between January 2016 and April 2018. Patients with HIE >18years and with non-contrast CT performed within the first 24hours of symptom onset were included. Patients with secondary spontaneous intracerebral hematoma and in whom radiomic variables were not available were excluded. Clinical, demographic and admission variables were collected. Patients were classified according to the Modified Rankin Scale (mRS) at discharge into good (mRS0-2) and poor prognosis (mRS3-6). After manual segmentation of each spontaneous intracerebral hematoma, the radiomics variables were obtained. The sample was divided into a training and testing cohort and a validation cohort (70-30%, respectively). Different methods of variable selection and dimensionality reduction were used, and different algorithms were used for model construction. Stratified 10-fold cross-validation were performed on the training and testing cohort and the mean area under the curve (AUC) were calculated. Once the models were trained, the sensitivity of each was calculated to predict functional prognosis at discharge in the validation cohort. Results: 105 patients with spontaneous intracerebral hematoma were analyzed. 105 radiomic variables were evaluated for each patient. P-SVM, KNN-E and RF-10 algorithms, in combination with the ANOVA variable selection method, were the best performing classifiers in the training and testing cohort (AUC: 0.798, 0.752 and 0.742, respectively)...(AU)

Quality of Life of Patients Who Have Suffered from Acute Cerebrovascular Accident (Investigation Based on EQ-5D-5L).

Background: Acute cerebrovascular accident is known to be one of the main causes of morbidity, mortality, long-term disability, and disability in society. To investigate the quality of life of patients who have suffered from acute cerebrovascular accident (hereinafter ACVA) in stratified groups by age, gender, diagnosis, type (primary or secondary), and severity of a stroke, as well as undergoing rehabilitation. Methods: This research is a cross-sectional descriptive-analytical study. The main research method is a survey. Data collection was carried out in 2020 in Almaty of the Republic of Kazakhstan by inpatient doctors (City Clinical Hospital No. 5 of the Public Health Department of Almaty), engaged in the rehabilitation treatment of patients with acute cerebrovascular accident. The standardized questionnaire EQ-5D-5L was used to assess the quality of life due to health conditions. Data on the state of "mobility", "self-care", "daily activities", "pain", "anxiety", as well as data on self-assessment of health status (according to the EQ VAS scale) were analyzed using the Level Sum Scores (hereinafter LSS). Results: The study involved 258 respondents who had a stroke. The survey was conducted 2 months after the respondents were discharged from the hospital. The average LSS index of patients who underwent ACVA was 10.2 (9.7±10.7). Significant differences in LSS levels ( P ≤ 0.001) were revealed by the severity of stroke and by the fact of rehabilitation. Differences in LSS levels by age, gender, diagnosis, and type of ACVA are insignificant (P > 0.05). The difference in health indicators of patients with primary and repeated strokes indicates the fact of deterioration in the quality of life with each subsequent stroke. The quality of life of patients with ACVA is associated with the fact of rehabilitation: low values of EQ VAS in the group of patients who did not undergo rehabilitation and high values of EQ VAS in those who underwent rehabilitation. Conclusion: After a stroke, the majority of patients tend to have a negative quality of life, mostly due to violations of the component "daily activities". The identified significant disparities in LSS and EQ VAS indicators further show that the quality of life varies among stratified groups. The kind (primary or secondary) and severity of the stroke, as well as the existence of rehabilitation, are indicators that impact the quality of life of patients who have had ACVA.

Candidate genes related to acute cerebral circulatory disorders in Preeclampsia in the Kazakh Population.

BACKGROUND: The purpose of this study is to conduct a comparative analysis of the population frequencies of alleles and genotypes of polymorphic variants of coagulation and fibrinolysis genes SERPINE1 rs1799889, ITGA2 rs1126643, THBD rs1042580, FII rs1799963, FV rs6025, FVII rs6046, angiogenesis and endothelial dysfunction PGF rs12411, FLT1 rs4769612, KDR rs2071559, ACE rs4340, GWAS associated with the development of acute cerebral circulatory disorders in preeclampsia, in an ethnically homogeneous population of Kazakhs with previously studied populations of the world. METHODS: The genomic database was analysed based on the results of genotyping of 1800 conditionally healthy individuals of Kazakh nationality ∼2.5 million SNPs using OmniChip 2.5 M Illumina chips at the DECODE Iceland Genomic Center as part of the joint implementation of the project "Genetic Studies of Preeclampsia in Populations of Central Asia and Europe" (InterPregGen) within the 7th Framework Programme of the European Commission under Grant Agreement No. 282540. RESULT: The study discovered a significantly higher population frequency of carrying the unfavorable rs1126643 allele of the ITGA2 gene polymorphism when compared with European populations. The population frequencies of carrying minor alleles of the SERPINE1 (rs179988) and KDR (rs2071559) genes in the Kazakh population were significantly lower when compared with the previously studied populations of Europe and Asia. An intermediate frequency of unfavorable minor alleles between European and Asian populations was found in Kazakhs for gene polymorphisms: FV rs6025, PGF rs12411, and ACE rs4340. The genomic analysis determined the choice of polymorphisms for their further replicative genotyping in patients with ACCD in PE in the Kazakh population. CONCLUSION: The obtained results will serve as a basis for the development of effective methods of early diagnosis and treatment of PE in pregnant women, carriers of unfavorable genotypes.

[The relationship of vascular complications with cerebrovascular reactivity and endothelial dysfunction in patients with obstructive sleep apnea]. / Svyaz' sosudistykh oslozhnenii s tserebrovaskulyarnoi reaktivnost'yu i endotelial'noi disfunktsiei u patsientov s obstruktivnym apnoe sna.

OBJECTIVE: To assess the relationship of vascular complications with cerebrovascular reactivity (CVR) and endothelial dysfunction in patients with obstructive sleep apnea (OSA). MATERIAL AND METHODS: One hundred and twelve patients were examined. The patients were stratified into the main group with moderate and severe OSA and the control group without apnea. All patients underwent anthropometry, polysomnography, transcranial dopplerography and duplex scanning of the brachial artery. RESULTS: Patients with OSA showed a more frequent decrease in post-occlusive vascular dilatation. The CVR indices in the hypercapnic test in the main group were in the range of 0.91-0.97 and significantly lower after 1 minute on the left, after 5 minutes on both sides and after 10 minutes on the left. A positive correlation during a hypercapnic test between the CVR on the left after 10 minutes and the desaturation index (r=0.287, p=0.021), between the CVR on the left after 5 and 10 minutes and acute cerebrovascular accident (r=0.248, p=0.048 and r=0.285, p=0.022, respectively), as well as a negative correlation between the indicators of the middle cerebral artery and chronic cerebral ischemia were established in patients with apnea. CONCLUSION: Timely assessment of pathological changes in central and peripheral hemodynamics in patients with OSA will allow diagnosing early signs of vascular complications, which will further improve the personalized strategy for the prevention of stroke and chronic cerebral ischemia.

[Results of the implementation of measures aimed at improving medical care for patients with vascular diseases in the Tomsk region]. / Itogi realizatsii meropriyatii, napravlennykh na sovershenstvovanie meditsinskoi pomoshchi bol'nym s sosudistymi zabolevaniyami na territorii Tomskoi oblasti.

OBJECTIVE: To study the dynamics of population indicators: the total number of deaths from diseases of the circulatory system, coronary heart disease, cerebrovascular diseases and strokes, hospitalization profile for strokes, their structure and mortality in the Tomsk region for several years in comparison with these indicators for the Russian Federation and the Siberian Federal District. MATERIAL AND METHODS: A retrospective study was conducted using acute cerebrovascular accidents monitoring data and data of the Territorial body of state statistics of the Tomsk region in comparison with the literature data. The indicators of all causes of death, from circulatory diseases, coronary heart disease, cerebrovascular diseases and stroke in the territory of the Tomsk region, profile of hospitalization, structure of acute cerebrovascular accidents were analyzed for several years. Particular attention was paid to case fatality rate, one of the key indicators of the effectiveness of the system of care for patients with stroke. RESULTS: Typical for many regions of the Russian Federation predominance of chronic forms in the structure of mortality from circulatory diseases, the absence of significant differences in the structure of strokes, as well as the features of the Tomsk region in the form of high levels of hospitalization profile and hospital case fatality rate, were revealed. The dependence of hospital mortality on logistics is shown, on the basis of which assumptions are made about the possible causes of high fatality rates in the region: excessive centralization of the system of vascular centers and the absence of really working mechanisms for timely reevacuation from them. CONCLUSION: To bring chronic circulatory diseases structure in line with international standards, it is necessary to regulate the rules for formulating and coding diagnoses. In order to reduce hospital fatality rates in the Tomsk region, it is necessary to carry out organizational measures: opening a primary vascular department in the area of responsibility of the regional stroke center, as well as strengthening rehabilitation and palliative services for the timely reevacuation of patients from vascular centers.

Influenza vaccine effect on risk of stroke occurrence: a systematic review and meta-analysis.

Background: Stroke is a significant global cause of mortality and long-term disability, potentially influenced by infections that heighten systemic inflammation and thrombotic events. The full impact of influenza vaccination on stroke remains uncertain. This systematic review and meta-analysis aimed to investigate the association between influenza immunization and stroke incidence. Methods: We searched for randomized controlled trials (RCTs), case-control, and cohort studies published in PubMed/Medline, Cochrane-Central-Register-of-Controlled-Trials (CENTRAL), and Embase until 5 December 2022, and identified articles investigating the effect of influenza vaccine on stroke occurrence. All articles were screened by two independent reviewers. We performed a meta-analysis to investigate the risk of stroke occurrence in vaccinated vs. unvaccinated individuals. The random-effects model was used in all statistical analyses. Results: Among the 26 articles meeting our criteria, 10 were retrospective cohort studies, 9 were case-control studies, 3 were prospective cohort studies, 3 were RCTs and 1 case-series. Overall, the studies showed a significant decrease in the risk of stroke incidence/hospitalization among vaccinated patients (OR = 0.81, 95% CI [0.77-0.86], p = 0.00001). Furthermore, studies showed flu vaccine decreases the occurrence of mortality among stroke patients (OR = 0.50, 95% CI [0.37-0.68], p = 0.00001). Sub-group analysis revealed significant protective effect for patients with specific comorbidities including atrial fibrillation (OR = 0.68, 95% CI [0.57-0.81], p = 0.0001), diabetes (OR = 0.76, 95% CI [0.66-0.87], p = 0.0001), Chronic obstructive pulmonary disease (OR = 0.70, 95% CI [0.61-0.81], p = 0.00001), and hypertension (OR = 0.76, 95% CI [0.70-83], p = 0.00001). Conclusion: The current meta-analysis further supports prior findings that influenza vaccination reduces stroke risk, particularly in patients with comorbidities. Guidelines should promote vaccination for at-risk individuals.

[Results of carotid endarterectomy in the acutest period of ischemic stroke]. / Rezul'taty karotidnoi endarterektomii v ostreishem periode ishemicheskogo insul'ta.

OBJECTIVE: Analysis of the results of carotid endarterectomy (CEE) in the acute period of ischemic stroke (IS). MATERIAL AND METHODS: This retrospective study included 128 patients (mean age 65.2±4.7 years, 84 (65.6%) men) who underwent CEE in the acute period. Inclusion criteria were: an ischemic focus in the brain with a diameter of no more than 2.5 cm according to MRI; mild neurological deficit (from 3 to 8 points on NIHSS); ≤3 points on the modified Rankin Scale (mRS); stenosis of ICA over 60%. Exclusion criteria were: severe neurological deficit; presence of decompensated comorbid dependence; contraindications to CEE. RESULTS: In the hospital postoperative period, 3.9% of patients were diagnosed with hemorrhagic transformation of the ischemic focus in the brain with progression of neurological deficit and level of consciousness to coma II. In 3.1% cases, a lethal outcome developed on 4-7 days after the operation. In 2.3% patients after CEE, the progression of neurological deficit was noted with the development of new ischemic foci according to postoperative neuroimaging. The probable cause of this event was a distal embolism that developed during the installation of a temporary shunt. Myocardial infarction was diagnosed in 3.9% of patients. The combined end point (death + myocardial infarction + ischemic stroke + hemorrhagic transformation) was 10.1%. CONCLUSION: CEE in the most acute period of ischemic stroke is accompanied by a high risk of hemorrhagic transformation, myocardial infarction, and death, which characterizes this revascularization option as unsafe.

[Recovery of social and everyday skills after a complex of functional spatially oriented rehabilitation in elderly patients with cerebral stroke]. / Otsenka effektivnosti vosstanovleniya sotsial'no-bytovykh navykov s ispol'zovaniem kompleksa funktsional'noi prostranstvenno-orientirovannoi reabilitatsii u pozhilykh patsientov s tserebral'nym insul'tom.

OBJECTIVE: To analyze the effectiveness of social recovery (trip to the store by bus and making purchases) in elderly patients with stroke in the right middle cerebral artery undergoing a course of specialized trainings in a complex of functional spatially oriented rehabilitation. MATERIAL AND METHODS: The study involved 44 patients with previous stroke (mean age 70.8±3.1 years) randomized into 2 equal groups: main group - basic standard of rehabilitation (exercises with instructor, mechanotherapeutic technique with cyclic simulators, massage of paretic limbs) and training of social adaptation in a complex of functional spatially oriented rehabilitation; control group - basic standard of rehabilitation alone. Duration of rehabilitation course was 14 days. To determine mean norm of timing of complex training of socially significant skill, we asked 23 volunteers without severe comorbidities to perform tasks of functional spatially oriented rehabilitation. RESULTS: After complex rehabilitation program, we found significant dynamics of time necessary for the following actions: "take a bag and hang it over shoulder", "open the pockets of the bag with a zipper (2 pockets)", "take the jacket off the hanger and put it on", "take the products from the basket and put in the pocket". Moreover, the main group was characterized by significantly lower impairment of daily activity (Barthel score 66.3±4.5 vs. baseline 45.7±4.9, p<0.05), improvement of functional independence (FIM score 76.7±1.5 vs. baseline 65.2±3.1, p>0.05). These values turned out to be significantly better than in the control group. CONCLUSION: These results indicate the effectiveness of functional spatially oriented rehabilitation in elderly patients with cerebral stroke. This approach increases personal independence in daily life and improves overall quality of life.

[Intraoperative and early postoperative risk factors of development of acute cerebrovascular accident after coronary artery bypass grafting in the elderly age.]

The article presents data on the problem of ischemic heart disease, surgical myocardial revascularization, as well as the risk of developing acute cerebrovascular accident (ACVA) in elderly patients with coronary artery bypass grafting (CABG). The authors conducted a study to identify risk factors for the development of stroke in elderly patients. Predictors of ACVA development in the operational and early postoperative periods were identified. It has been proven that the time of extubation, an increase in PCO2 levels, and hyperlactatemia are reliable intraoperative and early postoperative predictors of stroke in elderly patients with CABG. The practical significance of the study lies in the application of its results to predict the development of perioperative stroke in elderly patients with CABG.

[Study of the efficacy and safety of sequential use of the drugs Mexidol and Mexidol FORTE 250 in the treatment of stroke]. / Issledovanie effektivnosti i bezopasnosti posledovatel'nogo primeneniya preparatov Meksidol i Meksidol Forte 250 pri lechenii bol'nykh s ostrym ishemicheskim insul'tom.

OBJECTIVE: To evaluate the effect of Mexidol on the recovery of cognitive functions in patients after ischemic stroke (IS). MATERIAL AND METHODS: We examined 70 patients with acute IS, who were randomized into 2 groups by random sampling; The 1st group consisted of patients who, against the background of the main standard therapy for 14 days, received Mexidol intravenously, 500 mg 1 time per day, followed by oral administration of Mexidol FORTE 250, 750 mg per day for 60 days (40 patients; 28 men, 12 women). Group 2 consisted of 30 patients (21 men, 9 women) who received only standard therapy. RESULTS: Baseline scores on the MoCA and MMSE scales did not differ between the two groups. Retesting showed that the improvement on these scales was statistically more significant in the 1st group. The analysis of indicators of the evoked potential P300 confirmed a more pronounced positive trend in the 1st group (p<0.01). CONCLUSION: The use of sequential therapy with Mexidol is accompanied by a more complete recovery of cognitive functions in patients who have undergone IS.

[Evaluation of the effectiveness of using broadband modulation currents in medical rehabilitation of patients after acute cerebrovascular accident]. / Otsenka effektivnosti primeneniya tokov shirokopolosnoi modulyatsii v meditsinskoi reabilitatsii patsientov posle ostrogo narusheniya mozgovogo krovoobrashcheniya.

Every year in the world more than 15 million patients suffer from acute cerebrovascular accident. A special role in the organization of medical care for patients after acute cerebrovascular accident should be assigned to measures to improve the prevention of clinical manifestations and comprehensive rehabilitation. OBJECTIVE: To study the effect of broadband modulation currents on the manifestations of spasticity and on cognitive functions in patients after an ischemic stroke in the late recovery period. MATERIAL AND METHODS: The article presents data on the effectiveness of the use of broadband modulation currents in the late recovery period of medical rehabilitation of patients with ischemic stroke. The study included 80 patients who underwent ischemic stroke with movement disorders in the form of hemiparesis and increased muscle tone by the type of spasticity in the late recovery period. Control group patients (40 people) underwent standard drug therapy and medical rehabilitation, patients of the main group (40 people) received broadband modulation currents against the background of standard drug therapy and medical rehabilitation. The severity of spasticity and impaired motor function of the arm and leg was assessed according to the modified Ashfort Spasticity Scale (MAS) and goniometry parameters; the analysis of indicators of impairment of cognitive functions according to the data of the Montreal Cognitive Assessment Scale (MoCA) was carried out. RESULTS: After the course of treatment in patients of the main group, at all control points, there was a statistically significant positive dynamics of a decrease in spasticity, both in the proximal and in the distal parts of the upper limb, according to the modified Ashforth Spasticity Scale (MAS), while in the patients of the control group, only positive trend. After the course of treatment, a significant advantage of the influence of the developed method on cognitive impairment of functions in patients of the main group, who received broadband modulation currents, was revealed. This was confirmed by the increase in the total indicator of the MoCA scale to 26.7±0.6 points, which corresponded to the reference values. In patients of the control group, less pronounced results were obtained, the total indicator of the MoCA scale was 25.1±1.0 points, which was below the norm. CONCLUSION: The data obtained indicate that the inclusion of broadband modulation currents in the medical rehabilitation program contributes to a significant decrease in the severity of spasticity, increases the range of motion in the affected limb, and has a positive effect on the cognitive functions of patients.

[Application of modern non-drug technologies to improve the quality of life of patients with hemiparesis]. / Primenenie sovremennykh nemedikamentoznykh tekhnologii dlya povysheniya kachestva zhizni bol'nykh s gemiparezom.

In recent years, the improvement of the system of medical rehabilitation of patients with acute cerebrovascular accident has acquired special social significance due to the high morbidity. OBJECTIVE: To study the effect of the combined use of a multifunctional platform and massage with a pulsed low-frequency electrostatic field on the motor functions of the lower limb, coordination and balance, as well as on the psychoemotional status and quality of life of patients after an ischemic stroke with hemiparesis in the late recovery period. MATERIAL AND METHODS: The article presents data on the treatment of 120 patients who had an ischemic stroke with movement disorders in the form of hemiparesis with an increase in muscle tone by the type of spasticity in the late recovery period. All patients received standard drug therapy and underwent medical rehabilitation. The patients were divided into 3 groups: the main group - 40 patients who received massage with a pulsed low-frequency electrostatic field and training on a multifunctional platform with biofeedback (BFB) - COBS (mtd-Systems, Germany), a comparison group - 40 patients who received training on a multifunctional platform with biofeedback (BFB), control group - 40 patients. RESULTS: In the initial state, all patients included in the study showed an uneven distribution of the load in the protocols «normal standing position¼ and «standing balance¼ with an advantage towards the healthy leg. After the course of treatment in the patients of the main group, all the evaluated indices were normalized, in the patients of the comparison group statistically significant less pronounced results were obtained, and in the patients of the control group only a positive trend was noted. When studying the quality of life and the effectiveness of treatment according to the EQ-5D questionnaire in the examined patients in the initial state, the indicator averaged 7.8±0.8 points. After the course of treatment, the patients of the main group showed a statistically significant decrease in the indicators of the EQ-5D questionnaire from 7.8±0.8 points in the initial state to 5.1±1.1 (p<0.001), which lasted up to 6 months. In patients of the comparison group in all periods of observation, a decrease in the indicator was also noted, but less pronounced, in patients in the control group, only a positive trend. The data were supported by the Hospital Anxiety and Depression Scale (HADS) score. CONCLUSION: The use of complex rehabilitation with the inclusion of a multifunctional platform with biofeedback and electrostatic massage contributes to a pronounced improvement in the functional state of muscle tone, coordination and balance, a significant decrease in the level of anxiety and depression and has a pronounced positive effect on the quality of life and assessment of the health status of patients with hemiparesis in late recovery period after ischemic stroke.

[Stenting of the first segment of the spinal artery in the acutest period of ischemic stroke in the vertebrobasilar territory]. / Stentirovanie pervogo segmenta pozvonochnoi arterii v ostreishem periode ishemicheskogo insul'ta v vertebral'no-bazilyarnoi sisteme.

OBJECTIVE: To analyze hospital and long-term results of stenting of the V1 segment of the vertebral artery (VA) in the first hours after acute cerebral hemopoiesis/transient ischemic attack (stroke/TIA) in the vertebrobasilar territory (VT). MATERIAL AND METHODS: The current retrospective study from 2012 to 2019 included 169 patients with hemodynamically significant stenosis of the V1 segment of the VA, who underwent emergency stenting in the first hours after the onset of stroke. The mean time between the development of stroke and correction was 368.5±129.8 minutes. The average time between admission to the medical institution and submission to the X-ray operating room was 89.2±10.7 minutes. VA stenting was performed through the transfemoral approach. In 118 cases (69.8%) a drug eluting stent was implanted, in 51 (30.2%) a bare metal stent was implanted. 90% of VA segment V1 stenosis was diagnosed in 48 patients before the onset of stroke. Of these, 33 received conservative therapy for vertebrobasilar insufficiency (VBI) for 2.5±1.0 months in anticipation of regression of the disease. The remaining 15 did not have VBI symptoms and did not need active drug treatment. Ultimately, within this sample, the time interval between the visualization of stenosis and the onset of stroke was 3.0±1.0 months. In 17 patients, stroke/TIA in VT became recurrent. The period between two neurological events was 1.5±0.5 months. Nine patients did not wait for the planned intervention due to the development of an adverse neurological event before the appointed date of hospitalization. The other 8 did not appear for the interventional correction on time due to subjective reasons and were again admitted to the medical facility on an urgent basis. RESULTS: During the hospital follow-up period, no adverse cardiovascular events were recorded. When assessing the dynamics in the neurological status, there was a significant regression of the deficit by the time of discharge from the hospital. In the long-term follow-up period (38.2±20.4 months), a fatal outcome was recorded in 2.4% of cases (n=4). Non-fatal myocardial infaction was diagnosed in 5 patients (2.9%). Restenosis of the stent in the VA was visualized in 56 patients (33.1%). In 17 cases, it became symptomatic (10.0%). All patients underwent repeated stenting with a successful result of the procedure. CONCLUSION: Emergency stenting of hemodynamically significant stenosis of the V1 segment of the VA in the acute period of stroke in VT is a safe and effective method of revascularization characterized by the absence of adverse cardiovascular events at the hospital stage of observation.

[Adherence to treatment as a factor in increasing the effectiveness of psychological rehabilitation programs for stroke patients using augmented reality technology]. / Priverzhennost' k lecheniyu kak faktor povysheniya effektivnosti programm psikhologicheskoi reabilitatsii bol'nykh, perenesshikh insul't, s ispol'zovaniem tekhnologii dopolnennoi real'nosti.

PURPOSE OF THE STUDY: Studying the contribution of treatment adherence to the effective use of the Visual Medicine hardware and software complex (HSC) in the psychological rehabilitation of stroke patients. MATERIAL AND METHODS: The results of the use of APC in 81 patients undergoing a standard course of medical rehabilitation have been investigated (50 men and 31 women, average age 57.3±11.7 years). Compliance using the psycho-diagnostic questionnaire «Level of Compliance¼, which examines social, emotional and behavioral compliance; the state of higher mental functions (HMF) in dynamics by neuropsychological examination (tests for simultaneous and visual-spatial gnosis, kinesthetic, dynamic, spatial and constructive praxis) are studied. RESULTS AND CONCLUSION: It is shown that the use of a hardware-software complex helps to recover motor skills. However, the degree of positive dynamics of changes in the HMF state depends on the contribution of patient adherence to treatment, in particular, their «social compliance¼. It has been established that preventive diagnostics of social compliance at the average level, according to the questionnaire «Level of compliance¼, can be an indication for inclusion in the rehabilitation plan of training sessions with the program «Visual Medicine¼. Deviation towards low or high values signals the appointment of a medical psychologist consultation with the aim of further psychocorrectional work to achieve the optimal level of social compliance.

[Current issues in the rehabilitation of stroke patients against the background of a new coronavirus infection (COVID-19). Resolution of the Council of Experts]. / Aktual'nye voprosy reabilitatsii patsientov s insul'tom na fone novoi koronavirusnoi infektsii (COVID-19). Rezolyutsiya Soveta ekspertov.

The pandemic of the new coronavirus infection caused by SARS-CoV-2 has forced to reconsider the methods of rehabilitation of patients with emergency conditions, including neurology. The Council of Experts of Neurologists and Rehabilitation Therapists gathered to develop unified approaches to manage stroke patients based on a discussion of practical experience and, taking into account the scientific information on COVID-19 that was available by the time of the meeting. Stroke is a serious disabling condition that requires maximum rehabilitation efforts at all stages of medical care. In the context of the SARS-CoV-2 coronavirus epidemic, the process of medical rehabilitation and the routing of patients with stroke is undergoing major changes. Combining COVID-19 and stroke requires new approaches to rehabilitation and patient management. During the meeting, a resolution was developed in which the experts formulated the tactics of medical rehabilitation of patients with stroke and COVID-19 at the first and second stages. The arguments of the importance and practicability of carrying out measures of medical rehabilitation at the third stage is given and the need to continue consultations on the indicated topic is revealed.

Differential Dynamics of the Levels of Low Molecular Weight DNA Fragments in the Plasma of Patients With Ischemic and Hemorrhagic Strokes.

INTRODUCTION: To evaluate Low-Molecular-weight (LMW) DNA as a possible prognostic biomarker in acute ischemic and hemorrhagic stroke. METHODS: LMW DNA samples were isolated from plasma and cerebrospinal fluid by phenol deproteinization, analyzed by gradient polyacrylamide electrophoresis and quantified by spectrophotometry. RESULTS: Two common types of stroke, i.e. ischemic and hemorrhagic, differ by the temporal dynamics of cell-free DNA (cfDNA) accumulation. In hemorrhagic stroke, an initial increase in LMW DNA levels, most likely reflects an extent of the tissue damage, while in ischemic patients, the LMW DNA levels increase in parallel with the damage caused by hypoxia and subsequent compensatory reperfusion. CONCLUSION: These time-course data specify optimal assessment windows with maximum differentiating power for stroke outcomes: 24-48 hours post-event for ischemic stroke, and as close as possible to the moment of hospital admission for hemorrhagic stroke. These data also indicate the role of apoptosis in the formation of ischemic focus.

[Arterial stiffness in patients with acute cerebrovascular accident]. / Zhestkost' arterial'noi stenki u bol'nykh s ishemicheskimi narusheniyami mozgovogo krovoobrashcheniya.

OBJECTIVE: To identify correlations between parameters of vascular stiffness and characteristics of the clinical course of acute cerebrovascular accident (stroke). MATERIAL AND METHODS: Two hundred and seven patients with stroke (mean age 64.6±10.9 years; 115 men) treated in a neurological department of «Municipal Clinical Hospital Br. Bakhrushins of the Health Care Department of Moscow¼ were studied. All patients underwent a standard neurological and clinical-instrumental examination, including assessment of arterial stiffness by sphygmography. Analysis of the data was carried out depending on the severity of stroke and the pathogenetic subtype of stroke. RESULTS: The pathological value of the CAVI was detected in all patients with cerebral infarction. The highest values were noted in patients with an atherothrombotic subtype of stroke. A positive correlation was revealed between CAVI and the age of patients (r=0.57; p=0.0001), left ventricular myocardial mass index (r=0.55; p=0.0001), NIHSS score (r=0.6; p=0.0001) The inverse correlation was found between CAVI and glomerular filtration rate (r= -0.4; p=0.02). CONCLUSIONS: The factors determining the severity of stroke are age, arterial hypertension, type 2 diabetes, carotid atherosclerosis, left ventricular remodeling, and decreased glomerular filtration rate. The CAV and the toe-brachial index, rather than the ankle-brachial index, significantly distinguished patients with ischemic stroke from patients with transient ischemic attack.

[Acute cerebrovascular accidents associated with SARS-CoV-2 coronavirus infection (COVID-19)]. / Ostrye narusheniya mozgovogo krovoobrashcheniya, assotsiirovannye s koronovirusnoi infektsiei SARS-CoV-2(COVID-19).

Acute cerebrovascular accidents (ACVIs) associated with COVID-19 coronavirus infection are one of the most talked about problems in the medical community. To date, the true incidence of stroke in patients with COVID-19 remains unclear. So far, the published literature has been limited to case reports, case series, and observational cohort studies. The article analyzes possible risk factors, especially the age of patients, pathogenetic and clinical correlations of ACVA and SARS-CoV-2 (COVID-19). A clinical case of an 82-year-old patient with ischemic stroke and COVID-19 infection is described.

[The modern approaches to the restoration of postural balance in the patients suffering from the consequences of an acute cerebrovascular accident (CVA)].

BACKGROUND: the most frequent and severe consequences of an acute cerebrovascular accident (CVA) are locomotor and coordination disorders which significantly increase the risk of falling in a static position and when walking. The methods used for the rehabilitation of the affected patients are designed in the first place to enable the patients to acquire the skills necessary for maintaining the static balance. The modern equipment allows to carry out coordination training in the static position and also during walking. AIM: The objective of the present study was to evaluate, based on the results of our original research, the feasibility and effectiveness of the application of the «Balance tutor¼ system developed for the restoration of static and dynamic balance in the framework of the combined rehabilitation treatment of the patients suffering from impaired postural balance as a consequence of acute cerebrovascular accident (CVA). MATERIALS AND METHODS: A total of 56 patients presenting with impaired postural balance following CVA were available for the examination. All of them underwent functional testing to assess the static and dynamic balance, walking abilities, and the risk of falling down including the study with the use of computer-assisted stabilometry. RESULTS: The study has demonstrated that the inclusion of the «Balance tutor¼ system for the restoration of the static and dynamic balance in the combined rehabilitative treatment of the patients having postural balance disorders after the CVA reduces the risk of fall for a walking patient, improves his (her) static and dynamic balance, increases the patient's ability to move without exterior help. The patients comprising the main study group were found to experience a decrease of statokinesiogram space in the «eyes are open¼ position (p = 0.0576, the Mann-Whitney U test) as well as a reliable decrease of the statokinesiogram space in the «eyes are closed¼ position (p=0.0063, the Mann-Whitney U test). Similar changes occurred in speed of pressure center relocation. By the end of the rehabilitation course, the patients of the main group exhibited a reliable enhancement in the dynamic balance rates estimated with the use of the Berg Balance Scale (p=0.028, Tukey's criterion), an increase in stability based at the Tinneti scale, p=0.0291; Tukey's criterion), and a decrease of the risk of falling during walk assessed with the application of Dynamic Gait Index scale (p = 0.0001, Tukey's criterion). DISCUSSION: The results of the present study with the inclusion of the «Balance tutor¼ system in the program of combined rehabilitation of the patients suffering from the consequences of CVA in the form of the postural balance impairment give evidence of the feasibility and effectiveness of this approach. There is reason to believe that its application is likely to reduce the risk of falling down and to improve characteristics of static and dynamic balance. CONCLUSION: The inclusion of the «Balance tutor¼ system in the program of combined rehabilitation of the patients suffering from the consequences of CVA in the form of the postural balance impairment is both feasible and effective.