[Functional examinations of visual channels: clinical aspects]. / Funktsional'nye issledovaniia zritel'nykh kanalov: klinicheskie aspekty.

The review discusses literature data on the clinical relevance of functional assessment of magno- (M), parvo- (P), and koniocellular (K) pathways. It also covers the differential contribution of the M, P, and K channels to visual impairments and how it determines the prognosis, early diagnosis, and treatment choice in patients with neurodegenerative diseases of the retina and brain. Selective changes in the performance of the visual channels are investigated by the example of glaucoma and optic neuritis in multiple sclerosis (MS) patients. A detailed analysis of pattern electroretinogram and visual evoked potentials in response to pattern stimuli of varying luminance and chromatic contrast in glaucoma and MS and characteristic functional alterations (objective markers of pathology of the visual pathways) are presented.

[Functional examinations of visual channels: physiological basis]. / Funktsional'nye issledovaniya zritel'nykh kanalov: fiziologicheskie osnovy.

In this paper, technical details of visual evoked potentials (VEP) assessment and pattern electroretinography (PERG) are reviewed. Both methods are used to perform an objective functional examination of visual channels and to clarify the level, at which they have been damaged. Contributions of parvo- (P), magno- (M) and koniocellular (K) systems to the morphology of PERG and VEP responses are discussed with account to test conditions, selectively supportive of the activity of particular cell populations. The review analyzes the physiological role of such stimulation parameters as brightness and color contrast of the pattern elements as well as spatial and temporal frequency in detecting dysfunction of color channels and mistuning of the P- and M- pathways. Different times taken for neuronal integration and signal conduction along the M- and P- pathways determine the timing of the P- and M- VEP components, allowing us to judge their contribution to VEP morphology from the same recording.

[Distinctive morphological and functional changes in retinal ganglion cells associated with normal aging and early stage of glaucoma]. / Morfofunktsionalnye osobennosti izmeneniya ganglioznykh kletok setchatki pri fiziologicheskom starenii i v rannei stadii glaukomy.

UNLABELLED: Early diagnosis of primary open-angle glaucoma (POAG) is closely connected with detection of normal age-related changes in the retina. It is also essential to develop reliable methods for quantitative evaluation of retinal nerve fiber layer (RNFL) thickness and retinal ganglion cells (RGCs) structure and function as well as to extend opportunities for inter-instrumental comparisons. AIM: to assess the function of RGCs from parvo- and magnocellular pathways by means of pattern electroretinography and to evaluate the degree of retinal sensitivity loss and RNFL thickness using new methods of analysis in normal aging and the early stage of POAG. MATERIAL AND METHODS: Four groups were formed: group 1 - young healthy participants, group 2 - aged controls, group 3 - glaucoma suspects, and group 4 - early-stage POAG patients. In all groups we investigated the MD and PSD indices of static computer perimetry (HEP, Heidelberg Edge Perimeter, SAP and FDF tests) and RNFL thickness provided by HRT III (Heidelberg Engineering). Pattern electroretinograms (PERGs) were recorded with the RETImap system (Roland Consult) at the check sizes of 0.8° and 16°. For steady-state and transient PERGs the 0.8°/16° and N95/P50 ratios were calculated, respectively. RESULTS: There was a statistically significant difference in PERG amplitudes to 0.8° checks (p=0.0001) and in 0.8°/16° ratios (p=0.0001) between the groups 1 and 2. Differences between the groups 2 and 3 as well as 3 and 4 were statistically significant only as to 0.8° checks (p=0.03 and p=0.001, respectively). Responses to 16° checks were alike in all groups. We have also applied original formulas to determine the relative loss of RGCs and their axons and the congruence coefficient for morphological and functional parameters in normal aging and the early stage of POAG. CONCLUSION: The discovered age-related PERG changes convincingly indicate a greater parvocellular RGC loss as compared to magnocellular. Thus, the PERG ratio (0.8°/16°) should be corrected for the subject's age. The proposed indices of relative decline in retinal light sensitivity and RNFL thinning have been shown to be useful for quantifying the loss of RGC bodies and axons in normal aging and early-stage glaucoma.

Association of anti-phospholipasea2-receptor antibodies with clinical course of idiopathic membranous nephropathy.

Aim of the study - assessment of the presence of M-type phospholipase A2 receptor antibodies in Georgian patients with biopsy proven IMN and their correlation with the disease activity for the appliance and monitoring of immunosuppressive therapy. A total 37 patients, after exclusion of the possible secondary factors, with biopsy proven IMN entered the study. All patients received standard immunosuppressive therapy: cyclosporine combined with methylprednisolone. There were 28 (76%) patients with PLA2R-AB positive and 9 (24%) negative (assessed as 1:<10) at baseline. Among the 28 patients under immunosuppressive therapy at month 6 in 11 of them PLA2R-AB turned negative, in 14 decreased quantitatively but were persistent positive and in 3 of them PLA2R-AB once turned negative then relapsed after withdrawn of immunosuppressive therapy. Among 11 PLA2R-AB negative patients, 9 patients got complete remission of proteinuria and the other 2 patients only partial remission. At month 12 the range of proteinuria was significantly lower in PLA2R-AB negative group than in PLA2R-AB positive group. The level of circulating PLA2R-AB in IMN patients showed correlation with disease activity. The indicators of good prognosis of IMN were negative PLA2R-AB titer at baseline and progressive decreasing of titer under the immunosuppressive therapy in PLA2R-AB positive patients. The detection and measurement of PLA2R-AB in INM patients may be important tool in monitoring of the disease and efficacy of the treatment.

Single center experience in successful prevention of exit-site infection in patients on peritoneal dialysis.

The aim of our study was to use non-cytotoxic, easily available agent - 3% NaCl (hypertonic) saline compresses as prophylaxis measure for long-term prevention of ESI and avoid antibiotic resistance later. Advantages of hypertonic saline include excellent patient acceptance, ease of use, lack of adverse effects on exit site, adjacent skin, catheter or systemic reaction, and minimal expense. During the observational time of 36 months a total of 78 patients were enrolled in this study. Patients were randomized into three groups: in group A 36 patients, were using 3% saline compresses as ESI prophylaxis 3 times weekly, group B 22 patients were using mupirocine 2% ointment 3 times weekly as exit-site dressing and group C 30 patients were using no aseptic agents for exit-site care. Group A showed the minimal rate of ESI compare to groups B and C. None of the tunnel infections was complicated with peritonitis and catheter loss. The use hypertonic saline compresses as routinely daily or three times weekly exit-site care has a promising results for long-term catheter related infection prophylaxis.

HYPOTHALAMIC OREXINE SYSTEM ACCELERATES REGULATION OF SLEEP HOMEOSTASIS AND SLEEP-WAKEFULNESS CYCLE RECOVERY FROM BARBITURATE ANESTHESIA-INDUCED ARTIFICIAL SLEEP.

The work was aimed for the ascertainment of following question - whether Orexin-containing neurons of dorsal and lateral hypothalamus and brain Orexinergic system in general are those cellular targets which can accelerate recovery of disturbed sleep homeostasis and restoration of sleep-wakefulness cycle behavioral states from barbiturate anesthesia-induced artificial sleep. Investigation was carried out on 18 wild type white rats (weight 200-250gr). Different doses of Nembutal Sodium were used for the initiation of deep anesthesia. 30 min after barbiturate anesthesia induced artificial sleep serial electrical stimulations of dorsal or lateral hypothalamus were started. Stimulation period lasted for 1 hour with the 5 min intervals between subsequent stimulations applied by turn to the left and right side hypothalamic parts. EEG registration of cortical and hippocampal electrical activity was started 10 min after intra-peritoneal administration of Nembutal Sodium and continued continuously during 72 hour. According to obtained new evidences, serial electrical stimulations of dorsal and lateral hypothalamic Orexin-containing neurons significantly accelerate recovery of wakefulness, sleep homeostasis, disturbed because of barbiturate anesthesia induced artificial sleep and different behavioral states of sleep-wakefulness cycle. Hypothalamic Orexin-containing neurons can be considered as the cellular targets for regulating of sleep homeostasis through the acceleration of recovery of wakefulness, and SWC in general, from barbiturate anesthesia-induced deep sleep.

Influence of serial electrical stimulations of perifornical and posterior hypothalamic orexin-containing neurons on regulation of sleep homeostasis and sleep-wakefulness cycle recovery from experimental comatose state and anesthesia-induced deep sleep.

The work was aimed for the ascertainment of following question - whether Orexin-containing neurons of dorsal and lateral hypothalamic, and brain Orexinergic system in general, are those cellular targets which can speed up recovery of disturbed sleep homeostasis and accelerate restoration of sleep-wakefulness cycle phases during some pathological conditions - experimental comatose state and/or deep anesthesia-induced sleep. Study was carried out on white rats. Modeling of experimental comatose state was made by midbrain cytotoxic lesions at intra-collicular level.Animals were under artificial respiration and special care. Different doses of Sodium Ethaminal were used for deep anesthesia. 30 min after comatose state and/or deep anesthesia induced sleep serial electrical stimulations of posterior and/or perifornical hypothalamus were started. Stimulation period lasted for 1 hour with the 5 min intervals between subsequent stimulations applied by turn to the left and right side hypothalamic parts.EEG registration of cortical and hippocampal electrical activity was started immediately after experimental comatose state and deep anesthesia induced sleep and continued continuously during 72 hour. According to obtained new evidences, serial electrical stimulations of posterior and perifornical hypothalamic Orexin-containing neurons significantly accelerate recovery of sleep homeostasis, disturbed because of comatose state and/or deep anesthesia induced sleep. Speed up recovery of sleep homeostasis was manifested in acceleration of coming out from comatose state and deep anesthesia induced sleep and significant early restoration of sleep-wakefulness cycle behavioral states.

The character of sleep disturbances produced by multiple administrations of atropine the antagonist of brain muscarinic cholinergic system.

Modification of brain muscarinic cholinergic system normal functioning can be considered as an appropriate strategy for the study of its role in sleep-wakefulness cycle basic mechanisms in general and in the course/maintenance of PS in particular. For this aim systemic application of muscarinic cholinoreceptors antagonists is significant because it gives possibility to modify functioning all of known five sub-types of muscarinic cholinoreceptors and to study the character of sleep disturbances in these conditions. Problem is very topical because the question about the intimate aspects of BMChS involvement in PS maintaining mechanisms still remains unsolved. In cats Atropine systemic administration was made once daily at 10:00 a.m. and continuous EEG registration of sleep-wakefulness cycle ultradian structure, lasting for 10 hour daily, was started immediately. In sum each animal received anti-muscarinic drugs for 12 times. Thereafter drug administrations were ceased and EEG registration of sleep-wakefulness cycle ultradian structure was continued during 10 consecutive days. On the basis of results obtained in these conditions we can conclude that brain muscarinic cholinergic system normal functioning is significant for basic mechanisms of sleep-wakefulness cycle. During wakefulness, at the level of neocortex and hippocampus, MChS supports only EEG activation, while it is one of the main factors in PS triggering and maintaining mechanisms.

Changes of open field behavior in animal model of depression.

Animal model of depression was developed by means of chronic exposure of rat pups to anticholinergic drugs (Atropine, Scopolamine) during the early life period from postnatal day 7 (P7) and/or 14 (P14) to P21 and/or P28, respectively. Such procedure resulted in lasting behavioral changes that were evident long after drug discontinuation and persisted at mature age (2-3 month period). Behavioral changes included most indices of open field behavior. Modeled animals exhibited significant depression of locomotor activity certified by sharp reduction of the number of crossed squares, rising of a head and vertical standings. Grooming behavior was also significantly decreased. Frequency of center entrance and the time of staying in the center of open field were sharply shortened. Modeled animals exhibited complete loss of exploratory motivation which wasn't related to the enhancement of fear emotion so far as values of incidence of urination and defecation remained unchangeable. These findings indicate that postnatal exposure of rat pups to Atropine and/or Scopolamine induces lasting behavioral "despai"' or "refractory loss of interest" at mature age. In sum animal model of depression which are characterized by super sensitivity of brain muscarinic cholinergic system exhibit more depressed behavioral items in open field than other types of animal models of depression. These data imply the preference of muscarinic cholinergic super sensitivity for the development of depressive state and therefore they are very significant for both basic science and clinical research issues.

[Impact of a surgical treatment stage on the accommodability and binocular functions in patients with concomitant strabismus].

The surgical stage of treatment for concomitant strabismus was studied for its impact on accommodability and inocular functions. Thirty-four patients were examined. The author used the laser stroboscopic technique, estimated the accommodation convergence/accommodation (AC/A) ratio, and evaluated binocular functions at different working distances (in the color, polaroid, and scanning separation of the fields of vision) and on a synoptophore. Surgical treatment was shown to reduce the AC/A ratio, to normalize accommodation tone, and to improve or to restore binocular functions, which suggest their close relationship.

Kidney transplantation in Georgia: a single centre experience with living-related donors.

37 patients underwent living donor kidney Tx at the National Centre of Urology from January 2000 to December 2007. All transplants were performed from genetically related donors. The mean follow-up was 29,5 months. The following parameters were analysed: early and late posttransplant complications, rejection rate, the most recent Cr, patient and graft survival rates. Haemorrhage (5.4%), gastro-intestinal bleeding (10.8%) and graft thrombosis (5.4%) were the most important early complications. 6 (16.2%) episodes of acute cellular rejection were detected of whom 5 were treated successfully with bolus steroids. Two (5.4%) patients developed delayed graft function and needed postoperative dialyses. The mean value of the most recent serum Cr level is 1.6+/-1.1 g/dl (range: 0.7-6.2 g/dl). 1, 2 and 3 year patient survival for the whole group was 89.2%. 1, 2 and 3 year graft survival for the whole group was 89.2%, 83% and 83%, respectively. The mortality rate associated with kidney Tx has decreased from 38% in 1995-2000, to 5.4% in 2000-2007. The results of kidney Tx can achieve the acceptable level with improving surgical technique and experience. The pool of living-unrelated (spouses etc.) donors should be wider used to increase the number of transplants.

[Functional-morphologic aspects of changes of mucosal gingiva microcirculatory bed vessels in experimental gingivitis against the background of hypercholesterolemia].

The study of mucosal gingiva microcirculatory bed in conditions modeling the change of vascular wall permeability that promotes cell migration and plasmorrhagia. The experiments were made on 3 groups of chinchilla rabbits--body weight 1,7-2,5 kg: I-experimental gingivitis (10 animals); II-experimental hypercholesterolemia--the rabbits received aterogenic diet (0,3 g/kg of cholesterol) (10 animals). Two month after the aterogenic diet, gingivitis was modelled against the background of hypercholesterolemia (control for group II). IV-series--conditionally "normal"--5 rabbits. The light-optic and electron microscopic studies have revealed significant changes in extracellular matrix and gingiva mucous cells as well as in microcirculatory bed components in hypercholesterolemia. Hypercholesterolemia damages endotheliocytes, subendothelial zone, basal membrane abd changes permeability. The contact of lymphocytes and plasmocytes with the vascular wall confirms the trigger role of the vascular factor in damaging of periodontal complex.

[Ultrastructural characteristics of gingival mucous cellular composition in experimental gingivitis].

The aim of the work was to estimate morphological changes in cells of gingival mucous membrane in the experimental gingivitis model. Fifty rats with the body weight of 120-160 gr. were used in the experiment. Gingivitis was modeled by front teeth ligation after a preliminary exfoliation of mucous membrane in the dental neck area. The specimens were examined by histological method and electron microscopy on the 3rd, 5th, 14th and 28th days of the experiment. It has been shown that cellular population of plasmocytes, lymphocytes, fibroblasts and mast cells take part in the inflammatory process. In all the areas of microcirculation occurs transformation of endotheliocytes like papillas; the process of roughening of collagenous fibrils indicates their significant role in the inflammatory damage of gingiva.

Assessment of health-related quality of life in living kidney donors.

The health-related quality of life (HRQoL) is frequently applied to assess surgical or other treatment modalities. We evaluated the HRQoL of 57 kidney donors for comparison with 120 age-and sex-matched healthy individuals and 52 patients who underwent nephrectomy due to a renal tumor. The Short Form-36 (SF-36), Giessen Subjective Complaints List (GBB-24), and Zerssen's Mood Scale (Bf-S) questionnaires were used for this purpose. The evaluation procedure was completely anonymous and free of charge for all respondents. The mean scores of various domains calculated for all three questionnaires were compared between the groups. In three of eight SF-36 items--"social function," "bodily pain," and "vitality"--donors scored significantly better than the controls and patients. In all five GBB-24 items, donors scored higher than controls and patients. For "gastric complaints," the difference was significant. The mood analysis showed significant differences between the groups in favor of donors. The HRQoL of living kidney donors was not different from that of healthy subjects and significantly better than the HRQoL of urologic patients after nephrectomy. Donors should be monitored for both physical and psychosocial outcomes of the procedure. Further prospective studies are needed to facilitate potential donors' understanding of the complex issues related to organ donation.

Assessment of health-related quality of life in renal transplant recipients and dialysis patients.

Health-related quality of life (HRQoL) is becoming an important outcome measure in evaluation of various forms of renal replacement therapy (RRT). The Short Form-36 (SF-36), Giessen Subjective Complaints List (GBB-24), and Zerssen's Mood Scale (Bf-S) are internationally validated questionnaires for the assessment of HRQoL. The goal of the current study was to evaluate the HRQoL of renal transplant recipients and compare it with that of patients on different forms of RRT. The study population consisted of: (1) 120 patients on hemodialysis (HD); (2) 43 patients on peritoneal dialysis (PD); (3) nine recipients who lost their grafts and went back to dialysis; (4) 120 age- and sex-matched healthy individuals (controls); and (5) 48 renal transplant recipients. The mean SF-36 scores were not significantly different between control group and transplant recipients as well as HD and PD patients including previously transplanted patients. The dialysis patients scored significantly worse in all eight SF-36 domains compared with transplant recipients and healthy subjects. In all GBB-24 components, the transplant recipients scored significantly higher than HD and PD patients. In the "fatigue tendency," "limb pain," and "cardiac complaints" components, recipients scored significantly higher than control group subjects. The mood analysis (Bf-S) showed that the scores of transplant recipients and controls did not differ, being significantly higher than those of dialysis patients. The HRQoL of patients on HD and PD were similar and lower than that of the general population. Renal transplantation significantly improved HRQoL at least to the level of healthy individuals. Graft loss was associated with significant worsening of HRQoL.