[Innovative technologies and multimodal correction in medical rehabilitation of motor and neuropsychological disturbances due to stroke]. / Innovatsionnye tekhnologii i vozmozhnosti mul'timodal'noi korrektsii postinsul'tnykh dvigatel'nykh i neiropsikhologicheskikh narushenii.

The article presents an overview of innovative technologies based on the methods of sensorimotor retraining of the patient using various types of biofeedback (BFB) as the most promising in the medical rehabilitation (MR) of patients with cerebral stroke (CS). The works of a high level of evidence (RCTs, national and international clinical guidelines, meta-analyses, systematic reviews) of the Medline, Pubmed, PubMed Cochrane Library databases are analyzed, ClinicalTrials.gov. It is emphasized that training with multisensory effects on visual, auditory, vestibular and kinesthetic analyzers have a beneficial effect on cognitive-motor training and retraining, neuropsychological status of the patient and increase the level of motivation to achieve success in the rehabilitation process. The synergy of multimodal effects of digital technologies, BFB, virtual reality, and the brain-computer interface will expand the capabilities and improve the efficiency of MR of after stroke-patients.

[The enhanced external counterpulsation as a method of non-invasive auxiliary blood circulation used for the combined rehabilitative treatment of the patients surviving after ischemic stroke (a review)].

The present review of the foreign and domestic literature is concerned with the application of the method of enhanced external counterpulsation (EECP) therapy for the treatment of the patients presenting with various diseases. It is shown that many recent publications report extensive investigations of the clinical and neurophysiological aspects of the application of this method for the combined regenerative treatment of the patients surviving after ischemic stroke (IS). The possibility of the influence of EECP therapy on the system of regulation of the cerebral blood flow, the formation of collateral circulation in the ischemic tissue, and the cellular-humoral mechanisms are considered. It is concluded that the introduction of enhanced external counterpulsation therapy into the program of the combined rehabilitative treatment on an individual basis for the patients surviving after ischemic stroke is pathogenetically substantiated as promoting regression of clinical, neurological, and neuropsychological disorders.

[Effectiveness of rehabilitation with virtual reality and biofeedback in recovery of hand function after stroke]. / Effektivnost' reabilitatsii s virtual'noi real'nost'yu i biologicheskoi obratnoi svyaz'yu v vosstanovlenii funktsii kisti posle insul'ta.

OBJECTIVE: To evaluate the effectiveness and safety of the rehabilitation glove (RG) with virtual reality (VR) and biofeedback (BFB) on recovery of the hand function in patients during the late recovery period after first hemispheric ischemic stroke (IS). MATERIAL AND METHODS: The study was randomized and controlled. One hundred and six patients (age 58.8±4.3 years, time after stroke onset - 8.7±2.1 months) were included in the final analysis. The intervention group (n=56) received rehabilitation with RG and VR. The control group (n=50) received individualized physical therapy. The primary end points were a change in the Fugl-Meyer scale score (FMA-UE), in the Action Research Arm Test (ARAT), and in the nine holes peg test (NHPT). Secondary end points included changes in MRCS, MAS, MoCA, HADS, modified Barthel index (MBI) and quality of life (EQ-5D-5L). RESULTS: Improvement of the motor function in the intervention group on FMA-UE scale (an increase of ≥7 points in sections A-D) was observed in 46.4% of patients, on ARAT (an increase of ≥5 points) in 53.6% of patients. There was a significant decrease in time from 36.8±6.3 sec. to 22.0±3.9 sec. on NHPT. A negative correlation was observed between the average ARAT score and anxiety (r=-0.7; p<0.05) and depression (r=-0.67; p<0.05). There was also a significant increase in EQ-5D-5L (VAS) by the end of rehabilitation in both groups with better scores in the intervention group (p=0.03). CONCLUSION: Rehabilitation based on VR, RG, and BFB is effective in the rehabilitation of dexterous hand function in patients with first hemispheric IS.

[Multimodal technology in the correction of post-stroke motor disorders]. / Mul'timodal'naya tekhnologiya korrektsii postinsul'tnykh dvigatel'nykh narushenii.

OBJECTIVE: To evaluate the effectiveness of a comprehensive rehabilitation program with the inclusion of programmable FES and BFB-stabilometric training in patients with post-stroke statolocomotor disorders in the late recovery period of ischemic stroke (IS). MATERIAL AND METHODS: The study included 120 patients in the late recovery period of IS, 57 women and 63 men, average age 58.4±6.4 years. The duration of the stroke was 228.59±31.9 days. The main group (MG) included 30 patients who underwent FES and BFB-stabilometric training. Comparison group 1 (CG1, n=30) received computer stabilometric training with BFB. Comparison group 2 (CG2, n=30) received FES. The control group (CG3, n=30) received a standard rehabilitation program. MR programs were carried out for all patients in the amount of 15 procedures every other day (5 weeks). RESULTS: The complex of rehabilitation measures with the inclusion of FES and BFB-stabilometric training significantly improve the function of walking in the form of restoration of the motor stereotype by the 5th week of the study, which was confirmed by neurological scales and stabilometry data. CONCLUSIONS: The inclusion of FES and BFB-stabilometric training methods in the rehabilitation process leads to earlier motor adaptation of the patient, restoration of impaired balance function and quality of life, which is associated with an increase in plastic and associative processes of the brain.

[The effect of rehabilitation with sensory glove and virtual reality on concentration of brain-derived neurotrophic factor and event related potential P300 in the early rehabilitation period after ischemic stroke]. / Vliyanie reabilitatsii s sensornoi perchatkoi i virtual'noi real'nost'yu na dinamiku neirotroficheskogo faktora golovnogo mozga i kognitivnykh vyzvannykh potentsialov P300 v rannem vosstanovitel'nom periode ishemicheskogo insul'ta.

OBJECTIVE: To study the effect of rehabilitation with sensory glove (SG) and virtual reality (VR) on changes in brain-derived neurotrophic factor (BDNF) concentration and amplitude and latency of event related potential (ERP) P300 in the early rehabilitation period after hemispheric ischemic stroke (IS). MATERIAL AND METHODS: Ninety patients (mean age 58.0±9.7 years, time after stroke onset - 3.8±1.6 months) were randomized into intervention (IG) and control (CG) groups. Patients in both groups received 15 sessions of rehabilitation (30 min, 3 times a week). Patients in the IG (n=46) received rehabilitation with SG and VR. Patients in CG (n=44) received individualized physical therapy. The end points were a change in the MMSE, MoCA, 10-word Luria test, subtests of Wechsler Adult Intelligence Scale IV (WAIS IV) test, amplitude and latency of P300, and BDNF concentration on admission and at the end of rehabilitation. RESULTS: There was an improvement on MoCA test (p=0.049) and working memory index of the WAIS IV test (p=0.045) iIn the IG after completing rehabilitation the improvement on MoCA test (p=0.049) and working memory index of the WAIS IV test (p=0.045) was observed. There was aA trend tendency towards an significant increase on MMSE (p=0.093) and 10-word Luria test (p=0.052) was observed. In CG, an improvement with a trend towards significant differences (p≤0.12) on all above mentioned tests was also observednoted. In both groups there were no significant changes in the amplitude or latency of P300. Concentration of BDNF increased significantly in the IG (p=0.042), while in the CG a tendency (p=0.064) was observed (p=0.064). By the end of rehabilitation, the delta between groups in the increase of BDNF concentration was 17.9%, p=0.072. In both groups, there was a correlation between scores on cognitive tests and BDNF concentration. Absence/presence of cognitive disorders was not associated with initial or final BDNF concentrations or delta between groups. RESULTS: In the IG after completing rehabilitation the improvement on MoCA test (p=0.049) and working memory index of the WAIS IV test (p=0.045) was observed. There was a tendency towards significant increase on MMSE (p=0.093) and 10 word Luria test (p=0.052). In CG an improvement with a trend towards significant differences (p≤0.12) on all above mentioned tests was also observed. In both groups there were no significant changes in the amplitude or latency of P300. Concentration of BDNF increased significantly in the IG (p=0.042), while in the CG a tendency was observed (p=0.064). By the end of rehabilitation, the delta between groups in the increase of BDNF concentration was 17.9%, p=0.072. In both groups there was a correlation between scores on cognitive tests and BDNF concentration. Absence/presence of cognitive disorders was not associated with initial or final BDNF concentration or delta between groups. CONCLUSION: VR and SG in the early rehabilitation period after IS is are as equally effective as rehabilitation with individualized physical therapy (aerobic training) in increasing BDNF concentration and in improvement on cognitive tests.

[Development of criteria for assessing the quality of microbiological studies and for evaluating their efficiency in tuberculosis service facilities and the general health network].

The major available indicators of the efficiency of laboratory service activities in diagnosing tuberculosis, including those widely used in international practice and Russian traditional tuberculosis statistical data, are analyzed. The optimal criteria for assessing the quality and efficiency of work of the clinical diagnostic laboratories of the general health network and the bacteriological laboratories of a tuberculosis service in the detection, diagnosis, and chemotherapy monitoring of tuberculosis have been developed. The recommended levels of the indicators, which are to be achieved by well working laboratories, if a well-implemented tuberculosis-controlling program is available, are defined.

[Effectiveness of correction of post-stroke motor disorders using the methods of functional electrostimulation and BFB-stabilometric postural control]. / Éffektivnost' korrektsii postinsul'tnykh dvigatel'nykh narushenii s primeneniem metodov funktsional'noi élektrostimuliatsii i BOS-stabilometricheskogo postural'nogo kontrolia.

AIM: To evaluate the effectiveness of complex rehabilitation with the inclusion of functional electrostimulation (FES) and BFB-stabilometric postural control in patients with post-stroke motor disorders in the late recovery period. MATERIAL AND METHODS: Sixty-seven patients in the late recovery period of stroke, 31 women and 36 men, mean age 58.4±6.4 years, were studied. The duration of stroke was 228.59±31.9 days. Ischemic stroke was in 71.9% of patients, hemorrhagic stroke in 28.1%. The first group included 42 patients with stroke, who, in addition to standard treatment regimen, had FES and BFB stabilometric training. The second group comprised 25 patients with stroke, the rehabilitation of which did not include above-mentioned methods. RESULTS AND CONCLUSION: A complex of rehabilitation measures with the inclusion of FES and BFB stabilometric postural training made it possible to significantly improve the function of walking in the form of restoration of the motor stereotype. The clinical effect was traced 3 weeks after the beginning of rehabilitation, reaching a maximum by the 5th week. Inclusion of BFB-based methods in the rehabilitation process leads to earlier motor and social adaptation of the patient, restoration of the disturbed equilibrium function, which is associated with an increase in the plastic and associative processes of the brain.

[Monitoring of drug resistance in Mycobacterium tuberculosis in The Republic of Mariy El].

Drug resistance (DR) in Mycobacterium tuberculosis (MBT) has been monitored in the Republic of Mariy El. It has been established that there is a considerable prevalence of drug-resistance strains even among new cases. There is a gradual rise in the level of MBT DR, including multiple DR (MDR). In 2000 and 2006, the rates of primary MBT DR were 26.7 and 31.5% (including those of MDR were 10.2 and 13%), respectively. The proportion of strains resistant to 4 major antituberculous drugs (I, R, S, E) of the number of DR cultures increased from 19% in 2003 to 35% in 2005, which suggests the situation of high strain with the prevalence of DR tuberculosis in the Republic of Mariy El.

[The efficacy of semax in the tretament of patients at different stages of ischemic stroke]. / Éffektivnost' semaksa pri lechenii bol'nykh na raznykh stadiiakh ishemicheskogo insul'ta.

AIM: To evaluate the efficacy of semax and timing of rehabilitation on the dynamics of plasma BDNF levels, motor performance, and Barthel index score in patients after ischemic stroke (IS). MATERIAL AND METHODS: One hundred and ten patients after IS (43 men, 67 women, mean age 58.0±9.7, Ме 63 years) were examined. All patients were divided into early (89±9 days) and late (214±22 days) rehabilitation groups. Each group was subdivided into semax+ and semax- subgroups. Standard regimen of semax included 2 courses (6000 mcg/day) for 10 days with 20 day interval. Plasma BDNF levels, motor performance on the British Medical Research Council scale and Barthel index were assessed in all groups. RESULTS: Administration of semax, regardless of the timing of rehabilitation, increased BDNF plasma levels which remained high during the whole study period. In semax- subgroups high BDNF plasma levels were positively correlated with early rehabilitation. Administration of semax and high BDNF levels accelerated the improvement and ameliorated the final outcome of Barthel score index. There was a positive correlation between BDNF plasma levels and Barthel score, as well as a correlation between early rehabilitation and motor performance improvement. The correlation between BDNF plasma levels and Barthel score was modified by the timing of rehabilitation. CONCLUSION: Early rehabilitation and administration of semax increase BDNF plasma level, speed functional recovery, and improve motor performance.

[Sleep disorders and circadian rhythms in diseases of the cardiovascular system].

OBJECTIVE: To study disturbances of sleep and circadian rhythms in patients with cardiovascular diseases taking into account the level of melatonin secretion and to optimize a complex approach to their treatment. MATERIALS AND METHODS: The study included patients with cardiovascular diseases with- (n=121) and without (n=105) cerebrovascular diseases (CVD). All patients received melaxen in dose 3 mg daily 30-40 min before sleep. Examination of patients included assessment of neurological status, psychometric scales, the definition of circadian rhythm of the heart and blood pressure, determination of 6-SOMT in daily urine. RESULTS: Pathological changes in circadian rhythms affected sleep disturbances, emotional and cognitive disorders and were associated with a reduction in the level of 6-SOMT in the urine. These changes were most pronounced in patients with CVD and stroke. The inclusion of melaxen in the comprehensive regimen of treatment improved sleep, reduced mood disorders and normalized the circadian heart rate profile and blood pressure. CONCLUSION: The data obtained allowed to consider melaxen as an effective tool in the complex therapy of patients with CVD.

[Oral symptoms and immune status of patients with the Rossolimo-Melkersson-Rosenthal syndrome]. / Stomatologicheskie proiavleniia i immunnyi status bol'nykh sindromom Rossolimo-Melkersson-Rosenthal.

Clinical oral symptoms were studied in 210 patients with the Rossolimo-Melkersson-Rosenthal syndrome (RMRS); the immune status was evaluated in 17 of these. Oral status was characterized by high prevalence and intensity of caries and presence of chronic generalized periodontitis. Immunological studies revealed changes characteristic of immunodeficiency: increased counts of suppressor cytotoxic T-lymphocytes, decreased phagocytic activity of neutrophils, and dysimmunoglobulinemia; hence, RMRS was associated with secondary immunodeficiency.

[Post-stroke spasticity of the lower limb: a comprehensive rehabilitation of patients with the use of botulinum toxin (onabotulinumtoxin A)].

OBJECTIVE: To examine the efficacy of onabotulinumtoxin A (Botox) in the complex rehabilitation of patients with post-stroke spasticity of the leg in the early rehabilitation period of stroke. MATERIALS AND METHODS: The study group comprised 31 patients in the early recovery period after stroke with the presence of equino-varus deformity of the foot with spasticity grade 3 or more (MAS). All patients received injections of onabotulinumtoxin A (Botox) in a total dose 400 ED as part of a comprehensive rehabilitation program. Dynamics of neurological status, spasticity, pain, function of walking and everyday activity was evaluated. RESULTS AND СONCLUSION: The high efficacy of botulinum neurotoxin type A was demonstrated. The drug reduced the severity of spasticity and discomfort in the leg and foot; promoted independent movement and increased walking speed of the patient.

[Experience in using xeomin in the treatment of arm and hand spasticity in the early rehabilitation phase of stroke].

To reduce arm and hand spasticity, 28 patients in the early rehabilitation phase of ischemic hemisphere stroke received injections of the botulinum toxin A preparation xeomin in the content of complex rehabilitation programs. The following muscles: m. biceps brachii, m. flexor digitorum profundus, m. flexor digitorum superficialis, m. flexor carpi ulnaris, m. flexor carpi radialis were injected according to standard scheme. The total dose of drug was 200U in moderate (2-3 scores on the Ashworth scale) and 300U in marked (3-4 scores on the Ashworth scale) spasticity. Efficacy and safety of treatment was assessed at baseline and 2, 4, 8, 12, 16 weeks after injections. Xeomin significantly (p<0.05) reduced muscle tonus in patients with post-stroke spasticity of different severity. Clinical effect was seen 2 weeks after injection, it reached maximum at week 4 and then slowly decreased to week 16. The improved functional activity of the paretic arm (due to patient's and caregiver's reports) remained for to 12 weeks. The treatment was most effective in the group of patients with moderate spasticity. The correlation analysis confirmed that the severity of spasticity increased with the disease duration that reduced rehabilitation efficiency. The treatment with xeomin was safe, no serious side-effects were found.

[Treatment of vestibular vertigo and Ménière syndrome in outpatient clinics].

An aim of this study was to assess clinical efficacy and tolerability of tagista in the symptomatic treatment of vestibular vertigo and Ménière syndrome. Thirty-two patients, 16 women and 16 men, aged from 25 to 67 years, were examined. Vertigo was caused by chronic brain ischemia in 17 cases and by the disturbance of blood circulation in the vertebral-basilar system in 14 patients with osteochondrosis of cervical spine. One patient was diagnosed with Ménière syndrome. Tagista was used in dose 24 mg twice a day during 4 weeks in the combination with standard treatment, exercise therapy and stability training. The results revealed a statistically significant effect of the drug on main symptoms (frequency, duration and intensity of vertigo attacks etc) and its good tolerability that allowed to recommend the drug in neurological practice.

[The use of cerepro (choline alfoscerate) in the treatment of outpatients with chronic progressive cerebrovascular disease].

The main aim of the study was the evaluation of the efficacy and drug safety of cerepro (choline alfoscerate) used for treating outpatients with cerebrovascular disease. Ninety patients with cerebrovascular disease, who had motor, coordination, emotional and cognitive disturbances were enrolled in the study. Sixty patients of the group 1 had stroke, 30 patients (group 2) had chronic ischemic brain disease. All patients received basic therapy (antihypertensive, antiaggregant or anticoagulant, cholesterol-lowering drugs). Cerepro was administrated in combined therapy according to the scheme: 1000 mg cerepro (in 200 ml of the 0.9% NaCl solution) once a day intravenously in drops during 10 days; then 1200 mg daily per os during 6 weeks. We assessed the dynamic of neurological symptoms and restoration of lost functions (MMSE, Feeling-activity-mood test, HDRS, GCI). The results indicate the efficacy of cerepro in outpatients with chronic cerebrovascular disease and stroke. It was demonstrated that cerepro led to improvement of coordination neurological symptoms, cognitive and emotional functions, activity and mood in patients of both groups. Clinical effect was higher in patients after stroke. Cerepro was well tolerated.

[A possible effect of the immunomodulating therapy with beta-interferons and glatimer acetate on the development of thyroid disease in patients with multiple sclerosis].

Autoimmune thyroiditis and subclinical hypothyreosis occurred in 20-25% of patients with multiple sclerosis (MS) before the beginning of immunomodulating therapy. No correlation was found between thyroid disease and demographical characteristics (age, sex), type of MS course, rate of disease progression and disability scores on the EDSS. Thyroid disease in patients with MS may be provoked or enhanced by disease-modifying drugs (DMD). Female sex and a history of autoimmune thyroid disease were predict the thyroid gland dysfunction during the therapy with beta-interferons. Clinical thyreotoxicosis is the most dangerous and the therapy should be discontinued. We present the own data on thyroid function in 191 patients managed in the Central administrative okrug of Moscow and in the Moscow Center for Multiple Sclerosis. Thyroid disease was found in 34.6% of patients (the formation of nodes and subclinical hypothyreosis). Changes in the thyroid function were seen in patients treated with beta-interferon and the development of node goiter was found in patients treated with glatimer acetate (copaxon). The dynamics of thyroid gland structure during the treatment with DMD was followed during one year. Beta-interferons provoked the development of hypothyreosis. The study of thyroid gland in MS patients, in particular, those treated with DMD is needed.

[Effect of glatiramer acetate (copaxone) on the structure and functions of the thyroid gland in patients with multiple sclerosis].

A study included 158 patients stratified into 3 groups: 57 patients with multiple sclerosis (MS) of the main group who were treated with copaxone in dosage 20 mg/d during 4,3±2,6 years, 49 patients without MS with different neurological diseases of the control group and 52 patients diagnosed with "confirmed MS" in the remission stage who were not treated with disease-modifying drugs. Demographic data, severity of MS patient's state, ultra-sound and hormonal data assessing the thyroid gland function were analyzed. The results obtained in the study demonstrated the relative safety of copaxone in respect to changes in thyroid gland function, the low risk for the elevation of blood antibodies to thyreoperoxidase, changes of hormonal indices and the development of thyroid dysfunction.