[Dynamics of platelet hemostasis indices in patients with cardioembolic stroke against the background of atrial fibrillation]. / Dinamika pokazatelei trombotsitarnogo gemostaza u patsientov s kardioembolicheskim insul'tom.

OBJECTIVE: To study the parameters of platelet hemostasis in patients with cardioembolic ischemic stroke on the background of atrial fibrillation and taking warfarin to assess the effectiveness of antiplatelet drugs in the prevention of recurrent ischemic strokes. MATERIAL AND METHODS: 93 patients with ischemic stroke on the background of atrial fibrillation were examined, of which the main group consisted of 43 patients who took warfarin and 50 patients from the reference group without warfarin. The study of the platelet link of hemostasis using inductors (adrenaline, ristomycin, arachidonic acid, collagen, ADP) in patients of both groups was carried out. In the group of patients taking warfarin there was a significant increase in platelet aggregation for adrenaline up to 57.15 [29.51; 62.61] (p=0.0315), spontaneous aggregation 2.46 [1.39; 6.75] (p=0.047), reduction of platelet aggregation for collagen 14.45 [4.80; 43.63] (p=0.008). In 35 patients of the study group (n=93), laboratory resistance to aspirin was also revealed in terms of platelet aggregation to arachidonic acid, which is a criterion for evaluating the effectiveness of preventive measures for recurrent ischemic strokes with antiplatelet drugs. CONCLUSION: The obtained data are additional risk factors for recurrent strokes. It is also recommended to study platelet aggregation for arachidonic acid to assess the effectiveness of antiplatelet drugs prophylaxis of recurrent ischemic strokes.

[A clinical and genetic analysis of risk factors for the development of acute and chronic cerebral ischemia]. / Kliniko-geneticheskii analiz faktorov riska razvitiia ostroi i khronicheskoi ishemii golovnogo mozga.

To study the association between polymorphic markers in the ACE, SERPINE1, FGB, F5, F7, F12, GP1BA, GPIIIa, MTHFR, CYP11B2, PON1, PON2, NOS2, NOS2, HIFla, LTA, ALOX5AP genes and clinical characteristics of acute and chronic forms of circulatory disorders of the brain. MATERIAL AND METHODS: The analysis of polymorphic variants in ACE, FGB, F5, F7, F12, GP1BA, GPIIIa, SERPINE1, MTHFR, CYP11B2, PON1, PON2, NOS2, NOS3, PDE4D, HIF1a, LTA, ALOX5AP in 81 patients with chronic cerebral ischemia (CCI) and 69 patients with ischemic stroke (IS), and their interrelation with clinical manifestations of disease were investigated. RESULTS AND CONCLUSION: The association between the T/T genotype of the PDE4D SNP 83C>T polymorphism and a rapid progression of hypertensive disease (GB) was revealed (OR=6.22, CI=1.86-20.79, p=0.0036) in the group of patients with CCI. The association of the allele D and the DD genotype of the ACE (I>D, rs1799752) with cardioembolic stroke (OR=2.67, 95% CI=1.23-5.8, p=0.02 and OR=7.14, 95% CI=1.72-29.69, p=0.0057) was found. When comparing subgroups of patients with different degrees of stenosis of brachiocephalic arteries (BCA), the association of the allele C and the TC genotype of the GP1BA (rs2243093, -5T/C) with BCA occlusion and expressed hemodynamically significant stenosis (>75%) was revealed (OR=3.39, 95% CI=1.12-10.25, p=0.03 and OR=4.44, 95% CI=1.27-15.54, p=0.023, respectively). Thus, polymorphic markers in PDE4D, ACE, GP1BA in combination with certain clinical characteristics are risk factors for the progression of CCI and development of IS.

[The state of microcirculation and platelet hemostasis in patients with ischemic stroke after systemic thrombolytic therapy]. / Sostoianie mikrotsirkuliatsii i trombotsitarnogo zvena gemostaza u patsientov s ishemicheskim insul'tom posle provedeniia sistemnoi tromboliticheskoi terapii.

AIM: The state of microcirculation and platelet hemostasis in patients with ischemic stroke after systemic thrombolytic therapy. MATERIAL AND METHODS: Forty-two patients after systemic thrombolytic therapy (TLT) (mean age 64.26 [60.58; 68.06]) and 47 patients without TLT (54.52 [47.48; 60.83]) were studied. The study of platelet hemostasis was conducted with the determination of platelet aggregation (AT) on adrenaline, ADP, ristomycin, spontaneous aggregation on days 1, 7 and 14. Studies of the state of microcirculation of cerebral vessels were carried out using the laser Doppler flowmetry (LDF). RESULTS AND CONCLUSION: Characteristics of changes in induced AT and parameters of the microcirculation system in patients after systemic TLT at 1, 7 and 14 days in comparison with the indices of patients without TLT were revealed that allowed to expand the understanding of pathological mechanisms of the microcirculatory bed, their connection with violations of central hemodynamics and to obtain additional markers of disease course and prognosis.

[Platelet hemostasis in patients with ischemic stroke after systemic thrombolytic therapy]. / Osobennosti trombotsitarnogo gemostaza u patsientov s ishemicheskim insul'tom posle provedennoi sistemnoi tromboliticheskoi terapii.

AIM: To study the platelet aggregation (PA) in patients with ischemic stroke (IS) after systemic thrombolytic therapy (TLT). MATERIAL AND METHODS: Twenty-four patients, including 13 with atherothrombotic IS and 11 with cardioembolic IS, have been examined after systemic TLT. Spontaneous and adrenaline-induced PA, international normalized ratio, activated partial thromboplastin time, fibrinogen, neurological deficit severity on the NIHSS (2nd, 6-7th, 12-14th and 21st days after TLT), computed tomography (CT) of the brain (at baseline and 2nd day after TLT) were assessed. RESULTS: The correlation between TLT outcomes and characteristics of spontaneous and adrenaline-induced PA was shown. Patients with initially elevated PA (group 1, n=7) had the lowest NIHSS score in the 21st day. A group of patients with initially reduced PA (group 2, n=17) included a subgroup with no spontaneous aggregation (n=9) and a subgroup with hemostasis system dysregulation manifested with increased spontaneous PA and fibrinogen (n=8), in which the recovery of neurological functions was lower compared to group 1. CONCLUSION: The results of the study can be used for individualization of preventive antiaggregative and anticoagulative therapy after TLT.

[Characteristics of microcirculation in patients with acute ischemic stroke and chronic cerebral ischemia]. / Osobennosti sostoianiia mikrotsirkuliatsii u patsientov s ostrym ishemicheskim insul'tom i khronicheskoi ishemiei golovnogo mozga.

OBJECTIVE: To study microcirculation in patients with acute ischemic stroke (IS) using the method of laser Doppler fluorimetry (LDF). MATERIAL AND METHODS: We examined 19 patients with acute carotid IS, including 12 patients who received thrombolytic therapy. The reference group included 22 patients with chronic cerebral ischemia without a history of IS. Computed and magnetic resonance tomography of the brain, ultrasound diagnosis of head and neck vessels, the study of the changes in neurological status, emotional sphere, cognitive functions and laboratory methods were used. RESULTS: An index of total blood flow in the microcirculatory bed on the side of stroke was lower compared to that in patients with chronic cerebral ischemia. The study of parameters of microcirculatory bed regulation revealed an increase of blood inflow into the microcirculatory bed with the augmentation of the myogenic activity of arterioles and primarily the nutritional regimen of microhemocirculation. A decrease in the myogenic activity in the microcirculation system and nutritional direction of microhemodynamics were noted in patients with large IS. In some cases, non-nutritional regimen and/or venule congestion were observed. CONCLUSION: The study of the microcirculation system with the LDF method can be used as the method of early diagnosis of unfavorable variants of cerebral microcirculation that is necessary for outcome prognosis and its correction.

[Neuroprotective treatment of chronic cerebrovascular insufficiency].

OBJECTIVE: To study the efficacy of cerebrolysin in 300 patients with chronic brain ischemia (CBI), I and II stages. MATERIAL AND METHODS: The main group consisted of 195 patients with CBI, I stage and 105 patients with CBI, II stage. Patients of the control group (45 patients) did not receive cerebrolysin. Changes in neurological and emotional status, cognitive functions, indicators of platelet and erythrocyte aggregation, their deformity and morpho-densitometric parameters were studied. RESULTS AND CONCLUSION: Authors found the additional mechanisms of cerebrolysin action resulted in the improvement of morpho-densitometric characteristics of erythrocytes and hemorheological properties important for capillary blood flow.

[An impact of neuroprotective therapy on blood rheological and morphodensitometric parameters in patients with chronic cerebral ischemia].

OBJECTIVE: To explore the dynamics of aggregation of platelets and erythrocytes, their deformity and computed morphodensitometric parameters in patients with chronic cerebral ischemia, stages I and II, treated with cerebrolysin. MATERIAL AND METHODS: We examined 300 patients, including 87 men and 213 women, aged from 30 to 55 years. Patients were randomized by disease stage and treatment (standard treatment with or without cerebrolysin). The dynamics of neurological and emotional status as well as cognitive functions and results of laboratory studies were assessed. RESULTS AND CONCLUSION: Along with the total positive effect of cerebrolysin on the clinical picture, additional mechanisms of its action (antiaggregant, antihypoxic and membranotropic) improved the erythrocyte morphodensitometric parameters, hemostatic, hemorheological and blood gas transport characteristics, in particular on the microcirculatory level.

[A light-hardened polymeric material for metal-plastic whole-cast fixed dentures]. / Polimernyi material svetovogo otverzhdeniia dlia metalloplastmassovykh tsel'nolitykh nes''emnykh zubnykh protezov.

Self-hardening material for metal plastic permanent dentures, has been developed by the Central Research Institute of Dentistry for the first time in Russia. Its physicomechanical properties are described and the results of toxicological trials are presented. The new material is superior in wear resistance to foreign analogs Kulzer Dentacolor and ESPE Visio-Gem. Toxicological studies demonstrated the biological inertness of the material during long contact with the internal media of human organism and the absence of toxic, sensitizing, and mutagenic action.