[Monitoring and antibiotic resistance profile of tracheal aspirate microbiota in ICU children with severe craniocerebral trauma].

Nosocomial infections and their rational antibiotic treatment represent a major challenge for the healthcare nowadays. In this context, gramnegative bacteria including Pseudomonas aeruginosa, Acinetobacter baumanii and Enterobacteriaceae spp. are etiologically important and characterized by a significant level of antibiotic resistance. To examine dynamics of the respiratory tract colonization by hospital flora, tracheal aspirates obtained at three time points from 69 children with severe craniocerebral trauma during their stay in ICU were analysed. Colonization was observed on the 4th day of the ICU stay with predomination of K. pneumoniae (45%) and A. baumanii (27-37%). P. aeruginosa was detected after the 8th day of the ICU stay with the isolation rate of 33%. Substantial proportions of P. aeruginosa (61%), A. baumanii (78%) and K. pneumoniae (25%) were resistant to carbapenems. In 65 carbapemen resistant isolates, the presence of carbapenemases was examined using PCRs. OXA-48 carbapenemase was detected in 11 out of 14 (78%) K. pneumoniae isolates. Among the A. baumanii isolates, 30/31 (97%) carried OXA-40 and 1/31 (3%) had OXA-23 carbapenemases. None of the examined A. baumanii and K. pneumoniae isolates produced metallo-betalactamases (MBL). In contrast, all 20 carbapenem resistant P. aeruginosa isolates produced a MBL, and in 12 out of 20 (60%) of theme VIM-2 was detected. Thus, gramnegative nosocomial microflora rapidly colonizes ICU patients and has a high level of resistance to antibiotics, including carbapenems.

[On possibility of partial restore integrative brain activity in patients with vegetative state].

A combined approach to neuroreconstructive effects on pathogenesis mechanisms of vegetative state that develops as a result of severe traumatic brain injury (TBI). It is shown that under the influence of chemical transtimpanal vestibular dereception and transcranial micropolarization (TDCS) accelerated and more pronounced therapeutic effect than conventional therapy. Neurophysiological in-depth examination of the dynamics shows that over time in patients in a vegetative state, picking up the intensity, "tension" and "rigidity" of inter-regional cortical interactions in the organization that are beginning to dominate the area TPO cortex of both hemispheres. It is suggested that in the dislocation of the brain stem in severe TBI is vestibulotalamic tract, thanks to its anatomical location, is the least vulnerable. As a result, the prevailing afferentation forming inter-regional cortical interactions is vestibular afferent impulses. On its basis the pathological functional system, blocking the work of other functional systems of the damaged brain. Suggested treatments significantly reduce the amount of vestibular afferent flow and open up the possibility of recovery of more effective interafferential interactions. This greatly facilitates the work of the brain as a multimodal analyzer.

[The role of vestibular afferentation in the system cooperation's of cortical field's human brain].

For the purpose of studying of a role vestibular afftrentation in the organization of system interaction of cortical fields of a brain of the person dynamics of inter-regional cortical interactions at patients by a cervical dystonia in the course of their treatment by a method transtimpanal chemical vestibular dereception was investigated. It is shown, what even at unilateral vestibular dereception deep reorganization of system interaction distance the separated cortical areas, mentioning, first of all, back and forward associative zones of both hemispheres is observed. The laws specifying for an organizing role vestibular afftrentation in the organization of integrative activity of a brain that confirms its system value are revealed.

[Clinical and neurophysiological manifestations of cerebral asymmetry in cervical dystonia].

Based on the analysis of clinical and neurophysiological data with the use of up-to-date methods of EEG processing, the authors discuss a role of cerebral asymmetry (CA) in the pathogenesis of cervical dystonia (CD). Sixty-seven patients (31 male and 36 female) with CD have been studied. The pathological turn of the head to the right side (RT) was observed in 34 patients, to the left side (LT) - in 33 patients. The uni- or bilateral generalization of dystonic symptoms (Meig's syndrome, laterocollis) was found only in one-third of RT patients. The visual analysis of EEG of RT patients revealed the high level of EEG synchronization with signs of cortical irritation, with the prevalence in the left hemisphere, and the presence of focal epileptiform appearances in the temporal leads of the left or both hemispheres with the left-side prevalence. In LT patients, the EEG presentation was similar to normal but more often represented the variants of <> EEG-pattern. In these cases, the apparent manifestations of CA were not found. The coherent analysis revealed the formation of the network of <> coherent links, with bilateral spread, in RT patients. This may suggest the functional inequivalence of the peripersonal space of right and left hand and the dominate significance of striopallidar and thalamic structures of the left hemisphere for the total brain activity.