[ANALYSIS OF THE ASSOCIATION BETWEEN THR83ALA POLYMORPHISM OF MATRIX GLA-PROTEIN GENE AND LOWER EXTREMITY ARTERIAL CALCIFICATION].

Lower extremity arterial calcification (AC) is a common pathological process that has independent significance in the pathogenesis of many cardiovascular diseases. There is evidence that development of AC associated with Thr83Ala polymorphism of matrix GLA-protein gene. The objective of this study was to examine the association between Thr83Ala polymorphism of matrix Cla protein (MGP) gene and AC in male and female subjects of the Ukrainian population. 40 AC and 40 healthy controls were recruited to the study. MGP exon 4 Thr83Ala polymorphism (rs 4236) was examined using the polymerase chain reaction with subsequent restriction fragment length polymorphism analysis. The obtained data show that the substitution of threonin by alanine at position 83 in a molecule of MGP can affect its functional characteristics and anticalcinogenic properties. The distribution of homozygous carriers of a major allelic variant, and heterozygous and homozygous minor allele variants of Thr83Ala polymorphism in patients with AC was 40,0%, 47,5%, and 12,5% respectively. The corresponding distribution of variants in the control group was 32,5%, 42,5% and 25,0% (p=0,352 by χ2 -test). In women who are carriers of Ala/Ala-variant, CA occurs more rarely than in men with the same genotype (p=0,036 by χ2 -test). The substitution of threonine by alanine due to MGP exon 4 Thr83Ala polymorphism is related to a decrease in the likelihood of CA in female persons in the Ukrainian population.

[Clinical course of acute coronary syndrome in dependence on containing of homozystein and С677Т methylenetetrahydrofolate reductase gene polymorphism].

Nowadays to a numerous factors of IHD development risks hyperhomocysteinemia (HHc), C-reactive protein, fibrogen, as well as genetic disorders are relating. With development of IHD and its complications associated methylentetrahudrofolate reductase gene mutation of С677Т polymorphism. The purpose of the investigation was studying the connection between acute coronary syndrome severity (ACS) in dependence on plasma homocysteine containing and genotype by С677Т polymorphism MTHFR gene. Examined: 161 patients with ACS and 87 almost healthy people. Identification of 4th exon allelic polymorphism MTHFR С677Т gene (rs1801133) was conducted with method of polymerase chain reaction, the investigation of homocysteine containing with immunoenzymated method. The statistic analyze was performed with using of SPSS - 17 programme. According to results of study patients with ACS of homozygote by minor allele T С677Т MTHFR gene polymorphism by main allele C and heterozygote were associated with high homocysteine containing in plasma. While frequencies of T/T genotype was reliably higher in patients with ACS with segment ST elevation and complicated course compare with patients with ACS with segment ST elevation and non-complicated course and ACS without climbs of segment ST. Also, statistically reliable difference in genotypes distribution by C677T MTHFR gene polymorphism in dependence on homocysteine plasma level and clinical course of ACS severity were established.

The recognition, assessment and management of dementing disorders: conclusions from the Canadian Consensus Conference on Dementia.

OBJECTIVE: i) To develop evidence based consensus statements on which to build clinical practice guidelines for primary care physicians towards the recognition, assessment and management of dementing disorders; ii) to disseminate and evaluate the impact of these statements and guidelines built on these statements. OPTIONS: Structured approach to assessment, including recommended laboratory tests, choices for neuroimaging and referral; management of complications (especially behaviour problems and depression) and use of cognitive enhancing agents. POTENTIAL OUTCOMES: Consistent and improved clinical care of persons with dementia; cost containment by more selective use of laboratory investigations, neuroimaging and referrals; appropriate use of cognitive enhancing agents. EVIDENCE: Authors of each background paper were entrusted to: perform a literature search, discover additional relevant material including references cited in retrieved articles; consult with other experts in the field and then synthesize information. Standard rules of evidence were applied. Based upon this evidence, consensus statements were developed by a group of experts, guided by a steering committee of eight individuals from the areas of Neurology, Geriatric Medicine, Psychiatry, Family Medicine, Preventive Health Care and Health Care Systems. VALUES: Recommendations have been developed with particular attention to the context of primary care and are intended to support family physicians in their ongoing assessment and care of patients with dementia. BENEFITS, HARMS AND COSTS: Potential for improved clinical care of individuals with dementia. A dissemination and evaluation strategy will attempt to measure the impact of the recommendations. RECOMMENDATIONS: See text. VALIDATION: Four other sets of consensus statements and/or guidelines have been published recently. These recommendations are generally congruent with our own consensus statements. The consensus statements have been endorsed by relevant bodies in Canada.

Screening for cognitive impairment in general practice: toward a consensus.

We considered whether general practitioners should examine all older patients over a certain age for cognitive impairment in screening for early dementia. We invited presentations from key experts, selectively reviewed the literature, and developed a consensus statement. The efficacy of and benefits from unselective use of cognitive testing and informant questionnaires for detecting early dementia in older patients attending general practice are limited. Positive predictive values of cognitive screening for dementia are less than 50%, even for older patient populations. Higher values may be obtained by testing patients who have a relevant history of cognitive or functional decline. Whatever procedures are adopted for screening older general practice attenders for cognitive impairment or early dementia, investigation is still required into the relative merits of different health professionals performing the screening, the positive and negative effects on patients and their families, and the cost-benefit ratio. The majority view of workshop participants was that cognitive testing should occur for older patients when there is a reason to suspect dementia. Testing may occur in an individual considered to be at risk because of an informant history of cognitive or functional decline, clinical observation, or, sometimes, very old age. No single instrument for cognitive screening is suitable for global use. Screening programs must be supported by training and supplemented by education for professionals and families in management of dementia.

A correlation between cognitive performance and daily functioning in elderly people.

The Mini-Mental State Examination (MMSE) is widely used to detect dementia, but the diagnosis of dementia also depends on a decline in the level of daily functioning. Little is known about the relationship between performance on the MMSE and daily living abilities. This relationship was investigated in this study of an elderly population by comparing scores on the MMSE with those on both a direct assessment of everyday tasks and an indirect questionnaire about activities of daily living and physical self-maintenance. Forty-five subjects with varying mental abilities participated in the study. A significant correlation was found between MMSE scores and the measures of functional abilities; but the specificity and sensitivity to the diagnosis of dementia would be increased by assessing functional status, even indirectly, as well as cognitive ability.

Delusional double mourning: a complication of bereavement in dementia.

We describe two elderly patients with senile dementia who presented with the delusion that a parent had died within weeks of the actual death of a spouse. These fixed, systematized, and persistent beliefs do not correspond to the delusions of dementia or of the bereaved elderly that have been previously described. The phenomenology and implications of these "delusions of double mourning" are discussed.

Neurocysticercosis in the United States: 35 cases and a review.

Neurocysticercosis has become more prominent in the United States in recent years because of an increase in immigration from endemic regions and because of improved ease of diagnosis with computed tomography (CT). Neurocysticercosis should be suspected in any patient from a high-risk region who has symptoms or signs of a central nervous system disorder, especially seizures, headaches, or signs of increased intracranial pressure. The best diagnostic test is CT of the head, which usually shows a combination of multiple punctate calcifications; hydrocephalus; and parenchymal, subarachnoid, or intraventricular cysts with and without contrast enhancement. Cysticercosis is confirmed serologically by measurement of cysticercosis antibody titers in serum or cerebrospinal fluid and histologically by biopsy of a lesion. Treatment with praziquantel and dexamethasone is usually sufficient, but ventricular shunting or surgical removal of intraventricular or spinal cysts may be necessary. Whenever a case is identified, other household members should be examined for symptoms and signs of neurocysticercosis and screened for active Taenia solium infection.

MRI and the study of aphasia.

Three-dimensional magnetic resonance imaging (MRI) was used to study various aphasia and neurobehavioral syndromes due to embolic or thrombotic cerebral infarction. Two patients are presented to illustrate how MRI may complement, and sometimes improve on, CT for the in vivo demonstration of anatomic changes underlying said syndromes. MRI images were reconstructed at planes selected to match CT, and at coronal planes through the entire anteroposterior extent of the lesions. Both CT and MRI detected lesions; however, MRI provided better differentiation of gray and white matter. Coronal reconstructions aid in optimally visualizing the relationship of lesions to the opercular and perisylvian gyri. CT may be inadequate to define actual extent of lesions, whereas MRI may more clearly show that apparently subcortical lesions can, in fact, involve the cortex as well.

Dementia after surgery for cerebellar stroke: an unrecognized complication of acute hydrocephalus?

Three patients became demented after surgery for cerebellar hemorrhage or infarction with acute hydrocephalus. All were inattentive, perseverative, and disoriented. They had difficulty with memory, and trouble solving arithmetic problems or copying geometric figures. None showed aphasia, apraxia, or agnosia, although one had word-finding difficulty. One improved substantially in 6 months; one improved slightly in 1 year, and one did not change. None had persistent hydrocephalus. Acute hydrocephalus may have damaged the periventricular white matter to cause the dementia.

The anatomic basis of delusions after right cerebral infarction.

We studied the nature and causes of delusions after infarction of the right cerebral hemisphere. Delusions involved orientation in time and place, events in the recent past, and the identities of familiar individuals. Some were transient and disorganized, and others were more fixed. No particular site in the right hemisphere was associated with particular delusions. The different delusions may be varied manifestations of a basic disorder of thought and memory. The major determinant of the delusions was cerebral atrophy. Age, location, and size of lesion had no major effect. The superimposition of a new right hemisphere lesion on a diffusely atrophied brain seems to cause delusions that can be expressed verbally because the left hemisphere is relatively preserved.

[Effect of freezing-thawing on the activity of lactate dehydrogenase isoenzymes]. / Vliianie zamorazhivaniia na aktivnost' izofermentov laktatdegidrogenazy.

The activity of isolated M4- and H4-lactate dehydrogenase isoenzymes is studied after freezing in the saline solution to -8, -9.5, -23 and -30 degrees C. It is shown that the activity of H4-lactate dehydrogenase does not change, M4-lactate dehydrogenase being partially inactivated. It is demonstrated that a reduction in the M4-LDH activity is due to the effect of high salt concentrations on the freezing-out water from the solution and is an irreversible process. The fluorescence spectra of these isoenzymes are studied after freezing-thawing, and the interpretation of the observed changes in these spectra is suggested on the basis of possible alterations in the quaternary structure and sonformation of the enzyme molecule subunits. It is shown that the substrates and coenzymes of lactate dehydrogenase (NAD, NADH, pyruvate, lactate) completely or partially prevent the inactivation of M4-isoenzymes at freezing-thawing.