[Clinical and prognostic significance of genetic markers in craniocerebral injury (Part III)].

It is now becoming increasingly clear that the course and outcome of craniocerebral injury (CCI) are determined not only by its biomechanism, severity, patient's age, presence of premorbid factors, etc., but also by individual features of the genome of each patient, which puts traumatic brain injury among multifactorial diseases. The genome determines the presence or absence of«genetic predilection to the development of various complications and sequelae of CCI, which generally determines the progression of traumatic brain injury disease. The first part of the review by Potapov et al. (201 0) [2] was devoted to the role of apolipoprotein E (apoE) gene polymorphism in CCI, the second one [3]- to the role of inflammation and immune response genes in the course and outcome of CCI. The present (third) part will provide a review of modern data on the effect of genes underlying intracellular processes of oxidative stress, apoptosis, regeneration, and synthesis of neurotransmitters and their receptors.

[The structure of hospital morbidity and enhancement of medical care in neurosurgery department].

The article presents analysis of structure of hospital morbidity and indicators of activities of neurosurgery department of the Republic clinical hospital of emergency care of the Chechen Republic. The analysis date supports increasing quality of curative diagnostic processes and valuable development of algorithm of provision of medical care of this profile in curative preventive institution.

[Analysis of thyroid homeostasis disorders in patients with severe traumatic brain injury].

Aim of the study was to investigate the status of thyroid homeostasis and the relationship between severe traumatic brain injury (TBI) and thyroid disorders. The study included 56 patients. Protocol of the study concluded: noninvasive and invasive hemodynamic monitoring, including PICCO, transcranial Doppler ultrasonography, measurement of intracranial pressure (ICP), indirect calorimetry, levels of thyroid stimulating hormone (TSH), T3, T4 and free fractions. Patients were divided into three groups. Group 1--with normal thyroid hormones (n = 20), Group 2--with the low T3 (n = 23) and Group 3 with the low T3 and T4 (n = 13). Correlation between the Glasgow Coma Scale (GCS) and thyroid hormone levels was obtained: the first group between GCS and T4 (r = 0.50), GCS, and free fraction T4 (r = 0.51); between the GCS and TSH (r = 0.51), T3 (r = 0.48) and T4 (r = 0.57) in the second group, and the third--with TSH (r = 0.67). Poor outcomes in the first group compound 15%, in the second group--39.2%, and in the third group--62.5% of patients. Doses of vasopressors were significantly higher in groups 2 and 3 compared with a first group. ICP was significantly higher in the group with the low T3 and T4. Development of intracranial hypertension correlated with the formation of thyroid insufficiency. Deficiency of thyroid hormones, especially the simultaneous reduction and T3, and T4 is associated with poor outcome in patients with severe TBI. Doses of sympathomimetic drugs used to optimize the parameters of systemic hemodynamics in acute severe head injury were higher in patients with deficiency of thyroid hormones.

[Clinical and prognostic value of inflammatory genetic markers in traumatic brain injury].

The paper analyses the published data about association of polymorphic gene markers of different bioactive agents (interleukins, angiotensin convertase, catechol-O-methyltransferase, dopamine receptors etc.) with traumatic brain injury. Analysis of the entire pool of data concerning clinical and experimental studies of association of different polymorphic markers of candidate genes with outcome of traumatic brain injury allows to conclude that IL 1alpha and IL 1beta, IL 6, catechol-O-methyltransferase, angiotensin convertase, D2 dopamine receptors in fact play important role in neuroinflammatory response to injury and recovery of the brain ant its functions. Moreover presence or absence of certain polymorphic gene markers differentially influence separate pathogenetic mechanisms of brain injury (e.g., severity of brain edema, cerebral blood flow, cognitive functions). Consequently each of the investigated genes contributes in outcome after traumatic brain injury.

[Clinical and prognostic significance of genetic markers of ApoE gene in traumatic brain injury].

The review focuses on the analysis of available data about association of polymorphic genetic markers of gene encoding apolipoprotein E (APOE) with traumatic brain injury (TBI). The most investigated genetic marker of poor outcome after TBI is presence of 4 allele of APOE gene. According to most authors, carriers of this allele have worse functional outcome and lower indices of restoration of cognitive functions. Studies of association of polymorphic markers A(-491)T, T(-427)C and G(-219)T, located in promoter area of APOE gene, with course and outcome of TBI in Europeans, demonstrated that only carriers of TT genotype of polymorphic marker G(-219)T had much poorer recovery in comparison with carriers of GT and TT of this marker. However, in patients with TBI belonging to Chinese population association with higher risk of neurological deterioration was discovered for another polymorphic marker of the same area, A(-491). Increased risk was observed in carriers of AA genotype which determines raised level of APOE gene expression in combination with presence of 4 allele of the same gene. Analysis of the whole clinical and experimental investigations of association of different polymorphic markers of APOE gene with course and outcome of TBI allows to conclude that product of this gene, apolipoprotein E, in fact, plays important role in processes of recovery of brain and its functions being directly involved in neuroplasticity and neurotransmission thus facilitating functional integration of different brain areas.

[Population health in the Chechen Republic].

The activities of health care system and indicators of population health are analyzed in the Chechen Republic which undergoes chain of social disasters during last twenty years. The study used data of official statistical documents from various departments and author's immediate observation of events under study. The conclusions are made that serious problems exist in the health conditions of population in the Republic despite relatively safe official statistic indicators.