[Diagnosis, pathogenesis and treatment of attention deficiency syndrome]. / Diagnostika, patogenez i lechenie sindroma defitsita vnimaniya.

Attention deficit hyperactivity disorder is the dominant form of cognitive and behavioral dysfunctions in childhood, the disease has a chronic course and manifests in adolescents and adults in 50-80% of cases. An adequate diagnosis is the testing of parents and teachers using the Conners questionnaire in two stages, the second is mandatory after 6 months to confirm the persistence of symptoms over time. The pathogenesis is based on violations of mediation of dopamine and norepinephrine in the fronto-striate-thalamic system, responsible for the function of constant attention, caused by molecular genetic mechanisms. Atomoxetine (Cognitera) in combination with pedagogical and psychological methods of correction seems to be an adequate drug for many months of use, taking into account international and Russian experience of use.

[Development of speech disorders in children]. / Narusheniya razvitiya rechi u detei.

The function of the formation of speech skills is decisive in the development of a child in communication and assimilation of information. Early pediatric diagnosis should become a routine practice of monitoring children from infancy to school age for the timely correction of speech disorders and associated dysgraphia and dyslexia. According to the ICD-10 classification, speech developmental disorders are divided into the following options: articulation impairment, delay in expressive and impressive speech. Articulation disorders, stuttering, impaired expressive speech are the most common and most favorable prognosis for speech therapy interventions. The data on the effectiveness of disorders of the receptive (impressive) language are ambiguous, since there is a high likelihood of a combination with neurogenetic diseases and autism. The development of speech therapy programs will make it possible to broader coverage of those in need of treatment, including complex course therapy with neuropeptides (cortexin).

[Alternating hemiplegia with epilepsy]. / Al'terniruyushchaya gemiplegiya, assotsiirovannaya s epilepsiei.

A clinical case of a genetically confirmed diagnosis of alternating hemiplegia associated with epilepsy is presented. The combination of two types of seizures in a child made it difficult to make a diagnosis. The result of video-EEG monitoring made it possible to understand that a child showed both epileptic seizures and non-epileptic seizures simultaneously with different periodicities. The mutation in the ATP1A3 gene was verified with genome-wide sequencing and targeted therapy was prescribed in a timely manner. As a result, both types of seizures stopped after treatment.

[Clinical and laboratory features of primary acute myocardial infarction in patients with obstructive and non-obstructive coronary atherosclerosis].

According to the literature, 40-60% of patients with acute myocardial infarction (AMI) have obstructive multivessel coronary artery disease (CA) and 8.8% of patients have non-obstructive CA lesions. And it is around these two groups of patients that there are active discussions and disputes regarding the choice of optimal treatment tactics and further prognosis. The aim of the study was to study clinical and laboratory features of development and course of primary AMI in patients with multi-and single-vessel obstructive lesion of the CA compared with patients with non-obstructive CA lesions. Methods. The study has included patients hospitalized "through the ambulance channel" in the Department of cardiac intensive care of municipal clinical hospital named after S. S. Yudin Moscow with a diagnosis "primary acute myocardial infarction", ACS with and without ST segment elevation, unstable angina in 2015-2016. The diagnosis of acute myocardial infarction (AMI) was established at the hospital stage according to the criteria of the "Third universal definition of myocardial infarction" in 2012. The study included 1240 patients who underwent coronary angiography (CAG) no later than 12 hours from the time of admission. The first group (comparison group) consisted of patients with AMI and the first detected multivessel obstructive atherosclerotic lesion of CA (664 patients), the second (interest group) consisted of patients with AMI and non-obstructive atherosclerotic lesion of CA (96 patients) meeting the MINOCA criteria. The third group consisted of patients with single-vessel obstructive lesion and complete acute occlusion of the CA (272 patients). Patients with hemodynamically significant lesions of the left CA trunk were not included in the study. The clinical and laboratory features of the course of acute primary myocardial infarction in patients with obstructive and non-obstructive coronary atherosclerosis were studied. The generally accepted statistical processing methods were used. A year after discharge from the hospital, 727 patients (468 patients from the 1st group, 78 from the 2nd group, 181 from the 3rd group) were interviewed by means of a structured telephone survey about the course of the disease (collection of medical history). The median follow-up was 12 months. (interquartile range 11-13 months). The endpoints were: re-hospitalization for any reason, re-coronary event, death. The received answers are entered into questionnaires and statistically processed. Results and conclusions. In patients with AMI and non-obstructive atherosclerotic CA lesion, pain behind the sternum is observed one and a half times less often (54.2%) than in patients with obstructive CA lesion (MOAPCA 86.1%, OAPCA 89.7%) and the cardiac co duction system is almost three times more likely to be affected ( 30% versus 8.4% and 12%). Only 12.5% of patients in this group had an abnormal Q wave (Q - myocardial infarction) on the ECG, therefore, a smaller volume of myocardial damage and a lower level of troponin than in patients of groups 1 and 3. During the first year after the development of AMI, patients with obstructive coronary atherosclerosis did not experience repeated coronary events, there were no indications for conducting CAG, PCI or CABG, in contrast to patients with obstructive lesion of CA. For multivascular obstruction (group 1), PCI was performed in 9.6% of patients and 3.8% of CABG. PCI was performed in group 3 with obstructive single-vessel lesion of CA in 7.7% of patients. In patients with AMI and obstructive single-vessel atherosclerotic lesion of CA (group 3), two and a half times less often (9.1%) myocardial reperfusion injury is observed, while in patients with multivascular obstructive CA defeat, this syndrome was observed in 21.3%.

[Effect of Myocardial Reperfusion on Ischemic Mitral Regurgitation in Patients with Acute Myocardial Infarction].

BACKGROUND: During the restoration of blood flow in the ischemic area of the myocardium, viable cardiomyocytes are damaged over a few minutes of tissue reperfusion (reperfusion myocardial damage). It is known that ischemic mitral regurgitation (IMR) develops in 11-19 % of patients who have undergoing percutaneous coronary intervention (PCI) in symptomatic coronary heart disease (CHD). To present day, the influence of myocardial reperfusion on IMR in patients with acute myocardial infarction (AMI) is not fully understood. OBJECTIVE: To study dynamics of quantitative indicators of IMR in patients with AMI after myocardial reperfusion. MATERIALS AND METHODS: We included in this study 68 patients with AMI and IMR aged 36-79 years, who were hospitalized in cardiac intensive care unit of the Moscow S. S. Yudin hospital in 2016. All patients before and on the 7th day after PCI underwent doppler echocardiography study with calculation of quantitative parameters of IMR and index of local contractility (ILC) of the left ventricle (LV). RESULTS: Three groups of patients were identified based on the analysis of the dynamics of quantitative parameters of IMR after myocardial reperfusion: group 1 - patients who had a decrease in IMR (n=23, 33.8 %), group 2 - patients with increase of IMR (n=28, 41.1 %), group 3 - patients with unchanged IMR (n=17, 25.1 %). The study of systolicLV function in all patients before PCI revealed moderately decreased ejection fraction (EF) (mean 49.05±1.19 %). On day 7 after myocardial reperfusion in group 2 we detected significant increases of end-diastolic volume (EDV), end-systolic volume (ESV), and the volume of the left atrium (LA), while in groups 1 and 3 these indexes remained unchanged. LV ILC did not differ between three groups, both at admission and on day 7 after reperfusion (p>0.05). There was no correlation between severity of IMR and ILC (correlation coefficient 0.24). CONCLUSION: Dynamics of quantitative parameters of IMR in 7 days after myocardial reperfusion in patients with AMI without endogenous and drug protection of the myocardium from reperfusion injury was multidirectional. IMR decreased in 33.8, increased in 41.1 and did not change in 25.1 % of patients. Systolic function and LV ILC underwent no significant dynamics.

Dysbiosis in early sepsis can be modulated by a multispecies probiotic: a randomised controlled pilot trial.

The gut is hypothesised to play an important role in the development and progression of sepsis. It is however unknown whether the gut microbiome and the gut barrier function is already altered early in sepsis development and whether it is possible to modulate the microbiome in early sepsis. Therefore, a randomised, double blind, placebo-controlled pilot study to examine the alterations of the microbiome and the gut barrier in early sepsis and the influence of a concomitant probiotic intervention on dysbiosis at this early stage of the disease was conducted. Patients with early sepsis, defined as fulfilling the sepsis definition from the 2012 Surviving Sepsis Campaign guidelines but without signs of organ failure, received multispecies probiotic (Winclove 607 based on Omnibiotic® 10 AAD) for 28 days. Gut microbiome composition, function, gut barrier and bacterial translocation were studied. Patients with early sepsis had a significantly lower structural and functional alpha diversity, clustered differently and showed structural alterations on all taxonomic levels. Gut permeability was unaltered but endotoxin, endotoxin binding proteins and peptidoglycans were elevated in early sepsis patients compared to controls. Probiotic intervention successfully increased probiotic strains in stool and led to an improvement of functional diversity. Microbiome composition and function are altered in early sepsis. Probiotic intervention successfully modulates the microbiome and is therefore a promising tool for early intervention in sepsis.

[Clinical and neuroimaging signs of cardioembolic stroke laboratory in children]. / Klinicheskie i neirovizualizatsionnye priznaki kardioémbolicheskogo insul'ta u detei.

AIM: To study clinical and neuroimaging signs of cardioembolic stroke (CES) in children. MATERIAL AND METHODS: Ten children (mean age 3.5±3.5 years) were examined. Eight children met the diagnostic criteria of CES CASCADE, two children were diagnosed with CES based on the complex of symptoms. A comparison group consisted of 90 children with other subtypes of ischemic stroke (IS). The diagnosis was confirmed by MRI and magnetic-resonance angiography; symptom severity was assessed with PedNIHSS and PSOM. RESULTS AND CONCLUSION: The PedNIHSS score in the acute stage of CES was higher (18.4±9.34) compared to patients with other subtypes of IS (12.6±6.2; p=0.0065). Six patients had large cerebral infarctions with the involvement of basal ganglia, internal capsule, white matter and cerebral cortex. In two patients, the infarction affected the cerebral cortex and underlying white matter, in one patient it affected the cortex from one side and the basal ganglia from the other. A damage of the cortex was noted in one patient. The frequency of recurrent CES was 30%, of fatal cases 20%. Recurrent IS and severe residual neurological deficit were more frequent in CES. CONCLUSION: Early disease onset, acute development and progression of neurological deficit up to the maximal level in the first 5 min, marked severity of the acute stage (PedNIHSS score >15), early onset of neurological function recovery, marked residual neurological deficit (PSOM score >2) are the additional signs of CES.

[Clinical and neuroimaging signs of cardioembolic stroke in children]. / Klinicheskie i neirovizualizatsionnye priznaki kardioémbolicheskogo insul'ta u detei.

AIM: To study clinical and neuroimaging signs of cardioembolic stroke (CES) in children. MATERIAL AND METHODS: A group of 100 patients with arterial ischemic stroke (AIS), aged from 1 month to 15 years, was stratified into the main group (10 patients with CES) and the comparison group (90 patients with other subtypes of AIS). CT and MRI, MR-angiography, ultrasound study as well as assessment of clinical symptoms on PedNIHSS were performed. The duration of follow-up was from 2 month to 14 years. The follow-up allowed the assessment of occurrence of secondary strokes, severity of residual neurological symptoms on the PSOM and fatal outcomes. Special attention was drawn to the use of CASSADE criteria for CES. RESULTS AND CONCLUSION: Clinical features that help to diagnose CES, even in the absence of adequate neuroimaging, in patients with heart disease, which is a potential high risk factor for cardioembolia, were established. These factors include early disease onset, acute development and progression of neurological deficit to the maximal level in the first 5 min., marked severity of the acute period (PedNIHSS > 15), early recovery of neurological functions, significant residual neurological symptoms (PSOM > 2). These symptoms should be used in addition to the CASCADE criteria in the diagnosis of CES of AIS type in children.

[FEATURES OF MODIFYING EFFECT OF LOW-INTENSITY ELECTROMAGNETIC RADIATION OF NATURAL AND TECHNOGENIC ORIGIN ON VIABILITY AND FUNCTIONAL STATUS OF NEUTROPHILIC GRANULOCYTES].

AIM: Study effects of microwave electromagnetic radiation (EMR) of the SHF range in vitro on viability and functional status of neutrophilic granulocytes. MATERIALS AND METHODS: Neutrophils of peripheral blood of 30 conditionally healthy donors aged 18 - 20 years were exposed to the effect of broadband (natural, similar to sun radio emission) and, mono-frequency (technogenic, similar to emission of cell phones, PCs, microwave ovens, etc.) EMR with frequency range of 4 - 4.34 GHz, generated by a SHF-generator <>. 16 minutes after the effect, viability of neutrophilic granulocytes, phagocytic activity, lysosome activity ofcells were studied, NBT-reducing ability and cytokine content in supernatant were evaluated. RESULTS: The amount of viable neu- trophils significantly reduced after the effect of modelled EMR with technogenic frequency- temporal structure, functional status of viable cells did not change. Neutrophils retained viability after the effect of EMR of natural origin, increased levels of IL1ß and TNFα was determined in supernatants, functional status of neutrophils of men remained stable, and in women an increase of phagocytic ability and a reduction of production of oxygen radicals was noted. CONCLUSION: The detected reduction of the amount of viable neutrophils under the effect of EMR of technogenic origin could result in disturbances in the system of innate immunity, other homeostasis elements of the human organism and development of pathologic conditions. At the same time, the de- tected effects of EMR of natural origin. open perspectives of use of modelled microwave EMR of SHF range in prophylaxis and clinical medicine.

[Arterial ischemic stroke in children with mild head trauma]. / Arterial'nyĭ ishemicheskiĭ insul'ta u deteĭ s legkoĭ travmoĭ golovnogo mozga.

AIM: To study the relationship between mild head trauma (MHT) and arterial ischemic stroke (AIS) in children. MATERIAL AND METHODS: We examined 81 patients with AIS, aged from 1 month to 15 years. The sample was stratified into two groups: patients with AIS caused by MHT (main group) and patients without MHT (comparison group). RESULTS AND CONCLUSION: Based on the results of clinical and instrumental studies, we identified the relationship between AIS and MHT. The main group was characterized by the following features: moderate severity in the acute period, stabilization within 7 days, isolated subcortical localization of ischemic lesion, no MRI-signs of steno-occlusive cerebral arteriopathy and a trend towards the risk of recurrent strokes.

[Classification system CASCADE for childhood arterial ischemic stroke].

In this review, a new consensus-based classification system for childhood arterial ischemic stroke CASCADE (2012) is described. The CASCADE is an anatomically based classification system which offers the specific diagnostic interventions and suggests the unified terminology. So, it can be used both in clinical practice and in any research in childhood arterial ischemic stroke.

[Secondary prevention of ischemic stroke in children].

Pediatric arterial ischemic stroke (IS) is an important cause of lifelong disability. Arteriopathies due to trauma and infection are an important underlying cause of childhood arterial ischemic stroke. The secondary prevention of IS should be conducted taking into account the main pathogenetic mechanisms and vascular risk factors. For secondary stroke prevention, the majority of children are treated with either anticoagulation or antiplatelet therapies. This review focuses on the recent international clinical recommendations in secondary stroke prevention based on the results of randomized multicenter clinical studies published by the USA. cardiology association. Experience of anticoagulation or antiplatelet therapies for secondary stroke prevention is insufficient in Russia. Taking into account the available international recommendations is expedient for creation and practical application of the Russian standards for secondary arterial ischemic stroke prevention.

[Mitral valve remodeling in patients with acute myocardial infarction and ischemic mitral regurgitation].

We have studied alterations of mitral valve geometry and quantitative parameters of mitral regurgitation in 130 patients with acute myocardial infarction in acute and subacute stages of the disease. Quantitative data of mitral regurgitation have been assessed using two quantitative Doppler techniques--proximal isovelocity surface area method (PISA-method) and quantitative Doppler technique (Q-DE-method). As a result of the research we have received data showing that in patients with acute myocardial infarction and ischemic mitral regurgitation mitral valve remodeling occurs with deformation of mitral structures inducing mitral regurgitation. We have observed correlation between degree of ischemic mitral regurgitation and structural valve alteration in patients with acute myocardial infarction.

[Individual olfactory responses of students repeatedly exposed to essential oils].

The study demonstrated that periodical exposure students to essential oils throughout a session enhanced parasympathetic influence on the cardiac rhythm and decreased the level of psychoemotional stress.

[Prothrombotic disturbances in children after ischemic stroke].

Thirty-six patients with stroke, aged from 8 months to 15 years, and 28 control children, aged 1-15 years, were studied. In both groups, the evaluation of anamnesis, neurologic status and genotyping for 11 most common prothrombotic polymorphisms were carried out. Coagulogram tests and measurement of homocysteine were performed before the anticoagulant therapy in the main group. The total frequency of prothrombin gene mutations (G20210A, factor V Leiden, MTHFR C677T and MTRR A66G) was 2.8 times higher in the main group compared to the control one. The most frequent genotypes were 677TT (8.3% of cases) and 66GG (30.6%). In patients with stroke, the homocysteine level exceeded the upper limit of normal age and also was significantly elevated in carriers of abovementioned risk genotypes: 10.29 +/- 1.55 mcmol/l vs 7.33 +/- 0.6 mcmol/l (p = 0.018). The coagulogram revealed disorders of anticoagulant system, including the decrease of protein C activity (22.7% of cases), protein S activity (13.6%) and antithrombin III (12.5%) and the increase of D-dimer level (21% of cases). It has been suggested to screen for common prothrombotic states and measure homocysteine levels in children with ischemic stroke and to lower homocysteine levels by using vitamins B6 and B12' and diet.

[Diagnostics of ischemic stroke in children: a literature review and an analysis of clinical cases].

Ischemic stroke in children is a multidisciplinary problem which is based on various etiological factors. The establishment of diagnosis is complex and demands, besides the ascertainment of cerebral infarction by neuroimaging methods, the use of different tests for determination of the main disease. In Russia, the causes of IS in children are elucidated in about 40% of cases. The most plausible causes of the restricted diagnostics are the insufficient knowledge of physicians about etiological factors of this disease, absence of diagnostic standards and poor economic and technical support of municipal medical centers for children that do not allow the timely examination of patients in accordance with a brain stroke diagnostic algorithm. Two cases demonstrating as the variety of etiological factors in IS in children as well as the obvious restriction of diagnostic search are presented.

[Autonomic cardiovascular regulation in patients with tics and Tourette syndrome].

Autonomic cardiovascular regulation has been assessed in patients aged 4-15 years with Tourette syndrome (n = 22) and other tic disorders (n = 48). Symptom significance was estimated by a number of hyperkinetic episodes per 20 minutes, tic scale and variants of the disease course. The functional condition of autonomic nervous system was studied clinically and using spectral analysis of heart rate variability in both upright and supine positions. Negative correlation between the ratio of sympathetic and vagus influences and severity of the disease was found: the severer were tic symptoms, the stronger was a trend to vagotonia (beta = -0.36; p < 0.0025; F > 4.0). In orthostatic test, patients with Tourette syndrome demonstrated an unfavorable hypersympathicotonic type of cardiovascular system reaction. Patients were treated during 4 weeks with glycinum (0.2 +/- 0.1 mg/day), phenibutum (0.5 +/- 0.25 mg/day), clonazepam (1.5 +/- 0.5 mg/day), tiapride (200 +/- 100 mg/day), haloperidol (1-1.5 mg/day), rispolept (2 mg/day). There was no negative effect of the drugs on heart rate variability. On the contrary, the therapy reduced hyperkinetic symptoms and corrected autonomic influences on the sinus rhythm. It is suggested that changes in autonomic cardiovascular regulation might be of secondary character and do not need any special correction.

[Efficacy of acupressure therapy in combined treatment of psycho-autonomic neurotic disorders in children]. / Effektivnost' refleksoterapii v kompleksnom lechenii psikhovegetativnykh rasstroistv u detei.

The aim of the study was to evaluate the efficacy of acupuncture in combined treatment of psychoautonomic neurotic disorders in children. 163 children, mean age 12.5 years, were included in the study. Autonomic dysfunction score, clinoorthostatic test, sinocarotid test and heart rate variability analysis were used to assess the efficacy of different therapeutic strategies applied: complex (acupuncture + conventional drug treatment)--group 1; acupuncture treatment--group 2, and conventional drug treatment--group 3. After 2 months of treatment, a reduction of autonomic dysfunction score and an increase of percentage of patients with normal clinoorthostatic and sinocarotid tests were revealed in all the groups, being most evident in group 1. Heart rate spectral variability changed in patients given acupuncture treatment (groups 1 and 2). Relative augmentation of sympathetic activity was observed in patients with initial vagotonia, while those with initial symphaticotonia exhibited a relative parasympathetic activity increase. Thus, acupuncture exerts beneficial effects on functioning of autonomic nervous system. The method may be used either independently, or in addition to conventional drug treatment of psychoautonomic neurotic disorders in children.

[The effect of melatonin and mexamine on the human thyroid under in-vitro conditions]. / Vliianie melatonina i meksamina na shchitovidnuiu zhelezu cheloveka v usloviiakh in vitro.

In in vitro study of the human euthyroid and thyrotoxic thyroid gland melatonin (N-acetyl-5-methoxytryptamine) and, to a lesser measure mexamine (5-methoxytryptamine) had a dose-dependent inhibiting effect on thyroxine secretion. Moreover, melatonin weakened the TSH stimulating effect in relation to the secretory process in the thymus while mexamine did not. Despite the similarity in the quality of the effect of both methoxyindoles on the release of thyroxine, the mechanism of its realization differs: the action of melatonin is mediated by the adenylate-cyclase-cAMP system, but in the action of mexamine the cAMP-dependent mechanism does not take part. Maintenance of the sensibility of the human thyroid to the effect of TSH is an obligatory condition for realization of the action of both methoxyindoles on the secretory process in it.