[Neurodynamic speech disorders in the acute ischemic stroke]. / Neirodinamicheskie narusheniya rechi v ostrom periode ishemicheskogo insul'ta.

OBJECTIVE: To identify the features of the clinical picture and evaluate the dynamics of regression of neurodynamic speech disorders in comparison with cortical aphasia in patients with ischemic stroke (IS) in the carotid system. MATERIAL AND METHODS: We examined 268 patients with a median age of 59 (54; 70) years in the acute period of IS in the dominant hemisphere with the presence of cortical aphasia or neurodynamic speech disorders. The degree of speech recovery was characterized by an increase in the score on the Speech Questionnaire (ΔSQ) from 1 to 21 days after the development of IS. The patients were divided into group 1 (n=148) with a low level of recovery (ΔSQ≤6) and group 2 (n=120) with a high level (ΔSQ >6). RESULTS: Of the 268 patients, cortical aphasia was detected in 171 (63.8%) patients, and neurodynamic speech disorders characterized by significant variability of symptoms over the course of hours and days were detected in 97 (36.2%) patients. In patients with cortical aphasia, the majority of patients (63.2%) were classified into group 1, and among patients with neurodynamic speech disorders - into group 2 (58.8%), which showed the stability of the regression dynamics of speech disorders (p=0.001). In patients with cortical lesions the impressive side of speech suffered more often - in this group patients with sensorimotor aphasia predominate. In the case of neurodynamic speech disorders, motor and sensorimotor disorders are observed with approximately the same frequency (p=0.002). CONCLUSION: In comparison with cortical aphasias, the sensory component of speech suffers to a lesser extent in neurodynamic speech disorders. Neurodynamic speech disorders generally recover faster and more fully.

[Cerebrovascular complications in patients with moderate and small stenosis of the carotid arteries in the hospital period of coronary artery bypass grafting using cardiopulmonary bypass]. / Tserebrovaskulyarnye oslozhneniya u patsientov s gemodinamicheski neznachimymi stenozami sonnykh arterii v gospital'nom periode koronarnogo shuntirovaniya s ispol'zovaniem iskusstvennogo krovoobrashcheniya.

OBJECTIVE: Assessment of the incidence of acute cerebral circulatory disorder (ACCD) and decompensation of chronic cerebral ischemia (CCI) in the hospital period of coronary artery bypass graft performed using artificial circulation in patients with- and without moderate and minor carotid artery stenosis. MATERIAL AND METHODS: One hundred and twenty-eight patients were examined. Neurological and neuropsychological examinations, neuroimaging were performed, concentrations of S100ß protein in blood serum were determined. RESULTS: In the group with stenosis, 3.5% of patients were diagnosed with ACCD, while patients without carotid artery damage did not have this complication. The frequency of decompensation of CCI in patients with stenosis was significantly higher (52%) compared with the group without stenosis (34%). Early postoperative cognitive dysfunction (POCD) with an equally high frequency was diagnosed in both groups: 63% with stenosis and 65% without carotid artery stenosis. A decrease in the strength and mobility of nervous processes, deterioration of memory, workability and increased exhaustion of attention were revealed. CONCLUSION: Patients with moderate and minor stenoses are more susceptible to the development of cerebrovascular complications than patients who do not have atherosclerotic lesions of the carotid arteries and need more thorough preoperative preparation.

[Possibilities of application of cardio-ankle vascular index in patients with cerebrovascular diseases]. / Vozmozhnosti primeneniya serdechno-lodyzhechnogo sosudistogo indeksa u bol'nykh s tserebrovaskulyarnymi zabolevaniyami.

This publication focuses on the feasibility of using the cardio-ankle vascular index (CAVI) in patients with cerebrovascular diseases. The authors consider the pathological conditions and risk factors of stroke associated with increased arterial stiffness, methods for its assessment, the advantages of using CAVI, the experience of using CAVI in patients with cardiovascular diseases, in particular, in neurological patients. The complexity of the application of CAVI in the Russian population, promising directions for determining the index in neurology as well as the importance of CAVI borderline indicators are shown. It is emphasized that stroke patients should be screened with a mandatory study of CAVI.

[Methods of the videoendoscopic correction of the ureters strictures].

THE PURPOSE OF THE STUDY: a retrospective analysis of the results of patients treatment with ureteral strictures by evaluating the effectiveness of various methods of laparoscopic operations. MATERIALS AND METHODS: a retrospective analysis of the treatment of 30 patients operated in the Central Hospital of Civil Aviations from 2013 to the present time with strictures of all departments of the ureters, except the pelvic-ureteral segment (LMS), was performed. The study included 18 women and 12 men. The age of patients was 54+/-8.1 years (29-79 years) for men and 51+/-8.5 years (28-74 years) for women. According to the results of x-ray examinations, the length of ureter stricture was determined, after that selected the tactics of surgical treatment. The study included patients who underwent intestinal plastics of the ureter, the operation Boari, ureterocystoanastomosis, ureteroureterostomy. All stages of surgical interventions were performed laparoscopically. RESULTS: 23 patients (76.66%) had a smooth postoperative period. A month after the operation, ureteral stents were removed. Attacks of acute pyelonephritis, relapses of the disease were not observed during the follow-up period from 7 months to 3 years. Possible complications are analyzed. In one case, after intestinal plastic surgery of the ureter in the postoperative period, the phenomena of small bowel obstruction were noted, which required surgical treatment in the volume of applying a bypass eunoascendoanastomosis "side by side". In 7 cases, anastomosis strictures were diagnosed in the postoperative period. In the 5 cases, after examination (CT of the urinary tract with contrast, antegrade ureteropyelography), the anastomosis was recognized compensated. CONCLUSION: It is shown that all the necessary range of operations can be performed by laparoscopic method while preserving all the advantages of low-trauma access.

[Features of speech rehabilitation in the acute stroke in different forms of aphasia]. / Osobennosti rechevoi reabilitatsii v ostrom periode insul'ta pri raznykh formakh afaticheskikh rasstroistv.

AIM: To determine the dependence of speech recovery on the type of aphasia in patients with acute ischemic stroke in the carotid territory. MATERIAL AND METHODS: Three hundred and fifty-one patients, aged 61 [55; 72] years, with ischemic stroke were examined. The degree of speech recovery was characterized by an increase in the score on the Speech Questionnaire (SQ) on the 21st day from the beginning of the disease compared to baseline. Patients were divided into 2 groups: low (ΔSQ ≤6) and high (ΔSQ >6) recovery. Speech disorders were represented by motor, sensorimotor and subcortical aphasia. RESULTS: The group ΔSQ ≤6 was dominated by patients with sensorimotor aphasia (n=141, (76,6%)). In the ΔSQ >6 group, motor aphasia was more frequent (119 people (71.3%)), sensorimotor aphasia was observed in 48 patients (28.7%) (p=0.0001). Patients of the group with the worst speech restoration more often had cortical aphasia (n=108; 73.0%), and patients with subcortical aphasia slightly prevailed in the group with the best recovery: 40 (27.0%) in group I and 57 (47.5%) in group II (p=0.001). CONCLUSION: Motor aphasia and subcortical aphasia are associated with good recovery of speech function in the acute period of ischemic stroke.

[Combined neuroprotection in the treatment of post-stroke aphasia]. / Kombinirovannaia neiroprotektsiia v lechenii postinsul'tnykh afazii.

AIM: To evaluate the efficacy of combined neuroprotection in the restoration of speech function in patients with acute ischemic stroke in the carotid region. MATERIAL AND METHODS: The study included 257 patients (median age 60 (55; 72) years) with ischemic stroke and motor or sensorimotor aphasia. The degree of speech recovery was characterized by an increase in the score on the scale of the speech questionnaire (SQ) on the 21st day from the beginning of the disease. Patients were divided into low recovery (ΔSQ ≤6) and high recovery (ΔSQ >6) groups. All patients received neuroprotectors of different groups. RESULTS: The greatest efficacy was shown for cortexin in combination with mexidol: the ΔSQ >6 group included 24 (70.6%) and the group ΔSQ ≤6 10 (29.4%) patients out of 34 patients. The lowest efficacy was observed for gliatilin in monotherapy: an increase was ≤6 points in 24 (68.6%) patients and >6 points in 11 (31.4%), and for combinations of ceraxon and mexidol: 26 (61.9%) and 6 (38.1%) patients with low- and high level of speech recovery, respectively (p=0.041). CONCLUSION: Combined neuroprotective therapy using drugs with neuromodulatory and antioxidant effects (cortexin and mexidol) in the acute period of ischemic stroke is effective in the treatment of post-stroke aphasia.

[An effect of complex therapy on cognitive impairment in patients with chronic cerebral ischemia]. / Vliianie kompleksnoi terapii na kognitivnye narusheniia u patsientov s khronicheskoi ishemiei golovnogo mozga.

AIM: To study the efficacy of complex therapy in the correction of cognitive impairment in patients with chronic cerebral ischemia. MATERIAL AND METHODS: One hundred patients with chronic cerebral ischemia were examined. All of them received standard neurometabolic therapy. In the main group, patients were additionally treated with soft techniques of manual therapy. Cognitive status was assessed using the frontal assessment battery, the clock drawing test, MMSE, the Global Deterioration Scale and a sequencing test. RESULTS AND CONCLUSION: Patients with chronic cerebral ischemia demonstrated a significant impairment of cognitive functions. Patients who received comprehensive (drug and non-drug) treatment showed a more significant improvement in cognitive status than those receiving only neurometabolic therapy.

[The relationship of pathological ankle-brachial index and cognitive decline in patients after ischemic stroke]. / Sviaz' lodyzhechno-plechevogo indeksa i kognitivnykh narushenii u bol'nykh, perenesshikh ishemicheskii insul't.

AIM: To identify associations between cognitive impairment and values of ankle-brachial index (ABI) in patients after ischemic stroke at discharge from the hospital and over one-year follow-up. MATERIAL AND METHODS: The study included 375 patients with normal (n=192) and elevated (n=153) ABI who underwent ischemic stroke (IS). Neurological examination was performed using NIHSS, the Rankin scale, Barthel index, Rivermead Mobility Index at discharge from the hospital and over one-year follow-up. RESULTS AND CONCLUSION: Patients with elevated ABI had marked cognitive impairment and more severe neurological deficit compared to patients with normal ABI. Evaluation of ABI can help in predicting the development of post-stroke cognitive impairment in patients with IS.

[Stenosis of the carotid artery in women with ischemic stroke and markers of inflammation]. / Stenozy karotidnykh arterii u zhenshchin s ishemicheskim insul'tom i markery vospaleniia.

AIM: To assess the relationship between the severity of stenosis of the carotid arteries, the level of female sex hormones and markers of subclinical inflammation in women with ischemic stroke (IS). MATERIAL AND METHODS: Two hundred and eleven women (mean age 68.9±9.23 years) were examined. A history of cardiovascular disease, previous cardiovascular events, type and subtype of stroke were recorded. Neurological status was assessed using neurological scales. Atherosclerosis was diagnosed by color duplex scanning of brachiocephalic arteries and laboratory testing (estradiol, markers of subclinical inflammation). RESULTS: Carotid artery stenosis of ≥50% was found in 13.3% of patients, less severe stenosis in 36.0%. Stenosis of ≥50% was positively correlated with the level of IL-18, TNF-alpha, and negatively correlated with the level of IL-6, IL-4, and MMSE score. In dynamics, there was a decrease in the level of TNF-alpha in all groups of patients, and an increase in the IL-4 level in women with carotid artery stenosis of ≥50%. CONCLUSION: Study of the influence of markers of subclinical inflammation on the atherosclerosis progression and recurrent disorders of cerebral circulation in women with IS should be continued.

[Occupational burnout syndrome in workers of radio and television broadcasting center.]

Occupational burnout syndrome - an important health risk factor - is seen not only in social occupations, but also in "subject-object" occupation professionals. Complex study of work conditions and health used V.V. Boiko test for assessment of emotional burnout level in radio and television broadcasting center personnel. Considerable share (53,3%) of main occupations workers in radio and television broadcasting center demonstrates high level of occupational burnout (exhaustion phase has developed or is being developed). Median total points of occupational burnout syndrome equalled 123 (74,0; is5,0) that is higher than the similar parameter for many "subject-object" occupations. Emotional defence is manifested by withdrawal from emotional show at work, increased distance in communication with colleagues, at home with relatives, avoidance of work demanding emotional charge. Longer length of service is connected with less open emotions not only in occupational sphere, but outside profession with relatives, friends. The results obtained point to predisposition for lower performance and health disturbances, necessitate consideration of this factor in complex evaluation of work conditions and health of personnel engaged in radio and television communications.

Organisational basics of medical rehabilitation improvment in the health resort organisatons of the Armed Forces.

The article provides description of modern status of the system of medical rehabilitation for servicemen of the Armed Forces on the level of health resort treatment. Authors give results of work analysis of military health resort institutions, concerning medical rehabilitation for military servicemen. Studied problem issues, defined main ways of medical rehabilitation organization improvement in health resort treatment institutions.

[Clinical significance of the cardio-ankle vascular index in patients with stroke]. / Klinicheskoe znachenie otsenki serdechno-lodyzhechnogo sosudistogo indeksa u bol'nykh s ostrym narusheniem mozgovogo krovoobrashcheniya.

AIM: To study the clinical significance of the cardio-ankle vascular index (CAVI) in patients with stroke. MATERIAL AND METHODS: The study included 374 post-stroke patients. The state of peripheral arteries was assessed using CAVI and the ankle-shoulder index (ASI). RESULTS AND CONCLUSION: The pathological CAVI (>9.0) was identified in 45.4% patients, the reduced ASI (<0.9) in 19.8% patients. Stressful factors of daily life, hypodynamia, lack of work, low education were characteristic of the patients with pathological CAVI and ASI compared to those with normal CAVI. The frequency of diabetes mellitus, clinical signs of peripheral atherosclerosis, chronic heart failure and atrial fibrillation was higher in these patients as well. Ischemic stroke was more frequent in patients with peripheral atherosclerosis and higher vascular wall rigidity. Assessments of CAVI and ASI are necessary in patients with ischemic stroke to identify those with higher vascular wall rigidity and peripheral atherosclerosis and to undertake targeted preventive measures.

Competition between diffusion and electroconvection at an ion-selective surface in intensive current regimes.

Considering diffusion near a solid surface and simplifying the shape of concentration profile in diffusion-dominated layer allowed Nernst and Brunner to propose their famous equation for calculating the solute diffusion flux. Intensive (overlimiting) currents generate electroconvection (EC), which is a recently discovered interfacial phenomenon produced by the action of an external electric field on the electric space charge formed near an ion-selective interface. EC microscale vortices effectively mix the depleted solution layer that allows the reduction of diffusion transport limitations. Enhancement of ion transport by EC is important in membrane separation, nano-microfluidics, analytical chemistry, electrode kinetics and some other fields. This paper presents a review of the actual understanding of the transport mechanisms in intensive current regimes, where the role of diffusion declines in the profit of EC. We analyse recent publications devoted to explore the properties of different zones of the diffusion layer. Visualization of concentration profile and fluid current lines are considered as well as mathematical modelling of the overlimiting transfer.

[The restoration of speech in patients with aphasia depending on the manifestations of carotid atherosclerosis in stroke]. / Vosstanovlenie rechevykh funktsii u bol'nykh s postinsul'tnoi afaziei v zavisimosti ot vyrazhennosti ateroskleroticheskogo porazheniya tserebral'nykh arterii.

AIM: To study an effect of stenosing lesions of carotid arteries on the recovery of speech functions in acute stroke patients. MATERIAL AND METHODS: Medical histories of 253 patients (median age 58 [52,63]) with acute left hemispheric ischemic and hemorrhagic stroke and motor or sensorimotor aphasia were analyzed. The severity of atherosclerotic lesion of brachiocephalic arteries was assessed using color duplex scanning. According to the results of duplex scanning, patients were divided into 3 groups: 1 - without stenosis of extracranial arteries; 2 - with ≤50% stenosis of carotid arteries; 3 - with >50% stenosis of carotid arteries. RESULTS: Stenosis greater than 50% (group 3) was a predictor of the poor recovery of speech function while stenosis less than 50% (groups 1 and 2) had no effect on the outcome. CONCLUSION: The severe atherosclerosis of carotid arteries had a negative effect on speech recovery in acute stroke patients.

[The effect of cellex on cognitive and speech impairments in the acute stage of stroke].

OBJECTIVE: To study the effect of cellex on the recovery of cognitive and speech functions in the acute stage of stroke. MATERIAL AND METHODS: A multicenter comparative open clinical study of the efficacy and safety of cellex in treatment of patients with acute stroke was carried out in 6 clinical sites. The study involved 180 patients, including 147 (81.7%) with ischemic stroke and 33 (18.3%) with hemorrhagic stroke. Celex was introduced subcutaneously in dose 0.1 mg once a day during the first 10 days and from 21 to 27th days. RESULTS AND CONCLUSION: The rapid and complete recovery of neurological and cognitive functions was observed. The more marked dynamics was seen in patients with greater initial stroke severity and with large hemisphere lesions.

[HYGIENIC ASSESSMENT OF WORKING CONDITIONS OF EMPLOYEES OF BROADCASTING CENTER].

Hygienic assessment of working conditions of employees of the Omsk Regional Broadcasting Centre was performed on data of the analysis of materials of certification of workplaces. There were examined materials concerning 65 core profile workplaces, where 130 persons, including 35 women work. There was determined health risk for personnel in dependence on working conditions. The staff was noted to be exposed to the adverse impact of the following factors: chemical, physical (noise, general and local vibration, non-ionizing radiation, microclimate, lighting), severity and intensity ofwork. Class working conditions for 13,5% of workplaces on noise, 35.4% on non-ionizing radiation was assessed as a harmful of the first degree. Lightness indices at 78.5% of the workplaces did not meet the requirements of sanitary norms. At 7.7% of the workplaces levels of hardness of labor were assessed as harmful. The impact of such factors as biological, infrasound, ultrasound, ionizing radiation, aerosols with mainly fibrogenic action, was absent, their assessment was not carried out. Working conditions at 83.1% of workplaces were characterized as hazardous, including at 52.3% of the workplaces where there was established hazard class 3.1, at 30.7% of workplaces--Class 3.2. Among all the factors of occupational environment the largest contribution into the overall assessment of working conditions was made by the lightness factor (50.9%) and non-ionizing radiation (20.6%). The most harmful working conditions have been identified for workplaces of the operator of masthead antenna, engineer of radiocommunications, broadcasting and television, electromechanician of television (radiocommunication), (broadcasting), car driver.

[Factors associated with the detection of carotid artery stenosis of different severity in ischemic stroke patients]. / Faktory, assotsiirovannye s vyiavleniem stenozov karotidnykh arterii razlichnoi vyrazhennosti, u bol'nykh s ishemiches-kim insul'tom.

Objective. To study the factors associated with the detection of carotid artery (CA) stenosis of different severity in patients with ischemic stroke (IS). Material and methods. We studied 694 patients with IS. The assessment of brachiocephalic arteries (BCA) was performed using ultrasound duplex scanning. All patients were stratified into three groups by CA stenosis severity: group 1 included patients without stenosis or with mild CA stenosis (30%), group 2 - patients with moderate stenosis (30-49%) and group 3 - patients with ≥50% stenosis. The severity of neurological deficits was evaluated with the NIH Stroke Scale (NIHSS), IS subtypes were defined according to the TOAST. Results. Patients with ≥50% stenosis were more likely to have atherothrombotic IS subtype, risk factors for stroke and pronounced "rough" neurological deficit compared to patients with mild, moderate stenosis or without it. Patients with moderate stenosis more often had cardioembolic IS subtype with mild neurological deficits, whereas the hemodynamic IS subtype with mild to moderate neurological deficits was defined in the group without stenosis. Conclusion. Detection of CA stenosis of different severity allows to identify IS patients with unfavorable prognosis and a high risk of concomitant coronary artery disease.

[Clinical efficacy and pharmacoeconomic characteristics of the neuroprotection with low doses of cortexin in the treatment of acute ischemic stroke].

OBJECTIVE: To assess the efficacy of the cytoprotective neuropeptide cortexin in the complex treatment in acute and early rehabilitation stages of ischemic stroke (II). MATERIAL AND METHODS: A multicenter prospective double-blind placebo-controlled trial has been carried out. Two hundreds and seventy-two patients with II have been enrolled in the trial. Cortexin was administered in low doses (10 mg three times a day intramuscular, using the following schemes: group 1: 2 courses of cortexin; group 2: 1 course of cortexin with the following course of placebo; group 3: two courses of placebo. The duration of treatment was 70 days. Patients were examined during 4 visits using clinical tests and instrumental methods. RESULTS: High efficacy and safety of cortexin in the complex treatment of patients with II has been shown. The best therapeutic effect was seen in group 1 (two 10-day courses of cortexin). The results were confirmed by the pharmacoeconomic analysis of treatment tactics based on the estimation of "net monetary benefit". CONCLUSION: Cortexin is recommended for treatment and rehabilitation of patients with II.

[Indices of cerebrovascular reactivity in patients with diabetes mellitus complicated with cardiovascular autonomic neuropathy].

OBJECTIVES: To investigate cerebrovascular reactivity in patients with diabetes mellitus complicated with cardiovascular autonomic neuropathy. METHODS: We examined 34 patients with diabetes mellitus (9 men and 25 women). Functional tests (hypercapnic, cold, orthostatic and others) and indices of cerebral hemodynamics were used for the evaluation of cerebrovascular reactivity. RESULTS: There was a decrease in the rate of cerebral blood flow and the deterioration of cerebrovascular reserves in the middle cerebral artery of patients with diabetes mellitus with cardiovascular autonomic neuropathy and without it in comparison with the appropriate indices of healthy people. At the same time, no differences were found between diabetic patients with - and without cardiovascular autonomic neuropathy. CONCLUSIONS: The abnormalities of the cerebrovascular reactivity can play an important role in the pathogenesis of cerebrovascular disease in this group of patients.