[Treatment of attention deficit hyperactivity disorder in children: results of a multicenter, randomized, double-blind, placebo-controlled clinical trial]. / Terapiya sindroma defitsita vnimaniya s giperaktivnost'yu u detei: rezul'taty mnogotsentrovogo randomizirovannogo dvoinogo slepogo platsebo-kontroliruemogo klinicheskogo issledovaniya.

OBJECTIVE: Evaluation of the efficacy and safety of the new drug Prospekta in the treatment of attention deficit hyperactivity disorder (ADHD) in patients aged 7-12 years. MATERIAL AND METHODS: A multicenter (35 clinical centres) double-blind, placebo-controlled, randomized, parallel-group clinical trial enrolled 363 patients. The mean age was 9.3±1.7 years. Children of both sexes aged between 7 and 12 years with a diagnosis of ADHD confirmed by DSM-V diagnostic criteria were included in the study. Patients with a total score of 22 or more on the Attention Deficit Hyperactivity Disorder-Rating Scale-V (ADHD-RS-V) were included in the study. After randomisation, patients in group 1 received Prospekta, 1 tablet twice daily; patients in group 2 received placebo according to the study drug regimen. The primary efficacy criterion was the proportion of patients with a 25% or greater reduction in the overall ADHD-RS-V scale score after 8 weeks of treatment. As additional criteria for efficacy assessment were assessed: change of ADHD-RS-V total score from baseline after 8 weeks of treatment; Clinical Global Impression Efficacy Index (CGI-EI) score after 8 weeks of treatment; side effects. RESULTS: The proportion of patients with a 25% or more reduction in the ADHD-RS-V scale score after 8 weeks of treatment was 55.9% in the Prospekta group, and 43.3% in the placebo group (p=0.0199). There was a reduction of ADHD symptoms in the Prospekta group as a mean ADHD-RS-V score decreased by 10.2±7.7 (in the placebo group by 8.1±7.9); the difference between the mean ADHD-RS-V score reduction during Prospekta and placebo treatment was 2.09±7.81 (p=0.0096). Mean CGI-EI scores calculated on the basis of physician scores were different in the Prospekta group compared to the placebo group at 6.9±3.2 versus 8.0±3.1 (p=0.0012), indicating greater clinical efficacy of the study drug. The frequency of adverse events (AEs) did not differ significantly between the groups. There were a total of 66 AEs in 46 patients, including 31 AEs in 23 (13.2%) Prospekta group participants and 35 AEs in 23 (12.2%) placebo group participants (p=0.87). No cases of serious AEs were reported during the study. Prospekta is compatible with drugs used in pediatric practice. Prospekta did not cause an exciting effect and did not adversely affect the sleep of patients. CONCLUSION: The drug Prospekta is an effective and safe treatment for ADHD in patients 7-12 years old.

[Stroke risk stratification in elderly patients with comorbid sarcopenia and atherosclerosis]. / Stratifikatsii riska ostrykh narushenii mozgovogo krovoobrashcheniya pri sochetanii ateroskleroza i sarkopenii u patsientov pozhilogo vozrasta.

OBJECTIVE: The study was to investigate the features of carotid arteries atherosclerosis as the leading risk factor for atherothrombotic stroke in elderly patients depending on the presence of sarcopenia. MATERIAL AND METHODS: 2 groups of patients above the working age were examined: 110 patients with normal muscle mass and 24 suffering sarcopenia. Ultrasound examination of carotid and vertebral arteries extracranial segments was performed with an assessment of atherosclerotic changes severity, atherosclerotic plaques instability, 10-year risk of stroke (according to Framingham risk score) and a 10-year risk of fatal cardiovascular disease (SCORE risk scale). RESULTS: 10-year risk of fatal cardiovascular disease was 3 [2; 5] points for patients without sarcopenia, 3 [2; 3] points for patients with sarcopenia (p=0.81). The 10-year risk of stroke was 16 [12; 18] for patients without sarcopenia, 18 [15; 22] points for patients with sarcopenia (p=0.1). Due to the ultrasound examination data the incidence of carotid arteries atherosclerotic lesions in patients without sarcopenia was 50 (46.3%), in patients with sarcopenia - 18 (75.0%) (p=0.01). Statistically significant (p<0.05) increase in the atherosclerotic plaques instability signs was revealed in patients suffering sarcopenia compared to those without it: heterogeneous echotexture - 66.7% cases versus 38.2% (p=0.01), presence of hypoechoic masses - 41.7% patients vs 12.7% (p=0.02). CONCLUSION: It is important to take into account not only traditional risk factors in the overall assessment of cardiovascular risk as well as therapeutic and preventive measures planning in elderly patients, but also pay attention to body composition since modern diagnostic systems may be not sensitive enough to identify high-risk patients with comorbid atherosclerosis and sarcopenia.

[Paradoxical air embolism of intracerebral arteries as a complication of tooth extraction]. / Paradoksal'naya vozdushnaya emboliya vnutrimozgovykh arterii kak oslozhnenie ekstraktsii zuba.

The article describes the rare clinical case, demonstrating sudden onset of neurological manifestations (seizures and consequent formation of ischemic stroke foci) in a 29 year-old female patient during tooth extraction (right lower third molar) using the high-speed dental drill. Air injection through damaged tissues caused subcutaneous emphysema in the buccal area that caused air embolism. Presence of asymptomatic congenital heart defect in the patient (atrial septal defect) allowed the bubbles of air to move paradoxically from right to left with consequent embolization of small cerebral arteries. Treatment in specialized department was successful and had beneficial effect on patient's condition.

[Therapy of moderate cognitive impairment in the early recovery period of ischemic stroke]. / Terapiya umerennykh kognitivnykh rasstroistv v rannem vosstanovitel'nom periode ishemicheskogo insul'ta.

OBJECTIVE: To assess the efficacy and safety of prospecta in the treatment of moderate cognitive impairment in the early recovery period of ischemic stroke. MATERIAL AND METHODS: The study included 275 patients (mean age 64.0±8.1 years) with a history of single ischemic stroke from 3 to 6 months, with moderate cognitive impairment, and moderate activity in everyday life, who were randomized in two groups. During the screening phase, the severity of cognitive impairment was assessed with the Mini-Mental State Examination and Montreal Cognitive Assessment scales; the level of activity in everyday life was evaluated with the Barthel Scale; and quality of life was assessed with the Stroke Specific Quality of Life Scale. Patients took 2 tablets of prospecta or placebo 2 times a day for 24 weeks. The follow-up period was 4 weeks. The primary endpoint of the study was the proportion of patients with improvement in cognitive function (+1 or more on the MoCA test) after 24 weeks of treatment. The occurrence and type of adverse events (AEs), their severity, relationship to the drug, outcome, changes in vital signs, and the proportion of patients with clinically significant abnormality in laboratory tests were analyzed to assess the safety. RESULTS: A clinically significant improvement in cognitive function was obtained in 91.9% of patients in the prospecta group vs 82.,1% in the placebo group, (p=0.02). There were 57 AEs in 37 (27.4%) Prospecta group patients and 53 AEs in 39 (27.9%) Placebo group participants (p=1.00). No AEs were certainly associated with taking the medication. No clinically significant changes in vital signs or abnormal laboratory results were detected during the study. CONCLUSION: Prospecta is an effective and safe treatment option for patients with moderate cognitive impairment in the early recovery period of ischemic stroke.

[An analysis of the work of vascular service in Smolensk from 2009 to 2014]. / Analiz raboty sosudistoĭ sluzhby Smolenskogo regiona v period s 2009 po 2014 g.

MATERIAL AND METHODS: Report of the regional vascular service center of Smolensk work and work of vascular service of Smolensk region were analyzed. The aim of the study is to analyze work of the vascular service in Smolensk and Smolensk region in 2009-2014. RESULTS AND CONCLUSION: Mortality and morbidity in patients with cardio-vascular diseases in Smolensk Region are higher than in other regions of Russia. Recently a number of patients hospitalized to vascular service centers are increased. Infectious complications (pneumonia, bedsores, pyoderma) take lead place in mortality. Nowadays it's very important to solve the problem with prophylaxis of infectious complications in patients with acute ischemic stroke, also to solve problem with rehabilitation in patients with mild and severe motor disorders and disorders of praxis, gnosis. Continuous training of doctors and nurses in regional vascular service centers is needed. It will increase quality of medical service and improve rehabilitation prognosis in patients with ischemic stroke.

[An expert assessment of medical care quality in patients with acute disturbances of cerebral blood flow at prehospital stage]. / Ékspertnaia otsenka kachestva okazaniia meditsinskoi pomoshchi patsientam s ostrymi narusheniiami mozgovogo krovoobrashcheniia na dogospital'nom étape.

OBJECTIVE: To study the criteria of expert assessment of medical care quality in patients with acute disturbances of cerebral blood flow at prehospital stage in the Smolensk region. MATERIAL AND METHODS: We analyzed the adequacy of medical care to regulation documents of the Russian Federation and worked out several assessment criteria. Based on these criteria, we selected and analyzed 190 ambulance care records over 1 month. RESULTS AND CONCLUSION: The quality of ambulance care was estimated on a three-level scale: satisfactory, satisfactory with minor deficiencies, unsatisfactory. In the Smolensk region, it is characterized by relatively low estimates. These criteria allow to fairly assess the quality of medical care for patients with acute disturbances of cerebral blood flow at prehospital stage.

[Dynamics of clinical-epidemiological characteristics of stroke in Smolensk region].

To study epidemiological characteristics of acute disturbances of cerebral blood flow in Smolensk region, patients with stroke have been registered since 2004. The register data reveal that stroke morbidity is higher compared to other Russia regions (2.05 and 2,38 cases per 1000 people in 2004 and 2007, respectively). Hypertension appeared to be the main risk factor of stroke.

[Effect of mexidol on the course of post-traumatic epilepsy]. / Vliianie meksidola na techenie posttravmaticheskoi épilepsii.

The results of a complex 10-day therapy of patients with posttraumatic epilepsy, involving the antioxidant mexidol, are presented. The efficacy of the therapy was assessed based on the data of clinico-neurological, instrumental, and immunological examinations before and after the treatment and evaluated in terms of the dynamics of the neurological state of the patients, EEG features, and immunological data (including the content of proinflammatory IL-1 beta cytokine and antiinflammatory IL-4 cytokine in the blood serum). Based on a comparison of the results obtained in patients receiving traditional antiepileptic drugs with and without mexidol, it is possible to recommend the complex treatment involving mexidol for the therapy of patients suffering of the postraumatic epilepsy. Mexidol provides for an additional immunocorrection and enhances the effect of antiepileptic drugs.

[Pathogenesis and therapy of posttraumatic epilepsy]. / Patogenez i lechenie posttravmaticheskoi épilepsii.

Considerations on prevalence, conditions and development mechanisms of epilepsy after cranio cerebral injuries as well as peculiarities of its diagnosis using clinical, neurophysiologic and computed tomography methods are presented. Implications and limitations of the latter, frequency and features of neurological and mental disorders in relation to main appearances of the disease, i.e. types of epileptic seizures, etc., are regarded. Principles of treatment of posttraumatic epilepsy, the data on biochemical, neurochemical and neuropathological symptoms of epileptogenesis are summarized. The authors highlighted the advantages of monotherapy, importance of taking into account the patient's personality, contacting with a patients family and ensuring his or her rights and quality of life. Also, the bases and stages of patient's rehabilitation are discussed.

[The immunomodulating and antitoxic properties of preparations of lipopolysaccharides from representatives of the genus Francisella]. / Immunomoduliruiushchie i antitoksicheskie svoistva preparatov lipopolisakharidov predstavitelei roda Francisella.

The study of the biological properties of lipopolysaccharides (LPS) of bacteria of the genus Francisella (F. tularensis, F. novicida, F. novicida-like, F. philomiragia) revealed that the preparation of Francisella LPS possessed immunomodulating and antitoxic properties in the absence of toxicity. At the same time the structure of LPS (S or R) was found to produce an essential effect of the immunobiological activity of this molecule. Thus, the S-forms of LPS proved to be more effective as immunomodulators and the R-forms of LPS, as antagonists of classical endotoxins.

[Characterization of structure and antigenic activity of lipopolysaccharides of genus Francisella]. / Kharakteristika struktury i antigennoi aktivnosti preparatov liposakharidov razlichnykh predstavitelei roda Francisella.

Wild-type representatives of Francisella genus (F. tularensis, F. novicida, F. novicida-like, and F. philomiragia) produce S-type lipopolysaccharides (LPS) possessing different antigenic activity and common antigenic determinants in the core oligosaccharide. Electrophoretic analysis showed that F. philomiragia produced S-LPS containing two major molecular components with minor fractions between them, whereas S-LPS of F. tularensis, F. novicida, and F. novicida-like are characterized by the typical frequency distribution of molecules. A characteristic feature of Francisella LPS was the ability to form the dominant molecular components with similar electrophoretic mobility of major fractions of the original F. philomiragia LPS upon long storage in water solution. Natural virulent F. tularensis strains produce at least two types of S-LPS. Polysaccharide chains of type I S-LPS possess O-species-specific antigens, whereas the polysaccharide part of type II S-LPS has nonspecific antigenic epitopes. A decrease of F. tularensis virulence can be associated with impaired production of both S-LPS types or loss of S-LPS with O-species-specific antigenic activity.

[A rapid method for assessing the virulence of Francisella tularensis in vitro]. / Bystryi metod otsenki virulentnosti Francisella tularensis in vitro.

A rapid and simple method for the in vitro evaluation of the virulence of F. tularensis is proposed. The optimal parameters--the concentrations of bacteria and the substrate (phenolphthalein phosphate), the time incubation in the serum--have been developed and special conditions for strains of different subspecies have been selected. The proposed method makes it possible to greatly reduce the time of obtaining results and to exclude labor-consuming experiments on laboratory animals when working with large collections of F. tularensis laboratory and natural wild strains. Moreover, the method widens the possibilities of experimenters in the evaluation of the effect of some mutation on the virulence of the strain under study.