[Biomarkers of neuroinflammation in patients with chronic cerebral ischemia during the therapy with vinpocetine (study INFLAMARK)]. / Dinamika kontsentratsii biomarkerov neirovospaleniya v krovi u patsientov s khronicheskoi ishemiei golovnogo mozga na fone terapii vinpotsetinom: rezul'taty issledovaniya INFLAMARK.

OBJECTIVE: To evaluate the effect of vinpocetine therapy on clinical manifestations of chronic cerebral ischemia (CCI) and the blood concentrations of neuroinflammation markers (S100B, IL-1ß). MATERIAL AND METHODS: The study included 30 patients (mean age 61.6 [56.9; 67.9] years) with CCI that received vinpocetine (30 mg/day) for 3 months. Brain changes according to magnetic resonance imaging data were assessed using the STRIVE protocol. We analyzed the dynamics of changes in the clinical questionnaires: Montreal Cognitive Assessment Scale (MoCA), Hospital Anxiety and Depression Scale (HADS), Asthenic State Scale (ASS), Epworth Sleepiness Scale (ESS), general impressions of treatment (Global Rating of Change Scale, GRC). RESULTS: In 3 months after vinpocetine therapy there was a significant improvement in cognitive status (MoCA: 25.1±2.1 vs 26.6±1.4 p<0.05), emotional state (HADS: 8.4±1.4 vs 7.1±1.8 (p<0.05)), daytime sleep parameters (ESS 8.4±2.1 vs 6.2±2.3 p<0.05) and reduction in asthenia (ASS: 72.2±18.1 vs 52.3±9.3, p<0.05). A significantly larger proportion of patients assessed the improvement from therapy as «moderate¼ and «pronounced¼ (GRC, n=22, 73.3%). Concentrations of S100B and IL-1ß decreased significantly by the time therapy was completed. The overall severity of cerebrovascular changes according to MRI was significantly associated with blood levels of S100ß, but not IL-1ß: ß=0.504, p=0.026, 95% CI 0.149-0.901, mainly due to periventricular changes in white matter (ß=0.562, p=0.035, 95% CI (-0.024-0.820). Blood levels of S100ß correlated with MoCA test results (r=0.6795), and IL-1ß correlated with ESS scores (r=0. 6657). CONCLUSIONS: The use of vinpocetine can significantly reduce the severity of cognitive and affective disorders, asthenia, normalize the circadian rhythm of sleep, suppress the expression S100ß and IL-1ß in patients with CCI. One of the vinpocetine's mechanisms of action may be the inhibition of neuroinflammation.

[Analysis of the correlation between neuroimaging markers of the brain damage and the severity of postural instability in patients with chronic cerebrovascular insufficiency (NEMAN open observational study)]. / Svyaz' neirovizualizatsionnykh markerov porazheniya golovnogo mozga i vyrazhennosti postural'noi neustoichivosti u patsientov s khronicheskoi ishemiei golovnogo mozga (rezul'taty otkrytogo nablyudatel'nogo issledovaniya NEMAN).

OBJECTIVE: To analyze the relationship between the severity of postural instability in patients with CCI (chronic cerebral ischemia) and brain changes according to MRI, as well as to evaluate the efficacy and safety of vinpocetine. MATERIAL AND METHODS: The study included 60 patients with CCI: 40 people with postural instability made up the main group and 20 people without balance disorders - the control group. The severity of manifestations of cerebrovascular pathology was assessed according to the protocol STRIVE. Severity of postural instability was assessed with the VAS, anxiety syndrome - Hamilton Anxiety Rating Scale, asthenia - Asthenic Condition Scale, daytime sleepiness - Epworth Sleepiness Scale, cognitive impairment - Montreal scale assessment of cognitive functions, the overall impression of treatment - Global Rating of Change Scale. RESULTS: The main group was associated with older age, more significant decrease in cognitive functions, urination disorders, anxiety syndrome and asthenia, changes according to MRI of the brain. CCI burden scale was significantly associated with VAS: ß=0.479, P=0.035, 95% CI 0.023-0.928. The presence of lacunae was the most significant marker for the development of severe imbalance: ß=0.482, p=0.041, 95% CI 0.022-0.925. A significant relationship was found between the total number of lacunae and VAS (r=0.509, p=0.021), as well as between the number of lacunae in the basal ganglia (r=0.793, p=0.019), especially the lenticular nuclei (r=0.498, p=0.036), and VAS. After 3 months of vinpocetine treatment, a significant improvement in statodynamic function was noted in the main group, moreover - absence of anxiety, normalization of daytime sleep, «weak¼ asthenia, increasement in the value of the MoCA scale. Most of the patients regarded the improvement from the therapy as «moderate¼ and «pronounced¼. CONCLUSIONS: The presence of lacunes in the basal ganglia is a most prominent neuroimaging marker of brain damage in patients with CCI and postural instability. The use of vinpocetine can significantly reduce the severity of imbalance, anxiety and asthenia, and normalize the circadian rhythm of sleep.

[Quantative evaluation and analysis of the central mechanisms involved in analgesic effect of Alflutop in patients with chronic lower back pain]. / Kolichestvennaya otsenka i analiz tsentral'nykh mekhanizmov anal'geticheskogo effekta Alflutopa u patsientov s khronicheskoi bol'yu v nizhnei chasti spiny.

OBJECTIVE: Evaluation of Alfultop impact on nociceptive afferentation central mechanisms in patients with chronic lower back pain. MATERIALS AND METHODS: The study involved 40 patients with CLBP. The therapy included Alflutop, 2 ml once a day for 10 days. Mean VAS-pain, LANSS, Roland-Morris questionnaire, Global Rating of Change Scale (GRC), pressure pain thresholds data were analyzed. Follow-up duration was 3 months. RESULTS: Most of the patients were females (f:m=1.3:1); average age - 60.5 [54.2; 67.3] years with a mean disease duration of 14.3±4.2 mo. At visit 1, the VAS score was 63.2±9.4, LANSS 14.2±2.1 points, and the Roland-Morris questionnaire 9.9±3.5 points. There was a significant decrease in the pain threshold both in the zone of maximum pain, located in the lower back (3.97±0.9 kg/sm2), and in suprasegmental area (5.22±1.7 kg/sm2), and a pathological change in the temporal summation of pain (789.2±45.6 mm). After Alflutop therapy, significant changes in the parameters of the VAS, LANSS and Roland-Morris scores were recorded after 30 days of observation and maximum changes in 3 months. The pain threshold has significantly increased after 3 months of observation. The majority of patients rated the improvement from the therapy as «moderate¼ and «pronounced¼ (33/82.5%) according to the GRC scale. A significant relationship was established between the level of pain threshold and the intensity of pain on the VAS scale (R=0.714), its duration (R=0.799) and disability of the patients (R=0.706). CONCLUSIONS: Central sensitization develops in patients with CLBP, which correlates with VAS score of pain intensity, its duration and the degree of disability. Alflutop significantly reduces the intensity of the pain syndrome, its neuropathic component, significantly increases the level of pain threshold and improves the disability of patients in 3 months after the start of treatment.

[Main directions of differential diagnosis optimization and rational treatment of an acute vertigo attack]. / Osnovnye napravleniia optimizatsii differentsial'noi diagnostiki i ratsional'noi terapii ostrogo pristupa golovokruzheniia.

AIM: To develop and assess the validity of the clinical algorithm VERTIGO for the differential diagnosis of central and peripheral vertigo and optimization of treatment of patients with vertigo. MATERIAL AND METHODS: Sixty-five patients with an acute attack of vertigo, aged from 18 to 75 years (53±6.7 years), were studied. All patients underwent standard neurological examination. In case of signs of central vertigo, patients underwent neuroimaging. Diagnostic accuracy, sensitivity and specificity of the VERTIGO algorithm as well as its positive and negative prognostic values were calculated. RESULTS: The sensitivity of VERTIGO for the diagnosis of central vertigo was 100% (95% CI: 78.2-100%), specificity 94.0% (95% CI: 83.5-98.8%), positive prognostic value 83.3% (95% CI: 58.6-96.4%); negative prognostic value 100% (95% CI: 92.5-100%). Cohen's kappa estimated by the results of final diagnosis was 0.88. CONCLUSION: Differential treatment of patients with acute vertigo should be performed according to the current recommendations and include multimodal pharmacological medications, e.g. cavinton forte, to restore the vestibular control by the stimulation of neuroplasticity. The VERTIGO algorithm allows the increase of the efficacy of clinical differential diagnosis of central and peripheral vertigo.

[Neurogenic copulative dysfunction in men: theoretical aspects, differential diagnosis, and rational therapy].

UNLABELLED: Neurogenic copulative dysfunction (CD) is observed in different diseases and injuries of both the central and peripheral nervous system. CD concurrent with actual nervous system diseases has been established to be an important psychotraumatic factor that significantly reduces quality of life in these patients. AIM: To investigate the effect of aminophenylbutyric acid (Noophen) on male copulative function. SUBJECTS AND METHODS: Forty patients with chronic lumbosacral radiculopathy on an exacerbation and mild and moderate closed head injury were examined. RESULTS: The findings suggest that Noophen is effective in the combination therapy of neurogenic CD. CONCLUSION: The drug can normalize an autonomic control over nerve centers involved in the regulation of copulative function, and improve the psychoemotional status of patients.

[Hypertrophic basal pachymeningitis presenting as Tolosa-Hunt syndrome].

We examined 6 patients with hypertrophic basal pachymeningitis using clinical, laboratory and instrumental methods. The clinical presentations were similar to Tolosa-Hunt syndrome although the differences were noted. One case is described in-depth. Based on literature and own observations, we considered the etiology, pathogenesis, diagnostic features and treatment of hypertrophic basal pachymeningitis.

Pharmacokinetics and pharmacodynamics of a new local anesthetic agent.

We compared the effects of local anesthetics procaine, amethocaine (dicaine), bupivacaine, and a new agent RU-1148 on hydrolytic activity of human plasma butyrylcholinesterase. The butyrylcholinesterase-blocking activity of the test substances decreased in the following order: bupivacaine>amethocaine>procaine>RU-1148. The study of the capacity of these agents to form complexes with human plasma proteins and serum albumin showed that RU-1148 in therapeutic concentrations was transported by human serum albumin,beta-globulin, and acid glycoproteins. Study of the mechanisms of pharmacodynamic interactions between clonidine and RU-1148 demonstrated good prospects of their combined use.

Experimental approach to differentiation of the effects mediated by imidazole receptors and alpha2-adrenoceptors on platelets.

We studied parameters of specific binding for various ligands of imidazole receptors and alpha2-adrenoceptors on human platelets. Pharmacological activity of compounds was evaluated by their effects on platelet aggregation induced by ADP in low concentrations (0.125-1.5 microM). In contrast to alpha2-adrenoceptor agonist norepinephrine inducing reversible aggregation of cells, selective stimulation of imidazole receptors with moxonidine produced a disaggregation effect. The data suggest that human platelets can be used as an experimental test system for screening and study of molecular mechanisms underlying the influence of new compounds.

[Central nervous system damage in inflammatory demyelinating polyneuropathies]. / Porazhenie tsentral'noi nervnoi sistemy pri vospalitel'nykh demieliniziruiushchikh polinevropatiiakh.

The results of subclinical brain damage study of 20 patients with inflammatory demyelinating polyneuropathy, aged 46.5 +/- 3.7 years, are presented. Eleven patients were diagnosed to have Guillain--Barre syndrome and 9--chronic inflammatory demyelinating polyneuropathy. No clinical systems for central nervous system damage were found. Magnetic resonance tomography defected demyelination foci in periventricular and sub-cortical brain regions in 35% of the patients and diffuse atrophic process--in 55%. Registration of brainstem acoustic-evoked potentials showed bilateral latency increase and a change of a signal shape in 60% of the patients. Possible mechanisms of combined damage of central and peripheral nervous system in this pathology are discussed.

Blood clotting disorders in gestosis and pulmonary mechanisms of their compensation.

We studied blood coagulation system in women with uneventful pregnancy and with gestosis and evaluated the hemostasis-regulating role of the lungs in pregnancy and gestosis. We found a correlation between disorders in the pulmonary fibrinolytic function and severity of gestosis, and demonstrated the role of compensatory pulmonary mechanisms in the maintenance of adequate microcirculation in maternal organism and in the mother-placenta-fetus system. Prognostic and diagnostic criteria of gestosis and its complications are proposed.

[The immunosorption of the cerebrospinal fluid in the treatment of inflammatory demyelinating polyneuropathies]. / Immunosorbtsiia spinnomozgovoi zhidkosti v lechenii vospalitel'nykh demieliniziruiushchikh polinevropatii.

Immunosorption of cerebrospinal fluid with updated "Pall" immunofilters (Germany) was successfully performed in 3 patients with progressing hormone-resistant Guillain-Barré syndrome and chronic inflammatory demyelinating polyneuropathy. It was proved that clinical improvement in the patients' state correlated with a decrease in the contents of both total protein and immunoglobulins G, A, M in cerebrospinal fluid. It was suggested that the removal of these humoral factors had decreased a degree of inflammatory and demyelinating processes in inflammatory demyelinating polyneuropathies and had improved, thereby, the results of the treatment.

[A case of diagnosis of Landry ascending paralysis of herpetic etiology]. / Sluchai diagnostiki voskhodiashchego paralicha Landri gerpeticheskoi étiologii.

One clinical and pathomorphologic case of Landry paralysis with a proven etiological role of herpetic infection is reported. Acute clinical syndrome developed as a manifestation of exacerbation of chronic inflammation in the central nervous system. Advancement of the process and generalisation of herpetic infection was connected with immunodeficiency in this patient.

[Chronic inflammatory demyelinating polyneuropathies]. / Khronicheskie vospalitel'nye demieliniziruiushchie polinevropatii.

A chronic inflammatory demyelinating polyneuropathy (CIDP) is described both on the basis of authors' own observations and literary data. The disease is characterised by delayed onset with progredient, progredient-remittent and stable course of flaccid paresis of extremity together with mild distal sensitive disturbances, albumino-cytologic dissociation and dysimmunoglobulinemia. Cranial nerves damages and vestibulo-cerebellar disturbances were observed in a number of patients. This confirms the involvement of CNS in CIDP. The common character of clinical, immunological, laboratory and electrophysiological findings permits to consider CIDP and Guillain-Barré syndrome as autoimmune diseases. Meanwhile some recent findings on the formation of antibodies to peripheral nerves structures as well as high titers of antisulfamide and antigangliosides antibodies permit to suggest CIDP as separate nosological unit. Additional clinical data and the evaluation of the role of etiological and pathogenetic mechanisms are necessary for the final conclusion.