[Vestibular rehabilitation for peripheral vestibular hypofunction: an interdisciplinary consensus]. / Vestibulyarnaya reabilitatsiya pri perifericheskoi vestibulyarnoi gipofunktsii: mezhdistsiplinarnyi konsensus.

The literature review presents approaches to the management of patients with vestibular disorders. The principles of organization of vestibular rehabilitation in peripheral vestibular hypofunction, indications for appointment, factors influencing its implementation, technique, methods of evaluating effectiveness are considered in detail. Attention is drawn to the fact that the selection of exercises and the duration of vestibular rehabilitation is carried out individually and depends on many factors, including the nature of vestibular deficiency and the specific characteristics of the patient. The possibilities of using additional pharmacological therapy with histamine preparations, which can accelerate the onset of vestibular compensation, are shown. It is noted that vestibular rehabilitation is a safe and effective method of treating peripheral vestibular hypofunction and should be recommended to patients of all ages with vestibular disorders leading to limited social and physical activity.

[Current approaches in the treatment and rehabilitation of patients with neurological diseases after COVID-19. Resolution of the International Experts Forum]. / Lechenie i reabilitatsiya bol'nykh s nevrologicheskimi narusheniyami posle perenesennogo COVID-19. Rezolyutsiya Mezhdunarodnogo foruma ekspertov.

Despite the significant shift in global attention away from the pandemic, the problem of a new coronavirus infection remains important in the medical community. Almost 3 years after the start of the COVID-19 pandemic the issues of rehabilitation and management of delayed manifestations and sequelae of the disease are especially important. According to numerous available data, the new coronavirus infection is characterized by multiorgan lesions. Respiratory dysfunction, clotting disorders, myocardial dysfunction and various arrhythmias, acute coronary syndrome, acute renal failure, GI disorders, hepatocellular damage, hyperglycemia and ketosis, dermatological complications, ophthalmological symptoms and neurological disorders may be found. Significant prevalence of the latter in the post-coronavirus period necessitated this International Expert Forum to develop unified approaches to the management of patients with neurological complications and sequelae of new coronavirus infection based on practical experience and considering the scientific information available on COVID-19. The expert council developed a resolution formulating the tactics for the management of patients with neurological manifestations of COVID-19.

[The administration of neurocytoprotectors in a rat model of experimental spinal cord ischemia]. / Primenenie neirotsitoprotektorov v usloviiakh éksperimental'noi ishemii spinnogo mozga u krys.

AIM: To study an effect of cortexin on functional recovery and morphology of the spinal cord of rats with spinal cord ischemia. MATERIAL AND METHODS: Spinal cord ischemia was achieved by ligation of the infrarenal abdominal aorta in 16 rats stratified into two equal groups: the ligation of infrarenal aorta was performed in the control group, aorta ligation was performed also in the experimental group with preliminary intraperitoneally administration of cortexin in a dose of 0.15 mg/kg 30 min before procedure. Evaluation of neurologic deficit was performed by the Tarlov's scale. Morphological evaluation was made by analyzing the histological sections of the lumbar and sacral cord using the Nissl's method of coloring. Statistical analysis was performed as well. RESULTS AND CONCLUSION: A pronounced and significant effect of cortexin, which was clinically expressed in a decrease in neurological deficit (p=0.0095), morphologically in an increase in the number of normochromic neurons (р=0.01), and a decrease in shrunken neurons (р=0.0001) and shadow cells (р=0.0003), was noted. The results suggest a potential myeloprotective effect of cortexin. The drug can be considered in the context of treatment of vascular myelopathy.

[The comparative analysis of immunologic techniques of detection of anti-phospholipid antibodies].

The laboratory diagnostic of anti-phospholipid syndrome consists in detection of anti-phospholipid antibodies using technique of enzyme-linked immunosorbent assay namely in detection of anti-cardiolipin antibodies and antibodies to ß2-glycoprotein. In spite of the fact that serological diagnostic plays a key role in diagnosing anti-phospholipid syndrome application of laboratory tests s complicated by their insufficient standardization. The new approach to detection of anti-phospholipid antibodies became application of immune blotting on the basis of polyvinylidenfluoride membrane. As compared with enzyme-linked immunosorbent assay, the advantage of the mentioned technique is in using hydrophobic solid phase for sorption of antigens. The porous structure of polyvinylidenfluoride membrane orientates hydrophilic areas of phospholipids and by that ensures their more dense distribution imitating bi-lipid layer of membranes of living organism. To specify and compare value of different techniques the comparison was implemented concerning the results of measurement of anti-phospholipid antibodies in enzyme-linked immunosorbent assay test-systems of various manufacturers and reagents kits for immune blotting. The collection was assembled including bio-materials from 47 patients with non-cardioembolic ischemic strokes, 20 patients with recurrent thrombosis of deep veins of lower extremities and 50 patients with obstetrics pathology and also 30 healthy donors. In the given serums aKlaIgG, aKlaIgM, aß2glycoprotein I were measured using enzyme-linked immunosorbent assay technique assisted by test-systems of Euroimmun and Orgentes Diagnostica and the samples with the highest titre using immune blotting technique with reagents manufactured by Medipan. On the basis of measurement of anti-phospholipid antibodies by various enzyme-linked immunosorbent assay test-systems the rate of aß2glycoprotein I amounted to 31% in case of Euroimmun reagents kits for enzyme-linked immunosorbent assay, 78% in case of Orgentec Diagnistica test-systems for enzyme-linked immunosorbent assay, aKlaIgG - 2% and 30%, aKlaIgM - 31% and 54% correspondingly. The measurement of anti-phospholipid antibodies using immune blotting technique on Medipan test-systems in bio-samples with the highest titres detected aß2glycoprotein I in all patients, aKlaIgG in 70% and aKlaIgM in 30% of patients. The convergence between three commercial reagents kits varies from 20% to 88%. The standardization of commercial test-systems still to be achieved. The new technique of immune blotting can be appliedjointly with classic techniques ofserological diagnostic of anti-phospholipid syndrome. The absence of algorithms of diagnostic and standardization of different test-systems for detection of anti-phospholipid antibodies prejudices reliability of serological diagnosis of anti-phospholipid syndrome and therefore existence of anti-phospholipid syndrome as a nosologic unit.

[Preclinical studies of drugs on animal stroke models]. / Doklinicheskie issledovaniia lekarstvennykh sredstv na biologicheskikh modeliakh insul'ta.

Preclinical studies are studies using experimental models of stroke in animals as well as on neurons, cell neuronal cultures and surviving brain slices. They directed both towards testing the efficacy and evaluation of the mechanisms of action of drugs, and the study of the mechanisms of ischemic damage to search for new targets for stroke treatment. This article shows the basic principles of the organization and planning of animal models of ischemic stroke. Modeling of cerebral ischemia on the different models and animal species, the modern principles of assessment of brain damage are considered as well.

[THE CLINICAL LABORATORY MARKERS OF ATHEROSCLEROSIS IN PATIENTS WITH ATHEROTHROMBOTIC STROKE].

The laboratory biomarkers can effect on choice of tactics of treatment in patients with atherosclerotic stenosis ofcarotids and high risk of stroke. However, nowadays there is no established laboratory criteria of significant atherosclerotic affection of internal carotid. The purpose of study was to investigate informativeness of biomarkers of atherosclerosis in clinical molecuIar panel of expertise system of determining risk of stroke in patients with significant stenosis of carotid. The study included patients with 50-90% atherosclerotic stenosis of internal carotid in acute period of atherothrombotic stroke or transitory ischemic attack (group 1), patients with stable 50-90% atherosclerotic stenosis of inner carotid having no vascular events during 30 days before engaging into study (group II) and group of healthy volunteers without atherosclerosis of inner carotid. The examination of patients included anamnesis collection, evaluation of neurological status, analysis of serum level of biomarkers of atherosclerosis (lipoprotein-associatedphospholipase A2 (LP-PL A2), serum protein A associated with pregnancy (PA PP-A), lipoprotein (a) (LP(a)), asymmetric dimethylarginine (ADMA), C-reactive protein detected by highly sensitive technique (hsCRP) and lipid spectrum of blood) using enzyme-linked immunosorbent assay, duplex ultrasound scanning of brachiocephalic arteries. The stroke risk factors of other etiology were chosen as exclusion criteria except atherothrombotic one. The Mann-Whitney and Kruskal-Wallis tests were applied to establish group differences. The Data Mining techniques were applied to establish patterns of analyzing sample. Out of 356 examined patients, 30 patients of group 1, 51 patients of group II and 16 healthy volunteers were included in the study. All patients were comparable by gender and age (50-80 years). The serum level of hsCRP and ADMA in the group of patients of acutest period of ischemic stroke was significantly higher than in groups of patients with stable stenosis and healthy volunteers (p < 0.05). The comparison between three groups established no statistically significant differences in serum concentration of PAPP-A, LP-PL A2 and LP(a). The ADMA, hsCRP and PAPP-A can be recommended for including into clinical molecular panel for personalized diagnostic of causes of stroke along with clinical anamnestic data. The serum level of ADMA and hsCRP significantly increases in acute period of atherothrombotic stroke. The analysis of levels of ADMA, hsCR and PPAPP-A interpreted with regard to clinical anamnestic data can be proposed for enhancing quality of diagnostic of causes of stroke.

Neuroprotective effects of erythropoietin in focal brain ischemia in rats.

Neuroprotective effect of erythropoietin administered before ischemia has been previously demonstrated. The efficiency of erythropoietin administration after ischemia was not studied, though in case of success these protocols would be applied in clinical neurology. In our experiments on the model of transitory focal ischemia, erythropoietin was injected intraperitoneally during the early and delayed postischemic period (3 and 12 h). The size of the necrotic zone, neurological deficit, and the severity of brain edema were evaluated in 48 h. Injection of erythropoietin in 3 and 12 h after ischemia significantly reduced the size of necrosis (p = 0.0007 and p=0.0016, respectively), neurological deficit (p=0.0013 and p=0.0062, respectively), and brain edema (p=0.02 and p=0.0186, respectively). Injection of erythropoietin after transitory focal cerebral ischemia produced a pronounced neuroprotective effect.

[Early ischemic preconditioning against focal transient and permanent brain ischemia in rats: role of collateral circulation].

We hypothesize that early ischemic preconditioning (IPC) can afford protection against focal brief and prolonged cerebral ischemia with subsequent reperfusion as well as permanent brain ischemia in rats by amelioration of regional cerebral blood flow. Adult male Wistar rats (n=97) were subjected to transient (30 and 60 minutes) and permanent middle cerebral artery (MCA) occlusion. IPC protocol consisted of two episodes of 5-min common carotid artery occlusion + 5-min reperfusion prior to test ischemia either followed by 48 hours of reperfusion or not. Triphenyltetrazolium chloride and Evans blue were used for delineation of infarct size and anatomical area at risk (comprises ischemic penumbra and ischemic core), respectively. Blood flow in the MCA vascular bed was measured with use of Doppler ultrasound. The IPC resulted in significant infarct size limitation in both transient and permanent MCA occlusion. Importantly, IPC caused significant reduction of area at risk after 30 min of focal ischemia as compared to controls [med(min-max) 11.4% (3.59-2 0.35%) vs. 2.47% (0.8-9.31%), p = 0.018] but it failed to influence area at risk after 5 min of ischemia [med(min-max) 7.61% (6.32-10.87%) vs. 8.2% (4.87-9.65%), p > 0.05]. No differences in blood flow were found between IPC and control groups using Doppler ultrasound. This is suggestive of the fact that IPC does not really influence blood flow in the large cerebral arteries such as MCA but it might have some effect on smaller arteries. It seems that, along with well established cytoprotective effects of IPC, IPC-mediated reduction of area at risk by means of improvement in local cerebral blood flow may contribute to infarct size limitation after focal transient and permanent brain ischemia in rats.

[Neuroprotective effects of lipoic acid and superoxide dismutase in the rat model of cerebral ischemia].

BACKGROUND: the present study was aimed at investigation of neuroprotective effects of alpha-lipoic acid (LA) and superoxide dismutase (SOD) in brain ischemia in rats. METHODS: two models were used to produce brain ischemia: focal ischemia (permanent left middle cerebral artery occlusion) and permanent ligation of both CCA without subsequent reperfusion. Cu/Zn-SOD at a dose 5 mg/kg, i.v. and LA at a dose of 20 mg/kg, i.p. were injected 30 minutes prior or 5 minutes after onset of ischemia. The end-points of the study were histochemically determined: infarction size, ultrastructural changes in the cerebral tissue, and survival rate. RESULTS: LA administration 30 minutes prior to ischemia dramatically reduced infarction size (p < 0.001). Injection of LA 5 minutes after beginning of ischemia did not affect the infarction size. Besides, infarction ion size was unchanged after injection of SOD 30 minutes prior to ischemia. CONCLUSION: the LA treatment regimen used in this study resulted in significant cerebral protection against ischemia. In contrast, SOD did not show any protective effects in focal and forebrain ischemia.

[Noopept in the treatment of mild cognitive impairment in patients with stroke].

Noopept is a neuroprotector and nootropics. Literature data revealed the treatment effect of noopept on mild cognitive impairment in patients with discirculatory encephalopathy. The present open prospective study included 60 patients with stroke treated with noopept during 12 months. Cognitive functions were assessed before and after treatment using neuropsychological tests. An analysis of MMSE scores and lateral and categorical associations revealed the significant improvement of cognitive functions after 2 months in patients of the main group compared to the controls. The global assessment of efficacy revealed the mild improvement in the main group while no changes were found in the control group. The results have demonstrated that noopept, used in dose 20 mg daily during 2 months, improves cognitive functions in stroke patients and has a high level of safety.

[Antithrombotic therapy in the secondary prevention of stroke].

The review is devoted to the secondary prevention of ischemic events after ischemic stroke. Recommendations for antithrombotic therapy and prolonged indirect anticoagulant therapy with INR monitoring based on evidence-based medicine of the secondary prevention of ischemic stroke and TIA are presented. Patients who do not need anticoagulants should receive antiplatelet therapy. Due to the increasing number of patients resistant to antiaggregant therapy, the rapid and adequate evaluation of platelet function is needed. Current laboratory diagnostic methods have some shortcomings and do not meet criteria of evidence-based medicine. It is necessary to improve the laboratory diagnosis with the elaboration of reliable standardized methods.

[Protective effect of meloxicam against cerebral ischemia/reperfusion injury in normo- and hypertensive].

Normotensive and hypertensive male Wistar rats were subjected to the 3 h bilateral carotid artery occlusion followed by 72 h of reperfusion. The selective cycloxygenase-2 inhibitor meloxicam was administered intramuscularly after the cerebral reperfusion at a daily dose of 15 mg/kg. Doppler ultrasound was used to evaluate the cerebral blood flow during the reperfusion phase. The level of malondialdehyde (MDA) within the brain tissue homogenate was determined using spectrophotometry. The presence of arterial hypertension caused the altered response of brain tissue to ischemia/reperfusion. The meloxicam treatment significantly decreased the MDA level in normotensive rats subjected to ischemia-reperfusion. The protective effect of meloxicam against cerebral ischemia/reperfusion injury was more pronounced in hypertensive rats as compared to normotensive animals.

[Ultrasound-induced myocardial preconditioning: analysis of its effectiveness and mechanisms].

It has been shown that exposure of the isolated rat heart perfused according to Langendorff to therapeutic ultrasound (210 kHz and 0.5-1.5 W/cm2 ) induces a cardioprotective response similar to ischemic preconditioning. This reduces the infarct size and improves the postischemic systolic and diastolic function. The ATP-sensitive K+ channel blocker glybenclamide abolished the protection afforded by ultrasound; in contrast, the free radical scavenger N-2-MPG did not influence the ultrasound-induced cardioprotective response.

[An in vitro study of low-frequency ultrasound transmission through a musculoskeletal fragment of thoracic cage].

Low-frequency ultrasound transmission through a musculoskeletal fragment of thoracic cage was studied in vitro. The degree of ultrasound attenuation during noninvasive transthoracic application was estimated. The mean coefficient of ultrasound attenuation in thoracic cage was determined for the low-frequency region (210 kHz). The temperature effects of ultrasound application were also studied.