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AIM: To evaluate the efficacy and safety of tolpersione injection and oral formulations combined with NSAID over NSAID monotherapy in acute non-specific low back pain. MATERIAL AND METHODS: In this randomized double blind study 239 patients were included in the per protocol analysis. The first 5 days of treatment, patients received tolpersione or placebo injection which was followed by per os administration of tolpersione/placebo tablet up to 14 days. NSAID diclofenac tablet was used in both groups through the study. Functionality assessed by the Roland Morris Disability Questionnaire (RMDQ) at day 5 was the primary endpoint. Secondary endpoints were RMDQ at other time points, pain level change at rest and on movement assessed by the Visual Analogue Scale (VAS), the Clinical Global Impression of Improvement/Patient Global Impression of Improvement (CGI-I and PGI-I), change in the range of motion assessed by the distance from the fingertips to the floor, period of disability days, relative (%) changes in the daily dose of diclofenac from the 7th to the 14th day of therapy. RESULTS AND CONCLUSION: The primary and secondary endpoints clearly demonstrated the significant superiority of tolpersione added to NSAID monotherapy over NSAID monotherapy. The safety assessment revealed no statistically significant differences between the two groups. Based on the results, tolpersione injection and per os formulations can be considered an effective and safe drugs in the combined therapy for patients with acute nonspecific back pain.

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In patients with chronic cerebral ischemia on the background of hypertension grade 2, stage 2, our investigation revealed a significant decrease (by 30.1%) in the level of phospholipids in the erythrocyte membrane and cholesterol esters (by 44.2%), increase in lizofosfa-tidilholina, free cholesterol, triacylglycerides, and free fatty acids (by 23.2 - 46.2%), and change in the ratio of lipid fractions responsible for the structure formation and stabilization of erythrocyte membranes. It was found that the most effective correction of lipid profile in erythrocyte membranes was produced by 10-day injection of a combination of actovegin (200 mg intravenous bolus) and cereton (1000 mg choline alfoscerate intravenous drip in 200.0 mL of 0.9% sodium chloride solution), while the minimum ef- fect was produced by a combination of cerebrolysin (2152 mg concentrated complex of peptides from pig brain, intravenous drip in 100.0 mL of 0.9% sodium chloride solution) and mexidol (250 mg of 2-ethyl-6-methyl-3-hydroxypyridine succinate intravenous bolus). The combination of emoxypine (40 mg of 3-hydroxy-6-methyl-2-ethylpyridine, intramuscularly) and piracetam (1000 mg of 2-oxo-I-pyrrolidine-acetamide intravenous bolus) gave intermediate results.

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OBJECTIVE: To determine the dynamics of immunometabolic characteristics in patients with chronic ischemia of the brain (discirculatory encephalopathy - DE) under the influence of various combinations of neuroprotective and antioxidant drugs and on this basis to identify the most effective therapeutic combinations. MATERIAL AND METHODS: Authors analyzed the results of treatment of 57 patients with DE, stage II, comorbid to hypertension, stage II, which were divided into 3 groups that received comprehensive basic and advanced therapy with paired combinations of neuroprotective and antioxidant drugs. Clinical examination and assessment of neuropsychiatric status were performed. Immune disorders were assessed by the level of plasma cytokines (TNF, IL-1ß, IL-6, IL-8, IL-18, IL-4, IL-10 receptor antagonist IL-1 (RAIL), INF-γ, IL-2, IL-17), components of complement (C3, CA, C4, C5, CA), inhibitors (factor H, C1-inhibitor), immunoglobulin classes IgM, IgG, IgA, metabolic changes (concentrations of acylhydrazines, malondialdehyde, ceruloplasmin), C-reactive protein, neopterin concentrations, stable metabolites of nitric oxide, the activity of catalase, superoxide dismutase, total antioxidant activity of blood serum. RESULTS AND CONCLUSION: Laboratory and clinical efficacy of the combinations of neuroprotective and antioxidant drugs in DE reduced in the following order: actovegin and cereton → emoxipine and piracetam → cerebrolysin and mexidol.

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A comparative clinical study of 136 female patients with uncomplicated chronic calculous cholecystitis, including 106 patients examined in the pre- and postoperative periods of endoscopic cholecystectomy, revealed the effect of chronic illness and surgery on the neurological status and cognition which was more pronounced in adulthood. We investigated anxiety feelings before and after surgery. Our findings should be taken into consideration in the preoperative preparation of patients and their care in the postoperative period.

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Sixty hypertensive patients (mean age 64.9 +/- 1.5) with acute ischemic stroke were randomized into 2 groups. Both groups received conventional therapy (Aspirin Cardio, Trental, Prestarium, Arifon), which in the test group was added by Mexicor (0.3 gper day for 3 weeks). Circadian blood pressure (BP) and its variability were monitored in all patients at 1, 5, 10, 14, and 21 days after the stroke. NIH Stroke Scale, the Barthel ADL Index, Rankin Scale, Mini-Mental State Examination (MMSE) and Frontal Assessment Battery (FAB) were used for the neurological status assessment. Mexicor was shown to accelerate the systolic and diastolic BP lowering, reduction of BP variability (mainly nocturnal) and improvement of circadian BP profile (more patients showed dipper type hypertension and less - non-dipper, over-dipper and night-peaker patterns, compared with the control group). Mexicor had a positive effect on neurological status, cognitive function and focal neurological deficit severity.

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To specify correlations between neuromuscular, vegetative functions and CSF dynamics in patients with primary arterial hypotension, 22 young patients were examined with the aid of stimulation electroneuromyography, registration of evoked sympathetic cutaneous potential, echoencephalography and electrothermometry. The data obtained before and after antiorthostatic test were compared. A group of healthy subjects served as control. It has been shown that in patients with primary arterial hypotension with compensated neurological microsymptomatology, unpronounced under common conditions, there are well-defined signs of disorders in the work of neuromuscular structures, vegetative fibers, and in thermoregulation. These disorders undergo different changes under the influence of the antiorthostatic test and are accompanied in the majority of the patients by the enlargement of the ventricular system of the brain. It is assumed that in view of this fact, potentialities of adaptation are decreased in the disease in question. It is recommended that electroneuromyography and echoencephalography be used in an all-round estimation of the health status of patients suffering from primary arterial hypotension.

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Based on experimental and clinical studies the author formulates the general principles of the conservative treatment of peripheral nerve injuries. Emphasizes the necessity of exercising multimodality systemic actions on the body with the aid of neuromyostimulation and intake of nootropic agents. Provides the data on the comparative effectiveness of the complex of treatment measures and routine treatment with the commonly accepted methods. Considers the problems of establishing the individually optimal times of performing concomitant neuromyostimulation.

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Animal experiments and clinical studies were made to examine the effectiveness of combined neuro-myo-stimulation (conjugated electric stimulation of the injured nerve and muscles and intact reflexogenic areas together with conventional electric stimulation of the nerve) in the treatment of compression ischemic injury to the nerves. The combined neuro-myo-stimulation used in 27 rabbits with experimental compression ischemic injuries to the peripheral nerves made it possible to reduce the time of the recovery of the movements and sensitivity of the paresthetic limb and to reduce vegetative trophic disturbances. This conclusion was supported on the use of the combined neuro-myo-stimulation in the treatment of 16 patients with different injuries to the peripheral nervous system, in whose genesis the main part was played by compression ischemic factors.

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The effect of electroneuromyostimulation (ENMS) combined with Nootropil administration for trauma neuropathies was assessed using clinical and physiological tests in 58 patients. The combined intervention considerably accelerated the restoration of motor and sensory functions after the reconstructive neurosurgery on the extremities. Sensory functions substantially improved in 78% of the patients receiving ENMS and Nootropil and in 23% of those receiving the conventional treatment. The ENMS plus Nootropil treatment has been found to have advantages as compared with the conventional one.

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