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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.

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Clinical features and MRI-characteristics of two demyelinating diseases: acute disseminated encephalomyelitis (ADEM) and multiple sclerosis (MS) are discussed. Despite the seeming obviousness of differential-diagnostic criteria, the individual course of disease can, in some cases, accomplishes the differential diagnosis specifically in cases of recurrent (monophasic) ADEM and the first episode of acute demyelination, resembling ADEM, in MS. A clinical case of MS with acute manifestation resembling ADEM is described.

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The dynamics of neurological symptoms assessed with the Scandinavian stroke scale, the Barthel index and the modified Rankin scale was studied in 89 patients with moderate ischemic stroke who received citicoline (ceraxone) intravenously and orally. The results were compared to a group of 52 age-, sex- and stroke-matched patients who did not receive citicoline. To the date of discharge from the hospital (days 21-24), the full restoration (p<0.05) was noted in patients of the main group. Efficacy of citicoline was significantly (p<0.05) higher in patients younger than 70 years and when the drug was used in the first hours of disease.

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Carriage frequencies of alleles and genotypes of polymorphous locus of -174G>C IL6 (rs1800795) were analyzed in the patients with ischemic stroke (IS) of Russian ethnic descent (200 cases) and in the control group of the same ethnic descent with similar sex and age (140 controls). Significant differences were identified in frequencies of carriage (in homo- or heterozygous form) of allele IL6*-174G (p = 0.0029, OR = 2.9, 95% CI: 1.4-5.8), which can be considered as risk factor for IS and in frequencies of IL6*-174C/C genotype carriage, correspondingly (p = 0.0029, OR = 0.35, 95% CI: 0.17-0.69). After sex stratification of patients and controls similar significant differences were observed only between female patients and controls, after age stratification the difference was observed only for the age group older 60 years. Complex analysis of association of SNP -174G>C IL6 alleles and genotypes carriage in combination with SNP 4266A>G (Thr312Ala) FGA (rs6050) (see symbol) -249C>T FGB (rs1800788) with IS revealed protective combinations IL6*-174C/C + FGA* 4266A (see symbol) IL6*-174C/C + FGB*-249C, which were slightly more significant than single protective genotype IL6*-174C/C associated with IS and their ORs didn't differ substantially from the single genotypes's OR value. At the same time the combinations of alternative allele IL6*-174G with the same FGB*-249C or FGA* 4266A alleles were revealed and their association significance levels as well as OR values were lower than the values for the single risk allele IL6*-174G. In case of the mutual carriage of IL6*-174G allele with FGA*4266A/A, FGB*-249C/C genotypes or with combinations of these alleles/genotypes the "neutralized" effect became stronger. In other words, we observed association of IS with allele/genotype combinations of genes IL6, FGA and FGB, in which IL6 plays key role and FGA and FGB have modulating function. In analysis of association of fibrinogen plasma levels with three analyzed polymorphous loci significant differences were not revealed.

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Intracranial cerebral blood flow and cerebral perfusion reserve were examined in 50 patients with diabetes mellitus type I. The results were compared to the control group. There were changes in the intracranial cerebral blood flow and the decrease in cerebral perfusion reserve in patients with diabetes mellitus type I. The degree of the changes was correlated with the disease duration, compensation of carbohydrate metabolism, presence and degree of retino-and nephropathy.

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Authors studied the influence of the psychoemotional stress preceding the stroke on the dynamics of neurological symptoms (Glasgo coma scale, Scandinavian stroke scale and Barthel index) and on the conformational changes of albumin in 59 patients with intracerebral hemorrhage due to arterial hypertension. The psychoemotional stress was associated with less favorable clinical course and outcome of intracerebral hemorrhage. Conformational properties of albumin were changed in all patients with intracerebral hemorrhage compared to controls. Psychoemotional stress preceding stroke aggravated changes in albumin molecule.

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Different clinical/instrumental traits and factors of cardiovascular risk in stroke patients of different ages and able-bodied patients with discirculatory encephalopathy are compared. The frequency of some risk factors was even greater in more younger patients compared to older ones while the frequency of enlarged intima-media complex as a parameter of vascular remodeling was similar in both groups. Effects of different risk factors in the aspect of vascular remodeling were evaluated with regression analysis using odds-ratio with 95% confidence interval. The family history of cardiovascular disease with the early age at onset and visceral obesity are the most significant predictors of stroke, their contribution to the vascular remodeling is comparable to that in diabetes mellitus.

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We studied an effect of different nutrition algorithms on the outcome of neurological symptoms and laboratory data in patients with ischemic stroke. The active nutrition support included in the basic therapy from the beginning of the disease has a positive effect on the patient's state. The mixed artificial nutrition (enteral + intravenous) was more effective compared to the intravenous or enteral nutrition alone in improving the clinical state, shortening the duration of staying in intensive care wards and complete compensation of disturbances of protein and energy metabolism during the first day of disease.

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Carriage frequencies of alleles and genotypes of 10 functionally important single nucleotide polymorphisms that are located in genes FGA, FGB, APOE, LPL, ACE and CMA1 were analyzed in the ischemic stroke (IS) patients of Russian ethnic descent and in the control group of the same ethnic descent and of similar gender and age. Comparison between patients and control group revealed no significant differences in frequencies of individual alleles and genotypes for all the polymorphic loci studied. However, complex analysis of genetic predisposition using APSampler algorithm revealed carriage of allele (-491A) APOE as a predisposing factor for IS (p = 0.044, OR 3.8, 95% CI 1.0-15.1). Accordingly, carriage of genotype (-491T/T) APOE was associated with resistance to IS (p = 0.044, OR 0.26, 95% CI 0.07-1.0). The allele -249C FGB carriage addition to this genotype enhances its protective properties, p-value of the combination is 2-fold lower than that of the genotype (-491T/T) APOE (OR 0.17, 95% CI 0.04-0.8). Two more protective combinations were identified: biallelic (-427C) APOE + (1595G) LPL and triallelic (-491C) APOE + (1595G) LPL + (-1903G) CMAI (in both cases p = 0.0052, OR 0.18, 95% CI 0.05-0.66). Overall, involvement in formation of the risk of IS development in Russians was evidenced for alleles of four genes: APOE, FGB, LPL and CMA1, where APOE gene involvement was evidenced for alleles of two polymorphic loci, -491T and -427C. Linkage analysis suggested that involvement of these loci in insusceptibility to IS is mutually independent.

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The study was based on the hypothesis that the age-specific vascular disturbances, along with autoimmune processes, might play a role in the development of neurodegenerative changes in multiple sclerosis (MS) in patients above 45 years. Vascular disturbances were assessed using single photon emission computer tomography. Also magnetic resonance imaging, ultrasound dopplerography of the brain and evaluation of patient's neurological and mental state with the MMSE were used. The main group consisted of 10 patients with MS aged above 45 years with the history of vascular disturbances was studied before and after the treatment with fezam, a preparation contained piracetam and cinnarizine. It has been shown that in the presence of the vascular risk factors the neurological deficit can increase in this group of patients not only due to inflammation and demyelinization but to vascular disturbances as well. In these cases, the administration of fezam used in treatment of brain vascular disorders proved to be effective. The drug exerted a positive effect on the patient's mental state including cognitive dysfunction.

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We studied the blood and plasma viscosity and hematocrit in patients with ischemic stroke and in a control group. Patients with ischemic stroke had a marked hyperviscosity and elevated hematocrit levels which were correlated with arterial hypertension, alcohol consumption and tobacco smoking. In women aged 45-55 years, viscosity and hematocrit were correlated with age that may be explained by the hormonal changes. People with ischemic stroke had three variants of circadian patterns of viscosity and hematocrit with peaks at 9 am, 3 pm and 9 pm. In some patents a strong correlation between the time of stroke onset and circadian pattern was observed.

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We examined an association of the C-148T beta-fibrinogen gene polymorphism with fibrinogen level and platelet aggregation in patients with ischemic stroke and in people with vascular risk factors but no ischemic stroke. Among stroke patients, carriers of an -148T allele had significantly higher plasma fibrinogen level and platelet aggregation to norepinephrin compared to the C/C homozygotes. No significant differences in frequencies of a C-148 allele between stroke patients and controls were observed.

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The changes developing in the perifocal area of hematoma and perspectives of antioxidant and chelate therapy were studied on the model of experimental hemorrhagic stroke and in clinical conditions. Microcirculatory, ischemic and inflammation disturbances with a certain time sequence were found in the perifocal areas. These changes, along with hypostasis and oxidative stress, form the pathobiochemical cascade of changes in hemorrhagic stroke and are potential therapeutic targets. Administering of an antioxidant and chelate drug histochrome reduces the intensity of changes in the perifocal area in the experimental conditions. In clinical conditions, it accelerates the dynamics of brain and meningeal symptoms regression and improves the blood rheological properties.

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A randomized placebo-controlled study has been carried out in 3 Moscow hospitals. A sample included 90 patients who survived hemispheric ischemic stroke caused by pathology in the internal carotid artery 72 h before the treatment. Forty-five patients were given standard (basic) therapy and 45 patients received adjuvant batroxobin intravenously by 1,0 ml (10BU) drops on day 1, 3 and 5 and by 0,5 ml (5BU) drops on day 7 and 9 after admitting in a hospital. Assessment of the patients' state was conducted before the treatment, on day 3, 6 and 15. The European Stroke Scale was used to measure severity of clinical symptoms. The results suggest efficacy of batroxobin the use of which provides rapid good results, especially improvement in movement disorders. The use of this drug is accompanied by defibrinating effect. The drug is well tolerated.

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The subjects of the study were 46 patients at the acute stage of a first or repeated ischemic stroke (IS). The study revealed prevalence of procoagulating and thrombocyte activity of hemostasis, pronounced deficiency of physiological anticoagulants, high activity of Willebrand factor, and dislipidemia in these patients. The results show that secondary IS prophylaxy require combined antiaggregant therapy or combined therapy including anticoagulants and antithrombocyte agents plus correction of dislipidemia.

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Presented are the results of the use of histochrome in animals with experimental hemorrhagic stroke. An influence of the compound on cerebral edema and the dynamics of hemoglobulin converting as well as a role of MRT in diagnostic of experimental hemorrhagic stroke in different periods of the disease are discussed.

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Interaction of gene wellhaarig (we) with genes waved alopecia (wal) and hairless (hr) was studied in mice. The mutant gene we is responsible for the development of a specific waved coat in homozygotes. Homozygous mice carrying mutant gene wal also have a wavy coat, though a partial alopecia develops with time in these animals. In homozygotes for the hr gene, hair loss is observed beginning from the age of ten days. A series of crosses we/we and wal/wal yielded animals with we/+wal/wal and we/we wal/wal genotypes. In mice we/+wal/wal carrying gene we at a single dose, alopecia is accelerated significantly as compared to the single-dose homozygotes +/+wal/wal. In we/we wal/wal mice, alopecia starts earlier than in we/+wal/wal mice; by the age of one month, the double homozygotes are almost hairless except for small body areas covered with a sparse coat. In addition, curliness of the first-generation hair in mice we/we wal/wal is much more expressed than in +/+wal/wal and we/we+/+ mice. The obtained evidence suggests that the we gene is a modifier of the wal gene because the former enhances the effects of the wal gene, which is confirmed by the earlier onset of alopecia and progression of the latter in mice having the we/+wal/wal genotype and especially in we/we wal/wal animals. The we/we hr/+ mice do not differ in coat from we/we+/+ mice; in both cases, the coat is wavy. The coat of double homozygotes we/we hr/hr, is similar to that of we/we+/+ mice until ten days of age, when the signs of alopecia appear. By the age of 21 days, mice we/we hr/hr have lost their coat completely like mice +/+ hr/hr. Hence, the we gene is a modifier of the wal gene though it does not interact with hr gene during the coat formation.

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