Vol 11, No 1 (2017)

Introduction. Systemic thrombolytic therapy using recombinant tissue plasminogen activator (rtPA) is the “gold standard” of reperfusion therapy in certainpatients with ischemic stroke during the first 4.5 h after stroke onset.

Objective. To assess the clinical (severity of neurological symptoms) and laboratory (complete blood cell count test) factors that affect the disease prognosis aftersystemic thrombolytic therapy.

Materials and methods. Seventy patients (48 males and 22 females) aged 61 [54; 69] years with ischemic stroke who received systemic thrombolytic therapy withrtPA at a dose of 0.9 mg/kg were prospectively studied. Blood for the complete blood count test including neutrophil and lymphocyte counts was sampled before thethrombolytic therapy. The severity of neurological impairment was assessed using the NIH Stroke Scale. The functional prognosis was assessed 3 months afterstroke using the modified Rankin scale (mRS). Markers for the unfavorable prognosis of the acute phase of ischemic stroke (mRS score ≥3) were revealed by ROCanalysis involving sensitivity and specificity determination.

Results. Severity of neurological symptoms assessed using the NIH scale at admission was 15 [11; 17] points. Time between the manifestation of neurologicalsymptoms and admission to the hospital was 138 [117; 170] min; between admission and initiation of systemic thrombolytic therapy (the door-to-needle time),40 [30; 55] min. An unfavourable functional outcome of systemic thrombolytic therapy can be predicted according to the results of ROC analysis: the NIH score upon admissionbeing 12 or higher (sensitivity, 94%; specificity, 57%); neutrophil count, > 7.8•109/L (sensitivity, 45.5%; specificity, 90.6%); lymphocyte count, < 1.8•109/L(sensitivity, 81.8%; specificity, 59.4%).

Conclusions. The customized approach to systemic thrombolytic therapy can help predict its effectiveness and contribute to elaboration of adequate approachesto patient management. Patients with a potentially unfavourable prognosis for systemic thrombolysis can be the target group for using mechanical reperfusiontechniques such as thrombus extraction.

Introduction. Neuronal cell death (apoptosis) is not only a direct consequence of cerebral infarction, but also a crucial pathogenetic link of ischemic injury. Nevertheless, the role of apoptotic markers in prediction of the functional outcome of the acute phase of ischemic stroke (IS) has not been established.

Objective. To determine the possibility of predicting the outcome of the acute phase of ischemic stroke in the earliest period after its development by measuring thes FasL and sFas concentrations in peripheral blood.

Materials and methods. One hundred fifty-five individuals underwent in-hospital examination. They were subdivided into 3 groups: the control group included healthy volunteers (n=28) and two groups of patients depending on the outcome of the acute phase of IS: either with favourable (National Institutes of Health Stroke Scale score on day 21 ≤ 5) or unfavourable (the NIHSS score on day 21 > 5) outcomes. Concentrations of sFas and sFasL were measured on day 1, 7, and 21 after ischemic stroke by ELISA; the sFasL/sFas ratio was also determined.

Results. The outcome is favourable (NIHSS score on day 21 ≤ 5) if the sFasL/sFas ratio is ≤ 2.11 ± 0.58; otherwise, the outcome is unfavourable (NIHSS scoreon day 21 > 5).Conclusions. The proposed method is characterized by prognostic significance and high accuracy and can be used in clinical practice to determine the strategy for managing patients with IS.

Introduction. Cerebral endothelial cells express monocarboxylate transporters MCT1 for blood–brain barrier (BBB) transfer of lactate, which are regulated by CD147 activity, as well as lactate receptors GPR81 (HCAR1). Metabolism and intercellular transport of lactate is the crucial mechanism for regulating the function of BBB cells.

Objective. To study the effect of activity of GPR81 receptors in cerebral endothelial cells on expression of MCT1, CD147 and the mitochondrial dynamics, which will make it possible to explain the effect of local production of lactate by perivascular astrocytes on angiogenesis in the cerebral tissue.

Materials and methods. The culture of cerebral endothelial cells isolated from the brain of 15–17-day-old Wistar rat embryos was used in this study. Mitochondrial biogenesis of cerebral endothelial cells was studied using the standard MitoBiogenesis In-Cell ELISA Kit protocol (Abcam). Chemical hypoxia was induced by incubation in the presence of 50 μM iodoacetate for 30 min. 3Cl-5OH-BA (Calbiochem) at concentrations of 5, 50, and 500 μM was used as an agonist of GPR81 lactate receptors during 24 h. The number of cells expressing GPR81, CD147, and MCT1 molecules was evaluated using indirect double-antibody ELISA.

Results. It was found for the first time that prolonged dose-dependent stimulation of GPR81 receptors with 3Cl-5OH-BA intensifies mitochondrial biogenesis (up to 1.5-fold, р<0.05). Meanwhile, a statistically significant (p<0.05) inhibition of expression of monocarboxylate transporters MCT1 (from 81±1.6% to 40.7±4.4%) and the conjugated CD147 protein (from 57.4±3.3% to 48.3±2.9%) in cerebral endothelial cells in the study group compared to the control group.

Conclusions. The findings broaden the range of potential applications of GPR81 agonists for modulating intercellular interactions in a neurovascular unit and controlling the functional activity of cerebral microvessel endothelial cells.

Despite the fact that small fiber neuropathy (SFN) has already been studied for 30 years, it remains one of the most mysterious diseases that are extremely difficult to diagnose and cure. The prevalence of SFN is 52.95 per 100,000 population; diabetes mellitus is considered to be the most frequent cause of this disease. Chronic neuropathic pain syndrome, temperature sensation abnormalities, and vegetative disorders develop as a result of damage to fine myelinated Аδ- and unmyelinated C fibers. The disease mainly spreads in the upward direction: from feet to the proximal body parts and arms; primary axonal damage takes place. Although SFN is believed to be one of the most “benign” neuropathy types as it does not affect the large sensory and motor fibers, it significantly decreases patients’ quality of life.

Introduction. Application of contrast agents in vascular untrasonography has become a new direction in noninvasive assessment of signs of atherosclerotic plaque (ASP) instability; the type of plaque neovascularization being the major sign. However, questions regarding the accuracy of the methods for quantitative evaluation of plaque neovascularization are still to be answered.

Objective. To evaluate signs of ASP instability in the carotid arteries according to the contrast-enhanced duplex scanning data and to elaborate our own approach to quantitative evaluation of neovascularization.

Materials and methods. Twenty-six patients with carotid atherosclerosis who had been subjected to carotid endarterectomy (n=27) followed by morphological plaque verification were enrolled in this study. All patients underwent standard duplex scanning and scanning using contrast agent SonoVue.

Results. Neovascularization was revealed in all 27 patients with ASP according to the pathomorphological and contrast-enhanced ultrasonography data. The total number of vessels per cm2 of plaque was 6–51 [21±14/cm2] according to the ultrasonography data and 19–1224 [236±249/cm2] according to the pathomorphological examination. According to the ultrasonography data, the absolute values were close to the density of plaque vessels ≥ 30 μm in diameter determined during pathomorphological examination and did not differ significantly from this value (p = 0.67). The morphology data show that vessels <20 μm in diameter, which constituted up to 96% of all microvessels in ASP, cannot be detected by ultrasonography. In one case, ulceration of the ASP surface was detected only by contrast medium injection. Calcified plaques with different degrees of calcination imposed the greatest difficulties when performing ultrasonic assessment of neovascularization.

Conclusions. Contrast-enhanced untrasonography can be used as an informative method to noninvasively detect signs of ASP instability enabling rather accurate assessment of neovascularization at microvessel diameter ≥30 μm. Calcification of ASPs may significantly affect the study results.

Neuropathy of the ophthalmic nerve (the first branch of the trigeminal nerve, CN V: V1) is the most common manifestation of herpes zoster. Neuropathy of the ophthalmic nerve occurs in 20% of cases of herpes zoster. Three types of pain are differentiated in trigeminal neuralgia: chronic burning pain, paroxysmal pain, and pain resulting from nonpain stimulation. Cutaneous hypoesthesia, anesthesia, and dysesthesia develop. Postherpetic neuralgia is characterized by pain persisting 3 months and longer after herpetic eruption. Combination therapy including early administration of antiviral drugs and tricyclic antidepressants has been proved to be most effective.