Vol 10, No 1 (2016)

Original articles

Venous thrombogenesis and functional state of the hemorheology and hemostasis system in stroke patients

Ryabinkina Y.V., Piradov M.A., Tanashyan M.M., Shabalina A.A., Kostyreva M.V.

Abstract

Comparison of the results of investigation of the hemorheology and hemostasis system in patients with stroke of various types, localization, and severity who were treated at critical and intensive care units, with venous thromboembolic complications (VTECs) and without VTEC, demonstrated a high significance of impairments in the hemorheology and hemostasis system for VTEC pathogenesis in stroke patients. Despite ongoing anticoagulant therapy, aggravation of the prothrombogenic state was observed in VTEC patients. Ischemic stroke was associated with more severe changes compared to hemorrhagic stroke. Hemostasiological predictors of VTEC were identified. In patients without VTEC, both the coagulation and anticoagulation systems as well as the fibrinolysis system were preserved. The D-dimer and thrombophilia markers, such as hyperhomocysteinemia and antiphospholipid syndrome, were shown not to contribute to the development of VTEC in stroke patients.
Annals of Clinical and Experimental Neurology. 2016;10(1):
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Endothelial dysfunction indicators and hemorheological properties in acute ischemic stroke

Azhermacheva M.N., Alifirova V.M., Plotnikov D.M., Aliev O.I., Solovtsov M.A., Burkova K.I., Plotnikov M.B.

Abstract

We evaluated endothelial dysfunction and hemorheological indicators in acute ischemic stroke. The hemorheological indicators (blood viscosity, plasma viscosity, hematocrit, erythrocyte aggregation and deformability, fibrinogen concentration) were assessed three times: within the first 12 hours of the onset of symptoms and on day 3–5 and day 18–20 after hospitalization; the endothelial dysfunction indicators were examined on day 15–17 using a cuff test. Patients in the acute phase of ischemic stroke had pronounced changes in the hemorheological indicators that could be characterized as high blood viscosity syndrome. For example, we observed increased platelet aggregation that plays a key role in the blood viscosity value in blood vessels with low shear rates. We also observed reduced erythrocyte deformability at high shear rates. After treatment, patients had positive clinical dynamics according to neurological scales. Dynamics of the hemorheological indicators was as follows: erythrocyte aggregation decreased; blood viscosity tended to reduce; however, erythrocyte deformability tended to worsen. Therefore, the pathological changes in elastic properties of the erythrocyte membranes in stroke are not corrected by ongoing standard therapy. Assessment of the endothelial functional activity revealed that stroke patients had a decreased brachial artery response associated with reactive hyperemia and an increased response to the nitroglycerin test. The study demonstrated that treated patients with ischemic stroke had endothelial functional activity changes that manifested as a statistically significant increase in the endothelial dysfunction index. We concluded that the approach to stroke treatment requires complex pharmacological correction, in particular by means with the proven hemorheological activity.
Annals of Clinical and Experimental Neurology. 2016;10(1):
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Carbohydrate metabolism disorders and cerebral atherosclerosis in patients with ischemic cerebrovascular diseases

Antonova K.V., Medvedev R.B., Shabalina A.A., Lagoda O.V., Tanashyan M.M.

Abstract

Type 2 diabetes mellitus (T2DM) and metabolic syndrome (MS) facilitate the development of ischemic cerebrovascular diseases. This article presents the results of examination of patients with ischemic cerebrovascular diseases associated with T2DM and MS. We have found that T2DM adversely affects the progression of atherosclerosis in patients with cerebrovascular diseases, and activity of the atherosclerotic process in the great cerebral arteries directly depends on the duration of carbohydrate disorders.
Annals of Clinical and Experimental Neurology. 2016;10(1):
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Assessment of the operative memory capacity based on endogenous evoked potentials (P300 method) without neuropsychological testing

Gnezditskiy V.V., Chatskaya A.V., Korepina O.S., Klochkova O.I.

Abstract

We analyzed the dependence of the operative memory (OP) capacity on P300 parameters in healthy individuals and patients with a varying degree of memory impairments. Our findings demonstrated a strong correlation between the OP capacity and the P300 latent period. On this basis, we provided a atisfactory quantitative description of OP using the P300 latent period that was comparable to neuropsychological testing in most individuals and patients. Thus, the P300 method provides a quantitative measure of OP, which is particularly important when neuropsychological testing is not possible for some reasons, e.g., aphasia, unresponsive state, etc.
Annals of Clinical and Experimental Neurology. 2016;10(1):
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Structural reorganization of the sciatic, peroneal, and tibial nerves during osteosynthesis of lower leg fracture and after fracture consolidation (an experimental study)

Varsegova T.N., Shchudlo N.A., Shchudlo M.M., Stepanov M.A., Sayfutdinov M.S.

Abstract

The study purpose was to identify histological changes in the peripheral nerves and determine functional significance of subclinical neuropathy in experimental simulation of lower leg fractures. We simulated a tibial shaft fracture in 24 dogs under anesthesia and performed osteosynthesis using an Ilizarov apparatus. After 7, 14, 20, 35–37, and 50 days of fixation using the apparatus and 30, 60–90, and 120 days after removal of the apparatus, the dogs were euthanised. Electromyography was performed before fracture and within the main phases of the experiment. Samples of the sciatic, peroneal, and tibial nerves were studied histologically using computer morphometry of semithin araldite sections. After 37 days of fixation, the amplitude of M-responses of the tibialis anterior and gastrocnemius muscles decreased by 70% compared to the baseline value, increased after removal of the apparatus, but not restored. There were no sighs of nerve damage by bone fragments or wires. The fraction of degenerating myelinated fibers in the studied nerves was less than 13%. Reorganization of the Remak bundles led to a temporary increase in the number density of nerve fibers. Along with axonal atrophy, the peroneal nerve was characterized by demyelination-remyelination, and the tibial nerve was characterized by hypermyelination. The dynamics of numerical density of endoneurial blood vessels was also different. Despite minor sharp degenerative changes in myelinated fibers, persistent axonal atrophy, demyelination, and retrograde changes were not compensated for up to 120 days after removal of the apparatus. Correlations between the morphometric parameters of myelinated fibers and the M-response amplitude indicated a causal role of subclinical neurological changes in functional outcomes of fractures.
Annals of Clinical and Experimental Neurology. 2016;10(1):
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Aspirin resistance: clinical and molecular genetic evaluation techniques

Tanashyan M.M., Domashenko M.A., Raskurazhev A.A.

Abstract

The article discusses the issues related to the personalization of preventive measures for ischemic stroke, in particular those associated with resistance to one of the most common antiplatelet drugs, aspirin. A brief historical note on investigation of acetylsalicylic acid is provided. The paper addresses the issue of etiological factors and epidemiology of aspirin resistance. Ananalysis and comparison of various techniques for evaluation of this phenomenon are performed. Separately, a molecular genetic aspect of the pathology is considered. In conclusion, the recommendations for overcoming tolerance to aspirin therapy are provided.
Annals of Clinical and Experimental Neurology. 2016;10(1):
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The neuroprotective efficacy of carnosine-containing nanoliposomes and S-trolox-carnosine under oxidative stress conditions in vitro and in vivo

Fedorova T.N., Stvolinskiy S.L., Kulikova O.I., Konovalova E.V., Levacheva I.S., Samsonova O.-., Bakovskiy U.-.

Abstract

We investigated the protective effect of carnosine (carnosine-containing nanoliposomes and newly synthesized S-trolox-carnosine) in experiments in vivo on a model of acute hypobaric hypoxia in rodents and in vitro on neuronal cultures under oxidative stress conditions. We demonstrated the ability of new carnosine compounds to increase resistance of animals to acute hypobaric hypoxia, protecting the brain from oxidative damage. This effect is accompanied by preservation of acquired skills in the Morris water maze test, which is likely related to an increased efficiency of the brain antioxidant system. When oxidative stress was induced by hydrogen peroxide, spermine, acrolein, or cadmium in a suspension of cerebellar granule cells of the SAMP1 mouse line, a primary culture of rat cerebellar neurons, and a culture of neuronally differentiated PC-12 cells, carnosine (carnosine-containing nanoliposomes and S-trolox-carnosine) was able to inhibit generation of reactive oxygen species and reduce death of cells, enhancing the cell viability. The study results demonstrate high antihypoxic and antioxidant activities of the new carnosine compounds and open up prospects for the development and use of carnosine-based drugs in neurology.
Annals of Clinical and Experimental Neurology. 2016;10(1):
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A febrile epileptic status in a child: FIRES syndrome. A case report

Shatalin A.V., Kotov A.S., Borisova M.N., Panteleeva M.V., Matyuk Y.V., Romanova M.V., Kurysheva I.Y., Razheva I.V.

Abstract

The article describes a clinical case of severe childhood epileptic syndrome, FIRES (DESC) syndrome, which is a form of epileptic encephalopathy in school-age children caused by hyperthermia. The emergence of this severe childhood condition leads to involvement of all diagnostic and human resources available at a pediatric critical care clinic to identify and treat this form of epileptic paroxysm. The described clinical case also had a severe course with a prolonged epileptic status, which was resistant to antiepileptic pharmacotherapy, and hyperthermia. The presented case is a modest contribution to the treasury of information about this syndrome in our country, with the aim to increase the doctors’ awareness of the problem.
Annals of Clinical and Experimental Neurology. 2016;10(1):
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A clinical value of neuroplasticity in ischemic stroke

Damulin I.V., Ekusheva E.V.

Abstract

The article discusses the phenomenon of neuroplasticity and itsfeatures after stroke. The main methods for studying processes of reorganization and plastic changes in the central nervous system are described. Particular attention is paid to the factors determining post-stroke structural and functional reorganization, time parameters starting with the onset of stroke, and stages of post-stroke plastic reorganization; as well as to the afferent and efferent components of neuroplasticity that are closely interrelated. Various aspects of structural and functional reorganization both in the early ontogeny and in the acute and subacute period after stroke are considered. The role and significance of activation patterns in both cerebral hemispheres in recovery of impaired functions after stroke are discussed. The dynamism of neuroplasticity processes and their significance for the poststroke rehabilitation period are emphasized.
Annals of Clinical and Experimental Neurology. 2016;10(1):
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A role of genetic factors in the development of individual predisposition to ischemic stroke

Korchagin V.I., Mironov K.O., Dribnokhodova O.P., Maxsimova M.Y., Illarioshkin S.N., Tanashyn M.M., Platonov A.E., Shipulin G.A., Raskurazhev A.A., Piradov M.A.

Abstract

Intensive development of DNA analysis technologies and largescale genome-wide association studies have led to accumulation of a large array of data on the relationship between genetic factors and various phenotypic manifestations, including monogenic and polygenic hereditary diseases. This greatly has extended the capabilities of clinical diagnostics and predictive medicine in the field of socially significant diseases. For example, a role of a genetic component of the risk for such a multifactorial and polyetiologic disease as stroke is now actively explored. Large-scale studies have revealed both general and specific genetic markers associated only with a certain type and subtype of stroke. This review analyzes the current state of the problem of using genetic markers for diagnosis of stroke predisposition, complex issues associated with multiplicity of risk factors for stroke, and possible development in this area.
Annals of Clinical and Experimental Neurology. 2016;10(1):
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