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Aim. To develop a method for predicting the development of complications in rhinosinusitis patients based on the cytokine profile study. Methods. We examined 110 patients with rhinosinusitis and 30 healthy donors (control group). The patients were divided into the group without a complicated course of rhinosinusitis (first group, n=65) and the group with a complicated course of rhinosinusitis (second group, n=45). The blood serum levels of interleukin (IL)-1, IL-4, IL-8, IL-10, IL-17, IL-18, interferon (IFN)- were determined by enzyme immunoassay. Statistical analysis of the results was performed by using Microsoft Excel 2013 and Statistica 12.0 software. Statistically significant differences between the compared groups were determined by using the MannWhitney U-test, and p 0.05 was considered significant. Multivariate analysis included correlation analysis and stepwise regression analysis. The mathematical model consistency was determined by using Fisher's F-test, and p 0.05 was considered significant. Results. Changes in cytokine profile manifested by a decrease in the level of interleukin-1 (p=0.00001), interleukin-4 (p=0.045) and an increase in the level of interleukin-18 (p=0.00001) were revealed in patients with uncomplicated course of rhinosinusitis. The complicated course of rhinosinusitis was characterized by a decrease in the level of interleukin-1 (p=0.00002), interleukin-4 (p=0.049) and an increase in the level of interleukin-8 (p=0.023), interleukin-17 (p=0.00015) and interleukin-18 (p=0.0002). Comparative analysis of the first and the second groups of patients showed an increased level of interleukin-8 (p=0.00001), interleukin-17 (p=0.0001) and reduced levels of interleukin-18 (p=0.00045) in the group of patients with complicated course of rhinosinusitis. Based on interleukin-17, interleukin-8 and interleukin-18 levels, the mathematical model for predicting the development of complications in patients with rhinosinusitis was developed. Conclusion. The complicated course of rhinosinusitis was characterized by decreased levels of interleukin-1, interleukin-4 and increased levels of interleukin-17, interleukin-8 and interleukin-18, indicating a more pronounced inflammatory process; for personalized therapy, an approach based on interleukin-17, interleukin-8 and interleukin-18 levels was developed on which the development of a complicated course in patients with rhinosinusitis can be predicted.

Migraine is a common disease in pediatric practice. Its manifestations are extremely diverse in children. Pediatric migraine equivalents are a group of different disorders that are closely related to migraine and are more common in children long before the manifestation of migraine headache. Their verification presents significant difficulties in clinical practice, and this often predetermines the use of inadequate management strategies for these patients. Meanwhile, the diagnosis of and approaches to treating pediatric migraine equivalents have their own characteristics, the knowledge of which can significantly determine quality of life in patients. The paper considers modern ideas about pediatric periodic syndromes and data on their relationship to migraine and discusses the issues of their diagnosis and treatment.

ObjectivesSchool-age children with and without parent-reported listening difficulties (LiD) were compared on auditory processing, language, memory, and attention abilities. The objective was to extend what is known so far in the literature about children with LiD by using multiple measures and selective novel measures across the above areas.DesignTwenty-six children who were reported by their parents as having LiD and 26 age-matched typically developing children completed clinical tests of auditory processing and multiple measures of language, attention, and memory. All children had normal-range pure-tone hearing thresholds bilaterally. Group differences were examined.ResultsIn addition to significantly poorer speech-perception-in-noise scores, children with LiD had reduced speed and accuracy of word retrieval from long-term memory, poorer short-term memory, sentence recall, and inferencing ability. Statistically significant group differences were of moderate effect size; however, standard test scores of children with LiD were not clinically poor. No statistically significant group differences were observed in attention, working memory capacity, vocabulary, and nonverbal IQ.ConclusionsMild signal-to-noise ratio loss, as reflected by the group mean of children with LiD, supported the children's functional listening problems. In addition, children's relative weakness in select areas of language performance, short-term memory, and long-term memory lexical retrieval speed and accuracy added to previous research on evidence-based areas that need to be evaluated in children with LiD who almost always have heterogenous profiles. Importantly, the functional difficulties faced by children with LiD in relation to their test results indicated, to some extent, that commonly used assessments may not be adequately capturing the children's listening challenges.Supplemental Materialhttps://doi.org/10.23641/asha.12808607

Migraine is one of the most common types of headache, which can lead to a significant decrease in quality of life. Researchers identify migraine with aura, migraine without aura, and chronic migraine that substantially reduces the ability of patients to work and is frequently concurrent with mental disorders and drug-induced headache. The complications of migraine include status migrainosus, persistent aura without infarction, migrainous infarction (stroke), and a migraine aura-induced seizure. The diagnosis of migraine is based on complaints, past medical history, objective examination data, and the diagnostic criteria as laid down in the International Classification of Headache Disorders, 3 rd edition. Add-on trials are recommended only in the presence of red flags, such as the symptoms warning about the secondary nature of headache. Migraine treatment is aimed at reducing the frequency and intensity of attacks and the amount of analgesics taken. It includes three main approaches: behavioral therapy, seizure relief therapy, and preventive therapy. Behavioral therapy focuses on lifestyle modification. Nonsteroidal anti-inflammatory drugs, simple and combined analgesics, triptans, and antiemetic drugs for severe nausea or vomiting are recommended for seizure relief. Preventive therapy which includes antidepressants, anticonvulsants, beta-blockers, angiotensin II receptor antagonists, botulinum toxin type A-hemagglutinin complex and monoclonal antibodies to calcitonin gene-related peptide or its receptors, is indicated for frequent or severe migraine attacks and for chronic migraine. Pharmacotherapy is recommended to be combined with non-drug methods that involves cognitive behavioral therapy; progressive muscle relaxation; mindfulness; biofeedback; post-isometric relaxation; acupuncture; therapeutic exercises; greater occipital nerve block; non-invasive high-frequency repetitive transcranial magnetic stimulation; external stimulation of first trigeminal branch; and electrical stimulation of the occipital nerves (neurostimulation).

The paper deals with the actual problem of managing patients with drug-induced headache (DIH) in patients with primary headaches. It describes a clinical case of extremely severe DIH in a patient with chronic tension headache (TH). The paper analyzes the typical and atypical manifestations of DIH and discusses the role of prolonged stress in the development of TH. Special attention is paid to the problems with therapy and compliance during a long-term follow-up of the patient. Based on the clinical features of pain syndrome in the described patient, the authors suggest for the first time that the use of extremely high number of daily doses of combined narcotic analgesics for many years can result in recurrent DIH statuses. The paper discusses whether it is expedient to introduce the concept “DIH severity” and whether an additional clinical parameter “the number of doses of painkillers per month” can be of informative value, which has not been proposed yet in the literature. All the issues given in the paper are conjectural and are raised by the authors for further investigation of the DIH problem.

Introduction There is evidence in the literature over the past 5 years that pelvic and acetabular fractures are increasing in prevalence with the rise of injuries sustained in road traffic accidents, the growing number and severity of trauma, significant complication rate and unsatisfactory outcomes due to untimely surgical treatment. Objective Review current trends in the selection of surgical approaches and fixation of the pelvis and acetabulum, the postoperative rehabilitation strategies and identify factors for poor outcomes of surgical treatment. Material and methods We performed searches using HAC peer-reviewed and SCOPUS indexed journals, EMBASE, MEDLINE, Сochrane library, еLibrary.ru, Wiley Online Library with search criteria of pelvic fractures, displaced acetabular fractures, open reduction of the pelvis and acetabulum, osteosynthesis, minimally invasive osteosynthesis and primary total hip arthroplasty, approaches and complications of acetabular fracture surgery. Results Indications to surgical treatment of patients with concomitant, multiple and isolated fractures of the pelvis and acetabulum were identified with the use of current strategy and principles of damage control surgery and damage control orthopaedics. Surgical approaches for two-column acetabular fractures have been shown to be extensile and traumatic. Discussion Most authors report use of the active surgical strategy for displaced fractures of the pelvis and acetabulum. Open reduction internal fixation is the standard of care for pelvic and acetabular fractures. Conclusion Postoperative complications and long term rehabilitation of patients with pelvic and acetabular fractures support further research and development of new more effective approaches to address the solution of the challenging issue.

Cervicogenic headache (CH) is a syndrome of referred pain that originates in the neck structure. Despite the apparent simplicity of its determination, there is still no consensus on diagnostic criteria for cervicogenic headache amongst physicians of various specialties. In what cases is headache concurrent with neck pain a consequence of the pathology of the neck region, and in what cases is neck pain a consequence of a migraine attack? The review deals with the diagnosis, differential diagnosis, and therapy of CH.

To study asthenic symptoms in patients with adjustment disorders and to assess the efficacy of cytoflavin in their treatment.The study included 100 patients, aged 20 to 43 years, with a diagnosis of adjustment disorder. Clinical, neurophysiological and parametric methods were used. An asthenic state scale, the Multidimensional Fatigue Inventory (MFI-20), a digital rating scale (a 10-point variant) and the Headache Impact Test (HIT-6), the Psychological Stress Measure (PSM-25), the Cognitive Emotion Regulation Questionnaire, the Test of Variables of Attention (TOVA) were administered. Cytoflavin was used in a dose of 2 tab. 2 times a day for 25 days for the treatment of patients from the study group.In the study group, 48.0% of patients had a pronounced degree of asthenia, and 52% had a moderate one. The clinical improvement was achieved in 73.0%. In the subgroup with moderate asthenia, the improvement was recorded in 88.5% of cases, in the subgroup of patients with severe asthenia in 56.3% of patients. There was a significant decrease in the severity of indicators on the scales of general asthenia, decreased activity and mental asthenia; a significant decrease in the integral indicator of mental tension, a significant improvement in the indicator of attention, a decrease in the frequency and intensity of headache. The improvement in the functional state of the brain in the form of a decrease in the power of the alpha rhythm in the anterior cerebral cortex was shown.The results of the study allow us to conclude that the use of cytoflavin is effective in the treatment of adjustment disorders.Изучение астенических симптомов, возникающих на фоне расстройств адаптации с оценкой эффективности применения препарата цитофлавин в терапии таких нарушений.Под наблюдением находилось 100 пациентов в возрасте от 20 до 43 лет с диагнозом «расстройство адаптации». В работе использовались клинический, нейрофизиологический и параметрический методы исследования. Применялись шкала астенического состояния, Субъективная шкала оценки астении (MFI-20), цифровая рейтинговая шкала (10-балльный вариант) и индекс влияния головной боли (HIT-6), шкала психологического стресса PSM-25, опросник когнитивной регуляции эмоций (Cognitive Emotion Regulation Questionnaire), психофизиологический тест TOVA (The Test of Variables of Attention) для количественной оценки нарушений внимания и импульсивности. Для лечения пациентов исследуемой группы был использован препарат цитофлавин в дозе по 2 таблетки 2 раза в сутки в течение 25 дней.Согласно полученным данным, в исследуемой группе у 48,0% пациентов регистрировалась выраженная степень астении, а у 52% — умеренная. После курса лечения клиническое улучшение отмечалось у 73,0% пациентов, включенных в исследование. В подгруппе с умеренной степенью астении улучшение регистрировалось в 88,5% случаев, в подгруппе пациентов с астенией выраженной степени — у 56,3% пациентов. Отмечалось достоверное уменьшение выраженности показателей по шкалам общей астении, пониженной активности и психической астении; достоверное снижение интегрального показателя психической напряженности, достоверное улучшение показателя внимания, уменьшение частоты и интенсивности головной боли. После курса цитофлавина отмечено улучшение функционального состояния головного мозга в виде уменьшения мощности альфа-ритма в передних отделах коры больших полушарий. Таким образом, результаты настоящего исследования позволяют сделать вывод об эффективности применения цитофлавина в лечении расстройств адаптации.

The paper presents a case of generalized candidomycosis in a 67-year old woman. Literature data regarding the cases of respiratory mycoses and candida sepsis are summarized. This case is interesting from the point of view of difficulty of differential diagnosis in patients with respiratory mycosis and tuberculosis, choice of adequate treatment.

This study reveals the new method - endoprosthetic Achilles tendon. As a result of the study the optimal implant was created, operational surgery of Achilles tendon endoprosthetics was modified and the recover program was formed. Current method allows to avoid immobilization of the operated limb but to carry out early rehabilitation activities and exercises with intent to restore triceps muscular strength. The remote results in 6 month's after Achilles tendon replacement in 34 patients were excellent, in 46 patients were good and in 1 patient were unsatisfactory.

Management of variability of the cardiac rhythm (VCR) is widely applied as a marker of psycho emotional state in educational institutions. This approach is suitable for testing properties of the pupils for the detection of vocal signals. The aim of the study was a comparative analysis of VCR as an objective parameter corresponded with psycho-emotional tension and acoustic perception of the speech in youngsters under sophisticated condition of the competition between vocal signals pronounced by different individuals. Methods. VCR was measured in 44 male and female youngsters 1316 years old with the comparison of identification of competing acoustic signals random sequences of words simultaneously pronounced by male or female voice. VCR analysis provided distinction the prevalence of sympathetic versus parasympathetic tone reflecting high or moderate level of psycho-emotional tension. Results. Identification of target words pronounced by female voice in subjects with prevalence of sympathetic or parasympathetic tone was correct in 96% and 87% respectively. Target words pronounced by the male voice were correctly identified in 88% cases in both groups. It is suggested that in primary schools where women compose majority of teachers, the developing juvenile brain imprints the corresponding acoustic wave band. Under the conditions of psycho-emotional tension these links are realized with maximal effectiveness.

Funding Acknowledgements Type of funding sources: None. The increasing activity of the sympathetic nervous system was shown during myocardial infarction (MI). There are data that bio management application increases the vagal influences on a heart rate for patients with chronic coronary artery disease. The purpose of this study was the assessment of changes of vegetative regulation of heart rate in patients with MI, receiving along with standard methods of treatment and rehabilitation sessions of cardiorespiratory training (KRT). 48 patients with IM in an early period of disease at the age from 40 till 70 years were surveyed. The main group was created from 29 people by whom KRT (5–10 sessions) was carried out. The assessment of efficiency and safety of KRT was carried out on a clinical picture and parameters of heart rate variability (HRV) before, after, and during KRT. The Control group consisted of 19 patients receiving only standard treatment. To exclude hyperventilation syndrome, capnometry was performed before the start of the KRT session to determine the FetCO2 individual norm for the certain patient to control the training process in a particular session. After each active sample, the concentration of carbon dioxide in the air exhaled by the patient was measured, and when it decreased below 95% of the initial value, the depth of breathing was adjusted. The use of capnometry in the study avoided adverse events during the sessions. During carrying out of KRT, and after KRT worsening of the clinical picture at patients of the main group was not observed. HRV analysis at patients of the main group showed that after the end of KRT decrease in an index of tension (p Thus, the application of KRT realizing a mode of functional bio management of heart rate, as the instrument of psychophysiological support of standard medicament therapy showed the efficiency of its use in the program of rehabilitation of patients with myocardial infarction. The result of a comprehensive approach is the reduction of sympathetic and increase of vagal influences on heart rate, normalization of the main indicators of the cardiovascular system.

Funding Acknowledgements Type of funding sources: None. The increasing activity of the sympathetic nervous system was shown during myocardial infarction (MI). There are data that bio management application increases the vagal influences on a heart rate for patients with chronic coronary artery disease. The purpose of this study was the assessment of changes of vegetative regulation of heart rate in patients with MI, receiving along with standard methods of treatment and rehabilitation sessions of cardiorespiratory training (KRT). 48 patients with IM in an early period of disease at the age from 40 till 70 years were surveyed. The main group was created from 29 people by whom KRT (5–10 sessions) was carried out. The assessment of efficiency and safety of KRT was carried out on a clinical picture and parameters of heart rate variability (HRV) before, after, and during KRT. The Control group consisted of 19 patients receiving only standard treatment. To exclude hyperventilation syndrome, capnometry was performed before the start of the KRT session to determine the FetCO2 individual norm for the certain patient to control the training process in a particular session. After each active sample, the concentration of carbon dioxide in the air exhaled by the patient was measured, and when it decreased below 95% of the initial value, the depth of breathing was adjusted. The use of capnometry in the study avoided adverse events during the sessions. During carrying out of KRT, and after KRT worsening of the clinical picture at patients of the main group was not observed. HRV analysis at patients of the main group showed that after the end of KRT decrease in an index of tension (p Thus, the application of KRT realizing a mode of functional bio management of heart rate, as the instrument of psychophysiological support of standard medicament therapy showed the efficiency of its use in the program of rehabilitation of patients with myocardial infarction. The result of a comprehensive approach is the reduction of sympathetic and increase of vagal influences on heart rate, normalization of the main indicators of the cardiovascular system.

Baroreflex is an important mechanism for controlling arterial blood pressure (BP). The effectiveness of the baroreflex action is very important diagnostic indicator of cardiovascular system regulatory mechanisms. To assess the effectiveness of baroreflex action, it is necessary to analyze the relationship between the systemic hemodynamics, and in particular, between the signals of beat-to-beat values of blood pressure and heart rate (HR). The paper proposes an algorithm for the joint analysis of these signals. The purpose of the algorithm is the allocation of signal sections with predominantly in-phase and antiphase relationships. The algorithm is based on the window Fourier transform analysis and window calculation of the correlation coefficient, wherein window width is determined from the standard frequency ranges of the cardiac rhythm. Spectral and spectral-temporal analysis is used for generalized qualitative assessment of the interdependence between the signals of beat-to-beat BP values and heart rate. To test the algorithm, we performed synchronous recording of BP and heart rate for 300 s in healthy subjects under conditions of calm wakefulness with eyes closed. The results of their analysis with proposed algorithm are presented.

The high social significance and the development of new methods for the diagnosis and diseases and injuries treatment of the cervical spine necessitate a detailed study of the mechanisms of change and the development of new methods for diagnosing its functional state. The article is devoted to one of the subjects of the Medical Radio Electronics Department (No. 24) of St. Petersburg State University of Aerospace Instrumentation (SUAI) research work. With the task of developing tools for the comprehensive study of physiology and pathophysiology of the cervical spine by registering muscle and other neuronal surface bioelectric activity of this area. In order to solve this problem, the prototype lay out of the hardware-software complex to study the physiology and pathophysiology of the cervical spine using registration of neuronal and muscle activity was developed.

Background: Premature mortality under the age of 75 years exacerbates the burden of coronary artery disease (CAD) as the leading cause of death in the nation, with particular concerns being raised about its disproportionate effect on the vulnerable population of the Appalachian region compared to other regions of the United States. It is unknown whether the problem of premature CAD mortality in the Appalachian residents is further aggravated by disparities across various population groups within the Appalachian region itself. We hypothesized that within-region socioeconomic and geographic (rural-urban) disparities, independently of each other, aggravate the premature CAD mortality problem in the Appalachian population. Methods: A population-based study of age-adjusted premature CAD mortality among 25-74 year old residents of the Appalachian region was conducted (n=63,630,221). Counties’ rurality status was defined using the U.S. Department of Agriculture Economic Research Service’s (USDA ERS) Rural-Urban Continuum Codes: of 420 Appalachian counties, 217 were classifies as rural and 203 - as urban. To adjust for multiple covariates, general linear modeling (GLM) analysis was conducted (SAS, ver. 9.4). Results: Age-adjusted premature CAD mortality rates were higher in rural than urban Appalachian counties: 99.0 + 40.2 vs. 78.8 + 26.4 per 100,000 (p+ 7.3% vs. 24.4 + 5.7%, p+ 2.0% vs. 6.7 + 1.2%, p+ 3.5% vs. 16.0 + 3.6%, p+ 3.8% vs. 20.2 + 2.9%, p+ 3.8% vs. 32.0 + 3.5%, p+ 4.5% vs. 29.6 + 4.7%, pbeta 3.322, pbeta 0.947, pbeta -0.532, pbeta 2.761, pbeta 0.652, p Conclusions: Premature CAD mortality in rural Appalachian counties is statistically significantly higher than in urban Appalachian counties. Socioeconomic disparities and modifiable CAD risk factors further aggravate the problem.

Objective.To assess the outcomes of the treatment of patients with suppurative necrotic complications of diabetic foot syndrome (DFS) without critical ischemia with the use of programmed rehabilitation technologies (PRT).Materialand methods.The study included 82 patients. 40 patients (reference group) underwent conventional rehabilitation, while 42 patients (study group) were treated with PRT with the use of the original equipment AMP-01.Results.Use of PRT has been established to significantly improve the quality of rehabilitation, which helps to reduce the duration of inpatient treatment. The number of suppurative complications in the study group proved to be significantly less (p=0.014), and postoperative mortality was lower. The long-term outcomes of the treatment (number of late suppurative complications, ischemia progression, maintenance of foot support ability) in the study group was also found to be significantly better compared to the reference group.Conclusion.The use of PST promotes the improvement of short-term and long-term outcomes of the treatment of the patients with DFS suppurative necrotic complications.

Objectives. To clarify cognitive impairments in adults with attention deficit hyperactivity syndrome (ADHD) and to assess the efficacy of the formulation Memoplant in the treatment of this pathology. Materials and Methods. The results of clinical, psychological, and electroencephalographic studies of 40 patients aged 18–45 years with ADHD are presented. From recruitment into the study, all patients received Memoplant at a daily dose of 240 mg for eight weeks. Results and conclusions. Adult patients with ADHD had both subjective and objective impairments to memory and attention. EEG results suggested that patients showed dysfunction of the frontothalamic regulatory system and deficit of nonspecific activation by the reticular formation. Courses of Memoplant were followed by clinical improvements in 24 patients (60.0%). Repeat psychological and neurophysiological studies demonstrated decreases in attention deficit and improvements in memory measures.

Aim of the study: to assess non-motor symptoms and quality of life in patients with essential tremor (ET), different stages of Parkinson’s Disease (PD) and combination of ET and PD (ET-PD). Materials and methods of the research: We examined 82 patients with ET, 20 patients with ET-PD, 283 patients with PD, and 72 neurologically healthy volunteers. The neuropsychological status, intensity of motor symptoms, the grade of vegetative dysfunction and dyssomnia, and quality of life of patients were assessed. Results: Patients with ET showed wide range of nonmotor symptoms. The severity of cognitive impairment in group of patients with ET corresponded with the same severity of patients with early stages of PD. It is interesting that patients with ET showed more severe depression than patients with early stages of PD. The maximum severity of anxiety-depressive disorders was observed in patients with the combination of ET-PD. Conclusion: In spite of the fact that it is usual to consider the ET as a monosymptomatic benign disease, we have found significant non-motor disorders in this group of patients and a significant violation of the quality of life. The results of the study also give evidence that patients with ET-PD represent a special group of patients, characterized by special, both motor and non-motor symptoms. The data we obtained made it possible to form a deeper understanding of the generality of the clinical manifestations of ET, PD and ET-PD, which will make it possible to improve the quality of management of patients with these nosologies in clinical practice.

The technology of functional normalization of the cardiovascular system parameters by means of the alternating biofeedback on cardiac rhythm (cardiorespiratory training) with the use of a turning bed (verticalizer) is described, which allows to implement the oscillatory postural effects of ortho- and antiorthostatic nature automatically. Aim of the study. Increasing of application area of cardiorespiratory training due to the variety of options for biofeedback signals. Methods. The oscillation of the turning bed controlled by means of the parameters of heart rate variability sets for the examinee the order of alternation of the inspiration and expiration phases and the phases of the inspiration/expiration beginning. The method is available to patients with low vision, bedridden patients, early ages children; patients who are not able to understand the essence of the procedure. Results of researches. Positive dynamics of the test subjects’ functional state is, in particular, the normalization of activity of components of the autonomic nervous system; the reinstatement of the natural breathing pattern lost due to various reasons; increasing the variability of the heart rate; the cardiovascular system training due to moderate alternating ortho- and antiorthostatic load, estimated by number of physiological parameters.

Recommendations for the diagnosis and treatment of migraine based on the principles of evidence-based medicine are presented. The latest edition of the International Classification of Migraine is provided. Diagnostic methods and criteria are oriented to discriminating different types of migraine. Recommendations are given on the basis of data on the epidemiology and pathophysiological mechanisms of migraine. The most effective medication-based and non-medication-based approaches to the management of migraine patients are discussed.

Medication overuse headache (MOH) is defined as a secondary/symptomatic headache when HA occurs on 15 or more days per month, when the therapeutic agent is used excessively for three or more months. MOH is often combined with chronic forms of primary HA (chronic migraine and chronic tension headache). About 1% of the population periodically receives about 10 tablets of various analgesics per month. Due to high prevalence, high social and economic costs, high rates of recurrence, MOH represents a significant problem for both the health care system and practitioners. The review discusses issues of epidemiology, mechanisms of formation, diagnostic criteria and the most effective approaches to the treatment of MOH.

Currently, the number of patients with high-energy injuries of large segments of the skeleton due to road traffic and catotrauma is increasing. The number of patients with vascular pathology and disorders of the endocrine system is also increasing, which leads to a sharp increase in the population of patients who underwent limb amputation. Patients who underwent limb amputations present a significant medical and social problem. Stump malformations formed due to violations of surgical technique during reconstructive operations often complicate prosthetic fitting and the social adaptation of patients in this group. The possibilities of external prosthetics manufacturing are currently booming. Limb prosthetics manufacturing is a complex orthopedic, technical, biomechanical and general medical process, which results in medical and social rehabilitation. Functional results depend on the timing of prosthetics manufacturing. An important condition for safe walking is the preparation of a disabled person from the first days after amputation. An important role in the patient's rehabilitation is played by the school of walking, the purpose of which is to form the correct stereotype of walking, to learn how to walk on the prosthesis on various surfaces and to master actions in emergency situations.

E.V. Loshkarev (Klin. 1Med., 1926, No. 4), tracing the changes that are observed in this disease in white blood cells, found that the most characteristic of them is a drop in eosinophilia during seizures, with an increase in the number of eosinophils in favorable periods, and a similar change on the part of lymphocytes.

As you know, Ephedra vulgaris ("Kuzmich's grass") has been widely used in the treatment of rheumatism. Nagai, in 1887, extracted the alkaloid ephedrine from it.

Although the bites of venomous snakes found in Europe are far from so dangerous, cancer bites of a cobra, rattlesnake and other snakes found in India, Africa and America, nevertheless often (in 14%) and bites of our viper lead to death. If this is so, then the desire of researchers to find a correct remedy against poisoning with the poison of a viper that has got into the blood is understandable.

Already earlier, Barcroff (according to ref. Time Gaz., 1926, No. 13) indicated that one of the functions of the spleen is to preserve its supply of erythrocytes, which at certain moments - after hemorrhages, strong muscle exercises, etc.

AIM To determine the incidence of spreading bladder transitional cell carcinoma and primary adenocarcinoma to the prostate in patients with bladder cancer undergoing radical cystectomy. MATERIALS AND METHODS From 1995 to 2016, 283 men underwent radical cystectomy with removal of the bladder, perivesical tissue, prostate, seminal vesicles and pelvic lymph nodes. Prostate sparing cystectomy was performed in 45 (13.7%) patients. The whole prostate and the apex of the prostate were preserved in 21 (6.4%) and 24 (7.3%) patients, respectively. RESULTS AND DISCUSSION The spread of transitional cell cancer of the bladder to the prostate occurred in 50 (15.2%) patients. Twelve (3.6%) patients were found to have primary prostate adenocarcinoma. Clinically significant prostate cancer was diagnosed in 4 (33.3%) patients. CONCLUSION We believe that the high oncological risk of prostate sparing cystectomy, despite some functional advantages, dictates the need for complete removal of the prostate in the surgical treatment of bladder cancer.

To study emotional impairments in patients with migraine and to evaluate the efficiency of Noophen therapy for this pathology.63 patients aged 18 to 45 years with migraine without aura were examined. 56 patients used prophylactic antimigraine therapy: Group 1 (n = 26) received metoprolol and Group 2 took metoprolol in combination with Noophen.The patients with migraine had a significantly higher level of alexithymia than the controls. Concomitant anxiety disorders were found in 47 (74.6%) cases. The study provided evidence that the treatment was highly effective in Group 2 that exhibited a more pronounced decrease in pain intensity, a greater reduction in the levels of anxiety, and more vital activity.The results of this study allow a conclusion that emotional impairments are implicated in the pathogenesis and clinical presentations of migraine and that it is appropriate to use Noophen for the treatment of this pathology.Резюме Цель исследования. Изучение эмоциональных нарушений у пациентов с мигренью и оценка эффективности терапии данной патологии с применением препарата ноофен. Материалы и методы. Обследовали 63 пациента в возрасте от 18 до 45 лет, страдающих мигренью без ауры. 56 пациентам назначили профилактическую противомигренозную терапию. 26 пациентов 1-й группы получали метопролол, 2-й группы (n=30) - метопролол в комбинации с ноофеном. Результаты. Пациенты с мигренью характеризовались достоверно более высоким, чем в контрольной группе, уровнем алекситимии. В 47 (74,6%) случаях выявлены сочетанные тревожные расстройства. В ходе исследования доказана большая эффективность лечения во 2-й группе, в которой регистрировались более выраженное снижение интенсивности боли, большее снижение показателей тревоги и улучшение жизнедеятельности. Заключение. Результаты настоящего исследования позволяют сделать вывод о роли эмоциональных нарушений в патогенезе и клинической картине мигрени, а также о целесообразности применения препарата ноофен при данной патологии.

High prevalence of onychomycosis in developed countries is well-acknowledged. Less understanding one may find regarding clinical variability of the disease and the penetration of newer, effective diagnostic techniques to everyday derma- tology practice. Advent of dermoscopy as a diagnostic toolfor common skin and nail pathology may help diagnosing and differentiating onychomycosis in its early stages. Clinical experience gained by Russian dermatologists allows for describing major dermoscopic features of onychomycosis and devising a routine for its early diagnosis and treatment. Rational strategy of early intervention for onychomycosis embraces the population awareness, timely screening and administration of modern specialized forms of antifungals, such as amorolfine 5% lacquer.

To study the reactions of the cardiovascular system during continuous monitoring in the dynamics of their development and analysis of the main hemodynamic parameters during the movement and orientation of the subjects (postural loads), a vector-based method was developed for assessing changes in systemic hemodynamics parameters: stroke index and mean arterial pressure. The vector representation allows us to get an idea of the intensity of changes in the patient’s hemodynamic status, expressed through the length of the vector. Based on the proposed method, a classification of hemodynamic reactions was developed.

To study the effectiveness of intraoperative administration of Cytoflavine for the prevention of ischemic brain injury during cerebral aneurysm (CA) clipping with temporary occlusion of the leading artery under general anesthesia.The prospective cohort single-center study included 40 patients with CA ( the main group - 27 patients with intraoperative administration of cytoflavine; the comparison group -13 patients without use of cytoflavine), who underwent aneurism clipping with temporary occlusion of the afferent artery. We assesed the intraoperative state of the brain, the time of awakening and extubation of patients after surgery, neurological deficit and local ischemic changes in the area of surgery according to the CT of the brain in the early postoperative period, resuscitation bed-day and the relationship of these indicators with the duration of temporary occlusion of the afferent artery in the selected groups of patients.In intergroup comparison, patients of the main group treated with intraoperative cytoflavin showed a reduction in the time of awakening (p=0.013) and the time of extubation (p=0.01) both with temporary occlusion of the afferent artery and in patients without temporary occlusion (p0.05). The duration of resuscitation bed-day decreased in the main group of patients receiving intraoperatively cytoflavine (p=0.01), as well as in patients in the comparison group without temporary occlusion (p0.05).Temporary occlusion of the afferent artery with short intervals of vessel occlusion in combination with intraoperative intravenous administration of cytoflavine expands the tolerability to artery occlusion in patients operated in the 'cold' period, reduces the possibility of neurological deficit, reduces the recovery period and resuscitation bed-day after surgical clipping CA.Цель исследования - изучение эффективности интраоперационного введения препарата цитофлавин для профилактики ишемического повреждения головного мозга при нейрохирургических операциях клипирования церебральной аневризмы (ЦА) с использованием временной окклюзии приводящей артерии в условиях общей анестезии. Материал и методы. В проспективное когортное одноцентровое исследование включены 40 пациентов с ЦА (основная группа - 27 больных с интраоперационным введением цитофлавина; группа сравнения - 13 пациентов без использования цитофлавина), оперированных открытым способом с плановым использованием методики временной окклюзии питающей аневризму артерии. Определяли интраоперационное состояние мозга, сроки пробуждения и экстубации больных после выполнения хирургического вмешательства, неврологический дефицит и локальные ишемические изменения в зоне оперативного вмешательства по данным СКТ головного мозга в раннем послеоперационном периоде, реанимационный койко-день и взаимосвязь этих показателей с длительностью временной окклюзии приводящей артерии в выделенных группах пациентов. Результаты. При межгрупповом сравнении у пациентов основной группы, получавших интраоперационно цитофлавин, отмечено сокращение сроков пробуждения (p=0,013) и экстубации (p=0,01) как с временной окклюзией питающей аневризму артерии, так и без временного клипирования приводящего сосуда (p0,05). Продолжительность реанимационного койко-дня уменьшалась в основной группе пациентов, получавших интраоперационно препарат цитофлавин (p=0,01), а также у больных в группе сравнения без временного клипирования (p0,05). Выводы. Временное клипирование питающей аневризму артерии с короткими интервалами окклюзии сосуда в сочетании с интраоперационным внутривенным введением цитофлавина расширяет переносимость окклюзии артерии у пациентов, оперированных в 'холодном' периоде, уменьшает возможности возникновения неврологического дефицита, сокращает сроки восстановительного периода и реанимационного койко-дня после оперативного лечения клипирования ЦА.

Background:With new technologies for body composition assessment determining changes learn, muscle and fat mass. Prevention of sarcopenic obesity is timely detection of decrease.Objectives:Aim of the study was to compare the effectiveness of three methods of body composition assessment such as bioimpedans analysis (BIA), air-replacement bodyplatismography (BodPod) and Dual X-ray absorptiometry Total body program (DXA Total Body) in the verification of reducing of skeletal muscle mass as sign of sarcopenic obesity in obese patients.Methods:The study group included 95 patients aged 21-69 y.o. (average age 53,9±11,05 years) with BMI≥30.0 kg/m2. The control group included 37 patients aged 37-69 y.o (average age 50,73±10,6 years) of the same age without obesity with BMI 20.0-29.9 kg/m2. Body composition was tested using BIA, BodPod and DXA with calculating fat, lean and skeletal muscles mass (kg) and % in all the patients.Results:According to BIA the groups differ only in fat mass (FM) 42.75 (4.8;6.3) vs. 33.15 (28.4;35.5) kg; p=0.036 and did not differ (p>0.05) in lean (LM), skeletal muscle mass (SMM) and in % of FM and SMM. According to BodPod analyses groups differed in the FM 3.4 [36.81;69.94] vs 31.02 [23.22;38] kg, p=0.007, % FM 45.4 [42.1;53.8] vs 37.7 [28.6;41.1], p=0.003 and % LM - 54.6 [46.2;57.9] vs 62.3 [58.9;71.4], p=0.003, but had statistically equivalent values of LM 55 [49.48;67.77] vs 40.36 [33.12;49.06] kg, p=0.19. According to DXA Total Body analyses statistically significant differences (p0.05), but not in LM and % LM (p>0.05) (Table 1).Table 1.Effectiveness of three methods for body composition assessmentINDICATORSSTUDY GROUPCONTROL GROUPpWeight (kg)106 [96;122]80 [77;81]0.00251BMI (kg/m2)37.6 [104;124]26.8 [24;30]0.000000Bod Pod% fat mass45.4 [42.1;53.8]37.7 [28.6;41.1]0.003424% lean mass54.6 [46.2;57.9]62.3 [58.9;71.4]0.003424fat mass (kg)43.4 [36.81;69.935]31.016 [23.223;38.004]0.006836lean mass (kg)55.002 [49.48;67.77]40.359 [33.122;49.058]0.185377BIAfat mass (kg)42.75 [4.8;6.3]33.150 [28.4;35.5]0.035771lean mass (kg)59.5 [53.95;71.05]54.850 [49.9;62.6]0.458312skeletal muscle mass (kg)27.9 [23.9;33.2]25.6 [22;29.3]0.701678skeletal muscle mass (%)45.3 [43.3;47.7]47.1 [42.3;48.1]0.415687DXA Total Bodytotal body lean mass (g)97276 [86062; 109154]62628 [57839; 85068]0.602523total body fat mass (g)47030 [39300; 56729]25652 [22164; 36396]0.009796total body muscle mass (g)49861 [42793; 57088]36426 [32273; 43341]0.973711Conclusion:From methods of body composition assessment, air-replacement bodyplatismography (BodPod) is the most sensitive in the verification of skeletal muscle mass reduction in obese patients. This method shows that patients with obesity have a significantly reduced muscle mass compared with normal weight or overweight subjects.References:[1]L. A. Marchenkova, V. A. Vasileva, Motor and balance function disorders and possibilities of their correction in patients with obesity and metabolic syndrome // Lechashchiy vrach. 2019. № 4. S. 68.[2]P. Corbeil, M. Simoheau, D. Rancourt, A. Tremblay, N. Teasdale, Increased risk for falling associated with obesity: mathematical modeling of postural control // IEEE Transactions on Neural Systems and Rechabilitation Enqineering. 2001; 9 (2): 126-136.Disclosure of Interests:None declared

Post-stroke cognitive impairment and dementia are one of the major causes of the disability and quality of life deterioration following cerebrovascular accident. In this review we cover current views on the prevalence, mechanisms and risk factors of post-stroke cognitive deficit, according to recent publications of leading European opinion leaders in this area. We also focus on the approaches to the pharmacological treatment and the role of neuroprotective agents.

At a video facility for the study of intravital brain microcirculation, we found that, after a course treatment with vascular peptide bioregulator, the microvasculature density of the pial tunic in old (22–24 months) rats increased by about 2.5–2.8 times; the constriction and dilative reactions of the pial arterioles increased after the application of noradrenaline and acetylcholine onto the brain surface, respectively. However, perfusion into brain tissues did not increase, but the degree of oxygen saturation in microvessels of this tissue region increased.

Using a TV unit for microcirculation studies, we studied the density of the entire microvascular network and its arterial compartment in the pia mater of the sensorimotor cortex in intact young and aged rats (2-3 and 22-24 months) and aged rats after a course of vascular peptide bioregulator Slavinorm. The experiments showed that the density of microvascular network in intact animals decreased by 1.6 times with aging. Treatment with the peptide bioregulator 2.5-fold increased the density of the microvascular network in aged rats in comparison with intact animals of the same age, the density of the arterial compartment of the microvascular network in the pia mater increased by 2.8 times.

Objective: to investigate survival in patients with bladder cancer (BC) after radical cystectomy (RCE). Subjects and methods. Our clinic performed RCE using different urine derivations in 375 patients with BC. There were 324 (86.4%) men and 51 (13.6%) women. All the patients underwent clinical, laboratory, ultrasound, X-ray, and radiation studies. Results. The 10-year overall and cancer-specific survival rates were 43.4 and 47.2%, respectively. In patients without regional lymph node (LN) metastases, the 2- and 3-year overall survival rates were 81.2 and 67.2%. In those with regional LN metastases, the 2- and 5-year overall survival rates were 46.9 and 13.9%. In the negative LN group, the 2- and 5-year cancer-specific survival rates were 83.6% and 70.7%, respectively. In the positive LN group, these were 51.0 and 15.1%. The overall and cancer-specific survival rates also declined with higher tumor stage and grade. Conclusion. Tumor stage, regional LN metastases, and histopathological grade have a considerable independent impact on the overall and cancer-specific survival rates of patients with BC following RCE.

Topical treatment for onychomycosis gains momentum in dermatological practice as well as in antifungal formulations research pipeline. Decades of clinical use of internationally available antifungals bring no consensus on real clinical efficacy of topical monotherapy of fungal nail infection. Recommendations of national societies and expert bodies offer no clear guidance on principles and practice of combination therapy with systemic and topical antifungals. Clinical trials conducted to date indicate evidence-based superiority of naftifine 1% topical formulations in management of tinea pedis and onychomycosis. Recently, Russian and international authors evaluated the benefits of antifungal solutions in treatment of onychomycosis. New data on pathophysiology of fungal nail infection and local pharmacokinetics of drugs inside the affected nail elucidate the success of 1% solution of naftifine in topical treatment of onychomycosis.

In recent years, interest in non-drug methods of treating cardiovascular diseases, including the use of postural effects for rehabilitation purposes, has significantly increased. Hemodynamic reactions during postural effects are associated with a significant redistribution of blood and can be used to achieve certain positive hemodynamic reactions, and the problem of controlling the main hemodynamic parameters arises. To solve this problem, the complex of diagnostic indicators was expanded, in addition to those already included in clinical practice, such as arterial stiffness and central arterial pressure evaluation (they are important for identifying people with high cardiovascular risk). To achieve this goal, the developed system includes additional measuring channels, algorithms for processing the received signals, implemented methods for assessing the patient’s condition using an extended set of indicators.

Differential diagnosis of migraine, can be difficult, especially of migraine with aura. On the one hand, some diseases can produce symptoms similar to migraine (cerebral aneurysm before rupture, reversible cerebral vasoconstriction syndrome). On the other hand, migraine with aura and some other disorders are conditions that have common pathophysiological mechanisms (e.g., CADASIL and MELAS syndrome, antiphospholipid syndrome). Thirdly, clinical presentations of migraine are often difficult to distinguish from features of other headache conditions (migraine with aura - transient ischemic attack, migraine with visual aura - occipital epilepsy). The author discusses the differential diagnosis of acute headache, especially thunderclap headache, and main strategies of effective treatment of migraine attacks.Разнообразие клинических проявлений мигрени может приводить к сложностям в диагностике. Во-первых, некоторые заболевания обладают схожими с мигренью симптомами (например, церебральная аневризма до разрыва, синдром обратимой церебральной вазоконстрикции). Во-вторых, мигрень и другие заболевания могут иметь одинаковые механизмы развития (например, синдромы CADASIL и MELAS, антифосфолипидный синдром). В-третьих, истинную мигрень клинически сложно отличить от другой патологии (мигрень с аурой - транзиторная ишемическая атака, мигрень со зрительной аурой - варианты затылочной эпилепсии). В обзоре обсуждаются дифференциальный диагностический поиск при остро развившейся интенсивной головной боли, синдром 'громоподобной' головной боли и основные стратегии эффективного купирования приступов мигрени различной тяжести.

Aims: Alice-in-Wonderland syndrome (AIWS) is a rare neuropsychological syndrome that includes paroxysmal distortion of the body schema, depersonalization, derealization, visual hallucinations, distorted sense of time, and deja vu and jamais vu experiences. Alice-in-Wonderland syndrome may be an equivalent of a migraine attack. The objective of this study was to evaluate the clinical particulars of Alice-in-Wonderland syndrome in patients suffering from migraine. Place and Duration of Study: University Headache Clinic between June 2012 and November 2015. Methodology: The study sample involved 14 subjects with migraine as defined in the

Male Wistar-Kyoto rats received intracerebral transplantation of syngeneic mesenchymal stem cells (MSCs) at 22–24 months of age. The cognitive function of these animals was tested and the microvasculature density, tissue blood-flow rate, and oxygen saturation of mixed blood in the cortical microvasculature were measured in the sensorimotor cortex of the contralateral brain hemisphere under standard conditions, after norepinephrine application, and in global ischemia 3 weeks after cell transplantation. Rats at 2–3 and 22–24 months of age were used as the control groups. MSC transplantation had a positive impact on microcirculation in the cerebral cortex of old animals: deterioration of the vascular bed was prevented and the level of oxygen saturation of blood in the microvasculature was elevated; therefore, the tolerance of animals to the spasm of pial arterioles and global cerebral ischemia was increased, although aging-related decline of cognitive functions was not alleviated.