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Sialorrhea is a severe medical problem that is difficult to treat, which can lead to serious complications. In almost all cases, chronic sialorrhea is accompanied by a restriction of the child's contacts with peers, socialization difficulties, and a significant decrease in the quality of life. Nowadays, botulinum therapy can be an effective tool that significantly reduces sialorrhea manifestation.Oblective: to evaluate the effectiveness of Xeomin (incobotulinumtoxinA) in the treatment of sialorrhea in patients with spastic infantile cerebral palsy (ICP).Patients and methods. We enrolled 24 children with ICP (14 (58.3%) females, and 10 (41.7%) males) with various disease forms: 4 (16.6%) — with spastic hemiparesis, 6 (25.0%) — with spastic diplegia, and 14 (58.3%) — with spastic quadriparesis. IncobotulinumtoxinA injections were performed bilaterally in the parotid and submandibular salivary glands under ultrasound control at a total dose of 40-100 U (min 1.3, max 4.5 U/kg of body weight). IncobotulinumtoxinA. The Drooling Impact (DIS) and the Global Impression of Change Scale (GICS) were used 1, 3 and 6 months after IncobotulinumtoxinA injections to assess treatment effectiveness.Results and discussion. Botulinum toxin therapy resulted in a significant decrease in saliva discharge from the oral cavity 1 and 3 months after IncobotulinumtoxinA injections, which was demonstrated by a reduction in mean DIS score from 78.6±9.6 (min 62, max 95 points; 95% CI 74.6—82.7) to 48.7±6.7(min 25, max 61 points; 95% CI45.8—51.6) and 52.7±8.5points (min 22, max 65; 95% CI49.1—56.3), respectively, as well as an increase in delta GICSscore up to +1.3+0.8(min 0, max 3points; 95% CI 1.0—1.6) and +1.0+0.7points (min 0, max 3points; 95% CI 0.8—1.3), respectively. Adverse events were observed in 4patients (16.6%), which were classified as mild in 3 patients (did not require special treatment and completely stopped within six days) and moderate in 1 patient (also did not require special treatment and completely stopped within three weeks).Conclusion. In the majority (79.1%) of patients with ICP, it is possible to achieve high efficiency in reducing sialorrhea and this effect persists for at least 3 months.

This article is a critical review of palliative care for ALS patients in Russia. The authors summarize the principal European guidelines, analyze local practice guidelines regarding palliative care, present their experience in ALS patients care in a multidisciplinary team (projectof the Orthodox service "Miloserdie"). Аuthors describe the main approaches for ALS symptom management available in Russia (including swallowing difficulties, breathlessness, pain, difficulties in communication).

Objective: To evaluate the main symptoms of the upper gastrointestinal dysfunction (salivation and swallowing disorders) and to determine their impact on the quality of life for patients with PD of stages I-III, as well as the possibility of their correction by dopamine receptor agonists., Material and Methods: 252 patients (128 women and 124 men, 42-80 years old) with PD of stages I-III were examined using: UPDRS items «salivation», «swallowing» and «anorexia», scale of daily activity (Schwab and England ADL scale), questionnaire quality of life (PDQ-39), measurement of saliva amount, BMI, MMSE scale; 53 patients were treated with piribedil during 6 months., Results: The upper gastrointestinal tract dysfunction of mild to moderate severity was detected in 51.2% of patients. The prevalence of sialorrhea was 38.9, 42.9 and 46.2%, and that of dysphagia was 22.2, 24.3 and 17.3% at stages I-III, respectively. According to the results of the correlation analysis dysphagia is associated with a long history of PD, low BMI, high doses of levodopa and low Sch & En score; and sialorrhea is also associated with low BMI and with old age. For the early stages of PD we can tell, that the quality of patients' life deteriorates, and this to a large extent is due to impaired salivation and swallowing, which manifest themselves in daily activity and communication difficulties., Conclusions: The inclusion of piribedil (150-250 mg/day) in the 6-months therapy reduces the dysfunction of the upper gastrointestinal tract (by 61 and 74% of the initial level of dysphagia and sialorrhea, respectively) regardless the drug use in monotherapy or in complex therapy with levodopa.

Cholinesterase activity in mixed saliva of patients with somatic pathology was investigated. The results showed differences in enzyme activity depending on the disease. The highest salivary cholinesterase activity was detected in patients with bronchopulmonary pathology, and the lowest - in cardiovascular diseases. A reliable relationship between the changes in the activity of cholinesterase in saliva and the rate of salivation, and with patients taking atypical antipsychotics and M, H-anticholinergic drugs, was revealed., Competing Interests: The authors declare no conflict of interest.

The aim of the study was to compare dental and periodontal status, oral hygiene, salivation rate, functional parameters of saliva and oral microbiota composition in patients with gastroesophageal reflux disease (GERD) with acidic and subacidic refluctant. The study comprised 69 participants divided in 3 groups: 22 healthy volunteers (controls) and 2 main groups: 25 GERD patients with acidic (group 2) and 22 patients with subacidic refluctant (group 3). Poor dental and periodontal condition was revealed in group 3 patients probably because of aggressive intestinal content reflux in the oral cavity resulting in higher PMA an saliva pH values, Escherichia coli species in oral microbiota and low buffer capacity of saliva. The results show that GERD may be suspected due to oral manifestations thus promoting it's prompt treatment.

The purpose of our study was to identify false xerostomies in students of different nationalities studying at the Faculty of Dentistry of the Sechenov University and to assess the effectiveness of Splat Oral Care Foam 2 in 1 against xerostomia stress-induced. Based on the results of Fox test 40 people were selected who used Splat Oral Care Foam 2 in 1 for three weeks. The participants were divided in 4 groups of 10 depending on the nationality. Oral hygiene was assessed by OHI-S and Silness-Loe indices and saliva was collected by the method of M.M. Pozharitskaya to determine salivation rate. It was found that the use of Splat Oral Care Foam 2 in 1 significantly improves the level of oral hygiene and positively affects the rate of salivation, thereby improving the quality of life.

The aim of the study was to assess gender related salivation features. One hundred and seventy-five patients were enrolled in the study (115 females and 60 males aged from 18 to 75 years). The study results showed xerostomia to be more common in females and it's subjective symptoms are more prominent partly because of gender-related psychological reasons. Xylitol-based paste and spray were successfully used for symptoms relief.

Salivation after stroke (sialorrhea, hypersalivation, ptyalism) can be caused by the overproduction or a lack of utilization of saliva. Patients after stroke often have sialorrhea as a result of dysphagia. Neurogenic dysphagia in acute period after stroke occurs in 25-65% of patients. The mortality rate among people with post-stroke dysphagia and tube feeding ranges from 20 to 24%. Patients who suffering from profuse salivation have difficulties with articulation and swallowing, bad breath, irritation and maceration of perioral area, contamination of clothing and bed linen. Profuse salivation increases caregiver burden as well. Psychologically, profuse salivation leads to lower self-esteem and social isolation. Pulmonary aspiration is the most serious complication of sialorrhea. Injections of botulinum toxins in the large salivary glands and the m. cricopharyngeus are the most effective method of treatment.

In clinical research condition of the acide-basic balance in an oral cavity of 100 patients having diseases of a digestive path: gastro-esophagus reflux illness, a stomach ulcer of a stomach and a duodenal gut, nonspecific ulcer colitis and Crone disease was studied. Estiniated speed salivations, pH, amplitudes test saccharose and carbamide curves pH in mixed saliva and on surfaces of tongue. It was revealed, that at this pathology there was destabilization of systems of regulation of the acide-basic balance in an oral cavity, accompanied by increase of acide- and ammonia-producing of microflora activity, topographical redistribution of zones functional acidosis and alkalosis on surfaces of tongue. Correction of the revealed infringements demanded individual approach in each case. The used methods of pH-meter were sensitive enough and allowed to reveal and estimated changes of local homeostasis in oral cavity.

Such salivation parameters as saliva volume, total protein saliva concentration and amylolytic enzyme activity as well as their discharge levels were compared to the level of H. pylori contamination of the stomach mucous coat in clinically healthy people (30 people) and patients with complicated duodenum ulcer (142 patients) within various terms after the duodenoplasty eradication and within long-term periods after the selective proximal vagotomy (50 patients). The amylolytic enzyme activity and ptyalin discharge was higher in clinically healthy but HP-contaminated subjects than HP-negative people. A direct relationship that was expressed by the salivation volume and ptyalin discharge best of all with the level of the stomach mucous coat contamination in healthy volunteers and patients with duodenal ulcer was established.

Saliva secretion speed and some biochemical mixed saliva characteristics were studied in patients with a terminal stage of chronic renal insufficiency. There was reduction of salivary function by more than 2 times and an increase of urea and creatinine concentrations in mixed saliva before the dialysis start. In case of higher urea content in saliva the speed of salivation was the highest that could evidence for an adequate response of the salivary glands to toxic action of nitrogen metabolism end products. The function restoration after hemodialysis took place not in all the patients. Amino acid catabolism product concentration in mixed saliva fell after hemodialysis and correlated directly with the amount of urea and creatinine in blood plasma. It took place also in "urea ricochet" when its content in blood increased sharply 1 hour after hemodialysis due to urea washout from the tissues.

A comparative study of single unit activity in frontal cortex and periaqueductal gray (PAG) was carried out in dogs during classical conditioning. Three types of neuron reactions were identified: on-off responses to a conditioned stimulus and to the reward presentation, tonic responses during the conditioned stimulus and tonic responses to food reinforcement. The distribution of neuron responses in structures under study proved to be different. The neurons responding tonically during feeding were 2 times more frequently encountered in PAG than in the frontal cortex, on the other hand, the percentage of neurons with phasic on-off responses was 2 times higher in the frontal cortex than in PAG. A conclusion is made that the genesis of different types of responses was determined by different inputs to cortical neurons. During feeding some neurons in PAG and frontal cortex were activated from the common source.

The rate of sweets consumption was shown to determine, to a large extent, the salivary glands function. In children rarely consuming sweets the parotid blood flow and salivation increased after intake of a 10% sucrose solution. In children abusing sweets even crystal sugar failed to change the parotid glands blood filling with salivation virtually unaltered.

Unilateral conditioned reflexes and two-link reflex systems with regular rhythmic alternation of positive and inhibitory reflexes were elaborated by Abuladze method in four dogs with a preliminarily dissected rostral part of the callosal body. Whereas the rate of formation of simple unilateral positive reflexes did not differ from that of reflex formation in intact animals, the formation of two-link unilateral systems proved to be disturbed. In spite of considerable stabilization of positive and inhibitory reflexes, ultraparadoxical relations were revealed when the same stimuli were applied in the system which testified to the disturbance of the after-effect dynamics. It has been assumed that rostral parts of the callosal body take part in the fixation of traces as the first component of the memory mechanism.

Regularities attending the change in the lumen diameter and the area of the endothelial cells were studied in the capillaries of the rat parotid gland during the secretory cycle under conditions of circulatory ischemia. The mean lumen diameter and the area of endothelial cells failed to change during the secretory cycle and during the occlusion of the carotid artery. It is thus supposed that enhanced capillary blood flow during the discharge of saliva could be explained by the growing number of the functioning capillaries.

Neuronal activity in g. proreus was studied during classical secretory conditioning and its differentiation in dogs. Three types of changes in neuronal reaction pattern were identified during differential conditioned stimulus compared to the pattern observed during positive conditioned stimulus. It has been shown that signal significance of the conditioned stimulus may be coded by specific distribution of interspike intervals in response to different conditioned stimuli. In situation of successive inhibition or disinhibition of the differentiation some neurones displayed simultaneous appearance of interspike intervals specific for responses to current and previously presented conditioned stimuli.

In dogs with elaborated rhythmic and mozaic stereotypes of secretory and motor situational conditioned reflexes specific features were revealed in the action of some neurotropic drugs (amizyl, amedine, diphacil, pediphene, chlorpromazine and sodium oxybutyrate) on preparatory (latent) conditions of excitation and inhibition, appearing in the stabilized systems of reflexes. Pharmacological analysis has pointed to the predominantly cholinergic nature of preparatory and trigger mechanisms of alimentary conditioned activity. The blockade of M-cholinoreceptors (by means of amizyl and amedine) weakens or eliminates the preparatory conditions appearing in a dynamic stereotype and disturbs the trigger reactions within three to ten days. A pediphene blockade of H-cholinoreceptors intensifies the preparatory states.

In experiments on dogs, changes of conditioned alimentary reflexes were studied under stimulation (50-100 mcA, 1, 40, 100 imp/s, 0.5 ms) of the basolateral area of amygdala before and after electrolytic ablation (5 mA, 60 s) of the head of the caudate nucleus. Stimulation of the amygdala, which elicited inhibition of conditioned secretory reflexes and prolongation of latencies in intact dogs leads to opposite - activating - influences after destruction of the caudate nucleus head. A conclusion is made on the participation of neurophysiological and neurochemical mechanisms of the caudate nucleus in transmission of inhibitory effects of the amygdala on alimentary conditioned reflexes.

A correlation between the quantitative and qualitative parameters of the polarization salivation and the typological characteristics of experimental animals was revealed in chronic experiments on eight adult dogs with the ducts of the parotic salivary glands led out according to Pavlov--Glinsky technique. It is sug-ested that this correlation may be used as a test for determination of the animals' type.

Higher nervous activity of dogs was studied using Pavlovian method of alimentary salivary conditioned reflexes. Serotonin (5- hydroxytryptamine) content in the venous blood was defined by means of fluorescent spectrofluorimeter using orthophthalic dialdehyde. A high level of conditioned and unconditioned reflexes was accompanied by a low serotonin blood content, while a low level of reflexes was accompanied by a high serotonin content. Negative correlation is supposed to exist between the degree of activation of nervous processes and blood serotonin content. Blood serotonin content increased in dogs in experimental neurosis with expressed reduction of the level on alimentary conditioned and unconditioned reflexes.

Slow potentials (CNV and component P300) were recorded in the medial part of the prefrontal cortex of dogs trained to classical secretory conditioned reflex and its differentiation. CNV increased when the conditioned stimulus was preceded by a signal of different meaning, as compared with CNV to the same conditioned signal following the stimulus of the same meaning; the greatest values of CNV and P300 were observed in response to differential stimulus preceded by a positive signal.

In analysis of neuronal activity of g. proreus of dogs brain in response to positive and differentiation conditioned cutaneous stimuli, in 44% of 78 studied neurons "late responses" appeared in the form of impulse activity intensification elicited by a positive conditioned stimulus after the end of eating and by a differentiation one--during conditioned signal action; it persisted in different neurones for 30--60 s. By means of various functional tests it has been shown that these reactions are a neurophysiological correlate of animals emotional state gradient.

The analysis of motor conditioned reflexes was done on the base of Pavlovian strength law in experiments on monkeys and dogs. It was found that in normal experimental conditions direct strength relations significantly dominate. In extreme conditions which lower the excitability of the brain, direct strength relations sharply deepen, leading to narcotic phase. Comparison of the narcotic phase with other hypnotic phases brings to the understanding of the strength law within a wide range, from direct strength relations to reverse (paradoxical) ones, when narcotic and paradoxical phases are at different poles of the optimal state of the nervous excitability with their different mechanisms.

By means of the classical alimentary secretory method, a study was made of the characteristics of formation and preservation of complex systems of conditioned reflexes in dogs with a preliminarily lesioned cortex of the auditory analyser. It has been shown that a rhythmic-mozaic stereotype of conditioned reflexes to acoustic signals can be elaborated in the operated dogs, although conditioned activity is on a very low functional level. However, integration of two complex stereotypes into one single system is not achieved. The formation of a new stereotype in the operated dogs, in contrast to the intact animals, is not accompanied by an enhanced functional state (tone) of the brain, which points to an insufficiency of the self-regulating mechanisms of the cerebral cortex. It is suggested that special activating mechanisms which participate in controlling the functional state of the auditory system, are present in the cortical structures of the auditory analyser.

The study was carried out on dogs by the secretory-motor method with a two-side reinforcement. Simultaneous and unilateral lesion of the premotor cortex and of the dorsal part of the caudate nucleus head brought about prolonged disturbances of the vegetative components (pulse and respiratory rate) and in the choice of the side of food reinforcement. The change in the magnitude of conditioned salivation, latencies of secretion and motor reaction was temporary, and by the end of the third postoperative period their initial magnitudes were restored. The duration of the disturbances of higher nervous activity depended on the localization and extent of lesion of the caudate nucleus head. Tests were made with chlorpromazine and caffeine before and after the lesion of the brain structures. The tests in the postoperative period revealed latent disturbances in the dog higher nervous activity. It is assumed that the premotor cortex and the dorsal part of the caudate nucleus head are one of the sub-systems involved in the regulation of vegetative, somatic components of unconditioned behaviour and in the analysis of conditioned stimuli.

In chronic experiments on dogs with implanted electrodes prolonged (30 min) subthreshold (20-30 mca) low-frequency (1 imp/sec) stimulation of the dorsal part of the caudate nucleus head inhibited the achievement of conditioned secretory alimentary reflexes. High frequency (100 imp/sec) stimulation under the same experimental conditions facilitated conditioned and unconditioned alimentary secretory reflexes. Under the influence of stimulation--high-frequency stimulation in particular--of the dorsal part of the caudate nucleus head differentiation inhibition tends to disinhibition.

Formation and manifestation of classical and instrumental conditioned reflexes were studied in dogs under the action of electrical stimulation of the caudate nucleus and the putamen or after their electrolytic ablation. The extent of higher nervous activity changes depended on the localization of the electrodes in the nuclei and on the complexity of the tests used. Ablation of the caudate nucleus body elicited graver and longer disturbances in the system of conditioned reflexes than that of the head. Under the action of the neostriate nuclei delayed reactions changed to a greater extent than simple forms of conditioned reflexes. Proceeding from the data obtained, it has been assumed that the mechanism of neostriate influences on conditioned reflexes dependes on their comparatory function, the mechanism of comparing cortical and subcortical impulses at the striate level.

In dogs with previous learning experience, a low-frequency (1 imp/s), weak (20-50 mcA) amygdala stimulation produces dissimilar influences on formation rate and value of conditioned alimentary reflexes in dependence on stimulation localization. At stimulation of amygdala basolateral part, the reflexes formation proceeds 2-3 times slower than normally. Their value is significantly reduced, the triggering of the secretory reaction is delayed. Dorsomedial part stimulation accelerates the process of conditioning, intensifies the secretion but delays the start of secretory reaction. The elaboration of differentiation inhibition is facilitated by basolateral part stimulation and is impeded by dorsomedial amygdala activation.

It has been found that extirpation of the orbital zones of the cerebral cortex in dogs in which the structures of the limbic and striate levels of nervous integration were previously ablated, produced more profound disturbances of the higher nervous activity than the previous operations. Not only conditioned positive and inhibitory reactions were affected, but unconditioned alimentary reflexes as well, while food motivation sharply decreased. Further experiments on the operated animals and could go on, only when alimentary excitability was enhanced. A conclusion has been drawn that the orbital zones of the cerebral cortex are directly related to the achievement of an integrated alimentary behavioral reaction.