Search

The aim of the study is to investigate anthrax epizootiologic and epidemiologic situation in the Republic of Dagestan over the period of 1944–2010. Anthrax morbidity has been registered in 38 regions and Makhachkala. All in all 1001 anthrax cases and 3128 sick rural animals have been registered. Determined are 420 anthrax specified potentially hazardous areas (SPHA), the majority of them (77.4 %) have formed before 1969. Regions of the republic have been checked against the level of risk connected with anthrax infecting over the last 40 years. Therewith, they have been classified into three groups: with low, medium, and high epizootiological-and-epidemiological potential. 15 regions with high epizootiological-and-epidemiological potential have been marked as potentially hazardous on a regular basis. These regions occupy 31 % of the republic`s territory and 52.5 % of the SPHA territory. 84 % of patients and 88 % of fallen animals have been registered there for the past 40 years.

The study explores the Russian and international experience of using such forms of electronic voting in elections as with the help of a special device (complex) for electronic voting at a polling station (in a voting room, or another specially defined place), and remote electronic voting through a personal computer or a mobile device. The article analyzes the circumstances and conditions that contribute to the development and consolidation of electronic voting in the country's legislation, or, conversely, the conditions that lead to suspension or even rejecting electronic technologies from the electoral process at the state level. Up-to-date information on the use of electronic technologies in the elections has been examined. The stages, problems, and difficulties of introducing electronic voting technologies in elections, as well as directions for further improvement of electronic voting in countries that have chosen the path of long-term development of digitalization of the electoral process are highlighted. In the early 2000s, many countries of the world gained experience in the practical use of electronic technologies in elections. However, the scientific and technological achievements so far did not provide the necessary degree of voters' confidence in the security of the electronic voting system or any reliable result. The prejudice towards electronic voting technologies, as well as high-cost modern electronic systems for implementation, persist in many countries to this day. This is an objective obstacle to the widespread use of electronic technologies in the electoral process. At the same time, the experience of remote electronic voting in Russia and Estonia, the fragmentary inclusion of electronic voting in electoral procedures in a number of other countries, and the widespread use of electronic voting complexes show that electronic technologies in elections are already a reality.

The radiation-chemical decomposition of n-hexane in the nano-ZrO2 +n-hexane system under the action of gamma radiation at room temperature is studied by the method of Fourier-IR spectroscopy. The molecular and dissociative form of adsorption of n-hexane in zirconium nanodioxide was revealed. The intermediate products of the radiation-heterogeneous decomposition of n-hexane were analyzed.

Aim. To evaluate the effectiveness of the intrauterine levonorgestrel-releasing device (LNG-IUD) in the treatment of atypical hyperplasia and the use of LNG-IUD in combination with a gonadotropin-releasing hormone analog (3.6 mg goserelin depot) in the treatment of stage Ia highly differentiated endometrial adenocarcinoma in women wishing to preserve childbearing function, and to assess reproductive outcomes after treatment in these women. Materials and methods. A prospective and retrospective series of cases included all patients treated with LNG-IUD or LNG-IUD combined with goserelin 3.2 for atypical hyperplasia or early endometrial cancer (EC) treated in the Department of Innovative Oncology and Gynecology of the Institute of Oncogynecology and Mammology of the Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology from January 2018 to March 2022. Response rates and the relationship of the response with clinical and pathological factors were calculated. Results. Fifty-six patients diagnosed with atypical hyperplasia or stage Ia highly differentiated endometrial adenocarcinoma were treated with LNG-IUD and LNG-IUD combined with 3.2 mg of goserelin. Of the 56 patients who completed a 6-month course of hormonal treatment, 42 (82%) showed a complete response: 22 (91.7%) with atypical endometrial hyperplasia (AEH) and 20 (74.1%) with EC. In 4 (7.8%) patients, a partial response was reported: 2 (8.3%) with AEH and 2 (7.4%) with EC. No response was noted in 5 (9.8%) patients in the EC group only. Childbirth was reported in 13 (23.2%) women: 8 (29.6%) with AEH and 5 (17.2%) with EC. Two (3.6%) women were in the second trimester of pregnancy, and 17 (30.4%) women had an early pregnancy loss; 7 (25.9%) of them had AEH, and 10 (34.5%) had EC. The positive response rate was 90.2% at 6 months: 24 (100%) patients with atypical hyperplasia and 22 (81.5%) with EC. Patients with EC in combination with polycystic ovary syndrome and obesity and patients with the non-obese EC phenotype had a lower therapy efficacy. Conclusion. LNG-IUD therapy for the conservative treatment of atypical hyperplasia and LNG-IUD therapy combined with goserelin 3.2 for early EC led to a morphological cure in most patients and can be considered for women planning pregnancy.

Introduction. Contributing to high disability and mortality, cerebral small vessel disease (cSVD) is a common condition in senior and elderly individuals. Objective: to assess the 5-year survival as well as cognitive and MRI changes in patients with cSVD and cognitive impairment (CI). Materials and methods. A prospective 5-year study included 54 patients (of them 37 women; mean age: 60.51 6.76 years) with cSVD, CIs, and white matter hyperintensities (WMHs; Fazekas 23). Twenty-two subjects were followed up to assess cognitive functions and a type of CI, cSVD MRI features, WMH, white and grey matter, and cerebrospinal fluid (CSF) volume as well as microstructural brain changes and correlate cognitive and MRI parameters at 5 years timepoint after the baseline. Results. Dementia developed in 14% of the subjects and 14% of the subjects died over a 5-year period. The subjects assessed twice had controlled hypertension (HTN). CIs worsened in the domain of executive functions and memory with mixed-type CI worsening. The follow-up showed that the WMH and CSF volume increased while the white matter volume decreased and axial diffusivity increased in the corpus callosum. The CSF volume correlated with the Stroop Test results and delayed memory (r = 0.803 and r = 0.701, respectively) and with white matter atrophy (r = 0.256) while the latter correlated with the axial diffusivity increased in the corpus callosum (r = 0.560). Conclusion. cSVD with advanced WMHs is associated with high mortality and dementia progression. General cognition assessment and MRI scan are not enough sensitive to assess disorder progression over a 5-year period. Stroop Test and Delayed 10-Word Recall Test results and transition to mixed-type CI indicate CI worsening and, therefore, can be used for the follow-up assessment. Cognitive decline in extensive cSVD is mediated by the brain matter atrophy and altered CSF circulation.

High-density polyethylene sheets (HDPE), HDPE/GaAs and HDPE/ GaAs composites with GaAs and GaAs semiconductor fillers were studied by X-ray diffractometry at room temperature. The degree of crystallization of these samples was calculated and it was determined that the inclusion of fillers in the polymer matrix (x=1-10% composite) leads to an increase in the degree of crystallization by 1.3-1.4 times. The obtained results are explained by the change of the upper molecular structure of the polymer.

Introduction. Cerebral small vessel disease (CSVD), associated with age and vascular risk factors, as well as the main cause of vascular and degenerative mixed cognitive impairment (CI). Previously established microstructural predictors of CI (axial diffusion in normal-appearing periventricular white matter of the posterior left frontal lobe, the right midcingulate cortex, and the middle posterior part of the corpus callosum) can be used to calculate an integrative factor, exceeding the threshold value for which indicates the presence of CI. The use of this factor in the diagnosis of CI in CSVD is supported by the fact that leading mechanisms of CSVD are involved in the damage to areas of the brain that are strategic for CI. The aim of this study was to clarify the link between the known microstructural predictors of CI in CSVD and MRI findings that correspond to the main mechanisms of CSVD. Materials and methods. Patients (n = 74; including 48 women; average age 60.6 6.9 years) with CSVD and CI of varying severity underwent phase-contrast MRI and voxel-based morphometry (3T) to assess arterial, venous and CSF flow, as well as atrophy. Results. The established microstructural predictors of CI correlated with measures of arterial and venous blood flow, as well as atrophy. Linear regression models allow us to estimate cognitive impairment (CI) predictors in cerebral small vessel disease (CSVD), based on increased arterial velocity pulse index, CSF flow at the level of the cerebral aqueduct, cerebral aqueduct area and lateral ventricles volume, when there is reduced blood flow in the superior sagittal sinus and the overall arterial blood flow. Conclusion. The ability to calculate microstructural predictors of CI due to CSVD, based on MRI findings, indicates the validity of using an integrative measure of microstructural predictors of CI as a diagnostic tool of CI in CSVD.

Abstract Background Vaccines against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) are used to reduce the risk of developing Coronavirus Disease 2019 (COVID-19). Despite the significant benefits in terms of reduced risk of hospitalization and death, different adverse events may present after vaccination: among them, headache is one of the most common, but nowadays there is no summary presentation of its incidence and no description of its main features. Methods We searched PubMed and EMBASE covering the period between January 1st 2020 and August 6th, 2021, looking for record in English and with an abstract and using three main search terms (with specific variations): COVID-19/SARS-CoV-2; Vaccination; headache/adverse events. We selected manuscript including information on subjects developing headache after injection, and such information had to be derived from a structured form (i.e. no free reporting). Pooled estimates and 95% confidence intervals were calculated. Analyses were carried out by vaccine vs. placebo, by first vs. second dose, and by mRNA-based vs. “traditional” vaccines; finally, we addressed the impact of age and gender on post-vaccine headache onset. Results Out of 9338 records, 84 papers were included in the review, accounting for 1.57 million participants, 94% of whom received BNT162b2 or ChAdOx1. Headache was generally the third most common AE: it was detected in 22% (95% CI 18–27%) of subjects after the first dose of vaccine and in 29% (95% CI 23–35%) after the second, with an extreme heterogeneity. Those receiving placebo reported headache in 10–12% of cases. No differences were detected across different vaccines or by mRNA-based vs. “traditional” ones. None of the studies reported information on headache features. A lower prevalence of headache after the first injection of BNT162b2 among older participants was shown. Conclusions Our results show that vaccines are associated to a two-fold risk of developing headache within 7 days from injection, and the lack of difference between vaccine types enable to hypothesize that headache is secondary to systemic immunological reaction than to a vaccine-type specific reaction. Some descriptions report onset within the first 24 h and that in around one-third of the cases, headache has migraine-like features with pulsating quality, phono and photophobia; in 40–60% of the cases aggravation with activity is observed. The majority of patients used some medication to treat headache, the one perceived as the most effective being acetylsalicylic acid.

Introduction. Guidelines on Biological Therapy for Bronchial Asthma of the European Academy of Allergy and Clinical Immunology (EAACI) identified a number of controversial issues for additional outcome analysis using randomized clinical trials and data from routine clinical practice. In particular, there is unmet need to clarify algorithms for prescribing biologicals using predictors of response and its timing, taking into account risk factors and multimorbidity. Omalizumab is a recombinant humanized monoclonal anti-IgE antibody of IgG1 class used for the treatment of severe refractory atopic bronchial asthma (BA) and a variety of IgE-mediated diseases. Among biological agents, this "pioneer molecule" has the greatest experience in the "allergology and immunology" profile. Detailed description of the "nonresponders" portraits will allow to perform the therapy response assessment on time and facilitate rational planning of individual therapy, which is a prerequisite for biologicals era. Using only routine methods, it is possible to perform initial and dynamic screening to phenotype a heterogeneous cohort of patients with severe asthma and chose the optimal strategy. Aim. To identify predictors of nonresponse to omalizumab anti-IgE therapy in patients with severe atopic BA and to establish optimal timing of efficacy assessment using retrospective analysis of data from the Biologic Therapy Registry of Allergology and Immunology in routine clinical practice. Materials and methods. A retrospective single-center registry study was conducted at the Allergy and Immunology Reference Center from June 2017 to August 2021. 135 patients with severe BA, with confirmed perennial sensitization, who received omalizumab according to the recommendations of the current version of GINA, were selected from the clinical and dynamic observational system (registry). Dosing regimen and administration frequency of omalizumab were determined in accordance with the instructions for the drug. Assessment of therapy efficacy was performed at the time point 4, 6 and 12 months. Patients were subgrouped into "responders" and "non-responders" according to the following criteria: ACT score less than 19 and/or difference between initial ACT score in dynamics less than 3 points; forced expiratory volume in the first second less than 80%; combination of these two criteria. Nonparametric methods of descriptive statistics were used in data processing: median, interquartile range. Differences were considered significant at p0.05. MannWhitney U-test, KruskalWallis one-way analysis of variance, and Fisher's 2 test were used to compare quantitative characteristics. Results. Heterogeneous subgroups of patients differing in reaching the criteria of "non-responders" to treatment were identified; the informativity of modifiable and unmodifiable factors differed at time-points of dynamic observation. In the differential analysis, two profiles of "nonresponders" were defined in combination with the most significant predictors of "nonrsponse" to omalizumab. According to the data obtained, one of the clinical phenotypes, namely the combination of severe asthma with the Samters triad, corresponded to the characteristics of the patient "nonresponders": age of onset is about 30 years, females, severe exacerbations of BA while taking non-steroidal anti-inflammatory drugs, accompanied with high levels of eosinophilia. Conclusion. The data obtained illustrates the hypothesis of pathogenetic heterogeneity of severe BA with the phenomenon of overlapping phenotypes and can serve as an additional orienteer for creating the individual plan of anti-IgE therapy in real clinical practice.

Cytomegalovirus (CMV) infection is the most severe viral infection in renal transplant recipients, which can occur in the post-transplant period in both adult and pediatric recipients. Developing and applying an effective prevention and treatment strategy for pediatric renal graft recipients is a priority. Objective: to compare the effectiveness of the protocols used for the prevention of CMV infection in pediatric kidney transplant recipients.Materials and methods. The study enrolled 118 patients who underwent primary kidney transplantation at Shumakov National Medical Research Center of Transplantology and Artificial Organs. Based on retrospective analysis, all recipients were divided into two groups, depending on the prophylactic strategy after kidney transplantation. The followup period for pediatric kidney recipients ranged from 108 to 1803 (623.5 ± 379.5) days. CMV infection activity was monitored by polymerase chain reaction.Results. The frequency of CMV infection activation episodes at 3 and 6 months was independent of the prophylaxis strategy used. The recurrence rate of CMV infection one year after surgery was significantly lower (p = 0.037) with Strategy 2. No cases of CMV syndrome or CMV disease, graft dysfunction, or chronic rejection associated with CMV infection were reported. Increasing the dose of antiviral drugs in Strategy 1 did not increase the risk of cytotoxicity and nephrotoxicity, which are reversible (creatinine levels were not significantly different in the study groups at 3, 6, 12 months, p = 0.542, p = 0.287, p = 0.535, respectively). The incidence of kidney graft rejection did not increase in patients with lower doses of immunosuppressants in Strategy 2.Conclusion. Both prophylactic strategies are effective in pediatric kidney recipients. However, the choice of a strategy depends on the individual characteristics of the patient and requires a personalized approach.

Treatment of ureteral strictures in the long-term post-transplant period is a complex surgical procedure. We present successful clinical cases of developed laparoscopic ureteral stricture reconstruction methods at three levels (in the pelvis, along the ureter, in the anastomosis area). These methods have shown their clinical efficacy: they are less traumatic, there are no adverse events in the early and long-term postoperative periods, and there is accelerated rehabilitation of recipients after surgery.

Background. Focal segmental glomerulosclerosis (FSGS) of the graft in kidney recipients is a rare and difficultto-diagnose post-kidney transplant complication, which can lead to graft loss and death of the recipient. A unified protocol is required for the treatment of this disease.Materials and methods. A 15-year-old female patient C. diagnosed with stage 5 chronic kidney disease as a result of steroid-resistant nephrotic syndrome with hematuria underwent a living related-donor kidney transplantation. On the third day after the operation, laboratory and imaging data showed kidney graft dysfunction. Patient examinations established the cause of the graft dysfunction – idiopathic nephrotic syndrome in FSGS.Results. For the treatment of recurrent FSGS, the patient had her immunosuppressive therapy converted from tacrolimus to cyclosporin A, and received two 500 mg rituximab injections. Ten sessions of therapeutic plasma exchange (Plasauto Sigma) were performed to remove antibodies to podocytes. During the therapy, diuresis was restored, creatinine and urea levels decreased. Six months after the kidney transplant, graft function was fully restored. Conclusion. The absence of recurrent FSGS within six months during a single course of therapeutic plasma exchange with its subsequent cancellation after restoration of graft function allows to recommend the developed method for the treatment of FSGS in pediatric patients after kidney transplantation.

The cerebral small vessel disease (cSVD) is one of the main causes of vascular and mixed cognitive impairment (CI), and it is associated, in particular, with brain ageing. An understanding of structural tissue changes in an intact cerebral white matter in cSVD might allow one to develop the sensitive biomarkers for early diagnosis and monitoring of disease progression. Purpose of the study: to evaluate microstructural changes in the corpus callosum (CC) using diffusion MRI (D-MRI) approaches in cSVD patients with different severity of CI and reveal the most sensitive correlations of diffusion metrics with CI. Methods: the study included 166 cSVD patients (51.8% women; 60.4 ± 7.6 years) and 44 healthy volunteers (65.9% women; 59.6 ± 6.8 years). All subjects underwent D-MRI (3T) with signal (diffusion tensor and kurtosis) and biophysical (neurite orientation dispersion and density imaging, NODDI, white matter tract integrity, WMTI, multicompartment spherical mean technique, MC-SMT) modeling in three CC segments as well as a neuropsychological assessment. Results: in cSVD patients, microstructural changes were found in all CC segments already at the subjective CI stage, which was found to worsen into mild CI and dementia. More pronounced changes were observed in the forceps minor. Among the signal models FA, MD, MK, RD, and RK, as well as among the biophysical models, MC-SMT (EMD, ETR) and WMTI (AWF) metrics exhibited the largest area under the curve (>0.85), characterizing the loss of microstructural integrity, the severity of potential demyelination, and the proportion of intra-axonal water, respectively. Conclusion: the study reveals the relevance of advanced D-MRI approaches for the assessment of brain tissue changes in cSVD. The identified diffusion biomarkers could be used for the clarification and observation of CI progression. [ABSTRACT FROM AUTHOR]

The article is devoted to the issues of prevention and choice of therapy strategy for iron deficiency anemia in pregnant women. Iron deficiency anemia is a frequent complication during pregnancy and in the postnatal period. According to the World Health Organization (WHO), the frequency of anemia in pregnant women exceeds 40% and can reach 65% in developing countries. More than half of all cases of anemia during pregnancy are directly related to iron deficiency (ID), which can be as high as 80% or more during pregnancy. This indicates that existing iron reserves out of pregnancy are inadequate to compensate for the increasing need for iron intake during pregnancy. According to domestic authors, the vast majority of women have some kind of iron deficiency by the end of pregnancy, and some of them had a latent iron deficiency even before pregnancy. The development of anemia is preceded by sublatent and latent forms of iron deficiency associated with increased iron demand during gestation. The issues of early diagnostics of preclinical forms of iron deficiency with subsequent correction of this element insufficiency, which allows avoiding undesirable phenomena related to the development of anemia, remain particularly relevant. The prevention of iron deficiency anemia should be complex and individual, and the choice of a drug to compensate for iron deficiency should be based on high bioavailability of the drug with minimal side effects. According to available data, oral administration of bior trivalent iron preparations is not sufficient for the treatment of moderate to severe anemia. In this case, the administration of iron sulphate preparations should be combined with the prescription of prolonged or recombinant erythropoietin with a transition to intravenous administration of iron preparations.

Contemporary linguistics and stylistics provide no ambiguous interpretation of the expressivity concept and all of its definitions intersect with the concepts of emotionality, imagery, intensity, expressiveness, etc. Currently, deliberate attention is focused on the study of expressivity issue in both domestic and foreign linguistics, however, despite the rich theoretical material; there are no clear concepts and terms. Many contradictions are found in the very definition of expressivity: a number of scientists associate expressivity with both the functional side of the language and the semantics of words, while others describe it in terms of linguistic stylistics and lexicology. In the context of these problematic issues, the aim of the article was to develop an integrated approach to the conceptual interpretation of expressivity, means of expressivity, as well as to provide a clear demarcation between the first of the concepts and the term of emotionality. In this article, based on the analysis of literary sources, the following tasks has been implemented: we considered approaches to the interpretation of the expressivity concept, after which, during a contextual and stylistic analysis, we identified the key expressive means on the basis of four speeches announced by the famous British politician, Margaret Thatcher, which allowed to identify lexical and syntactic means creating expressiveness in the statements of the mentioned politician. The main research method in this article was a descriptive analysis, as well as a component analysis, which provides for the consideration of connotative interpretation focused on the speech units used by Margaret Thatcher in public. In the framework of this article, the most memorable speeches of the politician were analyzed in order to understand how she managed to manipulate the audience. In addition, the lexical and syntactic features of Margaret Thatchers linguistic image, as one of the most famous politicians, and, no less important, speakers, are revealed. In particular, anaphoras, epiphoras, rhetorical constructions, parentheses, emotionally marked vocabulary, metaphors, comparative figures of speech and elements of citation are highlighted, which allowed the policy-maker to attract the attention of the audience, increase her credibility, discredit opponents, etc.

Revolutionary technological development has been assumed to be the cause and basis of the same revolutionary changes in the modern environmental perception of youth. The purpose of the article is to show the changes in youth's sustainable perspectives on environmental issues via information and communication technologies and the changes in sustainable behaviour. The methodology of this study presents the analysis of related topics and qualitative research based on the online questionnaire. The collection of data helped to show that over 80 per cent of modern digital youth use information and communication technologies to raise their awareness of environmental concerns and their preference for the environmental issues that attract them the most by watching or reading the news online. The model of three variables ”awareness – attitude – behaviour”, was proposed. This model can be used to explain influencers and modes of action in the emotional domain of environmentally sustainable behaviour among young people. The study of changes in sustainable behavior based on the example of language and emotional domains in the era of information and communication technologies and may supplement existing research. Research may be of interest to philosophers, psychologists, sociologists, linguists and those concerned with the environmental issues.

An observational cohort study of patients diagnosed with endometrial cancer (EC) stage IA G1, or atypical endometrial hyperplasia (AEH), undergoing organ-preserving treatment, was conducted. Objective of the study: To determine CDO1, PITX2, and CDH13 gene methylation levels in early endometrial cancer and atypical hyperplasia specimens obtained before organ-preserving treatment in the patients with adequate response and with insufficient response to hormonal treatment. Materials and methods: A total of 41 endometrial specimens obtained during diagnostic uterine curettage in women with EC (n = 28) and AEH (n = 13), willing to preserve reproductive function, were studied; 18 specimens of uterine cancer IA stage G1 from peri- and early postmenopausal women (comparison group) were included in the study. The control group included 18 endometrial specimens from healthy women obtained by diagnostic curettage for missed abortion and/or intrauterine adhesions. Methylation levels were analyzed using the modified MS-HRM method. Results: All 13 women with AEH had a complete response (CR) to medical treatment. In the group undergoing organ-preserving treatment for uterine cancer IA stage G1 (n = 28), 14 patients had a complete response (EC CR group) and 14 did not (EC non-CR group). It was found that all groups had statistically significant differences in CDO1 gene methylation levels compared to the control group (p < 0.001) except for the EC CR group (p = 0.21). The p-value for the difference between EC CR and EC non-CR groups was <0.001. The differences in PITX2 gene methylation levels between the control and study groups were also significantly different (p < 0.001), except for the AEH group (p = 0.21). For the difference between EC CR and EC non-CR groups, the p-value was 0.43. For CDH13 gene methylation levels, statistically significant differences were found between the control and EC non-CR groups (p < 0.001), and the control and EC comparison groups (p = 0.005). When comparing the EC CR group with EC non-CR group, the p-value for this gene was <0.001. The simultaneous assessment of CDO1 and CDH13 genes methylation allowed for an accurate distinction between EC CR and EC non-CR groups (AUC = 0.96). Conclusion: The assessment of CDO1 and CDH13 gene methylation in endometrial specimens from patients with endometrial cancer (IA stage G1), scheduled for medical treatment, can predict the treatment outcome. [ABSTRACT FROM AUTHOR]

Objective. We aimed at assessing feasibility and safety of coronary angiography (CAG) and percutaneous coronary intervention (PCI) performed via distal radial access. Material and methods. Two-stage study was designed. First, radial artery diameter was measured with duplex ultrasound at the conventional (proximal) access and anatomic snuffbox (distal access) in 160 patients, and diameter percentage change was calculated. The given minimal difference in radial artery diameter at two access points CAG or PCI via distal access was performed in 134 patients to address safety outcomes at the study stage 2. Results. Median inner diameter of the radial artery was 2.3 (2.0-2.6) mm at the conventional access point, and 2.05 (1.8-2.5) mm – at the distal one. No access-related adverse events were recorded within intervention or during follow-up. Conclusions. The use of distal radial access to perform CAG and PCI is anatomically feasible and safe.

Cerebral microangiopathy (CMA) is the main cause of vascular cognitive disorders, the leading cause of mixed dementia, and the main modifiable risk factor in Alzheimers disease. Study objective. To investigate the role of arterial and venous blood flow and cerebrospinal fluid flow, as well as their interrelation in the development of cognitive disorders in patients with CMA. Materials and methods. Ninety-six patients (32 men and 64 women, mean age 60.66.3 years) with cognitive complaints and CMA, diagnosed according to the STRIVE international MRI criteria, were examined. The severity of cognitive disturbance was assessed based on the overall cognitive level (MoCA scale and independence in daily life), the results of memory tests (10 words memory test) and executive brain function tests (TMT B-A). Phase contrast MRI was used to measure blood flow in the internal carotid and vertebral arteries (total arterial blood flow), the internal jugular veins and the straight and superior sagittal sinuses, as well as the aqueductal cerebrospinal fluid flow. Arterial pulsation and intracranial compliance indices were calculated. Results. Dementia and severe memory impairment were statistically significantly associated with an increase in the arterial pulsation index, intracranial compliance index and the aqueductal CSF stroke volume. Significant disturbances in brain executive function were also associated with a decrease in the total arterial blood flow, as well as the venous blood flow in the straight and superior sagittal sinuses. The characteristics of blood flow and cerebrospinal fluid are closely related, and the arterial pulsation index affects all the studied parameters. Conclusion. The severity of cognitive disturbance in CMA is determined by an increase in the arterial pulsation index, the intracranial compliance index and the aqueductal CSF stroke volume, while the severity of dysregulation disorders is determined by a concurrent decrease in the total arterial blood flow and venous blood flow in the straight and superior sagittal sinuses. The specific changes in blood flow and CSF flow and their interrelation in patients with cognitive impairment due to CMA suggest the pathogenetic importance of cerebral hydrodynamic disturbances in the aetiology of brain damage and the development of cognitive impairment in CMA.

Introduction. Сerebral small vessel disease (SVD) is a one of the leading causes of cognitive decline, and of ischemic and hemorrhagic stroke. It is diagnosed with the MRI criteria elaborated by international society (STRIVE, 2013). The development of SVD is closely related with endothelial dysfunction. Of special importance are studies of factors produced by endothelium and participating in the pathogenesis of SVD. Objective: to clarify the relationships of tissue-type plasminogen activator (t-PA) and plasminogen activator inhibitor (PAI-1) with MRI signs of SVD. Materials and methods. Seventy-one patients (23 males and 48 females, mean age 60.56.9) with SVD diagnosed according to the STRIVE criteria were examined. Arterial hypertension of grade 1 was revealed in 12 patients, grade 2 in 7, and grade 3 in 37 patients. White matter hyperintensities (WMH), according to Fazekas (F) scale, were graded stage F1 in 17 patients, F2 in 23, and F3 in 30 patients. Control group comprised 21 age- and sex-matched individuals with normal brain MRI. Brain MRI (3 Tl) was performed in all patients, with the assessment of the following SVD features: WMH, lacunes, microbleeds, and enlarged perivascular spaces. Blood levels of t-PA and PAI-1 were measured by enzyme immunoassay. An ANOVA variance analysis was used (p0.05). Results. High t-PA level was associated with more severe WMHs assessed with Fazekas stages (p=0.000) and with larger volume of WMH (p=0.019), as well as with the size of subcortical and semioval perivascular spaces (p=0.001). This dependence was not related with the presence arterial hypertension or its characteristics (p0.05). PAI-1 levels were not associated (p0.05) with t-PA levels or MRI features of SVD. Conclusion. The determined effect of t-PA level on the severity of WMH and perivascular spaces, the SVD features associated with increased blood-brain permeability, confirms the role of endothelial dysfunction in the development of SVD and the involvement of t-PA in the mechanisms of brain injury.

Introduction. Cerebral microangiopathy (CMA) is one of the leading causes of cognitive impairment (CI). Recently proposed international standards for MRI diagnosis of SVD in aging and neurodegeneration (STRIVE, 2013) are aimed at standardization of SVD research. Objective: to clarify the severity and structure of CI and their relationships with vascular risk factors in SVD diagnosed with the STRIVE criteria. Material and methods: Ninety-six patients with with SVD and cognitive complaints (31 men and 65 women, mean age 61.0 6.6 years) were exmanied. The severity of CI was assessed with the MoCA scale: patients with MoCA26 points who were independent in their daily life were graded as having mild CI (MCI), and those who was dependent were graded as having dementia; in patients with MoCA26, the assessment of separate cognitive functions (CF) was made. The type of CI was determined according to isolated or predominantly impaired CF, and in case of equal impairment of several CFs the type was cassifide as mixed. Impairment of CF was assessed by a deviation from the normal test parameters: 1.5, mild and 2,5, severe. Results. The severity structure of CI was as follows: dementia, 15.5%, MCI, 66.7% and subjective CI, 17.7%. Neuropsychological profile of MCI included: isolated (21.3%) and predominantly (24.3%) executive dysfunction, predominantly amnestic dysfunction (28.3%), and mixed dysfunction (26.1%); in dementia we observed mixed dysfunction (80%), predominantly executive dysfunction (13.3%) and predominantly amnestic dysfunction (6.7%). A tendency to increase in the CI severity with age was revealed. Among the risk factors, only grade 3 arterial hypertension was significant for the development of dementia. Conclusions: Dementia in SVD patients aged 4669 is characterized by mainly mixed profile of CI and associated with grade 3 arterial hypertension. MCI is characterized by variability of the CI types and the lack of a clear link with vascular risk factors, which justifies the need for clarifying the causes and risk factors of SVD and mechanisms of the development of CI.

Keratoplasty in patients with recurrent destructive processes in the cornea nowadays remains one of the most serious problems in ophthalmic surgery.Purpose. The analysis of results of penetrating keratoplasty (PK) in patients with destructive processes of the cornea or the corneal graft depending on the initial level of GDNF and the activity of the MAP kinase cascade of the signaling pathways.Material and methods. The analysis of the results of PK was performed in 23 patients (34 eyes) with acute destructive processes of cornea or the corneal graft in different etiologies. The follow-up period was from 6 months to 2 years. The analysis of the results of treatment was carried out depending on the condition of the corneal graft at various times after PK.The immunohistochemical examination of the biological material (corneal disks of the recipient) was performed using antibodies to GDNF, phospho-ERK1 / 2, phospho-JNK1 / 2, Ki67, GAP43, Bcl2 and Bax.Results. The time of epithelialization of the graft after PK in destructive processes of the cornea was increased in 79% of cases. When the epithelialization of the corneal graft was completed more than 6 and 10 days after PK in the postoperative period persistent erosions of the graft (PEG) with ulceration were formed in 22% and 89% of cases, respectively.The intensity of immunohistochemical reactions with antibodies to GDNF, phospho-ERK1 / 2, phospho-JNK1 / 2 in corneal disks at the epithelialization time of up to 5, 10 days and more eythan 10 days after PK was reduced from moderately positive to weakly positive and negative, respectively.When the time of epithelialization was completed in 6-10 days and there was not PECG, the intensity of reactions with antibodies to GDNF remains moderately positive, phospho-ERK1 / 2, phospho-JNK1 / 2 was lightly positive; when there was PEG the intensity of all reactions was weakly positive.Conclusion. The severity of the destructive pathological process in the cornea and postoperative complications after PK in patients with destructive corneal processes depend on the degree of GDNF deficiency, the decrease in the activity of the MAP kinase cascade of signaling pathways; the density of nerve plexuses in the own corneal tissue or corneal graft, and the activity of apoptosis processes.