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Osteoporosis (OP) has traditionally been seen as a pathology that mainly occurs in postmenopausal women and elderly men, and until recently, the problem of this disease among males has not been given sufficient priority. At the moment, however, OP in men is widely acknowledged to be an important issue of modern health care. Given the etiological and pathogenetic characteristics, two categories of OP have been identified: primary and secondary. In the structure of male OP, the secondary category of OP accounts for up to 40-60 % of all cases. Hypogonadism is one of the common causes of bone loss in men. Initially, males develop a larger bone mass compared to women and, accordingly, greater bone strength. Men over the age of 50 do not undergo rapid bone mass loss, as women do after menopause, and the bone mass decreases more gradually, in a linear manner. With ageing, the trabecular number (Tb.N) in men are relatively maintained with underlying more pronounced thinning of Tb. N associated with decreased osteoblast-forming activity. Although the prevalence of OP among men is significantly lower than among women, the clinical consequences of OP in men are of a great importance. The primary strategy of the anti-osteoporotic therapy is to prevent OP and low-traumatic fractures. According to the current guidelines for the treatment of OP in men, bisphosphonates (BP) are the drugs of choice. Zoledronic acid is a highly effective nitrogen-containing BP, the first drug to be injected once a year. Intravenous injection of zoledronic acid is as effective in reducing the risk of fractures in men as in women.

In time, prescription of insulin therapy (IT) becomes inevitable for many patients with type 2 diabetes mellitus (DM) to achieve and maintain the target hypoglycemic range.According to the current guidelines, the addition of basal insulin to glucose-lowering therapy in patients with insufficient control of type 2 diabetes, gradual titration of its dose in accordance with a fasting blood glucose level is an effective and safe method for initiating IT. The properties of modern long-acting insulin analogues are considered. Glargine 300 U/ml is a modern analogue of long-acting insulin that is intended to be used once a day. The glargine molecule forms the basis of the drug. Increasing the concentration of glargine per volume unit and formation of a smaller subcutaneous depot led to a change in the pharmacokinetic properties of the drug. Glargine 300 IU/ml provides a more stable, long-term, predictable action with low glycemic variability as compared with glargine 100 IU/ml, which reduces the risk of hypoglycemia. The sugar-reducing efficacy and safety of insulin glargine 300 U/ml as evidenced by the findings of the international clinical phase III EDITION studies are discussed. Insulin glargine 300 U/ml showed a similar decrease in HbA1c levels compared to insulin glargine 100 U/ml with an improved safety profile (lower risk of developing episodes of confirmed or severe hypoglycemia at all times of the day, including the nighttime) and a less pronounced effect on the body weight of patients with type 2 diabetes. The efficacy and safety of the use of glargine 300 U/ml has been confirmed in type 2 diabetes patients with chronic kidney disease and the elderly. In the BRIGHT study, glargine 300 U/ml showed comparable glycemic control when it is being compared.

Diabetes mellitus (DM) is the biggest noncontagious epidemic in human history. This review is addressing an urgent challenge of modern healthcare - the treatment of type 2 diabetes mellitus (DM2). Key attention is paid to the prevention of the development and progression of type 2 diabetes complications and the need to manage risk factors for cardiovascular diseases (CVD), which are the leading cause of high mortality rates in people with type 2 diabetes. The clinical trials (CT) of recent decades contributed to the build-up of a solid evidence base on the effect of various antihyperglycemic drugs on the development of diabetic complications and outcomes in patients with T2DM. Also, the emergence of innovative classes of antihyperglycemic drugs have significantly expanded the potential of T2DM therapy. Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) are a class of glucose-lowering drugs that affect many pathogenetic mechanisms of T2DM and have a high safety profile. Creation of extended-release forms of GLP-1 RAs is an important step in the treatment of T2DM. Dulaglutide (Trulicity) has become the first GLP-1 RA for the treatment of T2DM (2016) authorized in Russia that can be used once weekly without regard to timing of food ingestion, which contributes to high compliance with treatment. The evidence base on the efficacy and safety of dulaglutide is continuously expanding. The authors paid attention to the issues of cardiovascular safety of the administration of dulaglutide, discussed the main results of REWIND study, and brought up a problem about the expediency of an earlier initiation of primary prevention of cardiovascular events in patients with type 2 diabetes. The results of the REWIND study made it possible to recommend the inclusion of GLP-1 RAs into the therapy of patients with type 2 diabetes and cardiovascular risk factors with a view to get additional advantages in terms of life prognosis.

Type 2 diabetes mellitus is a serious medical and social problem. The danger of the disease is associated with epidemic growth rates and chronic complications, leading to early disability, decreased quality of life and mortality. The prevention of diabetes complications is based on the optimal glucose-lowering therapy with the achievement of target metabolic parameters from the date the diagnosis of T2DM was established and throughout the patient’s life. The complex pathogenetic mechanisms of T2DM are the underlying rationale for drug therapy with a simultaneous effect on various disorders, which will provide a greater hypoglycemic potential and maintain effective glycemic control as T2DM progresses. The main reasons for poor disease control include clinical inertia, untimely intensification of drug therapy, and the use of treatment regimens that are insufficiently effective given the progressive course of the disease. The therapy for T2DM is based on clinical guidelines. The pathogenetic therapy options associated with the use of vildagliptin and metformin are considered. Much attention in modern diabetology is paid to the study of the influence of various therapeutic approaches on the disease progression rates from the perspective of improving prognosis and long-term maintenance of target glycemic control. The advantages of combined glucose-lowering therapy at the onset of T2DM are considered in comparison with the stepwise intensification of glucose-lowering therapy. The VERIFY study examined the long-term efficacy and safety of two treatment approaches: early vildagliptin and metformin combination therapy versus the traditional stepwise approach starting with metformin as initial therapy. The combined glucose-lowering therapy is an important direction in the treatment of patients with newly diagnosed type 2 diabetes.

EEG spectral power (θ1-, θ2-, α-, β1- and β2-ranges) was studied in subjects (n = 43, men, aged 18–21 years) with various trait anxiety levels during attention testing. Trait and state anxiety levels were assessed according to Spielberger prior to testing. In the initial state with the eyes open, subjects with low trait anxiety demonstrated significantly higher power of the EEG θ1- (in the occipital and left parietal cortical regions) and θ2- (in the left frontal and right temporal regions) bands than those with high anxiety level. At the same time, lower power of the EEG α-band (in the left central and frontal regions) was observed in subjects with high trait anxiety level, comparing to those with low anxiety levels. During the test, subjects with low anxiety demonstrated significant increase of spectral power in θ1- and β2-EEG frequency ranges in all areas of the cortex (except for the temporal region) compared with the preceding periods (with the eyes open). The increase of spectral power in the EEG θ1-band was also found in subjects with high trait anxiety level during the test. However, there was no intensification of β2-rhythm of the EEG. One can assume that the revealed patterns of EEG index dynamics reflect the domination of either orienting or defensive component in the motivational structure of subjects with different trait anxiety levels.

The process of the functional rearrangement of the motor cortex of the brain after stroke is due to neuroplasticity, and this underlies motor recovery. Functional magnetic resonance imaging (fMRI) and electroencephalography (EEG) are currently recognized as the most informative methods for studying these processes. The course of the neuroplastic process can be evaluated from the power levels of EEG rhythms during imagination of movements in the paralyzed arm in right-handed patients after stroke in the left hemisphere monitored at different times – before and after courses of neurorehabilitation using a brain–computer interface controlling a wrist exoskeleton. Powerful excitatory interactions in the primary motor cortex and frontoparietal areas in the lesioned and “intact” hemispheres are initially seen, and these probably reflect reorganization of neural networks. Rehabilitation courses were followed by restoration of bioelectrical activity in the primary motor cortex due to recovery of efficient connections with the premotor and superior parietal zones and decreases in the pathological influences of the contralateral hemisphere.

Post-stroke spasticity (PS) occurs in most patients with stroke and contributes to the development of pain syndrome and contractures, which substantially impairs the restoration of lost motor functions (MFs) and the quality of life of the patient. Objective : to evaluate the efficacy of a combination of botulinum toxin A (BTA) and multimodal stimulation in patients with arm PS. Patients and methods . The investigation enrolled 84 patients aged 18 to 85 years with PS, who had experienced ischemic stroke (IS) 1 month to 1 year before. In the study group (n=56), complex rehabilitation treatment was preceded by the use of BTA, while in the control group (n=28), multimodal rehabilitation therapy was performed without using BTA. Before and after treatment, neurological deficit was evaluated using the modified Ashworth scale (MAS), the Fugl—Meyer (FM) assessment scale, the British muscle strength grading scale, the Action Research Arm Test (ARAT), the Barthel index, and the modified Rankin scale. Results and discussion . According to MAS, there was a statistically significantly spasticity reduction after BTA use in the study group compared to the control one (median 1 [1; 2] and 2 [2; 3] scores, respectively; p=0.0003). According to the FM scale, an improvement in arm MFs was noted in the study group compared to the control one (median 29.5 [20; 42] and 21 [13.5; 31.5] scores, respectively; p=0.008) and according to the ARAT scale this was observed in the study and control groups (14.5 [7; 27] and 3 [0; 12] scores, respectively; p=0.0004). In patients with upper limb PS, the use of BTA before a rehabilitation cycle using multimodal stimulation was shown to be statistically significantly more effective than the similar neurorehabilitation cycles without prior BTA therapy. The findings can be used in the routine practice of a neurologist when planning rehabilitation for more effective and well-founded treatment in patients with arm PS. Conclusion . Incorporation of BTA into multimodal stimulation was ascertained to be effective in patients with PS.

The article presents the issues of epidemiology, classification, and clinic of hypothyroidism. The frequency of hypothyroidism increases significantly with age. The most common form is primary hypothyroidism, caused by a pathological process in the thyroid gland itself. Secondary hypothyroidism or tertiary hypothyroidism is caused by insufficient secretion of thyroid- stimulating hormone (TSH), or thyrotropin-releasing hormone. The article deals with the main causes of primary and secondary hypothyroidism. The most common cause of primary hypothyroidism is autoimmune thyroiditis, which can develop both separately and simultaneously with other autoimmune diseases, as part of polyglandular syndrome. Special attention should be paid to the change of thyroid status as a result of adverse side reactions when using a range of drugs. The questions about the mechanisms of thyroid insufficiency development as a result of unfavorable side reactions when using a number of drugs (lithium preparations, iodine-containing compounds, tyrosine kinase inhibitors, etc.) have been raised. Undiagnosed hypothyroidism is a risk factor for the progression of already existing cardiovascular diseases. The severity of clinical manifestations is determined by the severity of thyroid hormone deficiency. There are no significant clinical differences between the pronounced forms of primary and secondary hypothyroidism. Depending on the degree of lesion, secondary hypothyroidism may be complicated by other manifestations of hypothalamic-pituitary disorders, as well as the latter may include a decrease in the secretion of antidiuretic hormone at a certain stage of their development. Diagnostic difficulties are discussed, as hypothyroidism disrupts the functioning of most organs and systems of the body (musculoskeletal, cardiovascular, urinary, gastrointestinal, central and peripheral nervous systems) and can be masked by various diseases. The final diagnosis of hypothyroidism is clarified by a number of laboratory and instrumental studies. Substitution therapy with levothyroxine is used to treat hypothyroidism of any etiology.

A brain–computer interface (BCI) used to control a hand exoskeleton provides a tool for rehabilitation of the arm motor function (MF) after stroke and has proven efficacy and a potential to stimulate brain neuroplasticity. A study was made to analyze the effect of repeated rehabilitation courses with a BCI + exoskeleton (2 to 9 months after the first course) on the MF restoration in the late recovery period. MF recovery was assessed using a biomechanical analysis of the patient’s movements and clinical scales: the Fugl-Meyer Assessment (FMA) scale, the Action Research Arm Test (ARAT), and the Medical Research Council Weakness Scale sum score (MRC-SS). A positive effect of repeated rehabilitation courses with a BCI + exoskeleton on the MF recovery was observed in both patients with moderate paresis in the late recovery period and patients with severe paresis. The data may be useful for developing an appropriate protocol for the rehabilitation procedures that employ the exoskeleton controlled via a BCI with kinesthetic imagination of movements.

Arterial hypertension, diabetes mellitus, obesity and dyslipidemia continue to be the main risk factors for diseases of the circulatory system and the leading causes of mortality in the world, the combination of these diseases significantly increases the likelihood of the development and more rapid progression of cardiovascular and cerebrovascular pathology. Improving approaches to the diagnosis and treatment of these diseases is a priority problem in modern medicine. Currently, there is no universal drug that can influence all stages of pathological process in both cerebrovascular diseases and diabetes mellitus, and the problem of rational use of drugs in patients with comorbid pathology has not been completely resolved. A difficult clinical task includes not only the timely detection of the disease and the correct diagnosis, but also the choice of the safest and most effective medicine. A number of clinical studies have demonstrated the efficacy of mexidol in the treatment of this category of patients, which is determined by its complex, pleiotropic and multimodal mechanisms of action.Основными факторами риска болезней системы кровообращения и ведущими причинами смертности в мире продолжают оставаться артериальная гипертония, сахарный диабет, ожирение и дислипидемия, причем сочетание этих заболеваний существенно повышает вероятность развития и более быстрого прогрессирования кардио- и цереброваскулярной патологии. Совершенствование подходов к диагностике и терапии этих заболеваний является приоритетной проблемой современной медицины. В настоящее время не существует универсального препарата, позволяющего повлиять на все звенья патологического процесса как при цереброваскулярных заболеваниях, так и при сахарном диабете, и проблема рационального использования лекарственных средств у пациентов с коморбидной патологией окончательно не решена. Непростая клиническая задача заключается не только в своевременном выявлении заболевания и постановке правильного диагноза, но и в выборе наиболее безопасного и эффективного препарата. В ряде клинических исследований продемонстрирована эффективность Мексидола при лечении этой категории пациентов, что определяется его комплексным, плейотропным и мультимодальным механизмом действия.

This article compares a wide set of data classification methods used for creating brain–computer interfaces based on the recognition of EEG patterns during motor imagery of the hand. The GBM (gradient boosting models) classifier was found to work better than other classifiers using the dataset provided.

This review addresses the use of robotic devices in the rehabilitation of poststroke and posttrauma patients as a rehabilitation technology which has developed rapidly over the last decade. The types of devices used are described – manipulators and exoskeletons – along with the clinical protocols for their use and the effectiveness of rehabilitation procedures. Particular attention is paid to the neurophysiological basis of the rehabilitation potential of this technology, including analysis of measures of plastic rearrangements of the brain. Results obtained from state-of-the-art rehabilitation technology using hand exoskeletons controlled by brain–computer interfaces based on kinesthetic motor imagery are considered.

The aim of the present work was to study the effects of multiple courses of “BCI + hand exoskeleton” neurorehabilitation on the restoration of movements and resocialization of patients during the fi rst year after stroke. The study included seven patients with cerebral stroke who received two or more courses of sessions. All patients had poststroke hemiparesis of severity 1–4 points. Multiple courses of “BCI + hand exoskeleton” neurorehabilitation led to maintenance of the level of motor activity with further improvements, repeated courses yielding signifi cantly better results than single courses. Appropriate personal interpretation of illness, a positive attitude to recovery, and being motivated to take active part in the rehabilitation process were fundamental for effective rehabilitation of patients.

The incidence of diabetes mellitus (DM) is steadily increasing. InRussia, as in many countries, diabetes is a socially significant disease, while patients with type 2 diabetes account for 85–90% of the total number of people with diabetes. The development of optimal treatment tactics for diabetes mellitus is now one of the most urgent tasks of modern medicine.

The article deals with one of the frequent complications in diabetes mellitus diabetic neuropathy, which is associated with early disability of patients and an impaired quality of life. Distal neuropathy is the most common clinical form of diabetes. In this review, the clinical presentation, pathogenesis, and current treatment options with vitamin B complex are discussed in detail.

The focus on the problem of diabetes mellitus (DM) is associated with the increasing prevalence of the disease and the risk for the development of many vascular complications (nephropathy, retinopathy, lesions of the great vessels of the heart, brain, peripheral vascular disease of the lower limbs), in the development of which chronic hyperglycemia plays a crucial role. In 2011, the WHO decided that glycated hemoglobin (HbA1c) could be used as the diagnostic criterion for diabetes. The role of HbA1c in the choice of hypoglycemic therapy is invaluable. According to the Algorithms of Specialized Medical Care for Diabetes Mellitus Patients, stratification of treatment strategy in patients with newly diagnosed type 2 diabetes is determined by the initial HbA1c.

Over the past years, the focus has been growing on the prevention and treatment of obesity. Obesity has long been considered not just as excess body fat but as a chronic relapsing disease, the result of energy disbalance, which develops with an increase in food intake and reduced energy expenditure and is closely associated with a number of serious complications. Orlistat (Xenical), a peripherally acting drug without systemic effects [11, 24, 27], has been widely used in pharmacological treatment of obesity. Xenical is the most well-studied medication for weight loss. More than 30,000 patients with obesity were involved in clinical trials, of which over 2,500 patients had type 2 diabetes. Till today, the drug remains a breakthrough in the treatment of overweight/obesity.

To date, several options for starting and intensifying insulin therapy in patients with type 2 diabetes mellitus (T2DM) have been proposed. Meta-analyzes of the recent results shows that, with adequate use, all these regimens have the similar efficacy and safety; therefore, when choosing a therapeutic approach, the patient’s requirements and preferences become highly significant. The aim of this study was to assess how changes in the current practice of insulin therapy in patients with T2DM can impact the federal healthcare budget. Materials and Methods . Based on the results of the DURABLE clinical trial, we created a “decision tree” model that allowed us to calculate the costs of 48-week insulin therapy in 1000 T2DM patients who had never received insulin before that trial. The cases selected for modeling included patients on one of two starting regimens – basal insulin (glargine) or a ready-made mixture (biphasic lispro 25). After 24 weeks, upon achieving or not achieving the target HbA1c values, a decision was made whether to intensify the therapy by using the basal bolus therapy (glargine and lispro) or the ready-made mixtures (biphasic 25 or 50 lispro). The weighted average price of 1 IU insulin (according to public procurement data) was used for calculations . Results . Within the current practice of prescribing ready-made mixtures at the start and the intensification rate of 20%, the annual cost of purchasing insulin for the model population of 1,000 patients was 22.5 million rubles. If the use of ready-made mixtures increased to 35% at initiation and to 50% with intensification, the costs would be reduced by by 1.9 million rubles. In the cases when only basal insulin was prescribed for the start, the annual costs amounted to 23.8 million rubles (if only 20% of patients received a ready-made mixture with intensification) and to 22.8 million (if 50% of patients received a ready-made mixture with intensification). Conclusion. As a result of this analysis, an increase in the number of patients who use a ready-made mixture for the initiation or intensification of insulin therapy can lead to reducing the budget costs for purchasing insulin analogues for patients with type 2 diabetes mellitus.

The rehabilitation potential of post-stroke patients was evaluated after a rehabilitation procedure using a hand exoskeleton controlled via a brain–computer interface (BCI). Examples are given for parameters describing the motor and cognitive functions and the capacity for kinesthetic movement imagination. It is emphasized that instrumental quantitative methods are important to use for adequate assessment of both the rehabilitation potential and the effectiveness of the BCI + exoskeleton procedure.

Type 2 diabetes mellitus is a severe progressive disease associated with the high incidence of complications. The worldwide incidence of type 2 diabetes mellitus is known to be steadily growing which makes the management of this disease a topical medical problem. The majority of the patients all over the world fail to achieve recommended treatment end-points. The scientifically-sound choice of an adequate pharmacotherapeutic modality based on the available data on type 2 diabetes pathophysiology is of utmost importance under conditions of real clinical practice. The new updated ADA/EASD consensus of 2008 provides a well-grounded practical algorithm for the initiation and further adjustment of drug therapy in patients with type 2 diabetes mellitus. The HbA1c level of 7.0% or higher at any stage of the treatment should be regarded as a signal for active correction of the previous therapeutic regime. The early prescription of basal insulin contributes to the efficacious glycemic control and decreases the risk of long-term diabetic complications. Treatment with a combination of insulin and metformin is a highly effective approach to the management of patients with hyperglycemia and simultaneously slows down weight gain. The present algorithm enables clinicians to choose the most adequate hypoglycemic agents and combine different therapeutic modalities to the benefit of each individual patient.Терапия сахарного диабета 2-го типа (СД2) - актуальная медицинская задача. Его распространенность в мире постоянно растет, а по характеру течения он является тяжелым прогрессирующим заболеванием с высокой частотой осложнений. Большинство пациентов в разных странах мира не достигают рекомендованных терапевтических целей. В клинической практике выбор назначаемой фармакотерапии, основанный на научных данных о патофизиологии СД2, приобретает большое значение. Обсуждается современный обновленный консенсус ADA/EASD (2008) - обоснованный практический алгоритм для инициации и подбора фармакотерапии СД2. На любом этапе лечения СД2 показатель HbA1c l 7% следует рассматривать как сигнал к активному действию - изменению фармакотерапии. Подчеркивается необходимость раннего назначения базального инсулина, что помогает добиться эффективного контроля гликемии, снижает риск развития поздних осложнений. Инсулин в сочетании с метформином представляет особенно эффективную комбинацию для снижения гликемии, в то же время ограничивая увеличение массы тела. Современные алгоритмы помогают врачу лучше сориентироваться в выборе фармакотерапии и способствуют адекватному применению препаратов для лечения конкретного больного.

Treatment of diabetes mellitus type 2 (T2DM) is a serious challenge which forces to search for new approaches in order to improve the results of pharmacotherapy. Recent advances in diabetology pertain to incretin-directed therapies. Along with traditional defects (insulin resistance, β-cell dysfunction), a significant contribution to the development and progression of the disease is made by a reduction of "incretin effect" (Fig. 1). The concept of reduced "incretin effect" served as the basis for the development and introduction into clinical practice of the innovative medications the action of which is based on the "incretin effect" - glucagon-like peptide-1 (GLP-1) and gastric inhibitory polypeptide (GIP). [12, 17].

Objective. To study the potential for use of a bioengineered system consisting of an electroencephalograph, a personal computer running a program for the synchronous data transmission, recognition, and classification of electroencephalogram (EEG) signals, and formation of control commands in real time, combined with a hand exoskeleton (a bioengineered “brain–computer interface (BCI) with exoskeleton” system) for the motor rehabilitation of patients with poststroke upper limb paresis. Materials and methods. Brain–computer interfaces have potential for use in neurorehabilitation. A total of five patients with poststroke upper limb paresis received neurorehabilitation courses consisting of 8–10 sessions. All the patients had large foci of poststroke changes of cortical-subcortical locations as demonstrated by MRI scans. Results. Improvements in neurological status on the NIHSS were seen after courses of sessions, with significant increases in the volume and strength of movements in the paralyzed hand, improvements in the coordination of its movements, and minor decreases in the level of spasticity. There was an increase in daily activity on the Barthel index, mainly due to improvement in fi ne motor function. Levels of disability showed clear changes on the modified Rankin scale. Conclusions. Use of the “brain–computer interface (BCI) with exoskeleton” system in the rehabilitation of patients with poststroke paresis of the hand gave positive results, pointing to the need to continue these studies.

The dynamics of motor function recovery in a patient with an extensive brain lesion has been investigated during a course of neurorehabilitation assisted by a hand exoskeleton controlled by a brain–computer interface. Biomechanical analysis of the movements of the paretic arm recorded during the rehabilitation course was used for an unbiased assessment of motor function. Fifteen procedures involving hand exoskeleton control (one procedure per week) yielded the following results: (a) the velocity profile for targeted movements of the paretic hand became nearly bell-shaped; (b) the patient began to extend and abduct the hand, which was flexed and adducted at the beginning of the course; and (c) the patient started supinating the forearm, which was pronated at the beginning of the rehabilitation course. The first result is interpreted as improvement of the general level of control over the paretic hand, and the two other results are interpreted as a decrease in spasticity of the paretic hand.

The neurophysiological prerequisites for the development and operation of the brain-computer interfaces (BCI) that allow cerebral electrical signals alone to control external technical devices are considered. A BCI based on the discrimination of the EEG patterns related to imagery of extremity movements is described. The possibility of the rehabilitation of patients with motor disorders by means of the BCI based on motor imagery and the exoskeleton controlled by it is discussed.

We studied the dynamics of motor function recovery in a patient with severe brain damage in the course of neurorehabilitation using hand exoskeleton controlled by brain-computer interface. For estimating the motor function of paretic arm, we used the biomechanical analysis of movements registered during the course of rehabilitation. After 15 weekly sessions of hand exoskeleton control, the following results were obtained: a) the velocity profile of goal-directed movements of paretic hand became bell-shaped, b) the patient began to extend and abduct the hand which was flexed and adducted in the beginning of rehabilitation, and c) the patient began to supinate the forearm which was pronated in the beginning of rehabilitation. The first result is an evidence of the general improvement of the quality of motor control, while the second and third results prove that the spasticity of paretic arm has decreased.

New method for functional diagnostics of motion activity of fingers based on registration of digital movements and their biomechanical analysis is suggested. Kinematical and dynamical parameters of digital movement accounted by biomechanical model adequately reflect the patterns of motion disorders and give the objective numerical evaluation. The method includes: a) registration of digital movement in both intact and injured hands using electromagnetic system of MiniBirds type; b) calculation of individual biomechanical parameters of fingers - length of phalanges, position and alignment; c) calculation of kinematic parameters of movement - time-base of joint angles, angular velocities and accelerations, range of motion of separate joints, degree of coordination of changes in various joints angles (kinematic synergy); d) evalua-tion of dynamic parameters of motion - time-base of total muscular forces moment in joints (dynamic synergy); e) evaluation of functional state based on analysis of kinematic and dynamic parameters of motion before, during and after treatment.

The article presents preliminary results of iMove research study. By the time of this publication, the data of 47 patients have been processed. The patients in the experimental group (n = 36) were trained in kinesthetic motor imagery using brain-computer interface (BCI) and a controllable exoskeleton. In the control group, BCI imitation procedures were carried out. In average, the patients had 9 training sessions with a duration of up to 40 minutes. On completing the training, only the experimental group showed improvement in scores (results are presented as median and quartiles (25 %; 75 %)): grasp score increased from 0.5 (0.0; 13.0) to 3.0 (0.0; 15.5) points (р = 0.003) and pinch score increased from 0.5 (0.0; 7.5) to 1.0 (0.0; 12.0) points (р = 0.005) on ARAT scale. In the experimental group, a significant improvement in motor function was found in 33.3 % patients on ARAT scale, and in 30.5 % patients on Fugl-Meyer scale. In the control group, those scores were lower: 9.1 % and 18.2 % patients, respectively., В статье представлены предварительные результаты исследования iMove. На момент публикации получены данные по 47 пациентам. Основная группа (n = 36) пациентов проходила обучение кинестетическому воображению движения под контролем интерфейса мозг–компьютер (ИМК) с управляемым экзоскелетом. В контрольной группе проводили процедуры имитации ИМК. В среднем пациенты прошли 9 тренингов длительностью до 40 мин. По завершении тренингов только в основной группе выявлено улучшение по параметрам [Me (25 %; 75 %)]: шаровой захват кисти — c 0,5 (0,0; 13,0) до 3,0 (0,0; 15,5) балла (р = 0,003) и щипковый захват пальцев кисти — с 0,5 (0,0; 7,5) до 1,0 (0,0; 12,0) балла (р = 0,005) по шкале ARAT. В основной группе клинически значимое улучшение двигательной функции по шкале ARAT показали 33,3 % пациентов, а по шкале Fugl-Meyer — 30,5 %. В контрольной группе эти показатели были меньше: 9,1 и 18,2 % пациентов соответственно.

The objective of the present study was to determine the leading clinical and pathogenetic factors determining the clinical course of the pyoinflammatory ENT diseases in the patients with diabetes mellitus (DM) and to develop the algorithm for the rational therapy of these conditions. A total of 145 patients presenting with pyoinflammatory ENT diseases and concomitant diabetes mellitus were available for the examination that included the microbiological and biochemical studies, determination of the total lipid spectrum, glycated hemoglobin (HbA1c) level, and glycemic profile. Also, the body mass index of the patients was estimated along with the type and severity of obesity. Moreover, the character of antibacterial and hypoglycemic therapy was evaluated. The mathematical analysis of the data obtained revealed the clinical and biochemical parameters determining the clinical picture of the pyoinflammatory ENT diseases in the patients with diabetes mellitus. These were localization of the pyogenic process in the larynx, abdominal obesity, fasting hyperglycemia in excess of 8.3 mmol/l, and dyslipidemia accompanied by the reduction in the amount of high density lipoproteins to below 40 mg/100 ml and the increase of low density lipoproteins to above 155 mg/100 ml. The results of the study were used to develop the differentialalgorithm for the combined treatment of pyoinflammatory ENT diseases in the patients with diabetes mellitus based on the proposed original scale for the prediction of pyogenic complications.Цель работы - выявление ведущих клинических и патогенетических факторов, определяющих течение гнойно-воспалительных заболеваний ЛОР-органов у больных сахарным диабетом (СД) и разработка алгоритма рациональной терапии этих состояний. Обследованы 145 пациентов с гнойно-воспалительными заболеваниями ЛОР-органов на фоне СД. Проведено микробиологическое и биохимическое исследование, включающее развернутый липидный спектр, гликированный гемоглобин HbA1c и гликемический профиль. Определены индекс массы тела пациентов, а также характер и степень ожирения. Проанализирован характер проводимой антибактериальной и сахароснижающей терапии. На основании математического анализа полученных результатов выявлены клинико-биохимические показатели, определяющие характер течения гнойных заболеваний ЛОР-органов у больных СД. Это локализация гнойного процесса в гортани, абдоминальное ожирение, гипергликемия натощак более 8,3 ммоль/л и дислипидемия, сопровождающаяся уменьшением содержания липопротеинов высокой плотности ниже 40 мг/дл и увеличением уровня липопротеинов низкой плотности выше 155 мг/дл. Разработан дифференцированный алгоритм лечения гнойно-воспалительных заболеваний ЛОР-органов у больных СД на основании созданной нами шкалы прогноза развития гнойных осложнений.

Polysomnography has been performed and heart rate variability has been studied during night sleep in healthy young subjects of both sexes. It has been shown that, on average, a shift in autonomic support towards parasympathicotonia occurs during sleep, with a maximum at stages III and IV of NREM sleep. At stage II of NREM sleep and during REM sleep, a short-term activation of the sympathetic nervous system comparable to wakefulness is observed.

OBJECTIVES: To examine the mechanisms of alternative strategies developed by stroke patients to compensate their motor impairment and their role in recovery. MATERIAL AND METHODS: The three-dimensional kinematics of the upper limb were quantified during unconstrained reaching movements in seven healthy individuals and in 15 stroke patients. Nine patients were followed-up. Individual observations were correlated with anatomical and functional brain imaging described elsewhere (Feydy et al. Stroke 2002;33:1610). RESULTS: Healthy subjects used mainly elbow extension and shoulder flexion, scaled to movement distance. Patients with hemiparesis because of stroke used different patterns of joint recruitment with different scaling rules. Patients with the greatest impairment compensated by recruiting extra degrees of freedom, particularly trunk bending. Improvement was because of a restoration towards a normal movement pattern (recovery) and/or to a reinforcement of compensation, which led to a poorer outcome. CONCLUSION: Individual behavioural data are necessary to discuss the mechanisms of functional improvement following stroke with respect to recovery and/or compensation.

We are proposing a human arm model that consists of three rigid segments with seven degrees of freedom. The shoulder joint was modeled as a ball-and-socket joint and the elbow and wrist joints were modelled as skew-oblique joints. Optimal parameters for this model were calculated on the base of in vivo recordings with a spatial tracking system. The criterion of optimality was defined as the minimum of the mean-square deviation between the experimentally obtained sensor positions and orientations and their positions and orientations calculated by solving the direct kinematics problem. The minimal value of the direct kinematics error was found to be 0.5-0.6cm for sensor positions and 5-7 degrees for sensor orientations. We are proposing that these values serve as the assessment for the accuracy of the arm model.

The kinematics of the human arm in terms of angles of rotations in the joints is reconstructed from the spatial tracking system (Fastrack™ Polhemus) recordings. The human arm is modeled by three rigid bodies (the upper arm, the forearm and the hand) with seven degrees of freedom (three in the shoulder, two in the elbow and two in the wrist). Joint geometry parameters (orientations of the axes relative to the arm segments, the angles and the distances between the axes) have been calculated on the basis of passive rotations in the joints. The calculated parameters have been used to solve the direct kinematics problem for the reaching movements in different directions. The difference between calculated and recorded positions and accelerations of the hand has been used to assess the accuracy of the proposed method of kinematics reconstruction. The error analysis showed that spatial tracking system recordings and human arm kinematics reconstruction could reliably be used to accurately analyze multijoint movement in humans.

In this study, the equilibrium-point hypothesis of muscle-torque generation is used to evaluate the changes in central control parameters in the process of postural-maintenance learning. Muscle torque is described by a linear spring equation with modifiable stiffness, viscosity, and equilibrium angle. The stiffness is considered to be the estimation of the central command for antagonist-muscle coactivation and the equilibrium angle to be the estimation of the reciprocal command for a shift of invariant characteristics of the joint. In the experiments, a load applied to the forearm was released. The subjects were instructed to maintain their forearm in the initial horizontal position. Five sessions of approximately twenty trials each were carried out by eight subjects. During two "control" series, the load release was triggered by the experimenter. During three "learning" series, the load supported by one forearm was released by the subject's other hand. The elbow-joint angle, the angular acceleration, and the external load on the postural forearm were recorded. These recordings as well as anthropometric forearm characteristics were used to calculate the elbow-joint torque (which we called "experimental"). Linear regression analysis was performed to evaluate the equilibrium angle, joint stiffness, and viscosity at each trial. The "theoretical" torque was calculated using a linear spring equation with the found parameters. The good agreement observed between experimental and theoretical joint-torque time courses, apart from the very early period following unloading, argues in favor of the idea that the movement was mainly performed under a constant central command presetting the joint stiffness and the equilibrium angle. An overall increase in the stiffness occurred simultaneously with a decrease in the equilibrium angle during the "learning" series in all the subjects. This suggests that subjects learn to compensate for the disturbing effects of unloading by increasing the joint stiffness. The mechanism possibly responsible for the presetting of the central control parameters is discussed.

A new method of recording and reconstruction of upper-limb kinematics has been developed in order to analyze the mechanisms of motor recovery in disabled patients. It has been applied to the analysis of non constrained gestures in normal subjects and in patients with an hemiparesis following stroke. The results show evidence of new motor strategies and new co-ordinations developed to compensate for the motor impairment. In the future, this method could be applied to gesture recognition and synthesis and for the development of enhanced learning environments in rehabilitation.