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Clarification of the aetiology of ischemic stroke (IS) in young adults (aged between 18 and 45 years) is an extremely difficult task, as rare causes that are hardly known to neurologists are very common. One of these causes is paradoxical embolism due to pulmonary arteriovenous malformation (AVM), one of the manifestations of hereditary hemorrhagic telangiectasia (HHT). The diagnosis of HHT-associated pulmonary AVMs and IS is a multistep task that requires a personalized multidisciplinary approach using high-tech ultrasound, tomographic and genetic examination methods. This article discusses the clinical case of a young patient with HHT and recurrent IS through the mechanism of paradoxical embolism from pulmonary AVMs; issues of diagnosis, treatment and prevention of both the underlying disease and recurrent vascular events are discussed.

Relevance. Coronary artery transplantation operations are an effective method for the treatment of developmental anomalies and pathologies of the coronary arteries, which lead to a cascade of negative consequences. Pathologically altered coronary arteries cannot fully function normally and this condition leads to myocardial ischemia. Ischemic heart disease (CHD) is a chronic inflammatory disease that quickly leads to functional disorders in the body. CHD is mainly caused by atherosclerosis of the arteries and is the leading cause of death in most developed countries.The purpose of study. To study the operational possibilities of coronary artery transplantation.Materials and methods. In the course of this study, a review of foreign literature on the problem of surgical interventions on the coronary arteries was carried out, in addition, data from randomized controlled trials and controlled clinical trials were analyzed, which reported on various approaches to the treatment of pathologies of the heart vessels.Results. Coronary artery bypass grafting is most often performed in coronary heart disease caused by a sharp narrowing or occlusion of the lumen of the coronary artery. Coronary artery bypass grafting (CABG) is a major surgical operation, which consists in restoring blood circulation bypassing the stenotic area of the coronary artery using venous or arterial bypasses (grafts). At the same time, blood flow to the ischemic myocardium is restored, which leads to the restoration of the function and viability of the heart muscle. Coronary artery bypass grafting, as mentioned above, is a frequently performed surgical intervention, with almost 400,000 CABG surgeries performed annually, which proves its effectiveness in the treatment of coronary artery disease.Conclusion. This study proves the importance of coronary artery transplantation in the treatment of pathologies and anomalies of the arteries of the heart. There are several types of surgical interventions, and therefore it is necessary to approach each individual case individually and find the optimal solution. An important role in preventing postoperative complications and sudden cardiac arrest is played by careful preoperative diagnostics, including coronary angiography, echocardiography, computed tomography, and other methods. With careful preoperative diagnosis, a well-chosen operation strategy and postoperative prevention, it is possible to avoid repeated cardiac revascularization and achieve complete recovery of the patient with no complications for decades.

Relevance. Surgical interventions used in cardiovascular surgery often lead to the development of many different etiology and manifestations of purulent-septic complications. The development of this pathology worsens the course of the postoperative period and increases the duration of the patient's stay in the hospital. The range of these complications varies quite widely, which is explained by the different initial state of the patient's body, as well as the peculiarities of operations, care and treatment in the postoperative period.The purpose of this study is to study the frequency of occurrence of purulent-septic complications of mediastinal organs in surgery and to analyze the characteristics of this pathology.Materials and methods. In the course of this work, the analysis of foreign and domestic literature on the problem of the occurrence of purulent-septic complications of mediastinal organs in surgery was carried out.Results. The development of purulent-septic complications in cardiovascular surgery is due to a number of factors, among which it is necessary to note the presence of concomitant diseases, the peculiarities of some surgical interventions, inadequate antibacterial therapy. Due to the severity of the above factors, the development of many formidable purulent-septic diseases is possible. And unfortunately, even with timely treatment of the patient, the percentage of mortality from them remains quite high.Conclusion. Purulent-septic complications in cardiac surgery practice are a frequent phenomenon associated with a variety of risk factors. Such complications include mediastinitis, sepsis, pneumonia, urinary tract infections, local inflammatory reactions and much more. However, thanks to the knowledge of the causes of their occurrence and the features of the clinical course, it is possible to choose appropriate methods for correcting a particular condition at various stages of the patient's treatment.

Introduction. Mild cognitive impairment (MCI) negatively affects patients quality of life and is a risk factor for dementia. One of the main causes of MCI is cerebral small vessel disease (CSVD). The previously established link between decreased activity in the supplementary motor area (SMA) and cognitive impairment in patients with CSVD makes it possible to consider repetitive transcranial magnetic stimulation (rTMS) of the SMA with functional magnetic resonance imaging (fMRI)-assisted positioning as a promising method for treating MCI caused by CSVD. The aim of the study was to evaluate the efficacy and tolerability of fMRI-guided rTMS of the SMA in patients with MCI caused by CSVD. Materials and methods. Twenty patients were randomly assigned to the intervention (SMA stimulation; n = 10) and the control (vertex stimulation; n = 10) groups. All patients underwent 10 sessions of high-frequency rTMS. The MoCA scale, trail making test, Tower of London test, and copying and delayed recall in the ReyOsterrieth complex figure test were used to assess treatment effect. Testing was conducted before, immediately after and 3 months post rTMS. Results. The intervention group demonstrated a significant improvement in the MoCA, the Tower of London test and delayed recall in the ReyOsterrieth complex figure test immediately after rTMS. Statistically significant improvement in the MoCA and the Tower of London test results was maintained after 3 months. No statistically significant improvements were found in the control group. Groups were comparable in the incidence of headache during and in the 24-hour period after the stimulation session, and in unpleasant sensations during the session. Conclusion. fMRI-guided rTMS of the SMA is an effective and promising treatment method for MCI caused by CSVD, with effects lasting three or more months, and good tolerability.

Today special attention is paid to homomorphic encryption in the field of information security. Systems of homomorphic encryption represent such systems that allow arbitrary operations over ciphertext that are homomorphic to algebraic operations with plaintext. Some of such systems with ciphertext constructed over ideal lattices are reviewed in the paper. Ideal lattices, in turn, are promising mathematical primitives that allow achieving significant performance as compared to existing encryption systems. In addition, they are resistant to attacks based on quantum computer algorithms. The analysis of sets transforms in the reviewed systems showed that local dependencies and patterns exist between relations of its elements. For congruential encryption class systems, the relation between decryption conditions and noise levels is found. Moreover the private keys of encryption system participants can be hidden in a joint private key which is constructed with the factorial difficulty of recovery. The results can be used for modifying the existing NTRU encryption system and its complementation with homomorphic operations properties discovered recently. The study uses the provisions of set theory, introduces the concept of congruent transition, and deduces the necessary condition for a probabilistic encryption system. The obtained mathematical model is quite simple and allows a generalization of joint private key construction for arbitrary known number operations on a ciphertext. Research is underway to improve the computational efficiency of fully homomorphic encryption systems.

The article presents data from modern foreign and domestic scientific sources about the most common injuries when playing hockey, as well as measures to prevent injuries in this sport.

Objective: to evaluate the awareness of diseases causing to chronic arterial insufficiency by analyzing web search queries. Material and methods. In this study, we used the online keyword selection tool ‘Google Trends.’ The analysis was conducted for different countries and separately for CIS countries. Results. We found that the search query ‘obliterating endarteritis’ was most common in Kazakhstan and Pakistan, while the query ‘obliterating atherosclerosis’ was most common in Belarus, Trinidad, and Tobago. The query ‘leg cramps’ was most frequent among residents of Ukraine and the Republic of South Africa, whereas people residing in the Republic of Kazakhstan and Philippine Islands usually searched for ‘leg numbness.’ As for diagnostic methods, ‘angiography’ was the most frequent query in countries such as Bulgaria and Pakistan, while ‘dopplerography’ was the most popular query in the Republic of Kazakhstan. The most common queries related to treatment of chronic arterial insufficiency were ‘balloon angioplasty’ (most popular in Russia) and bypass surgery (most popular in Zambia, Ethiopia, Myanmar, and Ghana). The most frequent queries associated with pharmacotherapy were ‘acetylsalicylic acid’ and ‘pentoxifylline’ in the Russian Federation and Trinidad, Tobago, Jamaica, and Puerto Rico. Conclusion. The assessment of web search queries related to the diagnosis and treatment of chronic arterial insufficiency may help to understand the health status of people residing in different countries, which will enable effective disease prevention by reducing the risks and will ensure sufficient attention to timely diagnosis and effective treatment of chronic arterial insufficiency. It is also very important to inform people about obliteration of lower extremity and explain that people with such symptoms should consult their phusician rather than search for information online.

The article describes the clinical manifestations of dural arteriovenous fistula, which is an abnormal communication between the arteries of the dura mater and venous sinuses or cortical veins. The information on the etiology and pathogenesis of such a malformation in the domestic literature is limited to a few publications. The diagnosis is based on the identification of visual (pulsation of the earlobe) and acoustic phenomena in the patient, as well as the presence of a shunt between the posterior auricular artery (a branch of the external carotid artery) and the dural venous sinuses revealed by neuroimaging, in particular MR angiography. The best treatment method is a neurosurgical intervention using endovascular surgery.

The pain feeling in athletes results from nociceptive and antinociceptive systems activity. Mostly pain follows injuries. Ankle joints and ligaments injury is one of the most often trauma. Pain intensity directly depends on the number of injured structures and the degree of the injury. Besides that pain intensity depends upon various factors such as gender and age. The history of injuries can increase the risk of repeated injuries and pain may become chronic. Psycho-emotional experiences during the competition can lead to pain without physical injuries. Anesthesia is important aspect in athletes’ life and it must be effective. Not all currently available medication are approved by the World Anti-Doping Agency. Every year “WADA Prohibited List” is reviewed and every athlete must follow it. The permitted and most effective methods of pain relief for joints and ligaments injury are cooling aerosols, non-steroidal anti-infl ammatory drugs and kinesio taping. Each of these methods has its own characteristics.

Strokes are one of the most frequent reasons of population disability, that’s why rehabilitation of post-stroke patients is an urgent medical and social problem of modern healthcare system. In a considerable share of patients affected by stroke various disturbances of the higher psychic functions develop, including attention deficit, memory reduction, deceleration of thinking and quickness of psychic processes, up to dementia development. This aspect of stroke consequences is downplayed, at the same time CD to a great share predetermine the outcome of rehabilitation measures and the quality of the patient life. The article considers modern approaches to diagnostics and principles of therapy of moderate cognitive disturbances of vascular genesis.

The problem of searching for the prognostic factors for recovery of motor dysfunction following stroke is very relevant because of the high prevalence of acute cerebrovascular events. The severe disabling sequelae of stroke are associated with the enormous economic burden all over the world, which is aggravated by the lack of customized approaches to rehabilitation with allowance for the clinical data and neuroplastic features of the brain of each individual patient. Although modern diagnostic tools, including neuroimaging, have been introduced, many potential predictors of recovery of functions lost following a cerebrovascular accident still remain to be elucidated or refined. The best-studied prognostic factors for recovery of the functions lost following ischemic stroke are reviewed in this article.

The status of cognitive functions in 129 patients after strokewith deep hemispheric lesions was investigated. In the vastmajority of patients abnormalities (predominantly mild ormoderate) of the auditory-speech (95%) and the visual (83%)memory were observed. Mild and moderate abnormalities ofthe direct auditory-speech memory were predominant(85.6%), and delayed reproduction was mostly affected insevere disturbances. Moderate-to-severe abnormalities ofattention and moderate abnormalities of the dynamics ofmental processes prevailed in patients with right hemisphericlesions. As the result of complex therapy, memory mprovementwas observed in 65% of patients, improvement in theattention focusing in 72%, and improvement in the dynamicsof mental processes in 55% of patients.

We described the clinical features of urination apraxia as oneof post-stroke cortical neurogenic disturbances of bladderfunction. Neurological and urological symptoms and the dataof urodynamic and neurophysiological studies in a patient withurination apraxia resulting from the right-hemispheric lesionin the projection of cingulate gyrus are demonstrated. Thedifferential diagnosis was carried out with the case of motordetrusor atony after stroke in the right temporal lobe and theinsula, and with the case of imperative urination after stroke inthe left frontal lobe in the projection of cingulate gyrus.

Corticospinal tract (CST) is the major brain pathway yieldingmotor activity; however, functional role of the CST and other pathwaysin the implementation of such a socially important functionas walking in patients with stroke is not completely clear. Followingthe CST lesion the process of recovery involves not only CST onboth sides but also other pathways, including the extrapyramidaltracts: corticoreticular (CRP) and corticorubrospinal (CRSP)pathways. With the help of modern neurovisualization methods weshowed that Wallerian degeneration of the CST is not the only predictorof poor recovery of motor function after stroke, whereas acompensatory increase in fiber volume of CRP on the oppositeside may improve recovery of affected leg. Further studies of thefunctional significance of brain pathways including the CRP andCRSP in the recovery of post-stroke walking function will clarifyth mechanisms of neuroplasticity and predictors of recovery tooptimize the personalized approach to rehabilitation.

Posterior cortical atrophy (PCA) is a rare disease that manifestsmainly as disturbance of cortical visual function, agnosia.Blints syndrome (optic ataxia) is one of the clearest clinicalmarkers of the disease. The disease is caused by progressive atrophyof the visual cortex. Many researchers define PCA as anindependent disease, while others suggest that it is a posteriorvariant of Alzheimers disease, corticobasal degeneration, etc. Morphological studies of brain tissues support the neurodegenerativenature of the disease.

Cognitive impairments are an important medical and socialproblem associated with a high prevalence of this disease in thepopulation. 46% of patients develop dementia within 5 years afterthe diagnosis of mild cognitive impairments (MCIs). Voxelbasedmorphometry (VBM) is a modern neuroimaging techniquewell-proven in studying dementia. VBM in a combinationwith neuropsychological examination of patients enables clarifyingthe genesis of mild cognitive impairments (MCIs) and predictingfurther development of the disease as early as the initialstage of the pathology.

Motor recovery after ischemic stroke is associated with the neuralnetworks reorganization. fMRI studies of these networks inpatients with mild motor deficit showed that activation patterncan be used for the prognosis of functional recovery. However,characteristics and clinical relevance of activation patterns inpatients with severe to moderate motor deficit, its effective functioningin patients with different severity of primary sensorimotorsystem components (corticospinal tract [CST] and primarysensorimotor [SM] cortex) injury were not investigated. Twentyfivechronic hemispheric ischemic stroke patients were studied(13 males, 12 females; median age 38.05.9 years). Dependingon the severity of hand motor impairment and functional outcomethe patients were divided into 3 groups. All patients underwent1.5 T fMRI (Siemens Avanto) with passive block paradigmof paretic index finger movement (1 Hz frequency). Statisticmaps of group activation showed significant differences ingroups with different functional outcome: the more severe wasmotor deficit, the less SM activation volume size in injuredhemisphere was seen, and activation cluster center movedtowards non-primary motor cortex. The association between theactivation volume of SM and structural integrity of CST, assessedby fractional anisotropy index was revealed. Statistic maps ofindividual activation showed SM activation in injured hemispherein 38% patients with unfavourable (severe paresis, plegia)and moderate recovery with different physiologic lateralization,that is typical for the group with good recovery (mild and moderateparesis). These data do not allow us to consider the activationpattern as a marker of motor recovery and prognostic factorin patients with severe and moderate motor deficit. Our resultsshowed that sensorimotor networks formation and functioningdiffer depending on the CST sparing, and its effective work ispossible in certain degree CST integrity.

Transcranial magnetic stimulation (TMS) new method based on the neurons excitation by an alternating magnetic field. According literature high-frequency TMS could be effectiveness method in the treatment of drug-resistant central post-stroke pain (CPSP). The presented cases report describes the clinical observation of two patients with CPSP, with different localization and volume of thelesion. TMS was applied in the mode of high-frequency stimulation(10 Hz) to the primary motor cortex of the affected hemisphere.After stimulation, we record a significant reduction of painon a visual analog scale (VAS). It is shown that after the end ofTMS pain gradually returned to previous levels after 3-4 months.

The fMRI study of 7 healthy volunteers was performed to evaluatethe neuron networks of sensorimotor system during activeand passive movements of the left and right index fingers. Whileperforming all the tasks, the predominant activation of primarysensorimotor, premotor, supplementary motor areas, secondarysensory zones were shown on the contralateral side, as well asipsilateral cerebellar activation. It was demonstrated that brainactivation areas in both types of paradigm were corresponding,as well as the activation clusters size, amplitude and voxel coordinates,with the maximum values in the primary motor and sensorycortex. These results allow recommending the paradigm ofpassive index finger movements in given rate for the evaluation ofsensorimotor system in patients with movement disorders.

Its a traditional belief among neuroscientists that the speechfunction is located in some strictly definite areas of the left hemisphere:Brocas area in the rear part of the lower frontal gyrus(Brodmann area 44, or BA44), and Wernickes area in the rearpart of the upper temporal gyrus (BA22). However, data collectedwith the contemporary neurovisual research methods, in particular,with functional magnetic resonance imaging (fMRI),disprove the localizationist theory of speech. With the speciallydesigned speech task (paradigm) consisted of sentence readingand sentence continuation tests, we researched distribution ofspeech neuron network in healthy people and its reorganizationin patients with different types of aphasia. After processing ofcontrol sample data, we noticed activation of classic speech areas(Brocas and Wernickes) and their right hemisphere homologies.However, the amount of activations was predominant in theleft hemisphere. We also noticed bilateral activity in lower partsof pre-central (BA4) and post-central (BA1) gyri, in cerebellumhemispheres and in visual cortex (BA1718). In stroke patientsactivation in Brocas and Wernickes areas depended on a lesionlocation. Activation wasnt registered in case of damage of correspondingregion, but it was migrated on perilesional area. Werevealed new regions of activity at patients with aphasia, includingupper parietal gyrus (BA7), angular and over-marginal gyri(BA3940). Aforementioned activations were disclosed both inleft and right hemispheres. The research shows that the speechparadigm used demonstrates functioning of speech system in theoptimal way. The received data will increase understanding ofbrain structures involved in process of speech and their importancefor recovery of damaged speech functions.

Cerebral amyloid angiopathy (CAA) is characterized by -amyloid deposition in cortical and leptomeningeal arteries of small and medium size that disturbs normal structure of arterial wall. CAA is one of the often causes of peripheral intracerebral hemorrhages and cognitive impairment in old patients. We describe male patient, 52 years with CAA. Clinical picture was characterized by recurrent cortical-subcortical (lobar) hemorrhages, cognitive impairment of subcortiical type and epileptic seizures. MRI revealed superficial posthemorrhagic lesions. Gradient-echo MRI found small multiple asymptomatic hemorrhages in cerebral cortex and subcortical matter. Repeatgradientecho MRI carried out monthes revealed new clinically asymptomatic hemorrhages. Arterial hypertension as a cause of intracerebral hemorrhage was excluded on the base of atypical location of hemorrhage (superficial, but not deep). CAA diagnosis was made according to international Boston criteria: multiple lobar, cortical-subcortical hemorrhages not connected with other definite cause of intracerebral hemorrhage. Gradient-echo MRI is of a great importance in diagnosis of CAA, as it discovers small cortical and superficial hemorrhages, none detected by standard MRI regimes.

To analyze potential of different MRI methods in the quantitativeassessment of brain lesions after ischemic stroke, 19 patients(mean age 38.96.2 years) with hemiparesis of various severityresulted from supratentorial ischemic stroke (612 months priorthe examination) were studied. A relationship was establishedbetween such parameters as fractional anisotropy (FA), apparentdiffusion coefficient (ADC), size of the brain lesion, and severityof motor deficit. The FA and ADC values obtained in the corticospinaltract (CST) projection allow them to be considered asindicators of the degree of the CST post-ischemic damage predictingmotor deficit. FA was found to be the most reproducibleindicator of the CST structural integrity. FA threshold values(index, %) for unfavorable outcome of the motor functionrestoration were determined as follows: 50% for posterior limb ofinternal capsule, 42% for cerebral peduncle, and 65% for ponsvarolii. High sensitivity and specificity of the obtained parametersprovides ground for their use in identifying patients withpoor prognosis for the motor function restoration.