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Анализируются 200 пациентов с положительными тестами на скрытое левшество и исследованием когнитивных функций с применением авторского скринингового теста. Возраст больных — от 30 до 65 лет (в среднем 41,0 ± 5,3 года), из них мужчин — 116 (58,0 %), женщин — 84 (42,0 %). При использовании стандартного исследования неврологического статуса у них были установлены следующие неврологические коморбидные диагнозы: ишемический мозговой инсульт — у 22 больных (11,0 %), дискогенно-венозная люмбосакральная радикуломиелоишемия — у 74 (37,0 %), рассеянный склероз — у 16 (8,0 %), вегетососудистая дистония с гипоталамическими пароксизмами — у 74 (37,0 %), паркинсонизм — у 14 (7,0 %). Исследование тестов на скрытое левшество и состояние когнитивных функций в дополнение к стандартному изучению неврологического статуса значительно расширяет круг диагностических возможностей. Терапевтические и нейрореабилитационные мероприятия должны проводиться с учетом клинических симптомов и признаков всех коморбидных патологий и соблюдением правил хорошей клинической практики.

Membrane theory of muscle weakness in hereditary muscular dystrophy was described with accent of predominated Ca 2+ ions in skeletal muscle due to destruction of the sarcolemma and other membranes of the different organelles of the skeletal muscle. Showed the role of CT, MRI and phosphorus NMR-spectroscopy as well as the noninvasive the analysis cell-free fetus DNA in maternal plasma for prenatal diagnostic of muscular dystrophies. The different a trial attempts of treatment of muscular dystrophy was described.

Written ofmodern classification ofmuscular dystrophies (in modification), clinical-genetic peculiarities and diagnostics of basic types ofmuscular dystrophies (limb-girdle types, distal types, ocylopharyngeal and oculopharyngodistal).

The article gives a brief analysis of the use of artillery in the course of an anti-Eurasian operation in the east of Ukraine. Artillery units were involved in a significant number of fire missions with a large expenditure of ammunition. Most artillery missions are performed to defeat unobservable targets, the destruction and suppression of which, as a rule, requires a large amount of ammunition and considerable fire time, which leads to the heating of gun barrels. As a result of the heating of the barrels, the initial velocity of the projectiles changes, the scattering of projectiles from the point of aiming at a range that does not allow for which may lead to a decrease in the effectiveness of the fire, and in some cases to the non-fulfillment of the fire task. The artillery units and subunits received new and modernized weapons, for which there are no tables for determining the deviations of the initial velocity of shells from the tabulated value with the help of ABS-1 and the Table of Accounting, mixing the center of scatter of projectiles as a result of the heating of the barrel. Taking into account the combat experience of the use of artillery units and subunits, and on the basis of the conclusions drawn in the Rules of shooting and fire control of ground artillery of 2018 (PSiUO NA), amendments to the section on ballistic training for the need to take into account the corrections for the heating of gun barrels are missing, but there is no procedure for determining them. The article details the procedure for the work of the division's officials in organizing settlements and recording corrections for the heating of gun barrels during the preparation of installations for shooting and during the execution of fire missions. The example of the 152 mm cannon 2A36 divisions presents the procedure for using tables and formulas in the calculations, and also shows the magnitude of possible corrections for range as a result of the heating of the barrels and the displacement of the center of the projectile scattering from the aiming point. The need to provide artillery units with tables for determining the total deviation of the initial speed from the tabulated value using ABS-1 and tables for determining the number of conditional shots for different charge numbers, initial speed deviations and the ballistic coefficient for all artillery pieces that are in service with artillery units of the Armed Forces forces of Ukraine.

Skin melanoma is a malignant tumor originating in the cells of the melanocytic system, which is characterized by an aggressive clinical course, significant metastatic potential and unfavorable prognosis. These features of the tumor stipulate the need to improve measures to optimize early diagnosis of tumors. The article presents cases of pigmented skin melanoma to demonstrate the variability of clinical manifestations of this tumor requiring dermatologist skills in the differential diagnostics of neoplasms.

Pleomorphic rhabdomyosarcoma of the skin is a fast progressing tumor with high risk of development of lymphogenous and hematogenous metastasis, low survival rates and complex diagnostics. this clinical case describes the application of typing tumor cells on the basis of immunohistochemistry to establish the nature of the tumor clone neoplasms.

On the basis of the analysis of the use of artillery units during combat missions in the zone of the Antiterrorist operation in the East of Ukraine addressed the major issues of ballistic training activities and the main ways of their solution., В статье на основе анализа применения артиллерийских подразделений во время выполнения боевых задач в зоне проведения Антитеррористической операции на Востоке Украины рассмотрены основные проблемные вопросы проведения мероприятий баллистической подготовки и определены основные пути их решения., У статті на підставі аналізу застосування артилерійських підрозділів під час виконання бойових завдань у зоні проведення Антитерористичної операції на Сході України розглянуті основні проблемні питання проведення заходів балістичної підготовки та визначені основні шляхи їх вирішення.

A crucially novel type of modulation of the opioid reception is described and discussed in this review. Such a ligand as comenic acid does not bind with all sites of the receptors; it binds only to two points of the selectivity sites. Due to this, an intracellular response is not initiated (and homeostasis in the target cell is not disturbed). At the same time, the receptor is internalized (it is submerged in the membrane, and this event allows the receptor to be recovered). Thus, comenic acid functions as an allosteric modulator of opioid receptors with a rather specific mode of action. Such modulation is capable of removing cruel manifestations of the abstinence syndrome in morphine-dependent experimental animals (rats).

Using computer simulation of the binding between molecules of opioid ligands and key amino acids in the macromolecule of an opioid receptor, we calculated the enthalpies of binding. Negative values of enthalpies substantiated conclusions on the high probability of such binding, while positive enthalpies were indicative of the low probability of this process binding. We found that the enthalpy of binding of comenic acid with asparagine is +17.5, of comenic acid with tryptophan is −8.7, and of comenic acid with lysine is −27.6 kcal/mol. We conclude that comenic acid binds only with the sites of selectivity but not with all sites of the opioid receptor.

In the fall of 2000, jubilee celebrations were held dedicated to the centenary of the Department of Nervous and Mental Diseases at the current St. Petersburg State Medical University named after acad. I.P. Pavlov (until 1994 it was the 1st Leningrad Medical Institute named after Academician I.P. Pavlov).

One hundred forty-two patients (66 men and 76 women) from 20 autosomal-dominant pedigrees and 3 families including 5 "sporadic" cases were examined. A great similarity of clinical manifestations among those affected was noted. Clinical variability of phenotypes reflecting various phases of the disease and different expressions of the mutant gene were always within the limits of the identical final phenotype of the disease, namely the facio-scapulo-humero-peroneal-femoro (posterior group of the muscles)-gluteal (gluteus maximus). Thus, the clinically and genetically homogeneous group of patients with autosomal-dominant descending with a "jump" form of facioscapulohumeral dystrophy (FSHD), called facioscapuloperoneal dystrophy (FSPD), was examined. Among the observed cases we did not come across any having the autosomal-dominant gradually descending form of FSHD, called facioscapulolimb dystrophy (FSLD), in which the pelvic and proximal lower limb muscles get weak earlier than in the peroneal group (anterior tibial) muscles. We could not reveal the "pure" facioscapulohumeral phenotype of muscle weakness in 142 examined patients. A "pure" FSHD does not exist as a nosological entity. It represents only the syndrome which characterizes the initial phase of FSLD, but not of the FSPD. It is quite probable that FSPD and FSLD which may be differentiated clinically are two different diseases connected with the mutation of allelic or even different genes. Linkage studies in FSPD and FSLD mapping genes would confirm this data.

We carried out an analysis of 5 sporadic cases of lower motor neuron disease with predominant affection of the proximal parts of arms in 2 patients and distal parts in 3 patients. From clinical point of view, our own observations, along with similar cases reported in the literature with predominantly affected upper limbs, different progression of the disease and denervation changes during needle EMG, can argue for clinical heterogeneity of lower motor neuron disease. There were some difficulties in establishment of a differential diagnosis between atypical variants of amyotrophic lateral sclerosis ("flail arm" syndrome) and primary muscular atrophy of adults at the early stages of the disease. We suppose that atypical variants of amyotrophic lateral sclerosis resultant from affection of lower motor neuron only ("flail arm" syndrome and distal amyotrophy), could be distinguished from amyotrophic lateral sclerosis and considered as an independent entity.

Investigation of impulse activity of hypothalamic neurons is of a great importance in attempt to connect the neuronal function with its activity. We have proposed an original method of analysis of background and temperature-induced impulse activity of thermosensitive neurons from frontal hypothalamus. In acute experiments on cats under ketamine anastasia neuronal activity was measured by glass microelectrode. Measurements of background neuronal activity was performed during 30 s, and post-stimulus activity was measured during 60 s. Computer program calculated the mean value of background activity. These results were used to create bar graph in the range +/- 100% with time interval 10%. It is suggested that the results of analysis of background activity of thermosensitive hypothalamic neurons allow interpret the characteristics of functions of hypothalamic neurons.

We have designed apparatus of artificial ventilation of the lungs (AAV) for small laboratory animals on pneumoelements, examined static and dynamic characteristics of a generator of impulse signals and chose rational parametres of the apparatus. Some advantages of that model as compared with its analogues have been proved. The apparatus was approved at electrophysiological experiments on rats, 200-250 g. Monitoring of the most important parameters of the vital functions showed that external breathing on that apparatus was adequate.

Studied with the aid of the computerized tensiometer MPT2-Lauda (Germany) was dynamic surface tension (ST) of blood serum in patients with chronic hepatitis (ChH), hepatic cirrhosis (HC), and in essentially healthy people, with n = 44, 32, and 68 respectively. ChH was shown to be accompanied by a significant increase in ST indices in the region of short (t = 0.01 sec) times of the surface life as well as by a decrease in that of medium (t = 1 sec) and long (t--infinity) times. Rise in parameters of interphase tensiograms is a prognosis-negative sign with respect to the development of HC. Correlations have been established of indices of blood ST to its content of protein, lipid, and inorganic substances and to morphological signs of affection of the liver as well.

In facioscapulohumeral muscular dystrophy (FSHMD) patients, the mimic muscles can be involved asymmetrically and isolatedly or the weakness of these muscles can predominate in the clinical picture for a long period. In connection with this, difficulties can arise in differentiating between myogenic affections and neurogenic ones, due to damage of facial nerve. The purpose of the present paper is to analyze the peculiarities of clinical affection of mimic muscles for early diagnosis in FSHMD patients.

In patients and test animals similar changes in innervation have been revealed. Degeneration of some preterminal axons has been shown. The most manifested feature's increased ramification of distal axons. No signs of real reinnervation have been found. New collateral branches of preterminal, terminal and ++ultra-terminal axons usually have their ends at the same muscle fiber in the form of additional nervous terminals. Decreased average diameter of motor end-plates, revealed in the test animals, depends not on their degeneration, but on formation of new small motor end plates as a result of immature axonal ramification of distal axons. Acetylcholinesterase activity in the end-plates is decreased. A suggestion is made that excess of thyroid hormones in the skeletal muscle disturbs both the system of cyclic nucleotides and mechanisms of muscular contraction, connected with it and axoplasmic transport, respectively. The changes of the terminal intramuscular innervation revealed, structures of the motor end-plates with a decrease of acetylcholinesterase activity are supposed to result from disturbances of neurotrophic regulation of the muscle fibers because of the disturbances of the axoplasmic current as the excess of thyroid hormones.

To differentiate between thyrotoxic myopathy and myodystrophy (of the limb-girdle type), severe myasthenia, polymyositis, Addison's disease, proximal spinal muscular atrophy, steroid myopathy and neurosis special diagnostic indices have been developed based on specific muscular weakness (and atrophy) pattern early in the disease, the sequence of separate muscles involvement as the pathological process progresses, disproportion between muscular weakness and atrophy, excessive folds of the skin above the affected muscles and the presence of deep reflexes, purposeful analysis of the anamnesis. The diagnosis is confirmed by thyroid function study and/or myopathy regression in response to antithyroid therapy.

Additional study of six generations belonging to the K. kindred, which were previously investigated by Oransky in 1927 was carried out. 18 members of this kindred were studied. At the early stages of the disease a sharp dissimilarity of the phenotypes in the K. kindred resulting from the different rate of the development and intensity in the course of the disease was observed, varying from evident scapuloperoneal amyotrophy to the cases resembling Landouzy-Dejerine muscular dystrophy. At the late stages of the disease a considerable clinical simularity of those affected was noted. The clinical and genetic data allowed at the present time to consider the muscular dystrophy in the K. kindred as one of the varieties (namely, as a descending type with a "jump") of the facio-scapulo-limb (or facioscapulohumeral) muscular dystrophy. The scapuloperoneal syndrome could be a long stage in the development of the disorder in some members of the K. kindred.

The data obtained in mice with experimental thyrotoxic myopathy included a decrease in the median diameter of the muscle fibers by 17.1 per cent and various focal degenerative changes in less than 20 per cent of the muscle fibers; a statistically significant elevation in the activity of alpha-glycerophosphate dehydrogenase, as well as a reduction in phosphorylase activity and glycogen levels. There was also a significant diminution in the median diameter of the motor terminal plates, a decrease in cholinesterase activity and intensified collateral ramification of the distal axons. The major cause of the muscular weakness and structural changes in the skeletal muscles in thyrotoxic myopathy seems to lie in lowered cAMP concentrations and a weakened cAMP-dependent regulation of protein kinase.

200 case histories were analyzed (108 males and 92 females). 55 patients were under the author’s personal observation, 145 cases were taken from the literature. There were 163 hereditary and 37 ‘spora

The value of kdiss of the "proteinkinase-cAMP" complex was increased 1.8-fold, number of the nucleotide binding sites was increased 3.7-fold with simultaneous decrease in cAMP concentration, when the cyclase system was studied in skeletal muscles of mice with experimental thyrotoxic myopathy. Activities of phosphodiesterase, adenylate cyclase, rate of activation of adenylate cyclase by adrenaline and sodium fluoride did not significantly differ as compared with normal values. Impairment of hormonal regulation of the cAMP-dependent processes is apparently responsible for multiple molecular and structural injuries in skeletal muscles in thyrotoxicosis.

Two cases of chronic spinal muscular atrophy simulating the clinical picture of the facioscapulohumeral type and limb-girdle type of muscular dystrophy are reported. Both patients had a waddling gait, Gowers' maneuver in arising, terminal atrophies and pseudohypertrophies of some muscles, marked fasciculations, and fascicular tremor. The electromyogram revealed signs of anterior horn cell disease. Calf muscle biopsy (case 2) revealed 'myopathic' changes.

Results of the clinico-roentgenological observation of butterfly-like deformity of the middle dorsal vertebra body (a rare congenital anomaly) are presented. In the presence of an infection the patient developed a spinal pathology (lower central paraparesis, parahypesthesia, disturbances of the functions of pelvic organs). The neurological symptoms were found to be due to an adhesive process in the spinal meninges at the level of the deformed vertebra and the secondary compression-ischemic myelopathy. The treatment consisted in injecting prednisolone under the spinal meninges. The patient's roentgenograms were compared with a macerated museum preparation of dorsal vertebrae.

Additional study of six generations belonging to the K. kindred, which were previously investigated by Oransky in 1927 was carried out. 18 members of this kindred were studied. At the early stages of the disease a sharp dissimilarity of the phenotypes in the K. kindred resulting from the different rate of the development and intensity in the course of the disease was observed, varying from evident scapuloperoneal amyotrophy to the cases resembling Landouzy-Déjerine muscular dystrophy. At the late stages of the disease a considerable clinical simularity of those affected was noted. The clinical and genetic data allowed at the present time to consider the muscular dystrophy in the K. kindred as one of the varieties (namely, as a descending type with a "jump") of the facio-scapulo-limb (or facioscapulohumeral) muscular dystrophy. The scapuloperoneal syndrome could be a long stage in the development of the disorder in some members of the K. kindred.

In an experimental model of thyrotoxic myopathy in mice certain decrease in average diameter of muscle fibers (MF) has been revealed (by 16%). In 1-20% of the MF various types of focal pathologic reactions (loss of cross and longitudinal striation, glial, glomerular and adipose degeneration, Zenker's necrosis) increasing number, structural changes and position of nuclei are observed. Degree of atrophy and part of the altered fibers depend on duration and severity of thyrotoxicosis. Morphologic disorders localize focally and are not so vast as to be the cause of muscle weakness. The main cause of the latter and of the structural disorders in the skeletal muscle at thyrotoxic myopathy is, evidently, slacken of the hormonal control in cyclic adenosine monophosphate-dependent processes.

A report is presented of a patient with lesions of muscles of the face, shoulder girdle, wrists and shins. The clinical findings were similar to those noted in a patient with facioscapuloperoneal muscular dystrophy. An analysis of statistical and dynamic formulas of muscular lesions with regard to electromyographic findings made it possible to determine the neurogenic nature of the damage. It is shown that under clinical conditions, using the formula of muscular lesions, one may differentiate between facioscapuloperoneal muscular atrophy and facioscapuloperoneal myodystrophy and Stark-Keser's spinal scapuloperoneal atrophy. It is proposed that the term neurogenic "scapulotibial syndrome" should be used instead of "scapuloperoneal" one.

The paper deals with a description of the clinical picture and diagnosis of the main types of myodystrophies taking into account formes of muscular damages and a trend of generalization of a pathological process at the early phase of the disease. The clinical picture of endocrine myopathies was also studied. The authors revealed almost the same formula of muscular damages. Muscles of the pelvic girdle and femurs mainly suffered and to a lesser degree--muscles of the shoulder girdle and shoulders. According to the data of the clinical picture, histopathology and electromyography endocrinic myopathies are phenocopies of hereditary myodystrophies.

In mice used as a thyrotoxic myopathy model, activity of some oxidation-reduction enzymes, phosphorilase and glycogen content have been studied. Three series of experiments with separate controls have been carried out. Powdered thyroidin is given to the mice per os through a special cannula. The experiment is performed for 5 months. Musculus rectus femoris is studied. With development of thyrotoxicosis and myopathy, the diameter decreases and the form of the muscle fiber undergoes certain changes. alpha-glycerophosphate dehydrogenase (GPhDG) and succinate dehydrogenase activity increases. A definite division of fibers into two types, I and II remains unchanged, while differences between the fibers of I and Ia types disappear. The core-targetoid fibers are found among muscle fibers of I and Ia types, while those of "moth-eaten" belong to the II type. Glycogen content and phosphorilase activity decrease. Subdivision of the muscle fibers into the types according to the reactions revealing glycogen and phosphorilase activity is poorly expressed or absent. Adenosintriphosphatase and lactate dehydrogenase activities do not differ essentially from that in the control. Evidently, at hyperthyroidism the oxidation-reduction processes in the muscle fibers are disturbed and first of all in the link which is connected with the main enzyme (GPhDG) activity. This results in decay and disturbance of the myofibrillar proteins synthesis, serving as one of the reasons for appearance of the muscle atrophy.

The authors studied 42 patients with endocrine myopathy. In thyrotoxic myopathy prevalent muscle lesions of the pelvic girdle and femur were found. EMG studies (with the aid of point electrodes), histological and histochemical studies of the muscles in patients with thyrotoxicosis indicate a primary muscular character of the atrophies. The report contains descriptions of pathomorphological and histochemical changes in the muscles in experimental thyrotoxic myopathy.

In patients with thyrotoxic myopathy, histological investigation showed the decrease in mean diameter of skeletal muscles, and increased collateral branching of distal axons. The percentage of afflicted fibers was not high with focal pathology. The signs of true reinnervation were absent. Electroneuromyographic investigation confirmed mild myopathy. The authors discuss the possible participation of cyclic nucleotide system disorders in muscular weakness in these patients.

A series of 263 patients with thyrotoxic myopathy (TM) (47 males and 216 females) were studied. A total of 151 patients were investigated by the author and 112 case reports were taken from the literature. New clinical peculiarities of TM were detected. The author presented a quantitative assessment of the incidence, degree of weakness and atrophy of individual muscles, described the topography of muscular lesions at different phases of the development of thyrotoxicosis and myopathy. He also proposed an original formula of muscular weakness and atrophy which makes it possible to identify myopathy in its initial stage even when there are no evident clinical manifestations of thyrotoxicosis. Thus, a new method of early diagnosis of TM on the basis of topography of muscular lesions and other clinical characteristics is proposed. This method provides reliable evidence for the preliminary diagnosis of thyrotoxicosis. In addition to thyrotoxicosis correction the question is raised about the pathogenetic treatment of TM.

The authors have given a critical review of existing classifications of myodystrophies from 1884 till 1973. They propose a new systematization based on the formula of muscular lesions during different phases of the disease and on the formula of a generalization of the myodystrophical process. It is assumed that the formula of muscular atrophies and the direction of the generalization of the myodystrophical process is genetically conditioned and should be considered as an important sign of hereditary neuro-muscular diseases. The authors believe that the facio-scapulo-limb type of myodystrophy both clinically and genetically is not homogenous. This form of dystrophy should be divided into 2 variants: a gradually descending one and a descending one with a "jumping" of muscular atrophies from the upper half of the body (face, shoulder) to the peroneal group of muscles on the skin.

Additional study was carried out of six generations belonging to the K. kindred, which were previously investigated by Oransky (1927). Eighteen members of this kindred were studied. In the early stages of the disease a sharp dissimilarity was observed in the pheno-types in the K. kindred, resulting from different rates of development and varying intensity in the course of the disease, so that it ranges from evident scapulo-peroneal amyotrophy to cases resembling Landouzy-Dejerine muscular dystrophy. In the later stages of the disease the clinical data on those affected were noted to be very similar. Muscular dystrophy in the K. kindred has been inherited as an autosomal-dominant type for five generations. The penetrance of the gene is almost complete. The expressivity of the gene varies from abortive to severe forms of the disease. From the clinical and genetic data available at the present time, is seems that the muscular dystrophy in the K. kindred is one of the varieties (namely, a descending type with a “jump”) of the facio-scapulo-limb (or facioscapulohumeral) muscular dystrophy. The scapulo-peroneal syndrome could be a long stage in the development of the disorder in some members of the K. kindred. As well as muscular dystrophy, some muscle anomalies have been independently inherited in the K. kindred. Apparently, muscular dystrophy and muscle defects are caused by the non-allele genes; this ensures the independent distribution of these signs among the members of the K. kindred.