The aim of the research was to study the effect of the inclusion in the scheme cytoflavin patient care during the recovery period of ischemic stroke in the neuropsychological changes in the status and content of neurotrophins in serum. For this purpose we surveyed 52 patients who underwent a first ischemic stroke (29 women and 23 men) aged 52-74 years. Patients were divided into 2 groups: primary (25 patients) received in addition to basic therapy cytoflavin: intravenously at 20 ml per 400 ml of 5% glucose solution, 1 time a day for 10 days, then into 2 tablets 2 times a day for half an hour before food for a month, and the comparison group (27 patients) who received standard treatment. The control group consisted of 12 healthy people. In addition to standard clinical and laboratory tests were carried out a comprehensive neuropsychological study and evaluation of the data on the scale NIHSS, Bartell, Beck, Spielberger-Hanin, test «frontal dysfunction of the battery» and the Mini-Mental State Examination. Furthermore, determination carried neurotrophic factors: nerve growth factor (NGF) and brain-derived neurotrophic factor brain (BDNF). The study was conducted in the dynamics: before treatment and 2 months after treatment. Patients in the recovery period of the first ischemic stroke revealed moderate manifestations of neuropsychological disorders status and reduction of neurotrophic factors. Inclusion in cytoflavin scheme increased the efficiency of the treatment, which was manifested in a more pronounced when compared with the results of basic therapy, positive dynamics of neurological symptoms and improved cognitive function, accompanied by an increase in BDNF levels. The data on the efficacy and safety allow us to recommend its inclusion in the scheme of treatment of patients in the recovery period after the first carotid ischemic stroke.

Effect of antioxidant therapy on neurotrophins and processes of rehabilitation after stroke

The results of the study on the influence of carbon dioxide baths differing in the total mineralization levels on the clinical course of hypertensive disease associated with coronary heart disease and on various functional systems of the body. The data obtained provide an insight into the role of salt concentrations (10 and 20 g/l) in carbon dioxide bath water (1.2 g/l) applied for the traditional treatment of the patients with hypertensive disease associated with concomitant coronary heart disease and musculoskeletal pathology. Highly mineralized bath water has a greater influence on the functional state of the cardiovascular system by causing a more pronounced decrease in peripheral vascular resistance and hypotensive effect. Baths with a salt concentration of 20 g/l markedly reduced pain and had anti-inflammatory effect in the patients with pathology of support and locomotor organs.

The influence of carbon dioxide baths differing in the total mineralization levels on the functional state of the cardiovascular system of the patients presenting with hypertensive disease associated with coronary heart disease

Objective: No new U-net (nnU-Net) is a newly-developed deep learning neural network, whose advantages in medical image segmentation have been noticed recently. This study aimed to investigate the value of the nnU-Net-based model for computed tomography angiography (CTA) imaging in assisting the evaluation of carotid artery stenosis (CAS) and atherosclerotic plaque. Methods: This study retrospectively enrolled 93 CAS-suspected patients who underwent head and neck CTA examination, then randomly divided them into the training set (N = 70) and the validation set (N = 23) in a 3:1 ratio. The radiologist-marked images in the training set were used for the development of the nnU-Net model, which was subsequently tested in the validation set. Results: In the training set, the nnU-Net had already displayed a good performance for CAS diagnosis and atherosclerotic plaque segmentation. Then, its utility was further confirmed in the validation set: the Dice similarity coefficient value of the nnU-Net model in segmenting background, blood vessels, calcification plaques, and dark spots reached 0.975, 0.974 0.795, and 0.498, accordingly. Besides, the nnU-Net model displayed a good consistency with physicians in assessing CAS (Kappa = 0.893), stenosis degree (Kappa = 0.930), the number of calcification plaque (Kappa = 0.922), non-calcification (Kappa = 0.768) and mixed plaque (Kappa = 0.793), as well as the max thickness of calcification plaque (intraclass correlation coefficient = 0.972). Additionally, the evaluation time of the nnU-Net model was shortened compared with the physicians (27.3 ± 4.4 s vs. 296.8 ± 81.1 s, p < 0.001). Conclusion: The automatic segmentation model based on nnU-Net shows good accuracy, reliability, and efficiency in assisting CTA to evaluate CAS and carotid atherosclerotic plaques.

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The application of the nnU-Net-based automatic segmentation model in assisting carotid artery stenosis and carotid atherosclerotic plaque evaluation

Complex Plaques in the Proximal Descending Aorta: An Underestimated Embolic Source of Stroke

Ischemic stroke (IS) related to atherosclerosis of large arteries is one of the leading causes of mortality and disability in developed countries. Atherosclerotic internal carotid artery stenosis (ICAS) contributes to 20% of all cerebral ischemia cases. Nowadays, atherosclerosis prevention and treatment measures aim at controlling the atherosclerosis risk factors, or at the interventional (surgical or endovascular) management of mature occlusive lesions. There is a definite lack of the established circulating biomarkers which, once modulated, could prevent development of atherosclerosis, and consequently prevent the carotid-artery-related IS. Recent studies emphasize that microRNA (miRNA) are the emerging particles that could potentially play a pivotal role in this approach. There are some research studies on the association between the expression of small non-coding microRNAs with a carotid plaque development and vulnerability. However, the data remain inconsistent. In addition, all major studies on carotid atherosclerotic plaque were conducted on cell culture or animal models; very few were conducted on humans, whereas the accumulating evidence demonstrates that it cannot be automatically extrapolated to processes in humans. Therefore, this paper aims to review the current knowledge on how miRNA participate in the process of carotid plaque formation and rupture, as well as stroke occurrence. We discuss potential target miRNA that could be used as a prognostic or therapeutic tool.

/pdf/micrornas-associated-with-carotid-plaque-development-and-1qnpni41.pdf

microRNAs Associated with Carotid Plaque Development and Vulnerability: The Clinician’s Perspective

Atherosclerosis is a well-known disease leading to cardiovascular events, including myocardial infarction and ischemic stroke. These conditions lead to a high mortality rate, which explains the interest in their prevention, early detection, and treatment. Molecular imaging is able to shed light on the basic pathophysiological processes, such as inflammation, that cause the progression and instability of plaque. The most common radiotracers used in clinical practice can detect increased energy metabolism (FDG), macrophage number (somatostatin receptor imaging), the intensity of cell proliferation in the area (labeled choline), and microcalcifications (fluoride imaging). These radiopharmaceuticals, especially FDG and labeled sodium fluoride, can predict cardiovascular events. The limitations of molecular imaging in atherosclerosis include low uptake of highly specific tracers, possible overlap with other diseases of the vessel wall, and specific features of certain tracers’ physiological distribution. A common protocol for patient preparation, data acquisition, and quantification is needed in the area of atherosclerosis imaging research.

Clinical Molecular Imaging for Atherosclerotic Plaque.

The paper shows the efficiency and safety of increasing the therapeutic window for systemic thrombolysis in verified ischemic stroke in the vertebrobasilar system (VBS), as well as the possibility of effective reperfusion in patients with stenotic occlusive lesions of the basilar artery and clinical signs of severe truncal stroke. Thrombolytic therapy (TLT) over 4.5 hours and in a neurological deficit of >25 scores according to the National Institute of Health (NIHSS) Scale should be performed only within the framework of clinical trials. TLT for stroke in the VBS may substantially alter the approach to rendering care in this pathology and contribute to an increase in the number of patients with a good functional outcome.

/pdf/tromboliticheskaia-terapiia-u-patsientov-s-ishemicheskim-1zg6zi9izw.pdf

Тромболитическая терапия у пациентов с ишемическим инсультом в вертебрально-базилярной системе

The purpose of our study is to investigate the risk factors of in-hospital mortality among patients who were admitted in an emergency setting to a non-specialized tertiary center during the first peak of coronavirus disease in Moscow in 2020. The Federal Center of Brain and Neurotechnologies of the Federal Medical and Biological Agency of Russia was repurposed for medical care for COVID-19 patients from 6th of April to 16th of June 2020 and admitted the patients who were transported by an ambulance with severe disease. In our study, we analyzed the data of 635 hospitalized patients aged 59.1 ± 15.1 years. The data included epidemiologic and demographic characteristics, laboratory, echocardiographic and radiographic findings, comorbidities, and complications of the COVID-19, developed during the hospital stay. Results of our study support previous reports that risk factors of mortality among hospitalized patients are older age, male gender (OR 1.91, 95% CI 1.03–3.52), previous myocardial infarction (OR 3.15, 95% CI 1.47–6.73), previous acute cerebrovascular event (stroke, OR = 3.78, 95% CI 1.44–9.92), known oncological disease (OR = 3.39, 95% CI 1.39–8.26), and alcohol abuse (OR 6.98, 95% CI 1.62–30.13). According to the data collected, high body mass index and smoking did not influence the clinical outcome. Arterial hypertension was found to be protective against in-hospital mortality in patients with coronavirus pneumonia in the older age group. The neutrophil-to-lymphocyte ratio showed a significant increase in those patients who died during the hospitalization, and the borderline was found to be 2.5. CT pattern of “crazy paving” was more prevalent in those patients who died since their first CT scan, and it was a 4-fold increase in the risk of death in case of aortic and coronal calcinosis (4.22, 95% CI 2.13–8.40). Results largely support data from other studies and emphasize that some factors play a major role in patients’ stratification and medical care provided to them.

V. G. Lelyuk

Papers

Clinical Molecular Imaging for Atherosclerotic Plaque.

Тромболитическая терапия у пациентов с ишемическим инсультом в вертебрально-базилярной системе

Risk Factors of In-Hospital Mortality in Non-Specialized Tertiary Center Repurposed for Medical Care to COVID-19 Patients in Russia

Echographic features of atherosclerotic lesions of extracranial carotid arteries in carotid ischemic stroke

State of intra- and extracranial arteries, white matter and cerebral cortex in asymptomatic hypertensive patients