Vol 71, No 4 (2016)

Article consists of literature review, authors experience of the application of neurovisualization and neurophysiological research methods to predict the recovery of consciousness in patients in vegetative state (VS). According to the literature data PET with FDG has higher sensitivity in the detection of signs of consciousness, then functional MRI (fMRI). The method fMRI allows assessing the functional activity of the brain in a state of rest and in response to stimulation with different modalities ― visual, auditory, etc (with the application of active and passive paradigm). A higher specificity in the detection of signs of consciousness have the methodology of fMRI with the active paradigm, at the same time, the absence of signs of consciousness according to the fMRI can not be charged as a basis for the conclusion of a poor prognosis in a particular patient. Neurophysiological tests (EEG, TMS, EP, etc) are more readily available and quite effective. Based on the literature analysis, the authors comes to the conclusion that neurovisualization and neurophysiological tests used in the prediction of the outcome of VS reflects the residual functional activity of different brain areas, in a context of diffuse brain damage, and the recovery of consciousness is usually combined with the restoring of the functional activity off the thalamocortical tracts, which activity, indirectly, is evaluated using these methods. In the authors' opinions, the main disadvantage in the interpretation of the is the lack of a common pathophysiological concept of the organization of brain functions in VS patients. The authors offer for the discussion their concept of stable pathological states of the brain, which is based on the works of Russian pathophysiologists.

Objective: to determine the role of serum Klotho (s-Klotho) protein levels changes in patients with different stages of chronic kidney disease (CKD).

Methods: The study involved 130 patients with CKD stages 1–5D (mean age ― 41±6.7 years). Serum levels of parathyroid hormone (PTH), calcium, phosphorus and s-Klotho protein (ELISA method) at baseline and after 1 year of follow-up were examined in all the patients so as the blood pressure (BP), including central (aortic), pulse wave velocity ― with the help of «Sphygmоcor» (Australia), echocardiography, radiography of the abdominal aorta in a lateral projection were also performed.

Results: when comparing the s-Klotho levels in patients with different CKD stages, it was found that the level change associated with the reduction of glomerular filtration rate (GFR) ahead of phosphorus and PTH increase in serum, stared at 3A CKD, whereas hyperphosphatemia and PTH increase started at 4–5 CKD stages. According to ROC analysis, decreasing of s-Klotho levels below 387 pg/ml was indicated a calcification risk of abdominal aorta increased with an 80% sensitivity and 75% specificity. In addition, a strong negative relationship of low s-Klotho levels and heart remodeling was found. When comparing the patients with hypertension who were receiving antihypertensive monotherapy, the highest serum levels of Klotho protein were observed in those of them whose target blood pressure level was achieved primarily through Angiotensin II Receptors Blockers (ARB), compared to those who was administered another drug group (p<0.01) or has not reached the target blood pressure level (p=0,008).

Conclusion: The change of serum Klotho levels (decrease) in CKD progression is associated with the degree (increase) of cardiovascular calcification and remodeling (the development of left ventricular hypertrophy, and cardiomyopathy) and it can be seen as an early independent marker of the cardiovascular system lesions in CKD. Our preliminary data of the effect of blood pressure correction on s-Klotho levels may indicate the possibility of drug maintaining serum Klotho levels and it requires further research.

This review reflects the current state of simulation technologies in neurosurgery and, in particular, in spinal surgery. Currently, there are different types of simulations used in spine surgery including the biological, artificial and virtual models. Simulations help to facilitate an optimal study of the anatomy, understand the spatial relationships between organs and tissues, plan properly the surgical intervention, and gain tactile surgical skills. The implementation of simulation technologies in the educational process provides objective assessment of the initial level of training, improvement of the competence in trained professionals, as well as prevention of surgical errors in various clinical situations.

Background: Problems of optimization diagnosis methods and prognosis for lung cancer remain unsolved. Lung cancer occupied the leading positions among cancer diseases.

Aims: Establishing change patterns in the parameters of endogenous intoxication and lipid peroxidation in the saliva of patients with lung cancer depending on the histologic type of tumor.

Materials and methods: The case-control study enrolled 516 men, who were divided into 3 groups: main (lung cancer, n=256), comparison group (non-malignant lung diseases, n=60), and control group (relatively healthy, n=200). Questioning and biochemical saliva study were carried out to all participants. Patients of the main group and the comparison group were hospitalized for surgical treatment, after which underwent the histological verification of the diagnosis. We used the spectrophotometric methods of investigation of parameters of lipid peroxidation and endogenous intoxication. Between-group differences were evaluated by nonparametric tests.

Results: Malondialdehyde as a product of lipid peroxidation is a little informative result. For more information it is necessary to determine the individual fractions of middle toxins count distribution ratio 280/254 nm, as well as to take into account the level of conjugated diene, triene conjugates, and Schiff bases. The following changes are observed at the transition from the control group to the comparison group, and then to the main: increased levels of triene conjugates and Schiff bases, as well as malondialdehyde. At the same time we detected the reduction in the level of diene conjugates, which confirms the fact of the increase in the oxidative stress process associated with benign diseases and lung cancer. In addition, there is a decrease in the content of individual fractions of middle toxins, but 280/254 nm partition coefficient growth is observed.

Conclusions: The findings support the hypothesis of the association processes of lipid peroxidation and endogenous intoxication with the development of lung cancer. It confirmed the dependence of these parameters on the histological type of tumor, the presence / absence and the degree of prevalence of remote and regional metastasis.

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