The purpose of the study. To analyze prevalence of diseases of musculoskeletal system in the Arkhangelsk region. The methods. The data of official statistics was used to implement analysis of general morbidity of main diseases of musculoskeletal system of adult population the Arkhangelsk region during 2010-2015 as compared with corresponding morbidity in the North-Western Federal and the Russian Federation in general. The results. In the Arkhangelsk region, among general morbidity percentage of diseases of musculoskeletal system made up to 4.2% (7th rank). The increasing of common morbidity of diseases of musculoskeletal system in adult population was marked in the Arkhangelsk region up to 14% and in the Russian Federation up to 7%. Since 2010, in the Arkhangelsk region the study established increasing of common morbidity rheumatoid joint inflammation up to 22%, spondylopathy up to 65%, osteoarthrosis up to 32.4%, osteoporosis up to 46% and systemic diseases of connective tissue up to 11.5% surpassing average Russian indices. At that, number of cases of reactive arthritis decreased up to 17.2% Conclusions. In the Arkhangelsk region, the register of diseases of musculoskeletal system on the basis of region rheumatological center is to be developed to implement an objective assessment in the existent situation.
Abstract. Despite a high prevalence of mild cognitive impairment (MCI), there are no accepted algorithms of diff erentiating the syndrome and the prognosis evaluation of later cognitive decline at this time. Objective. To identify biomarkers of poor prognosis in the various MCI types by optimizing neuropsychological examination in combination with MRI morphometry of brain structures. Patients and methods. We examined 45 patients (9 men, 36 women, mean age 72 ± 6.7 years) with MCI according to the modifi ed Petersen’s criteria and the DSM-5 criteria. All patients underwent the MMSE scale, the Detailed Neuropsychological Testing (DNT), which included a Ten Words Test (TWT), a “Double Test” (DT), a visual acuity test, a high-fi eld magnetic resonance imaging (MRI) of the brain with morphometry of cerebral structures (FreeSurfer, FSL). Results. According to the MMSE score, MCI were found in 26 (58%) patients. During the DNT, depending on the state of memory, 14 participants of the study identifi ed a non-amnestic type of MCI (na-MCI), 15 — an amnestic variant with impaired reproduction (ar-MCI), and 16 people — an amnestic type with a primary memory defect (apm-MCI). Volume changes of the anterior corpus callosum segment (CCA) were signifi cantly associated with the Immediate Recall after 4th reading and the Delayed Recall in the general MCI group (rho = 0.58; 0.58; p < 0.05) and the apmMCI group (rho = 0.6; 0.56; p < 0.05). Kruskal–Wallis Test showed that there were signifi cant group diff erences in the volumes of the CCA, right caudate nucleus, left cerebellar hemisphere cortex, posterior corpus callosum segment and left thalamus. At the same time, the fi rst three structures were combined into a set of informative features for differentiating the type of MCI based on the results of Forward stepwise Discriminant Analysis with a 77.3% accurate classifi cation rate (Wilks’s Lambda: 0.35962; approx. F (6.78) = 8.678, p < 0.001). ROC-analysis established the threshold values of the CCA volumes of ≤ 0.05% and the right caudate nucleus volumes of ≤ 0.23% (81.25% sensitivity in both cases; 62.1% and 60.7% specifi city; AUC 0.787 and 0.767; 95% CI 0.639–0.865 and 0.615–0.881; OR 7.1 and 6.7 (95% CI 1.6–30.6 and 1.6–29), associated with a memory defect in persons with MCI, while the ORs are 7.1 and 6.7 (95% CI 1.6–30.6 and 1.6–29), respectively. When both cerebral structures were included in the logit model, 88.6% classifi cation accuracy, 92.6% sensitivity, and 82.4% specifi city of the method were achieved. Conclusion. It has been demonstrated that classifying patients into the various types of MCI based on the data of memory function refl ected by the DNT and supplemented with MRI morphometry of the brain areas may be used as a sensitive and specifi c instrument for determining the category of patients with a high risk of Alzheimer’s disease. A neuropsychological profi le with a defect in primary memory, atrophic changes in anterior segment of the corpus callosum and the right caudate nucleus have been proposed as biomarkers of poor prognosis. Further longitudinal studies are necessary to clarify the proposed biomarkers of poor prognosis information and to detail the mechanisms of the neurodegenerative process.
Боль в спине -одна из наиболее актуальных медико-социальных проблем. В течение жизни хотя бы один эпизод боли в спине отмечается у 70-80% людей [1]. Ежегодно в США с жалобами на боль в спине к врачу обращаются от 15 до 20% жителей, из них 50% -лица трудоспособного воз-раста [2], что обусловливает большое социально-экономи-ческое значение данной проблемы. M. Harreby (2002)
Cognitive impairments (CI) are a serious problem in modern society, because they significantly reduce patients’ quality of life and tend to progress. Age-related diseases such as neurodegenerative — first of all Alzheimer’s disease (AD) and cerebrovascular disorders are key causes leading to CI. At present, approaches to treating these diseases have limited effectiveness in restoring cognitive functions, and do not change disease course, although they can slow cognitive decline.Understanding the immunopathogenesis of neurodegenerative and cerebrovascular diseases defines new targets and approaches to their treatment. In addition, suppression of neuroinflammation is advisable in the cases of early nonclarified cognitive decline, when information from routine medical, laboratory and instrumental examination of patients is insufficient to identify the causes of CI.This article summarizes current understanding of the immunopathogenesis of AD and chronic cerebral ischemia. The mechanism of neuroinflammation is presented as a cascade of sequential events that are closed in a self-perpetuating inflammatory response in the end. So called damage-associated molecular patterns, specific receptors that can bind them (pattern recognition receptors), intracellular signal transduction in microglia, cytokines and adhesion molecules are considered as potential points of application of immunomodulatory therapy. The review provides information on the current level of development of immunotherapy of AD, chronic cerebral ischemia and offers the prospect of its application.
The article presents modern ideas about the pathogenesis of cognitive disorders in cerebrovascular pathology at the cellular level. Dysfunction of neurovascular units is associated with impaired microcirculation, hypoxia, deficiency of energy resources, development of neuroinflammation, increased nitric oxide synthesis and oxidative stress, glutamate excitotoxicity, intracellular calcium accumulation, endothelial dysfunction, impaired circulation of cerebrovascular fluid, venous outflow from the cranial cavity and utilization of brain metabolic products, including misshaped proteins. The above determines the possibility of the combined development of cerebrovascular and neurodegenerative diseases, primarily Alzheimer’s disease. Currently, mixed (vascularneurodegenerative) brain damage is considered as the main cause of cognitive disorders, which is confirmed by the data of post-mortem studies. Pathogenetic therapy of dementia with cholinesterase inhibitors and memantine does not eliminate the cognitive defect, but only slows down its progression. The impossibility of restoring the premorbid level of daily activity of the patient in the treatment of cognitive impairment at the stage of dementia dictates the need for the use of adjuvant nootropic and neuroprotective agents until the breakdown of the functional reserve, that is, at the stage of moderate cognitive impairment. Nicotinoyl gamma-aminobutyric acid has nootropic, tranquilizing, psychostimulant and antioxidant properties. Studies of the last decade have proven the ability of nicotinoyl gamma-aminobutyric acid to suppress neuroinflammation and apoptosis of cells of the central nervous system, increase the expression of angiogenic and cytoskeletal proteins, normalize the permeability of the blood-brain barrier, which can be used to improve the function of neurovascular units and correct vascular-neurodegenerative cognitive impairment. A small number of drug interactions with nicotinoyl gamma-aminobutyric acid allows it to be included in the complex therapy of comorbid patients.
Aim. To investigate the dynamics of the prevalence of cardiovascular disease (CVD) risk factors (RFs) in men and women from a representative sample of the Ryazan Region general population.Material and methods. As a part of the epidemiological study EPOCH, a cross-sectional standardised screening of a representative sample of the Ryazan Region general population (n=2098) was performed. All respondents underwent a standardised questionnaire survey, anthropometry, and blood pressure (BP) measurement. The examination was repeated 5 years later, in 1760 participants (response rate 83,8%).Results. Over 5 years, the prevalence of arterial hypertension (AH) in the urban population increased from 34,8% to 39,1% (p<0,05). In the whole sample, AH prevalence remained stable (39,3% and 36,6% at the second and first screening, respectively), similar to the prevalence of diabetes mellitus (DM) (4,5% and 3,4%, respectively). Smoking prevalence in urban women increased from 6,0% to 9,2% (p<0,05) and did not change in men (51,8% in 2002 and 49,6% 5 years later). The prevalence of excessive alcohol consumption decreased from 7,7% to 5,6% (p<0,01), while the prevalence of excessive salt consumption remained the same. Obesity prevalence increased in women (from 23,6% to 28,3%; p<0,001) and only slightly changed in men (11,7% in 2002 and 14,0% 5 years later; p=0,68). Awareness of CVD in family history increased from 46,7% to 59,8% (p<0,001).Conclusion. In a representative sample of the Ryazan Region general population, the prevalence of CVD RFs remained high over 5 years of the follow-up.
Лапочкин Олег Лонгинович-главный врач 1 Пантелеева Маргарита Владимировна-канд. мед. наук, ст. науч. сотр. детского неврологического отделения 2
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