Vegetative Status Research Articles

Assessment of systemic hemodynamic changes in medical workers of PCR laboratories when using personal protective equipment

In the conditions of the COVID-19 pandemic, clinical diagnostic laboratories conducting a test for the presence of coronavirus using polymerase chain reaction (PCR), in most cases, work with significant overload. Performing professional duties in these conditions imposes special requirements on medical personnel. First of all, this concerns the parameters of systemic hemodynamics as an objective criterion of health risk.
 The study aims to analyze the state of systemic hemodynamics in medical workers of PCR laboratories when working in the conditions of the COVID–19 pandemic when using personal protective equipment against a biological factor.
 The researchers have conducted the study in the winter period of the year in PCR laboratories for the diagnosis of a new coronavirus infection. The observation group included 33 people aged 32.5±1.44 years and 1–33 months of experience in the PCR laboratory. We have evaluated the key parameters of systemic hemodynamics, heart rate variability and the degree of oxygen saturation in the blood of laboratory staff. The authors have carried out measurements at the beginning and end of the work shift.
 There was a significant increase in heart rate (by 3.7%), minute heart volume (by 5.2%), myocardial oxygen consumption (by 5.6%) at the end of the work shift compared with its beginning. The values of these parameters of systemic hemodynamics remained within the normal range. At the same time, the increase in the values of these indicators indicates a significant strain on self-regulatory mechanisms and the development of fatigue.
 When using personal protective equipment against a biological factor, the tension of the systemic mechanisms of hemodynamic self-regulation in medical workers of PCR laboratories increases. The degree of severity of the tension of these mechanisms significantly depends on the features of the functional state of the cardiovascular system and vegetative status. At the same time, it is necessary to provide a physiological and hygienic justification for the duration of the periods of work of medical workers of PCR laboratories when using various types of personal protective equipment against a biological factor, which justifies the relevance of further research.
 Limitations. The results of this study were obtained on a relatively small sample. Therefore, in order to increase its representativeness, it is necessary to increase the number of participants, which will allow leveling the existing restrictions.
 Ethics. The study was conducted in compliance with the ethical standards set out in the Helsinki Declaration of 1975 with additions of 2008. The study participants signed a form of "Informed Voluntary consent to conduct a study", developed in accordance with the requirements of the local ethics committee of the Federal State Budgetary Educational Institution of the Volga State Medical University of the Ministry of Health of the Russian Federation.

Low Morbidity and Mortality in Children with Severe Traumatic Brain Injury Treated According to the Lund Concept: A Population-Based Study.

Previous reports of mortality and morbidity in pediatric severe traumatic brain injury (TBI) vary considerably, with few population-based studies. Mortality rates from 3-33 % and varying morbidity have been reported, most commonly using the Extended Glasgow Outcome Scale (eGOS). The Lund concept is a treatment algorithm for severe TBI aiming at controlling intracranial pressure (ICP) by reducing cerebral perfusion pressure (CPP). The aim of the present study was to retrospectively assess mortality and morbidity in a population of pediatric TBI treated according to the Lund concept. All cases of severe pediatric TBI (age <18 years) in the southern region of Sweden during 19 years were identified. Patients were treated according to the Lund concept. Mortality, eGOS, ICP, CPP, time in the neurosurgical intensive care unit (NICU), drugs delivered and surgical procedures were recorded. Data were analyzed both by dichotomized outcomes and by ordinal statistics. A total of 135 cases of severe TBI <18 years of age were recorded (incidence 2.0/100000) and 86 patients were admitted to the tertiary NICU. Mortality including all cases was 43% (mortality rate 0.7/100,000) and in NICU 10%. Outcome was good in 60%, moderate in 25%, unfavorable in 15%, with none in a vegetative status. In both dichotomized and ordinal analyses, CPP <40 mm Hg and ICP >15 were associated with poor outcome, supporting current guidelines. However, high CPP also was associated with increased mortality and morbidity, supporting that elevated CPP might increase cerebral edema. In this study, the Lund concept resulted in low mortality and a favorable outcome in a majority of severe pediatric TBI patients; however, randomized controlled trials are warranted to verify this.

Transcriptome profiling at the transition to the reproductive stage uncovers stage and tissue-specific genes in wheat

BackgroundThe transition from vegetative to floral phase is the result of complex crosstalk of exogenous and endogenous floral integrators. This critical physiological event is the response to environmental interaction, which causes biochemical cascades of reactions at different internal tissues, organs, and releases signals that make the plant moves from vegetative status to a reproductive phase. This network controlling flowering time is not deciphered largely in bread wheat. In this study, a comparative transcriptome analysis at a transition time in combination with genetic mapping was used to identify responsible genes in a stage and tissue-specific manner. For this reason, two winter cultivars that have been bred in Germany showing contrasting and stable heading time in different environments were selected for the analysis.ResultsIn total, 670 and 1075 differentially expressed genes in the shoot apical meristem and leaf tissue, respectively, could be identified in 23 QTL intervals for the heading date. In the transition apex, Histone methylation H3-K36 and regulation of circadian rhythm are both controlled by the same homoeolog genes mapped in QTL TaHd112, TaHd124, and TaHd137. TaAGL14 gene that identifies the floral meristem was mapped in TaHd054 in the double ridge. In the same stage, the homoeolog located on chromosome 7D of FLOWERING TIME LOCUS T mapped on chr 7B, which evolved an antagonist function and acts as a flowering repressor was uncovered. The wheat orthologue of transcription factor ASYMMETRIC LEAVES 1 (AS1) was identified in the late reproductive stage and was mapped in TaHd102, which is strongly associated with heading date. Deletion of eight nucleotides in the AS1 promoter could be identified in the binding site of the SUPPRESSOR OF CONSTANS OVEREXPRESSION 1 (SOC1) gene in the late flowering cultivar. Both proteins AS1 and SOC1 are inducing flowering time in response to gibberellin biosynthesis.ConclusionThe global transcriptomic at the transition phase uncovered stage and tissue-specific genes mapped in QTL of heading date in winter wheat. In response to Gibberellin signaling, wheat orthologous transcription factor AS1 is expressed in the late reproductive phase of the floral transition. The locus harboring this gene is the strongest QTL associated with the heading date trait in the German cultivars. Consequently, we conclude that this is another indication of the Gibberellin biosynthesis as the mechanism behind the heading variation in wheat.

Electrophysiological parameters of the HRV of animals with different vegetative status

Studies of the electrophysiological indicators of the VCR in the Cows of the Jersey breed with different levels of autonomic regulation were not previously carried out, and their normal values in the accessible literature are not described. Given the subtlety of the mechanisms of autonomic heart regulation, there is a need to expand the diagnosis of very common heart disease in animals. The purpose of research is to study the electrophysiological parameters of the variability of the heart rhythm in cattle to assess the possibility of including them in an integrated approach to the analysis of the functioning of the heart in animals. The 103 healthy cows of the Jersey breed studied. The dependence of the change in electrophysiological indicators of the variability of the heart rhythm on the vegetative status of the animal has been studied. To register cardio intervalograms, a computer complex electrophysiological laboratory “Conan - 4.5” was used. The recording was carried out in cattle in a calm state in a standing position. The electrophysiological indicators of the VCR were studied. In this regard, it is advisable to include the assessment of these parameters to include in the basic set of a complex of diagnostics of heart disease in cattle.

Особенности вегетативного статуса и качества жизни у пациенток репродуктивного возраста с недифференцированной дисплазией соединительной ткани

The purpose — to study the features of vegetative status and quality of life in female patients of reproductive age with UCTD. Material and methods. We examined 88 female patients (average age 25.0 ± 6.5 years) with UCTD. The control group consisted of 100 practically healthy women without signs of UCTD (average age 26.6 ± 5.4 years). All patients with UCTD had a deficiency of 25(OH)D. In the group of women with UCTD, a significant decrease in the magnesium content in blood serum and oral fluid was diagnosed in comparison with the control group (p = 0.001). The patients were treated with Magnerot (Worwag Pharma, GmbH&amp;Co., KG, Germany) and Fortedetrim (MEDANA PHARMA, SA, Poland) for 8 weeks. After 8 weeks of therapy with Fortedetrim, vitamin D content (25 (OH)D) in blood serum reached reference values and amounted to 36.2 ± 5.2 ng/ml (p = 0.001). After 8 weeks of treatment with Magnerot, the magnesium content in blood serum and oral fluid also reached reference values and amounted to 0.95 ± 0.04 mmol/l and 0.62 ± 0.06 mmol/l, respectively (p = 0.001). Results and discussion. The obtained results testify to a statistically significant decrease in the level of personal anxiety, manifestations of depression, autonomic disorders and improvement in QOL and values of the questionnaire of childbearing role orientations against the background of treatment with Magnerot and Fortedetrim for two months (p &lt; 0.05). Conclusion. The results obtained indicate the need to include magnesium and vitamin D preparations in the program of medical rehabilitation of women of reproductive age with UCTD and its mandatory combination with psychological rehabilitation, taking into account the fact that stressful states and depressive disorders are accompanied by magnesium deficiency. The health protection of such patients becomes especially significant under the catastrophic demographic situation in the Russian Federation («demographic pitfall»).

Синдром вегетативной дисфункции пациентов, перенесших COVID-19, на 3 этапе медицинской реабилитации

At the moment, post-COVID-19 syndrome is a poorly studied aspect of the past pandemic, the clinical signs of which largely coincide with the symptoms of autonomic dysfunction. When examining patients who underwent COVID-19, symptoms of the autonomic nervous system disorder are often revealed. The use of vegetative status assessment methods will allow detecting, confirming and adjusting a rehabilitation program for such patients. The purpose — to analyze the results of the vegetative status assessment in patients who underwent COVID-19, admitted to post-COVID rehabilitation. Material and methods. We examined 100 patients with a confirmed history of COVID-19 infection who were admitted for post- COVID-19 rehabilitation as part of stage 3 of medical rehabilitation. Results. Autonomic dysfunction was observed in two thirds of patients and corresponded to the complaints without correlation with clinical manifestations. The most common symptoms were asthenia and shortness of breath during exercise. After a comprehensive rehabilitation, positive dynamics was observed; however, residual phenomena requiring further correction persisted in patients with autonomic dysfunction. Conclusions. The data obtained confirmed that patients who underwent COVID-19 have chronic symptoms of post-COVID-19 syndrome associated with the autonomic system disorder.

Swidden Agriculture Landscape Mapping Using MODIS Vegetation Index Time Series and Its Spatio-Temporal Dynamics in Northern Laos

Swidden agriculture or shifting cultivation is still being widely practiced in tropical developing countries and Laos has spared no effort to eradicate it since the mid-1990s. So far, the development of swidden agriculture in this land-locked mountainous country during the 2000–2020 bi-decade remains poorly examined. Moderate-resolution Imaging Spectroradiometer (MODIS) time-series products have shown potential in monitoring vegetative status; however, only extremely limited cases of remote sensing of swidden agriculture landscapes have been reported. Taking northern Laos as a study area and using 2001–2020 MODIS vegetation indices products, the Savitzky–Golay filter, the Mann–Kendall trend test and a threshold method were employed to delineate and monitor annual patterns and dynamics of swidden agriculture landscape at the village level. The results showed that: MODIS Normalized Difference Vegetation Index (NDVI) time series perform better in delineating the temporal development of swidden agriculture. The swidden agriculture landscape has shown a general descending trend in the past decades, especially in the 2010s, with an annual average of 14.70 × 104 ha. The total number of swidden-practicing villages (or districts) also displayed a declining trend and there were 957 villages or 91 districts practicing it continuously between 2001 and 2020. An average of 32 villages per year or two districts per decade highlights the difficulty in ending swidden agriculture in Laos, although the government of Laos has established a number of policies for the eradication of swidden agriculture by 2020. This study provides a necessary methodological reference for monitoring a two-decade evolution and transformation of swidden agriculture in the tropics.

Impact of environmental conditions, stress severity and dose application on caffeine-related improved lentil productivity

Flowering and pod formation are two of the most sensitive pheno-phases in lentil ( Lens culinaris Medik.) development, and both can be strongly influenced by environmental conditions, biotic or abiotic stress. Caffeine (1,3,7-trimethylxanthine), a secondary metabolite within purine alkaloids, has a strong potential for its use as an active ingredient in biostimulant formulations. To evaluate the impact of environmental conditions, stress type, and dose on caffeine application effectiveness, we compared how various doses of caffeine influenced lentil production, pod formation, reproductive phenology, and foliar stress markers in irrigated plants, water-stressed plants, and plants exposed to the stem holoparasite field dodder ( Cuscuta campestris Yunck.) in a controlled greenhouse experiment. Three caffeine concentrations (10 −5 M, 10 −4 M, and 10 −3 M) were tested, which were applied twice (at initial flowering and pod formation), and compared to a control treatment (without caffeine). Results showed that the highest caffeine dose increased lentil production by nearly 50% in irrigated plants, but not in water-stressed plants or those exposed to the holoparasite. Both water deficit and parasitism had a very negative impact on lentil production, with a yield reduction of 66% and 87% respectively, effects that were not counterbalanced by caffeine application. Furthermore, foliar stress markers, such as F v / F m ratio and malondialdehyde content, showed a much stronger sensitivity of lentil plants to biotic than abiotic stress, and a higher impact of both stresses on flowering and fruit formation than on the vegetative physiological status. We conclude that (i) both abiotic and biotic factors strongly negatively influence the physiology of lentil plants, in particular pod and lentil production; and (ii) environmental conditions and both abiotic and biotic stresses have a strong impact on the potential response of plants to caffeine when used as a potential ingredient for biostimulant formulations. • Caffeine treatment at the highest studied dose (10 −3 M) improved fruit and lentil production. • Caffeine treatment effects were observed under suboptimal growth conditions, but not under severe stress. • Both water deficit and holoparasitism by field dodder strongly negatively affected fruit and seed production. • Holoparasitism caused even more negative effects than water deficit on lentil production and the photosynthetic apparatus.

Динамика показателей остеопатического статуса на фоне лечения у пациентов с паническими атаками

This article presents the records of a study of the effect of osteopathic treatment on the dynamics of craniosacral mechanism indices in patients with panic attacks. The study involved patients of both sexes with a mean age of 36.8±2.2 years with complaints of panic attack symptom complex; the treatment duration ranged from 6 to 8 weeks. A factor analysis of the internal structure of the patients' functional state before and after osteopathic treatment was carried out. It was ascertained that after osteopathic treatment the number of complaints decreased, indices of well-being improved, and the vegetative status normalized.

20 years experience in diagnostics and treatment of the ektopated pancreas in the gastroduodenal zone in children

Ectopia of the pancreas is a rare malformation that requires an individual approach to treatment. We present our experience in the diagnosis and treatment of 119 patients with EPI in the gastroduodenal zone. The main indication for surgical treatment is with a long-term intractable pain symptom. 28 (23.5%) patients were operated on, most of them from the laparoscopic approach. To determine the enzymatic activity of the gland, an assessment of the vegetative status was used. Vagotonia can be one of the causes of exocrine activity and hyperperistalsis of the stomach and duodenum. Among the operated patients, the parasympathetic type of autonomic nervous regulation was more common. Evaluation of the histostructure of the removed EPG macro- preparations indicated the predominance of type 3, indicating the presence of all components similar in structure to the tissue of a normal pancreas.

Electroencephalographic and Autonomic Correlates of Imaginary and Real Movements of Legs in Right-Handers and Left-Handers

—Changes in the spectral power (SP) of electroencephalogram (EEG) in the α-band and the heart rate variability (HRV) were studied in subjects with right and left motor dominance profiles during imaginary and real flexion of right and left feet. During the implementation of motor tasks, a pronounced desynchronization of α-rhythm in frontal and central leads and its less significant changes in parietal and occipital zones of both hemispheres were revealed. The peculiarity of right-handers during mental and real leg movements was the variable and asymmetric character of changes in the SP of α-rhythm in the bilateral leads from various cortical areas. In left-handed subjects, when imagining and performing movements, the desynchronization of α-rhythm in different leads had the same severity and there were practically no hemispheric asymmetry in SP. Right-handers had are latively stable vegetative status during the performance of motor tasks, and HRV changes occurred mainly with real leg movements. In left-handers HRV parameters changed more strongly and mainly during mental actions with their feet. Correlations were found between the α-rhythm SP and HRV parameters, depending on the type of movement and the motor dominance profile of subjects. The obtained data reflect the peculiarities of regulation mechanisms of voluntary leg movements and the differences in the vegetative support of motor activity in right-handed and left-handed people.

PREDICTORS OF THE DEVELOPMENT OF OBSTETRICS COMPLICATIONS AND THE MANAGEMENT ALGORITHM OF PREGNANT WOMEN WITH CONNECTIVE TISSUE DYSPLASIA OF THE HEART

Pregnancy, even under the condition of its physiological course, is accompanied by tension of all functional systems of the body, which occurs already from the first trimester of pregnancy and increases during the period of their functional restructuring. In the presence of undifferentiated connective tissue dysplasia (UCTD), gestational processes may be disrupted and lead to obstetric losses. The purpose of the work is devoted to the optimization of pregnancy management tactics, treatment and prevention of obstetric complications in women with connective tissue dysplasia and mitral valve prolapse, complicated by extrasystolic arrhythmia, through the differentiated use of complex drug treatment, which makes it possible to normalize the main pathogenetic factors of the development of pregnancy complications with this comorbid pathology. Material and methods. To solve the goal, 164 pregnant women with signs of UCTD and mitral valve prolaps (MVP) and 26 healthy pregnant women were examined. In addition to a general clinical and obstetric examination, all pregnant women underwent a laboratory-instrumental study of the state of the fetus and fetoplacental complex, the state of the cardiovascular system, vascular endothelium, the activity of lipid peroxidation and antioxidant defense systems, and the determination of blood electrolyte balance. Research results and their discussion. It was established that the course of pregnancy in women with undifferentiated connective tissue dysplasia and mitral valve prolapse, complicated by extrasystolic arrhythmia (EA), is accompanied by a significantly higher frequency of obstetric and perinatal pregnancy complications during the entire gestation period (r=0.756-0.869, p&lt;0.05). In pregnant women with UCTD and MVP syndrome, complicated by EA, the disease is clinically manifested by the development of both arrhythmic symptoms and signs of impaired vegetative status, which significantly shortens the time of blood supply and worsens metabolic processes in the myocardium and placenta, which are the direct causes of placental dysfunction, fetal growth retardation, the development of labor abnormalities and complications in the early postpartum period. The specified disorders in pregnant women with PMC on the background of UCTD are associated with hypo- and dyselectrolytemia of Mg2+, K+ and hypercalcemia, imbalances in the redox system, and the severity of endothelial dysfunction. In pregnant women with UCTD and MVP under the influence of the recommended treatment with arginine-carnitine and vitamin-mineral complex, the level of electrolytes, electrophysiological and functional indicators of the systolic-diastolic function of the myocardium were normalized to the level of healthy pregnant women due to the restoration of metabolic processes and improvement of peripheral hemodynamics, which was accompanied by satisfactory uterine placental-fetal blood flow (according to dopplerometry), a decrease in the frequency of miscarriage, preeclampsia, FGR and complications during childbirth and the postpartum period. Addition of the selective beta-adrenergic blocker nebivolol to the proposed medical support of pregnant women contributed to the elimination of extrasystole, was manifested by a reliable improvement of electrophysiological parameters and systolic-diastolic function of the heart. The obtained hemodynamic, antiarrhythmic and metabolic effects of the proposed complex therapy in pregnant women with UCTD and MVP complicated by extrasystolic arrhythmia were accompanied by a significant decrease in the frequency of pregnancy and childbirth complications. Conclusions. Recommended treatment algorithm have been proposed for the optimal management of pregnant women with UCTD and MVP syndrome, complicated by EA

Inhibition of Delayed Cerebral Ischemia by Magnesium Is Insufficient for Subarachnoid Hemorrhage Patients: A Network Meta-Analysis.

Objective After subarachnoid hemorrhage, magnesium could reduce the incidence of delayed cerebral ischemia; however, it is still controversial. This study updated the results of recently published magnesium-related studies and conducted an exploratory analysis of the impact of application strategies and intervention factors on the results. Methods Public databases were searched from the date of their inception to May 10, 2021. Randomized controlled trials on magnesium agent-related regimens for subarachnoid hemorrhage patients were included. Results In total, 28 articles were included in the meta-analysis. For delayed cerebral ischemia, magnesium-related interventions significantly reduced the risk of delayed cerebral ischemia compared with nonmagnesium interventions (odds ratios: 0.40; 95% confidence interval: 0.28–0.56; p < 0.01). For cerebral vasospasm, a random effects model showed that magnesium significantly reduced the risk of cerebral vasospasm (odds ratios: 0.46; 95% confidence interval: 0.33–0.63; p < 0.01). In the subgroup analysis, intracranial magnesium (odds ratios: 6.67; 95% confidence interval: 1.14–38.83; p=0.03) and magnesium plus hydrogen (odds ratios: 10; 95% confidence interval: 1.59–62.73; p=0.01) produced significant results in improving the good recovery rate compared to the control. In the network meta-analysis, magnesium plus nimodipine and simvastatin even showed an effective trend in death/persistent vegetative status improvement. Conclusion This study supports the beneficial effect of magnesium in reducing the risk of delayed cerebral ischemia. Based on a single randomized controlled trial, immediate intracranial magnesium therapy with intravenous hydrogen after subarachnoid hemorrhage can increase the good recovery rate. Therefore, more high-quality studies are needed to confirm this finding.

Herbage and Silage Quality Improved More by Mixing Barley and Faba Bean Than by N Fertilization or Stage of Harvest

Legume–cereal mixtures are pivotal in yielding a more balanced forage composition compared to the sole crops, due to the well-adjusted equilibrium of carbohydrate and protein. However, great attention is required in choosing the optimal ratio of the components for the mixtures and other agronomic practices (including N fertilization and stage of harvest), because they can sharply change the forage composition and quality. To fill this gap, the present research compared the herbage and silage qualities and key fermentative and nutritional traits of biomasses obtained by: (i) five mixtures (i.e., 100:0; 75:25, 50:50, 25:75, and 0:100) of hybrid barley (Hordeum vulgare L.) and faba bean (Vicia faba var. minor); (ii) two N barley fertilization rates (0 vs. 140 kg N ha−1); and (iii) three stages of harvest (milky, early dough and soft dough). We found that the presence of faba bean improved the forage quality, either herbage or silage, through different mechanisms. In the herbage mixtures, faba bean inclusion increased crude protein (CP), and, when compared to the fertilized barley, also water-soluble sugar (WSCs) concentration, with small effects on the relative feed values (RFV) and total digestible nutrients (TDN). In the silage, the higher the faba bean share in the mixture, the higher the RFV, the non-fibrous carbohydrates, and total and lactic acid concentrations, and the lower the pH and the hemicellulose and cellulose concentrations, particularly at the early and mid stages of harvest. These improvements were likely due to the high ability of faba bean to attain a vegetative status (i.e., low dry matter concentration) by the end of the cropping season, and to improve the organic acid production. Our results suggest that the inclusion of faba bean in a barley-based silage system can widen the window for silage harvesting, thanks to its ability to sustain the fermentation process, despite a lower WSC to CP ratio compared to the unfertilized barley. These results occurred almost irrespectively of the faba bean share in the mixture and barley fertilization. This implies that when designing intercrop mixtures, the effect of crop densities on yield should be considered more than on quality.

The use of heated oxygen-helium mixture in patients with arterial hypertension

BACKGROUND: The spread of arterial hypertension is associated with the presence of such risk factors as smoking, excess body weight, violation of lipid metabolism, the current psycho-emotional load.&#x0D; AIMS: to assess the effectiveness of the use of heated oxygen-helium mixture in the rehabilitation of patients with arterial hypertension at the outpatient polyclinic stage.&#x0D; MATERIAL AND METHODS: The supervision was 67 people aged from 40 to 56 years (48.254.12 years old) with a verified diagnosis: arterial hypertension I and II art., Low and medium risk, the duration of the disease was 7 years to 15 years (8.982.2 years). Patients were divided into two groups: I Group (n=35) the main, patients underwent a course of rehabilitation with the inclusion of oxygen-helium mixture; group II (n=32) comparisons, patients underwent a course of rehabilitation without the use of mixture. Breathing was carried out in cyclical and fractionated mode: the breathing mixture is 5 minutes then breathing with atmospheric air 5 minutes (one cycle), 3 such cycles for the procedure. The course of treatment consisted of 1 procedure per day within 10 days from the first day of the study.&#x0D; To assess the clinical efficiency of reducing treatment, the study was carried out before the start of regenerative treatment and at the end of the course. The effectiveness of this method was assessed by the following indicators: assessment of vegetative status using cardiac rhythm variability indicators; evaluation of blood flow and elastic-elastic properties in the distal arteries of the lower extremities; evaluation of the adaptation of the cardiovascular system to physical exertion with the help of the Harvard Step test, a 6-minute walking test; the level of cortisol in saliva was determined using the immunosyluminescence method; the level of depression and anxiety.&#x0D; RESULTS: In the main group of patients, there was a positive dynamics in the form of normalization of vegetative status, an increase in the activity of the parasympathetic department of the autonomic nervous system, a decrease in the tone of the sympathetic nervous system, the improvement of elastic properties at the level of the distal arteries of the leg (rear tibial artery, the artery of the foot). After the course of respiration, an increase in physical exhaust tolerance was revealed from the patients examined with arterial hypertension, which passed the respiratory rate of heated oxygen-helium mixture and increase the speed of adaptation processes of recovery of the cardiovascular system after exercise. This analysis of the dynamics of the level of cortisol in saliva demonstrated a tendency to reduce the level in patients of the main group. The results of the study indicate the improvement of the psycho-emotional state of patients with arterial hypertension.&#x0D; CONCLUSION: The use of heated oxygen-helium mixture has a positive effect on the functional state of patients with arterial hypertension.

Оценка влияния остеопатического лечения на динамику психовегетативных симптомов у пациентов с тревожно-фобическими расстройствами

The article highlights the materials of the influence of complex rehabilitation measures with the inclusion of osteopathic treatment on the symptom’s dynamics in patients with anxiety-phobic disorders. The study involved patients of both sexes, aged from 23 to 49 years, the treatment lasted from 6 to 8 weeks. It has been determined that against the osteopathic treatment, the number of complaints in patients decreases, the indices of vegetative status return to normal, and the frequency of incidences of somatic dysfunctions decreases.

The role of the craniotomy size in the surgical evacuation of acute subdural hematomas in elderly patients: a retrospective multicentric study.

Elderly patients operated for an acute subdural hematoma (ASDH) frequently have a poor outcome, with a high frequency of death, vegetative status, or severe disability (Glasgow Outcome Score [GOS] 1-3). Minicraniotomy has been proposed as a minimally invasive surgical treatment to reduce the impact of surgery in the elderly population. The present study aimed to compare the influence of the size of the craniotomy on the functional outcome in patients undergoing surgical treatment for ASDH. We selected patients ≥70 years old admitted to 5 Italian tertiary referral neurosurgical for the treatment of a post-traumatic ASDH between January 1, 2016, and December 31, 2019. We collected demographic data, clinical data (GCS, GOS, Charlson Comorbidity Index [CCI], antiplatelet/anticoagulant therapy, neurological deficits, seizure, pupillary size, length of stay), surgical data (craniotomy size, dividing the patients into 3 groups based on the corresponding tertile, and surgery duration), radiological data (ASDH side and thickness, midline shift, other post-traumatic lesions, extent of ASDH evacuation) and we assessed the functional outcome at hospital discharge and 6-month follow-up considering GOS=1-3 as a poor outcome. ANOVA and χ2 Tests and logistic regression models were used to assess differences in and associations between clinical-radiological characteristics and functional outcomes. We included 136 patients (76 males) with a mean age of 78±6 years. Forty-five patients underwent a small craniotomy, 47 a medium size, and 44 a large craniotomy. Among the different craniotomy size groups, there were no differences in gender, anticoagulant/antithrombotic therapy, CCI, side of ASDH, ASDH thickness, preoperative GCS, focal deficits, seizures, and presence of other post-traumatic lesions. Patients undergoing small craniotomies were older than patients undergoing medium-large craniotomies; ASDH treated with medium size craniotomy were thinner than the others; patients undergoing large craniotomies showed greater midline shift and a higher rate of anisocoria. The three groups did not differ for functional outcome and postoperative midline shift, but the length of surgery and the rate of >50% of ASDH evacuation were lower in the small craniotomy group. A small craniotomy was not inferior to larger craniotomies in determining functional outcomes in the treatment of ASDH in the elderly.

CLINICAL AND NEUROLOGICAL FEATURES OF PATIENTS WITH ENDOCRINE PATHOLOGY

The autonomic nervous system plays an important role in the functioning of the human body. It regulates the work of internal organs, ensures the maintenance of homeostasis, adaptive reactions, motor and mental activity, affects immunity and emotions. In turn, the imbalance of the functional state of the patient's brain leads to disruption of the activity of nonspecific systems and is manifested by characteristic disorders in the cognitive, mental and vegetative status of the patient. The mechanism of chronic pathological adaptation is based on an automatic metabolism, genetically predetermined with the participation of the regulatory role of the nervous and endocrine systems.

The Difficult Decision Not to Prescribe Artificial Nutrition by Health Professionals and Family: Bioethical Aspects.

IntroductionBioethics and nutrition are essential issues in end of life, advanced dementia, life-sustaining therapies, permanent vegetative status, and unacceptably minimal quality of life. Even though artificially administered nutrition (AAN), for this type of health condition, does not improve quality of life and extension of life, and there is evidence of complications (pulmonary and gastrointestinal), it has been used frequently. It had been easier considering cardiopulmonary resuscitation as an ineffective treatment than AAN for a healthy team and/or family. For this reason, many times, this issue has been forgotten.ObjectivesThis study aimed to discuss bioethical principles and AAN in the involved patients.DiscussionThe AAN has been an essential source of ethical concern and controversy. There is a conceptual doubt about AAN be or not be a medical treatment. It would be a form of nourishment, which constitutes primary care. These principles should be used to guide the decision-making of healthcare professionals in collaboration with patients and their surrogates.ConclusionsThis difficult decision about whether or not to prescribe AAN in patients with a poor prognosis and without benefits should be based on discussions with the bioethics committee, encouraging the use of advanced directives, education, and support for the patient, family, and health team, in addition to the establishment of effective protocols on the subject. All of this would benefit the most important person in this process, the patient.

Orthostatic Hypotension Management in Patients with Traumatic Cervical Myelopathy

Aim. To study the incidence and severity of orthostatic hypotension and develop a method for its correction in patients after spinal cord injury (SCI) at the cervical level. Material and мethods. The study included 120 patients after spinal cord injury at cervical level with tetraplegia C5–C8 motor levels since injury more than 1 year divided into 3 groups comparable in terms of demographic, neurological and functional parameters. The group 1 (control) received standard therapy (exercise therapy, modalities, ergotherapy, massage), the group 2 received standard therapy and permanent wearing of an abdominal bandage during the day, the group 3 received rehabilitation identical to the group 2 in conjunction with low-intensity laser therapy (reflex-segmental technique). Evaluation of the results was carried out at the beginning (T1), at the end (T2) after a 30-day rehabilitation course; in assessing the state of the ANS used heart rate variability, ABPM, tilt test, deep breathing test; the motor system was assessed using the international neurological assessment standard — ASIA Impairment Scale, the FIM motor subscale (FIMm). Results and discussion. The quantity of 35% of patients have orthostatic hypotension while subjective manifestations during the tilt test was seen only in 22% of patients. At the initial examination, there were no differences between the groups in terms of vegetative and functional status. There were no changes in neurological status in all groups, functional activity increased by 6 ± 5.4 points in the control group (FIMm), and 6 ± 4.6 and 7 ± 4.5 points in 2 and 3 groups, respectively without any the statistical differences between the groups (F = 0.51; p = 0.42) at the end of rehabilitation. There were positive changes in vegetative parameters in all groups, with the exception of the mean night systolic blood pressure (SBP) between the 1 and 2 groups. Intergroup comparison have shown positive changes in all vegetative parameters that was higher in the 2 and 3 groups: decreasing drop of SBP during tilt test was 4 ± 2.8. and 5 ± 3.2 mm Hg, increase in inspiratory- expiratory index (RRmax / RRmin) 0.5 ± 0.08 and 0.7 ± 0.10 units, increase in daytime mean SBP (ABPM) 5 ± 1.1 and 8 ± 1.4 mm Hg respectively in groups 2 and 3, against 2 ± 1.9 mm Hg. and 0.2 ± 0.05 units, 3 ± 0.9 mm Hg in the group 1. In group 3, the value and increase in RRmax / RRmin (1.21 ± 0.11; 1.23 ± 0.13; 1.27 ± 0.15, respectively, in 1, 2 and 3 groups), mean daytime SBP (105 ± 3; 108 ± 3; 110 ± 4 mm Hg, respectively in 1, 2, and 3 groups) was higher in the group 3. Conclusion. Orthostatic Hypotension (OH) occured in one third of patients in the late period after SCI at the cervical level, the method of OH management that included daytime abdominal bandage wearing and using low-intensity laser radiation (905 nm, 50 Hz) on the cardioreflex zones has shown its preliminary effectiveness.