64 research outputs found

    Special aspects of development of business in the knowledge-based economy

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    The article deals with the questions of development of the theory of business in the knowledge-based economy or information economy and substantiates the new direction of research of questions, connected with the category "business", from positions of the information components influencing it. Β© IDOSI Publications, 2013

    Formation of larynx topographic-anatomic relations with neck organs and structures in the intermediate fetal period of ontogenesis

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    Objectivesto present topographic and anatomic characteristics of the larynx relationship with neck organs and structures in the intermediate fetal period of human ontogenesis. Material and methods.The study included 85 organocomplexes of the fetuses neck of both sexes, from the 14th to the 27th week of development. The study material was divided into 2 age periods: the first group fetuses aged 1420 weeks; the second group 2127 weeks. The classical morphological techniques were used: (macromicroscopic preparation, modified method of saw cuts according to N.I. Pirogov, histotopographic method). Results.Larynx syntopy with thyroid gland, cervical esophagus, thymus, submandibular glands was described in detail. Larynx skeletotopy with incisurae jugularis sterni, cervical vertebrae, hyoid bone, mandible was described quantitatively. Conclusion.The data, obtained as a result of the study, supplement the data on the topographic anatomy of larynx and some neck organs and structures in the prenatal period of human ontogenesis. The revealed formation features of larynx and other neck organs and structures topography can be used in the study of intravital anatomy

    Production of polyclonal antibodies and development of fluorescence polarization immunoassay for sulfanilamide

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    N-sulfanil-4-aminobutyric acid (SAB), which mimics common parts of the sulfonamides' structure, was synthesized and used to produce antibodies to sulfanilamide. Rabbit polyclonal antibodies have been raised using SAB conjugates with ovalbumin (OVA) or soybean trypsin inhibitor (STI). The immunogen based on SAB-STI could yield higher affinity anitbodies against sulfanilamide. The same SAB derivative was used for synthesis of a fluorescein-labeled tracer with fluorescein-thiocarbamyl ethylendiamine. A fluorescence polarization immunoassay (FPIA) for sulfanilamide was developed. The limits of detection sulfanilamide were 0.07, 0.10, and 0.07 ΞΌg mL -1 for water, diluted milk, and precipitated milk samples, respectively. The developed FPIA exhibited sensitivities below the respective maximal residue limits (MRLs) for individual sulfonamides (0.1 ΞΌg mL -1). The coefficients of variation of results for milk samples were lower than 5%. Total time for simple sample pretreatment and measurement is about 10 min for one sample. High cross-reactivity with sulfaguanidine (96%), sulfamethoxypyridazine (75%), and sulfachloropyridazine (28%), which have planar structures, could be suitable for simultaneous detection of these sulfa drugs in milk and developed fluorescence polarization immunoassay could be classified as a group-selective assay. Copyright Β© Taylor & Francis, Inc

    Π‘Π»ΠΎΠΊ провСдСния возбуТдСния ΠΏΠΎ пСрифСричСскому Π½Π΅Ρ€Π²Ρƒ ΠΊΠ°ΠΊ элСктрофизиологичСский Ρ„Π΅Π½ΠΎΠΌΠ΅Π½: ΠΎΠ±Π·ΠΎΡ€ Π»ΠΈΡ‚Π΅Ρ€Π°Ρ‚ΡƒΡ€Ρ‹

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    Evaluation and interpretation of electrophysiological phenomena often plays an important role in the diagnosis of neuromuscular diseases. Motor nerve conduction block is a reduction of either amplitude or area of the compound motor action potential elicited by proximal to distal motor nerve stimulation. Today, the value of conduction block in the diagnosis of demyelinating and axonal neuropathies, as well as the diagnostic criteria for these disorders, are still under discussion.Objective of the review of the literature is to highlight the value of conduction block as an electrophysiological phenomenon in the light of clinical manifestations. There is no consensus in the literature which motor response parameters should be used as partial conduction block criteria. The diversity of pathogenic forms in which conduction block can be registered does not allow to consider the phenomenon as a sign of only demyelinating lesions, and the term conduction block should be considered as a pure electrophysiological phenomenon. Different pathophysiological mechanisms of conduction block formation should be studied separately within each nosology. Conduction block detection does not allow to specify a particular diagnosis, however, in conjunction with clinical and anamnestic data, it may be the main argument in the diagnosis of a number of peripheral nerves diseases.Π‘Π»ΠΎΠΊ провСдСния – элСктрофизиологичСский Ρ„Π΅Π½ΠΎΠΌΠ΅Π½ сниТСния Π°ΠΌΠΏΠ»ΠΈΡ‚ΡƒΠ΄Ρ‹ ΠΈΠ»ΠΈ ΠΏΠ»ΠΎΡ‰Π°Π΄ΠΈ ΠΌΠΎΡ‚ΠΎΡ€Π½ΠΎΠ³ΠΎ ΠΎΡ‚Π²Π΅Ρ‚Π° ΠΏΡ€ΠΈ стимуляции Π² ΠΏΡ€ΠΎΠΊΡΠΈΠΌΠ°Π»ΡŒΠ½ΠΎΠΉ Ρ‚ΠΎΡ‡ΠΊΠ΅ ΠΎΡ‚Π½ΠΎΡΠΈΡ‚Π΅Π»ΡŒΠ½ΠΎ Π΄ΠΈΡΡ‚Π°Π»ΡŒΠ½ΠΎΠ³ΠΎ ΠΎΡ‚Π²Π΅Ρ‚Π°. БСгодня продолТаСтся обсуТдСниС значСния Π±Π»ΠΎΠΊΠ° провСдСния Π² диагностикС Π΄Π΅ΠΌΠΈΠ΅Π»ΠΈΠ½ΠΈΠ·ΠΈΡ€ΡƒΡŽΡ‰ΠΈΡ… ΠΈ Π°ΠΊΡΠΎΠ½Π°Π»ΡŒΠ½Ρ‹Ρ… Π½Π΅ΠΉΡ€ΠΎΠΏΠ°Ρ‚ΠΈΠΉ, Π° Ρ‚Π°ΠΊΠΆΠ΅ ΠΊΡ€ΠΈΡ‚Π΅Ρ€ΠΈΠ΅Π² диагностики состояний, ΠΏΡ€ΠΈ ΠΊΠΎΡ‚ΠΎΡ€Ρ‹Ρ… рСгистрируСтся этот Ρ„Π΅Π½ΠΎΠΌΠ΅Π½.ЦСль ΠΎΠ±Π·ΠΎΡ€Π° Π»ΠΈΡ‚Π΅Ρ€Π°Ρ‚ΡƒΡ€Ρ‹ – ΠΎΡΠ²Π΅Ρ‚ΠΈΡ‚ΡŒ Ρ‚Π΅ΠΌΡƒ Π±Π»ΠΎΠΊΠ° провСдСния ΠΏΠΎ Π½Π΅Ρ€Π²Ρƒ ΠΊΠ°ΠΊ элСктрофизиологичСского Ρ„Π΅Π½ΠΎΠΌΠ΅Π½Π° Π² свСтС клиничСских проявлСний, для опрСдСлСния Π΅Π³ΠΎ Ρ€ΠΎΠ»ΠΈ Π² диагностикС ряда Π±ΠΎΠ»Π΅Π·Π½Π΅ΠΉ пСрифСричСских Π½Π΅Ρ€Π²ΠΎΠ². Π’ Π»ΠΈΡ‚Π΅Ρ€Π°Ρ‚ΡƒΡ€Π΅ Π½Π΅Ρ‚ Π΅Π΄ΠΈΠ½ΠΎΠ³ΠΎ мнСния, ΠΊΠ°ΠΊΠΈΠ΅ ΠΏΠ°Ρ€Π°ΠΌΠ΅Ρ‚Ρ€Ρ‹ ΠΌΠΎΡ‚ΠΎΡ€Π½ΠΎΠ³ΠΎ ΠΎΡ‚Π²Π΅Ρ‚Π° слСдуСт ΠΈΡΠΏΠΎΠ»ΡŒΠ·ΠΎΠ²Π°Ρ‚ΡŒ Π² качСствС ΠΊΡ€ΠΈΡ‚Π΅Ρ€ΠΈΠ΅Π² частичного Π±Π»ΠΎΠΊΠ° провСдСния. Π Π°Π·Π½ΠΎΠΎΠ±Ρ€Π°Π·ΠΈΠ΅ патогСнСтичСских Ρ„ΠΎΡ€ΠΌ, ΠΏΡ€ΠΈ ΠΊΠΎΡ‚ΠΎΡ€Ρ‹Ρ… ΠΌΠΎΠΆΠ½ΠΎ ΠΎΠ±Π½Π°Ρ€ΡƒΠΆΠΈΡ‚ΡŒ Π±Π»ΠΎΠΊ провСдСния, Π½Π΅ позволяСт Ρ€Π°ΡΡΠΌΠ°Ρ‚Ρ€ΠΈΠ²Π°Ρ‚ΡŒ этот Ρ„Π΅Π½ΠΎΠΌΠ΅Π½ ΠΊΠ°ΠΊ ΠΏΡ€ΠΈΠ·Π½Π°ΠΊ ΠΈΡΠΊΠ»ΡŽΡ‡ΠΈΡ‚Π΅Π»ΡŒΠ½ΠΎ Π΄Π΅ΠΌΠΈΠ΅Π»ΠΈΠ½ΠΈΠ·ΠΈΡ€ΡƒΡŽΡ‰Π΅Π³ΠΎ пораТСния Π½Π΅Ρ€Π²ΠΎΠ². ΠžΠ±Ρ‰ΠΈΠ΅ ΠΈ частныС патофизиологичСскиС ΠΌΠ΅Ρ…Π°Π½ΠΈΠ·ΠΌΡ‹ формирования Π±Π»ΠΎΠΊΠ° провСдСния ΠΏΡ€ΠΈ Ρ€Π°Π·Π½Ρ‹Ρ… нСйропатиях Π½Π΅ΠΎΠ±Ρ…ΠΎΠ΄ΠΈΠΌΠΎ ΠΈΠ·ΡƒΡ‡Π°Ρ‚ΡŒ ΠΎΡ‚Π΄Π΅Π»ΡŒΠ½ΠΎ Π² Ρ€Π°ΠΌΠΊΠ°Ρ… ΠΊΠ°ΠΆΠ΄ΠΎΠΉ нозологичСской Ρ„ΠΎΡ€ΠΌΡ‹. НозологичСская Π½Π΅ΡΠΏΠ΅Ρ†ΠΈΡ„ΠΈΡ‡Π½ΠΎΡΡ‚ΡŒ Π±Π»ΠΎΠΊΠ° привСдСния Π½Π΅ позволяСт ΡΡƒΠ΄ΠΈΡ‚ΡŒ ΠΎ Π΄ΠΈΠ°Π³Π½ΠΎΠ·Π΅, Ρ‚Π΅ΠΌ Π½Π΅ ΠΌΠ΅Π½Π΅Π΅ Π² совокупности с клиничСскими ΠΈ анамнСстичСскими Π΄Π°Π½Π½Ρ‹ΠΌΠΈ ΠΎΠ±Π½Π°Ρ€ΡƒΠΆΠ΅Π½ΠΈΠ΅ Π±Π»ΠΎΠΊΠ° привСдСния ΠΌΠΎΠΆΠ΅Ρ‚ Π±Ρ‹Ρ‚ΡŒ основным Π°Ρ€Π³ΡƒΠΌΠ΅Π½Ρ‚ΠΎΠΌ Π² диагностикС ряда Π±ΠΎΠ»Π΅Π·Π½Π΅ΠΉ пСрифСричСских Π½Π΅Ρ€Π²ΠΎΠ²

    Phosphorylation of H,K-ATPase Ξ±-subunit in microsomes from rabbit gastric mucosa by cAMP-dependent protein kinase

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    A 100-kDa protein that is a main component of the microsomal fraction from rabbit gastric mucosa is phosphorylated by cAMP-dependent protein kinase (PKA) in the presence of 0.2% Triton X-100. Microsomes from rabbit gastric mucosa possess activity of H,K-ATPase but not activity of Na,K-ATPase. Incubation of microsomes with 5 ΞΌM fluo

    Serotonin limits generation of chromaffin cells during adrenal organ development

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    Adrenal glands are the major organs releasing catecholamines and regulating our stress response. The mechanisms balancing generation of adrenergic chromaffin cells and protecting against neuroblastoma tumors are still enigmatic. Here we revealed that serotonin (5HT) controls the numbers of chromaffin cells by acting upon their immediate progenitor "bridge" cells via 5-hydroxytryptamine receptor 3A (HTR3A), and the aggressive HTR3Ahigh human neuroblastoma cell lines reduce proliferation in response to HTR3A-specific agonists. In embryos (in vivo), the physiological increase of 5HT caused a prolongation of the cell cycle in "bridge" progenitors leading to a smaller chromaffin population and changing the balance of hormones and behavioral patterns in adulthood. These behavioral effects and smaller adrenals were mirrored in the progeny of pregnant female mice subjected to experimental stress, suggesting a maternal-fetal link that controls developmental adaptations. Finally, these results corresponded to a size-distribution of adrenals found in wild rodents with different coping strategies

    Clinical and genetic characteristics of Charcot–Marie–Tooth disease type 4D (type Lom) in Russia

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    Introduction. Charcot–Marie–Tooth disease type 4D is a hereditary demyelinating neuropathy, that occurs with the high frequency in patients of Roma origin. It is characterized by early onset at the age of 2–10 years and hearing impairment, manifested by the 3rd decade of life.Aim of the study. To describe the clinical and genetic characteristics of Charcot–Marie–Tooth disease type 4D in Russian patients of Roma origin.Materials and methods. For 14 probands from unrelated families of Roma origin with a clinical diagnosis of Charcot–Marie–Tooth disease, genetic tests for the pathogenic variants c. 442C>T in the NDRG1 gene and c. 3325C>T in the SH3TC2 gene was carried out. For 8 patients with Charcot–Marie–Tooth disease type 4D, detailed clinical and electrophysiological examination was performed.Results. In 11 families of Roma origin, the c. 442C>T pathogenic variant in the NDRG1 gene in a homozygous state was detected, which accounted for 79 % all observed Roma patients with Charcot–Marie–Tooth disease. There are 12 of the 14 tested families live in the European part of Russia, 7 of them are from nearby regions. The average age of onset was 3.3 years. The first symptom in 7 of 8 patients was gait disturbances. At the time of examination (age range 6–19 years), all patients showed marked hypotrophy and weakness of the feet, lower leg, hands muscles, feet deformities, reduction or loss of tendon reflexes.Discussion. Due to the detection of only one pathogenic variant in most Russian patients of Roma origin with Charcot–Marie–Tooth disease, the knowledge of the ethnicity of a proband with early myelinopathy can significantly simplify the confirmation of the diagnosis on the molecular level

    Анализ Π΄Π°Π½Π½Ρ‹Ρ… ΠΎ ΠΌΠ΅Ρ‚ΠΎΠ΄ΠΈΠΊΠ°Ρ… клиничСской ΠΎΡ†Π΅Π½ΠΊΠΈ, ΡƒΠΊΠ°Π·Π°Π½Π½Ρ‹Ρ… Π² клиничСских рСкомСндациях, Ρ€Π°Π·ΠΌΠ΅Ρ‰Π΅Π½Π½Ρ‹Ρ… Π½Π° ΠΈΠ½Ρ„ΠΎΡ€ΠΌΠ°Ρ†ΠΈΠΎΠ½Π½ΠΎΠΌ рСсурсС ΠœΠΈΠ½Π·Π΄Ρ€Π°Π²Π° России Β«Π ΡƒΠ±Ρ€ΠΈΠΊΠ°Ρ‚ΠΎΡ€ клиничСских Ρ€Π΅ΠΊΠΎΠΌΠ΅Π½Π΄Π°Ρ†ΠΈΠΉΒ»

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    One of the key elements of medical care is the assessment of the patient’s condition, which allows making a diagnosis and evaluating theΒ patient’s health status, the severity of the diseaseΒ  and the prognosis of its outcome. To date, medical professionals use various methods ofΒ assessing the patient’s condition; these methods are listed in β€œClinical Recommendations”  posted in the information resource of the MinistryΒ of Healthcare of Russia.Objective: to analyze and systemize the many methods of clinical evaluation, e. g. scores, indices, questionnaires andΒ other approaches that appear in the clinical guidelines.Methods. We analyzed the clinical guidelines developed by professional non-profitΒ medicalΒ  organizations and posted on the information resource of the Ministry of Healthcare of the Russian Federation under the β€œClinicalΒ Recommendations” category. A list of clinical assessment methodsΒ  derived from these guidelines was composed and potential problems inΒ their implementation by medical organizations were identified.Results. The unified list of clinical assessments presented in the guidelinesΒ includes 175 clinicalΒ  assessment methods. The most common methods of clinical evaluation were the VAS pain scoreΒ  (in 23 clinicalΒ guidelines), the Glasgow coma scale (in 11 clinical guidelines), and the ECOG scaleΒ  (in 10 clinical guidelines).Conclusion. The methods ofΒ clinical evaluation, indicated in the Minzdrav information resourceΒ  are narrowly specialized; they are used and interpreted by a physician.Β Some importantΒ  information about these methods and their validation is missing, which necessitates furtherΒ  efforts by the medical communityΒ to improve and update these methods.Одним ΠΈΠ· ΠΊΠ»ΡŽΡ‡Π΅Π²Ρ‹Ρ… элСмСнтов оказания мСдицинской ΠΏΠΎΠΌΠΎΡ‰ΠΈ являСтся ΠΎΡ†Π΅Π½ΠΊΠ° состояния ΠΏΠ°Ρ†ΠΈΠ΅Π½Ρ‚Π°, которая позволяСт ΡƒΡΡ‚Π°Π½ΠΎΠ²ΠΈΡ‚ΡŒΒ Π΄ΠΈΠ°Π³Π½ΠΎΠ·, ΠΎΡ†Π΅Π½ΠΈΡ‚ΡŒ состояниС Π·Π΄ΠΎΡ€ΠΎΠ²ΡŒΡ ΠΏΠ°Ρ†ΠΈΠ΅Π½Ρ‚Π° Π²Β  настоящий ΠΌΠΎΠΌΠ΅Π½Ρ‚, ΡΡ‚Π΅ΠΏΠ΅Π½ΡŒ тяТСсти заболСвания (ΠΈ Π΅Π³ΠΎΒ  ослоТнСний) ΠΈ ΠΏΡ€ΠΎΠ³Π½ΠΎΠ· Сго тСчСния. На сСгодняшний дСнь  мСдицинскими спСциалистами Ρ€Π°Π·Π½Ρ‹Ρ… Π½Π°ΠΏΡ€Π°Π²Π»Π΅Π½ΠΈΠΉ оказания  мСдицинской ΠΏΠΎΠΌΠΎΡ‰ΠΈ примСняСтся мноТСство ΠΌΠ΅Ρ‚ΠΎΠ΄ΠΈΠΊ ΠΎΡ†Π΅Π½ΠΊΠΈΒ  состояния ΠΏΠ°Ρ†ΠΈΠ΅Π½Ρ‚Π°, ΠΊΠΎΡ‚ΠΎΡ€Ρ‹Π΅ ΠΎΠ½ΠΈ использовали Π² клиничСских  рСкомСндациях (КР) ΠΏΠΎ диагностикС ΠΈ Π»Π΅Ρ‡Π΅Π½ΠΈΡŽ Π·Π°Π±ΠΎΠ»Π΅Π²Π°Π½ΠΈΠΉ,Β  Ρ€Π°Π·ΠΌΠ΅Ρ‰Π΅Π½Π½Ρ‹Ρ… Π½Π° ΠΈΠ½Ρ„ΠΎΡ€ΠΌΠ°Ρ†ΠΈΠΎΠ½Π½ΠΎΠΌ рСсурсС ΠœΠΈΠ½Π·Π΄Ρ€Π°Π²Π° России Β«Π ΡƒΠ±Ρ€ΠΈΠΊΠ°Ρ‚ΠΎΡ€ клиничСских Ρ€Π΅ΠΊΠΎΠΌΠ΅Π½Π΄Π°Ρ†ΠΈΠΉΒ».ЦСль – систСматизация Π΄Π°Π½Π½Ρ‹Ρ… ΠΎ примСняСмых Π² отСчСствСнных клиничСских рСкомСндациях ΡˆΠΊΠ°Π»Π°Ρ…, индСксах, опросниках ΠΈ Π΄Ρ€ΡƒΠ³ΠΈΡ…Β ΠΌΠ΅Ρ‚ΠΎΠ΄ΠΈΠΊΠ°Ρ… клиничСской ΠΎΡ†Π΅Π½ΠΊΠΈ состояния ΠΏΠ°Ρ†ΠΈΠ΅Π½Ρ‚Π°.ΠœΠ°Ρ‚Π΅Ρ€ΠΈΠ°Π»Ρ‹ ΠΈ ΠΌΠ΅Ρ‚ΠΎΠ΄Ρ‹. ΠŸΡ€ΠΎΠ²Π΅Π΄Π΅Π½ Π°Π½Π°Π»ΠΈΠ· клиничСских Ρ€Π΅ΠΊΠΎΠΌΠ΅Π½Π΄Π°Ρ†ΠΈΠΉ, ΡƒΡ‚Π²Π΅Ρ€ΠΆΠ΄Π΅Π½Π½Ρ‹Ρ… ΠΏΡ€ΠΎΡ„Π΅ΡΡΠΈΠΎΠ½Π°Π»ΡŒΠ½Ρ‹ΠΌΠΈΒ  нСкоммСрчСскими мСдицинскими организациями ΠΈ Ρ€Π°Π·ΠΌΠ΅Ρ‰Π΅Π½Π½Ρ‹Ρ…Β  Π½Π° ΠΈΠ½Ρ„ΠΎΡ€ΠΌΠ°Ρ†ΠΈΠΎΠ½Π½ΠΎΠΌ рСсурсС ΠœΠΈΠ½ΠΈΡΡ‚Π΅Ρ€ΡΡ‚Π²Π° здравоохранСния  Российской Π€Π΅Π΄Π΅Ρ€Π°Ρ†ΠΈΠΈ Β«Π ΡƒΠ±Ρ€ΠΈΠΊΠ°Ρ‚ΠΎΡ€ клиничСских Ρ€Π΅ΠΊΠΎΠΌΠ΅Π½Π΄Π°Ρ†ΠΈΠΉΒ», Π² части ΠΌΠ΅Ρ‚ΠΎΠ΄ΠΈΠΊ клиничСской ΠΎΡ†Π΅Π½ΠΊΠΈ.Β Π‘Ρ„ΠΎΡ€ΠΌΠΈΡ€ΠΎΠ²Π°Π½ ΠΏΠ΅Ρ€Π΅Ρ‡Π΅Π½ΡŒ ΠΌΠ΅Ρ‚ΠΎΠ΄ΠΈΠΊ клиничСской ΠΎΡ†Π΅Π½ΠΊΠΈ, ΡƒΠΊΠ°Π·Π°Π½Π½Ρ‹Ρ… Π² КР, выявлСны Π²ΠΎΠ·ΠΌΠΎΠΆΠ½Ρ‹Π΅ прСпятствия ΠΏΡ€ΠΈ Π²Π½Π΅Π΄Ρ€Π΅Π½ΠΈΠΈ мСдицинскими организациями ΠΌΠ΅Ρ‚ΠΎΠ΄ΠΈΠΊ клиничСской ΠΎΡ†Π΅Π½ΠΊΠΈ.Π Π΅Π·ΡƒΠ»ΡŒΡ‚Π°Ρ‚Ρ‹. Π‘Ρ„ΠΎΡ€ΠΌΠΈΡ€ΠΎΠ²Π°Π½ Π΅Π΄ΠΈΠ½Ρ‹ΠΉ ΠΏΠ΅Ρ€Π΅Ρ‡Π΅Π½ΡŒ ΠΌΠ΅Ρ‚ΠΎΠ΄ΠΈΠΊ клиничСской ΠΎΡ†Π΅Π½ΠΊΠΈ,Β Π²ΠΊΠ»ΡŽΡ‡Π°ΡŽΡ‰ΠΈΠΉ Π² сСбя 175 ΠΌΠ΅Ρ‚ΠΎΠ΄ΠΈΠΊ,Β  прСдставлСнных Π² КР. НаиболСС распространСнными Π² КР  ΠΌΠ΅Ρ‚ΠΎΠ΄ΠΈΠΊΠ°ΠΌΠΈ клиничСской ΠΎΡ†Π΅Π½ΠΊΠΈ оказалась шкала Π±ΠΎΠ»ΠΈ VASΒ  (упоминаСтся Π² 23 клиничСских рСкомСндациях), шкала ΠΊΠΎΠΌΡ‹ ΠΏΠΎΒ  Glasgow (упоминаСтся Π² 11 клиничСских рСкомСндациях), шкала ECOG (упоминаСтся Π² 10 КР).Π—Π°ΠΊΠ»ΡŽΡ‡Π΅Π½ΠΈΠ΅. ΠœΠ΅Ρ‚ΠΎΠ΄ΠΈΠΊΠΈ клиничСской ΠΎΡ†Π΅Π½ΠΊΠΈ, ΡƒΠΊΠ°Π·Π°Π½Π½Ρ‹Π΅ Π² КР, Π² основном ΡΠ²Π»ΡΡŽΡ‚ΡΡΒ ΡƒΠ·ΠΊΠΎΡΠΏΠ΅Ρ†ΠΈΠ°Π»ΠΈΠ·ΠΈΡ€ΠΎΠ²Π°Π½Π½Ρ‹ΠΌΠΈ, ΠΏΡ€ΠΈΠΌΠ΅Π½ΡΡŽΡ‚ΡΡ ΠΈΒ  ΠΎΡ†Π΅Π½ΠΈΠ²Π°ΡŽΡ‚ΡΡ Π²Ρ€Π°Ρ‡ΠΎΠΌ. Π’ связи с отсутствиСм Π²ΠΎ ΠΌΠ½ΠΎΠ³ΠΈΡ… КР  Π½Π΅ΠΎΠ±Ρ…ΠΎΠ΄ΠΈΠΌΡ‹Ρ… свСдСний ΠΎ ΠΌΠ΅Ρ‚ΠΎΠ΄ΠΈΠΊΠ°Ρ… ΠΈ Π΄Π°Π½Π½Ρ‹Ρ… ΠΎΠ± ΠΈΡ… Π²Π°Π»ΠΈΠ΄Π°Ρ†ΠΈΠΈΒ  Π½Π΅ΠΎΠ±Ρ…ΠΎΠ΄ΠΈΠΌΠΎ ΠΏΡ€ΠΎΠ΄ΠΎΠ»ΠΆΠ΅Π½ΠΈΠ΅ Ρ€Π°Π±ΠΎΡ‚ ΠΏΡ€ΠΎΡ„Π΅ΡΡΠΈΠΎΠ½Π°Π»ΡŒΠ½ΠΎΠ³ΠΎ мСдицинского сообщСства ΠΏΠΎ Π°ΠΊΡ‚ΡƒΠ°Π»ΠΈΠ·Π°Ρ†ΠΈΠΈΒ Π΄Π°Π½Π½Ρ‹Ρ… ΠΌΠ΅Ρ‚ΠΎΠ΄ΠΈΠΊ

    Клинико-гСнСтичСскиС характСристики Π±ΠΎΠ»Π΅Π·Π½ΠΈ Π¨Π°Ρ€ΠΊΠΎβ€“ΠœΠ°Ρ€ΠΈβ€“Π’ΡƒΡ‚Π° Ρ‚ΠΈΠΏΠ° 4D (Ρ‚ΠΈΠΏΠ° Lom) Π² России

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    Introduction. Charcot–Marie–Tooth disease type 4D is a hereditary demyelinating neuropathy, that occurs with the high frequency in patients of Roma origin. It is characterized by early onset at the age of 2–10 years and hearing impairment, manifested by the 3rd decade of life.Aim of the study. To describe the clinical and genetic characteristics of Charcot–Marie–Tooth disease type 4D in Russian patients of Roma origin.Materials and methods. For 14 probands from unrelated families of Roma origin with a clinical diagnosis of Charcot–Marie–Tooth disease, genetic tests for the pathogenic variants c. 442C>T in the NDRG1 gene and c. 3325C>T in the SH3TC2 gene was carried out. For 8 patients with Charcot–Marie–Tooth disease type 4D, detailed clinical and electrophysiological examination was performed.Results. In 11 families of Roma origin, the c. 442C>T pathogenic variant in the NDRG1 gene in a homozygous state was detected, which accounted for 79 % all observed Roma patients with Charcot–Marie–Tooth disease. There are 12 of the 14 tested families live in the European part of Russia, 7 of them are from nearby regions. The average age of onset was 3.3 years. The first symptom in 7 of 8 patients was gait disturbances. At the time of examination (age range 6–19 years), all patients showed marked hypotrophy and weakness of the feet, lower leg, hands muscles, feet deformities, reduction or loss of tendon reflexes.Discussion. Due to the detection of only one pathogenic variant in most Russian patients of Roma origin with Charcot–Marie–Tooth disease, the knowledge of the ethnicity of a proband with early myelinopathy can significantly simplify the confirmation of the diagnosis on the molecular level.Π’Π²Π΅Π΄Π΅Π½ΠΈΠ΅. Π‘ΠΎΠ»Π΅Π·Π½ΡŒ Π¨Π°Ρ€ΠΊΠΎβ€“ΠœΠ°Ρ€ΠΈβ€“Π’ΡƒΡ‚Π° Ρ‚ΠΈΠΏΠ° 4D – наслСдствСнная Π΄Π΅ΠΌΠΈΠ΅Π»ΠΈΠ½ΠΈΠ·ΠΈΡ€ΡƒΡŽΡ‰Π°Ρ нСйропатия, Π²ΡΡ‚Ρ€Π΅Ρ‡Π°ΡŽΡ‰Π°ΡΡΡ с наибольшСй частотой Ρƒ ΠΏΠ°Ρ†ΠΈΠ΅Π½Ρ‚ΠΎΠ² цыганского происхоТдСния ΠΈ Ρ…Π°Ρ€Π°ΠΊΡ‚Π΅Ρ€ΠΈΠ·ΡƒΡŽΡ‰Π°ΡΡΡ Ρ€Π°Π½Π½ΠΈΠΌ Π΄Π΅Π±ΡŽΡ‚ΠΎΠΌ Π² возрастС 2–10 Π»Π΅Ρ‚ ΠΈ Π½Π°Ρ€ΡƒΡˆΠ΅Π½ΠΈΠ΅ΠΌ слуха, ΠΏΡ€ΠΎΡΠ²Π»ΡΡŽΡ‰ΠΈΠΌΡΡ ΠΊ 3-ΠΉ Π΄Π΅ΠΊΠ°Π΄Π΅ ΠΆΠΈΠ·Π½ΠΈ.ЦСль исслСдования – ΠΎΠΏΠΈΡΠ°Ρ‚ΡŒ ΠΊΠ»ΠΈΠ½ΠΈΠΊΠΎ-гСнСтичСскиС характСристики Π±ΠΎΠ»Π΅Π·Π½ΠΈ Π¨Π°Ρ€ΠΊΠΎβ€“ΠœΠ°Ρ€ΠΈβ€“Π’ΡƒΡ‚Π° Ρ‚ΠΈΠΏΠ° 4D Ρƒ российских ΠΏΠ°Ρ†ΠΈΠ΅Π½Ρ‚ΠΎΠ² цыганского происхоТдСния.ΠœΠ°Ρ‚Π΅Ρ€ΠΈΠ°Π»Ρ‹ ΠΈ ΠΌΠ΅Ρ‚ΠΎΠ΄Ρ‹. ΠŸΡ€ΠΎΠ±Π°Π½Π΄Π°ΠΌ ΠΈΠ· 14 нСродствСнных сСмСй цыганского происхоТдСния с клиничСским Π΄ΠΈΠ°Π³Π½ΠΎΠ·ΠΎΠΌ «наслСдствСнная ΠΌΠΎΡ‚ΠΎΡ€Π½ΠΎ-сСнсорная нСйропатия» ΠΏΡ€ΠΎΠ²Π΅Π΄Π΅Π½ поиск ΠΏΠ°Ρ‚ΠΎΠ³Π΅Π½Π½Ρ‹Ρ… Π²Π°Ρ€ΠΈΠ°Π½Ρ‚ΠΎΠ² c. 442C>T Π² Π³Π΅Π½Π΅ NDRG1 ΠΈ с. 3325C>T Π² Π³Π΅Π½Π΅ SH3TC2. Π£ 8 ΠΏΠ°Ρ†ΠΈΠ΅Π½Ρ‚ΠΎΠ² с болСзнью Π¨Π°Ρ€ΠΊΠΎβ€“ΠœΠ°Ρ€ΠΈβ€“Π’ΡƒΡ‚Π° Ρ‚ΠΈΠΏΠ° 4D ΠΏΡ€ΠΎΠ²Π΅Π΄Π΅Π½Π° ΠΎΡ†Π΅Π½ΠΊΠ° клиничСского статуса, Ρƒ 3 ΠΏΠ°Ρ†ΠΈΠ΅Π½Ρ‚ΠΎΠ² – Π°Π½Π°Π»ΠΈΠ· элСктронСйромиографичСских Π΄Π°Π½Π½Ρ‹Ρ….Π Π΅Π·ΡƒΠ»ΡŒΡ‚Π°Ρ‚Ρ‹. Π’ 11 ΡΠ΅ΠΌΡŒΡΡ… цыганского происхоТдСния ΠΎΠ±Π½Π°Ρ€ΡƒΠΆΠ΅Π½ ΠΏΠ°Ρ‚ΠΎΠ³Π΅Π½Π½Ρ‹ΠΉ Π²Π°Ρ€ΠΈΠ°Π½Ρ‚ c. 442C>T Π² Π³Π΅Π½Π΅ NDRG1 Π² Π³ΠΎΠΌΠΎΠ·ΠΈΠ³ΠΎΡ‚Π½ΠΎΠΌ состоянии, Ρ‡Ρ‚ΠΎ составило 79 % всСх обслСдованных Ρ†Ρ‹Π³Π°Π½ с наслСдствСнной ΠΌΠΎΡ‚ΠΎΡ€Π½ΠΎ-сСнсорной Π½Π΅ΠΉΡ€ΠΎΠΏΠ°Ρ‚ΠΈΠ΅ΠΉ. Из 14 обслСдованных сСмСй 12 ΠΏΡ€ΠΎΠΆΠΈΠ²Π°ΡŽΡ‚ Π² СвропСйской части России, 7 ΠΈΠ· Π½ΠΈΡ… – Π² близкорасполоТСнных ΡΡƒΠ±ΡŠΠ΅ΠΊΡ‚Π°Ρ… Российской Π€Π΅Π΄Π΅Ρ€Π°Ρ†ΠΈΠΈ. Возраст Π΄Π΅Π±ΡŽΡ‚Π° Π±ΠΎΠ»Π΅Π·Π½ΠΈ составил Π² срСднСм 3,3 Π³ΠΎΠ΄Π°. Π£ 7 ΠΈΠ· 8 ΠΏΠ°Ρ†ΠΈΠ΅Π½Ρ‚ΠΎΠ² 1-ΠΌ симптомом Π±Ρ‹Π»ΠΎ Π½Π°Ρ€ΡƒΡˆΠ΅Π½ΠΈΠ΅ ΠΏΠΎΡ…ΠΎΠ΄ΠΊΠΈ. На ΠΌΠΎΠΌΠ΅Π½Ρ‚ осмотра (возраст ΠΏΠ°Ρ†ΠΈΠ΅Π½Ρ‚ΠΎΠ² ΠΎΡ‚ 6 Π΄ΠΎ 19 Π»Π΅Ρ‚) Ρƒ всСх ΠΏΠ°Ρ†ΠΈΠ΅Π½Ρ‚ΠΎΠ² выявлСны выраТСнная гипотрофия ΠΈ ΡΠ»Π°Π±ΠΎΡΡ‚ΡŒ ΠΌΡ‹ΡˆΡ† стоп, Π³ΠΎΠ»Π΅Π½Π΅ΠΉ, кистСй, дСформация стоп, сниТСниС ΠΈΠ»ΠΈ отсутствиС ΡΡƒΡ…ΠΎΠΆΠΈΠ»ΡŒΠ½Ρ‹Ρ… рСфлСксов с Π½ΠΎΠ³.ΠžΠ±ΡΡƒΠΆΠ΄Π΅Π½ΠΈΠ΅. Учитывая выявлСниС ΠΎΠ΄Π½ΠΎΠ³ΠΎ ΠΈ Ρ‚ΠΎΠ³ΠΎ ΠΆΠ΅ ΠΏΠ°Ρ‚ΠΎΠ³Π΅Π½Π½ΠΎΠ³ΠΎ Π²Π°Ρ€ΠΈΠ°Π½Ρ‚Π° Ρƒ Π±ΠΎΠ»ΡŒΡˆΠΈΠ½ΡΡ‚Π²Π° ΠΏΠ°Ρ†ΠΈΠ΅Π½Ρ‚ΠΎΠ² цыганского происхоТдСния с наслСдствСнной ΠΌΠΎΡ‚ΠΎΡ€Π½ΠΎΠΉ сСнсорной Π½Π΅ΠΉΡ€ΠΎΠΏΠ°Ρ‚ΠΈΠ΅ΠΉ, Π·Π½Π°Π½ΠΈΠ΅ этничСской принадлСТности ΠΏΡ€ΠΎΠ±Π°Π½Π΄Π° с Ρ€Π°Π½Π½Π΅ΠΉ ΠΌΠΈΠ΅Π»ΠΈΠ½ΠΎΠΏΠ°Ρ‚ΠΈΠ΅ΠΉ Π·Π½Π°Ρ‡ΠΈΡ‚Π΅Π»ΡŒΠ½ΠΎ ΡƒΠΏΡ€ΠΎΡ‰Π°Π΅Ρ‚ поиск молСкулярно-гСнСтичСской ΠΏΡ€ΠΈΡ‡ΠΈΠ½Ρ‹ Π±ΠΎΠ»Π΅Π·Π½ΠΈ

    ЀСнотипичСская Π²Π°Ρ€ΠΈΠ°Π±Π΅Π»ΡŒΠ½ΠΎΡΡ‚ΡŒ TRPV4-ассоциированных Π½Π΅ΠΉΡ€ΠΎΠΏΠ°Ρ‚ΠΈΠΉ ΠΈ Π½Π΅ΠΉΡ€ΠΎΠ½ΠΎΠΏΠ°Ρ‚ΠΈΠΉ: сСрия клиничСских наблюдСний

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    TRPV4‑associated neuromuscular diseases represent a clinical spectrum of neuropathies and motor neuron disorders. To date, 3 phenotypic forms are distinguished. There are Charcot–Marie–Tooth disease type 2C, distal hereditary motor neuropathy type 8 (DHMN8), scapulo‑peroneal spinal muscular atrophy (SPSMA). Here we report 3 families with DNMN8 and one family with SPSMA. In all cases, DNA‑analysis revealed single nucleotide variants in the TRPV4 gene previously reported as pathogenic. In 3 probands, a combination of signs of both motor and motor‑sensory neuropathies led to difficulties in the establishment of the clinical diagnosis. Patients had mild sensory disturbances in the feet, but in all of these cases nerve conduction study revealed normal sensory nerve action potentials. Considering the prevailing signs of motor neuropathy, these patients were diagnosed with DNMN8. Clinical signs of sensory disturbances are regarded as notΒ  contradictingΒ  theΒ  diagnosis,Β  sinceΒ  theyΒ  canΒ  beΒ  observedΒ  inΒ  variousΒ  formsΒ  ofΒ  distalΒ  motorΒ  neuropathies. The clinical features of SPSMA in one patient corresponded to those previously described in the literature. The involvement of the shoulder girdle muscles and the peroneal muscles and neurogenic changes in needle electromyography allow suspecting SPSMA clinically. A distinctive features of TRPV4‑associated neuromuscular diseases are the vocal cords paresis, sensorineural hearing loss and respiratory failure, however they are not obligatory according to our clinical reports.TRPV4‑ассоциированныС Π½Π΅Ρ€Π²Π½ΠΎβ€‘ΠΌΡ‹ΡˆΠ΅Ρ‡Π½Ρ‹Π΅ Π±ΠΎΠ»Π΅Π·Π½ΠΈ ΠΏΡ€Π΅Π΄ΡΡ‚Π°Π²Π»ΡΡŽΡ‚ собой клиничСский спСктр состояний, Π² ΠΊΠΎΡ‚ΠΎΡ€ΠΎΠΌ Π²Ρ‹Π΄Π΅Π»ΡΡŽΡ‚ 3 фСнотипичСскиС Ρ„ΠΎΡ€ΠΌΡ‹: болСзнь Π¨Π°Ρ€ΠΊΠΎβ€“ΠœΠ°Ρ€ΠΈβ€“Π’ΡƒΡ‚Π° 2Π‘, Π΄ΠΈΡΡ‚Π°Π»ΡŒΠ½ΡƒΡŽ Π½Π°ΡΠ»Π΅Π΄ΡΡ‚Π²Π΅Π½Π½ΡƒΡŽ ΠΌΠΎΡ‚ΠΎΡ€Π½ΡƒΡŽ Π½Π΅ΠΉΡ€ΠΎΠΏΠ°Ρ‚ΠΈΡŽ 8‑го Ρ‚ΠΈΠΏΠ° (Π”ΠΠœΠ8), ΡΠΊΠ°ΠΏΡƒΠ»ΠΎβ€‘ΠΏΠ΅Ρ€ΠΎΠ½Π΅Π°Π»ΡŒΠ½ΡƒΡŽ ΡΠΏΠΈΠ½Π°Π»ΡŒΠ½ΡƒΡŽ ΠΌΡ‹ΡˆΠ΅Ρ‡Π½ΡƒΡŽ Π°Ρ‚Ρ€ΠΎΡ„ΠΈΡŽ (БПБМА). Π’ настоящСй ΠΏΡƒΠ±Π»ΠΈΠΊΠ°Ρ†ΠΈΠΈ приводится описаниС 3 сСмСй с Π”ΠΠœΠ8 ΠΈ 1 сСмьи с БПБМА, Ρƒ ΠΊΠΎΡ‚ΠΎΡ€Ρ‹Ρ… Π”ΠΠšβ€‘Π΄ΠΈΠ°Π³Π½ΠΎΡΡ‚ΠΈΠΊΠ° выявила Π²Π°Ρ€ΠΈΠ°Π½Ρ‚Ρ‹ Π½ΡƒΠΊΠ»Π΅ΠΎΡ‚ΠΈΠ΄Π½ΠΎΠΉ ΠΏΠΎΡΠ»Π΅Π΄ΠΎΠ²Π°Ρ‚Π΅Π»ΡŒΠ½ΠΎΡΡ‚ΠΈ Π² Π³Π΅Π½Π΅ TRPV4, Ρ€Π°Π½Π΅Π΅ описанныС ΠΊΠ°ΠΊ ΠΏΠ°Ρ‚ΠΎΠ³Π΅Π½Π½Ρ‹Π΅. Π£ осмотрСнных Π½Π°ΠΌΠΈ 3 ΠΏΡ€ΠΎΠ±Π°Π½Π΄ΠΎΠ² установлСниС клиничСской Ρ„ΠΎΡ€ΠΌΡ‹ заболСвания Π²Ρ‹Π·Π²Π°Π»ΠΎ затруднСния Π² связи с сочСтаниСм ΠΏΡ€ΠΈΠ·Π½Π°ΠΊΠΎΠ² ΠΊΠ°ΠΊ ΠΌΠΎΡ‚ΠΎΡ€Π½ΠΎΠΉ, Ρ‚Π°ΠΊ ΠΈ моторно‑сСнсорной Π½Π΅ΠΉΡ€ΠΎΠΏΠ°Ρ‚ΠΈΠΈ. Π£ Π±ΠΎΠ»ΡŒΠ½Ρ‹Ρ… ΠΎΡ‚ΠΌΠ΅Ρ‡Π°Π»ΠΈΡΡŒ Π»Π΅Π³ΠΊΠΈΠ΅ Ρ‡ΡƒΠ²ΡΡ‚Π²ΠΈΡ‚Π΅Π»ΡŒΠ½Ρ‹Π΅ Π½Π°Ρ€ΡƒΡˆΠ΅Π½ΠΈΡ Π² стопах, Π½ΠΎ ΠΏΡ€ΠΈ этом Π½ΠΈ Π² ΠΎΠ΄Π½ΠΎΠΌ ΠΈΠ· этих случаСв Π½Π΅ выявлСно ΠΏΡ€ΠΈΠ·Π½Π°ΠΊΠΎΠ² вовлСчСния сСнсорных Π²ΠΎΠ»ΠΎΠΊΠΎΠ½ Π½Π΅Ρ€Π²ΠΎΠ² Ρ€ΡƒΠΊ ΠΈ Π½ΠΎΠ³ ΠΏΡ€ΠΈ элСктромиографии. Π‘ ΡƒΡ‡Π΅Ρ‚ΠΎΠΌ ΠΏΡ€Π΅ΠΎΠ±Π»Π°Π΄Π°ΡŽΡ‰ΠΈΡ… ΠΏΡ€ΠΈΠ·Π½Π°ΠΊΠΎΠ² вовлСчСния ΠΌΠΎΡ‚ΠΎΡ€Π½ΠΎΠΉ ΠΏΠΎΡ€Ρ†ΠΈΠΈ пСрифСричСской Π½Π΅Ρ€Π²Π½ΠΎΠΉ систСмы ΠΏΠΎ клиничСским ΠΈ элСктрофизиологичСским Π΄Π°Π½Π½Ρ‹ΠΌ этим Π±ΠΎΠ»ΡŒΠ½Ρ‹ΠΌ установлСн Π΄ΠΈΠ°Π³Π½ΠΎΠ· Π”ΠΠœΠ8. ΠšΠ»ΠΈΠ½ΠΈΡ‡Π΅ΡΠΊΠΈΠ΅ ΠΏΡ€ΠΈΠ·Π½Π°ΠΊΠΈ Π½Π°Ρ€ΡƒΡˆΠ΅Π½ΠΈΡ Ρ‡ΡƒΠ²ΡΡ‚Π²ΠΈΡ‚Π΅Π»ΡŒΠ½ΠΎΡΡ‚ΠΈ расцСнСны ΠΊΠ°ΠΊ Π½Π΅ ΠΏΡ€ΠΎΡ‚ΠΈΠ²ΠΎΡ€Π΅Ρ‡Π°Ρ‰ΠΈΠ΅ Π΄ΠΈΠ°Π³Π½ΠΎΠ·Ρƒ, Ρ‚Π°ΠΊ ΠΊΠ°ΠΊ извСстно, Ρ‡Ρ‚ΠΎ Π»Π΅Π³ΠΊΠΈΠ΅ сСнсорныС Π½Π°Ρ€ΡƒΡˆΠ΅Π½ΠΈΡ ΠΌΠΎΠ³ΡƒΡ‚ ΠΎΡ‚ΠΌΠ΅Ρ‡Π°Ρ‚ΡŒΡΡ ΠΏΡ€ΠΈ Ρ€Π°Π·Π½Ρ‹Ρ… Ρ„ΠΎΡ€ΠΌΠ°Ρ… Π΄ΠΈΡΡ‚Π°Π»ΡŒΠ½Ρ‹Ρ… ΠΌΠΎΡ‚ΠΎΡ€Π½Ρ‹Ρ… Π½Π΅ΠΉΡ€ΠΎΠΏΠ°Ρ‚ΠΈΠΉ. ΠšΠ»ΠΈΠ½ΠΈΡ‡Π΅ΡΠΊΠΈΠ΅ ΠΏΡ€ΠΈΠ·Π½Π°ΠΊΠΈ БПБМА ΠΎΠ΄Π½ΠΎΠΉ больной соотвСтствовали Ρ€Π°Π½Π΅Π΅ описанным Π² Π»ΠΈΡ‚Π΅Ρ€Π°Ρ‚ΡƒΡ€Π΅. Π‘ΠΎΡ‡Π΅Ρ‚Π°Π½ΠΈΠ΅ пораТСния ΠΌΡ‹ΡˆΡ† ΠΏΠ»Π΅Ρ‡Π΅Π²ΠΎΠ³ΠΎ пояса ΠΈ ΠΏΠ΅Ρ€ΠΎΠ½Π΅Π°Π»ΡŒΠ½ΠΎΠΉ Π³Ρ€ΡƒΠΏΠΏΡ‹ ΠΏΡ€ΠΈ Π½Π°Π»ΠΈΡ‡ΠΈΠΈ Π½Π΅ΠΉΡ€ΠΎΠ³Π΅Π½Π½ΠΎΠ³ΠΎ процСсса ΠΏΠΎ Π΄Π°Π½Π½Ρ‹ΠΌ ΠΈΠ³ΠΎΠ»ΡŒΡ‡Π°Ρ‚ΠΎΠΉ элСктромиографии позволяСт Π·Π°ΠΏΠΎΠ΄ΠΎΠ·Ρ€ΠΈΡ‚ΡŒ Π΄Π°Π½Π½ΡƒΡŽ Ρ„ΠΎΡ€ΠΌΡƒ Π±ΠΎΠ»Π΅Π·Π½ΠΈ Π½Π° клиничСском этапС. ΠžΡ‚Π»ΠΈΡ‡ΠΈΡ‚Π΅Π»ΡŒΠ½Ρ‹ΠΌΠΈ особСнностями TRPV4‑ассоциированных Π½Π΅Ρ€Π²Π½ΠΎβ€‘ΠΌΡ‹ΡˆΠ΅Ρ‡Π½Ρ‹Ρ… Π±ΠΎΠ»Π΅Π·Π½Π΅ΠΉ ΡΠ²Π»ΡΡŽΡ‚ΡΡ ΠΏΠ°Ρ€Π΅Π· голосовых связок, нСйросСнсорная Ρ‚ΡƒΠ³ΠΎΡƒΡ…ΠΎΡΡ‚ΡŒ ΠΈ Π΄Ρ‹Ρ…Π°Ρ‚Π΅Π»ΡŒΠ½Π°Ρ Π½Π΅Π΄ΠΎΡΡ‚Π°Ρ‚ΠΎΡ‡Π½ΠΎΡΡ‚ΡŒ. Однако, ΠΊΠ°ΠΊ ΠΏΠΎΠΊΠ°Π·Π°Π»ΠΈ наши наблюдСния, эти Π½Π°Ρ€ΡƒΡˆΠ΅Π½ΠΈΡ Π½Π΅ ΡΠ²Π»ΡΡŽΡ‚ΡΡ ΠΎΠ±Π»ΠΈΠ³Π°Ρ‚Π½Ρ‹ΠΌΠΈ
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