Low rates of restenosis in primary lateral carotid artery endarterectomy

Carotid artery endarterectomy (CAE) is a treatment of choice for symptomatic and asymptomatic high-grade carotid stenosis, showing great results in reducing stroke morbidity. The optimal technique of the arterial closure is, however, still under discussion, with both patch angioplasty and primary closure having numerous advantages and pitfalls. The definite evidence is still lacking. The aim of this study was to evaluate the results of the modified primary closure technique during CEA. Incidence of restenosis more than 8 months after the surgery was measured. A retrospective observational study to evaluate modified primary internal carotid artery closure was conducted in Republican Vilnius University Hospital from January 1st, 2014 to December 31st, 2018. The patients were enrolled in the trial during their routine follow-up by their surgeon.  During the visit, after an informed consent was signed, a qualified investigator performed carotid duplex ultrasound scan, documenting the restenosis rates. Patients also filled in the comorbidity assessment questionnaire, which included their smoking habits, history of hypertension and their adherence to antihypertensive medication as well as cholesterol levels and statin therapy, additional related comorbidities. Out of 342 patients that underwent CAE with primary closure in the Republican Vilnius university hospital from 2014 to 2018, 42 patients were identified as deceased, therefore a follow-up was impossible. Out of planned 150 (50%) consequently selected patients, 125 gave an informed consent to be enrolled into the study. Out of those 6 pre-occlusions were established during the review of the patient medical data and therefore were excluded from the study. In general, we analyzed the data of 119 patients and 125 CAE with a modified primary suture closure. The mean follow-up time was 35.78 months (SE 0.992; SD 11,046). At the time of a follow up, 3 (2,4%) carotid artery occlusions were identified and promptly evaluated. Restenosis rates varied: 5,6% of patients had low grade (<50%), 5,6% had moderate grade (50-69%) and 1,6% had high grade (70-99%) stenosis. The modified lateral CAE with primary closure technique, used in our hospital’s contemporary practice has shown to be a promising alternative to the classical primary suture, due to reduced restenosis rates. More prospective and randomized studies are needed to evaluate this technique in comparison to other CAE closure techniques

К вопросу оценки социально-бытовой адаптации больных с последствиями мозгового инсульта

Цель работы – оценить эффективность восстановительного лечения и уровня социальной адаптации пациентов, перенесших мозговой инсульт, с помощью надежных и валидных тестовых шкал. Для изучения динамики функционального состояния отобрано 100 пациентов в восстановительном периоде полушарного ишемического инсульта, прошедших курс лечения в стационаре и в дальнейшем госпитализированных повторно в сроки до 1 года (63 мужчины и 37 женщины в возрасте от 36 до 74 лет). В группе катамнестического наблюдения проведено скрининговое исследование функционального состояния, реабилитационного прогноза и динамики восстановления в процессе лечения. С помощью математических методов выполнено сравнительное изучение унифицированных шкал социально-бытовой и двигательной активности – PULSES Profile, Functional Independence Measure (FIM) и Rehabilitation Activities Profile – поиск кореляций изучаемых факторов, чувствительности и взаимной дополняемости шкал, воспроизводимости результатов измерения, возможных ошибок в оценке и выводах и т. д

Изучение особенностей моторного дефицита у больных в восстановительном периоде ишемического инсульта

Мета нашого дослідження полягала в аналізі функціонального стану різних рівнів рухової системи — моторної кори великих півкуль, пірамідного шляху, периферичного нейромоторного апарату, а також в уточненні особливостей патофізіологічних механізмів рухових порушень при ішемічному інсульті із застосуванням стимуляційної ЕНМГ і МС.Our study presents the results of clinical and neurophysiologic study of motor disorders in 92 patients aged 42–79 years in early and late recovery after hemispheric ischemic stroke and 30 control subjects. Selective role of spasticity was estimated in clinical pattern of motor disorders in group of patients with different disorders of muscular tonus with the same degree of paresis. Using clinico-neurophysiological analysis we also investigated peculiarities of pyramidal syndrome in hemispheric vascular lesion. The obtained results confirm neuroanatomical and neurophysiological peculiarities of brain hemispheres.Представлены результаты клинического и нейрофизиологического изучения моторного дефицита у 92 больных в возрасте 42–79 лет в раннем и позднем восстановительном периоде ишемического инсульта полушарной локализации, а также 30 пациентов контрольной группы. Проведена оценка избирательной роли изменений мышечного тонуса в структуре двигательных нарушений в группе больных с различными двигательно-тоническими расстройствами. Изучены особенности пирамидного синдрома при латерализованном полушарном сосудистом поражении. Полученные результаты подтверждают нейроанатомические и нейрофизиологические особенности полушарий мозга

Low Rates of Restenosis in Primary Lateral Carotid Artery Endarterectomy

Carotid artery endarterectomy (CAE) is a treatment of choice for symptomatic and asymptomatic high-grade carotid stenosis, showing great results in reducing stroke morbidity. The optimal technique of the arterial closure is, however, still under discussion, with both patch angioplasty and primary closure having numerous advantages and pitfalls. The definite evidence is still lacking. The aim of this study was to evaluate the results of the modified primary closure technique during CEA. Incidence of restenosis more than 8 months after the surgery was measured. A retrospective observational study to evaluate modified primary internal carotid artery closure was conducted in Republican Vilnius University Hospital from January 1st, 2014 to December 31st, 2018. The patients were enrolled in the trial during their routine follow-up by their surgeon. During the visit, after an informed consent was signed, a qualified investigator performed carotid duplex ultrasound scan, documenting the restenosis rates. Patients also filled in the comorbidity assessment questionnaire, which included their smoking habits, history of hypertension and their adherence to antihypertensive medication as well as cholesterol levels and statin therapy, additional related comorbidities. Out of 342 patients that underwent CAE with primary closure in the Republican Vilnius university hospital from 2014 to 2018, 42 patients were identified as deceased, therefore a follow-up was impossible. Out of planned 150 (50%) consequently selected patients, 125 gave an informed consent to be enrolled into the study. Out of those 6 pre-occlusions were established during the review of the patient medical data and therefore were excluded from the study. In general, we analyzed the data of 119 patients and 125 CAE with a modified primary suture closure. The mean follow-up time was 35.78 months (SE 0.992; SD 11,046). At the time of a follow up, 3 (2,4%) carotid artery occlusions were identified and promptly evaluated. Restenosis rates varied: 5,6% of patients had low grade (<50%), 5,6% had moderate grade (50-69%) and 1,6% had high grade (70-99%) stenosis. The modified lateral CAE with primary closure technique, used in our hospital's contemporary practice has shown to be a promising alternative to the classical primary suture, due to reduced restenosis rates. More prospective and randomized studies are needed to evaluate this technique in comparison to other CAE closure techniques

SARS-CoV-2 Impact on Red Blood Cell Morphology

Severe COVID-19 alters the biochemical and morphological characteristics of blood cells in a wide variety of ways. To date, however, the vast majority of research has been devoted to the study of leukocytes, while erythrocyte morphological changes have received significantly less attention. The aim of this research was to identify erythrocyte morphology abnormalities that occur in COVID-19, compare the number of different poikilocyte types, and measure erythrocyte sizes to provide data on size dispersion. Red blood cells obtained from 6 control donors (800–2200 cells per donor) and 5 COVID-19 patients (800–1900 cells per patient) were examined using low-voltage scanning electron microscopy. We did not discover any forms of erythrocyte morphology abnormalities that would be specific to COVID-19. Among COVID-19 patients, we observed an increase in the number of acanthocytes (p = 0.01) and a decrease in the number of spherocytes (p = 0.03). In addition, our research demonstrates that COVID-19 causes an increase in the median (p = 0.004) and interquartile range (p = 0.009) when assessing erythrocyte size. The limitation of our study is a small number of participants

Problems of violations of venous circulation of blood are in neurology

Проблема цереброваскулярной патологии – одна из основных в клинической неврологии, что обусловлено значительной распространенностью сосудистых заболеваний мозга, высокой смертностью вследствие острых нарушений мозгового кровообращения и тяжелой, стойкой инвалидизацией, наступающей у больных. В последние десятилетия предметом систематического, углубленного изучения являются вопросы патогенеза, закономерностей клинического течения, диагностики и дифференцированной терапии мозгового инсульта, а также разработки новых методов комплексного изучения патологии головного мозга, в том числе его функционального состояния. Вместе с тем, менее изученными остаются проблемы нарушения венозного кровообращения, несмотря на существующие теснейшие регуляторные взаимоотношения артериовенозной гемодинамики и функционирования артериальной сети и венозного русла как единой сосудистой системы

Identification of Genetic Risk Factors of Severe COVID-19 Using Extensive Phenotypic Data: A Proof-of-Concept Study in a Cohort of Russian Patients

The COVID-19 pandemic has drawn the attention of many researchers to the interaction between pathogen and host genomes. Over the last two years, numerous studies have been conducted to identify the genetic risk factors that predict COVID-19 severity and outcome. However, such an analysis might be complicated in cohorts of limited size and/or in case of limited breadth of genome coverage. In this work, we tried to circumvent these challenges by searching for candidate genes and genetic variants associated with a variety of quantitative and binary traits in a cohort of 840 COVID-19 patients from Russia. While we found no gene- or pathway-level associations with the disease severity and outcome, we discovered eleven independent candidate loci associated with quantitative traits in COVID-19 patients. Out of these, the most significant associations correspond to rs1651553 in MYH14p = 1.4 × 10−7), rs11243705 in SETX (p = 8.2 × 10−6), and rs16885 in ATXN1 (p = 1.3 × 10−5). One of the identified variants, rs33985936 in SCN11A, was successfully replicated in an independent study, and three of the variants were found to be associated with blood-related quantitative traits according to the UK Biobank data (rs33985936 in SCN11A, rs16885 in ATXN1, and rs4747194 in CDH23). Moreover, we show that a risk score based on these variants can predict the severity and outcome of hospitalization in our cohort of patients. Given these findings, we believe that our work may serve as proof-of-concept study demonstrating the utility of quantitative traits and extensive phenotyping for identification of genetic risk factors of severe COVID-19