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Dynamics of post-stroke hand paresis kinematic pattern during rehabilitation 康复期间中风后手部麻痹运动模式的动力学研究
Pub Date : 2019-08-31 DOI: 10.24075/brsmu.2019.056
A. Khizhnikova, A. Klochkov, A. Kotov–Smolenskiy, N. Suponeva, M. Piradov
According to the literature data, only 5–20% of post-stroke patients are able to restore the hand motor function completely. Correct goal setting and individual approach to the patient's functional recovery are important. Our study aimed to develop an algorithm of impaired hand motor functioning assessment for post-stroke patients and to determine the principles of the rehabilitation tactics choosing based on the biomechanical analysis. Twenty five patients with hemispheric stroke and 10 healthy volunteers participated in the study. Formal clinical observation scales (Fugl-Meyer Assessment, Ashworth Scale, ARAT) and video motion analysis were used for evaluation of the hand motor function. Patients were divided into 2 groups according to the hand paresis severity (mild/moderate and pronounced/severe). Rehabilitation was carried out in both groups, including mechanotherapy, massage and physical therapy. It was revealed that in the 1st group of patients the motor function recovery in the paretic hand was due to movement performance recovery: biomechanical parameters restoration directly correlated with a decrease in the paresis degree according to the Fugl-Meyer Assessment Scale (r = 0.94; p = 0.01). In the 2nd group of patients, the motor function recovery in the paretic hand was due to motor deficit compensation: according to biomechanical analysis, the pathological motor synergies inversely correlated with a decrease in the paresis degree (r = –0.9; p = 0.03). As a result of the study, an algorithm for selecting the patient management tactics based on the baseline clinical indicators was developed.
根据文献资料,只有5-20%的脑卒中后患者能够完全恢复手部运动功能。正确的目标设定和个性化的方法对患者的功能恢复是重要的。本研究旨在开发脑卒中后患者手部运动功能受损评估算法,并基于生物力学分析确定康复策略选择原则。25名半脑卒中患者和10名健康志愿者参加了这项研究。采用正式临床观察量表(Fugl-Meyer量表、Ashworth量表、ARAT量表)和视频运动分析评估手部运动功能。根据手部轻瘫的严重程度(轻/中度、明显/严重)将患者分为2组。两组均进行康复治疗,包括机械治疗、按摩治疗和物理治疗。结果显示,第一组患者瘫手的运动功能恢复主要是由于运动性能的恢复,Fugl-Meyer评定量表生物力学参数的恢复与瘫手程度的降低直接相关(r = 0.94;P = 0.01)。在第二组患者中,麻痹手的运动功能恢复是由于运动缺陷代偿:根据生物力学分析,病理性运动协同作用与麻痹程度的降低呈负相关(r = -0.9;P = 0.03)。根据研究结果,提出了一种基于基线临床指标的患者管理策略选择算法。
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引用次数: 1
A medical career: barriers to professional identity 医疗事业:职业认同的障碍
Pub Date : 2019-08-26 DOI: 10.24075/brsmu.2019.055
E. Mettini, B. Yasko, B. Kazarin, M. Ostroushko
Sometimes, a minor scientific event leaves a much more memorable trace than a large conference. On May 30–31, 2019, Pirogov Russian National Research Medical University hosted a symposium on medical identities in various communities. Reports, reviews and discussions presented at the symposium focused on the problem of identity, a unique phenomenon that results from self-reflecting on a complex dynamic process of personal development. Professional identity is particularly important for a medical doctor. This article inspired by the reports of our colleagues summarizes the results of the symposium.
有时候,一个小的科学事件会比一个大型会议留下更难忘的痕迹。2019年5月30日至31日,俄罗斯国立皮罗戈夫研究医科大学举办了一场关于不同社区医学身份的研讨会。研讨会上的报告、评论和讨论集中在身份问题上,这是一种独特的现象,是对个人发展的复杂动态过程进行自我反思的结果。职业身份对医生来说尤为重要。这篇文章受我们同事报告的启发,总结了研讨会的成果。
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引用次数: 0
Associations between blood and cerebrospinal fluid flow impairments assessed with phase-contrast MRI and brain damage in patients with age-related cerebral small vessel disease 与年龄相关的脑小血管疾病患者的相衬MRI评估血液和脑脊液流动障碍与脑损伤之间的关系
Pub Date : 2019-08-25 DOI: 10.24075/brsmu.2019.054
E. Kremneva, B. M. Akhmetzyanov, L. Dobrynina, M. Krotenkova
Hemodynamic parameters of blood and cerebrospinal fluid (CSF) flow can be measured in vivo using phase-contrast MRI (PC-MRI). This opens new horizons for studying the mechanisms implicated in the development and progression of age-related cerebral small vessel disease (SVD). In this paper, we analyze associations between cerebral arterial, venous and CSF flow impairments and SVD features visible on MRI. The study was carried out in 96 patients with SVD (aged 60.91 ± 6.57 years) and 23 healthy volunteers (59.13 ± 6.56 years). The protocol of the MRI examination included routine MRI sequences (T2, FLAIR, T1, SWI, and DWI) applied to assess the severity of brain damage according to STRIVE advisory standards and PC-MRI used to quantify blood flow in the major arteries and veins of the neck, the straight and upper sagittal sinuses, and CSF flow at the aqueduct level. We analyzed the associations between linear and volumetric parameters of blood/CSF flow and the degree of brain matter damage using the Fazekas scale. We observed a reduction in tABF, stVBF, sssVBF, aqLF, Saq, and ICC values and a rise in Pi associated with WMH progression, as well as a gradual decline in tABF and an increase in Pi, Saq and ICC associated with a growing number of lacunes (р < 0.05). Patients with early (< 5) MB had lower sssVBF and stVBF rates in comparison with patients without MB; aqLF, Saq, and ICC values were elevated in patients with 5 to 10 MB, as compared to patients without MB or early (< 5) MB. The established associations between MRI findings in patients with SVD and blood/CSF flow impairments suggest the important role of mechanisms implicated in the disruption of Monro–Kellie intracranial homeostasis in promoting SVD.
血液和脑脊液(CSF)流动的血流动力学参数可以使用相衬MRI (PC-MRI)在体内测量。这为研究与年龄相关的脑血管疾病(SVD)的发生和进展有关的机制开辟了新的视野。在本文中,我们分析脑动脉、静脉和脑脊液血流损伤与MRI可见的SVD特征之间的关系。研究对象为96例SVD患者(年龄60.91±6.57岁)和23名健康志愿者(年龄59.13±6.56岁)。MRI检查方案包括常规MRI序列(T2、FLAIR、T1、SWI和DWI),根据STRIVE咨询标准评估脑损伤的严重程度,PC-MRI用于量化颈部大动脉和静脉、直窦和上矢状窦的血流,以及导水管水平的脑脊液血流。我们使用Fazekas量表分析了血/脑脊液流量的线性参数和容量参数与脑物质损伤程度之间的关系。我们观察到tABF、stVBF、sssVBF、aqLF、Saq和ICC值降低,Pi升高与WMH进展相关,tABF逐渐下降,Pi、Saq和ICC升高与窝隙数量增加相关(p < 0.05)。早期(< 5)MB患者与无MB患者相比,sssVBF和stVBF率较低;与没有MB或早期(< 5)MB的患者相比,5 - 10 MB患者的aqLF、Saq和ICC值升高。SVD患者的MRI表现与血/CSF血流损伤之间已建立的关联表明,在SVD的促进过程中,破坏mono - kellie颅内稳态的机制起着重要作用。
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引用次数: 0
The feasibility of using computer-based models for reducing the risks of complications associated with temporary dentures 使用计算机模型降低临时假牙并发症风险的可行性
Pub Date : 2019-08-16 DOI: 10.24075/brsmu.2019.050
N. V. Bagryantseva, S. Gazhva, A. A. Baranov, L. Shubin, V. A. Bagryantsev, O. Bagryantseva
Contemporary prosthetic dentistry has a vast arsenal of solutions for completely edentulous patients. However, it is crucial to consider a variety of factors that can cause complications in patients wearing temporary dentures in the osseointegration period. The aim of this study was to retrospectively analyze the medical records of completely edentulous patients wearing temporary removable or fixed dentures in the osseointegration period, to identify the risk factors for complications and to calculate the odds of adverse events. We performed a multivariate analysis and developed a computerized algorithm that could be used to facilitate selection of the proper denture type and material. The algorithm demonstrates high sensitivity and specificity: 94.37 (76.2 : 98.7) and 92.56 (79.8 : 97.6), respectively; the AUC value is 0.921 (0.843 : 0.963). We are planning to develop a software based on the proposed algorithm that would help the dentist to make a more objective decision when selecting the type of temporary denture and its material.
当代义肢牙科为完全无牙的患者提供了大量的解决方案。然而,考虑各种可能导致患者在骨整合期佩戴临时义齿并发症的因素是至关重要的。本研究的目的是回顾性分析全无牙患者在骨整合期佩戴临时活动或固定义齿的医疗记录,以确定并发症的危险因素并计算不良事件的发生率。我们进行了多变量分析,并开发了一种计算机算法,可用于方便选择合适的义齿类型和材料。该算法具有较高的灵敏度和特异性,分别为94.37(76.2:98.7)和92.56 (79.8:97.6);AUC值为0.921(0.843:0.963)。我们正计划开发一个基于所提出算法的软件,帮助牙医在选择临时假牙的类型和材料时做出更客观的决定。
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引用次数: 0
Application of culture-based, mass spectrometry and molecular methods to the study of gut microbiota in children 基于培养、质谱和分子方法在儿童肠道微生物群研究中的应用
Pub Date : 2019-08-09 DOI: 10.24075/brsmu.2019.048
Boris A. Efimov, A. V. Chaplin, S. R. Sokolova, Z. A. Chernaia, A. Pikina, A. M. Savilova, L. Kafarskaya
In recent decades, nucleic acid sequencing technologies used for metagenomic analysis have become the main methods for assessing the composition of microbiota. At the same time, the use of novel methods of cultivation and identification of microorganisms in microbiological research led to the renaissance of culture-based technologies, because facilitated the discovery and isolation of both new strains of well-known microorganisms as well as uncultivated and unexplored bacterial taxa. The aim of this study was to evaluate the potential of using the culture-based method for the assessment of the qualitative and quantitative composition of the intestinal microbiota in healthy children. Eleven growth media were inoculated with serial dilutions of stool samples in order to analyze the profile of dominant anaerobic bacteria, as well as aerobic bacteria and fungi in 20 healthy children aged 2–4 years. The identification of microorganisms was performed using MALDI TOF MS and 16S rRNA gene fragment sequencing were used. 1,819 isolated and identified strains belong to 7 phyla, 13 classes, 18 orders, 33 families, 77 genera and 149 species in the Bacteria domain. The Bacteroidetes, Firmicutes, Actinobacteria and Proteobacteria phyla were most abundant and frequent. The greatest species diversity (more than 85 species) was found in the Firmicutes phylum. Ten new previously uncharacterized bacterial strains were isolated.
近几十年来,用于宏基因组分析的核酸测序技术已成为评估微生物群组成的主要方法。同时,在微生物学研究中使用新的培养和鉴定微生物的方法导致了基于培养的技术的复兴,因为它促进了发现和分离已知微生物的新菌株以及未培养和未探索的细菌分类群。本研究的目的是评估使用基于培养的方法来评估健康儿童肠道微生物群的定性和定量组成的潜力。用11种培养基接种连续稀释的粪便样本,分析20例2 ~ 4岁健康儿童粪便中优势厌氧菌、好氧菌和真菌的分布。微生物鉴定采用MALDI TOF MS, 16S rRNA基因片段测序。分离鉴定菌株1819株,隶属于细菌域7门13纲18目33科77属149种。拟杆菌门、厚壁菌门、放线菌门和变形菌门数量最多,出现频率最高。厚壁菌门的物种多样性最大,超过85种。分离出10株以前未被鉴定的新菌株。
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引用次数: 2
Synchrotron IR-microspectroscopy-based visualization of molecular and chemical interactions between dental cement, biomimetic composite and native dental tissue 基于同步加速器红外显微光谱的牙水泥、仿生复合材料和原生牙组织之间分子和化学相互作用的可视化研究
Pub Date : 2019-08-01 DOI: 10.24075/brsmu.2019.047
D. Goloshchapov, V. Kashkarov, Y. Ippolitov, I. Ippolitov, J. Vongsvivut, P. Seredin
The low affinity of composite materials for the hard tissue of human teeth poses a challenge to restorative dentists. This study was undertaken to explore molecular and chemical characteristics of the interface between the dental cement, the buffer layer formed from a next generation biomimetic material that mimics the organic mineral composition of human enamel and dentin, and the intact native hard dental tissue. Seven plane-parallel dental slices were analyzed using synchrotron IR microspectroscopy. The obtained absorption spectra of functional molecular groups were organized into cluster maps. This allowed us to identify the intact tissue, the adhesive agent and the biomimetic layer at their interface and to localize and measure concentrations of functional groups involved in the integration of the biomimetic composite into the hard tissue of the human tooth. The proposed biomimetic material is based on nanocrystal carbonate-substituted calcium hydroxyapatite synthesized from a biogenic calcium source and a complex of basic polar amino acids copying the composition of the human tooth and can form a functional bond with hard dental tissue.
复合材料对人类牙齿硬组织的亲和力较低,对修复牙医提出了挑战。本研究旨在探索牙水泥、下一代仿生材料(模仿人类牙釉质和牙本质的有机矿物成分)形成的缓冲层与完整的天然硬牙组织之间界面的分子和化学特性。采用同步红外显微光谱技术对7片平面平行牙片进行了分析。得到的官能团吸收光谱被组织成簇状图。这使我们能够在界面处识别完整的组织、粘合剂和仿生层,并定位和测量参与将仿生复合材料整合到人类牙齿硬组织中的官能团的浓度。拟制的仿生材料是基于纳米晶碳酸盐取代的钙羟基磷灰石,由生物钙源和复制人类牙齿组成的碱性极性氨基酸复合物合成,可以与硬牙组织形成功能键。
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引用次数: 2
The impact of electronic devices on the physical growth and development of modern youth and recommendations on their safe use 电子设备对现代青少年身体生长发育的影响及安全使用的建议
Pub Date : 2019-07-23 DOI: 10.24075/brsmu.2019.046
O. Milushkina, N. Skoblina, S. Markelova, A. Tatarinchik, E. P. Melikhova, I. I. Libina, M. Popov
The impact of excessive exposure to electronic devices (ED) on youth health remains understudied. There is a pressing need to develop recommendations for the safe use of stationary and mobile ED aimed at minimizing health risks. In this work, we assess the effect of ED on the physical growth and development of high-school and university students and provide recommendations for preventing the negative impact of prolonged screen time on health. The study recruited 460 high-school and 598 university students. Standard anthropometric measurements were taken. The psychological and emotional state of the participants was evaluated using the Test Anxiety Inventory by Spielberg (modified by Khanin). To estimate daily and weekly exposure to ED the participants were asked to fill out standardized questionnaires. In high school students, the average screen time was 7 h a day; in university students, 8.5 to 10 h a day. Only 60% of the participants, regardless of their place of residence or the type of educational institution they were attending, were physically healthy. We conclude that prolonged and frequent exposure to ED is one of the factors that can interfere with normal physical growth and development in youth. Regular daily use of stationary ED increases the risk of developing body weight deficit by 24% and gaining excess body weight by 10%. We recommend that students should eliminate computers, laptops and stationary ED from their daily activities for at least one day at the weekend and reduce total screen time to 3 hours a day.
过度接触电子设备对青少年健康的影响仍未得到充分研究。迫切需要制定安全使用固定式和移动式ED的建议,以尽量减少健康风险。在这项工作中,我们评估了ED对高中生和大学生身体生长发育的影响,并提出了预防长时间屏幕对健康的负面影响的建议。这项研究招募了460名高中生和598名大学生。进行了标准人体测量。参与者的心理和情绪状态采用斯皮尔伯格(经Khanin修改)的测试焦虑量表进行评估。为了估计每天和每周接触ED的情况,参与者被要求填写标准化的问卷。高中生平均每天看屏幕的时间为7小时;在大学生中,每天8.5到10小时。只有60%的参与者,无论他们的居住地或他们就读的教育机构类型如何,身体健康。我们的结论是,长期和频繁接触ED是影响青少年正常身体生长发育的因素之一。每天定期使用固定式ED会使体重不足的风险增加24%,超重的风险增加10%。我们建议学生在周末至少一天的日常活动中远离电脑、笔记本电脑和固定ED,并将每天看屏幕的时间减少到3小时。
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引用次数: 8
Molecular-genetic and phenotypic characteristics of desmoid-type fibromatosis 硬纤维瘤病的分子遗传学和表型特征
Pub Date : 2019-07-18 DOI: 10.24075/brsmu.2019.045
А. Музаффарова, О. В. Новикова, Ю. Сачков, Ф. М. Кипкеева, Е. К. Гинтер, А. В. Карпухин, OV Novikova, Sachkov IYu, EK Ginter
Desmoid-type fibromatosis (DF) is a rare mesenchymal tumor occurring in only 2 to 4 people per 1,000,000 population a year. Desmoid tumors are either seen sporadically or in individuals with familial adenomatous polyposis (FAP). The etiology of sporadic DF is uncertain. The aim of this study was to estimate the potential significance of germline mutations in the APC gene in patients with sporadic DF. APC exons were amplified, studied using conformation sensitive gel electrophoresis and then Sanger-sequenced. The obtained data were processed in Statistica 10. Mutations were detected in 6 (12%) of 51 participants with sporadic DF. Those 6 patients shared a typical DF phenotype characterized by early age of onset (5.8 years on average, in contrast to the patients without APC mutations, who developed DF at 19 years of age; p = 0.02), severe clinical course, multifocal localization on the trunk, and poor prognosis. All of the detected APC mutations were localized to the 3'-end of the gene. For the purpose of comparison, we analyzed a sample of 12 patients with FAP-associated DF. Of those patients, 6 carried mutations in the APC gene. In the analyzed sample, the patients with FAP and the mutant APC gene developed DF at older age (35 years) than the patients with sporadic DF (p = 0.004) and their tumors were not multifocal. This means that sporadic and FAP-associated desmoids have different phenotypes in patients with APC mutations. Patients with sporadic tumors have mutations at the 3'-end of the APC gene more often than individuals with FAP-associated DF. To our knowledge, this is the first study to characterize the subtype of sporadic desmoid fibromatosis phenotypically determined by germline mutations in the APC gene.
纤维瘤病(DF)是一种罕见的间充质肿瘤,每年每100万人中仅发生2至4例。硬纤维瘤是偶发或家族性腺瘤性息肉病(FAP)的个体。散发性DF的病因不确定。本研究的目的是评估散发性DF患者APC基因种系突变的潜在意义。扩增APC外显子,使用构象敏感凝胶电泳进行研究,然后进行sanger测序。所得数据在Statistica 10中进行处理。51例散发性DF患者中有6例(12%)检测到突变。这6例患者具有典型的DF表型,其特征是发病年龄早(平均5.8岁),而没有APC突变的患者发病年龄为19岁;P = 0.02),临床病程严重,躯干多灶定位,预后差。所有检测到的APC突变都定位在基因的3'端。为了比较,我们分析了12例fap相关DF患者的样本。在这些患者中,有6人携带APC基因突变。在分析的样本中,FAP和突变型APC基因患者发生DF的年龄(35岁)比散发性DF患者(p = 0.004)大(p = 0.004),且其肿瘤不是多灶性的。这意味着散发性和fap相关的硬纤维瘤在APC突变患者中具有不同的表型。散发性肿瘤患者的APC基因3'端突变比fap相关的DF患者更常见。据我们所知,这是首次研究散发性硬纤维瘤病的亚型,其表型由APC基因的种系突变决定。
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引用次数: 0
Extracellular Vesicles in Heart Disease: Excitement for the Future ? 心脏疾病中的细胞外囊泡:令人兴奋的未来?
Pub Date : 2014-01-01 DOI: 10.5772/58390
Kirsty M Danielson, Saumya Das

Extracellular vesicles (EV), including exosomes, microvesicles and apoptotic bodies, are released from numerous cell types and are involved in intercellular communication, physiological functions and the pathology of disease. They have been shown to carry and transfer a wide range of cargo including proteins, lipids and nucleic acids. The role of EVs in cardiac physiology and heart disease is an emerging field that has produced intriguing findings in recent years. This review will outline what is currently known about EVs in the cardiovascular system, including cellular origins, functional roles and utility as biomarkers and potential therapeutics.

细胞外囊泡(EV)包括外泌体、微囊泡和凋亡小体,从多种细胞类型中释放出来,参与细胞间通讯、生理功能和疾病病理。它们已被证明可以携带和转移包括蛋白质、脂质和核酸在内的各种各样的货物。ev在心脏生理学和心脏病中的作用是近年来产生有趣发现的新兴领域。本文将概述目前已知的EVs在心血管系统中的作用,包括细胞起源、功能作用和作为生物标志物和潜在治疗方法的效用。
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引用次数: 48
Perspectives on the Potential Therapeutic Uses of Vesicles. 对囊泡潜在治疗用途的展望。
Pub Date : 2013-01-01 DOI: 10.5772/57393
Giovanni Camussi, Peter J Quesenberry

The role of extracellular vesicles as an important mediator of cell-to-cell communication has been well established by many studies that have shown their capability for exchanging proteins, bioactive lipids and nucleic acids. Extracellular vesicles have been implicated in several physiological and pathological processes according to the cell of origin. Identification of the innate properties of extracellular vesicles derived from stem cells and from immune cells has led to the possibility of their exploitation in regenerative medicine and immune therapies. As extracellular vesicles are able to cross biological barriers, express surface receptors and contain defined cargoes able to target specific cells/tissues, they may represent a biocompatible and effective tool for drug delivery. Herein, we review and discuss the perspectives related to the therapeutic opportunities of extracellular vesicles.

细胞外囊泡作为细胞间通讯的重要媒介的作用已经被许多研究证实,它们具有交换蛋白质、生物活性脂质和核酸的能力。根据细胞起源的不同,细胞外囊泡参与了多种生理和病理过程。从干细胞和免疫细胞中提取的细胞外囊泡的固有特性的鉴定,使其在再生医学和免疫疗法中的利用成为可能。由于细胞外囊泡能够跨越生物屏障,表达表面受体并含有能够靶向特定细胞/组织的特定货物,因此它们可能是一种生物相容性和有效的药物递送工具。在此,我们回顾和讨论与细胞外囊泡治疗机会有关的观点。
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引用次数: 23
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Exosomes and microvesicles
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