Advanced reperfusion enabling the restoration of blood flow in areas of previously reduced perfusion are leading methods in the modern therapy of the acute phase of ischemic stroke (IS). However, despite successful restoration of blood flow through the affected vessel, reperfusion injury following ischemia can lead to worsening tissue damage due to the progression of cellular metabolic disorders and the initiation of programmed cell death in the ischemic region. In this situation, treatment effectiveness and disease outcomes are largely dependent on the severity of reperfusion injury. This review presents current information on the main stages of the ischemic-hypoxic cascade and ischemia/reperfusion syndrome in IS. The features of the molecular and cellular responses to post-ischemic reperfusion are discussed, the main factors of reperfusion injury are considered, and variants of the “reperfusion paradox” are considered. The article discusses the treatment of reperfusion injury seeking to minimize the adverse consequences of hypoxia-induced damage.
Objective. To evaluate the prognostic value of levels of neurospecific proteins (NSP) in the acute period of encephalitis caused by varicella zoster virus (VZV) for predicting the nature and duration of neurological deficit in children. Materials and methods. A single-center prospective and retrospective study was conducted during the period 2018–2025. Clinical, neurological, and laboratory monitoring was carried out during the study in 35 patients aged from five months to 18 years who were inpatients at the clinic of the Federal Scientific and Clinical Center for Infectious Diseases of the Federal Medical and Biological Agency of Russia with severe and extremely severe VZV encephalitis during the acute period of the disease (5–7 days from onset) and once every three months during the two-year follow-up period. Neurological deficit was assessed using the International Classification of Functioning (ICF). Group 1 included patients with total scores of 22–38, which corresponded to a clinically severe disease, while group 2 included patients with total scores of 40–64, which corresponded to extremely severe disease. Concentrations of NSE (neuron-specific enolase (NSE) and S100B protein were determined in the cerebrospinal fluid (CSF) and blood of all patients. Results. A predominance of extremely severe disease was noted – in 51
Objective. To analyze the dynamics of the level of consciousness assessed on the clinical Coma Recovery Scale – Revised (CRS-R) in relation to reductions in post-intensive care syndrome (PIC syndrome) in patients with chronic disorders of consciousness (CDC). Materials and methods. The study included 76 patients (47 men and 29 women). Mean treatment duration in the Department of Early Medical Rehabilitation was 13.3 bed-days. During this time, patients received an average of 84 h of rehabilitation. Results. The “Neuromuscular disorders” domain was the most common on admission and was detected in 73 of 76 patients; symptoms such as critical illness polymyoneuropathy and inactivity dysphagia persisted most stably until discharge. The most favorable dynamics were noted in the “autonomic-metabolic” domain, where complete elimination of disorders occurred in eight patients. Overall, the mean PIC syndrome score decreased after rehabilitation courses, from severe (6.2) to moderate (4.2). In addition, linear regression analysis established that each 1-point decrease in PIC added, on average, 0.78 points on the CRS-R scale. Conclusion. Partial regression of PIC syndrome during rehabilitation therapy allowed the true clinical picture of the level of consciousness of patients with CNS to become apparent, as an increase in the score on the CRS-R scale.
Objective. To assess the frequency, structure, and predictors of the development of cognitive dysfunction three months after COVID-associated pneumonia. Materials and methods. This prospective cohort study included 340 patients with COVID-associated pneumonia and 34 controls. Comprehensive investigation three months after discharge from a single-infection hospital included assessment of cognitive functions (MoCA, SDMT, Munsterberg test), asthenia (MFI-20 scale), and quality of life (SF-36 scale), along with analysis of a wide range of clinical and laboratory parameters in the acute period of the disease. Results. Cognitive impairment was detected in 24.4
Investigations of muscle activity during passive movements in mechanotherapy settings, as well as during the motor imagery used in neurorehabilitation using neural interfaces, and their comparison with muscle activity during real movements constitute a pressing issue in the rehabilitation of lower limb motor functions. The present study analyzes the EMG activity of the lower limb muscles in 42 healthy participants during passive movements of the right or left foot using a mechanotherapy device (a pair of alternating dorsiflexions and plantar flexions), during similar real movements, and during kinesthetic imagery of these movements. During real foot movements, predominant activation is of the anterior tibial muscles (TA) and their activation is phase-dependent – the activity of these muscles significantly increases or decreases depending on the phase of the movement (dorsiflexion or plantar flexion of the foot). During foot motor imagery, phase dependence is expressed, but to a lesser degree than during real movements; during passive movement, only one significant difference was found, which was between the first phase of dorsiflexion and the last phase of plantar flexion of the right foot. Factor and correlation analyses identified muscles that were synergistically activated during the tasks performed: the right and left gastrocnemius muscles (Gs) and the right biceps femoris (BF) during passive and imagined foot movements, and the right and left vastus lateralis (VL) during real movements. Thus, EMG activity of the lower limb muscles is found both during passive movement and during kinesthetic imagery, indicating activation of spinal-cortical and corticospinal connections in these conditions, which is of no small importance in the context of movement rehabilitation.
