When studying oncology diseases, it is necessary not only to assess their nature, progress and outcome depending on the local disease process, but also to take into account overall health, since multiple organ damage has a prognostic value and determines the disease outcome. All mechanisms and structures that have an integrative and homeostatic effect on the overall health should be considered. One of these structures is the autonomic nervous system. Traditionally, the autonomic nervous system has been considered in terms of 3 components: sympathetic, parasympathetic and intestinal. However, in recent years, ideas about neuroendocrine and neuroimmune systems have come to the fore, justifying the expansion of the concept "autonomy of the nervous system." In case of autonomous dysfunction, dysregulation of the involuntary body functions occurs, and autonomic neuropathy develops. There are cardiovascular, gastrointestinal, urogenital, and sudomotor forms of autonomic neuropathy, which are characterized by certain changes in various pathological states, especially in malignant processes. We pay attention to breast cancer, which ranks first in the structure of oncology diseases in the Russian Federation. Nowadays, there are only a few studies devoted to the changes in the autonomic nervous system in patients with breast cancer during anticancer drug therapy, taking into account the disease progress and clinical features, as well as methods for dysfunction remodeling. The article analyzes a number of scientific information sources that can help to study various forms of autonomic neuropathy in patients with breast cancer and allow assessing the use of medical rehabilitation for such patients. Key words: autonomic nervous system, autonomic neuropathy, breast cancer, antitumor drug therapy. При изучении онкологического заболевания необходимо не только оценивать его характер, течение и исход в зависимости от локального процесса, но и учитывать общее состояние организма, так как множественное поражение органов имеет прогностическое значение и определяет исход заболевания. Следует рассматривать все механизмы и структуры, которые оказывают интегративное и гомеостатическое действие на организм в целом. Одной из таких структур является вегетативная нервная система. Традиционно вегетативная нервная система рассматривалась в аспекте 3 составляющих: симпатической, парасимпатической и кишечной. Однако в последнее время на первый план вышли представления о нейроэндокринных и нейроиммунных системах, обосновывающие расширение значения понятия «автономность нервной системы». При поражении автономной нервной системы возникает дисрегуляция непроизвольных функций организма, развивается автономная нейропатия. Выделяют кардиоваскулярную, гастроинтестинальную, урогенитальную, судомоторную формы автономной нейропатии, которые характеризуются определенными изменениями при различных патологических состояниях организма, особенно при злокачественных процессах. Фокус нашего научного внимания был направлен на рак молочной железы, который занимает первое место в структуре онкологических заболеваний в Российской Федерации. В литературе представлены немногочисленные исследования, отражающие изменения состояния вегетативной нервной системы у больных раком молочной железы в процессе противоопухолевой лекарственной терапии с учётом характера течения и клинических особенностей болезни, а также методы рациональной коррекции её дисфункции. В статье приведен анализ ряда научных источников, которые могут помочь в исследовании различных форм автономной нейропатии у больных раком молочной железы и позволят оценить возможность применения медицинской реабилитации для данной категории пациентов. Ключевые слова: вегетативная (автономная) нервная система, автономная нейропатия, рак молочной железы, противоопухолевая лекарственная терапия.

Acute cerebrovascular accidents remain an urgent problem in neurology. Heterogeneous pathologies accompanying stroke determine its course and development of complications. Such pathologies require early remodeling during the rehabilitation process. Understaging the symptoms of cardiac autonomic neuropathy (CAN) associated with type 2 diabetes mellitus (DM 2) worsens the patient prognosis after an ischemic stroke. The aim of the paper is to study the manifestations of cardiac autonomic neuropathy in patients with ischemic stroke associated with type 2 diabetes mellitus and to assess their dynamics during verticalization. Materials and Methods. The study involved 60 patients of both sexes (aged 45–75) with acute ischemic stroke (IS). The first group consisted of 30 patients with DM 2, the second group enrolled 30 patients without diabetes. At the beginning of the study, we collected complaints, anamnesis, analyzed risk factors for CAN, examined the patients according to the NIH Stroke Scale and the Rankin Scale, carried out cardiovascular tests (CVT) for CAN detection, electrocardiography, 24-hour blood pressure monitoring, and electroneuromyography. The patients underwent passive verticalization for 12 days, which was followed by neurological examination, CVT and ECG. We used both descriptive (calculating the median, 25th and 75th quartiles) and nonparametric statistics (Mann–Whitney U-test, Wilcoxon signed-rank test, Cochran's Q test) for data processing. Results. Initially, patients with DM 2 demonstrated significant changes in all CVTs, and a predominance of the advanced CAN. Confirmed CAN prevailed in the patients of the second group. After verticalization, some positive changes in neurological scales, CVT, and CAN severity were observed in patients of both groups. However, at the end of the trial, the decrease in CAN manifestation in patients with IS associated with DM 2 was less pronounced as compared with patients without DM. Conclusion. Passive verticalization helps to reduce CAN manifestations in patients with IS, including those with associated DM 2. Keywords: cardiac autonomic neuropathy, verticalization, ischemic stroke, diabetes mellitus. Острые нарушения мозгового кровообращения остаются актуальной проблемой неврологии. Гетерогенные патологии, сопутствующие инсульту, обусловливают особенности его течения, развитие осложнений, что требует своевременной коррекции при составлении реабилитационных программ. Недооценка симптомов кардиальной автономной нейропатии (КАН) на фоне сахарного диабета 2-го типа (СД 2) ухудшает прогноз при ишемическом инсульте. Цель работы – изучить проявления кардиальной автономной нейропатии у пациентов с ишемическим инсультом на фоне СД 2 и оценить их динамику при проведении вертикализации. Материалы и методы. В исследовании участвовали 60 пациентов обоего пола 45–75 лет с ишемическим инсультом (ИИ) в острейшем периоде. Первую группу составили 30 пациентов с СД 2, вторую группу – 30 пациентов без данного заболевания. В начале исследования проводились сбор жалоб, анамнеза, анализ факторов риска КАН, оценка по шкалам NIHSS, Рэнкин, кардиоваскулярные тесты (КВТ) на выявление КАН, электрокардиография, суточное мониторирование артериального давления, электронейромиография. На протяжении 12 дней пациентам осуществлялась пассивная вертикализация. Затем повторно проводились неврологический осмотр, КВТ и ЭКГ. Для статистической обработки данных использовалась описательная (подсчет медианы, 25-го и 75-го квартилей) и непараметрическая статистика (критерии Манна–Уитни, Вилкоксона, Кохрена). Результаты. Исходно у пациентов с СД 2 выявлены выраженные изменения всех КВТ, преобладание прогрессирующей формы КАН. Во второй группе преобладала подтвержденная форма КАН. После курса вертикализации отмечена положительная динамика по неврологическим шкалам, КВТ, степени выраженности КАН в обеих группах при сохранении различий между ними. У пациентов с ИИ на фоне СД 2 уменьшение проявлений КАН в конце исследования было менее выраженным по сравнению с пациентами без СД. Выводы. Пассивная вертикализация способствует уменьшению проявлений КАН у пациентов с ИИ, в т.ч. на фоне СД 2. Ключевые слова: кардиальная автономная нейропатия, вертикализация, ишемический инсульт, сахарный диабет.

The review presents the main risk factors for cerebral venous thrombosis (CVT). It outlines current understanding of their role in the pathogenesis of venous strokes. The purpose of the review is to systematize the CVT risk factors according to their effect on a particular component of the Virchow’s triad. Pubmed and eLIBRARY, as well as publications and papers on the issue were considered to be the main sources. As a rule, CVT is a multifactorial disease, which is more typical for young people, more often women. However, it can also occur in children and elderly patients. Since CVT does not always have a specific onset, knowledge of risk factors can help in the early disease diagnostics. In comparison with arterial thrombosis, CVT prognosis is generally more favorable. However, the consequences of the disease remain in 15–30 % of patients. The article presents the factors influencing CVT prognosis and outcome. It is considered, that such patients require timely detection and early diagnostics, as it will increase treatment efficacy, reduce after-effects and mortality. Keywords: cerebral venous thrombosis, risk factors, deep vein thrombosis, superficial vein thrombosis, venous stroke. В обзоре представлены основные факторы риска развития церебральных венозных тромбозов (ЦВТ). Обсуждаются современные представления о роли этих факторов в патогенезе венозных инсультов. Целью данного обзора является систематизация факторов риска ЦВТ в зависимости от влияния на тот или иной компонент триады Вирхова. В качестве источников информации использовались данные электронных библиотек Pubmed, eLIBRARY , а также публикации и статьи по данной проблеме. ЦВТ представляет собой, как правило, мультифакторное заболевание, более характерное для лиц молодого возраста, чаще женского пола, но также встречающееся у детей и пожилых пациентов. Поскольку ЦВТ не всегда имеет специфическое начало, знание факторов риска может помочь в ранней диагностике этого заболевания. Прогноз при ЦВТ, по сравнению с артериальным тромбозом, в целом более благоприятный. Однако у 15–30 % пациентов остаются последствия данного заболевания. В статье представлены факторы, влияющие на прогноз и исход ЦВТ. Постулируется, что указанная категория пациентов требует своевременного распознавания и ранней диагностики заболевания, что будет способствовать повышению эффективности лечения, уменьшению последствий патологии и снижению летальности. Ключевые слова: церебральный венозный тромбоз, факторы риска, тромбоз глубоких вен, тромбоз поверхностных вен, венозный инсульт.

Eighty four patients with clinical signs of acute cerebrovasculardisease were examined. According to MRI, 20 patients were diagnosedwith venous infarction, and 64 patients were diagnosedwith arterial infarction. Venous strokes developed more frequentlyin patients at a relatively young age and in females. The clinicalpicture of venous stroke is characterized by subacute and slowdevelopment of clinical manifestations; prevalence of cerebralsymptoms over focal symptoms; symptoms indicative of cerebralvenous discirculation; a tendency towards relatively rapid regressionof cerebral symptoms. According to MRI, the localizationof infarction in venous stroke does not coincide with territoriesof blood supply to the main intracranial arteries; the form of fociis irregular, and their contours are rough and indistinct; signs ofcerebral venous discirculation, intracranial venous stasis, and vasogenicedema are visualized.

We conducted an epidemiological study of an open population(aged 4059 yrs) restricted to the two therapeutic clusters of aregional out-patient clinic, Ulyanovsk city. A total of 500 peoplewere examined, including 157 men and 343 women. The meanage was 51.16.8 yrs. Arterial hypertension was diagnosed in46.8% of the population. The prevalence of definite casesof cerebrovascular disease (CVD) was 25.4%, including:hypertensive cerebral crises (HCC) 3.6%, transient ischemicattacks 0.6%, stroke 3.6%, initial stages of cerebrovasculardisease (ISCVD) 7.0%, and chronic cerebrovascular disease(CCD) 10.6%. The prevalence of all types of CVD wassimilar among both sexes, with the exception of HCCoccurring much more frequently in women. Two types of CVDdominated in the structure of CVD, CCI and ISCVD (68.8%of all registered cases of CVD). A significant prevalence(52%) of initial-stage cases of CVD, ISCVD and CCI-stage I,underlines the need for active preventive measures of acuteand severe chronic forms of CVD.

To study abnormalities of central and cerebral hemodynamics inchronic cerebrovascular pathology, 65 patients were examinedwith long-term stable idiopathic arterial hypotension (IAH),mean age of 40.2 (8.1) years. According to neurologic examination,all patients were distributed into two groups. The first groupcomprised 19 (29%) patients with somatoform disturbances, andthe second group comprised 46 (71%) patients with cerebrovascularpathology: early signs of cerebral blood supply impairmentand dyscirculatory encephalopathy, stage I. Patients from thesecond group were older and had longer hypotension anamnesis.Cerebral and central hemodynamics was examined with duplexultrasonography of internal carotid arteries (ICA), vertebralarteries (VA) and medial cerebral arteries and with transthoracicechocardiography. In all patients ICA ultrasound showed moderateslowness of blood velocity and compensatory reduction ofvascular resistance. There was no compensatory vasodilatationin VA, which resulted in considerable blood flow reduction,most expressed in the second group. The cardiac index wasincreased in both groups: in the first group due to increase in theleft ventricular contractility and in the second group due toincrease in the cardiac rate. Cerebrovascular disorders inpatients with IAH are associated with age, duration of arterialhypotension, predominant deterioration of blood supply in thevertebral-basilar system and hyperkinetic state of central hemodynamics.

The planning and assessment of therapeutic and preventivemeasures aimed at decreasing the burden of cardiovascular diseases(CVD) are impossible without reliable information concerningbasic epidemiologic characteristics and risk factors(RF) for these disorders. This study aimed at investigating theprevalence of risk factors for CVD among people aged 4059years old. As a part of a general population screening 157 malesand 343 females underwent standardized examination. Dataobtained from the study suggest the following prevalence of RF:positive family history of cardiovascular diseases 17%, hypertension 47%, ischemic heart disease 9%, diabetes 3.4%,atrial fibrillation 1.8%, transient ischemic attacks 1.4%,hypertensive cerebral crisis 5.6%. Behavioural risk factors,such as smoking, alcohol abuse and low physical activity, werealso assessed. Differences in frequency of risk factors detectiondepending on sex, age and education have been furthermoredemonstrated. These data substantiate the necessity of improvingthe effectiveness of preventive measures among people aged4059 years old, and might be used for planning and assessmentof the therapeutic and preventive care.

Objective. To assess antioxidant therapy (ascorbic acid (AA), Cytoflavin) prescribed as part of the standard treatment scheme based on clinical and morphological data in cerebral infarct. Materials and methods. The study was performed from 2010 to 2014 in eight vascular centers in the Russian Federation. A total of 373 patients with acute ischemic stroke in the carotid basin were studied. Group 1 consisted of 132 patients who received 5% AA solution at a daily dose of 20 ml; group 2 consisted of 113 patients receiving the antioxidant Cytoflavin at a daily dose of 20 ml for 10 days; group 3 consisted of 108 patients receiving Cytoflavin for 20 days, the dose being decreased to 10 ml from day 11 to day 20. Patients’ status was evaluated using a set of clinical, laboratory, and instrumented methods. Results and conclusions. Analysis of CT scan results obtained on treatment days 1 and 21 showed that Cytoflavin led to significant regression of the volume of cerebral ischemia, by an average factor of 1.5–1.7. No significant morphological changes were seen in the AA-treated group; among Cytoflavin-treated patients there was a two-fold reduction in the proportion of patients in which the volume of cerebral ischemia increased during the period 1–21 days. In patients with initial assessments of at least 14 points on the NIH scale, Cytoflavin treatment for 20 days promoted more marked improvements in neurological, functional, and cognitive status than seen in patients given infusions for 10 days.

Objective. To investigate the efficacy of Cortexin in the treatment of cognitive and affective disorders in cerebral ischemia (AI) developing on the background of arterial hypertension or atherosclerosis. Materials and methods. We present an analysis of the all-Russian screening program for the efficacy of Cortexin, “Cognitive and Affective Disorders in the Treatment of Cerebral Ischemia with Cortexin” (KarKaDÉ), in 50,000 patients with AI developing on the background of arterial hypertension and/or atherosclerosis in 2013 in 70 Russian cities. Results. All patients received Cortexin at a dose of 10 mg/day for 10 days and were investigated before treatment and on days 11 and 30 after the first dose. More extensive analysis was applied to results from the treatment of 500 patients with stage II AI, mean age 63.7 ± 10.23 years. Treatment efficacy was evaluated using a five-point rating scale for subjective and objective neurological symptoms, the five-word memory test, the Schulte test, the MMSE, the Hamilton scales for evaluation of anxiety, and the short form of the Geriatric Depression Scale. Conclusions. Treatment decreased or completely eliminated focal neurological symptomatology and produced positive changes in measures of cognitive impairments, these changes being accompanied by normalization of patients’ emotional status and decreases in the level of depression.

AIM:To evaluate the impact of incorporating cytoflavin in a treatment regimen for patients with different stages of hypertensive disease (HD).SUBJECTS AND METHODS:The results of treatment were analyzed in 140 patients with HD (53 with Stage I, 50 with Stage II, and 37 with Stage III). According to the treatment regimen, the patients were divided into 2 groups. A study group (n=74) received combination treatment involving antihypertensive therapy and cytoflavin intravenously dropwisely in a single dose of 200 ml of 5% glucose solution for 10 days, then 2 tablets twice daily for 60 days, with a total cycle time being 70 days. A comparison group (n=66) had antihypertensive therapy only. Thirty apparently healthy individuals (a control group) were examined to have reference values. All the patients were examined using conventional clinical and laboratory studies. The patients' complaints and neurological status were assessed using respective questionnaires over time - before and after treatment.RESULTS:The incorporation of cytoflavin in a treatment regimen was ascertained to reduce the degree of anxiety, depressive, dissomnic, and cognitive disorders, improves quality of life in patients with Stage I HD, and lowers the degree of asthenic and autonomic disorders in all disease stages.CONCLUSION:The found efficacy and safety of the drug may recommend its incorporation in combination therapy regimens for Stages I-III HD.

AIM:To evaluate the efficacy of cytoflavin in the treatment of patients with hypertensive encephalopathy (HE).SUBJECTS AND METHODS:One hundred and forty patients aged 39 to 73 years, diagnosed with HE, were examined and randomized to 2 groups. A study group (n = 74) received cytoflavin in a dose of 2 tablets b.i.d. on days 1 to 25 days inclusive during standard basic therapy. A comparison group (n = 66 persons) had standard basic therapy only. A control group consisted of 30 apparently healthy individuals. The investigators studied the frequency of headache, dizziness, and other complaints and the intensity of cephalalgic syndrome, by using a visual analog scale, the quality of life by the Medical Outcomes Study 36-Item Short-Form Health Survey (MOS SF-36) questionnaire, that of sleep by the subjective sleep characteristics questionnaire elaborated at the Moscow City Somnological Center, the level of asthenia by a subjective asthenia rating scale (Multidimensional Fatigue Inventory (MFI-20), and autonomic status, by applying objective and subjective scales on days 1 and 25 of therapy.RESULTS:The study has shown that cytoflavin used in the above dose for 25 days reduces the frequency and magnitude of complaints of headache, dizziness, "venous" complaints, the degree of autonomic and asthenic disorders, and impairments in the quality of sleep and life in the patients with HE at all disease stages. A stepwise discriminant analysis has indicated that the degree of cephalgic syndrome, and autonomic disorders, and worse sleep quality are the most effective points for using the energy-modifier cytoflavin.CONCLUSION:HE treatment based on the current pathogenetic principles may have a preventive impact on the development of HE or slow down the rate of its progression.