Purpose of the study: to examine sensibility of baroreceptors and the autonomic nervous in the passive orthostatic test in patients with chronic impairment of consciousness due to severe brain damage and determine their role in the rehabilitation process.Materials and methods. The study included 30 patients with long-term impairment of consciousness due to severe brain damage (group 1), 10 of them being in the vegetative state (VS) and 20 being in the minimally conscious state (MCS). Craniocerebral trauma was the main cause of severe damage in that group (53% of patients). The comparison group included 24 patients with focal neurological symptoms caused predominantly — 79.2% of cases — by cerebrovascular disorders (group 2). The control group (group 3) consisted of 22 healthy volunteers of a comparable age. All measurements were done with the help of a Task Force Monitor 1030i (CNSystem, Austria) in the course of passive orthostatic test at 0°–30°–60°–0°. Changes in the power of low-frequency (LFS) and highfrequency spectrum (HFS) of heart rate variability and baroreceptors sensibility (BRS) were analyzed. Statistical analysis was carried out using Statistica-10 software. Significance of inter-group differences on unrelated samples was determined by the Mann–Whitney U-test. Differences between groups were considered significant at P 0.05.Results. Maximal background values of BRS were found in the control group. In group 1 and 2 patients, considerable decrease of that index was noted, which was proportional to the brain damage severity. Similar dynamics was observed for the indices of autonomic nervous system sensibility (LFS and HFS). The main trend of orthostatic changes of BRS, LFS, and HFS was characterized by progressive decrease of the indices with increase of the patients’ angle of tilting and their return to the baseline level after the patients were put back into the horizontal position. 4 patients of group 1 (14%) displayed signs of orthostatic disorders upon tilting to 30°: in 3 cases, orthostatic hypotension was observed, and in one case the postural orthostatic tachycardia syndrome (POTS) was diagnosed. Those patients differed by lower BRS and higher sympathetic system activity (LFS) vs. the same indices of other patients in that group.Conclusion. Patients with chronic impairment of consciousness during the post-comatose period after a severe brain damage display a significant decrease of baroreceptors sensibility and autonomic nervous system disorders manifesting in significantly lower activity of the sympathetic and parasympathetic systems. The prominence of such disorders is associated with brain damage severity. Their risk of developing orthostatic hypotension during tilting towards a vertical position is higher in patients who have lower baroreceptors sensibility, and this should be taken into account beginning the process of their verticalization.

The number of dialysis patients is increasing every year and is estimated to be more than 2 million, with an annual increase of 6–12% in dialysis programs. There is a high correlation between cognitive impairment and mortality in dialysis patients, which suggests the relevance of screening cognitive functions in dialysis patients using different neuropsychological scales.Aim of the study was to test the cognitive status and identify cognitive impairment in patients with terminal stage of chronic kidney disease treated using program hemodialysis, as well as to evaluate risk factors for cognitive impairment in this category of patients.Material and methods. 83 patients aged 28 to 78 years (mean age 56.7±13.7 years) were examined. The main group included 53 people who received program hemodialysis, of them 23 men and 30 women. The mean age of patients in this group was 58.3±13.3 years. The control group composed of 30 individuals without kidney diseases, including 13 men and 17 women. The mean age in the control group was 53.6±14.9 years. The MoCA and SLUMS scales were chosen for detecting cognitive impairment and assessment of neuropsychological status. We used mathematical methods of research data processing such as inductive statistics and correlation analysis.Results. Cognitive impairment was found to be significantly more frequent in dialysis patients (75.5–81.1% of cases, P=0.05) compared to those without kidney pathology. The SLUMS scale was shown to be more sensitive than MoCA (P=0.05, CI 95.0%). The risk factors of cognitive impairment in dialysis patients included increased dialysis duration, age (rs=–0.298) and low estimated urea dialysis adequacy index (Kt/V less than 1.2).Conclusion. A high risk of cognitive impairment is common in dialysis patients. For its timely detection,  the screening neuropsychological test are recommended to be used by clinicians. Cognitive impairment, diagnosed by the tests, is an indication for a specialist consultation.

Objectives: Patients in the post-comatose period after critical brain damages and long-term treatment in intensive care units require special approaches to verticalization due to the risk of orthostatic circulatory disorders and deepening of ischemic processes in the brain. Aim: to study orthostatic disorders occurring during verticalization in patients with and without chronic consciousness disorders, after severe brain damages. Material and methods: 72 patients were examined during the post-comatose period, including 49 (68%) after severe stroke, 17 after severe brain injury, 3 patients with posthypoxic encephalopathy and 3 after brain tumor removal. Non-invasive registration of blood pressure (BP) in the brachial artery and monitoring beat to beat of BP was performed using Drager's bedside monitor complete with a finger sensor. Heart rate monitoring was performed automatically by computer-controlled R to R intervals in real time. The results: Orthostatic circulatory disorders were detected in the majority (19 out of 24) of patients with chronic consciousness impairments and in 12 out of 48 patients who were conscious. The most frequent disorder in group 1 was postural tachycardia syndrome, which was not revealed in patients of group 2. Orthostatic hypotension was observed in 25% of group 1 patients and in 20,8% of group 2 patients. Orthostatic hypertension in both groups did not exceed 10%. Conclusion: orthostatic circulatory disorders were revealed in 19 out of 24 patients in group 1 (79,2%) and in 25% in group 2. Application of the new protocol with real-time monitoring of BP and HR allowed to perform verticalization in all patients without complications. The structure of orthostatic circulatory disorders was established, which should be considered at the beginning of the process of verticalization of patients in the post-comatose period after severe brain damages.

1 Федеральное государственое бюджетное учреждение «Центральный научно-исследовательский институт организации и информатизации здравоохранения» Министерства здравоохранения, Москва, Россия 2 Федеральное агентство научных организаций, Москва, Россия В целях усиления государственной поддержки отечественной медицинской науки и повышения эффективности использова-ния научно-технического потенциала федеральных клиник в настоящее время создана правовая база для оказания медицинской помощи в рамках клинической апробации методов профилактики, диагностики, лечения и реабилитации. В статье рассматривают-ся проблемы организации медицинской помощи в рамках клинической апробации. Показано, что приоритетными направлениями нормотворчества в этой сфере являются создание действенных механизмов оценки результативности новых технологий, а также безопасности медицинской помощи, оказываемой пациентам, отобранным и госпитализированным в институты и научные центры по тематике научных исследований.Ключевые слова: клиническая апробация, медицинская наука, клинические исследования, новые медицинские технологии. In order to strengthen the state support of national medical science and to improve the effectiveness of the use of scientific and technological potential of federal clinics currently a legal framework is created for medical care delivery within clinical testing of methods of prevention, diagnostics, treatment and rehabilitation. the article considers the problems of medical care organization within clinical testing. It is shown that the priority areas of rulemaking in this sphere are the creation of viable mechanisms for assessment the effectiveness of new technologies as well as the security of medical care provided to patients who are selected and hospitalized to institutions and research centers according to the themes of scientific researches. PROBLEMS OF MEDICAL CARE DELIVERY WITHIN CLINICAL TESTING