FAQ: Tissue Engineering of Heart

5 facts about regenerative medicine, artificial tissues and prospects of growing hearts.

The term "tissue engineering" is sometimes used as a synonym for "Regenerative Medicine". In general, the term "tissue», tissue-engineering, emerged in the last 15 years, and it reflects the fact that scientists have not only been providing individual cells, tissues, they learned to cut, replant, but also learned how to create their chosen structure.

• 1.Cell Transplantation

This means that come from cells of a living organism, i.e. a piece of tissue or an organ, is parsed into individual cells (understands it with enzymes that destroy the connection between these cells, but the cell is not damaged, that is, they should remain live), then the live cells are cultivated, that is planted to a particular substrate. Interesting fact: the cells to grow and develop, must be attached to some solid support - just in limbo, in incubating liquid, they do not last long. These cells are cultured for some time, and then they can be transplanted, for example, in a certain matrix (or something called in English scaffold, scaffold), these scaffolds incremented fabric, and then grown, in fact, that specialized tissue which was needed. It is, in principle, can be used as an implant, for example, for human transplantation. In this case the cells may be taken from a man and change him well; in principle, it may be a situation where the cells can be transplanted from one person or from one species to individuals of the same species. A situation may be when the cells are taken from an entirely different species.

• 2.Artificial tissue

Why is it in general can be important and interesting? There are many fabrics that easily enough can be extended, that is, where the cells multiply, where they can grow. For example, it is artificial ligament. You can make artificial ligaments on polymer fibers, that is, to take living cells and to plant their man, who had a ligament defect. This task engineering, bioengineering, but it is not fundamental in terms of biology. On the other hand, in recent years, particularly interesting directions that work with tissue engineering of the most important and highly specialized organs such as the heart.

• 3.Growing tissue structure

We took in our lab newborn rats heart cells that still have the ability to aggregate with each other and connect to the network excitable after landing on a substrate. These rat heart cells dismantled, then planted and grown on a substrate corresponding to the layer strip of cardiac tissue. Next, we applied the polymeric nanofibers in order to give these cells a proper shape. It turns out the cells, if we landed on their polymeric nanofibers of a certain type, and recognize these fibers are oriented in its growth in the direction of the fibers and their location. Thus, with the help of these nano-fiber matrices can define the structure of the tissue that we want to grow. But this is nothing more than the approaches to the much more interesting things that become possible only now, in connection with the opening of a Japanese scientist Shinya Yamanaka reprogramming cells. For heart protection person should buy Meldonium, Mexidol, Asparcam, Riboxin, Vitamin B12.

• 4.Artificial heart tissue

Talk about how to transplant, for example, rat or human cells somewhere to take human cells from one area of the heart transplant and in the other, it seems unrealistic. But the discovery of Shinya Yamanaka allows you to do the following thing: the cells can be taken from a person, such as his piece of skin, and converted into so-called pluripotent state (ie the cells, highly specialized, returned the ability to differentiate and then into cells of any type in the body; " pluripotent "- meaning that they can be a lot of things). In this situation, tissue engineering gets a completely new and exciting momentum. Because it can take a human skin cell, to transfer them to this induced pluripotent state (in which they, incidentally, may well divide and multiply), to bring them to the proper amount, then hold their differentiation, for example, in heart cells or liver cells, in kidney cells or nerve cells - it depends upon the desired end. If done, for example, cardiac cells, then these cells can produce cardiac implants that will actually be of human heart tissue, from which the cells were taken. In fact, you can even grow a single artificial heart, but it is a very difficult technical problem, because the heart has a complex structure. But to grow a strip of heart - it is quite real.

Solution cultivation of artificial heart - this, of course, a very important task, which is likely to be decided in the next decade.

• 5.Prospects for artificial tissue

But even the formation of the strip has a great role, because this strip of heart tissue, which is identical in its characteristics of cardiac tissue of the patient can check the effect of cardiac drugs. And it will be immediately clear how these drugs will work on this man. That is such a strip can work out the most effective selection of antiarrhythmic drugs for that person. Similarly, if you create a similar piece of tissue from the liver cells, it is possible to pick up the drugs - hepato-protectors or reducing medications that will work most effectively for a particular patient. Therefore, in the near future such a patient-oriented pharmacy, probably, it will be very actively developed. And I think that in the not too distant future it will be a very important area in modern pharmacology. And here, as always, tissue engineering combined with polymer chemistry, and with the new techniques of molecular biology and modern pharmaceuticals, that is, in this case the synthesis of science will be most effective.

What is unique in the human brain?

Professor of Medicine, Dr. Doping tells about brain development, neoteny and behavioral plasticity.

The human brain - a large, but by itself the size is not so important. More importantly, in the brain. In the process of growth and brain development is the formation of neural networks - contacts between neurons: the right contacts are enhanced, removed unnecessary. This process is really never ends. Even an elderly person there are some changes in neural networks. Therefore, for example, and 90-year-old man can learn new words. However, the main formation of neural networks occurs in the first 10 years of life.

Scientists have always wondered why the human brain as a result of development can generate new opportunities. There are several hypotheses. The famous linguist Noam Chomsky and his colleagues hypothesized that in the brain there are congenital brain modules that are responsible for human-specific cognitive function - for example, for the formation of language skills. The existence of language and complex communication mechanisms are very important for the people - all the modern technology exist only because we learned how to pass information from generation to generation.

Naturally, scientists are very interested in this hypothesis, and began to look for evidence of the existence of such modules in the brain at a biochemical level. But it is not found. It turned out that the human brain does not exist any anatomical structure, specific to humans. That is, it turns out that there is a new feature, a structure that is responsible for it, no. Then, having recovered from the shock, scientists have thought that it is not so strange, because the human brain is very plastic. Even an elderly person after a stroke may in some time to restore some of the lost capacity, as undamaged parts of the brain can take over the function of damaged.

Brain Plasticity exists at two levels. The first is that our brain is susceptible to the absorption of new information. If we look at the brain of insects, we see that almost all of their behavior inherent in the structure of the brain. That is, for every insect irritation will react only with one specific way. No plasticity in behavior is not - simply because of all the behavioral instincts fully defined. But human behavior is not predetermined. For example, if you attack a cat, you are at first frightened, but then realize that you are not afraid of cats, and will cease to be afraid of them. This is the behavioral plasticity.

Another level of plasticity of the brain - is the plasticity of neural networks. Restore lost abilities after a stroke is one of the examples of such plasticity. There are also more radical examples. In children, there are diseases in which the brain takes place autoimmune reaction leading to frequent epileptic seizures and, if untreated, death.

The only known way to deal with this disease - to remove one of the cerebral hemispheres.

To improve brains they use Cogitum, Nootorpil, Phenylpiracetam, Semax, Cerebrolysin, Cerebramin and Pinealon.

Of course, the baby's brain requires more than a year to compensate for the loss of an entire hemisphere. However, after this period all abilities are recovered, and no one even suspects that such person does not have half of the brain. This example clearly visible manifestation of plasticity of neural networks, neurons when one is damaged another area portion assumes the first function.

When it became more or less clear, the researchers realized that naive to expect that in our brain, there are some specific areas and structures that are responsible for language, because different regions of the brain can take over different functions. This means that a certain monkey neural network could be responsible for the movement of the hands, and we have it may be responsible for the movement of the language. And instead of gesticulating like a monkey, we have the ability to communicate through speech.

Almost simultaneously with the idea of the modular organization of the brain there is another hypothesis - neotenic. Neoteny - this is when the adult organism retains the features of child development that are inherent in other species. For example, axolotl - these are amphibians that resemble larvae of other species, but are adult organisms.

As for the man - about 100 years ago, scientists were very fond of studying the skull and the shape and noticed an interesting phenomenon: the adult human skull is similar to the skull of a baby chimpanzee, gorilla or any other ape. Skull Monkey for life continues to evolve, and in humans the shape of the skull remains frozen at the Junior level. Probably all noticed that when chimpanzees are small, they have a human face. And if you look at the adult monkeys, they have a huge jaw and relatively small skull.

After this observation, in the 1970s, the famous evolutionary biologist Stephen Jay Gould put forward the hypothesis that perhaps it is not even in the bones, but the fact that the human brain never loses his infantile characteristics. That is the human brain retains plasticity behavioral characteristic of young monkeys, but they disappear in a few months after birth. That is why we can learn, we have more social contacts, we are all interested. We like to stay at the children throughout their lives.

Naturally, the human brain is not fully remain in the children's condition, but some of the processes really slowed down. For example, the formation of the neural network takes a very long time - 10-15 years. This means that for a long period, a person is not fully grown from a psychological point of view and can not be completely independent. If there are no other members of the community: parents, relatives who can provide support and help - people will not be able to fully fight for existence. 

Heart autowaves

Professor of Medicine, Dr. Doping tells about vortex rings, population waves and hearing how the airwaves. When the concept was introduced autowaves? What is special about autowaves? What are some examples of autowaves? And are there autowaves?

What is auto-waves, how they differ from the waves? Everyone knows what the water waves, ocean waves, even such as the tsunami or just small ripples - a mechanical wave. If you throw a stone into the pond, ran a circular wave, it eventually fades. Just because of the energy of the stone hitting the water enough for it to wave ran some distance, plus increases the perimeter, that is, the incident energy per unit of perimeter. This wave in systems where energy is conserved. A autowaves - a wave of switching, that is, the transition of the medium from one state to another, or, for example, a change in electrical potential - what happens in biological objects. At the same time to maintain the wave energy is taken from the same environment in which it is distributed. The most obvious example is the spread autowaves herbal fire or wildfire.

Imagine to ourselves that we have a two-dimensional system, and we have launched a wave at some point in the plane. It ran; it will be a kind of topological expanding ring, and this wave will run at a constant speed, because its speed is determined solely by the parameters of the medium. That is the energy of all the time is stored in the medium. She is no need to slow down, she kept enough energy to continue its movement. And now imagine that this wave has come across an obstacle and began to go around. And suddenly the obstacle has disappeared. In this situation, the germination begins waves inside the medium, where it was an obstacle to restore the environment, and begin twisting the so-called "spiral waves," or "self-wave vortex".

For Heart problem is often used Coramine, Asparcam, Meldonium, Mexidol.

In physics, the phenomenon is known: in order to make a transition from one state to another (as in the most primitive autowaves case - it's just a phase transition of the first kind), you need a certain critical indignation. That is, this disturbance, a change must be more certain, because otherwise it will not run out tide.

Biophysics of Excitable Systems

Professor of Medicine, Dr. Doping tells about electrophysiology, the study of excitable systems and heart vortices.

Biophysics - this is what they do physics when investigating biological objects. There are many definitions of Biophysics. One of them - the study of biological objects by physical methods. But I like it when there are people in front of, rather than hardware, because the physicists specifically trained in physics, especially in Russia and the former Soviet Union, built thinking a little differently than the classical biologists. These people are engaged in biophysics. If Biophysics - the study of the living physicists, it is absolutely boundless region, which can be through the levels, trace layers. The measurement of molecular biology at the molecular level. It's already closed with chemistry. And it is impossible to draw a clear boundary between what chemists do - high molecular weight compounds, and that makes biologists and molecular engineering, researchers, when watching some subtle things.

Since the main excitable systems in the living body are two - is nervous and if we do not take digestive (this detail), - we have been a part of it - the heart tissue. And for what it's done? Interesting is not tissue itself, and heart functioning. We all know that the damage to the heart is almost instantaneous and very quick death. And as it always has been known since ancient epic "I struck by an arrow in the heart." Two things: cut off the head - all go nuts. I hit the heart - too bad.

For Heart problem is often used Meldonium, Mexidol, Coramine, Asparcam.

On the one hand, we understand that there are many similarities between rat and human heart. If this was not a general, the heart and Biophysics would not. But the fact is that there is a big difference. And we, for example, do these differences come across. My Japanese graduate student who did this work, using an ordinary Japanese dia-rhythmic, gave it to the culture of rat cardiac cells, to see what would happen; He saw nothing. And when we started to deal with it, it turned out that a very widely used dia-rhythmics third class will only work on human cells, because they have a special ion channels that are blocked by these dia-rhythmics. But the rats of these ion channels do not. It would seem quite an obvious thing, but it got its unexpected confirmation. That is, if we want to develop a drug for humans, we have to use human tissue.

Swirl Heart Arrhythmia

Professor of Medicine, Dr. Doping tells about tachyarrhythmias, pacemakers, and the theory of self-wave vortices. What is the role of the heart in the body? What functions are performed by the cell - pacemakers? What does the damage wave excitation?

What is the role of the heart in the human body? If you factor out all the lyrical digressions, the heart - this pump. Heart gives the ability to pump blood through the tissue of the small circle of blood is enriched with oxygen, over a large range, it sends oxygen to the tissue, removes metabolites, thus allowing the whole body.

Excitation in the heart extends from the sinus node. The atrium has a small concave, where the cells called pacemakers. These cells are the pacemakers, they set the rhythm of the heart, there runs a wave of excitement that covers the atrium first, and then the ventricles. When the heart is running excitation wave, she could face any obstacle. For example, it can be heart tissue damage due to a heart attack. If the excitation wave is on the right heart, it works efficiently.

For Heart problem is often used Mexidol, Meldonium, Coramine, Asparcam.

The theory of vortices of heart there are more than 50 years. The first hypothesis that paroxysmal tachycardia is due to the occurrence of rientri, voiced by none other than the brilliant mathematician Norbert Wiener. The first work on this subject was published in 1946, Wiener and his Mexican counterpart, Arturo Rosenbluth. The article was devoted to reentry around the upper vena cava as a cause of paroxysmal tachycardias.

Dysplasia of Connective Tissue

Professor of Medicine, Dr. Doping tells about the high intelligence displastics, cardiovascular disease and fluid overload syndrome. What positive effects gives the connective tissue dysplasia? What disease is most often faced by people with this genetic feature? What are the methods of care for patients with connective tissue dysplasia?

Displastics, we believe, are the bearers of a higher intelligence. They have higher IQ than average in the population, so it is very successful people. The second positive point: these people are biologically and physiologically look more attractive than the general population. And, as I tell my patients, they lag behind their passport, biological age. The third point, statistically proven: I do not want to sound like some kind of a revolutionary discovery, but it is quite an accurate observation that they are less likely, at least 2 times, suffering from cancer.

Among the functional sufferings that afflict displastics, you can specify the headaches, diseases of coronary system, blood pressure instability. Moreover, we have experience in treating resistant to medical treatment of hypertension, quite a successful experience when we are changing the conditions of the venous blood is in responsible hormonally-zone, we get such "side" effects. Not only that we are pursuing the aim to cure, for example, a patient of chronic pelvic pain, which is also in the register of these diseases as causes of female infertility, but we still get a fairly robust effects on various groups of other diseases that traditionally are not associated with these problems.

For migraine and headache treatment is often used Picamilon ,Vitamin B6 injection, and Peptide Complex ¹19.

Our observation is that displastics there are still a number of problems, which become clinically significant. There are a variety of gastrointestinal disorders, which are characteristic only for long enough displastics and treated by gastroenterologists, sometimes successfully, sometimes less successfully. I do not want to offend his colleagues, but nevertheless gastroenterologists do not always know what you need, for example, remember that there are vessels that have a system that provides the blood supply to the abdominal organs. There are a classification of Shaposhnikov, our compatriot, who eventually determined that such ischemic disease of the abdominal cavity, chronic abdominal ischemia.

Methods for the diagnosis and treatment of Migraine

Professor of Medicine, Dr. Doping tells about the causes of headaches, connective tissue dysplasia and poor circulation. What causes migraine? How dangerous is this phenomenon? What today there are approaches to the treatment of functional headache?

Migraine is functional headache. Classification of migraine is very extensive. Based on the socio-economic importance, in 2000 it was carried to the global problems of mankind as to the problems that lead to maladjustment of man. The problem lies in the fact that many people simply do not seek medical help. Of the one hundred respondents surveyed by telephone, 70 people said that migraine knocks them out of the rut and robs normal operation. Migraine is still dangerous and the fact that poses a risk of various complications: migraine status migraine stroke. It is discirculation, poor circulation in the brain.

To date, we firmly believe that people who suffer from migraines, are people with undifferentiated forms of connective tissue dysplasia. They have 100% of the features identified in the circulatory hormone responsible area and beyond. Result after endovascular reconstruction in the zone of 65-70% of the cases it was not pleased for us. That is, the problem of 30% were forced to reflect, think and move on. On our way we passed the following steps: when we are studying the blood circulation in the pelvic organs, hormone responsible area, reconstructed vessels, iliac vein, common structures, reconstructed renal veins, gets results.

For migraine treatment is often used Vitamin B6, Picamilon and Peptide Complex ¹19.

Publication of our American colleagues, 2010, says that the detected estradiolic receptors scattered in both men and women, in the human body, which is just, in our opinion, may be the trigger zones, influencing which dishormonal condition can lead to improve the tone, as one option. I'm not trying to deny all those achievements, all the knowledge that existed before us. It is our hypothesis, our theory. But this is what keeps the blood vessels in certain alert.

Cardiovascular Dystonia

Neurologist Dr. Doping tells about the autonomic nervous system, psycho-vegetative syndrome and diagnostic difficulties.

Vegetative dystonia, Cardio-vascular dystonia or vegetative dystonia syndrome, and neurological perspective on this issue. The autonomic system and, accordingly, its violation lurking in this term, has a number of structural elements of the organization: the central link, the so-called segmental, segmental and peripheral units. Accordingly, autonomic dystonia divided into the following components syndrome - a psycho-vegetative syndrome, autonomic insufficiency syndrome, syndrome angiotrophopatic. What is it and what do you eat?

Angiotrophopatic syndrome - is, in fact, the peripheral autonomic nervous system lesions that appear in the background of some other co-morbidities. This diabetes, infectious diseases, neurological disorders accompanied by pain syndromes such as complex regional pain syndrome, is a systemic disease in which necessarily visible, noticeable and is subject to the treatment of the underlying disease.

Autonomic failure - it is also largely a condition manifested more important systemic disorders. That is a decrease in cardiac rhythm when changing body position, it is possible decrease in blood pressure when sudden change in body position, such as standing up, without the pain of heart attacks until, unfortunately, the sudden nocturnal death syndrome. It develops mostly in elderly patients on the background of some neurodegenerative diseases or is a consequence of the current status or the current condition in which the subject underlying disease treatment.

Now about psycho-vegetative syndrome. The syndrome vegetative dystonia was formulated in the 70s, maybe even a little earlier as a syndrome, not as some sort of condition. And his study was completed by the fact that the autonomic system - a stand-alone system, to do what is beyond our will. Regardless of my will is the respiration rate, heart rate, vascular tone, and many of the processes aimed at maintaining homeostasis, to increase so-called catabolic or anabolic processes, which are aimed at maintaining the body's homeostasis and survival. It is part of the autonomic nervous system.

Great interest in this has been a long time, and in the second half of the last century has been active use and study of autonomic reflexes, depending on a given situation. Then there was a whole laboratory based on the first honey in the department of nervous diseases, which was engaged in the autonomic nervous system, under the control of Alexander M. Wayne. Then there was formulated a theory that autonomic failure, and autonomic dystonia syndrome - it is only a syndrome, that is a secondary condition. Such changes, or similar disorders now engaged neurologists, faced with this general practitioners, cardiologists, internists and psychiatrists.

What is, strictly speaking, substrates? Why autonomic failure, a so-called segmental, or loss of peripheral units - a purely neurological work, but psycho-vegetative syndrome, segmental or defeat - it's a big mystery?

Unfortunately, in real life, often in the scientific life there is the term "vegetative dystonia", with which we began. What does this mean? Autonomic reactions, vegetative response to some external stimulation. This stimulation can be anything, ranging from stress factors, ending the weather conditions change in some internal state of homeostasis, exercise and so on.

What is the reason? Suprasegmental system, which deals with autonomic management, autonomic system, autonomic innervation, - a system which has very strong ties and contacts with the systems responsible for motivation, emotion and all the emotional substratum of all our reactions. It is the relative area of the brain is responsible for our emotions, fears, desires, motivation and so on. If their violation is required to run some autonomic symptoms.

The downside syndrome vegetative dystonia, which is studied by neurologists, and, unfortunately, is now often treated by neurologists - is the lack of proper diagnosis.

Because when first taken out syndrome, in contrast to the failure of autonomic disorders and angiotrofopaticheskih where secondary autonomic disorders in the apparent disease, vegetative dystonia syndrome is often the leading diagnosis, there is searched for a reason for this.

According to the report of the Commission on psychiatric health, 26% of the population in prosperous Europe has a mental illness and requires monitoring. Prevail in the structure of diseases anxiety disorder and depressive disorder. General statistics on Russia or Moscow, I have not met, but for a variety of publications by 25% of patients have a similar condition. I must say that often these patients just complaints related vegetative disturbances, that is manifested various palpitations, pains of various localization, nonlocalizability sensations, general asthenic complaints: complaints of weakness, the overall malaise, a feeling of dissatisfaction with sleep, feeling of lack of rest during the time available to rest, inability to sleep, - complained of the presence of some overvalued ideas, the presence of migratory uncomfortable sensations in the end, the presence of physical symptoms that have no physical evidence - are examples of fairly complex patients who are often on the receiving GP did not receive proper diagnosis by the fact that hide behind a diagnosis of vegetative dystonia.

The same psycho-vegetative syndrome is mostly just a consequence of some emotional disturbance, as I said, most alarming, or depressive disorders range. Personality characteristics of these patients - a change in the threshold of sensations, that is, and as a result the patient complained of a much more significant than they are for each of any normal person. Do you have a numb arm or my hand? Yes, numb, but I'll say it quietly, because I know that it happens, I know that it goes through. A man with a depressive or anxiety disorder is much more important to take this complaint, it will be one of the major sensations, it will not leave him, accordingly, it is with this complaint will not leave the doctor. And if with it numb hand will not leave a neurologist, which, in principle, to the psychiatrist it is sometimes a little bit to go, just to the neighboring office, then, if we are talking about cardiology, gastroenterology and doctors somatic specialties, this is a very extensive expensive test, long search drugs, and, according to statistics, which often issue of psychiatric experts, 80-90% of patients with anxiety or depressive disorders, with the dominant somatic disorders receive their diagnosis within 8-12 years after the onset of the complaints are not received, of course, at the same time proper treatment, did not give a proper survey and give the development of distrust of physicians and health care in general.

What all of this are the substrate - only whether psychiatric or some morphological too? Surprisingly, but the further we move on to the study of anatomical and biochemical substrates, the more we begin to lose. In fact, about a hundred years ago, such a condition, such as epilepsy, treated with psychiatrists, it was considered a mental illness. Currently, those involved neurologists. Dementia, or dementia, too, at one time been treated by psychiatrists, it is now engaged to a lesser extent, psychiatrists, neurologists are more specialized centers. Another thing is that the diagnosis of the organizational moments - it's still a mental inheritance, as it is a question of capacity and incapacity of the person. So, many of somatoform or some mental reactions must now be examined and treated by psychiatrists.

Often medicational choice in this case are not any or psycho-stimulants, relatively speaking, vitamin, vascular or nootropics and drugs that increase the adaptive process - is antidepressants various groups may be modified if perception is neuroleptics. However, morphological changes it has, change the threshold of perception - it neurochemistry, rather deep, powerful and, most importantly, even having a certain hereditary roots. (For example, Meldonium, Mexidol, Phenibut, Cerebrolysin).

It proves a definite genetic link, predisposing certain level of response to external stimuli.

This reaction to external stimuli can be transmitted as a suspected genetic or by environmental mechanisms. If we are in a single environment perceive this or that tradition to respond to any external factors, then, of course, the man raised in a particular environment, will inherit this tradition and will continue to spread.

Currently relevant is a slight change in the organization of assistance to these patients, the diagnosis is considered to be unlawful as a vascular encephalopathy syndrome and unlawful arrest of diagnostic search in the formulation of this syndrome. And the future, perhaps, is the development of a neurochemical direction in finding a substrate that can be removed, and the adequate development of certain schools of psychotherapy, which will change the perception, if not, what to do with this perception.

Viewpoint - Prospects for medical diagnostics

New methods of disease diagnosis

"Individual monitoring using microarrays could lead to a revolutionary breakthrough in the diagnosis and treatment"

In medical diagnosis involves understanding a set of rules, methods, decisions that will ultimately allow to come to a conclusion about the presence or probability of the presence of a disease.

Functional diagnostics is a specific and fairly well-defined division of medical diagnostics. Assessing the prospects and development of functional diagnostics in recent years, it should be noted that there are skeptics and optimists. Skeptics say that as the basis for functional diagnostics is clinical physiology, that is, an analysis of regulatory processes that occur in the human body and indicating the presence of the disease, and she clinical physiology in recent years has not undergone major changes, and functional diagnostics is currently underway stabilization phase without waiting for revolutionary breakthroughs.

Optimists argue quite the opposite. They say that the accumulation of technological innovation and the data obtained in recent years, leading to qualitative and quantitative changes, which open up new horizons in the field.

There is no doubt that with the development of modern technology we are able to identify all the earlier regulation changes associated with the disease. But I would like to draw attention not to quantitative and qualitative trends in the functional diagnosis. Traditionally, the subject of the study were the processes in the body, occurring either in a state of relative rest or with artificially created "significant" load, that is, in fact it was "provocative" functional diagnostics. The first successful attempt to go to the "observation" functional diagnosis can be considered in the creation of the 60-ies of XX century equipment for the continuous monitoring of ECG (Holter AN) and blood pressure (A. Ninman) in a "real life activity."

It took 50 years of distrust, skepticism, pessimism, and improve recognition, and these methods have become indispensable in the detection and treatment of disorders of rhythm and conduction of the heart and arterial hypertension. Now we understand that that hypertension, which traditionally was detected at the doctor - it is only 40-60% of the "iceberg" real hypertension. Part of it was a false hypertension - "white coat hypertension". A very disturbing nocturnal hypertension, and hypertension, which occurs only in the workplace, has become available for the detection and correction only when using modern devices that automatically measure the pressure every 15-30 minutes.

Moreover, the equipment is already in the form of bracelets for every second of BP control in a "real emotional and physical" stress. In 2014 in the United States for the first time allowed for clinical use in implantable pulmonary artery system for continuous measurement and transfer to the center of the observation data on the pressure in the pulmonary circulation in the "home". This technological breakthrough has led to tangible results when observing and treating patients with low cardiac output. Great efforts in the creation of implantable devices allowing all monitored parameters over a wide range of cardiovascular system, marked by the firms producing implantable pacemakers.

Practically we can say that "the genie out of the bottle" and we stand on the threshold of creating a "Monitoring of functional diagnostics" on the basis of implantable microchips. The optimists dream of a secure microchips, which will be "a warning" be implanted, and a man working for a long time to collect the necessary information that will identify the earliest adverse functional changes. That is, functional diagnostics will focus on the identification and correction of prior disease. This trend - individual monitoring using microchips - can lead to a revolutionary breakthrough in the diagnosis and treatment.

"Decision-making in the diagnosis rests with the man, but assistance provided by technology, it is important"

Recently there has been not only the emergence of new methods of diagnosis, but also, surprisingly, the revival of the methods that have recently seemed obsolete. Moreover, these approaches take on a very different role in the diagnosis, than it was before.

As one example, we can mention the introduction of new methods of microscopic analysis. Reducing the role and relevance of these methods it is determined by a small precision microscopic methods, but more high cost. A blood smear is expensive, automatic analyzer analyzes faster and cheaper. Implementation of an automated sample preparation systems, automatic photographic products, the development of decision support systems, and much more made of microscopic methods and more accurate, and less expensive. Already installed in some clinics robotic systems that can automatically produce photographs of a large number of drugs. The role of the diagnostician is reduced to the analysis of the images obtained. The next image recognition system. It is clear that the decision is up to the person, but the assistance provided by technology, becomes significant.

Plus new microscopy techniques gradually from research laboratories are moving to the clinic. It is not only new equipment, but new experimental approaches. We are talking primarily about the systems associated with the use of fluorescent proteins, which have long been used for research purposes, or in screening systems. Last fairly quickly develops into diagnostic applications.

Another interesting example - the development of flow cytometry methods. This method analyzes the presence of certain proteins on the cell surface, which is very important, for example, for the differential diagnosis of leukemia and lymphoma. Tumor cells differ quite specific set of proteins on their surface, revealing that, you can make a diagnosis. The problem is that it is necessary to identify a lot of the markers. Earlier, at the same time it was possible to identify two, rarely more markers. If a lot, there is no problem of tumor cells. But if the tumor cells is small, they recognize numerous among normal almost impossible. Now implemented approaches that simultaneously identifies eight markers. Part of them are used to identify a population of tumor, and the part - for the characteristic properties of tumor cells.

"Analysis of the survey data allows in practice to implement the principle of personalized medicine"

Over the past two decades we have undergone a radical renewal of the methods of quantitative and qualitative analysis of the molecular basis of life. From the detection of certain types of molecules in the fundamental and applied biomedical science irrevocably shifted to the detection of whole classes of molecules in their total or almost total population.

Such methods have total -omics name, generic name of branches of science, ends with the suffix "-omics". For example, genomics studies the genes ensembles, ie genomes. Transcriptomics - ensembles mRNA, ie transcriptome. Proteomics - ensembles of proteins, ie proteomes. Metabolomics - ensembles of metabolic reactions, that is, metabolome, and so on.

Using multiple omics technology has made possible the old dream of Medicine of antiquity, breathed new life into the clinical paradigm, formulated even Galen and Avicenna: "Treat the patient, not the disease."

Analysis of the results of different surveys allows omics finally actually implement the above-mentioned principle of personalized medicine and prescribe a particular patient is the treatment that is most suitable to him.

Nevertheless analyze "raw" results of each of omicsn research for personalized medicine purposes is very difficult because of the large amounts of poorly structured data, which represent the "raw" data.

To help in the processing of "raw" data come powerful mathematical and statistical methods are available to the bioinformatics. One of the main tracks deep synthesis and analysis omiksnyh data is the transition from a description in terms of individual molecules (protein, RNA, DNA, etc.) to more general characteristics describing the signaling pathway, that is a complex set of interacting genes and their products (proteins) which determines the metabolic fate and mitotic cells.

As a set of signaling pathways called signalomom, the approach of examining changes in these ways can be called signalomics. Due to the law of large numbers (as the signaling pathways contain hundreds of genes and gene products) at the level of signalomnom manage to overcome a significant part of the stochastic noise, which greatly complicates the analysis of systemic changes at the genomic / transcriptomic / proteomic level. Correlating the results of various genomic / transcriptomic / proteomic research signalomnom level, as a rule, is also higher than at the genomic / transcriptomic / proteomic.

It is at signalomnom level can not find an effective marker-predictors individual effectiveness of many drugs, such as anticancer, as well as to solve more ambitious than personalized medicine, the problem - "re-profiling of drugs» (drug repurposing), ie search for those diseases in which can various medications to be effective, previously created for treating other diseases. This conversion is made possible by the accumulation in the public domain the results of millions of genomic / transcriptomic / proteomic / metabolomnyh and so on research in various pathological conditions.

It is well-known that Meldonium is excellent for heart, as well as Cogitum for Brains.

"To carry out a genetic analysis of the genome sequenced, and understand what you will have the disease - this naive dream, unfortunately, not been realized"

It is very difficult to say in general for all the diseases at once, which is needed diagnostic methods. The first is to separate the genetic from nongenetic diseases. If we talk about autoimmune diseases, then they need to pay attention to the antibodies. Some diseases require imaging techniques such as magnetic resonance imaging or positron emission tomography. Speaking of neuropsychiatric diseases, in which only in rare cases there is a certain genetic basis, which has been well studied and where genetic diagnosis helps.

To conduct genetic analysis, sequenced the genome and understand what you will have the disease - this naive dream, unfortunately, was not realized. It turned out that we all have quite a large number of nucleotide polymorphisms, and when you, for example, get an analysis of the entire genome, you will have a lot of genetic changes, and will not understand how you can just tie this particular mutation in this gene is a and that the disease symptom. So in most cases, it is a traditional descriptive diagnosis, when the patient comes to the doctor and describe their problems, because, unfortunately, no clear markers, for example, schizophrenia does not exist, and psychiatrists have to investigate symptoms.

If some other diseases can more clearly see what is called a biomarker, when you something measure and can accurately understand: if a person, for example, found in the blood some substance, then he has some disease. The best example is phenylketonuria, which is determined by the phenylalanine concentration in the blood. Doctors dream of finding these biomarkers for many other diseases, but common diseases such biomarkers are rare. And for the majority of diseases mental plan of how to be sad as it may sound, these markers there is little, so the patient is still going to the doctor and complains of their symptoms, and the doctor examines it and sees a manifestation of the classic symptoms, or, as is now fashionable to say, endophenotypes, and it makes the diagnosis.

In neurodegenerative diseases, neuroimaging techniques are informative: for example, in Parkinson's disease in the late stages with the help of positron emission tomography can fix the loss of dopamine neurons, but in the early stages it is impossible, and in fact the most important thing - is to diagnose the problem in humans until the full development of the disease! So, what I am saying applies primarily to neurodegenerative and psychiatric diseases, which I do. In cardiology, oncology and immunology, for example, has a very successful diagnostic methods. Unfortunately, the plan neuropsychiatric diseases the situation is completely different, because when something can be detected, is often already too late. This is a very big problem: how to diagnose the disease at an early stage, when you can still stop the neurodegenerative process?

"The methods of early diagnosis of diseases of the brain to develop a much more difficult compared to other diseases, because no one really knows how the brain works"

If we, for example, the treatment of cancer, the most effective means to combat them is surgery. Therefore, the earlier a tumor is diagnosed, the sooner a cancer can be cured.

At the moment, an effective method of finding tumors is computed tomography. If physicists can develop better imaging - higher resolution and ability to detect tumor cells - it will be the most promising method of detecting tumors at an early stage.

Of course, the development of early diagnostic methods often lead to new methods of treatment of the disease. But if the early diagnosis of diabetes or cardiovascular disease prevention really allows the development of these diseases, the harder the brain. It is much harder to develop treatments for diseases of the brain, because no one really knows how the brain works.

Take a common Alzheimer's and Parkinson's. They are considered a disease of older people, but in fact they have become ill between the ages of 20 to 40 years. Now they are diagnosed only when the brain destruction reached the point that symptoms.

Let's say you 25 years. Imagine that there is a diagnostic method that allows you with a 100 percent chance to say that if you will live, say, 70 years, then you will develop Alzheimer's. But what is the meaning of such diagnostic methods, if the treatment of this disease still does not?

In general, there are two promising areas: the improvement of devices based on physical principles - the same imagers, as well as improved chemical methods of diagnosis based on the presence in the blood of biological molecules - markers of early stages of the disease.

Stroke: Causes and Symptoms

What is the cause of the stroke, what symptoms to help recognize it and what methods of treatment practiced in modern medicine.

Stroke is an acute cerebrovascular accident, in which the die part of the brain. Depending on which particular area of the brain affected, stroke patient lost some brain function and cease to function various organs. There are two key kinds of stroke - ischemic and hemorrhagic. In an ischemic stroke patient is a "blockage" thrombus one of the arteries in the brain. This leads to the cessation of blood flow in arteries and gradual death of brain tissue located "downstream". In hemorrhagic stroke is bleeding in the brain due to violation of the integrity of the walls of blood vessels. This type of stroke is less common, but its consequences are usually disastrous.

In addition, cases of stroke occur, which combine a blockage of the arteries by a thrombus, and bleeding in the brain. As a result of a stroke indirectly violated the functions of those organs run by the affected brain cells. If the stroke affects motor neurons, their death results in the inability to perform movements, and subsequently - to muscle atrophy. If the affected area get the nerve cells, which manages the functions of the pelvic organs, there is dysfunction of the bladder and other organs. When a stroke is often violated it. stroke effects depend on what part of the brain damaged. Interestingly, since the neural pathways intersect, a stroke in the left hemisphere of the brain leads to the loss of limb function on the right side of the body and vice versa.

Causes of stroke

A key role in the development of ischemic stroke injury plays intima - the so-called endothelium. This damage causes the growth of atherosclerotic plaques - sealing intima inside the accumulation of lipids, especially cholesterol and its esters. Plaque silently maturing for many years, but at one point, which is very difficult to predict, it becomes very fragile tire (scientists call these unstable plaques). If the action is a factor that led to the destabilization of the plaque continues, sharply increases the risk of laceration of her shell, and then poured the contents of the plaque, and there is a blockage of the vessel. The main risk factor for plaque rupture - high blood pressure. Mechanisms strain of atherosclerotic plaques in stroke and myocardial infarction are similar, but there are some differences. Myocardial infarction plaque ruptures in a vessel of the heart, which is then plugged. Stroke can be caused by rupture of an atherosclerotic plaque, placed in one of the arteries in the brain, but often toil plaques that are found in the carotid arteries, ie much upstream, closer to the heart. The released when their anguish hazardous components are carried upstream, get to the brain and cause a blockage (thrombosis).

Under optimal mean arterial pressure 120 and the pressure below 70 mm Hg. Art. Pressure greater than 140 and 90 mm Hg. Art. - A sign of hypertension. The higher the pressure, the higher the risk of stroke. A person with a pressure greater than 170 and / or 110 mm Hg. Art., even though he is young, is at high risk of stroke. At the same time he can feel good, because its vessels adapted to this pressure. This fact greatly complicates the effective prevention of stroke - people in good physical shape with hardly believe that at one point can be profound disabilities.

Another mechanism of stroke, which is now often found - the so-called embolic stroke. This is an option for ischemic stroke, which occurs not because of the rupture of plaque in the cerebral vessel, and because of the fact that the vessel is sealed with a blood clot (embolus), departing from the cavities of the heart. In the so-called atrial fibrillation (atrial fibrillation), at which a chaotic contraction of the atria, they can form clots that can suddenly break away. After separation from the wall of the atrial thrombi migrate into the left ventricle, and from there - to the aorta, the aorta of - in the internal carotid artery and inside of fly into one of the arteries of the brain - often in midbrain. With such a mechanism is sealed vessel. The prevalence of atrial fibrillation is very high, it reaches up to 2% of the adult population, and the frequency progresses with age. In people older than 75 years, it can be observed in every fifth. (Meldonium and Mexidol could help to avoid it).

As for hemorrhagic stroke, the main reasons for its development are high blood pressure, and congenital or acquired lesion of the vascular wall. In hemorrhagic stroke may be a gap of vessels of a size, resulting in a large area of the brain is filled with blood. Blood can be poured under the lining of the brain, the brain squeezing from the outside, as well as get into the ventricles - the so-called brain water, which is located within the brain. When the vessel rupture and release large amounts of blood in certain brain cavity effects are usually more serious than in ischemic stroke. Mortality in hemorrhagic stroke is much higher.

It so happens that high blood pressure is imposed on congenital brain aneurysm (changes in the vascular wall, leading to dilatation, "spread" of vessels). A person can live a long time with congenital aneurysms, and if he has normal pressure, these deviations can not be reflected on health. But such an aneurysm can rupture at high blood pressure. This leads to the fact that the blood is poured into a large volume of the brain. In addition, an important role can play a bleeding disorder. If they are, they represent a danger, even seemingly safe medicines, especially against the background of high blood pressure. For example, aspirin may increase the risk of hemorrhagic stroke in patients with uncontrolled blood pressure patients.

Stroke Symptoms

The harbinger of stroke could be a sharp rise in blood pressure. Symptoms develop quickly enough. The most common of them - the speech disorder, gait, coordination, muscle weakness and falls. Violations of the motor areas correspond to the area of brain damage, who died due to occlusion of a particular artery. In addition, a range of motion is disturbed, you can see which artery is affected. In addition to the typical signs of a stroke, sometimes there are non-specific symptoms that occur when a large number of different diseases: the sudden sharp headache, nausea, vomiting, dizziness. Movement disorders and speech disorders usually appear rapidly after developing headache, and weakness.

Large strokes, in which a major artery clogged, almost always occur with a sharp decrease in motor activity and speech impairments. Such symptoms should not be confused with symptoms of other diseases. Small strokes, developing the so-called pool vertebra-basilar arteries that supply blood to areas of the brain responsible for balance, can only occur in small motor disorders, which are visible only neurologist. The patient in this case will feel sharp dizzy spells, wobble, nausea or headache.

Stroke Prevention

The stroke risk are people first of all with high blood pressure. Other hazards - smoking, high blood cholesterol levels (above 5.5 mmol / L), a bleeding disorder. Too rapid blood clotting - so-called congenital thrombophilia - can lead to ischemic stroke at a young age. And "bad" blood clotting is dangerous in terms of the risk of stroke, but its hemorrhagic version. Man with genetically caused bad blood clotting risks to move a stroke before the age of 30 years, often preceded by stress and, as a consequence, the blood pressure raising episode, which serves as a trigger factor for stroke.

Due to the low adherence to the prevention of many young people, especially men, do not know that they have a very high blood pressure. And in order to prevent a stroke, you need at least once every six months to measure blood pressure. If it is higher than 135/85 mm Hg. Art., it is necessary to consult a cardiologist. In addition, if a person knows that his immediate family had a stroke before the age of 60 years, then he needs to go through in-depth preventive care, in particular to check the blood clotting. People who abuse psychoactive drugs, alcohol and narcotic substances, are also stroke risk in young age.

In recent years, doctors are studying the link between stroke and migraine. Earlier in migraine treated as a relatively benign disease of unknown origin, but it is now clear that migraine - this is largely a vascular disease. When a stroke may develop severe migraine attacks. Due to the fact that the stroke takes place under the guise of a migraine, he risks being unrecognized in time, so patients who live with severe migraines, you need to take additional preventive measures. (Someone uses Meldonium and Mexidol for stroke prevention).

Stroke treatment

In case of ischemic stroke can restore blood flow in the vessel during the first 4.5 hours. To do this, enter the thrombolytic drug, which leads to the destruction of a thrombus. In this case, there are chances to prevent the death of brain cells when blockage of the artery. This is a fairly standard practice abroad, but in Russia it is rarely done: to take the risk to a patient with stroke thrombolytic drug, you need to have exceptionally high competence. Trying to dissolve the clot, can stimulate bleeding in the neighboring region of the brain, that is, eliminate the ischemic but cause more severe, hemorrhagic stroke in a nearby brain area. Therefore, according to Ministry of Health statistics, less than 1% of ischemic stroke treated with thrombolytic agents in Russia. Nevertheless, this preparation for the future. But if you miss 4.5 hours, then further administered drug is meaningless, because all the brain cells die already. After entering the drug should be a great period of rehabilitation.

One of the vectors of the treatment of stroke - the development of operational techniques by analogy with myocardial infarction. Carry out balloon dilatation and stenting of arteries in the brain is much more difficult than the arteries of the heart, because of their small caliber, tortuosity. In addition, brain cells die more rapidly heart cells, and the operation time is considerably less.

Rehabilitation after stroke

In modern medicine, there are reliable methods of rehabilitation after a stroke. Properly structured rehabilitation can cause adjacent parts of the brain take over the function of dead cells. To do this, select the correct motor mode, drug therapy, speech therapy and the use of neuropsychological approaches. Neurorehabilitation - this is a very complex and expensive teamwork. About 90% of patients with ischemic stroke are more successful after several months of well-built rehabilitation.

The situation with hemorrhagic stroke is more severe. The possibilities of rehabilitation in such a stroke less, but these patients can be helped - at least to ensure that they can communicate with other people and be seen at home.

The most severe patients - those who have suffered a severe hemorrhagic stroke and is in a coma. These patients usually die cerebral cortex, which is the substratum of the personality. In this case, the ability to recover much less. But science there are cases where patients regaining consciousness after a long coma, because some areas of the cerebral cortex were still alive. In the case of the treatment of severe stroke, it is necessary to ask the opinion of a second doctor. To make decisions, it is important to understand the amount of damage. If struck by all the cerebral cortex and subcortical nuclei, the doctors honestly say that the possibility of recovery, alas, no. But if certain areas of the cerebral cortex (the departments that are responsible for our consciousness, for motor functions) live, it may be possible to recover consciousness when properly structured neuro-rehabilitation. Everything depends on the level of the lesion, the degree of severity of the events that took place at an early stage.

Every year in Russia ill stroke from 500 to 700 thousand people. The death rate from stroke is approximately 300 thousand people per year. During the year, about half die of stroke patients, and 90% remain profound disabilities.