Репозиторий Университета

© 2018, Silicea-Poligraf. All rights reserved. Aim. Assessment of prognostic significance of endothelial dysfunction markers: stable metabolites of nitric oxide (NOx), von Willebrand factor (vWF), endothelin-1 (E1), homocysteine and tissue plasminogen activator (tPA) in essential hypertension (EAH) patients not taking antihypertension therapy systematically. Material and methods. Totally, 12 EAH patients investigated (45 males, 79 females) (mean age 51,4±6,5 y.o., mean duration of AH 7,9±7,3 y.). Concentration of NOx in plasma was measured by spectrophotometry, and of vWF, homocysteine, E1 and tPA — by immune enzyme assay. Results. By the increase of SCORE risk level, there was significant increase of concentrations of NOx, E1, homocysteine and vWF in EAH patients (p<0,05), there were no changes in tPA levels (p>0,05). In 8 (8±1,1) years after baseline assessment, 115 patients were assessed second time. Of those 13 (11,3%) had cardiovascular events (CVE) and 5 (4,3%) died. By single factorial regression, the rate of CVE in EAH patients relate to homocystein level (р=0,01), NOx (р=0,001) and vWF (р=0,001). By multifactorial analysis, prognostic statistical significance is found for NOx (relative risk (RR) =3,8, р=0,006) and vWF (RR =3,5, р=0,005). In ROC-analysis there were found threshold levels of NOx (>46,6 mcM/L, AUC =0,863) and vWF (>1,68 mg/dL, AUC =0,738), the increase of which is followed by CVE development risk for the levels of NOx >46,6 mcM/L 3,8 times (sensitivity 81,9% and specificity 65,8%), vWF >1,68 mg/dL — 3,5 times (sensitivity 74,3% and specificity 62,7%). Combination of the parameters point on the risk increase up to 6,5 times (р=0,00007). Conclusion. NOx with the threshold of >46,6 mcM/L (RR =3,8) and vWF >1,68 mg/dL (RR =3,5) do show independent prognostic value for 5-year CVE risk assessment in EAH patients that can be applied as an additional method for risk stratification to estimate a group for more aggressive therapy and CVE prevention.

© 2019 All rights reserved. Objective: to compare strategies of invasive treatment of patients with non-ST elevation acute coronary syndrome (NSTEACS) hospitalized in 2014 and 2015. Materials and methods. We have analyzed treatment strategy used in patients with NSTEACS hospitalized in cardio-reanimation department of a city hospital during one month in two successive years (January 2014 and November 2015). We have compared indications to, and timing of coronary angiography, numbers of performed percutaneous coronary interventions (PCI) and coronary artery bypass grafting surgeries. Results. Portion of patients subjected to invasive procedures in 2014 was 26 %, in 2015-42 %. All 32 primary procedures were PCIs. An increase was due to delayed interventions (24-72 hours), which were not performed in 2014. We also more often used selective multivessel coronary stenting, what facilitated availability of invasive treatment for elderly patients. Hospital mortality of patients with NSTEACS decreased from 16 to 7 %.

© 2018 Media Sphera Publishing Group.All right reserved. Objective. This study aimed to assess the cognitive functions and cerebral blood flow measured with arterial spin labeling (ASL) and their possible correlations with vascular age in untreated middle-aged patients with grade 1-2 essential arterial hypertension (EAH). Methods. We examined 73 subjects aged 40-59 years (33 with EAH and 40 healthy volunteers [controls]). Neuropsychological assessment included Montreal Cognitive Assessment (MoCA), Trail Making test (part A and part B), Stroop Color and Word Test, verbal fluency test (phonemic verbal fluency and semantic verbal fluency), 10-item word list learning task. All subjects underwent brain MRI. MRI protocol included ASL. Vascular age was calculated by two techniques-using Framingham Heart Study risk tables and SCORE project scales. Results. Patients with EAH had lower performance on phonemic verbal fluency test and lower mean MoCA score (29.2±1.4 vs. 28.1±1.7 points) compared to controls (13.4±3.2, p=0.002; 29.2±1.4, p=0.001, respectively). White matter hyperintensities (WMH) were present in 7.5 % controls and in 51.5 % EAH patients (p=0.0002). Cerebral blood flow (CBF) in EAH patients was lower in both right (39.1±5.6 vs. 45.8±3.2 ml/100 g/min) and left frontal lobes of the brain (39.2±6.2 45.2±3.6 ml/100 g/min, respectively) compared to controls (p<0.001). EAH patients without WMH had lower CBF compared to controls (right frontal lobe: 39.5±5.1 ml/100 g/min, p=0.0002; left frontal lobe: 38.9±4.3 ml/100 g/min, p=0.00002). In EAH patients vascular age (57.7±7.4 and 64.6±11.0 years as measured by SCORE project scales and Framingham Heart Study risk tables, respectively) was significantly (p<0.001) greater than chronological one (50.2±6.2 years) and was significantly (p<0.001) higher than the corresponding values in the control group. Correlation analysis revealed negative significant associations between vascular age and MoCA score, phonemic verbal fluency test score and CBF. Conclusions. Treatment-naive middle-aged patients with uncomplicated grade 1-2 EAH compared to normotensive controls have lower mean scores in phonemic fluency test and MoCA, lower CBF, even in the absence of WMH, which correlates with vascular age, particularly with the value calculated by Framingham Heart Study risk tables. Early vascular ageing is important factor of brain impairment in hypertension in middle-aged patients even at early stages of EAH.

© 2018 Media Sphera Publishing Group.All right reserved. Aim: to assess the state of vascular bed, parenchyma, and perfusion of lungs in patients with chronic thromboembolic pulmonary hypertension (CTEPH) using the method of subtraction computed tomography (CT). Methods. CT pulmonary angiography (CTPA) was performed in 45 patients with verified CTEPH (18 men, 27 women, age 26-79 years) by CT scanner using the "Lung subtraction" standard protocol. Parameters analyzed were characteristics of the state of main pulmonary artery (MPA) and the right ventricle (RV), and calculated CT angiographic (CTA) obstruction and perfusion defect scores. Results. Significant correlation was found between CTA obstruction score and perfusion defect score (r=0.34, p=0.02). Mean pulmonary arterial pressure (mPAP) correlated with MPA diameter (r=0.4, p=0.02), RV wall thickness (r=0.6, p=0.0003) and the ratio of MPA diameter to ascending aortic diameter (r=0.5, p=0.002). Significant correlation was also found between RV wall thickness and pulmonary vascular resistance (PVR) (r=0.4, p=0.04). Neither CTA obstruction score nor perfusion defect score correlated with PVR and mPAP. The data of CT did not correlate with results of 6-minute walk test. Conclusion. In patients with CTEPH subtraction CTPA allows carrying out complex diagnostics of the state of vascular bed, parenchyma and perfusion of the lungs.

© 2018 Media Sphera Publishing Group.All right reserved. Aim. To estimate association between disorders of salt-water homeostasis on admision and the remote one-year prognosis for patients hospitalized with decompensated CHF NYHA FC III-IV. Materials and methods. This prospective study was based on clinical amnestic data and results of one-year follow-up of 111 consecutive patients admitted for decompensation of CHF to the State Clinical Hospital No. 24 in January 2015-February 2016. Results. The relative risk of death within one year for patients hospitalized for decompensated CHF with disorders of water and salt homeostasis increased 1.43 times by the end of one-year follow-up compared to patients with normal blood levels of sodium and potassium on admission (RR=1.43; 95 % CI: 1.10-1.87; p<0.01). Furthermore, the relative risk of death within one year was significantly increased 1.4 times in the subgroup of patients with hypernatremia (RR=1.41; 95 % CI: 0.99-2.01; p<0.05, respectively) and 1.4 and 2.3 times in subgroups with hypo-/hyperkalemia respectively (RR=1.39; 95 % CI: 0.93-2.07; p<0.05 and RR=2.23; 95 % CI: 1.04-4.78; p<0.01) compared to patients with normal blood levels of sodium and potassium on admission. Conclusion. Disturbed water and salt homeostasis on admission of patients hospitalized for decompensated NYHA FC III-IV CHF is a predictor for an unfavorable remote prognosis.

© 2018 Limited Liability Company KlinMed Consulting. All Rights Reserved.  Aim: to assess clinical efficacy and expediency (appropriateness) of simultaneous single stage combined coronary stenting and closure of atrial septal defect. Materials and methods. Of total number of patients who underwent endovascular correction of atrial septal defect (ASD) (n=91), in 6 (6.6%) the procedure of endovascular repair of secondary ASD was combined with performed at same session coronary stenting. Mean age of these patients was 63±6.4 years. Mean diameter of ASD according to transesophageal echocardiography was 13.7±3.1 мм (from 10 to 17 mm). Two patients had dysplasia of atrial septum with pronounced aneurysmal protrusion in the right atrial cavity. Estimate of coronary arteries (CA) involvement SYNTAX score was 14.5±4.9. Results. At initial stage we performed coronary stenting, then ASD closure with occluder. Technical success of combined endovascular procedures was 100%. Six ASD occluders were implanted in 6 patients. Mean occluder diameter was 21±7,3 mm. Immediately after occluder implantation complete defect closure was achieved in 5 cases, in one case small residual shunt was observed. CA stenting procedure, in one patient after successful recanalization of chronic CA occlusion, in all cases was fulfilled without complications. At control examination after 13.5±1.5 months complete closure of defects was preserved. In all cases significant reduction of right heart chambers occurred. According to echocardiography right atrial volume decreased from 48.6±5.6 to 32.6±3.3 cm 3 , right ventricular volume - from 45.2±5.1 to 33.4±3.8 cm 3 , systolic pulmonary pressure fell from 49.7±8.6 to 32.6±6.9 mm Hg. According to control coronary angiog-raphy good effect of endovascular procedures was preserved. Tolerance to exercise rose from 68.5±11.8 до 85.3±12.4 W. Conclusion. Same time CA stenting and endovascular ASD closure appears to be safe and effective procedure. The strategy used was not associated with additive risk for a patient and shortened duration of hospital stay.

© 2018 Limited Liability Company KlinMed Consulting. All Rights Reserved. Until today, there are no universally accepted methods for detection of unstable atherosclerotic plaques, even though many recent studies were devoted to this issue. In this article we present modern possibilities of computed tomography in visualization of atherosclerotic coronary lesion, including the detection of unstable lesions, whot in turn, can help in diagnosing subclinical exacerbation of ischemic heart disease and in the stratification of risks of acute coronary events.

© 2018 Stavropol State Medical University. All Rights Reserved. The aim of the study was to assess clinical value of galectin-3 levels evaluation in patients with heart failure. The study results demonstrated decrease of plasma galectin-3 levels after pharmacotherapy. The decrease of galectin-3 levels was accompanied by clinical improvement in patients with heart failure. Thus, galectin-3 can be used as an additional biomarker for HF diagnostics and pharmacotherapy monitoring in patients with heart failure.

© 2018, Dynasty Publishing House. All rights reserved. The objective. To specify the duration of persistence of antigens and DNA of Mycoplasma pneumoniae (M. pneumoniae) and Mycoplasma hominis (M. hominis) cells in the free state and as part of circulating immune complexes in blood of children suffering from bronchial asthma. Patients and methods. In the University Children’s Clinical Hospital of the Sechenov University, 161 children aged 1 to 14 years were observed. Group 1 (treatment group) included 126 children with bronchial asthma. 55 children (43.7%) had a mild course of disease, 52 children – moderate (42.1%) and 19 children (15.1%) – severe. All children were in the exacerbation period. Group 2 (control) consisted of 35 children with ARVI. The mean age of children in group 1 – 5.4 ± 1.8 years (79 boys (62.7%) and 47 girls (37.3%)); in group 2 – 5.7 ± 1.9 years (20 boys (57.1%) and 15 girls (42.9%). Diagnostic methods used: cultivation of mycoplasmas, preparation of immune serums, aggregate-haemagglutination assays (AHAA), polymerase chain reaction (PCR), direct immunofluorescence (DIF), methods of detection of circulating immune complexes (CIC). Results. AHAA examination of 126 serum samples of children from group 1 with BA, M. pneumoniae and M. hominis antigens in the free state were found in 73 and 50% of cases, respectively. In children of group 2 AHAA detected M. pneumoniae and M. hominis significantly more rarely: M. pneumoniae was found in 3 (8.6%) children (p = 95.3), M. hominis – in 2 (5.7%) children (p = 97.1). Further examination of serum samples of children with BA found M. pneumoniae and M. hominis cell DNA in 7.14 and 16.6% of cases, respectively. The work has shown that M. pneumoniae antigens are found in the composition of CIC in 55.5% of cases, M. hominis antigens – in 46.8% of cases, DNA – in 26.98 and 46.8%, respectively. For treatment of mycoplasma infection, children with BA received three azitromicin courses in the dose 10 mg/kg for 3 days with a 4-day interval. Conclusion. These data are indicative of long-term persistence of mycoplasma cell antigens and DNA in the free state and in CIC in blood of children with BA. Mycoplasmas can be regarded as one of the factors of inducing BA exacerbations in children. Tests for mycoplasma infection are indicated in patients with BA. Addition of macrolides to standard BA therapy in children with mycoplasma infection, as a rule, yields positive results.

© 2018 Stavropol State Medical University. All Rights Reserved. A retrospective analysis included 31 patients aged 23 to 78 years with the signs of SIRS from the departments of therapy, pulmonology and the intensive care unit (ICU) with the diagnosis of severe community-acquired or hospital-acquired pneumonia. The plasma level of presepsin protein was assessed using the Pathfast immunochemiluminescence analyzer (Japan). It was revealed that at hospitalization, the level of PSP was significantly higher in patients with SIRS than in healthy individuals. Patients with the diagnosis of sepsis (later confirmed by hemoculture) showed a higher concentration during hospitalization and at all subsequent time points of the study, which characterizes presepsin as a marker of sepsis in difficult clinical settings.

© 2018 Stavropol State Medical University. All Rights Reserved. 57 men and 43 women, aged 22.0±4.2 years were examined to determine the clinical and prognostic value of matrix metalloproteinases in heart remodeling in CTD. Serum concentrations of MMP-1, MMP-9, TIMP-1 were determined by ELI-SA («Cloud-Clone Corp.», China). Imbalance of MMP-1, MMP-9 and their inhibitor - TIMP-1 was revealed in patients with CTD. Significant increase in MMP-1 level was registered in cases of MVP with myxomatous degeneration and mitral regurgitation of II degree. Risk of cardiac remodeling progression at three-year follow-up increases in cases of elevated of MMP-1/TIMP-1 coefficient. Identified changes in the MMPs system in patients with CTD may be used as additional criteria of severity and determination of probability of progression of heart connective tissue structures remodeling.

© 2018 Izdatel'stvo Meditsina. All Rights Reserved. Subtle cognithe decline (SCD) is characterized by patients 'complai?Us about their memory and other cognirixe fimctions that do not make difficult professional or social acth'ity. Clinical neuivpsychological research reveals some changes, which does not fit defiiution of mild cognitive impairment. SCD as well as subjective cognithe degradation can predict more severe cognitive disorder, including dementia. The primary aim of the research was to analyze neuropsychological features of middle-aged and elder patients who sufferfrom SCD. PatietU groups were based on age, cardiovascular risk factor and the state of emotional condition. Material and methods. We analyzed the data of320patients, including 234 women and S6 men of45-59, 60-74, 75-S9 age groups. These results were compared to 104 healthy subjects of the same age groups. The research included clinical and neuropsychological evaluation of cognith'e fiinctions and emotional status. Results. The most significant differences between healthy subjects and the ones with SCD of various age groups were memory scores and executive functions as well as decline in Mini mental state examination and Frontal Assessme?it Battery. The dif-ferences in age connected cognitive status ofpatients with SCD and healthy ones were found. The comparison ofpatients with mild and subtle anxiety disorders with patie?its without emotional disorder of the same age has not revealed any significant differences. It was found that cardiovascular riskfactors influence frontal managing functions. C onclusion. The collected data confirm SCD specification amongpremild cognitive functions and decline show the peculiarities of age connected cognitive status as well as absence of negative connection between emotional disorder.

© 2018 Vysshee Obrazovanie v Rossii. All rights reserved. The article addresses the problem of epistemological basis of pedagogy and its research methods. This is particularly relevant in the light of the formation of theoretical framework in pedagogy. The following topical themes are discussed in the article: a) inductive, hypothetico-deductive and abductive reasoning in pedagogy, b) causal explanations of pedagogical phenomena, c) argumentation of pedagogical conclusions and consequences, including empirical, theoretical and contextual types of argumentation. The authors briefly touch upon the logical interpretation of “norm” and “evaluation” in pedagogy. The problems related to pedagogical theory constructing are identified including incompleteness of abductive model, insufficient evidence of all types of pedagogical argumentation and causal interpretation, and lack of clarity of the category “measure”.

© 2018 Medical Education. All Rights Reserved. Chest computed tomography (CT) helps better understanding clinical and pathological features of respiratory diseases. However, interpretation of CT images is difficult without information on clinical course of the disease in the given patient. Therefore, the definite diagnosis could be reached through cooperation of a clinician and a radiologist. This publication presents a lecture aimed at improving a physician's knowledge on interpretation of lung computed tomography (CT) patterns including imaging, structure and extension of abnormal signs. This information is believed to help the clinician to diagnose and differentiate pulmonary diseases based both on CT syndromes and clinical signs. A particular attention is paid on lung tissue attenuation pattern as the most common chest CT abnormality that includes five key entities, such as ground glass opacity, mosaic attenuation, consolidation, atelectasis, and soft-tissue mass.

© 2018 Ima-Press Publishing House. All Rights Reserved. Based on the data available in the literature, the author has first systematized in detail the main stages of the design and clinical introduction of serotonin and norepinephrine reuptake inhibitor (SNRI) antidepressants. Theoretical prerequisites for their emergence are described. The evaluation of the efficiency of depression therapy with drugs of this group in clinical trials and post-marketing studies is analyzed in the historical context. The reasons for temporary restrictions on their wide use are considered. There are data on the design of novel representatives of SNRI antidepressants.

© 2018 Ima-Press Publishing House. All Rights Reserved. Objective: to investigate the effectiveness of cognitive and motor training as an additional method to basic therapy in patients with Alzheimer's disease (AD) and vascular cognitive impairment (VCI). Patients and methods: The investigation enrolled 41 patients (15 women and 26 men; mean age. 73.59±6.3 years), including 32 patients with AD (mean age 74.94±5.15 years) and 9 patients with VCI (mean age, 72.31±4.98 years). Cognitive impairment (CI) corresponded to mild dementia in 15 patients (5 women and 10 men; mean age 74.6±2.8 years) and to moderate dementia in 29 (10 women and 19 men; mean age 72.1±3.2 years). The patients were randomly assigned to individual, group, and mixed (individual and then group) cognitive training groups. Quantitative scales were used to assess changes in CI and emotional and behavioral disorders after 1.5, 3, and 6 months of therapy. Results and discussion: During cognitive and motor training, all the groups showed a significant decrease in the severity of CI (p < 0.05), depression, anxiety, and apathy. The effectiveness of the training was further influenced by the severity of concomitant cardiovascular disease, the degree of apathy, adherence to the training, and the early initiation of basic symptomatic therapy. The greatest positive changes in anxiety and depressive disorders were noted in the patients receiving group cognitive and motor training. Conclusion: The results of the investigation allow group cognitive and motor training to be recommended as a mainstay in the therapy of patients with CI concurrent with emotional disorders.

© 2018 Izdatel'stvo Meditsina. All Rights Reserved. Subjective cognitive decline (SCD) is characterized by subjective complaints of patients about memory impairment and/or other cognitive functions accompanied by absence of significant changes during neuropsychological test. It is shown, that subjective cognitive decline may be a predictor of clinically significant cognitive disorder development to the extent of dementia. The primary aim of the research was the analyses of neuropsychological characteristics of patients with SCD depending on their age, gender, cardiovascular risk factors and their emotional affectivity. Materials and methods. The testing results of 150 patients (103 females, 47 males) aging from 45 to 59 and from 60 to 74 (66 patients) were analyzed in comparison with 92 healthy subjects of the same age. The research included clinical examination and application of scales and surveys, which estimate cognitive functions. Results. The most significant differences among healthy subjects were memory markers’ impairment as well as directory functions of the elder group. Patients with SCD additionally showed disorders of speech and constructive praxis deterioration. No significant differences in neuropsychological markers between SCD-positive and SCD-negative gender groups were not found. Comparison of patients with emotionally-affective disorder with healthy control of the same age did not reveal any significant difference. Either there was no influence of cardiovascular risk factors on neuropsychological testing indices. Conclusion. Analyses of possible age and gender factors accompanying emotionally-affective and cardiovascular changes that influence neuropsychological characteristics of patients with SCD showed the crucial meaning of age, being found in more indices of elderly people than the ones of the healthy group.

© 2018 Russian Electronic Journal of Radiology.All Rights Reserved. Purpose. To reveal the important clinical and radiologic characteristics of bony defects developing near vertical root fractures according to cone-beam computed tomography findings, which can be used for the diagnosis and differential diagnosis of root fractures. Material and methods. Eighty clinical cases suggestive for vertical root fractures were analyzed in the study. Teeth with vertical root fractures confirmed after extraction (n = 65) were divided according to tooth group and fracture propagation pattern as well as associated bone resorption according to cone-beam computed tomography. Clinical and radiographic features of vertical root fractures were compared with the mimicking conditions to reveal the differences. Results. From 80 teeth 65 were fractured; the conditions mimicking vertical root fractures included chronic periodontitis (2 cases), periapical pathology (13 cases), strip perforations (5 cases), and accessory canals (3 cases). The characteristic combination of clinical and radiographic features of vertical root fractures included a deep narrow periodontal pocket (52,3%), dehiscence-like defect of the buccal cortical plate with no or a lesser extent of periodontal destruction reflection on the other sites of the dentition and at the proximal surface(s) of the fractured root. Discussion: The differential diagnosis of vertical root fractures is a challenging task. The detection of fracture with cone-beam computed tomography is not always possible. However, this method may be used for the diagnosis of fractures by ascertaining the form and location of the bony defect. Conclusions. The analyses of characteristic features of the bony defect in conjunction with clinical findings allowed for diagnosis of vertical root fractures.

© 2018 Russian Electronic Journal of Radiology. All Rights Reserved. Purpose. Post-mortem MRI characteristics of the distribution and severity of nonimmune fetal hydrops (NFH). Materials and methods. The analysis of autopsy material of 2 stillborn and 22 newborns, divided into three groups was carried out. Group I consisted of the bodies of the dead due to NFH, group II - the bodies of newborns who died with the presence of general edema syndrome in the absence of NFH, group III (control) - the bodies of deceased newborns in the absence of NFH and general edema syndrome. Before autopsy, MRI was performed. On T1- and T2-weighted images was determined by the thickness and signal intensity of the skin with subcuta-neous tissue and the subsequent calculation of the tissue hydration index. The volume of fluid in the pericardial cavity, pleural and abdominal cavities determined when using three-dimensional processing of the obtained tomograms and calculated their specific volume in the corresponding cavities. Results. The values of the specific volume of free fluid in the pleural cavities and abdominal cavity less than 8% should be considered a natural postmortem sign, rather than the life-time accumulation of transudate, when examining the bodies of deceased newborns on the first day after death. The mean values of absolute and specific volumes of pleural fluid had the maxi-mum values in the NFH observations, exceeding the values of the control group by 6.3 and 5.1 times, respectively. The highest values of the absolute amount of ascites were observed in the group with general edema syndrome. In the NFH group, all cases had hydrothorax, 85.7% of cases had ascites, and 42.9% had hydropericardium. In the group of newborns with general ede-ma syndrome, hydrothorax was detected in 57.1%, ascites - in 85.7%, and hydropericardium - in 42.9% of cases. The thickness of the skin with subcutaneous tissue depended on the localization and group of research. The most pronounced deviations from the control level were recorded for the average values of the skin thickness of the anterior chest wall in group I and the scalp of the fronto-parietal region in group II. The mean values of the tissue hydration index were higher in the group with NFH, and the lowest in the control group. Conclusion. Postmortem MRI performing, allows an objective assessment of the nature and severity of anasarca and pathological fluid accumulations in the serous cavities of dead fe-tuses and newborns. In this regard, postmortem MRI is recommended as a mandatory component of the autopsy of the bodies of fetuses and newborns that died as a result of nonimmune fetal hydrops.

© 2018 Ima-Press Publishing House. All Rights Reserved. The recently discovered glymphatic system (GS) ensures the efficient clearance of interstitialfluid and soluble compounds from the central nervous system into cerebrospinal fluid (CSF), which compensates for the lack of conventional lymphatic vessels in the brain parenchyma. This unique anatomical and physiological phenomenon had been unknown until 2012. GS lacks inherent proper vessels P the cuirent of CSF and interstitial fluid is carried out directly inside the arterial walls (the perivascular pathway) or near the walls of the cerebral arteries and veins (the paravascular pathway). Current biorheological technologies could establish a special role of aquaporin-4 in the filtration of CSF and interstitial fluid. The close link between GS and the CSF circulatoiy system allows the established views on fluid dynamics within the brain to be reconsidered. The discoveiy ofGS can contribute to our understanding of the pathogenesis of increased intracranial pressure and neurodegenerative diseases, as well as to the elaboration of new therapeutic approaches to their treatment.