[Analysis of intracranial saccular aneurysm wall: neuroimaging and histopathological correlates]. / Issledovanie stenki intrakranial'nykh meshotchatykh anevrizm: neirovizualizatsionnye i gistopatologicheskie korrelyaty.

BACKGROUND: Contrast enhancement of intracranial aneurysm wall during MRI with targeted visualization of vascular wall correlates with previous aneurysm rupture and, according to some data, may be a predictor of further rupture of unruptured aneurysms. OBJECTIVE: To analyze possible causes of aneurysm contrast enhancement considering morphological data of aneurysm walls. MATERIAL AND METHODS: The study included 44 patients with intracranial aneurysms who underwent preoperative MRI between November 2020 and September 2022. Each aneurysm was assessed regarding contrast enhancement pattern. Microsurgical treatment of aneurysm was accompanied by resection of its wall for subsequent histological and immunohistochemical analysis regarding thrombosis, inflammation and neovascularization. Specimens were subjected to histological and immunochemical analysis. Immunohistochemical analysis was valuable to estimate inflammatory markers CD68 and CD3, as well as neurovascularization marker SD31. RESULTS: Aneurysms with contrast-enhanced walls were characterized by higher number of CD3+, CD68+, CD31+ cells and parietal clots. Intensity of contrast enhancement correlated with aneurysm wall abnormalities. CONCLUSION: Contrast enhancement of aneurysm wall can characterize various morphological abnormalities.

[National and world experience in functioning of centers for collective use of biological resource collections of tumors of the central nervous system]. / Analiz mirovogo i otechestvennogo opyta funktsionirovaniya tsentrov kollektivnogo pol'zovaniya bioresursnymi kollektsiyami opukholei tsentral'noi nervnoi sistemy.

Collective use center is an organization or structural unit with unique resource providing access to this resource for internal and third-party users. Collective use centers are a relatively new phenomenon in bioresource collections, especially collections of human biological material due to some ethical and legal issues. At the same time, the demand for human biological material continues to grow in fundamental and applied researches. The collective use center «Bioresource collection of tissues and cell cultures of tumors of the human nervous system for fundamental and applied researches¼ has worked since October 14, 2022. This center has access to unique collection of the Laboratory of Neurosurgical Anatomy and Conservation of Human Biological Tissues of the Burdenko Neurosurgical Center. OBJECTIVE: To analyze the experience of collective use center and biobank of the Burdenko Neurosurgical Center compared to national and international data on functioning of collective use centers specializing in tumors of the human central nervous system. MATERIAL AND METHODS: We reviewed the PubMed and e-Library databases using the following keywords: core facilities brain tumors, repository of collective use brain tumors, biobank of CNS tumors, central nervous system tumor collection centers. We also analyzed the organizations registered on the portal of scientific and technical infrastructure of the Russian Federation. RESULTS: We analyzed 275 publications devoted to collective use centers and biobanks. These biobanks do not position themselves as collective use centers but actively realize biological material for researches. Structure of institutions presented on the portal of scientific and technical infrastructure of the Russian Federation is characterized. The collective use center «Bioresource collection of tissues and cell cultures of tumors of the human nervous system for fundamental and applied researches¼ has access to biobank of the Burdenko Neurosurgical Center. To date, the biobank contains more than 8478 aliquots of tumor tissue frozen at ultra-low temperature (-196°C) and obtained from 1993 patients. Considering available data, we established the basic principles of work in collective use centers with bioresource collections. CONCLUSION: Collective use centers with bioresource collections of tumors of the central nervous system are rare. There is only one collective use center organized at the Burdenko Neurosurgical Center on the portal of scientific and technical infrastructure of the Russian Federation. At the same time, there is an urgent need to increase their number and activity in Russia and other countries worldwide. You can use the resource of brain tumor collections by leaving a request on the official website of this organization in the «Collective use center¼ section.

[Genetic factors in degenerative disc disease]. / Rol' geneticheskikh faktorov v razvitii degenerativno-distroficheskogo porazheniya mezhpozvonkovykh diskov.

OBJECTIVE: To analyze available literature data on the role of genetic factors in degenerative disc disease. METHODOLOGY: We reviewed the PubMed, MEDLINE, Cohrane Library, e-Library databases using the following keywords: degenerative spine lesions, intervertebral disc herniation, pathogenesis, genetic regulation. RESULTS: Searching depth was 2002-2022. We reviewed 84 references. Exclusion criteria: duplicate publications, reviews without detailed description of results, opinions. Finally, we included 43 the most significant studies. CONCLUSION: There are literature data on proinflammatory cytokines, growth factors and osteodestructive processes in pathogenesis of degenerative disc disease. However, there is only fragmentary information about the role of genetic regulation of these processes. Some factors, such as microRNA, TGF-b, VEGF, MMP are still poorly understood.

[Magnetic resonance imaging of saccular intracranial aneurysm wall]. / MR-vizualizatsiya sosudistoi stenki meshotchatykh intrakranial'nykh anevrizm.

BACKGROUND: Hemorrhage from intracranial aneurysms is associated with high risk of adverse outcomes. In this regard, surgical treatment of unruptured asymptomatic aneurysms has been actively developed in recent decades. One of the objectives is searching for predictors of aneurysm rupture to clarify the indications for surgery. Non-invasive analysis of vascular wall is actively discussed in last years. OBJECTIVE: To evaluate the possibilities of MRI of ruptured and unruptured intracranial aneurysm walls and determine clinical significance of certain morphological patterns. MATERIAL AND METHODS: The study included 111 patients with 158 ruptured and unruptured saccular aneurysms who underwent MRI according to a special protocol between November 2020 and September 2023. We analyzed each aneurysm regarding features of contrast enhancement and changes in SWAN images. After that, we compared these data with ruptures. RESULTS: Wall of ruptured and unruptured aneurysms can accumulate contrast agent. We found 5 types of contrast enhancement. Thick-layer contrast enhancement was accompanied by 9.6-fold higher risk of aneurysm rupture compared to aneurysms without contrast enhancement. Dark MR signal from intracranial aneurysm wall in SWAN imaging is a significant sign of rupture. CONCLUSION: MRI of the vascular wall is valuable to verify ruptured aneurysms. Unruptured aneurysms can accumulate contrast agent inside the wall, and pattern of accumulation differs from ruptured aneurysms. Morphological analysis is needed to confirm contrast enhancement as a marker of aneurysm rupture.

[Metastatic brain lesion following gastrointestinal stromal tumor of the stomach complicated by coma.( A case report and literature review)]. / Metastaticheskoe porazhenie golovnogo mozga gastrointestinal'noi stromal'noi opukhol'yu zheludka, oslozhnivsheesya razvitiem komatoznogo sostoyaniya. (Opisanie sluchaya i obzor literatury).

The authors present an extremely rare case of metastatic brain lesion in a patient with gastrointestinal stromal tumor of the stomach. There are literature data on 23 cases of metastatic lesions of the brain, skull and soft tissues of the head in similar patients. Atypical localization of metastases can lead to some diagnostic difficulties, unreasonable cancellation of chemotherapy and delayed surgical treatment. A feature of our observation was postoperative coma determined by the features of the underlying disease.

[Non-invasive diagnosis of brain gliomas by histological type using neuroradiomics in standardized regions of interest: towards digital biopsy]. / Neinvazivnaya diagnostika gliom golovnogo mozga po gistologicheskomu tipu s pomoshch'yu neiroradiomiki v standartizirovannykh zonakh interesa: na puti k tsifrovoi biopsii.

The future of contemporary neuroimaging does not solely lie in novel image-capturing technologies, but also in better methods for extraction of useful information from these images. Scientists see great promise in radiomics, i.e. the methodology for analysis of multiple features in medical image. However, there are certain issues in this field impairing reproducibility of results. One such issue is no standards in establishing the regions of interest. OBJECTIVE: To introduce a standardized method for identification of regions of interest when analyzing MR images using radiomics; to test the hypothesis that this approach is effective for distinguishing different histological types of gliomas. MATERIAL AND METHODS: We analyzed preoperative MR data in 83 adults with various gliomas (WHO classification, 2016), i.e. oligodendroglioma, anaplastic oligodendroglioma, anaplastic astrocytoma, and glioblastoma. Radiomic features were computed for T1, T1-enhanced, T2 and T2-FLAIR modalities in four standardized volumetric regions of interest by 356 voxels (46.93 mm3): 1) contrast enhancement; 2) edema-infiltration; 3) area adjacent to edema-infiltration; 4) reference area in contralateral hemisphere. Subsequently, mathematical models were trained to classify MR-images of glioma depending on histological type and quantitative features. RESULTS: Mean accuracy of differential diagnosis of 4 histological types of gliomas in experiments with machine learning was 81.6%, mean accuracy of identification of tumor types - from 94.1% to 99.5%. The best results were obtained using support vector machines and random forest model. CONCLUSION: In a pilot study, the proposed standardization of regions of interest demonstrated high effectiveness for MR-based differential diagnosis of oligodendroglioma, anaplastic oligodendroglioma, anaplastic astrocytoma and glioblastoma. There are grounds for applying and improving this methodology in further studies.

3D pseudo-continuous arterial spin labeling-MRI (3D PCASL-MRI) in the differential diagnosis between glioblastomas and primary central nervous system lymphomas.

PURPOSE: The aim of the study was to compare the parameters of blood flow in glioblastomas and primary central nervous system lymphomas (PCNSLs), measured by pseudo-continuous arterial spin labeling MRI (3D PCASL), and to determine the informativeness of this method in the differential diagnosis between these lesions. METHODS: The study included MRI data of 139 patients with PCNSL (n = 21) and glioblastomas (n = 118), performed in the Burdenko Neurosurgical Center. No patients received chemotherapy, hormone therapy, or radiation therapy prior to MRI. On the 3D PCASL perfusion map, the absolute and normalized values of tumor blood flow were calculated in the glioblastoma and PCNSL groups (maxTBFmean and nTBF). RESULTS: MaxTBFmean and nTBF in the glioblastoma group were significantly higher than those in the PCNSL group: 168.9 ml/100 g/min versus 65.6 and 9.3 versus 3.7, respectively (p < 0.001). Arterial spin labeling perfusion had high sensitivity (86% for maxTBFmean, 95% for nTBF) and specificity (77% for maxTBFmean, 73% for nTBF) in the differential diagnosis between PCNSL and glioblastomas. Blood flow thresholds were 98.9 ml/100 g/min using absolute blood flow values and 6.1 using normalized values, AUC > 0.88. CONCLUSION: The inclusion of 3D PCASL in the standard MRI protocol can increase the specificity of the differential diagnosis between glioblastomas and PCNSL.

[Intraoperative and early postoperative risk factors of development of acute cerebrovascular accident after coronary artery bypass grafting in the elderly age.]

The article presents data on the problem of ischemic heart disease, surgical myocardial revascularization, as well as the risk of developing acute cerebrovascular accident (ACVA) in elderly patients with coronary artery bypass grafting (CABG). The authors conducted a study to identify risk factors for the development of stroke in elderly patients. Predictors of ACVA development in the operational and early postoperative periods were identified. It has been proven that the time of extubation, an increase in PCO2 levels, and hyperlactatemia are reliable intraoperative and early postoperative predictors of stroke in elderly patients with CABG. The practical significance of the study lies in the application of its results to predict the development of perioperative stroke in elderly patients with CABG.

Beta coronaviruses and human endocrine system: new data (review of literature).

A new dangerous respiratory disease COVID-19 was first reported in China in December 2019, the pathogen SARS-Coronavirus 2 (SARS-CoV-2), belonging to the beta coronavirus genus, which, in addition to SARS-CoV-2, includes SARS-CoV-1 and MERS-CoV. The genome of SARS-CoV-2 is almost 80% similar to SARS-CoV-1 and 50% to MERS-CoV. The mechanisms of infection of SARS-CoV-1 and SARS-CoV-2 are also similar and occur through the binding of the virus to the type 2 angiotensin-converting enzyme protein (ACE2), which is widely represented in the human body with predominant expression in endocrine tissues. In this connection, SARS-CoV-1 and SARS-CoV-2 affect the organs of the endocrine system, causing damage and hormonal changes that affect the prognosis of the course of COVID-19. This literature review is devoted to the analysis of changes in the organs of the endocrine system that occur during infection with SARS-CoV-1 and SARS-CoV-2, as well as the potential effect of hormones on susceptibility to SARS-CoV-2.

Educational video for training specialists in clinical laboratory diagnostics.

The adaptation of educational programs under restrictions during the SARS-CoV-2 coronavirus pandemic and after it is based not only on the widespread use of video lectures, but also on the introduction of a number of new educational technologies. Hybrid learning will become the cornerstone of future educational technologies in clinical laboratory diagnostics and will contribute to the creation of virtual practical classes with examples of analysis of laboratory testing results based on case histories (Case Technologies). The key aspect in the implementation of video cases into the educational process is the development of video materials. The use of educational video cases developed by Vector-Best in the process of training specialists in clinical laboratory diagnostics during the cycles «Retraining¼ and «General Improvement¼ at the Department of Clinical Laboratory Diagnostics of the Saratov State Medical University named after V. I. Razumovsky of the Ministry of Health of Russia was a convenient format and received positive assessment of cadets. Currently, the «IVD gallery¼ section has appeared on the FLM website and the placement of an additional educational resource - a library of educational video cases.

Feasibility of generalised diffusion kurtosis imaging approach for brain glioma grading.

PURPOSE: An accurate differentiation of brain glioma grade constitutes an important clinical issue. Powerful non-invasive approach based on diffusion MRI has already demonstrated its feasibility in glioma grade stratification. However, the conventional diffusion tensor (DTI) and kurtosis imaging (DKI) demonstrated moderate sensitivity and performance in glioma grading. In the present work, we apply generalised DKI (gDKI) approach in order to assess its diagnostic accuracy and potential application in glioma grading. METHODS: Diffusion scalar metrics were obtained from 50 patients with different glioma grades confirmed by histological tests following biopsy or surgery. All patients were divided into two groups with low- and high-grade gliomas as grade II versus grades III and IV, respectively. For a comparison, trained radiologists segmented the brain tissue into three regions with solid tumour, oedema, and normal appearing white matter. For each region, we estimated the conventional and gDKI metrics including DTI maps. RESULTS: We found high correlations between DKI and gDKI metrics in high-grade glioma. Further, gDKI metrics enabled introduction of a complementary measure for glioma differentiation based on correlations between the conventional and generalised approaches. Both conventional and generalised DKI metrics showed quantitative maps of tumour heterogeneity and oedema behaviour. gDKI approach demonstrated largely similar sensitivity and specificity in low-high glioma differentiation as in the case of conventional DKI method. CONCLUSION: The generalised diffusion kurtosis imaging enables differentiation of low- and high-grade gliomas at the same level as the conventional DKI. Additionally, gDKI exhibited higher sensitivity to tumour heterogeneity and tissue contrast between tumour and healthy tissue and, thus, may contribute as a complementary source of information on tumour differentiation.

[What is primary: frailty or sarcopenia? (literature review).]

Among the many geriatric syndromes, undoubtedly, one of the first places is, in other words, the leading positions are occupied by frailty and sarcopenia. Despite their wide coverage in the modern scientific medical literature, the question of the relationship of these geriatric syndromes with each other is still relevant. Which of the above syndromes is primary and which is secondary? Do they compete with each other, mutually burden each other, do not depend on each other, or are they united by common pathological mechanisms? This literature review is devoted to these issues.

[Risk factors of frailty in elderly women with the chronic non-infectious diseases.]

Against the background of an aging population, there is an increase in the frequency and prevalence of chronic non-infectious diseases with age. The syndrome of frailty, the frequency of which also increases with aging, is considered as a prognostic factor for the adverse outcomes of chronic diseases and mortality among geriatric patients. Moreover, in women, frailty is more common than in men. An earlier diagnosis and identification of signs of frailty is necessary to prevent the progression of both the syndrome itself and multiple age-associated chronic diseases.

[Relationship of kidney functions with geriatric syndromes in elderly and old women.]

Against the background of aging, there is an increase in the number of diseases associated with age, geriatric syndromes that contribute to the development of disorders of physical and functional activity, the risk of disability and mortality increases. One of the widespread diseases is chronic kidney disease (CKD), which is dangerous not only in itself, but also as a factor in the progression of other age-associated diseases and geriatric syndromes, including frailty and sarcopenia. Among patients of older age groups, CKD is more common in women than in men. A number of researchers are studying the problems of polymorbidity, the development and progression of geriatric syndromes in patients with CKD in the pre-dialysis and dialysis stages. Undoubtedly, the negative role of severe late stages of CKD in the development of senile asthenia and sarcopenia, at the same time, the relationship of these geriatric syndromes with early pre-dialysis stages of CKD has been insufficiently studied. Therefore, it is of undoubted scientific interest to identify correlations between signs of sarcopenia and frailty in elderly and senile women, depending on renal function, stage of CKD.

[Reflux nephropathy in children: pathogenesis and prognosis. Part 1].

The purpose of this review is to analyze the modern literature about renal damage caused by vesicoureteral reflux (VUR). VUR is the most common urodynamic pathology in children and reflux nephropathy (RN), as its main complication, ranks first among the causes of chronic kidney disease (CKD). The risk factors for the appearance and progression of RN are presented in the first part of the review. In the framework of this issue, the main methods of treatment of VUR and associated urinary tract infection are described. The possibilities of conservative and surgical methods for the elimination of reflux for prevention of RN and prognosis of its course are considered. The main morphological aspects of RN formation are described.

[Reflux nephropathy in children: pathogenesis and prognosis. Part 2].

The second part of this review is devoted to the issues of modern and promising diagnosis of RN in children. The advantages and limits of the available methods for recording the structural and functional state of the kidneys in childhood are considered. Particular attention is paid to possibilities non-invasive methods for diagnosis and prediction of the disease course. Data on promising biomarkers of the early stages of RN formation and progression are presented. For the purpose of a comprehensive and adequate assessment of morphological changes in the kidneys, the necessity of studying various combinations of cytokines in biological media with the subsequent determination of the optimal spectrum is shown. The sensitivity and specificity of molecular indicators of renal damage reviewed as potential targets for renoprotective therapy in the nearest future.

[Magnetic resonance relaxometry in high-grade glioma subregion assessment - neuroimaging and morphological correlates]. / Magnitno-rezonansnaya relaksometriya v otsenke subregionov gliom golovnogo mozga vysokoi stepeni zlokachestvennosti ­ neirovizualizatsionnye i morfologicheskie korrelyaty.

OBJECTIVE: To analyze the differences of high-grade glioma subregions using magnetic resonance relaxometry with compilation of images (MAGiC) and arterial spin labeling (ASL), as well as to compare quantitative measurements of these techniques with morphological data. MATERIAL AND METHODS: The study enrolled 35 patients with newly diagnosed supratentorial gliomas (23 - grade IV, 12 - grade III). We measured relaxometric values (T1, T2, proton density), tumor blood flow (TBF) in glioma subregions and normal-appearing brain matter. Neuronavigation was intraoperatively used to obtain tissue samples from active tumor growth zone, perifocal infiltrative edema zone and adjacent brain matter along surgical approach. RESULTS: ASL perfusion revealed higher tumor blood flow (TBF) in active tumor growth region compared to perifocal infiltrative edema zone (p<0.01). Relaxometric values (T1, T2, proton density) in perifocal zone were higher (p<0.01) compared to adjacent intact white matter along surgical approach. However, there were no differences in TBF between these zones. Proton density in tumor-adjacent intact white matter was higher (p<0.01) compared to normal-appearing white matter in ipsilateral hemisphere. There was inverse correlation between T2 and TBF in active tumor growth zone (Spearman rank R= -0.58; p=0.0016). We found inverse correlation between T2 and Ki67 proliferative index and direct correlation between TBF and Ki67 in this zone. Nevertheless, these relationships were insignificant after multiple test adjustment. CONCLUSION: Our study advocates for complementary power of ASL perfusion and MR relaxometry in assessment of high-grade brain glioma subregions. More malignant tumor zones tend to have higher TBF and shorter T2. Further investigation is needed to prove the capability of MAGiC to reveal foci of increased relaxometric values in tumor-adjacent normal-appearing white matter.

[Brainstem arachnoid cyst: case report and review]. / Arakhnoidal'naya kista stvola mozga: opisanie klinicheskogo sluchaya i obzor literatury.

There are no literature data on brainstem arachnoid cysts in humans. OBJECTIVE: To describe the clinical case of brainstem (pontomesencephalic) arachnoid cyst and to analyze classification, pathogenesis, differential diagnosis and treatment of this pathology considering literature data and own experience. MATERIAL AND METHODS: A 29-year-old patient with pontomesencephalic arachnoid cyst is reported. The disease manifested in childhood with a headache aggravated by bending and pushing. Later, syncope, vegetative-visceral paroxysms, mild oculomotor disturbances, transient paresthesia and numbness of the left half of the face occurred. Headaches became significantly more severe and resulted nausea and vomiting. Magnetic resonance imaging (MRI) revealed a two-chambered arachnoid cyst. A smaller chamber was localized in interpeduncular cistern, a larger one - in brainstem. RESULTS AND DISCUSSION: Differential diagnosis included cystic glioma and Virchow-Robin space enlargement. Fenestration of the cyst wall within interpeduncular cistern was performed via right-sided pterional approach. The diagnosis was verified by histological examination. The follow-up period was 14 months. We observed postoperative cyst reduction confirmed by MR data and regression of all symptoms except for minimal signs of medial longitudinal fasciculus dysfunction. CONCLUSION: Correct surgical approach for brainstem arachnoid cyst complicated by progressive neurological deterioration is confirmed by postoperative regression of cyst and symptoms.

Hypovitaminosis D in the elderly: relationship with sarcopenia and dementia (review of literature).

The growth in the world population of elderly and senile people provokes interest in the processes and mechanisms leading to aging and age-associated diseases. Hypovitaminosis D is common in geriatric patients and has been suggested by a number of authors as a cause of diseases such as dementia and sarcopenia. This literature review is devoted to the analysis of the role of vitamin D in the development of the above diseases, their prevention and treatment.

Potential targets for preclinical diagnostics of acute kidney injury in covid-19 patients (review of literature).

An relevance of the topic was defined by the high occurrence, unfavorable prognosis, lack of diagnostic techniques for early stages of acute kidney injury (AKI) disclosed in patients with COVID-19 (Coronavirus Disease 2019). Screening of medical literature for selection of AKI preclinical biomarkers was considered as main aim of this review. More than 200 publications from Russian Science Citation Index (RSCI), Scopus, The Cochrane Library, and MEDLINE were reviewed. Such risk factors as hypoxemia, increased intrathoracic pressure associated with Acute Respiratory Distress Syndrome (ARDS), hypertension (HT) involving endothelial dysfunction, and Diabetes mellitus were considered to be associated with AKI. There were explicated cytopathic and immune-mediated (cytokine-induced) mechanisms of COVID-19 associated AKI pathogenesis. Multiple methodological approaches were defined for detection and identification of the biomarkers based on urine proteome and metabolome screening. Perspective ways in the preclinical diagnostics of AKI such as detection of the markers of injury of the hypoxia-sensitive proximal canaliculi and the ATP metabolites that reflect first stages of the energy metabolism disorder in the epithelium lining canaliculi were identified in this study. The instantaneous and non-invasive investigation of different markers was regarded as possible method of the prognostication. The accuracy of the diagnosis on the initial stages of AKI, substantiate for preventive start of therapy, and make projections on the disease`s outcome will be improved due to the identification of high-sensitive specific biomarkers.