[Focal cortical dysplasia: visual assessment of MRI and MR morphometry data]. / Fokal'naya kortikal'naya displaziya: sravnitel'nyi analiz vizual'noi otsenki dannykh magnitno-rezonansnoi tomografii i magnitno-rezonansnoi morfometrii.

OBJECTIVE: Assessing the diagnostic significance of MR morphometry in determining the localization of focal cortical dysplasias (FCD). MATERIAL AND METHODS: The study included 13 children after surgery for drug-resistant epilepsy caused by FCD type II and stable postoperative remission of seizures (Engel class IA, median follow-up 56 months). We analyzed the results of independent expert assessment of native MR data by three radiologists (HARNESS protocol) and MR morphometry data regarding accuracy of FCD localization. We considered 2 indicators, i.e. local cortical thickening and gray-white matter blurring. RESULTS: FCD detection rate was higher after MR morphometry compared to visual analysis of native MR data using the HARNESS protocol. MR morphometry also makes it possible to more often identify gray-white matter blurring as a sign often missed by radiologists (p<0.05). CONCLUSION: MR morphometry is an additional non-invasive method for assessing the localization of FCD.

[Surgical treatment of epilepsy in children with focal cortical dysplasia in central gyri]. / Khirurgicheskoe lechenie epilepsii u detei s fokal'nymi kortikal'nymi displaziyami tsentral'nykh izvilin.

Focal cortical dysplasias are known to be the most frequent and furtive lesions leading to intractable epilepsy in children. Epilepsy surgery in central gyri, been effective in 60-70% of cases, is still significantly challenging due to the high risk of postoperative permanent neurological impairment. STUDY AIMS: Assessment of the outcome after epilepsy surgery in children with FCD in central lobules. MATERIAL AND METHODS: Nine patients, median age 3.7 ys, IQR=5.7 ys (min 1.8- max 15.7 ys) with FCD in central gyri and DR-epilepsy underwent surgery. Standard preoperative evaluation included MRI and video-EEG. Invasive recordings were used in 2 cases, coupled by fMRI in 2. An ECOG and neuronavigation, as well as stimulation and mapping of primary motor cortex were used routinely during the procedure. Gross total resection was achieved in 7 patients according to postoperative MRI. RESULTS AND CONCLUSIONS: Six patients with new or worsening of already existing hemiparesis recovered within a year after surgery. At the last FU (med 5 ys) favorable outcome (Engel class IA) has been achieved in 6 cases (66.7%), while two patients with persisting seizures reported seizing less frequently (Engel II-III). Three patients were able to discontinue AED-treatment and four children resumed development with improvement in cognition and behavior.

[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.

[«Burr hole¼ microsurgery for vestibular schwannoma]. / «Burr hole¼ mikrokhirurgiya vestibulyarnykh shvannom.

OBJECTIVE: To evaluate the efficacy and safety of minimally invasive «burr hole¼ microsurgery for vestibular schwannoma. MATERIAL AND METHODS: A retrospective analysis of postoperative outcomes in 50 consecutive patients with vestibular schwannoma was performed. All patients underwent burr hole microsurgery between 2016 and 2020. RESULTS: All patients satisfactorily tolerated surgical treatment. Total resection was carried out in 21 (42%) cases, almost total resection - in 21 (42%) patients (>95% of baseline volume). Subtotal resection was performed in 8 (16%) cases. Mean surgery time was 132 min (range 60-340). Postoperative deterioration of facial nerve function occurred in 20 (40%) patients. Severe dysfunction (House-Brackmann grade V-VI) was observed only in three patients. Other 17 patients had moderate dysfunction of the facial nerve (House-Brackmann grade III-IV). Useful hearing was preserved in 6 (50%) out of 12 patients with preoperative useful hearing. CONCLUSION: Minimally invasive burr hole microsurgery is an effective method for vestibular schwannoma. Moreover, the proposed technique reduces surgery time due to simpler craniotomy and wound closure.

[MR-guided non-invasive typing of brain gliomas using machine learning]. / Pervye rezul'taty neinvazivnogo tipirovaniya gliom golovnogo mozga po dannym magnitno-rezonansnoi tomografii s pomoshch'yu mashinnogo obucheniya.

Gliomas are the most common neuroepithelial brain tumors. The modern classification of tumors of central nervous system and treatment approaches are based on tissue and molecular features of a particular neoplasm. Today, histological and molecular genetic typing of tumors can only be carried out through invasive procedures. In this regard, non-invasive preoperative diagnosis in neurooncology is appreclated. One of the perspective areas is artificial intelligence applied for neuroimaging to identify significant patterns associated with histological and molecular profiles of tumors and not obvlous for a specialist. OBJECTIVE: To evaluate diagnostic accuracy of deep learning methods for glioma typing according to the 2007 WHO classification based on preoperative magnetic resonance imaging (MRI) data. MATERIAL AND METHODS: The study included MR scans of patients with glial tumors undergoing neurosurgical treatment at the Burdenko National Medical Research Center for Neurosurgery. All patients underwent preoperative contrast-enhanced MRI. 2D and 3D MR scans were used for learning of artificial neural networks with two architectures (Resnest200e and DenseNet, respectively) in classifying tumors into 4 categories (WHO grades I-IV). Learning was provided on 80% of random examinations. Classification quality metrics were evaluated in other 20% of examinations (validation and test samples). RESULTS: Analysis included 707 contrast-enhanced T1 welghted images. 3D classification based on DenseNet model showed the best result in predicting WHO tumor grade (accuracy 83%, AUC 0.95). Other authors reported similar results for other methods. CONCLUSION: The first results of our study confirmed the fundamental possibility of grading axial contrast-enhanced T1 images according to the 2007 WHO classes using deep learning models.

[Lessons learnt from 101 hemispheric pediatric epilepsy surgeries part ii: pitfalls and complications]. / Uroki 101 gemisferotomii u detei s polusharnoi simptomaticheskoi epilepsiei. Chast' II: oslozhneniya i oshibki.

OBJECTIVE: To evaluate the spectrum of pitfalls and complications after hemisherotomy basing on a retrospective study of a large consecutive pediatric cohort of patients from a single institution. MATERIAL AND METHODS: One hundred and one patients (med. age - 43 months) with refractory seizures underwent hemispherotomy. Developmental pathology was the anatomical substrate of disorder in 42 patients. The infantile post-stroke scarring and gliosis was the origin of epilepsy in the majority of 43 cases with acquired etiology. The progressive pathology (RE, S-W and TS) was the etiology in the rest of children (16 cases). The lateral periinsular technique was used to isolate the sick hemisphere in 55 patients; the vertical parasagittal approach was employed in 46 cases. Median perioperative blood loss constituted 10.5 ml/kg, but was markedly larger in kids with hemimegaly (52.8 ml/kg); 57 patients needed hemotransfusion during surgery. Median length of stay in ICU was 14.7 hours, and the length of stay in the hospital until discharge - 6.5 days. Eight patients underwent second-look surgery to complete sectioning of undercut commissural fibers. FU is known in 91 patients (med. length - 1.5 years). RESULTS: Major surgical complications with serious hemorrhage and/or surgery induced life-threatening events developed in 7 patients (one of them has died on the 5th day post-surgery for the causes of brain edema and uncontrolled hyponatremia). Various early and late infectious complications were noted in 4 cases. Ten patients experienced new not anticipated but temporary neurological deficit. Nine patients needed shunting for the causes of hydrocephalus within several first months post-hemispherotomy. Early seizure onset was associated with probability of all complications in general (p=0.02), and developmental etiology - with intraoperative bleeding and hemorrhagic complications (p=0.03). CONCLUSION: Children with developmental etiology, particularly those with hemimegalencephaly, are most challengeable in terms of perioperative hemorrhage and serious complications. Patients with relapse or persisting seizures should be evaluated for the possibility of incomplete hemispheric isolation and have good chances to become SF by re-doing hemispherotomy.

[Surgical treatment of epilepsy in children with focal cortical dysplasia]. / Khirurgicheskoe lechenie epilepsii u detei s fokal'noi kortikal'noi displaziei.

OBJECTIVE: Surgery is the first-line treatment option in children with FCD and refractory epilepsy, but the rate of success and patient numbers who became free of seizures vary widely from series to series. STUDY AIMS: To elicit variables affecting the outcome and predicting achievement of the long-term seizure-free status. MATERIAL AND METHODS: One hundred sixty-nine children with cortical dysplasia and DR-epilepsy underwent surgery Preoperative evaluation included prolonged video-EEG and MRI (in all patients) and neuropsychological testing when possible. Fourteen patients underwent invasive EEG, fMRI and MEG were used also in some cases. Including 27 repeat procedures the list of overall 196 surgeries performed consists of: cortectomy (lesionectomy with or without adjacent epileptogenic cortices) ­ in 116 cases; lobectomy ­ in 46; and various disconnective procedures ­ in 34 patients. Almost routinely employed intraoperative ECOG (134 surgeries) was combined with stimulation and/or SSEP in 47 cases to map eloquent cortex (with CST-tracking in some). A new permanent and not anticipated neurological deficit developed post-surgery in 5 cases (2,5%). Patients were follow-upped using video-EEG and MRI and FU which lasts more than 2 years (median ­ 3 years) is known in 56 cases. Thirty-two children were free of seizures at the last check (57,2% rate of Engel IA). A list of variables regarding patients' demography, seizure type, lesion pathology and localization, and those related to surgery and its extent were evaluated to figure out anyone associated with favorable outcome. RESULTS: Both Type II FCDs and their anatomically complete excision are positive predictors for favorable outcome and achievement of SF-status (p<0,05). Residual epileptic activity on immediate post-resection ECOG do not affect the outcome. CONCLUSION: Patients with Type II FCD, particularly with Type IIb malformations are the best candidates for curative surgery, including cases with lesions in brain eloquent areas. Kids with Type I FCD have much less chances to become free of seizures when attempting focal cortectomy. However, some of them with early onset catastrophic epilepsies may benefit from larger surgeries using lobectomy or various disconnections.

3D pCASL-perfusion in preoperative assessment of brain gliomas in large cohort of patients.

The aim of the study was to evaluate the role of pseudocontinuous arterial spin labeling perfusion (pCASL-perfusion) in preoperative assessment of cerebral glioma grades. The study group consisted of 253 patients, aged 7-78 years with supratentorial gliomas (65 low-grade gliomas (LGG), 188 high-grade gliomas (HGG)). We used 3D pCASL-perfusion for each patient in order to calculate the tumor blood flow (TBF). We obtained maximal tumor blood flow (maxTBF) in small regions of interest (30 ± 10 mm2) and then normalized absolute maximum tumor blood flow (nTBF) to that of the contralateral normal-appearing white matter of the centrum semiovale. MaxTBF and nTBF values significantly differed between HGG and LGG groups (p < 0.001), as well as between patient groups separated by the grades (grade II vs. grade III) (p < 0.001). Moreover, we performed ROC-analysis which demonstrated high sensitivity and specificity in differentiating between HGG and LGG. We found significant differences for maxTBF and nTBF between grade III and IV gliomas, however, ROC-analysis showed low sensitivity and specificity. We did not observe a significant difference in TBF for astrocytomas and oligodendrogliomas. Our study demonstrates that 3D pCASL-perfusion as an effective diagnostic tool for preoperative differentiation of glioma grades.

[Evaluation of the effectiveness of rectal suppositories containing a dense extract from licorice roots at the stage of spa-and-resort rehabilitation of patients with chronic infectious prostatitis].

The objective of the present paper was to evaluate the effectiveness of Suppeksol rectal suppositories applied either as a self-contained therapeutic means or in combination with natural spa-and-resort factors for the rehabilitative treatment of patients with chronic infectious prostatitis. It is shown that Suppeksol suppositories containing a dense extract from licorice roots have beneficial effect on all systems and organs affected by pathological processes associated with chronic prostatitis especially when applied in combination with natural spa-and-resort factors.

[Persistence of the influenza virus in children with congenital CNS pathology]. / Persistentsiia virusa grippa u detei s vrozhdennoi patologiei TsNS.

Sick infants born to mothers who experienced influenza during pregnancy were examined. The cerebrospinal fluid, serum and blood cells were collected from such children with signs of congenital immune deficiency and progressive pathology of the central nervous system. None of the specimens yielded infectious influenza virus, but by means of molecular hybridization virus-specific genetic sequences were found in small amounts in the cerebrospinal fluid and serum and in high concentrations in blood cells. Persistence of genes NP, M and H1 of influenza A/H1N1 virus was observed in the blood cells of one infant for 83 days (the observation period). At the same time, the lack of antibodies to viral M protein in serum of this baby was demonstrated by the immune blotting method.

[Congenital encephalomyelopathy as a possible slow infection in humans]. / Vrozhdennaia éntsefalomielopatiia kak vozmozhnaia medlennaia grippoznaia infektsiia u cheloveka.

A slow influenzal congenital infection of man (in a child aged 2.5 years) is described for the first time. The infection manifests itself by encephalomyelopathy (retarded psychomotor development, sluggish spinal pareses of the limbs) and resembles Werdnig-Hoffmann amyotrophy. Besides, one can ses neuroendocrine disorders (hypophyseal nanism, hypogonadism ) and the signs of immunodeficiency. The long-term persistence of influenza A virus, its defective form was detected in the blood and CSF by means of molecular hybridization. In addition, the summarized data on the clinical studies of congenital influenzal injuries to the CNS in children, carried out by the author are provided. The theoretical evidence for the work was experimental slow influenzal infection in mice obtained for the first time at the N.F.Gamaleia Institute of Epidemiology and Microbiology (Moscow).

[Clinical picture and pathogenesis of the Refsum syndrome]. / K kliniki i patogenezu sindroma Refsuma.

The author reports of 2 cases (sisters of 13 and 15 years old) with the Refsum syndrome. The disease had its onset at the age of 12 and 5 years with a progressive development and remissions. The clinical picture was characterized by a recurrent syndrome of polyradiculoneurites with a slight protein cellular dissociation in the CSF, an expressed sensitive ataxia with elements of cerebellar disorders, a drop in the acuity of sight, audition, intellectual level and a deformation of the talipes of the Friedreich type. In a single examination of fatty acids in the blood serum by the method of gas chromotography there were no data pointing to the existence of 3, 7, 11, 15-tetra metylhexadecone acids. On the basis of an immunological study the author discusses the role of autoimmune reactions in the pathogenesis of the diseases. A differential diagnosis was conducted between acanthocytosis and porphyria with recommendations in regard to treatment.

[McArdle's disease (a familial case)]. / Bolezn' MakArdlia (semeinoe nabliudenie)

The author describes a family (48 year old mother and 15 year old son) with the muscular variant of glycogenosis-McArde's metabolic myopathy. The mother has been ill since 22 years old, the son--since 7. The disease had a slowly progressive development. The clinical picture was characterized by convulsions of the type of cramps following physical loadings on muscles of the body and extremities. Convulsions were accompanied by pain, an induration and enlargment of the muscles, muscle fatigue and increased significantly in an artifical ischemia of the extremities. A histochemical study of the muscle revealed a pathological accumulation of glycogen. The content of lactic and pyruvic acid in the blood after work in ischemic conditions did not change significantly. A study of the sugar curve in the blood with a loading with glucose and a parallel determination of insulin by a radioimmune method found hyperinsulinemia and a dysfunction of the pancreas.

[Clinical characteristics of various paroxysmal states in young children]. / Klinicheskaia kharakteristika nekotorykh paroksizmal'nykh sostoianii u detei rannego vozrasta.

The overwhelming majority among paroxysmal states in young children belongs to febrile attacks and their combination with other paroxysms as well as to respiratory-affective attacks and syncopes. The hereditary factor and perinatal disorders are essential factors in the genesis of infantile paroxysms. In rare cases syncopic and respiratory-affective paroxysms may be life-threatening. Electroencephalography often reveals epileptic activity and other disturbances of the cortical rhythm. The prognosis of the development of epilepsy should be made with due consideration for the etiological factors, heredity, characteristics of the course of paroxysms, premorbid development of the child, electroencephalographic findings and the results of a follow-up.

[The fibrogenic property of mineral wool dust obtained from ferronickel slags]. / O fibrogennosti pyli mineral'noi vaty, poluchennoi iz ferronikelevykh shlakov.

Dust of mineral wool obtained from ferronickel slags was demonstrated to be capable of inducing moderate pneumofibrosis. Small contents of manganese, nickel, chrome and cobalt in the mineral wool particles necessitate further investigations for their probable mutagenic effect.

[The alkaline phosphatase and aminotransferase activity of the blood serum and liver in rats with chronic poisoning by the dust from a mineral wool made of ferronickel slag]. / Aktivnost' shchelochnoi fosfatazy, aminotransferaz syvorotki krovi i pecheny krys pri khronicheskoi intoksikatsii pyl'iu mineral'noi vaty iz ferronikelevogo shlaka.

The authors investigated the activity of alkaline phosphatase, alanine- and aspartate-aminotransferases of the blood serum, mitochondria and postmitochondrial fraction of the liver in conditions of administration of mineral cotton from ferronickel slag. It was shown that 1 and 3 months after introduction of mineral cotton dust changes occurred in the activity of these enzymes. Restoration of these enzymes occurred 6 months after introduction of mineral cotton dust.

[The characteristics of the biological action and regulation of submicroscopic aerosols in the industrial environment]. / Ob osobennostiakh biologicheskogo deistviia i reglamentatsii v proizvodstvennoi srede submikroskopicheskikh aérozolei.

Biologic action was studied of the silicon nitride powder with varying disperse composition. When producing and using the silicon nitride powder on an enlarged scale one must remember of its higher toxicity and fibrogenicity. There is a need of employing some method of determination of the submicroscopic aerosol disperse composition under industrial conditions.

[Improvement in the program and methods of conducting an internship in occupational hygiene]. / Pro vdoskonalennia prohramy i metodiv provedennia internatury z hihiieny pratsi.

The authors describe their experience gained with conducting internship training in occupational hygiene for graduating students of medical and prophylaxis departments of medical colleges. Special attention is called to the matter of learning by those engaged in internship studies of practical skills of work of a physician-occupational hygienist relating, in particular, to exercising sanitary inspection, both preventive and running, in industrial settings. Measures were proposed to improve the programme and curriculum to be guided by in conducting the above internship training.

[Functional activity of peripheral blood leukocytes as criteria of the general toxic and sensitizing action of polyoxypropyleneamine hardeners of synthetic resins]. / Funktsional'naia aktivnost' leikotsitov perifericheskoi krovi kak kriterii obshchetoksicheskogo i sensibiliziruiushchego deistviia polioksipropilenaminnykh otverditelei sinteticheskikh smol.

General toxic and sensitizing characteristics of polyoxypropylenamine (POPamine) hardeners of synthetic resins under chronic inhalation impact of their aerosols were experimentally studied. Characteristic variations of synthetic activity of blood leukocytes were studied during the process of chronic POPamine intoxication. High allergic effect of those compounds was established along with the conformity of body sensitizing indicators to variations in synthetic activity of peripheral blood cells. It was concluded that the account of sensitizing POPamine characteristics was necessary when setting up hygienic standards for the work zone air. The possibility of using the indicators of synthetic activity of blood leukocytes as an additional criterion for evaluating allergenic activity of chemical substances was also pointed out.