[Congenital basal encephaloceles involving functionally important structures]. / Vrozhdennye bazal'nye entsefalotsele, vklyuchayushchie funktsional'no znachimye struktury.

In rare cases, basal encephaloceles can include important brain structures (pituitary gland, chiasm, third ventricle walls, cerebral vessels). MATERIAL AND METHODS: We reviewed 43 articles (78 cases) devoted to basal encephaloceles involving functionally important structures. Analysis included transsphenoidal and sphenoethmoidal hernias. RESULTS: Nasal breathing disorders were found in 76.9% of cases, decreased visual acuity - 53.8%, endocrine disorders - 44.9%, nasal CSF leakage - 14.1%, meningitis - 10.3%. Concomitant malformations occurred in 85.9%. Severe respiratory disorders (52.6%, p<0.05) and multiple concomitant malformations (71.7%, p<0.05) were more common among patients with sphenoethmoidal encephalocele. Among 78 patients, 73.1% underwent surgery while follow-up was preferable in 26.9% of cases. There was progression of endocrine disorders (9.5%), visual impairment (4.8%) and nasal breathing disorders (4.8%) in follow-up period. Surgical treatment also has many risks. Transcranial, transnasal, transoral and combined approaches are currently used. It was not possible to establish the most effective surgical approach due to heterogeneous clinical data. Postoperative complications occurred in 47.4% of cases (endocrine disorders - 33.3%, CSF leakage - 8.8%, visual impairment - 1.8%, infectious complications - 14%). Mortality rate was 3.5%. CONCLUSION: Congenital basal encephalocele involving functionally important structures is an extremely rare developmental defect. Such patients often have concomitant anomalies. Comprehensive examination is necessary to estimate the structures included in hernial sac and concomitant diseases. Treatment strategy should be determined individually after thorough examination and comparison of all risks. Surgical treatment is associated with high risk of complications due to damage to the structures comprising encephalocele.

[Autologous fibrin glue for endoscopic skull base repair in patients with cerebrospinal fluid leakage]. / Primenenie autologichnogo fibrinovogo kleya v endoskopicheskoi plastike defektov osnovaniya cherepa pri nazal'nykh likvoreyakh.

The main stages of endoscopic skull base repair in patients with cerebrospinal fluid (CSF) leakage are identification of bone boundaries of the fistula and its closure by auto- and allografts. Fibrin glue can be used to fix plastic materials and additionally seal skull base defect. OBJECTIVE: To analyze efficacy and safety of Vivostat autologous fibrin glue for endoscopic skull base repair in patients with nasal CSF leakage and to compare postoperative outcomes after defect closure by Vivostat fibrin glue and allogeneic fibrin glue. MATERIAL AND METHODS: A retro- and prospective analysis included 56 patients with nasal CSF leakage who were treated at the Burdenko Neurosurgery Center between January 2021 and June 2022. Patients were divided into 2 groups: Vivostat fibrin glue (n=27, 48.2%) and allogeneic fibrin glue (n=29, 51.8%). Demographic and clinical perioperative data were analyzed. RESULTS: No early postoperative recurrence of CSF leakage was registered in both groups, whereas meningitis occurred in 2 cases in each group. Recurrent CSF leakage in delayed postoperative period occurred in 1 patient (3.4%) of the control group (p>0.05). Incidence of perioperative complications, subfebrile temperature in early postoperative period, surgery time and hospital-stay were similar. CONCLUSION: Vivostat autologous fibrin glue is a safe and effective method for fixing the grafts in endoscopic skull base repair. The advantages of this approach are easy application, elimination of the risk of allergic, immunological and infectious complications, as well as acceleration of tissue regeneration.

[Difficulties in differential diagnosis of sagittal synostosis (scaphocephaly)]. / Trudnosti differentsial'noi diagnostiki sagittal'nogo sinostoza (skafotsefalii).

Craniosynostosis is characterized by congenital absence or premature closure of skull sutures. The most common form of craniosynostosis is synostosis of sagittal suture followed by scaphocephaly. There are some head deformities similar to scaphocephaly such as positional and constitutional dolichocephaly, etc. These patients have no sagittal suture synostosis. However, there are difficulties in differential diagnosis between these deformities and scaphocephaly. OBJECTIVE: To develop differential diagnostic criteria between dolichocephalic head deformities and true scaphocephaly following sagittal synostosis. MATERIAL AND METHODS: The study included 33 patients with dolichocephaly (25 (75.8%) boys and 8 (24.2%) girls) between December 2013 and August 2022. The inclusion criterion was available CT or ultrasound data confirming or excluding sagittal synostosis. Age of patients was 8.62±7.71 (1.77-36) months. We analyzed anamnestic, clinical and radiological data. Radiological data was compared with diagnostic findings in 20 patients with scaphocephaly. Both groups were comparable in age, gender and cranial index. RESULTS: We present clinical and radiological signs, as well as algorithm for differential diagnosis between scaphocephaly and dolichocephaly. CONCLUSION: There are objective difficulties in differential diagnosis between scaphocephaly following sagittal synostosis and dolichocephalic head deformities. In most cases, we cannot establish the cause of congenital forms of dolichocephaly. The most likely causes may be pre- and postnatal compressive and positional effects. Ultrasound of skull sutures is preferable for differential diagnosis between these abnormalities. Correction of dolichocephaly can be carried out according to aesthetic indications with individual cranial orthoses.

[Differential diagnosis of pneumonia as a complication of nasal liquorrhea in the context of the COVID-19 pandemic: Case report].

Nasal liquorrhea the outflow of cerebrospinal fluid from the cerebrospinal fluid spaces of the cranial cavity into the nasal cavity or paranasal sinuses due to the presence of a congenital or acquired defect in the bones of the skull base and meninges of various etiologies. Nasal liquorrhea leads to potentially fatal complications: meningitis, meningoencephalitis, pneumocephalus, brain abscess. Also, with nasal liquorrhea, less dangerous complications may occur: aspiration bronchopneumonia and gastritis. The article presents a case of aspiration pneumonia in two patients with nasal liquorrhea treated at the Burdenko National Medical Research Center for Neurosurgery during the COVID-19 pandemic. Both patients noted the profuse nature of the nasal liquorrhea, complained of coughing in a horizontal position. In both cases, no RNA virus (SARS-CoV-2) was detected during the polymerase chain reaction. Antibodies (IgG, M) to coronavirus were not detected. Computed tomography of the chest organs in both cases revealed areas of frosted glass darkening. Since no data was obtained for coronavirus infection (negative tests for coronavirus, lack of antibodies), changes in the lungs were interpreted as a consequence of constant aspiration of CSF. The patients were admitted to a separate ward. Both patients underwent endoscopic endonasal plasty of the skull base defect. The postoperative period in both cases was uneventful. In both cases, the patients underwent computer tomography scan of the chest organs one month later. On the photographs, the signs of pneumonia completely regressed.

[Multiple skull base defects: features of pathogenesis, diagnosis and treatment]. / Mnozhestvennye defekty osnovaniya cherepa: osobennosti patogeneza, diagnostiki i lecheniya.

OBJECTIVE: To determine the risk factors of multiple skull base defects, as well as features of diagnosis and treatment of this pathology. MATERIAL AND METHODS: A retrospective analysis included 39 patients who underwent surgery for nasal CSF leakage at the Burdenko Neurosurgical Center in 2000-2019. The study recruited patients with multiple simultant skull base defects. RESULTS: Traumatic defects were observed in 23 (59%) patients, spontaneous defects - in 16 (41%) cases. All patients underwent endoscopic endonasal closure of skull base defects with autografts. CONCLUSION: Multiple defects are more common in severe traumatic brain injury. The main risk factors of multiple spontaneous defects are female sex and overweight. Adequate diagnosis implies high-resolution CT (slice width 0.5-1 mm), as well as intraoperative control of all suspicious and «weak¼ areas. Endoscopic endonasal technique is effective and safe for multiple skull base defects (efficiency 97%).

[Endoscopic endonasal reconstruction of skull base defects in the lateral recess of the sphenoid sinus: evaluation of computed tomograms for planning operations]. / Endoskopicheskaya endonazal'naya plastika defektov osnovaniya cherepa v oblasti lateral'nogo karmana klinovidnoi pazukhi: otsenka komp'yuternykh tomogramm dlya planirovaniya operatsii.

OBJECTIVE: Determine the influence of the anatomical features and sizes of the lateral pocket with a defect on the choice of surgical access and the quality of the performed plastics. MATERIAL AND METHODS: A retrospective analysis of computed tomograms of 38 patients who underwent surgical treatment at the Burdenko National Medical Research Center for Neurosurgery of the Ministry of Health of Russia about defects of the skull base in the area of the lateral pocket of the sphenoid sinus. The patients were divided into three groups depending on the approach used (the 1st group), the recurrence rate (the 2nd group), and the characteristics of intraoperative visualization of the defect (the 3rd group). RESULTS: There were no statistically significant differences in anatomical features in patients who underwent trans-pterygoid and transsphenoidal approaches, as well as in patients of the 2nd group. Patients of the 3rd group (with visualization features) showed statistically significant differences between the distance from the defect to the VR line (p=0.007). In patients with good visualization of the defect using direct optics, this distance was shorter than in patients in whom the defect was visualized with an angled endoscope. No other anatomical differences were noted. CONCLUSIONS: The anatomical features of the lateral pocket structure (type of pneumatization, size and volume) did not affect the choice of access to the defect and the frequency of recurrence. When comparing the approaches, it was noted that the trans-pterygoid access, providing direct visualization of defects, minimizes the risk of recurrence in the postoperative period. An objective anatomical indicator for choosing an access to the defects of the lateral pocket can be the distance from the defect to the VR line: at a distance of more than 0.7 cm, it is advisable to perform a trans-pterygoid approach; at a distance of less than 0.7 cm, it is possible to achieve direct visualization of the defect and perform high-quality plastic surgery with a transsphenoidal access.

[The сardiometabolic assessment of the glycemic variability in patients with diabetes mellitus: the role of the glucocardiomonitoring].

Aim To study quantitatively the two-way relationship between parameters of glycemic variability and development of cardiovascular events in patients with type 2 diabetes mellitus (DM) on chronic sulfonylurea (SM) therapy by synchronous, professional glucose and cardiac monitoring.Material and methods The study included 421 patients with type 2 DM on SM therapy. A 5-day synchronous glucose and cardiac monitoring was performed for these patients in a retrospective mode using an iPro2 (Medtronic, USA) continuous glycemia monitoring (CGM) system and Holter monitoring. Glycemic endpoints (CGM-parameters of glycemia variability and integral indexes) and cardiological endpoints (ventricular rhythm disorders (VRD), ST segment depression (dST), and corrected QT interval (QTc)) were evaluated.Results Clear correlations were found between the ST segment depression and the increase in TIR-HYPO index and the length of QTc. The strongest correlation was observed for VRD and the increase in TIR-HYPO. Moderate correlations were observed between VRD and the decrease in TIR-NORMO and between increased variabilities of glycemia (increases in SD and number of glycemia excursions >4 mmol/l/h) and integral indexes (mean CGM-level of glycemia and HbA1c). Elongation of the QTc interval was associated with increased TIR-HYPO, decrease in maximum glycemia, and development of dST.Conclusion The glucose and cardiac monitoring confirmed the close interrelation between the quality of glycemic control and cardiovascular disorders and should be recommended for a wider use in real-life clinical practice for determining the cardiometabolic status of patients and personalization of hypoglycemic therapy.

[The pharmacogenetics of hypoglycemia and the glycemic variability at the patients ith type 2 diabetes mellitus].

AIM: To investigate the link between the hypoglycemia (registrated accurately by the professional Continuous Glucose Monitoring CGM; severe hypoglycemia at home) and the hetero-/homozygote carriage of single nucleotide polymorphisms (SNP) of cytochrome systems geneCYP2C9(rs1799853CYP2C9*2 иrs1057910CYP2C9*3) at the patients with Type 2 Diabetes Mellitus (T2DM) used sulphonylurea (SU). MATERIALS AND METHODS: In Study Case-Control 120 T2DM-SU-patients genotyped by SNPs of geneCYP2C9(using PCR-RT) had been done the professional CGM (System iPro2, Medtronic) recorded Time in Range of Hypoglycemia (TIR-HYPO), level of Minimal CGM-hypoglycemia (MinGl) and standard CGM-parameters of Glycemic Variability. Severe hypoglycemia at home was recorded from visit to visit. The odds ratio (OR) of metabolic disturbances had been assessed for carriage SNPs in comparison with wide alleles. RESULTS: The Study established that carriage of SNPsrs1799853andrs1057910geneCYP2C9at T2DM-SU-patients associated with rising of Glycemic Variability and frequency of CGM-hypoglycemia (MinGl decreasing, increasing of TIR-HYPO and number of Glycemia Excursion 4 mmol/L/h), as well as increasing severe hypoglycemia at home (p0.05). Thus, OR at the carriage ofrs1799853andrs1057910respectively equaled: for CGM-hypoglycemia 7.78 (3.0220.01) and 5.80 (0.23145.87); number of Glycemia Excursion 4 mmol/L/h 5.76 (2.2914.43) and 4.44 (1.4313.76); MinGl3.9 mmol/L 4.39 (1.7910.75) and 6.26 (1.8421.30); CV40% (vs30%) 3.63 (1.0412.62) and 15.22 (0.59393.94);p0.05. CONCLUSION: At the real clinical practice the assessment of carriage of SNPs of geneCYP2C9before inclusion of SU to glucose-lowering scheme of T2DM-therapy it necessary to carry out for the detecting patients with a higher risk of hypoglycemia and rising of Glycemic Variability.

[Management of complex skull base defects accompanied by pneumocephalus]. / Taktika lecheniia defektov osnovaniia cherepa, soprovozhdaiushchikhsia pnevmotsefaliei.

AIM: The study aim was to analyze our own experience in treating patients with complex skull base defects accompanied by pneumocephalus and, based on the findings, to develop an optimal treatment approach for this pathology. MATERIAL AND METHODS: We retrospectively reviewed a series of 30 patients with complex skull base defects accompanied by pneumocephalus who underwent inpatient treatment at the Burdenko Neurosurgical Institute in the period from 2001 to 2017. We analyzed demographic characteristics of patients (gender, age), clinical data (etiology, somatic and neuropsychiatric status, radiological data), and treatment aspects (conservative or surgical treatment, used approach, defect characteristics, reconstructive materials). Treatment outcomes were assessed based on analysis of changes in clinical manifestations, postoperative complications, and recurrences. The obtained data were compared to the results of literature review. RESULTS: In the series of 30 patients with complex skull base defects accompanied by pneumocephalus, the mean age was 41 years (range, 17-68 years); there were 17 (59%) males and 13 (41%) females. Etiologically, there were 17 (59%) traumatic cases, 11 (36%) iatrogenic cases, and 2 (5%) spontaneous cases. Clinically, the patients presented with the following manifestations: psycho-neurological symptoms (41%), nasal cerebrospinal fluid (CSF) leak (36%), impaired consciousness (27%), and meningitis (23%). Eight patients with acute injuries underwent complex conservative treatment that included infusion, and anti-edema, vascular, metabolic, anticonvulsant, and antibacterial therapy. In cases of conservative treatment failure or tension pneumocephalus accompanied by abrupt worsening of the patient's condition, surgical treatment was used. A total of 24 interventions (including revision surgery) were performed in 22 patients. All patients underwent endoscopic endonasal reconstruction of complex skull base defects. Tissues used for reconstruction included the fascia lata and adipose tissue (77%), fascia lata and cartilage/bone from the nasal septum (14%), and a pedicled nasoseptal flap (9%). The success rate of reconstructive interventions was 91%. There were 2 (9%) recurrences. Postoperative complications in the form of meningitis occurred in 4 (18%) patients. CONCLUSION: In the case of a nasal cerebrospinal leak history and worsening of the patient's condition accompanied by common cerebral and psychiatric symptoms, the development of pneumocephalus should be considered first, the early diagnosis of which will facilitate choosing the correct treatment approach. In the case of acute injury in patients with the established diagnosis of pneumocephalus caused by gas-forming infection, conservative therapy is indicated in the early period after neurosurgical interventions with opening of the meninges. Tension pneumocephalus together with a skull base bone defect (according to CT) and a nasal CSF leak history is the indication for surgical treatment. In this case, the endoscopic endonasal technique is the method of choice.

[Modern aspects of surgical treatment of nasal liquorrhea with localization of defect in frontal sinus]. / Sovremennye aspekty khirurgicheskogo lecheniia nazal'noi likvorei s lokalizatsiei defekta v lobnoi pazukhe.

Defects localized in the frontal sinus are difficult for surgical treatment, since there is a large number of anatomical variations in the structure of the naso-frontal canal and the sinus itself. With the development of endoscopic technology and paying attention to the modern tendency of minimal invasive surgery, new invasive approaches to reach frontal sinus, such as endoscopic approach according to Draf I-III and combined approaches were developed and put into practice. OBJECTIVE: To summarize and to analyze the results of treatment of nasal liquorrhea with localization of the defect in the frontal sinus using endoscopic endonasal and combined intra-extranasal approaches. MATERIAL AND METHODS: A retrospective analysis of a series of 43 cases of nasal liquorrhea with a frontal sinus defect being treated at the NMRCN Burdenko during the period from 2001 to 2017. To select access, a classification of frontal sinus defects according to their localization was developed. The analysis of demographic and clinical data of patients, as well as intraoperative and postoperative data analysis were done. RESULTS: In the series of 43 patients, endoscopic endonasal approach was performed in 28 (65%) cases. Combined approach was performed at 15 (35%) patients. The success rate of plastic surgery with endoscopic endonasal approach was 86% (24 of 28), with combined approach - 93% (14 of 15). CONCLUSION: Endoscopic endonasal and combined approaches are the methods of choice for plastic surgery of defects of the skull base in the frontal sinus as they are effective and safe. The choice of approach depends on anatomical features of the frontal sinus and on the localization of defect.

[The causes of late diagnostics of vestibular shwannomas]. / Prichiny pozdnei diagnostiki vestibuliarnykh shvannom.

AIM: The objective of the present study was to elucidate the causes of late diagnostics of vestibular shwannomas based on the results of the analysis of the medical histories of the patients admitted to the Academician N.N. Burdenko National Medical Research Centre of Neurosurgery for the management of this condition. MATERIAL AND METHODS: We undertook the retrospective review of a series of 192 cases of vestibular shwannomas in the patients treated based at the N.N. Burdenko National Medical Research Centre of Neurosurgery in 2015. The study included the analysis of demographic characteristics of the patients as well as their anamnestic and clinical data. RESULTS AND DISCUSSION: A total of 55 (29%) patients were found to have small tumours (Samii T1-T3) whereas 137 (71%) ones presented with giant neoplasms including T4a and T4b tumours (in accordance with the Samii classification) in 63 (33%) and 74 (38%) patients respectively. The duration of the disease from the appearance of its first clinical symptoms up to the establishment of the definitive diagnosis was 41 months on the average. 37 (19%) patients appeared to have paid no attention to the unilateral impairment of hearing. 46 (24%) patients applied for the medical assistance to the therapists and neurologists. 56 (29%) patients had remained for a long time under the supervision of the ENT specialists and surdologists based at the local outpatient facilities. CONCLUSION: More than 2/3 of the examined patients presenting with vestibular shwannomas apply for the medical assistance at the late stages of the disease. Such situation can be attributed to the low level of oncological alertness among the general population and health providers, the poor awareness of the general practitioners and otorhinolaryngologists about this pathology, the unavailability or inefficient application of the modern neurovisualization technologies, in the first place magnetic resonance imaging. The problems encountered in connection with the performance of screening studies give evidence of the necessity of the introduction of up-to-date otoneurological and audiological investigations as well as the neurovisualization techniques into the everyday clinical practice for the comprehensive examination of all the patients suffering from unilateral hearing loss.

[Experience of treating patients with lateral sphenoid sinus recess CSF leak]. / Nash opyt lecheniia patsientov s nazal'noi likvoreei iz lateral'nogo karmana klinovidnoi pazukhi.

According to various authors, the rate of sphenoid sinus defects ranges from 15 to 26%. In the sphenoid sinus, the most common defect localization is the lateral recess - 35.3%. Regardless of the etiology and pathogenesis of lateral sphenoid sinus recess cerebrospinal fluid (CSF) leak, the treatment approach is aimed at plastic closure of the defect. Surgery in this area is associated with a high rate of recurrences (25%) due to a complex anatomical landscape and inapplicability of a direct approach. PURPOSE: The study purpose was to analyze our own experience in treating patients with CSF leak and meningoencephalocele in the lateral sphenoid sinus recess and, based on the obtained results, develop an algorithm for the treatment of this pathology. MATERIAL AND METHODS: We retrospectively reviewed a series of 89 patients with CSF leak and meningoencephalocele in the lateral sphenoid sinus recess who were treated at the Burdenko Neurosurgical Institute in the period between 2001 and 2017. The demographic characteristics of patients, clinical data, and aspects of surgical treatment were analyzed. Treatment outcomes were assessed based on analysis of recurrences and postoperative complications. The obtained data were compared to the literature data. RESULTS: In the series of 89 patients with CSF leak and meningoencephalocele in the lateral sphenoid sinus recess, the mean age was 49 years. Surgery through the transsphenoid approach was performed in 89 (74%) patients. There were 25 (28%) recurrences in this group. Nine (7%) patients underwent repair of a complex skull base defect using the transethmoidal approach; there were 3 (33%) recurrences. The transpterygoid approach was used in 22 (17%) patients; there were 3 (14%) recurrences in this group. CONCLUSION: Endoscopic endonasal repair is an effective technique for treating complex skull base defects in the lateral sphenoid sinus recess. The choice of an approach to the defect depends on the degree of pneumatization of the sphenoid sinus, surgeon's experience, and availability of the necessary equipment and tools. The endoscopic transpterygoid approach is advisable to use in cases of excessive pneumatisation of the sinus with developed lateral processes and recurrent nasal CSF leak. This enables visualization of the defect edges in this hard-to-reach area and adequate repair.

[A modern approach to the diagnosis of nasal liquorrhea]. / Sovremennyi podkhod k diagnostike nazal'noi likvorei.

Nasal liquorrhea is cerebrospinal fluid leakage from cerebrospinal fluid spaces of the cerebral cavity into the nasal cavity or paranasal sinuses due to congenital or acquired abnormalities of the skull base bones and meninges of various etiologies. The severity of liquorrhea varies from hidden manifestations to profuse leakage of cerebrospinal fluid from the nasal cavity. The diagnosis of overt nasal liquorrhea is not problematic, but the diagnosis of latent liquorrhea is a challenge. In this case, the disease leads to potentially fatal complications, such as meningitis (the risk amounts to 10-37%), pneumocephaly, pneumonia, etc. These peculiarites give rise to two main tasks: early diagnosis confirming liquorrhea and accurate identification of the CSF fistula location when planning further surgical management. PURPOSE: The study purpose was to review and comparatively analyze all modern methods of diagnosing nasal liquorrhea as well as to substantiate the most effective and promising approaches and algorithms. MATERIAL AND METHODS: The study included papers in English and Russian found in the Pubmed database and related to the diagnosis of basal liquorrhea of different etiology and localization. RESULTS: This review demonstrates that diagnostic tests vary widely in sensitivity, specificity, accuracy, invasiveness, and cost. Given all the criteria, detection of beta-2 transferrin or beta-trace protein is the best method for confirming nasal liquorrhea, and high-resolution computed tomography is the best technique for localization of the abnormality. CONCLUSION: Based on the review, we suggest a diagnostic algorithm for nasal liquorrhea. However, the evidence presented in this review is unfortunately not very reliable, which indicates the existing need for more accurate studies.

[Nasal schwannoma with skull base destruction in a child (a case report and literature review)]. / Nazal'naia shvannoma s destruktsiei osnovaniia cherepa u rebenka (sluchai iz praktiki i obzor literatury).

Schwannomas (neurinomas) are benign, encapsulated, and slow-growing neoplasms developing from any peripheral, cranial, or vegetative nerve that has the Schwann sheath. Schwannomas of the nasal cavity and paranasal sinuses in adults occur rarely, less than 4% of cases. The world literature lacks similar data for the pediatric age group because these tumors in children are unique and extremely rare. The most common clinical symptoms of sinonasal schwannoma are nasal breathing disorders, hyposmia or anosmia, and snoring at night. Other symptoms are associated with intranasal schwannoma invasion of neighboring organs and tissues and include exophthalmos, epiphora (lacrimation), headaches, and anesthesia in the facial area. In this article, we describe a rare case of diagnosis and successful surgical treatment of a child with intranasal schwannoma destructing the skull base.

[Modeling of schizophrenia with Levodopa + Carbidopa].

Animal experimental modeling of mental disorders helps revealing mechanisms of the diseases and identifying effective methods of their treatment. The aim this study was to develop a new model of schizophrenia by oral Levodopa + Carbidopa (LC) administration. It was found that introduction of LC to rats induced a significant reduction of emotional reactions, hypersensitivity to a sound, a decreased exploratory activity and stereotype behavior, locomotor hyperactivity in some rats. It is concluded that LC introduction to rats may be used as an alternative dopaminergic animal model of schizophrenia.

[Principles of diagnosis and treatment of tinnitus]. / Printsipy diagnostiki i lecheniya shuma v ushakh.

Tinnitus is one of the most common otological symptoms and can be defined as the conscious perception of sound lasting more than 5 minutes in the absence of an external auditory stimulus. Based on the review of articles, a comparative analysis of modern methods of diagnosis and treatment of tinnitus was carried out in order to substantiate the most effective and promising algorithms for providing care to patients. Diagnosis of tinnitus includes taking anamnesis, assessing the severity of tinnitus using questionnaires, otoscopy, hearing examination, and performing additional tests. In case of secondary murmur, etiotropic therapy should be started as soon as possible to prevent hearing loss and other complications. For primary noise, the most effective treatments are cognitive-behavioral therapy, tinnitus maskers and sound therapy, transcutaneous electrical stimulation, and biofeedback. Magnetic stimulation, invasive neuromodulation, drug therapy have a lower level of effectiveness and evidence base.

[Impact of antidiabetic therapy on the risk of cardiovascular diseases and their complications in patients with type 2 diabetes mellitus].

In Russia, diabetes mellitus afflicts 8 million people, 90% of them had type 2 diabetes mellitus (T2DM) and this figure is growing steadily. At the same time there is a rise in the incidence of macrovascular events (unstable angina pectoris, myocardial infarction). Coronary heart disease and its attack are a major cause of death in the developed countries, including Russia. To prevent chronic complications of DM is likely to be the most urgent task of not only modern diabetology, but also medical science as a whole. In this connection, of great value are the results of a few large international randomized controlled studies, the main objective of which was to evaluate the impact of the rate of blood glucose control on the incidence and outcomes of cardiovascular diseases in patients with T2DM

[Study of capability for recognition of complex visual stimuli of different quantities in the lower monkeys].

Capability of monkeys for identification of quantitative signs has been studied at recognition and comparison of two- and three-dimensional objects in quantities from 1 to 8. The work was carried out on two species of the low monkeys: rhesus macaque (Macaca mulatta) and brown capuchins (Cebus apella). The studied representatives of the monkeys have been established to be able to differentiate planar images and casts of cherries in various quantity combinations from 1 to 8 and to identify identical signs of visual stimuli. The obtained data indicate the ability of monkeys to abstract and to form preverbal notions of quantitative signs of objects.

[Complex behavior forms in the lower monkeys in the process of identification of quantitative signs of visual stimuli].

Complex behavior forms and the ability of monkeys to recognize and to compare by identity the two-dimensional images and three-dimensional objects of various colors in the amount from 5 to 9 were studied. The study was carried out on two species of the lower monkeys of different levels of phylogenetic development: on rhesus monkeys (Macaca mulatta) and on brown capuchins (Cebus apella). It has been established that the representatives of the studied monkey species are able to differentiate large counted multitudes of two-dimensional (images of squares) and three-dimensional (objects of round shape) stimuli of red, yellow, and green colors in different quantitative rations--from 5 to 9 at solving modifications of tasks of the type "choice by the sample". In the course of learning, species-related differences of the monkeys' behavior are revealed. The brown capuchins managed solving all tasks and their combinations better than rhesus monkeys. The obtained data indicate the capability for recognition of counted multitudes (from 5 to 9) regardless of color of the stimuli and the existence of quantitative notions, of the idea of "quantity" in the lower monkeys.

[Intellectual activity during formation of quantitative concepts in the lower and higher monkeys].

Results of study of formation of quantitative concepts in the lower and higher monkey are presented. Various authors used different methods of study of this issue. It has been established that not only the higher primates, such as chimpanzee and orangutans, but also the lower ones--macaques, capuchins, squirrel monkeys--have the "mathematical capabilities". The detailed study of formation of quantitative concepts in primates of different levels of phylogenesis allows disclosing mechanisms of formation of this function in human.