[Failed back surgery syndrome: the role of central sensitization and treatment approaches]. / Sindrom neudachnoi operatsii na pozvonochnike: rol' tsentral'noi sensitizatsii i podkhody k lecheniyu.

OBJECTIVE: To study a role of central sensitization (CS) in patients with Failed Back Surgery Syndrome (FBSS) after decompression of the lumbar and/or sacral roots. MATERIAL AND METHODS: The study included three groups of patients: 1) early FBSS (e-FBSS, n=23), pain after surgery decreased, but continued to significantly bother the patient, or recurred in the first 6 months after surgery; 2) middle FBSS (m-FBSS, n=42), pain after surgery completely stopped, but recurred within 6-12 months; 3) late FBSS (l-FBSS, n=31), if pain relapse occurred more than 12 months later. Neurological status assessment, study of muscle trigger zones (MTZ), postoperative scar trigger zones (TZS), pain assessment according to the Visual Analogue Scale (VAS), CS assessment according to the Russian version of the Central Sensitization Inventory (CSI) were performed. Treatment included the following stages: stage 1 (non-steroidal anti-inflammatory drug (NSAID) meloxicam 15 mg 7 days); stage 2 (aminophenylbutyric acid hydrochloride (APAH) 250 mg 3 times a day 14 days); stage 3 (fluvoxamine 50 mg daily 8 weeks); stage 4 (MTZ and TZS treatment, fitness program). In addition to the previously described 96 patients, 15 patients (4 men and 11 women, aged 36-47 years) with FBSS and widespread pain, corresponding to the criteria for fibromyalgia ACTTION-APS Pain Taxonomy, who took only milnacipran 25-50 mg daily for two months (WSP-FBSS group), were studied. RESULTS: At baseline, CSI and VAS are as follows: CSI=72.2±6.5; VAS=58.5±8.8 in the e-FBSS group; CSI=49.2±9.0; VAS=39.5±5.3 in the m-FBSS group; CSI=18.1±5.9; VAS=18.1±5.4 in the l-FBSS group. All patients have active MTZ and TZS. The differences between MTZ and TZS subgroups were in the reproduction of pain - the appearance of pain characteristic of the patient during stimulation (pressure) of the MTZ or TZS. In the e-FBSS group, there is the low efficacy of NSAIDs, the moderate efficacy of APAH, the high efficacy of fluvoxamine. In the m-FBSS group, the moderate efficacy of NSAIDs and APAH and the high efficacy of fluvoxamine are observed. In the l-FBSS group, there is the high efficacy of NSAIDs. In the WSP-FBSS group, VAS and CSI are 58.8±9.2 mm and 75.1±8.04, respectively, before treatment, 15.51±5.1 mm (p=0.00032) and 25.6±8.2 (p=0.0002), respectively, after 2 months of treatment. CONCLUSIONS: In patients with FBSS, MTZ and TZS should be treated taking into account CS. The study shows the efficacy of APAH, fluvoxamine and milnacipran in the presence of CS.

[A comparative study of the efficacy and safety of the eyebrow supraorbital approach in cerebral aneurysm surgery]. / Sravnitel'noe issledovanie éffektivnosti i bezopasnosti transbrovnogo supraorbital'nogo dostupa v khirurgii anevrizm golovnogo mozga.

OBJECTIVE: The study objective was to compare the efficacy and safety of supraorbital eyebrow (SEA) and pterional (PA) approaches in surgery of anterior circle of Willis (ACW) aneurysms and to determine the advantages and disadvantages of SEA in aneurysm clipping. MATERIAL AND METHODS: The analysis included 166 patients with ACW aneurysms aged 18 to 70 years who were treated in the Neurosurgery Department of the Interregional Clinical Diagnostic Center (Kazan) in the period from 2013 to 2016. At the first stage of the study, factors affecting surgical outcomes were compared (by using the Glasgow outcome scale (GOS)) in subpopulations of patients operated on using SEA (n=49) and PA (n=117). At the second stage, we compared the efficacy and safety of approaches using a case-control subanalysis in appropriate subgroups of the SEA (n=37) and PA (n=37) groups. The subgroups were comparable in the following factors: gender, age, severity of subarachnoid hemorrhage (SAH) on (Fisher scale), severity of the patient's condition (Hunt-Hess scale), size and location of the aneurysm, surgery duration, intraoperative aneurysm rupture (IOAR), amount of blood loss, rate of frontal sinus surgery, rate of nasal CSF leak, rate of intraoperative and postoperative complications, hemorrhagic and ischemic complications according to postoperative CT, patient's satisfaction with the cosmetic result of surgery (visual analogue scale - VAS), and treatment outcomes (GOS). Treatment outcomes (GOS) and patient's satisfaction with the cosmetic result of surgery (VAS) were considered as the efficacy parameters. The safety parameters included the amount of blood loss, rate of frontal sinus surgery, rate of nasal CSF leak, and rate of intraoperative and postoperative (hemorrhagic and ischemic) complications. RESULTS: At the first stage of the study, we found that the amount of intraoperative blood loss in the subpopulation of patients with ACW aneurysms who were operated on using SEA was statistically significantly less than that in the PA group (p=0.0000002). In the postoperative period, patients who underwent surgery using SEA less frequently experienced neurological deficit (p=0.003), less frequently developed first epileptic seizures (p=0.035), and had a lower rate of hemorrhagic complications (p=0.003) and better treatment outcomes (GOS) (p=0.01). Comparison of appropriate subgroups in the SEA and PA groups, which were selected according to the case-control methodology and were comparable in the main factors affecting treatment outcomes, confirmed statistically significantly lower blood loss for SEA (p=0.0000002) than for PA. Compared to the SEA group, the PA group was characterized by more frequent, but not statistically significantly different, IOAR (p=1), postoperative worsening of neurological deficit (p=0.115), newly developed epileptic seizures (p=0.493), and hemorrhagic complications (p=0.0557). There were no deaths in both groups. In the SEA group, the treatment outcome was scored 4 and 5 (GOS, favorable outcome); in the PA group, the treatment outcome was scored 3 (GOS) in 2 (5.4%) patients and 4 or 5 in 35 (94.6%) patients (p=0.063). The mean subjective score of satisfaction with the treatment result (VAS) in the SEA group was significantly higher (9.4±1) than in the PA group (8.8±1; p=0.01). CONCLUSION: SEA is an adequate approach for clipping ACW aneurysms, in particular ACA-AComA and MCA aneurysms, which is as effective and safe as the pterional approach.

[A supraorbital trans-eyebrow approach in surgery of chiasmatic-sellar and anterior cranial fossa tumors]. / Supraorbital'nyi transbrovnyi dostup v khirurgii opukholei khiazmal'no-selliarnoi oblasti i perednei cherepnoi iamki.

OBJECTIVE: to analyze 31 resections of chiasmatic-sellar region (CSR) and anterior cranial fossa (ACF) tumors using the supraorbital trans-eyebrow approach (STA). MATERIAL AND METHODS: We analyzed medical histories of 31 patients who underwent tumor resection using STA in the period between October 2013 and April 2017. We analyzed the age and gender of patients, size and location of the tumor, presence of a neurological deficit, vision and olfactory functions before and after surgery, surgery duration, amount of intraoperative blood loss, rate of frontal sinus trephination and nasal liquorrhea, hemorrhagic and ischemic complications after surgery, Simpson grade of tumor resection, patient's condition before and after surgery (Glasgow Outcome Scale and Karnofsky Scale), and degree of patient satisfaction with the cosmetic result of surgery. A total of 26 meningiomas (20 sphenoid plate, tubercle, and diaphragm tumors, 3 lesser sphenoid wing meningiomas, 2 orbital roof tumors, and 1 anterior clinoid process meningioma), 3 frontal lobe gliomas, and 2 pituitary adenomas were resected. RESULTS: In all 31 operations, the approach was adequate and enabled tumor resection without lethal outcomes. The mean surgery duration was 174.6±64.4 min. The mean blood loss was 190±96.6 mL (50-380 mL). After surgery, none of the patients developed motor deficits and new epileptic seizures. Neurological deficit aggravation in the form of impaired vision and mental disorders occurred in 8 (25.8%) patients. Vision impaired in 4 (12.9%) patients, improved in 6 (19.3%) patients, and remained unchanged in 21 (67.7%) patients. An endocrinological deficit in the form of partial hypopituitarism developed in 3 (9.6%) patients; in 4 (12.9%) patients, there were mental disorders that regressed by the end of the first month of therapy. There were no intracerebral and subarachnoid hemorrhages. In 2 (6.4%) patients, small epidural hematomas were diagnosed, which did not require surgical treatment. There were only good outcomes (a GOS score of 4 or 5). After surgery, the median Karnofsky index in the STA group was 90±7. In all 31 (100%) patients, the postoperative wound healed by primary intention, without infectious complications and wound liquorrhea. One (4%) patient developed eyebrow palsy; 3 (12%) patients had hypoesthesia in the supraorbital region. The mean VAS score of patient satisfaction with the cosmetic result was 9.36 (median 10±1). The mean follow-up period was 16.2±13.5 months (2-38 months). CONCLUSION: The STA is adequate for removal of CSR and ACF tumors under proper selection of patients. It provides an adequate view of anatomical structures and enables successful tumor resection through a less traumatic access.

[The prevention and treatment of nasal liquorrhea in transnasal surgery of the base of the skull]. / Profilaktika i lechenie nazal'noĭ likvorei v transnazal'noĭ khirurgii osnovaniia cherepa.

The objective of the present study was to estimate the effectiveness of different methods for the reconstruction of defects in the base of the skull. It was shown that the use of the modern technique for this purpose decreases the risk of the development of postoperative complications. The vascularized flaps can be applied to hermetically close defects in the base of the skull during surgery with the use of the extended transnasal approach. It is concluded that the proposed procedure accelerates the healing process and allows the flaps to be used repeatedly if necessary.

[Failed back syndrome in patients after the surgery for compressive lumbosacral radiculopathy].

A study of 80 patients after the surgery for compressive lumbosacral radiculopathy revealed that myogenic trigger zones and skin zones of hyperalgesia in lumbar and low extremities on the side of radicular compression and the contralateral side were formed before the surgery. Trigger zones remained in the latent state after the surgery in 33 patients who had no anxiety and depressive symptoms before the operation. These zones were treated with exercises (a fitness program). Symptoms of anxiety and depression that predict the relapse of pain in the post-surgery period were noted in 47 patients. The relapse of pain followed the <> in these patients but it was caused by the pain conditioned by trigger zones formed before the surgery in the insufficiency of the antinociceptive system. Moreover, an iatrogenic zone emerged in the post-surgery scar. Treatment of this group of patients should include antidepressants (velaxin), local anesthetics (novocaine, plasters with 5% lidocaine gel) and later - a fitness program.

[Primary tumors of the central nervous system in the Republic of Tatarstan: clinical epidemiology and medical care organization].

The paper provides data on the incidence of primary tumors of the central nervous system in the Republic of Tatarstan from 1991 to 2000. It also presents sociohygienic characteristics of patients with primary tumors of the brain and spinal cord. The compliance of the diagnosis and treatment of this pathology with state-of-the-art capacities is analyzed. It is concluded that patients were admitted for specialized treatment in the late phases of disease. Early diagnosis and introduction of current methods affecting a pathological process can improve the results of treatment in neurocancer patients in the republic.

[Possible configuration of dimers of Gua-Cyt bases. Computation by molecular mechanic models and density functional theory]. / Vozmozhnye konfiguratsii dimerov osnovanii DNK Gua-Cyt. Raschety metodami mekhaniki i teorii funktsional plotnosti.

The energies of interactions between guanine and cytosine in various mutual positions were calculated by the methods of molecular mechanics with refined atom-atom potential functions and the quantum mechanics theory of density functional. Both methods indicate three types of mutual positions of bases in local energy minima. These types correspond to (1) nearly coplanar base positions with intermolecular hydrogen bond formation (base pairing); (2) arrangements of two bases in nearly parallel planes one above another (base stacking); and (3) nearly perpendicular positions of base planes. According to the calculations, the global energy minimum corresponds to the Watson-Crick base pair with three hydrogen bonds. A specific feature of the pair is a transition from many positions of type (2) to positions of type (1) without any energy barrier. This feature is revealed by both methods. Another special feature of this pair is a deviation, for most of mutual base positions, of the amine group atoms from the ring plane, the deviation being more pronounced for Gua. These features are important for understanding the conformational behavior of DNA fragments and the RNA structure.

A study of the hydration of deoxydinucleoside monophosphates containing thymine, uracil and its 5-halogen derivatives: Monte Carlo simulation.

An extensive Monte Carlo simulation of hydration of various conformations of the dinucleoside monophosphates (DNP), containing thymine, uracil and its 5-halogen derivatives has been performed. An anti-anti conformation is the most energetically stable one for each of the DNPs. In the majority of cases the energy preference is determined by water-water interaction. For other dimers conformational energy is the most important factor, or both the factors are of nearly equal importance. The introduction of the methyl group into the 5-position of uracil ring most noticeably influences the conformational energy and leads to the decrease of its stabilizing contribution to the total interaction energy. The introduction of halogen atoms increases the relative content of anti-syn and syn-anti conformations of DNPs as compared to the parent ones due to the formation of an energetically more favorable water structure around these conformations. A correlation is observed between the Monte Carlo results for the halogenated DNPs and their experimental photoproduct distribution. The data obtained demonstrates a sequence dependence in the photochemistry of the halogenated dinucleoside monophosphates.

Protein-nucleic acid recognition: simulation of base and "model" amino acids complexes in DMSO by the Monte Carlo method.

A computer simulation of guanine (G), cytosine (C), the G-C base pair, protonated C (CH+), acetic acid in neutral (AcOH) and deprotonated (AcO-) forms, G-AcO-, C-AcOH, and CH(+)-AcO- complexes, solvated in DMSO was carried out by the Monte Carlo method. It is shown that the G-C base pair formation in DMSO is energetically favorable. The G-AcO- complex formation is comparable with the formation of G-C base pair in energetically favorability. In this case the acetate anion can replace C in the G-C base pair. The formation of the C-AcOH complex is much less favorable than the formation of the G-C pair. However proton transfer from AcOH to C leads to the formation of the CH(+)-AcO- complex, which is the most favorable of all complexes studied. Here the acetic acid can replace G in a G-C base pair. The formation of G-AcO- and CH(+)-AcO- specific complexes detected in DMSO with the help of experiment and theory is a competitive process with respect to the formation of G-C base pairs, and can be considered the primary step in the real mechanism of protein-nucleic acid recognition.

The study of the stability of Watson-Crick nucleic acid base pairs in water and dimethyl sulfoxide: computer simulation by the Monte Carlo method.

An extensive computer simulation of nucleic acid bases and Watson-Crick base pairs in a water cluster and DMSO cluster is performed by the Monte Carlo method. It is demonstrated that the unfavorable energetics of pair formation in a water cluster is determined by the significant destabilizing contribution of solvent to the energy of complex formation. It is shown that the formation of coplanar base pairs in a DMSO cluster is favorable. The DMSO cluster stabilizes A-U and A-T base pairs and the insignificant destabilization of the G-C base pair by a DMSO cluster is much less than the stabilization which occurs due to the attraction between bases.

Theoretical investigation of excimer and exciplex states of uracil and halogen derivatives: effect of nonparallelism of bases.

Theoretical modeling of initial steps of the photodimerization mechanism of uracil, 5-methyl-and 5-halogen derivatives was performed. The interaction energy of bases in stacked dimers in the ground and lowest excited states was calculated as a function of the distance between the base planes and of the rotation angles within the perturbation theory for the extended Hückel treatment. The existence of excimer and exciplex region on the potential surface of the excited state was revealed. The excimer (exciplex) geometry has the planes nonparallel with more close contact of the C5-C6 bonds as compared to the ground state of dimers. The results provide new information useful for understanding the photodimerization mechanism of bases and testifies that the singlet excimer state can be a precursor of the photodimerization reaction.

[The effect of dimephosphon on the cerebral circulatory regulation system in patients with brain tumors]. / Vliianie dimefosfona na sistemu reguliatsii tserebral'nogo krovoobrashcheniia u bol'nykh s opukholiami golovnogo mozga.

The paper provides the results of studies of the effects produced by the new vasoactive agent Dimephosphone, which normalizes the function of the nervous system, on the performance of the regulatory mechanisms responsible for the circulatory provision of chemical and physical homeostasis of the brain in patients with cerebral neoplasms. A five-day course of Dimephosphone monotherapy was demonstrated to normalize the cerebral circulatory regulatory system in the preoperative period. Preoperative Dimephosphone normalization of the regulatory mechanisms of cerebral circulatory provision ensures the tolerance of the cerebral circulatory system to intraoperative injury. The drug used in the course treatment of patients accelerates the normalization of cerebral vascular responsiveness at the site of surgical intervention.

[The effect of dimephosphon, sermion and piracetam on the reactivity of the cerebral vessels, on local cerebral blood flow and on oxygen tension in brain tissue]. / Vliianie dimefosfona, sermiona i piratsetama na reaktivnost' mozgovykh sosudov, lokal'nyi mozgovoi krovotok i napriazhenie kisloroda v tkani golovnogo mozga.

The paper gives the results of experimental and clinical studies of the nootropic agents dimephosphone, sermion, and piracetam on local cerebral circulation, cerebrovascular responsiveness and O2 tension. The vasoactivity of the parameters studied has been shown to be displayed by their ability to normalize cerebrovascular responsiveness and it is associated with decreased brain tissue oxygen consumption when dimephosphone is applied and with its increased one when sermion and piracetam are used.

[The strength of the elements of the human spinal column and the problems of the etiology, pathogenesis and principles of the treatment of degenerative spinal lesions]. / Prochnost' élementov pozvonochnogo stolba cheloveka i nekotorye voprosy étiologii, patogeneza i printsipov lecheniia degenerativnykh porazhenii pozvonochnika.

The study was made of strength characteristics of the vertebra and intervertebral disks of moving parts of human spine in postembryonic ontogenesis. The authors have obtained statistically significant data on degenerative dystrophic changes and lesions of human spine. Pathogenetic issues, conservative and surgical treatment policies in degenerative lesions are considered. The authors hold, that osteochondrosis is not the right term to denote degenerative lesions of the spine.

[Sensitivity of biological objects to the effects of the geomagnetic field]. / O chuvstvitel'nosti biologicheskikh ob''ektov k vozdeistviiu geomagnitnogo polia.

It is shown on the basis of calculations of energy sublevels of the hyperfine structure that the effect of the geomagnetic field upon the impurity atoms in the volume of living cells should be considered in relation to the value of geomagnetic field induction pulses delta B. When delta B > or = 10 pT and the dielectric constant epsilon > or = 10, magnetodipole transitions between sublevels of the hyperfine structure within one term are possible in impurity atoms in their 2P-state. During magnetic storms with delta B > or = 100 nT magnetodipole or magnetoquadrupole forced transitions from 2P1/2 and 2P3/2 states to 2S1/2 metastable state are possible in the resonant zones formed by intersection of hyperfine energy sublevels of the corresponding excited levels.

[The control of the regulatory system of intracranial blood circulation in neurosurgical patients]. / Kontrol' sistemy reguliatsii vnutricherepnogo krovoobrashcheniia u neirokhirurgicheskikh bol'nykh.

The authors suggest the principles of evaluation of the condition of the system regulating the circulatory provision of cerebral physical and chemical homeostasis, as well as a measurement complex and a set of instrumentally recorded values for control over the cerebral arteries' and veins' response to unified loads of physical and chemical nature in patients with neurosurgical pathology. The scientific and practical significance of such an approach to evaluation of cerebral blood circulation is reasoned by the results of accumulated experience in controlling the activity of some regulations of circulatory provision of the brain in healthy females and males differing in age and in 114 patients with brain tumors.

A Monte Carlo simulation of hydration of xanthine-derivatives and their stacked forms.

Results on a Monte Carlo simulation of the hydration of monomer and possible stacked dimer forms of a purine alkaloid series in 200- and 400-water molecule clusters are presented. Investigation of different purine stacked dimers in a 200-water molecule cluster reveals that for caffeine there exists one, for theophylline two and for theobromine four dimers are energetically favorable. For caffeine, the same energetically favored stacked dimer form is observed in both the 200- and 400-water molecule cluster. The main factor stabilizing the preferred dimer stacks is the change in the interaction between water molecules of the monomer cluster and those water molecules in the dimer cluster.

Hydration of uracil and thymine methylderivatives: a Monte Carlo simulation.

The simulation performed shows that under methylation of uracil and thymine NH-groups the interaction energy between a base and water (Uwb) is increased. It is also detected that the increase in this energy was observed in the 1st and the 3rd sectors. These conclusions do not confirm the assumption made in the literature on the character of an interaction between methylated bases and water. According to this assumption, when the NH-groups are methylated, the energy of Uwb in these sectors decreases as a result of the van der Waals interactions between a methyl group and water, whose energy compensates the increase in the Uwb energy due to the breaking of an H-bond. Regularity of water molecules near a hydrophobic group under the hydration of polar molecules is detected for the first time.

[The role of sensitive bacteria in determining the count of phage negative colonies on solid growth media]. / Rol' chuvstvitel'nykh bakterii v opredelenii chisla negativnykh kolonii faga na plotnykh pitatel'nykh sredakh.

The purpose of the work was to study how the number of phage negative colonies on a solid growth medium depended on the concentration of a sensitive bacterial strain. For the system of phage lambda and a sensitive E. coli cell, the number of negative colonies was maximal at a concentration of ca. 4 X 10(8) cells/ml.