[Surgical treatment of eloquent brain area tumors using neurophysiological mapping of the speech and motor areas and conduction tracts]. / Khirurgicheskoe lechenie opukholei funktsional'no znachimykh zon golovnogo mozga s primeneniem metoda neirofiziologicheskogo kartirovaniya rechevykh, motornykh zon i provodyashchikh putei.

AIM: To evaluate the efficacy of intraoperative neurophysiological mapping in removing eloquent brain area tumors (EBATs). MATERIAL AND METHODS: Sixty five EBAT patients underwent surgical treatment using intraoperative neurophysiological mapping at the Pirogov National Medical and Surgical Center in the period from 2014 to 2015. On primary neurological examination, 46 (71%) patients were detected with motor deficits of varying severity. Speech disorders were diagnosed in 17 (26%) patients. Sixteen patients with concomitant or isolated lesions of the speech centers underwent awake surgery using the asleep-awake-asleep protocol. Standard neurophysiological monitoring included transcranial stimulation as well as motor and, if necessary, speech mapping. The motor and speech areas were mapped with allowance for the preoperative planning data (obtained with a navigation station) synchronized with functional MRI. In this case, a broader representation of the motor and speech centers was revealed in 12 (19%) patients. During speech mapping, no speech disorders were detected in 7 patients; in 9 patients, stimulation of the cerebral cortex in the intended surgical area induced motor (3 patients), sensory (4), and amnesic (2) aphasia. In the total group, we identified 11 patients in whom the tumor was located near the internal capsule. Upon mapping of the conduction tracts in the internal capsule area, the stimulus strength during tumor resection was gradually decreased from 10 mA to 5 mA. Tumor resection was stopped when responses retained at a stimulus strength of 5 mA, which, when compared to the navigation data, corresponded to a distance of about 5 mm to the internal capsule. Completeness of tumor resection was evaluated (contrast-enhanced MRI) in all patients on the first postoperative day. RESULTS: According to the control MRI data, the tumor was resected totally in 60% of patients, subtotally in 24% of patients, and partially in 16% of patients. In the early postoperative period, the development or aggravation of a motor neurological deficit was detected in 18 patients: worsening of paresis was observed in 11 patients, and worsening of speech disorders occurred in 7 patients. After 4 months, motor and speech disorders regressed in 10 patients. Therefore, a persistent neurological deficit developed after surgery in 8 (12%) patients (motor deficit in 5 cases; speech deficit in 3 cases). CONCLUSION: Resection of eloquent brain area tumors using intraoperative neurophysiological monitoring enables complete resection of the tumor at a low risk of persistent neurological deficits, which ultimately improves the patient's life prognosis.

[Assessing the impact of citicoline on the efficiency of rehabilitation measures in patients with ischemic stroke].

OBJECTIVE: To evaluate the effect of citicoline on the efficacy of rehabilitation measures in patients with ischemic stroke (IS). MATERIAL AND METHODS: Sixty patients were examined in the acute period of hemispheric IS. All patients underwent routine comprehensive treatment. The study group included 30 patients who received citicoline within the first 24 hours after IS onset. The control group consisted of 30 patients who were not treated with citicoline. The examination of patients included the assessment of neurological deficit, cognitive functions, P300 evoked potentials, head single photon emission computed tomography. RESULTS: Six months after the onset of disease, there was a significant improvement in cognitive functions as assessed with the MMSE and MoСa scale, and P300 latency in the main group. There was a trend towards the improvement in the activities of daily living (Barthel index) in patients of the main group compared to the control group. SPECT results showed the improvement in cerebral perfusion in an affected hemisphere: in Broca's area, the rear sections of the upper and middle frontal gyrus, the parietal lobe (p <0,05). CONCLUSION: Citicoline significantly improves cognitive function, which in turn has a positive effect on the efficacy of remediation and indirectly improves cerebral perfusion in patients with hemispheric IS.

[Melatonin in the correction of sleep in post-stroke patients].

AIM: To assess an effect of melatonin on quality of life and effectiveness of rehabilitation in patients with ischemic stroke (IS) suffered from insomnia due to sleep initiation disturbance. MATERIAL AND METHODS: Sixty post-stroke patients with insomnia were stratified into two groups matched for characteristics assessed in the study. Patients of the main group received melatonin during 21 days. In the first three days after admission and 21 days after the first examination, we administered the MMSE, the Rankin scale, FOSQ, NIHSS, EuroQol, the Epworth sleepiness scale (ESS) and used instrumental methods of examination (computed and magnetic-resonance tomography, electroencephalography, polysomnography). RESULTS: After 3 weeks, there was a reduction (p<0.05) in ESS scores in the main group compared to the control group (5.7 and 10 scores, respectively). Significant between-group differences were identified for polysomnographic parameters: latency to sleep was 17.8 min in the main group and 20.5 min in the control group (p<0.05), the number of microactivations was 15 and 18, respectively (p<0.05). There was a trend towards more rapid recovery in the main group (on average 8.4 days) compared to the control group (10.2 days), but the differences did not reach the level of statistical significance p<0.05. CONCLUSION: Melatonin reduced sleepiness (measured with the ESS), latency to sleep and number of wakings (microactivations) and was likely to promote the recovery in IS patients with insomnia due to sleep initiation disturbance.

[Treatment of sleep disorders in patients with mild cranial-brain injury in the early rehabilitation period].

OBJECTIVE: To study the effect of melatonin (melaxen) on sleep disorders in patients with mild cranial-brain injury (CBI) in the early rehabilitation period. MATERIAL AND METHODS: Sixty patients were randomized to equal groups treated or not treated with melaxen. Along with neurological and somatic examination, polysomnography and scales for measurement depression and quality of life ( ESS, BDI, EuroQol etc) were used. RESULTS AND CONCLUSION: Melatonin improved sleep (sleep latency, number of wakings per night etc) and decreased the severity of depression in the early rehabilitation period after mild CBI. Further research is needed to fully understand the effect of melatonin on sleep disorders in CBI, in particular in its later stages.

An experimental test of the fractal model for drainage of foam films.

Drainage of foam films with different radii (50-150 µm), stabilized by hexathylene glycol dodecyl ether C(12)E(6) and in a presence of 0.024 M NaCl, were analyzed in the light of a recent dynamic fractal classification of [1]. The latter accounts for the effect of film surface corrugations developed during the film drainage. For simplicity, the film surface mobility is neglected since the presence of surfactants reduces dramatically the film surface velocity. The magnitude of surface non-homogeneities, caused by the film drainage, is accounted via a dynamic fractal dimension parameter α being spanned between zero and two. Depending on the α-value the film drains by different kinetic laws. For example, if the thin film is planar α=2 and it drains according to the Reynolds law; if α=1 the film contains an axisymmetric dimple causing faster drainage; if α=1/2 the film exhibits number of asymmetric dimples and the film drains even faster; finally if α=0 the film contains spatially uncorrelated domains causing the fastest possible drainage. The present analysis of experimental data suggests that the parameter α is inversely proportional to the film radius R and it is independent of the type and concentration of surfactants. A semi-empirical model for α is proposed, thus completing the generic dynamic fractal classification.

[Risk factors for metabolic syndrome in workers exposed to vibration].

The study covered prevalence of metabolic syndrome and its risk factors among mining and machinery industry workers. Reliably higher incidence of metabolic syndrome was revealed in workers exposed to vibration, when compared with the reference group. The authors calculated relative risk of metabolic syndrome development after exposure to the factor studied.