[Risk factors for de novo generalized tonic-clonic seizures in patients with supratentorial meningiomas after neurosurgical treatment]. / Faktory riska razvitiya generalizovannykh toniko-klonicheskikh epilepticheskikh pristupov de novo u patsientov s supratentorial'nymi meningiomami posle neirokhirurgicheskogo lecheniya.

OBJECTIVE: To identify risk factors for de novo epileptic seizures in the early postoperative period in patients with supratentorial meningiomas. MATERIAL AND METHODS: A retrospective case-control study was conducted in a ratio of 3 to 1. The case histories of all patients with supratentorial meningiomas that met the inclusion and exclusion criteria, who underwent surgical removal of the neoplasm in 01.01.17 to 12.31.20, were studied in the neurosurgical department of the Research Institute of Emergency Medicine named after N.V. Sklifosovsky. Of 133 patients without epileptic seizures and a history of taking antiepileptic drugs before surgery, 10% (n=14) had a de novo generalized tonic-clonic seizure in the early postoperative period. Among the remaining 119 patients, 42 patients were selected to form the control group, similar in age, localization and volume of the tumor with patients in the main group. In all patients, the clinical condition, the results of preoperative and postoperative neuroimaging with contrast enhancement, the course of the intraoperative period, as well as the duration and outcomes of hospitalization were assessed. RESULTS: The risk factors for the development of de novo seizures were an increase in the volume of cerebral edema compared with the preoperative one according to postoperative CT data and the development of hemorrhagic transformation of cerebral edema. CONCLUSION: A prospective study is needed to determine risk factors for de novo seizures and determine prophylactic treatment.

The use of epidural spinal cord stimulation in patients with chronic disorders of consciousness - neuroimaging and clinical results.

OBJECTIVE: Chronic disorders of consciousness are considered as a serious unresolved problem complicated by significant medical, social, and economic burden. Therefore, improving the conditions and facilitating the rehabilitation management of these patients is of particular interest. In recent years, interesting results of the use of spinal cord stimulation in patients with chronic disorders of consciousness appeared in the world literature, which makes the use of this technique promising in this category of patients. PATIENTS AND METHODS: We analyzed the results of high cervical spinal cord stimulation, both, in tonic and "Burst" modes, in 21 patients with chronic disorders of consciousness and severe spasticity managed in the last two years in FRCC ICMR. In 9 of them pre- and post-stimulation fMRI before and right after the stimulation was also performed for brain functional connectivity assessment. RESULTS: Improvement of the consciousness level was observed in 38.1% (n = 8) and a decrease in spasticity was obtained in 52.4% (n=11) of the patients. The difference in CRS-R score before and after spinal cord stimulation was statistically significant (p=0.028). The fMRI results revealed an increase in functional connectivity of the right anterior insula with several areas that are part of the Dorsal Attention, Visual and Default Mode networks after spinal cord stimulation. CONCLUSIONS: Epidural spinal stimulation at the upper cervical spine level demonstrated its effectiveness in patients with chronic diseases of consciousness of various etiology. Evaluation of the effect of specific stimulation modes requires further controlled study in larger group of patients.

Development of the Electric Vehicles Market in Russia as a Necessary Condition for Benefiting from the Global Trend towards Transport Electrification.

Growing market of electric vehicles (EV) is one of the stable trends in the modern world economy. The development of EV market in Russia is a feasible direction of economic policy, as it is a way to interest international auto concerns in developing of their business in our country, which will reduce the costs of using the results of global scientific and technological progress and create an opportunity for domestic companies to integrate into the technological chain creating added value. The phased development of the electric car market should include three successive stages: 1) subsidizing pioneering use, when demand is provided by specialized support measures; 2) transition to mass use, when all elements of the market (demand, supply, and state support measures) are shifted towards the mass distribution of electric vehicles; 3) free market and reaping benefits from transport electrification. The most critical is the successful completion of the first stage, which requires the construction of a minimum sufficient charging infrastructure in large cities and key highways of the country as well as bringing annual sales to 40 000 new electric vehicles.

[Features of assessing the quality of medical care for patients with chronic heart failure of older age groups (review).]

The review presents a literature analysis on the quality of medical care in general and the criteria for their assessment. The main discussion is conducted in several areas: what indicators are currently available; which of them can be used in elderly and senile age groups; what indicators should be used in this category of patients. Based on the review, it should be concluded, that the existing quality indicators do not reflect the specifics of providing care to elderly and senile people with chronic heart failure. It is concluded, that many issues have not yet been resolved and further research is needed on this issue. In our opinion, the assessment of the quality of medical care for chronic heart failure, primarily in elderly and senile patients, should be carried out taking into account age characteristics and using additional quality indicators, which should be introduced in a separate paragraph in the profile order.

Oxidative Damage of Proteins Precedes Loss of Cholinergic Phenotype in the Septal Neurons of Olfactory Bulbectomized Mice.

BACKGROUND: The development of cholinergic deficit is considered an early sign of a number of pathological conditions, including Alzheimer's disease. Cholinergic dysfunction underlies cognitive decline associated with both normal aging and Alzheimer's disease. OBJECTIVE: Here, we studied a possible mechanism of functional impairment of cholinergic neurons using an olfactory bulbectomy model. METHODS: Male mice were subjected to olfactory bulbectomy or sham surgery. Three weeks after that they were trained in Morris water maze and then euthanized one month after surgery. The cholinergic indices as well as the indices of oxidative stress were studied using immunohistochemistry, western blot and ELISA. Gene expression was studied using RT-qPCR. RESULTS: The experimental treatment was followed by impaired learning of a standard spatial task in a water maze. This was associated with a decrease in the number of cells containing choline acetyltransferase (ChAT), in relation to total number of neurons in the medial septum and lower ChAT enzymatic activity in the hippocampus. However, the levels of mRNAs of ChAT, vesicular ACh transporter and acetylcholine esterase remained unchanged in bulbectomized mice compared to sham-operated animals. These alterations were preceded by the accumulation of protein-bound carbonyls, indicating oxidative damage of proteins, whereas oxidative damage of nucleic acids was not detected. CONCLUSION: We assume that in olfactory bulbectomy model, oxidative damage of proteins may cause cholinergic dysfunction rather than irreversible neuronal damage. These data indicate that cholinergic neurons of the basal forebrain are very sensitive to oxidative stress, which may be responsible for the appearance of early cognitive decline in Alzheimer's disease.

[Study of the clinical efficacy and safety of the scheme of step therapy of nonsteroidal anti-inflammatory drugs and a complex of B vitamins in patients with low back pain]. / Issledovanie effektivnosti i bezopasnosti stupenchatoi terapii nesteroidnymi protivovospalitel'nymi preparatami i vitaminami gruppy B u patsientov s ostroi dorsalgiei.

OBJECTIVE: The purpose of the study. Comparison of efficacy and safety of treatment with Texared/Neurobion and Amelotex/Milgama in patients with acute dorsalgia. MATERIAL AND METHODS: An open, observational, retrospective - prospective study involved 70 patients with acute lumbar dorsalgia. Two groups of 35 patients were formed, who were prescribed step therapy with Texared and Neurobion (group 1) and Amelotex and Milgamma (group 2). The groups of patients are comparable by gender (in group 1 - 25 (71%) women, in group 2 - 24 (69%), the average age is 50.1±10.5 and 52.8±12.0 years, respectively. The groups are comparable in the nature and severity of clinical symptoms, but not homogeneous in the nature of concomitant diseases. RESULTS AND CONCLUSION: In two groups, there was a comparable improvement in the condition after treatment according to the Oswestry and Roland-Morris questionnaires, an increase in the quality of sleep by the 10th day of observation. In the 1st group, the decrease in pain syndrome by VAS is more pronounced: by the 3rd visit, the decrease is 7.5 points more than in the 2nd group (p<0.05). In group 1, by the 2nd visit, the median pain intensity for VAS decreased by 10 points (p<0.05), by the 3rd - by 30 points (p<0.05). In group 1, the improvement in general well-being according to the assessment of the patient and the doctor was more pronounced (p<0.05). Evaluation of the effectiveness of both types of therapy demonstrated comparable results, both in the opinion of the doctor and in the opinion of the patient. The results of treatment in both groups are comparable in terms of satisfaction with treatment and ease of use according to the patient's assessment. In group 1, there was less pain of intramuscular administration of the drug. 32 (91%) patients of group 1 positively assessed the convenience of using the proposed treatment regimen. No significant adverse events were detected in the two groups.

[Psychometric properties of the Russian version of the brief «Reasons for Living Inventory¼]. / Psikhometricheskie svoistva russkoyazychnoi versii «Kratkogo oprosnika prichin dlya zhizni¼.

OBJECTIVE: To investigate psychometric properties of the Russian version of the brief Reasons for Living Inventory (bRFL) in patients with non-psychotic mental disorders (NPMD) and to define its association with current suicide ideation. MATERIAL AND METHODS: Six hundred and 15 consecutive patients with NPMD were included. The median age was 27 (19) years; 403 (65.5%) were female. Cronbach's alpha, Cronbach's alpha coefficient if an item is deleted and corrected item-total correlation were used for the internal consistency evaluation. The internal structure assessment was based on the exploratory and confirmatory factor analysis. To identify an association of bRFL with current suicidal ideation, MANCOVA was used. RESULTS: An internal consistency of bRFL was good (Cronbach's Alpha-0.856). The exploratory factor analysis revealed a 6-factor model, explaining 80.22% of variance. These factors were: «survival and coping beliefs¼, «responsibility to family¼, «child related concerns¼, «fear of suicide¼, «fear of social disapproval¼ and «moral objections¼. The confirmatory factor analysis indicated a good agreement of the 6-factor model with an empirical data (CMIN/DF - 2.98, CFI - 0.956, SRMR - 0.05, RMSEA - 0.057, PNFI - 0.497). Regardless of gender and age, the total scores of bRFL and its subscales were significantly lower in patients with suicide ideation (p<0.01). CONCLUSION: The Russian version of bRFL is a reliable and valid tool for the assessment of the adaptive beliefs and expectations that form an anti-suicidal barrier.

[Long-term postoperative outcomes in patients with drug-resistant epilepsy]. / Otdalennye rezul'taty khirurgicheskogo lecheniya patsientov s farmakorezistentnymi formami epilepsii.

Epilepsy surgery is effective in 30-82% of patients with drug-resistant epilepsy. However, risk factors of unfavorable outcomes after epilepsy surgery require further study. OBJECTIVE: To evaluate risk factors of favorable and unfavorable long-term postoperative outcomes in patients with drug-resistant epilepsy. MATERIAL AND METHODS: Postoperative outcomes in a large cohort of patients with epilepsy are reported for the first time in the Russian Federation. There were 271 patients with drug-resistant scheduled for surgery. Preoperative examination and surgical treatment were carried out between January 1, 2014 and December 12, 2019 at the Evdokimov Moscow State University of Medicine and Dentistry and Sklifosovsky Research Institute for Emergency Care. We used Engel grading system to assess postoperative outcomes after 12, 24, 48 and 60 months. We distinguished favorable (Engel I-II) and unfavorable (Engel III-IV) outcomes and analyzed the factors influencing postoperative results in these patients. RESULTS: There were 319 surgical procedures in 271 patients (217 primary resections, implantation of vagus nerve stimulator in 31 patients, 9 redo resections and 8 radiosurgical procedures). Focal cortical dysplasia (FCD) was found in 162 (60%) patients, «dual pathology¼ - in 118 (44%) cases. In 12 months after surgery, favorable outcomes (Engel l-II) were observed in 69% of patients (n=148), after 24 months - in 71% (n=127) of patients. Postoperative complications occurred in 6 (1.9%) patients. There was no mortality. The earlier onset of epilepsy (p=0.01), multifocal (p=0.002) and bilateral lesions (p=0.0038) were the most significant risk factors of unfavorable postoperative outcomes. CONCLUSION: Surgical resection is effective approach for drug-resistant epilepsy.

[Noninvasive magnetic stimulation with endoscopic navigation for the treatment of cricopharyngeal failure in chronic critical illness]. / Neinvazivnaya magnitnaya stimulyatsiya s endoskopicheskoi navigatsiei dlya lecheniya krikofaringeal'noi nedostatochnosti u patsientov v khronicheskom kriticheskom sostoyanii.

OBJECTIVE: To assess the efficacy of treatment of cricopharyngeal insufficiency in chronic critical illness caused by severe brain injury using non-invasive magnetic stimulation with endoscopic navigation. MATERIAL AND METHODS: Thirty patients (19 men and 11 women, mean age 50±12 years) were studied. The exposure was carried out by a bipolar alternating magnetic field using an inductor located in the projection of the hyoid bone. The study compared the standard therapy and the complex of therapeutic measures, in which the proposed non-invasive magnetic stimulation method with endoscopic navigation was included. The procedure was carried out daily without regime changes, with objective control 1 time in 10 days. The duration of the first course was 10 days, followed by a decision to extend the course for another 10 days, depending on the objective dynamics. Evaluation was performed with the Rosenbek Penetration and Aspiration Scale (PAS), the Fiberoptic Endoscopic Dysphagia Severity Scale (FEDSS), The Mann assessment of swallowing ability (MASA) and the Functional oral intake scale (FOIS). RESULTS AND CONCLUSION: Improvements of swallowing function were observed in both groups, but qualitative changes were more pronounced in the main group. The use of the proposed method made it possible to obtain a more stable and predictable result.

[Long-term EEG monitoring in patients with acute traumatic brain injury]. / Dlitel'noe monitorirovanie elektroentsefalogrammy u bol'nykh s tyazheloi cherepno-mozgovoi travmoi.

OBJECTIVE: To investigate the informativeness of long-term scalp EEG monitoring in patients with acute traumatic brain injury (TBI). MATERIAL AND METHODS: The informativity of long-term EEG monitoring (LTM) was performed in 60 patients with acute severe TBI. Odd ratios (OR) of unfavorable outcome and non-convulsive status epilepticus (NCSE) among clinical, neurophysiological and radiological features were calculated. RESULTS: EEG features of the unfavorable outcome are: slowing of the dominant background rhythm below q range (OR 3.5, CI 1.2-10.7), absence of frontal-occipital gradient (OR 10.2, CI 1.89-10.12), absence of reactivity (OR 8.75, CI 2.14-35.7), absence of variability (OR 6.25, CI 1.72-22.6) and absence of NREM sleep, stage 2 (OR 5.8, CI 1.79-18.91). Clinical features associated with the unfavorable outcome are: a decrease in GCS score (OR 1.25, CI 1.07-1.47), TBI severity (OR 2.46, CI 1.16-5.18), axial dislocation (OR 4.45, CI 1.08-18.29). ORs for NCSE are significant for the following EEG features: presence of rhythmic and periodic patterns (RPP) (OR 11.92, CI 1.37-103.39), stimulus induced RPP (OR 23.14, CI 2.56-209.34), "plus" modifier (OR 4.11, CI 1.13-14.91) and electrographic evolution (OR 13.05, CI 3.59-47.39). Background rhythm slowing below q range reduces NCSE probability (OR 3.33, CI 1.09-10). CONCLUSION: Long-term EEG monitoring is an informative tool for prognosis of outcome and diagnosis of NCSE in patients with severe TBI. The risk of NCSE increases with Marshall score but NCSE is not associated with poor outcome that requires an individual selection of intensive care.

Modeling of Interspecific Interaction of Yersinia pseudotuberculosis and Listeria monocytogenes in a Mixed-Species Biofilms with Microorganisms Isolated from Coastal Waters of the Sea of Japan.

We studied the possibility of formation of mixed-species biofilms by Yersinia pseudotuberculosis and Listeria monocytogenes with marine saprotrophic bacteria Flavobacterium sp. and Micrococcus luteus isolated from the coastal waters of the Sea of Japan in summer. Model experiments showed that Flavobacterium sp. and Micrococcus luteus can form both single- and mixed-species biofilms with the specified pathogenic bacteria thus stimulating their growth. This can contribute to the preservation of the pathogens in the marine environment.

[Results of analysis of the prescriptions for elderly patients in ambulatory practice.]

A randomized retrospective analysis of medical records of patients aged 65 years and older receiving ambulatory medical care was carried out in order to assess drug prescriptions for the detection of polypharmacy and potentially dangerous and significant drug interactions. The average number of visits per patient over 65 is 11,2±8,4. Comorbidity was detected in 89,4% of patients. Polypharmacy was detected in 76,6% of patients. In 1/3 of cases, patients were prescribed not recommended drugs (Beers criteria 2015). Authors found 364 interactions of various hazard categories. The obtained data shows that it is mandatory to implement various systems of prescription audit for the timely detection of potentially hazardous and incompatible drugs, as well as to correct prescriptions and improve efficacy and safety of drug use in patients older than 65 years.

[Possibilities for predicting of cardiac arrhythmias and conductivity disorders in former athletes.]

In order to analyze the relationship between the athletic qualification and syndrome of cardiac rhythm and conductivity disturbances in former athletes, a retrospective analysis of medical records of 39 male former athletes with cardiovascular complaints (mean age 61,6±11,3 years, mean duration of career in sports 23,9±17,3 years, mean duration of post-athletic period 20,1±9,9 years) was carried out. The patients were screened for cardiac arrhythmias and underwent echocardiography. The overall prevalence of sustained paroxysms of atrial fibrillation was 42%, increasing with the athletic qualification. Ryan grade 4b-5 premature ventricular contractions were found in 14% of patients. 3 parameters were found to be the independent predictors of arrhythmias in former athletes, i. e. athletic qualification, multifocal atherosclerosis (as an anti-risk factor), and age. The coefficient of determinance for the created prognostic model reached 43%. Further prospective studies are needed to validate an algorithm.

[Factors limiting nutritional support for patients in chronic critical illness].

Patients in chronic critical illness after brain injury may experience various conditions that limit nutritional support. The aim of this work is to analyze the factors limiting or hindering the provision of nutritional support (in particular, enteral clinical nutrition) in patients in chronic critical illness after brain damage. Material and methods. This study is a prospective observational cohort study. In the course of the study, 47 patients (27 men and 20 women, mean age 52±18.4 years) in a chronic critical illness who were undergoing rehabilitation after brain damage and who had certain limitations in the provision of nutritional support were evaluated. The duration of the patients' stay in the intensive care unit was from 21 to 30 days. During hospitalization, adverse events and conditions were recorded in these patients, limiting the conduct of enteral clinical nutrition. Results. Among the undesirable phenomena and conditions limiting enteral nutrition, diarrheal syndrome most often developed - in 41.7% of patients (associated with the use of antibiotics in 25.0% of the examined). The second group in terms of frequency - the development of surgical pathology (of various etiology) - in 31.7% of patients, which attracted special attention, taking into account the neurological and/or neurosurgical nature of the underlying disease. At the same time, the appearance of a high residual volume of the stomach against the background of an increase in hydrocephalus developed only in 5.0% of cases. More attention should be paid to patients who are in the most severe physical condition, since they have a high probability of the occurrence of several factors at once that limit the use of clinical nutrition - this category of the studied sample included 19.1% of patients. Conclusion. Strict adherence to the technology of enteral nutrition can increase the efficiency of enteral nutrition in patients in chronic critical condition.

[Exosomes secretion and autophagy in long-term protection of neurons from excitotoxic damage]. / Sekretsiia ékzosom i autofagiia pri vyrabotke ustoichivosti neironov k ékzaitotoksicheskomu povrezhdeniiu.

In the model of induced neuronal resistance to the toxic effect of glutamate (deprivation of trophic factors), exosome secretion is demonstrated. Exosomes are secreted at the development of resistance during deprivation and at the first 24 h after preconditioning, as was shown by dot blot of extracellular fluid using anti-CD63 antibody. The autophagy inhibitor bafilomycin (0.01 µM) significantly reduces the quantity of the secreted exosomes at the stage of autophagy induction and at 24 h after induction. At the same time, inhibition of autophagy during the deprivation of trophic factors prevents the development of resistance, but inhibition of autophagy during the first 24 h after deprivation does not affect the development of resistance. We suggest that the long-term effects of preconditioning may be mediated by exosome secretion.

Interaction of Salmonella enteritidis and Salmonella typhimurium in Microbial Association Formed by Them in In Vitro Experiment.

We studied the interaction of Salmonella enteritidis and Salmonella typhimurium in the microbial association formed by these microorganisms in vitro. It was found that S. typhimurium in microbial association in LB-broth inhibited reproduction of S. enteritidis, which attested to its higher competitiveness. The concentration of S. typhimurium in the medium in 6 h reached 92-93% of the total number of bacteria. Parallel growth of the populations of S. enteritidis and S. typhimurium was observed only during the first hour, but later, S. typhimurium always exceeded S. enteritidis by the growth dynamics. The competitive advantage of S. typhimurium was observed both in the absence and presence of 60-MDa virulence plasmid.

[Plasma D-dimer volume as a subclinical marker of thrombotic risk in elderly patients with atrial fibrillation.]

Aged patients with atrial fibrillation (AF) are at high risk of both thromboembolic and haemorrhagic complications of disease and of its treatment. A study was provided to assess the role of D-dimer plasma level as a marker of thrombosis in aged patients with AF having no clinical signs of active thrombosis depending on used treatment strategy and quantitative thrombotic and haemorrhagic risk of AF. The results show that D-dimer plasma levels correlate with scores of thromboembolic and haemorrhagic risks in group on antiplatelet agents but not anticoagulants, with the difference in D-dimer level driven by subgroup on CHA2DS2-VASc score ≥5. High D-dimer level was associated with in-hospital mortality and rhythm of AF at the moment of blood sample collection. Therefore, an accuracy of risk prognosis of fatal complications of AF for elderly patients may be increased by using the laboratory markers of thrombus formation such as D-dimer and by using the obtained results to guide an antithrombotic therapy.

The Missing Link: How Exosomes and miRNAs can Help in Bridging Psychiatry and Molecular Biology in the Context of Depression, Bipolar Disorder and Schizophrenia.

MicroRNAs (miRNAs) only recently have been recognized as promising molecules for both fundamental and clinical neuroscience. We provide a literature review of miRNA biomarker studies in three most prominent psychiatric disorders (depression, bipolar disorder and schizophrenia) with the particular focus on depression due to its social and healthcare importance. Our search resulted in 191 unique miRNAs across 35 human studies measuring miRNA levels in blood, serum or plasma. 30 miRNAs replicated in more than one study. Most miRNAs targeted neuroplasticity and neurodevelopment pathways. Various limitations do not allow us to make firm conclusions on clinical potential of studied miRNAs. Based on our results we discuss the rationale for future research investigations of exosomal mechanisms to overcome methodological caveats both in studying etiology and pathogenesis, and providing an objective back-up for clinical decisions.

[Psychometric properties of the Stigma Scale of Epilepsy]. / Psikhometricheskie svoistva shkaly stigmy pri épilepsii.

AIM: To assess the psychometric properties of the Stigma Scale of Epilepsy, a short simple to complete questionnaire to quickly and reliably determine the presence and the level of perceived stigma in a particular patient, as well as to assess the prevalence, socio-demographic, clinical and socio-psychological factors associated with this phenomenon. MATERIAL AND METHODS: The study included 398 patients with epilepsy. Exploratory (EFA) and confirmatory factor analysis (CFA) were used to assess the psychometric characteristics of the scale. RESULTS AND CONCLUSION: The EFA showed a two-factor scale structure explaining 57.25% of the variance. Values of GFI 0.948, CFI 0.927 and RMSEA 0.057 after the data correction show a good conformity of the model to the empirical data. Cronbach's alpha coefficient was 0.862 for the scale, 0.815 for factor 1, 0.809 for factor 2, which indicates a high consistency of both the entire scale and its subscales. The Russian-language variant of the Stigma Scale of Epilepsy is a short, economical to use tool with good psychometric properties for assessing perceived stigma in patients with epilepsy.

[Epilepsy as a social problem]. / Épilepsiia kak sotsial'naia problema.

The article considers the problem of social restrictions caused by epilepsy. Information on historical aspects and discrimination of patients with epilepsy is presented. The authors consider factors influencing marital status of patients in different countries and present information on the differences in medical restrictions to driving in different countries and in the Russian Federation. Employment status of patients with epilepsy, restrictions related to objective reasons and attitudes of patients and others toward epilepsy are elucidated.