Pro-Gastrin-Releasing Peptide as a Marker of Small Cell Lung Cancer.

The serum levels of pro-gastrin-releasing peptide (proGRP), neuron-specific enolase (NSE), and chromogranin A (CgA) were studied in 69 patients with small cell lung cancer and 50 apparently healthy donors. A significant increase of all studied biochemical markers was revealed in small cell lung cancer patients, while the highest diagnostic efficiency was demonstrated by proGRP compared to NSE and CgA. ProGRP is a promising biochemical marker of small cell lung cancer, especially sensitive in patients with distant metastases (in the brain, liver, and bones).

Chromogranin B in blood serum of patients with neuroendocrine tumors.

Neuroendocrine tumors (NETs) are a heterogeneous group of neoplasms from cells of the diffuse neuroendocrine system. Chromogranin B (CgB) is an acidic protein of the granin family, which can be used to detect the tumours of neuroendocrine nature. Analysis of levels and evaluation of the diagnostic efficiency of CgB in the blood serum of patients with NETs of various localizations. Patients with NETs (n=121) without specific treatment were examined. In the study were presented next localizations: 74 - pancreas, 20 - stomach, 12 - large intestine, 15 - other localizations (lungs, mammary gland, prostate gland, NETs with unidentified primary). 54 practically healthy donors were examined as control group. The determination of CgB in blood serum was performed with ELISA method on BEP 2000 analyzer using a standardized test system Human Chromogranin B (USCN, China). CgB levels in common NET group (median 18.9 ng/mL) were statistically significantly higher than in the control group (8.8 ng/mL). The highest median was obtained in group of intestinal NETs (21.2 ng/ml), which exceeded the median of the control group by more than 2.4 times. According to ROC analysis in the common NET group relative to the control group, the area under the curve AUC was 0.88 (95% CI 0.83-0.929). According to cut-off level of CgB - 15.8 ng/ml, the diagnostic sensitivity was 69.4%, with a specificity of 96.3%. The highest diagnostic sensitivity was in the group of the intestinal NETs (75.0%) and pancreas (71.2%). The study showed the significance of CgB as a potential biochemical marker of NETs with various localizations, alternative to CgA.

[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.

[IMPACT OF THE CHEMICAL OCCUPATIONAL FACTORS ON THE DEVELOPMENT OF ALLERGIC DISEASES IN HEALTHCARE PRACTITIONERS].

There was performed the assessment of the degree of the impact of the chemical occupational factors on the development of allergic diseases in healthcare practitioners of the Sverdlovsk Region. According to results of the certification of 145 workplaces in medical institutions of the Sverdlovsk Region's it was revealed that the health care professionals mostly contact with the chemical substances which were the strong allergens with potent nfavorable impact on the health. In the formation of allergic diseases in healthcare practitioners the leading role is belonged to antibiotics, vitamins and other medicines, as well as formaldehyde; there is less detected sensitization to cotton dust and synthetic detergents.

[EEG changes in patients with Alzheimer's disease]. / Izmeneniya elektroentsefalogrammy u patsientov s bolezn'yu Al'tsgeimera.

The prevalence of cognitive impairment is steadily increasing compared to previous years. According to the World Health Organization, the number of people living with dementia will increase reaching 82 million in 2030 and 152 million in 2050. The most common cause is Alzheimer's disease (AD). The pathophysiological process in AD begins several years before the onset of clinical symptoms; so identifying it at an early stage would likely improve the clinical prognosis. The article presents EEG changes in patients with AD, and discusses the possibility of using EEG as a screening method for examining patients with cognitive impairment.

Local epileptic activity, histological and neuroimaging findings in symptomatic epilepsy.

OBJECTIVE: This study is aimed at revealing the relationship between local interictal epileptic activity, cytoarchitectural disturbances and magnetic resonance imaging (MRI) findings. MATERIAL AND METHODS: We prospectively investigated a series of 25 patients with symptomatic epilepsy due to isolated forms of focal cortical dysplasia (FCD) or hippocampal sclerosis and low-grade tumours associated with FCD, all of whom underwent tailored surgical procedures under intraoperative electrocorticography; we conducted neuropathological examinations of 92 biopsies taken from different places. We examined the relationship between dysplastic changes in the cortex and the absence or presence of seizure patterns (SPs), including regular spikes/sharp waves, recruiting discharges, paroxysmal fast activity and rhythmic delta-theta activity. Comparisons with MRI findings were also performed. RESULTS: Complete removal of the SPs zone was associated with better results of surgical treatment. Areas with isolated architectural abnormalities were associated with SPs significantly more often than those where the cortex contains immature or giant neurons; these areas were associated with SPs more than areas containing dysmorphic neurons. The extent of MRI signs appearance in the neocortex correlated neither with the presence of SPs nor with the types of histological changes. CONCLUSIONS: We suppose an inverse relationship between the morphological changes in neurons and their ability to generate epileptic activity. Electrocorticography may be used for the identification of the MRI-negative epileptogenic lesions.

[Epilepsy syndromes associated with hearing loss]. / Epilepticheskie sindromy, assotsiirovannye so snizheniem slukha.

Patients with epilepsy who have also hearing loss represent a distinct group of patients, often with aggravated medical history, comorbidities and high potential for disability. The etiopathogenetic factors of epilepsy and hearing loss may be common to these conditions (neuroinfections, craniocerebral injuries, cerebral circulatory disorders, perinatal pathology, etc.). In addition, these two syndromes may occur as part of hereditary diseases, so their timely recognition and genetic diagnosis are important for determining further medical and genetic prognosis. This article provides an overview of orphan genetic diseases associated with epilepsy and hearing loss - MERRF syndrome, MELAS syndrome, EAST syndrome, Ayme-Grippsyndrome, epilepsy, hearing loss and mental retardation syndromes, associated with mutations in SPATA5 gene, DOOR syndrome, Gustavson syndrome.

Memristive Neural Networks for Predicting Seizure Activity.

The aim of the study is to assess the possibilities of predicting epileptiform activity using the neuronal activity data recorded from the hippocampus and medial entorhinal cortex of mice with chronic epileptiform activity. To reach this goal, a deep artificial neural network (ANN) has been developed and its implementation based on memristive devices has been demonstrated. Materials and Methods: The biological part of the investigation. Young healthy outbred CD1 mice were used in our study. They were divided into two groups: control (n=6) and the group with induced chronic epileptiform activity (n=6). Local field potentials (LFP) were recorded from the hippocampus and medial entorhinal cortex of the mice of both groups to register neuronal activity. The LFP recordings were used for deep ANN training. Epileptiform activity in mice was modeled by intraperitoneal injection of pilocarpine (280 mg/kg). LFP were recorded in the awake mice a month after the induction of epileptiform activity.Mathematical part of the investigation. A deep long short-term memory (LSTM) ANN capable of predicting biological signals of neuronal activity in mice has been developed. The ANN implementation is based on memristive devices, which are described by the equations of the redox processes running in the memristive thin metal-oxide-metal films, e.g., Au/ZrO2(Y)/TiN/Ti and Au/SiO2(Y)/TiN/Ti. In order to train the developed ANN to predict epileptiform activity, a supervised learning algorithm was used, which allowed us to adjust the network parameters and train LSTM on the described recordings of neuronal activity. Results: After training on the LFP recordings from the hippocampus and medial entorhinal cortex of the mice with chronic epileptiform activity, the proposed deep ANN has demonstrated high values of evaluation metric (root-mean-square error, RMSE) and successfully predicted epileptiform activity shortly before its occurrence (40 ms). The results of the numerical experiments have shown that the RMSE value of 0.019 was reached, which indicates the efficacy of proposed approach. The accuracy of epileptiform activity prediction 40 ms before its occurrence is a significant result and shows the potential of the developed neural network architecture. Conclusion: The proposed deep ANN can be used to predict pathological neuronal activity including epileptic seizure (focal) activity in mice before its actual occurrence. Besides, it can be applied for building a long-term prognosis of the disease course based on the LFP data. Thus, the proposed ANN based on memristive devices represents a novel approach to the prediction and analysis of pathological neuronal activity possessing a potential for improving the diagnosis and prognostication of epileptic seizures and other diseases associated with neuronal activity.

[Characteristics of morphofunctional state of the pancreas in children with metabolic syndrome].

The paper presents the results of a study of the morphofunctional state of the pancreas in children with metabolic syndrome. It is shown that in the absolute majority of children identified various changes in the structure of the pancreas. Decrease Postprandial response and uneven increase in gland due to a head in the postprandial period, indicating a decrease in body adaptation abilities and a high risk of pancreatitis in children with MS. The interrelation between total size and size of the head of the pancreas on an empty stomach with disorders of carbohydrate metabolism. Obtained data indicate the need for in-depth examination of children with metabolic syndrome in order to timely diagnosis of chronic pancreatitis.

[Current concepts about autonomic dysfunction in patients with epilepsy]. / Sovremennye predstavleniya o vegetativnoi disfunktsii u patsientov s epilepsiei.

Autonomic dysfunction is frequently observed in people with epilepsy. Ictal and postictal dysautonomia is not only manifestation of autonomic seizures, but could be a life threatening condition in some cases and contribute to sudden unexpected death (SUDEP). Interictal decrease of autonomic activity is associated with duration and severity of epilepsy, it is the most prominent in focal and drug-resistant epilepsy. Progress in our understanding of the underlying mechanisms, development of the autonomic assessment methods, and its integration in novel technical solutions for seizure detection will improve the quality of care for people with epilepsy.

[COVID-19-associated damage of the peripheral nervous system]. / COVID-19-assotsiirovannye porazheniya perifericheskoi nervnoi sistemy.

Based on the available literature data, the article discusses the prevalence of various forms of damage of the peripheral nervous system in COVID-19 and in the post-COVID period. Information about the clinical features and the course of individual cranial neuropathies, chronic dysimmune neuropathies, Guillain-Barré syndrome, drug-induced neuropathies, fine fiber neuropathy, myasthenia gravis and polyneuropathy of critical conditions was systemized in the context of coronavirus infection. SARS-CoV-2 can trigger various stages of pathogenesis, including neuroimmune ones, which cause long-term consequences of COVID-19, including those associated with the damage of the peripheral nervous system. Awareness of COVID-19-associated pathological conditions will allow assessment of the possible risks of damage of the peripheral nervous system, recognize them at early stages and develop more effective approaches for treatment.

Epilepsy and COVID-19: Management of Patients and Optimization of Antiepileptic Treatment in the Pandemic.

There are as yet no data pointing to any increase in the incidence of the novel coronavirus infection (COVID-19) or a more severe course of illness in patients with epilepsy. However, considering the high prevalence of epilepsy in patients over 60 years of age, the high comorbidity of epilepsy and a whole series of somatic diseases, and the need to maintain the opportunity for constant access to antiepileptic medications and follow-up of epilepsy patients, we can expect a whole set of difficulties in the management of these patients in the conditions imposed by the COVID-19 pandemic. This article addresses the main principles of the management of epilepsy patients in the conditions of the COVID-19 pandemic: the need to follow regimes; preservation of regular and continuous taking of antiepileptic drugs, including consideration of interdrug interactions; and switching patients to i.v. forms of antiepileptic drugs where necessary.

[Clinical results and prospects for the use of phenosanic acid in patients with focal epilepsy]. / Klinicheskie rezul'taty i perspektivy primeneniya fenozanovoi kisloty u vzroslykh patsientov s fokal'noi epilepsiei.

OBJECTIVE: To study the efficacy and safety of using a new original synthetic antioxidant - phenosanic acid as an adjunct therapy in patients with focal epilepsy. MATERIAL AND METHODS: A randomized, double-blind, placebo-controlled, parallel-group study evaluated the efficacy and safety of phenosanic acid as an adjunct therapy to basic antiepileptic drugs in 120 patients with focal epilepsy. Primary purpose: to study the dynamic of seizure frequency. Secondary purposes: to study the dynamic of seizure-free days, the dynamics of bilateral tonic-clonic seizures, the results of questionnaires and scales (General Dynamics Assessment, Visual Analogue Scale (VAS), Quality of Life in Epilepsy (QOLIE-31-P), European Quality of Life Questionnaire (EQ-5D), Hospital Anxiety and Depression Scale (HADS), Frontal Asstssment Battery (FAB), Mini-Mental State Examination (MMSE)). RESULTS: Phenosanic acid (Dibufelon) showed statistically significant benefit over placebo in the primary indicator of efficacy (reduction in the frequency of epileptic seizures by at least 50%) and in the secondary indicators. The drug was safe and well tolerated by the patients. CONCLUSION: The addition of phenosanic acid (Dibufelon) to base antiepileptic drugs seems to be perspective because of its positive effect on reducing the number of epileptic seizures, as well as on comorbid disorders in the emotional and cognitive spheres.

[Epilepsy and COVID-19: patient management and optimization of antiepileptic therapy during pandemic]. / Epilepsiya i COVID-19: vedenie bol'nykh i optimizatsiya protivoepilepticheskoi terapii v usloviyakh pandemii.

There is currently no data on the increased incidence of new coronavirus infection (COVID-19) or on the more severe course of the disease in patients with epilepsy. However, given the high prevalence of epilepsy among patients after age 60, an increased burden of somatic comorbidities among people with epilepsy, as well as the need of continuous access to antiepileptic drugs (AED) and care for patients with epilepsy, there are a number of important concerns in time of regarding the management of epilepsy during COVID-19 pandemic. The article discusses the main principles of epilepsy management during the COVID-19 pandemic: the need to comply with the regime; the importance of AED adherence, taking into account drug-drug interactions; switching patients to intravenous AED forms if necessary.

[Assessment of quality of life and treatment adherence in patients with dizziness treated with vasobral]. / Otsenka kachestva zhizni i priverzhennosti lecheniiu preparatom vazobral patsientov s golovokruzheniem.

AIM: To study indicators of quality of life and adherence to treatment with vazobral in patients with dizziness of vascular genesis. MATERIAL AND METHODS: Vazobral was administered to 330 patients with vertigo due to cerebrovascular disease for 3 months during a non-inferiority, open-label study. Quality of life (measured using VAS and the second part of the EQ-5D questionnaire), severity and frequency of dizziness attacks (using VAS), the overall effectiveness of treatment on the basis of objective (according to the doctor) and subjective (using CGI) assessments, treatment adherence were evaluated. RESULTS AND CONCLUSION: The positive effect of vazobral was reported by 320 patients (97.0%), 223 of them (67.6%) indicated a decrease in the frequency of episodes of dizziness by at least 50%, and 95 patients (28.8%) had complete relief of dizziness. Two hundred and sixty-two (79.4%) patients took the drug in full accordance with recommendations. Patients living alone missed drug intake more often. Improvement of quality of life was noted in 326 (98.8%) patients, scores for all domains of the questionnaire EQ-5D at baseline and in the end of the study were 50.8±18.1 and 78.8±14.7%, respectively (p<0.001). The tolerability of treatment was characterized by good tolerability.

[Surgical treatment patients with drug-resistant unilateral MRI-positive temporal forms of epilepsy]. / Khirurgicheskoe lechenie patsientov s farmakorezistentnymi MR-pozitivnymi simptomaticheskimi odnostoronnimi visochnymi formami épilepsii.

AIM: To evaluate the results of surgical treatment of patients with unilateral MRI-positive temporal forms of drug-resistant epilepsy. MATERIAL AND METHODS: A prospective analysis of 50 patients with unilateral MRI-positive temporal forms of drug-resistant epilepsy, who had undergone resective surgery in the Scientific Research Institute of Emergency Medicine of N.V. Sklifosovsky (Moscow) and in University Clinic of Moscow State University of Medicine and Dentistry between 01.01.14 and 12.12.17, has been performed. MRI-positive temporal symptomatic epilepsy was identified in 79 (55%) patients. MRI results showed unilateral temporal epileptogenic lesions in 50 (67%) patients. These patients were assigned to medial frontal lobectomy. RESULTS: 82% patients become 'seizure free' 12 and 24 months after surgical treatment. In other cases, seizures become less frequent and severe. CONCLUSION: The results confirm the efficacy and safety of surgical treatment of drug-resistant MRI-positive temporal forms of epilepsy.

[Morphofunctional condition of the pancreas in children and teenagers with obesity and metabolic syndrome].

30 childs and teenagers (6- 15-years-old) were examined (16 boys and 14 girls). The signs of metabolic syndrome were revealed in 13 persons (43%) (VOZ, 1999). Echogenicity of pancreatic acinar tissue was reinforced in all persons with obesity, (80%) hyperechogenic inclusions were observed in 67% of the patients. Trustworthy correlation of the pancreatic head size, pancreatic tail size and the obesity degree as well as the disease duration was demonstrated. Postprandial pancreatic reaction was reduced in the most part of the patients with obesity (77%). Postprandial pancreatic reaction was more significantly reduced in the children with obesity and metabolic syndrome than in the children with obesity, who hasn't the signs of metabolic syndrome (15,3% and 7,5%). So, it is necessary the special examination of the children with obesity to reveal chronic pancreatitis.

[Post-stroke rehabilitation training with a brain-computer interface: a clinical and neuropsychological study]. / Klinicheskaia i instrumental'naia otsenka terapii sosudistykh kognitivnykh rasstroistv.

AIM: To evaluate the efficacy of cytoflavin in the treatment of patients with chronic cerebral ischemia and mild cognitive impairment predominantly of vascular origin. MATERIAL AND METHODS: Treatment results of 140 patients, aged 60-74, with chronic cerebral ischemia were analyzed. The main group included 77 patients (35 men and 42 women of average age 66.38±4.64 years) who received cytoflavin throughout the observation period: 2 tablets twice a day 30 minutes before meals. The comparison group included 63 patients (26 men and 37 women of average age 67.48±5.22 years) who during the whole period of observation received ethyl methyl hydroxypyridine succinate: 2 tablets (250 mg) twice a day, according to the same scheme as in the main group. Treatment efficacy was assessed by neuropsychological testing and P300 evoked potentials. RESULTS AND CONCLUSION: During treatment, there was an improvement in neurophysiological parameters in both groups, which was more pronounced in patients treated with cytoflavin: their P300 amplitude increased by1.3 times in the left hemisphere (from 9.21 (8.36, 10.11) to 12.41 (10.23, 13.37 µV) and 1,7 times in the right hemisphere (from 6.48 (5.26, 7.35) to 11.04 (9.29, 12.18) µV). Our study confirms the advisability of using drugs that have complex cytoprotective and energy-correcting mechanism in patients with cognitive impairment. Cytoflavin has shown the high efficacy and safety and can be recommended as part of complex therapy for cognitive disorders. Using simple and inexpensive instrumental methods (assessment of cognitive P300 evoked potential) along with diagnostic scales in patients with cognitive impairment can significantly objectify the assessment of treatment dynamics.

[Indication of antiepileptic drugs to patients with epilepsy: results of the survey of neurologists]. / Prioritety v naznachenii protivoépilepticheskikh preparatov patsientam s épilepsiei po rezul'tatam oprosa vrachei-nevrologov.

AIM: To study knowledge and opinions of neurologists about priorities in using antiepileptic drugs (AEP). MATERIAL AND METHODS: Eighty-one neurologists from Moscow and surrounding regions were surveyed to identify the factors that influenced the choice of AEP. RESULTS AND CONCLUSION: Valproic acid was the most frequently used drug followed by levetiracetam and carbamazepine, which reflected the overall picture of PEP indication in patients with epilepsy in the Russian population. Levetiracetam occupies a leading position as the starting drug for treatment of epilepsy; most often prescribed to women, patients with generalized seizures and idiopathic epilepsy. It is the drug of choice as adjuvant remedies for Duo therapy.

[Anxiety disorders in epilepsy]. / Trevozhnye rasstroistva pri épilepsii.

This review is devoted to the place of anxiety disorders in the spectrum of psychiatric comorbidity in patients with epilepsy. The authors present general characteristics of anxiety manifestations and current views on the classification and qualification of anxiety disorders in such patients. Recent data show the relationship of anxiety with different forms of epilepsy, demographic and gender characteristics, localization of epileptic focus. The problem of bidirectional relationship of anxiety and epilepsy as well as the temporal relationship between anxiety and epileptic states are considered.