Vol 67, No 9 (2012)

Mechanisms of HIV transportation through blood-brain barrier, vascular plexus and interaction with cerebral cells having CD-4-receptors, ССR-5- and CXCR-4-coreceptors were studied. Cerebral damage developed through latent and acute periods also known as HIV-encephalopathy, HIV-associated neurocognitive dysfunction etc. Cerebral lesions are caused by a variety of chemical agents from pro-inflammatory cytokines to toxic HIV-proteins resulting in development of HIV-dementia through several years. Even early stage of this process revealed significant disturbances of glucose metabolism and evoked potentials EEG alterations which can serve as a marker of HIV-infection. Genetic differences of HIV in blood and spinal liquor with different drug resistance were revealed implying a new approach to therapy development.

The new possibilities in therapy of cerebral aneurysms, arteriovenous malformations and hypertensive intracranial hematomas recently have come into the neurosurgical sphere due to development of neurovisualization and neurophysiology methods and widely usage of microsurgical principles as well as neuroendoscopy, neuronavigation systems and methods of intraoperative control for operative radicality in surgery of non-traumatic intracranial hemorrhages. Besides this progress was not possible without extensive development of several aspects of anesthesiology and reanimatology focused on anesthetic management and intensive care of neurosurgical patients in particular. Timely diagnostics and optimal choice of treatment methods in patients with non-traumatic intracranial hemorrhages allow to achieve good functional outcomes with trend to mortality minimization.

The paper presents main types of surgically relevant posttraumatic lesions in 4136 patients with skull vault as well as skull base defects, craniofacial deformities, recurrent CSF leaks, arterio-venous fistulas, aneurysms and pseudoaneurysms etc. Classification of TBI sequelae and complications as well as its clinical course grading is presented. The use of modern neuroimaging techniques for studying pathophysiologic mechanisms and complications of TBI has been demonstrated. Special emphasis was given to minimally invasive and reconstructive surgery; computer modeling with subsequent full-copy stereolitographic laser implant setup was shown which is of great importance in cases of large and complex skull base and craniofacial deformities. Patient selection for transcranial and endonasal CSF leak closure techniques was justified. Treatment of post-traumatic vascular injuries using Serbinenko balloon-catheters as well as modern techniques such as stents, coils and embolization has been demonstrated.

The latest advances in molecular medicine, medical genetics and neurobiology have provided for a new look at processes occurring in cells of the brain and have allowed to discover previously unknown phenomena associated with mental traits and to propose new biomedical direction which include genomics, psychiatry and neurobiology ― brain genomics. The application of modern molecular and cellular technologies of genome analysis in the brain in common psychiatric disorders (autism, schizophrenia and Alzheimer’s disease) has shown that genomic instability is a phathogenetic mechanism of central nervous system abnormalities and plays a role in the brain development. Genomic disbalance alters neural homeostasis leads to cell death and is an important biological marker of psychiatric disorders which determine genomic pathways. These alterations lead to synaptic disfunction and neurodegeneration. In the present review, the main advances of brain genomics and potential application in diagnostic, clinical and therapeutic practice.

The contribution scientific publications of Russian Academy of Medical Sciences (RAMS) in the national publication stream, indexed by Web of Science over the past thirty years, was estimated. The indicators of publication activity that are necessary for the institutions of RAMS to achieve in short-term period the conformity with bibliometric indicators, established by Presidential Decree of May 7, 2012 (to increase the share of Russian publications in Web of Science to 2.44% in 2015) were calculated. It is shown that the current structure of global science, where publications in medicine make up for approximately one third of scientific publications in the world, set for RAMS scientists particularly difficult task: to double in three years the number of publications in Web of Sci. In the article are proposed the priorities and the necessary steps to fulfill this task.