Vol 71, No 4 (2016)


Vegetative State: Difficulty in Identifying Consciousness and Predicting Outcome

Kondratyeva E.A., Avdunina I.A., Kondratyev A.N., Ulitin A.U., Ivanova N.E., Petrova M.V., Luginina E.V., Grechko A.V.


Article consists of literature review, authors experience of the application of neurovisualization and neurophysiological research methods to predict the recovery of consciousness in patients in vegetative state (VS). According to the literature data PET with FDG has higher sensitivity in the detection of signs of consciousness, then functional MRI (fMRI). The method fMRI allows assessing the functional activity of the brain in a state of rest and in response to stimulation with different modalities ― visual, auditory, etc (with the application of active and passive paradigm). A higher specificity in the detection of signs of consciousness have the methodology of fMRI with the active paradigm, at the same time, the absence of signs of consciousness according to the fMRI can not be charged as a basis for the conclusion of a poor prognosis in a particular patient. Neurophysiological tests (EEG, TMS, EP, etc) are more readily available and quite effective. Based on the literature analysis, the authors comes to the conclusion that neurovisualization and neurophysiological tests used in the prediction of the outcome of VS reflects the residual functional activity of different brain areas, in a context of diffuse brain damage, and the recovery of consciousness is usually combined with the restoring of the functional activity off the thalamocortical tracts, which activity, indirectly, is evaluated using these methods. In the authors' opinions, the main disadvantage in the interpretation of the is the lack of a common pathophysiological concept of the organization of brain functions in VS patients. The authors offer for the discussion their concept of stable pathological states of the brain, which is based on the works of Russian pathophysiologists.

Annals of the Russian academy of medical sciences. 2016;71(4):273-280
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Methods of Molecular Transfusion in the Intensive Therapy of Critical States

Yaroustovsky M.B., Abramyan M.V., Krotenko N.P., Komardina E.V.


Development of extracorporeal blood purification acquires greater significance in the intensive care of multiple organ failures (MOF) with all the pathophysiological aspects of its constituent parts. MOF are the main cause of mortality among critically ill patients and treatment of these patients require significant investment. The purpose of the implementation of extracorporeal blood correction techniques today is multiple organ support therapy (MOST). Early extracorporeal therapy is used only in the treatment of renal failure. Today extracorporeal techniques are increasingly being used to replace the functions of various organs and systems. MOST includes diffusion, convection, filtration, sorption, apheresis methodic. They affect the molecular and electrolyte composition of blood, allow to correct, repair, replace, and maintain homeostasis in severe multiorgan dysfunction. Extracorporeal new molecular technologies have been successfully applied in the intensive care of severe heart and respiratory failure, acute kidney injury and acute hepatic dysfunction, in the treatment of severe sepsis, metabolic disorders, the correction of immune imbalance.

Annals of the Russian academy of medical sciences. 2016;71(4):281-287
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Decreased Serum Levels of Klotho Protein in Chronic Kidney Disease Patients: Clinical Imortance

Milovanova L.Y., Mukhin N.A., Kozlovskaya L.V., Milovanov Y.S., Kiyakbaev G.G., Rogova I.V., Lebedeva M.V., Androsova T.V., Milovanova S.Y., Gil A.Y., Taranova M.V.


Objective: to determine the role of serum Klotho (s-Klotho) protein levels changes in patients with different stages of chronic kidney disease (CKD).

Methods: The study involved 130 patients with CKD stages 1–5D (mean age ― 41±6.7 years). Serum levels of parathyroid hormone (PTH), calcium, phosphorus and s-Klotho protein (ELISA method) at baseline and after 1 year of follow-up were examined in all the patients so as the blood pressure (BP), including central (aortic), pulse wave velocity ― with the help of «Sphygmоcor» (Australia), echocardiography, radiography of the abdominal aorta in a lateral projection were also performed.

Results: when comparing the s-Klotho levels in patients with different CKD stages, it was found that the level change associated with the reduction of glomerular filtration rate (GFR) ahead of phosphorus and PTH increase in serum, stared at 3A CKD, whereas hyperphosphatemia and PTH increase started at 4–5 CKD stages. According to ROC analysis, decreasing of s-Klotho levels below 387 pg/ml was indicated a calcification risk of abdominal aorta increased with an 80% sensitivity and 75% specificity. In addition, a strong negative relationship of low s-Klotho levels and heart remodeling was found. When comparing the patients with hypertension who were receiving antihypertensive monotherapy, the highest serum levels of Klotho protein were observed in those of them whose target blood pressure level was achieved primarily through Angiotensin II Receptors Blockers (ARB), compared to those who was administered another drug group (p<0.01) or has not reached the target blood pressure level (p=0,008).

Conclusion: The change of serum Klotho levels (decrease) in CKD progression is associated with the degree (increase) of cardiovascular calcification and remodeling (the development of left ventricular hypertrophy, and cardiomyopathy) and it can be seen as an early independent marker of the cardiovascular system lesions in CKD. Our preliminary data of the effect of blood pressure correction on s-Klotho levels may indicate the possibility of drug maintaining serum Klotho levels and it requires further research.

Annals of the Russian academy of medical sciences. 2016;71(4):288-296
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Simulation technologies in spinal surgery

Byvaltsev V.A., Kalinin A.A., Belykh E.G., Stepanov I.A.


This review reflects the current state of simulation technologies in neurosurgery and, in particular, in spinal surgery. Currently, there are different types of simulations used in spine surgery including the biological, artificial and virtual models. Simulations help to facilitate an optimal study of the anatomy, understand the spatial relationships between organs and tissues, plan properly the surgical intervention, and gain tactile surgical skills. The implementation of simulation technologies in the educational process provides objective assessment of the initial level of training, improvement of the competence in trained professionals, as well as prevention of surgical errors in various clinical situations.


Annals of the Russian academy of medical sciences. 2016;71(4):297-303
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Neuroinflammatory, Neurodegenerative and Structural Brain Biomarkers of the Main Types of Post-Stroke Cognitive Impairment in Acute Period of Ischemic Stroke

Kulesh A.A., Drobakha V.E., Nekrasova I.V., Kuklina E.M., Shestakov V.V.


Background. Post-stroke cognitive impairment is a clinically heterogeneous condition, some types of which cannot be fully differentiated neuropsychologically that necessitates the active search for biomarkers. Aims: analyze parameters of neuroinflammation and neurodegeneration in combination with neuroimaging markers in patients with different types of post-stroke cognitive impairment in acute ischemic stroke.

Materials and methods. In 72 patients we performed the assessment of cognitive status and distinguished 3 types: normal cognition, dysexecutive, and mixed cognitive impairment. In each group we determined the concentration of cytokines (IL-1β, IL-6, TNFα, IL-10) in liquor and serum, β-amyloid 1−40 in liquor and a number of MRI morphometric parameters and fractional anisotropy.

Results. In all groups of patients we detected higher level of
IL-10 in serum compared with the control. Patients with dysexecutive cognitive impairment had higher concentration of IL-1β, IL-10 in liquor, IL-6 level in serum, lower fractional anisotropy of ipsilateral thalamus compared with patients with normal cognition and largest size of infarct. Patients with dysexecutive and mixed cognitive impairment had the higher area of leukoareosis and ventricular volume, reduced fractional anisotropy of contralateral cingulum compared with patients with normal cognition. Patients with mixed cognitive impairment characterized by lower fractional anisotropy of contralateral fronto-occipital fasciculus compared with patients with dysexecutive cognitive deficit.

Conclusions. Serum and cerebrospinal fluid concentrations of cytokines studied in combination with MRI parameters particularly fractional anisotropy seems to be informative biomarkers of pathogenic types of PSCI.

Annals of the Russian academy of medical sciences. 2016;71(4):304-312
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Status Indicators of Lipid Peroxidation and Endogenous Intoxication in Lung Cancer Patients

Belskaya L.V., Kosenok V.K., Massard Z., Zav’yalov A.A.


Background: Problems of optimization diagnosis methods and prognosis for lung cancer remain unsolved. Lung cancer occupied the leading positions among cancer diseases.

Aims: Establishing change patterns in the parameters of endogenous intoxication and lipid peroxidation in the saliva of patients with lung cancer depending on the histologic type of tumor.

Materials and methods: The case-control study enrolled 516 men, who were divided into 3 groups: main (lung cancer, n=256), comparison group (non-malignant lung diseases, n=60), and control group (relatively healthy, n=200). Questioning and biochemical saliva study were carried out to all participants. Patients of the main group and the comparison group were hospitalized for surgical treatment, after which underwent the histological verification of the diagnosis. We used the spectrophotometric methods of investigation of parameters of lipid peroxidation and endogenous intoxication. Between-group differences were evaluated by nonparametric tests.

Results: Malondialdehyde as a product of lipid peroxidation is a little informative result. For more information it is necessary to determine the individual fractions of middle toxins count distribution ratio 280/254 nm, as well as to take into account the level of conjugated diene, triene conjugates, and Schiff bases. The following changes are observed at the transition from the control group to the comparison group, and then to the main: increased levels of triene conjugates and Schiff bases, as well as malondialdehyde. At the same time we detected the reduction in the level of diene conjugates, which confirms the fact of the increase in the oxidative stress process associated with benign diseases and lung cancer. In addition, there is a decrease in the content of individual fractions of middle toxins, but 280/254 nm partition coefficient growth is observed.

Conclusions: The findings support the hypothesis of the association processes of lipid peroxidation and endogenous intoxication with the development of lung cancer. It confirmed the dependence of these parameters on the histological type of tumor, the presence / absence and the degree of prevalence of remote and regional metastasis.

Annals of the Russian academy of medical sciences. 2016;71(4):313-322
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Early Rectal Cancer: Can Transanal Endoscopic Microsurgery (TEM) Become the Standard Treatment?

Shelygin Y.A., Chernyshov S.V., Mainovskaya O.A., Zarodnyuk I.V., Orlova L.P., Rybakov E.G.


Aim. Transanal endoscopic microsurgery (TEM) is a main treatment technique for rectal adenomas, but can also be used for selected malignant tumors. This study presents TEM experience.

Methods. The study enrolled patients with rectal adenomas, and selected adenocarcinomas. Preoperative work-up included: digital rectal examination, rectoscopy with biopsy, colonoscopy, EUS, pelvic MRI.

Results. Three hundred and thirty patients [mean age of 61,4±10 (33–88)] underwent TEM. The mean size ± SD of tumors was 3.2±1.2 cm (0.6–10.0). Mean distance from anal verge was 6.7±2.6 cm (2.0–14.0). Preoperative biopsy revealed: adenoma ― 263/330 (79,7%), adenocarcinoma ― 67/330 (20,3%). The median operating time was 40 (15–220) min. Tumor-free margins were obtained in all operative specimens. In 5/330 (1.5%) cases tumors were fragmented. The morbidity rate was 19/330 (5.7%). Pathological investigation revealed: adenoma in 192/330 (58.1%) cases, adenocarcinoma stage Tis, T1, T2 and T3 in 138/330 (41.9%). Median follow-up lasted for 24 (1–57) months. Five patients (2.0%) with adenoma and four patients (5.2%) with adenocarcinoma had local recurrence.

Conclusion. Transanal endoscopic microsurgery for rectal adenomas and selected malignant tumors is associated with low morbidity and low recurrents rates.

Annals of the Russian academy of medical sciences. 2016;71(4):323-331
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Igor' Nikolaevich Denisov



Annals of the Russian academy of medical sciences. 2016;71(4):332-333
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Kuchma Vladislav Remirovich



Annals of the Russian academy of medical sciences. 2016;71(4):334-335
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