The combination of stroke and COVID-19 infection is often characterized by severe clinical symptoms, with a high incidence of complications and adverse outcomes in such patients. The key pathogenetic mechanism of stroke development in the context of COVID-19 is the hyperproduction of proinflammatory cytokines, which leads to disturbances in the hemostatic system, endothelial dysfunction, and, consequently, the formation of thrombotic complications. The risk of large cerebral vessel involvement in patients with stroke and COVID-19 is significantly higher than in patients without COVID-19, and during the first year after disease onset, the threat of recurrent vascular events persists. The development of post-COVID syndrome in this patient category is associated with the persistence of immune and metabolic disorders. Among the most common manifestations of post-COVID syndrome are cognitive impairment, reduced attention, fatigue, headaches, sleep disturbances, and anxiety-depressive states. The presence of comorbidities, particularly cardiovascular and metabolic diseases, exacerbates the course of post-COVID syndrome and worsens the prognosis. Early diagnosis of hemostatic disorders and monitoring of proinflammatory cytokines are of particular importance, as they enable timely therapeutic adjustments. A promising approach is the use of monoclonal antibodies targeting interleukin-6 receptors, which helps reduce the incidence of multiorgan complications. Comprehensive rehabilitation, including pharmacological, physical, respiratory, and psycho-emotional interventions, should be carried out individually, taking into account the severity of neurological deficits and comorbid conditions. Thus, patients who have suffered a stroke in the context of COVID-19 require a multi-level approach aimed at correcting post-COVID manifestations and preventing recurrent vascular events.

Ischemic stroke remains one of the leading causes of death and disability, especially among elderly patients. One of the key adaptive mechanisms in the post-ischemic period is neoangiogenesis, which promotes revascularization and restoration of the metabolism of neurons in the penumbra zone. The aim of the study was an immunohistochemical assessment of the age — related features of neoangiogenesis in the acute period of cerebral cortex infarction. Methods. The study was conducted on archived autopsy material — fragments of the frontal lobe of the cerebral cortex of patients with verified ischemic stroke (n=154) and the control group (n=30). The patients of both groups were divided by age into subgroups: young (18–44 years old), middle-aged (45–59 years old) and elderly (60–74 years old). The samples were examined histologically and immunohistochemically using antibodies to CD31 and VEGF-A. Results. The most pronounced neoangiogenesis (high number of vessels and VEGF-positive cells) was observed in young patients with ischemic stroke already in the early stages. VEGF-A expression was observed mainly in small-caliber blood vessels and neurons of the penumbra zone, especially in the group of young patients. On the contrary, in elderly patients with a large number of risk factors, the development of cerebral infarction was accompanied by a significant decrease in these indicators, especially in penumbra, which correlated with early high mortality. Conclusion. Increased VEGF expression combined with an increase in the number of small-caliber blood vessels is one of the key initiating factors of compensatory neoangiogenesis and activation of collateral blood supply and neurogenesis, collectively aimed at maintaining the functional activity of neurons in the penumbra zone. The high mortality of elderly patients in the first days after an ischemic stroke may be due to dysregulation of proangiogenic factors and a decrease in the activity of these adaptive reactions with age.

Purpose. To evaluate neuroimaging criteria of trigeminal neuralgia and the effect on the recurrence rate in the postoperative period. Material and methods. A prospective study was conducted. There are 32 patients with clinical manifestations of type 1 TN and the presence of neurovascular conflict according to MRI of the brain. The age of the subjects ranged from 21 to 74 years old. All the studied patients underwent microvascular decompression of the trigeminal nerve root from retrosigmoid access. The neuroimaging criteria studied are: assessment of neurovascular conflict, cerebellopontine cistern parameters (cross-sectional area), trigeminal nerve parameters (length, cross-sectional area) and trigeminal pontine angle. Results. The present study analyzes the dynamics in various neuroimaging criteria of TN in the pre- and postoperative periods, their relationship with the frequency of recurrence. There was a significant decrease in the values of the trigeminal pontine angle (W=1,84; p=0,08), a decrease in length (W=2,4; p=0,036) and the cross-sectional area of the trigeminal nerve root (W=2,87; p=0.04) after microvascular decompression. Recurrence after microvascular decompression occurs more often in patients with initially (according to preoperative MR data) shorter (r=0.895; p=0.04) and thinner (r=0.945; p=0.015) by the root of the trigeminal nerve, a narrow cerebellopontine cistern (r=0.254; p=0.68). The acute trigeminal pontine angle before (r=0.945; p=0.015) and after surgery (r=1; p=0) is a predictor of redaction. Conclusion. Among the neuroimaging criteria affecting the high probability of recurrence after microvascular decompression, reliable predictors are acute trigeminal pontine angle, shortened and thinned trigeminal nerve root and narrow cerebellopontine cistern.

Justification. Schizophrenia is often combined with alcohol consumption, which can exacerbate cognitive deficits in patients. Goal. To compare the profile of cognitive impairment in patients with schizophrenia and comorbid alcohol dependence (SchAl) and in patients with schizophrenia alone (Sch). Materials and methods. 54 patients with paranoid schizophrenia (F20.0): SchAl (n=26) and Sch (n=28). BACS and WCST were used; nonparametric analysis with correction of multiple comparisons; effect sizes are presented. Results. SchAl has more pronounced decreases in auditory and working memory, as well as executive functions; the composite BACS score is lower than that of Sch. Conclusion. Comorbid alcohol dependence is associated with additional cognitive deficits in schizophrenia, primarily in the domains of auditory and working memory and executive functions. These features should be taken into account when interpreting the results and when planning rehabilitation programs.

Determining the frequency of cases of primary incidence of mental disorders of a non-psychotic nature of working-age people in a general polyclinic and comparing the results obtained with data from reporting statistical forms. Data of reporting statistical forms No. 10 of the Ministry of Health of the Russian Federation for the Khabarovsk Territory and the city of Khabarovsk for 2018–2022 were analyzed; 1572 medical records of patients aged 20–59 years in 2018–2022; 897 patients of the general medical clinic presenting psychopathological complaints. Used: clinical-epidemiological, clinical-psychopathological, psychometric methods. New data were obtained on the primary incidence of mental disorders of a non-psychotic nature of persons aged 20 to 59 years based on the results of a study in a general medical clinic. New data were obtained on the discrepancy between the incidence rate, the diagnostic structure of the incidence of non-psychotic disorders based on the results of an epidemiological study and the analysis of statistical reports. The reason for the differences is determined by the specifics of the clinical manifestations of mental disorders. Patients with signs of depressive and neurotic disorders rarely consult a psychiatrist, which is associated with the peculiarities of mental abnormalities, which patients associate with physical distress, overwork. Patients with organic and personality disorders more often fall into the field of vision of psychiatrists, which is associated with noticeable emotional-volitional, intellectual-mnestic deviations, behavioral characteristics.

Hypoxic brain injury can be a serious complication in the heart and vascular surgery. The majority of patients with hypoxic brain injury have impaired consciousness, and therefore there is a need for reliable methods of predicting the neurological outcome. In our study, we analyzed the value of electroencephalography reactivity in prediction of outcome in heart surgery patients with hypoxic brain injury. Materials and methods. The analysis included 77 patients after surgery of dissecting aortic aneurysms, valvular pathology, and coronary heart disease with impaired consciousness and hypoxic brain injury. The average age of the patients was 61.7 ± 11 years. All studies were performed during the first five days in the intensive care unit. Inclusion criteria: patients with impaired consciousness (<10 points on a scale of FOUR) after surgery with cardiopulmonary bypass and after circulatory arrest in the perioperative period. All patients underwent video EEG monitoring. Stimuli were used to assess reactivity: passive eye opening and closing, name calling, sound stimulus, and pain stimulus. The presence of reactivity was noted with any change in the amplitude or frequency of the background rhythm. The assessment of reactivity performed without sedation. The outcome assessed with the Glasgow outcome scale (GOS) at the time of discharge from the hospital as favorable with GOS 3–5, unfavorable with GOS 1–2. Results. A favorable outcome observed in 43 patients (55 %): due to perioperative circulatory arrest in 10 patients (23,3 %) and surgical complications in 33 patients (76,7 %). The unfavorable outcome observed in 34 patients (45 %): due to perioperative circulatory arrest in 20 patients (58.8 %) and surgical complications in 14 patients (41,2 %). Presence of EEG reactivity observed in 41 (53 %) patients, and the absence of EEG reactivity observed in 36 (47 %) patients. In the group of patients with presence of EEG reactivity, a favorable outcome was recorded in 36 (87.8 %) cases, an unfavorable outcome in 5 (12.2 %) cases. In patients with lack of reactivity according to EEG data, a favorable outcome was observed in 7 (19.4 %) cases, an unfavorable outcome in 29 (80.5 %) cases. The sensitivity of the method for predicting an unfavorable outcome based on the absence of EEG reactivity is 85 %, and the specificity is 84 %. Conclusion. Assessment of EEG-reactivity has high sensitivity and specificity in prediction of neurological outcome in cardiac surgery patients with hypoxic brain injury, however, it cannot be used as an isolated method and should be part of a multimodal approach.

Pillar Pain syndrome is a persistent pain in the tenar and hypotenar areas that occurs after surgery, with axial support on the arm with wrist extension. Based on the analysis of modern scientific research and publications, the modern understanding of the etiology, pathogenesis, diagnosis and treatment of Pillar Pain syndrome has been studied. Scientific articles in the databases PubMed, eLibrary, Scopus, Medscape, Cyberleninka were analyzed. The following terms were used in search queries: «Pillar pain syndrome», «complications after decompression of the carpal tunnel», «long-term results of surgical treatment of carpal tunnel syndrome», «treatment of Pillar pain», «transverse ligament of the wrist». Data from 41 foreign and 9 domestic articles were selected on the topic under consideration. Based on a review of the literature on the topic under study, data were obtained that Pillar pain syndrome occurs in up to 61 % of all operated patients for the carpal tunnel, but it does not have proven etiological and pathogenetic factors, as well as a developed treatment protocol. It is worth noting that no translation of this term has been found in the Russian-language literature, therefore, the authors of this article propose the introduction of the term BON syndrome — pain syndrome during support load. There are no major studies in the domestic and foreign literature devoted to the systematic study of BON syndrome. Despite the available results of modern scientific research, the question of the origin, development and treatment of this condition remains open. Probably, there is a connection with biomechanical, neurogenic factors. To date, there are no generally accepted approaches to prevention and standardized treatment protocols, which requires further research.

Genetic technologies open up opportunities for studying the molecular basis of a wide range of hereditary pathologies, including mental disorders. Modeling certain genomic variants in cellular and animal models allows us to establish their functional significance and potential mechanisms of involvement in the disease progression, as well as lays the material basis for the development and testing of promising drugs. Here, in this study, we created the first line of transgenic mice carrying the P654L (rs139336954) mutation in the Plxna3 nerve tissue morphogenesis protein and studied their cognitive and behavioral characteristics. The Plxna3 protein, together with the Nrp1/Nrp2 co-receptor, detects signals from the repellent molecules Sema3a and Sema3f and determines the direction of cell migration and nerve fiber growth, the processes that are crucial for the proper development of the finely tuned nervous system. According to bioinformatic analysis, this mutation alters the structure of the extracellular domain of Plxna3, which could potentially disrupt the reception of Sema3a and/or Sema3f. Studies of the behavior of mice carrying the Plxna3-P654L (rs139336954) mutation have revealed increased anxiety, a high degree of orderliness, and reduced sensitivity to external stimuli, which could potentially be interpreted as symptoms of obsessive-compulsive personality disorder. No significant macroscopic or histological differences in brain structure were detected between the control and experimental groups. In this study, we draw attention for the first time to the genomic variant rs139336954 in the Plxna3 gene as a potential cause of obsessive-compulsive personality disorder and propose a novel transgenic model organism for studying the pathogenesis of this disease.

Background: Surgical management of lumbosacral lipomas typically involves untethering of the cord and lipoma resection, but closure of the dura can be achieved by a primary watertight suture or by an expansile duraplasty. The optimal closure strategy remains debated. We retrospectively compared outcomes of primary dural closure versus expansile duraplasty in pediatric lumbosacral lipoma resection, and autologous aponeurotic grafts versus synthetic dural substitutes within the duraplasty group. Methods: We reviewed 52 children and adolescents who underwent surgical treatment of lumbosacral lipomas. Primary dural closure was performed in 34 patients, and expansile duraplasty (using a dural graft) in 18 i.e., aponeurotic graft (n=13) and a synthetic dural substitute (n=5). Postoperative neurological function, re-tethering events, urodynamic changes, wound complications, reoperations, and final ambulatory status (McCormick scale) were recorded over a median follow-up of 3.5 years. Outcomes were compared between closure technique groups and between graft types. Results: New or worsened postoperative neurological deficits occurred in 5/34 (14.7 %) with primary closure versus 1/18 (5.6 %) with expansile duraplasty (p=0.26). Symptomatic retethering (clinical relapse with MRI confirmation) required repeat surgery in 7/34 (20.6 %) of primary closure cases versus 1/18 (5.6 %) in the duraplasty group (p=0.09). Wound complications (superficial dehiscence or CSF leak) were low in both groups (8.8 % vs 11.1 %, p=0.79), and all were managed conservatively (no reoperation). Urodynamic improvement occurred in 11/34 (32.4 %) of primary closure patients versus 9/18 (50 %) of duraplasty patients (p=0.18). Repeat untethering surgery was needed in 4/34 (11.8 %) of primary closure cases and 1/18 (5.6 %) of duraplasty cases (p=0.41). At final follow-up, 21/34 (61.8 %) of primary closure patients versus 14/18 (77.8 %) of duraplasty patients had fully independent ambulation (McCormick I), and fewer duraplasty patients had severe motor impairment (McCormick III–IV: 5/34 [14.7 %] vs 1/18 [5.6 %]). Within the duraplasty group, postoperative neurological worsening occurred in 1/13 (7.7 %) of those with autologous graft versus 0/5 with synthetic graft (p=0.52). One patient (7.7 %) with autologous graft had retethering requiring surgery; none did in the synthetic graft subgroup (p=0.55). Urodynamic improvement rates were comparable (53.8 % vs 40 %, p=0.63), as were wound complication (15.4 % vs 20 %, p=0.81) and reoperation rates (7.7 % vs 0, p=0.52). Functional independence (McCormick I) was similar (76.9 % vs 80 %). Conclusions: Expansile duraplasty trended toward better neurological and re-tethering outcomes than primary dural closure, likely by providing more intradural space around the neural placode. Wound complication and CSF leak rates were low with either technique when meticulous multilayer closure was used. Bladder function tended to improve more after duraplasty, suggesting better decompression. These results support the use of expansile duraplasty (with either graft type) to potentially reduce tethering recurrence without increasing complications in children undergoing lipoma resection.

Sensory alalia is a childhood disease characterized by severe developmental impairment of expressive speech. Despite the availability of various correctional programs, the full-fledged treatment of children with this disease remains a big problem. This is due to the difficulty of early diagnosis of sensory alalia, as well as the need for an integrated approach in the treatment of such patients, which includes not only drug therapy, but also the presence of a specific environment and classes with a speech therapist and a child psychologist. In this present work side a clinical case of comprehensive treatment of a child with sensory alalia.

This study analyzes the role of atherogenesis factors and arterial stiffness indicators in the development of vascular cognitive impairments, including dementia and mild cognitive impairment, in patients without extensive focal brain lesions. The influence of atherogenesis indicators such as the percentage of maximal stenosis of brachiocephalic arteries, intima-media complex thickness in the same arteries, and blood lipid profiles (total cholesterol, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, triglycerides, atherogenic index) was assessed. Arteriosclerosis markers were represented by parameters of stiffness of central arteries (carotid-femoral pulse wave velocity, augmentation index) and regional (brachiocephalic) arteries (pulsatility index and end diastole pulse wave velocity). The study demonstrated that end diastole pulse wave velocity is the only statistically significant factor influencing the formation of vascular cognitive impairment.

The study is devoted to the analysis of correlation between socio-psychological factors and recurrent headache (RH) in adolescents and assessment of their role as predictors and markers of this type of pathology. The aim of the study: to investigate the role of socio-psychological factors as predictors and markers of recurrent headache in adolescents. Materials and methods. The study included 385 students of comprehensive schools in Krasnoyarsk, with 164 (42.6%) boys and 221 (57.4%) girls aged 12-18; the median age was 16 [15; 17] years. The study was conducted by the online survey using the Google Forms screening questionnaire and the psychometric questionnaire "Adaptation Resource of a Teenager". The indicators were compared in groups with the presence of RН (n = 227) and without RН (n = 158), as well as in groups formed taking into account the presence/absence of RН and gender. The informative significance of the indicators was assessed by the values of the odds ratios (OR) and their confidence intervals (CI). The data were processed in the Statistica 12 program. Results. The presence of RН in adolescents is associated with emotional disorders, asthenia, and decreased adaptive resources. Gender differences in the frequency of occurrence of the studied indicators and their informative significance as predictors and markers of RН in adolescents were established. Conclusion. The presence of a significant association of a number of socio-psychological characteristics was revealed, and their role as predictors and markers of RН in adolescents was determined. The data obtained indicate the feasibility of a personalized approach to the diagnosis and correction of predictors and markers of RН in order to prevent this pathology.