ABSTRACT
Moyamoya angiopathy is a chronic progressive cerebrovascular disease characterized by stenosis and occlusion of the distal segments of the internal carotid arteries and/or proximal segments of the middle and anterior cerebral arteries, with a gradual compensatory restructuring of the cerebral circulation to the system of the external carotid arteries. Today, the main treatment method for Moyamoya angiopathy is surgical revascularization of the brain. A search and analysis of publications on the treatment of adult patients with Moyamoya angiopathy was carried out in the PubMed and Medscape databases over the past 10 years. We present a case of an adult female patient with a hemorrhagic form of Moyamoya angiopathy stage IV according to J. Suzuki, who underwent staged combined revascularization of both cerebral hemispheres. Surgical revascularization included the creation of a low-flow extra-intracranial shunt combined with a combination of indirect synangiosis. The combination of direct and indirect methods of surgical revascularization enables to achieve the development of an extensive network of collaterals and fully compensate for cerebral circulatory disorders both in the early and late postoperative periods, which is confirmed by instrumental diagnostic data. Combined revascularization is the most effective modern method of treating patients with Moyamoya angiopathy due to the complementary influence of direct and indirect components of revascularization.
Subject(s)
Cardiovascular Diseases , Moyamoya Disease , Vascular Diseases , Adult , Humans , Female , Moyamoya Disease/diagnostic imaging , Moyamoya Disease/surgery , BrainABSTRACT
OBJECTIVE: To assess the main performance indicators of neurosurgical departments in surgical treatment of cerebral aneurysms in the Russian Federation. MATERIAL AND METHODS: We analyzed 22 neurosurgical departments (19 regional and 3 federal hospitals) in 2017 and 2021. The study enrolled 6.135 patients including 3.160 ones in 2017 and 2.975 ones in 2021. We studied the features of surgical treatment of cerebral aneurysms in different volume hospitals and factors influencing postoperative outcomes. RESULTS: The number of surgeries for cerebral aneurysms decreased from 2.950 in 2017 to 2.711 in 2021. Postoperative mortality rate was 6.3% and 5.6%, respectively. The number of microsurgical interventions decreased from 60% in 2017 to 48% in 2021. The share of endovascular interventions increased from 40% to 52%, respectively. Endovascular embolization was accompanied by stenting in 55% of cases. Simultaneous revascularization was carried out in 2% of cases. In 2021, the number of patients undergoing surgery in acute period of hemorrhage increased to 70% (in 2017 - 61%). The number of hospitals performing more than 50 surgical interventions for cerebral aneurysms annually increased from 14 in 2017 to 17 in 2021. CONCLUSION: Certain changes in neurosurgical service occurred in 2021 compared to 2017. Lower number of surgical interventions for cerebral aneurysms, most likely caused by the COVID-19 pandemic, is accompanied by lower postoperative mortality. Endovascular interventions and revascularization techniques became more common. The number of surgeries in acute period after aneurysm rupture and hospitals performing more than 50 surgical interventions for cerebral aneurysms annually increased.
Subject(s)
Aneurysm, Ruptured , Embolization, Therapeutic , Endovascular Procedures , Intracranial Aneurysm , Subarachnoid Hemorrhage , Humans , Intracranial Aneurysm/surgery , Pandemics , Neurosurgical Procedures/adverse effects , Neurosurgical Procedures/methods , Treatment Outcome , Embolization, Therapeutic/methods , Aneurysm, Ruptured/surgery , Endovascular Procedures/adverse effects , Endovascular Procedures/methods , Subarachnoid Hemorrhage/surgery , Retrospective StudiesABSTRACT
OBJECTIVE: To determine the frequency of Ponticulus posticus and Ponticulus lateralis among patients admitted to a24-hour emergency hospital. MATERIAL AND METHODS: The study included 2887 patients with a traumatic history who were admitted to the hospital for emergency reasons. This principle of sampling allowed us to exclude a high concentration of studies of patients with chronic neurological diseases, the cause of which could be symptomatic Kimmerle's anomaly (KA). During the period 01.01.20 to 31.12.20, primary CT was performed on an emergency basis in 7348 patients. Of these, CT scans of the brain and cervical spine were performed in 2965 patients. Some patients (78 people) were excluded from the study due to the presence of cervical vertebral fractures and metal artifacts in the craniovertebral region. RESULTS: The Ponticulus posticus was detected in 1162 (40.2%) patients, among them class 3 and 4 was detected in 27.7%, and class 2 ossification in 12.5%. This Ponticulus posticus was significantly more common (χ2 test, p=0.0005) in men. The Ponticulus lateralis was identified in 231 patients (8%), among them 94 patients (3.3%) had complete ponticulus on both sides, 29 patients (1%) - on one side, and 108 patients (3.7%) - two-sided incomplete ponticulus. In patients with class 2-3-4, Ponticulus lateralis were detected significantly more often (χ2 test, p<0.0001). CONCLUSION: The cumulative incidence of KA was 42%, 17% of patients are carriers of a complete KA bridge, which is significantly higher than in the European or Asian regions. The data suggest that KA is not the result of ossification of the posterior atlanto-occipital membrane, since different classes of KA occur equally often at different ages. Further studies of KA are needed, including its occurrence in patients of the neurological department and its correlation with individual neurological syndromes to determine the need for surgical treatment in the population.
Subject(s)
Cervical Atlas , Male , Humans , Hospitalization , Hospitals , Brain , PatientsABSTRACT
OBJECTIVE: To study the long-term results of surgical treatment of patients operated on for cerebral aneurysms and their impact on functional recovery, independence and cognitive functions in the long-term period. MATERIAL AND METHODS: A multivariate regression analysis of long-term results of surgical treatment of 324 patients for cerebral aneurysms was performed (on average after 3.5 years). Upon admission of the patient to the hospital for surgical intervention, a clinical diagnostic examination was performed to confirm the diagnosis and determine the volume, timing and type of intervention. In the late period, a clinical neurological study was performed, which included an assessment of the degree of disability with the Barthel index and a modified Rankin scale, cognitive functions with MMSE, and the mental sphere with HADS. RESULTS: The severity of the condition at admission, corresponding to grade III-IV according to the Hunt-Hess classification, was the risk factor for an unfavorable prognosis for the recovery of patients in the long-term period of cerebral aneurysm surgery. The severe condition of patients at the onset of the disease increases the risk of disability by 1.9 times (p<0.05) and the risk of dementia by 6 times (p<0.05). An independent risk factor for the development of cognitive impairment is the patient's age: with an increase in age by 1 year, the MMSE score decreases by 0.27 (p<0.05). The prevalence of hemorrhage according to the Fisher classification, corresponding to grade III, is a predictor of the development of angiospasm in 91% of cases. In patients with established angiospasm, the risk of developing dementia and pre-dementia cognitive impairment was 57.3% (p<0.05). The best predictions for recovery of cognitive functions in the long-term period were observed in patients who underwent simultaneous aneurysm clipping with extra-intracranial anastomosis (mean MMSE score 25) compared with patients who underwent only aneurysm clipping (mean score 20), endovascular intervention (average score 21) or microsurgical intervention followed by intrathecal fibrinolytic injection (mean MMSE score of 20) (p<0.05). CONCLUSION: The predictors of unfavorable recovery of cognitive functions and the development of disability in the long-term period of surgical treatment of cerebral aneurysms were the severity of the condition at admission, corresponding to III-IV st. according to the Hunt-Hess classification, the age of the patient at the time of the intervention, the prevalence of hemorrhage according to Fisher, and the choice of surgical technique.
Subject(s)
Aneurysm, Ruptured , Dementia , Intracranial Aneurysm , Subarachnoid Hemorrhage , Humans , Intracranial Aneurysm/complications , Intracranial Aneurysm/surgery , Subarachnoid Hemorrhage/etiology , Microsurgery/adverse effects , Microsurgery/methods , Neurosurgical Procedures/adverse effects , Neurosurgical Procedures/methods , Dementia/complications , Treatment Outcome , Retrospective Studies , Aneurysm, Ruptured/surgeryABSTRACT
OBJECTIVE: To present the technique of extra-intracranial bypass surgery using the orifice of maxillary artery bypass, to evaluate the advantages and disadvantages of this and alternative revascularization options. MATERIAL AND METHODS: Radial artery graft harvesting was performed at the 1st stage. Simultaneously, the second team of surgeons performed a combined (submandibular and anterior) access to the donor artery (mandibular segment of maxillary artery behind the ramus of the mandible). Craniotomy and mobilization of potential recipient arteries (M2-M3 segments of the middle cerebral artery) were performed at the 2nd stage. Distal anastomosis in end-to-side fashion was formed with M3 segment of the middle cerebral artery. At the 3rd stage, radial artery was passed through a subcutaneous tunnel in zygomatic region. The orifice of maxillary artery was resected together with distal external carotid artery (ECA) and orifice of superficial temporal artery. After transposition of ECA and orifice of maxillary artery, proximal end-to-end anastomosis was performed with radial artery. After that, the main surgical stage was performed, i.e. exclusion of M3 segment of the middle cerebral artery together with aneurysm. RESULTS: Harvesting of mandibular segment of the maxillary artery as a donor vessel reduces the length of bypass graft to 12-14 cm since this branch is localized close to the skull base. You can also form optimal proximal end-to-end anastomosis for intracranial redirecting blood flow maxillary artery. CONCLUSION: The described method makes it possible to form anastomosis with a short bypass graft and reduce the risk of thrombosis. This procedure is effective for cerebral bypass in patients with skull base tumors, complex aneurysms, and occlusive-stenotic lesions of carotid arteries.
Subject(s)
Cerebral Revascularization , Intracranial Aneurysm , Anastomosis, Surgical/methods , Cerebral Revascularization/methods , Humans , Intracranial Aneurysm/diagnostic imaging , Intracranial Aneurysm/surgery , Maxillary Artery/diagnostic imaging , Maxillary Artery/surgery , Middle Cerebral Artery/surgeryABSTRACT
OBJECTIVE: To conduct a systematic review and meta-analysis to determine the frequency of Kimmerle's anomaly (KA) in patients with grades III and IV vertebral artery (VA) sulcus ossification. MATERIAL AND METHODS: We searched the PubMed and eLIBRARY.RU databases, identified 68 articles in English, and obtained data of 29.770 patients. To date, no study in Russia has reported KA. The incidence of KA was determined using single-group meta-analysis. We used odds ratios (OR) to investigate the association between sex and the frequency of KA. Publication bias was assessed using the Egger test. RESULTS: The pooled prevalence of complete KA was 8.6% (95%, confidence interval (CI) 7.8-9.5%); however, the Egger test confirmed publication bias (t=2.102, p=0.022), which was eliminated by dividing the patient sample by geographic macroregions. The incidence of KA in Europe and Asia was 10.1% and 6.5%, respectively. The pooled prevalence of KA associated with grade III ossification was 7.2% (95% CI 4.9-10.4%). The OR of KA in men vs. women was 1.23 (95% CI 1.098-1.389). CONCLUSION: The incidence of KA was significantly associated with the macroregion. Nearly 15.8% of the population may show grades III and IV VA sulcus ossification, and surgical treatment is required in some patients. KA formation is more typical for males. A population study is warranted to clarify the frequency of KA in the Russian population.
Subject(s)
Osteogenesis , Vertebral Artery , Asia , Europe , Female , Humans , Male , Prevalence , Vertebral Artery/diagnostic imagingABSTRACT
BACKGROUND: Intracranial aneurysms (IAs) pose a high risk of spontaneous subarachnoid hemorrhage. In the most complex cases, the only way to exclude the aneurysm from the circulation is to perform a high-flow extracranial-to-intracranial bypass, thus creating a new bloodstream. This avoids severe ischemic complications; however, it requires careful consideration of individual anatomy and hemodynamic parameters. Computational fluid dynamics (CFD) can be of great help in planning such a surgery by creating 3D patient-specific models of cerebral circulation. OBJECTIVE: Assessment of the perspectivity of high-flow extracranial-to-intracranial bypass planning using computational modeling. MATERIAL AND METHODS: In this research work, we have applied the CFD methods to a patient with a giant thrombosed IA of the internal carotid artery (ICA). Preoperative CTA images and Gamma Multivox workstation were used to create a 3D model with current geometry and three additional models: Normal anatomy (no IA), Occlusion (with ligated ICA), Virtual bypass (with bypass and ligated ICA). The postoperative data were also available. Boundary conditions were based on PC-MRI measurements. Calculation of hemodynamics was conducted with a finite element package ANSYS Workbench 19. RESULTS: The results demonstrated an increase in the blood flow on the affected side by more than 70% after the virtual surgery and uniformity of flow distribution between the affected and contralateral sides, indicating that the treatment is likely to be efficient. Later, postoperative data confirmed that. CONCLUSION: The study showed that virtual preoperative CFD modeling could significantly simplify and improve surgical planning.
Subject(s)
Cerebral Revascularization , Intracranial Aneurysm , Subarachnoid Hemorrhage , Carotid Artery, Internal/surgery , Cerebral Revascularization/methods , Cerebrovascular Circulation , Humans , Intracranial Aneurysm/diagnostic imaging , Intracranial Aneurysm/surgery , Neurosurgical Procedures/methods , Subarachnoid Hemorrhage/diagnostic imaging , Subarachnoid Hemorrhage/surgeryABSTRACT
OBJECTIVE: To investigate the clinical features of associated mental disorders in amyotrophic lateral sclerosis (ALS). MATERIAL AND METHODS: Twenty-seven patients (9 men and 18 women, mean age 59.8±11.9 years) with the upper and lower motor neuron lesions were studied. The average duration of the disease at the time of examination was 3.2±2.4 years. Clinical psychopathological and follow-up methods were used. The severity of cognitive impairment was measured with the Edinburgh Cognitive and Behavioral ALS Screen (ECAS). The Montgomery-Asberg Depression Rating Scale (MADRS) was used to assess the severity of depression. RESULTS: Most patients (88.9%) had cognitive impairments. Amnestic disorders were primarily presented by hypo- and dysmnesia. These patients showed slow thinking, torpidity combined with circumstantiality and a tendency to detail. In addition to attentional fluctuations, we observed reduced attentional capacity, higher distractibility, and difficulty concentrating. The later stages of the disease were accompanied by the overall decline of thinking ability and intelligence with severe perseverations, and failure in the adequate self-assessment. More than half of the patients also developed the symptoms, such as dynamic aphasia, as well as functional speech disorders, i.e. gnosis and praxis. The vast majority of the patients had affective disorders (92.3%). So far as the symptoms of the underlying neurological condition worsened, the associated depressive symptoms prevailed (62.9%). Particular attention should be given to the clinical cases of ALS associated with psychotic disorders such as acute schizophrenia-like psychotic disorders. CONCLUSION: Presence of affective, cognitive and behavioral disorders, as well as a specific neuroimaging pattern, are considered as a whole as the manifestation of the behavioral variant of frontotemporal dementia (FTD). This provides support for the current opinion suggesting the similarity of ALS and FTD, which allows for considering these diseases as different phenotypic manifestations of a single pathological process.
Subject(s)
Amyotrophic Lateral Sclerosis , Cognition Disorders , Frontotemporal Dementia , Aged , Amyotrophic Lateral Sclerosis/complications , Amyotrophic Lateral Sclerosis/diagnosis , Cognition , Cognition Disorders/complications , Female , Frontotemporal Dementia/diagnosis , Humans , Male , Middle Aged , Neuropsychological TestsABSTRACT
INTRODUCTION: Giant phiKZ-like bacteriophages have a unique protein formation inside the capsid, an inner body (IB) with supercoiled DNA molecule wrapped around it. Standard cryo-electron microscopy (cryo-EM) approaches do not allow to distinguish this structure from the surrounding nucleic acid of the phage. We previously developed an analytical approach to visualize protein-DNA complexes on Escherichia coli bacterial cell slices using the chemical element phosphorus as a marker. In the study presented, we adapted this technique for much smaller objects, namely the capsids of phiKZ-like bacteriophages. MATERIAL AND METHODS: Following electron microscopy techniques were used in the study: analytical (AEM) (electron energy loss spectroscopy, EELS), and cryo-EM (images of samples subjected to low and high dose of electron irradiation were compared). RESULTS: We studied DNA packaging inside the capsids of giant bacteriophages phiEL from the Myoviridae family that infect Pseudomonas aeruginosa. Phosphorus distribution maps were obtained, showing an asymmetrical arrangement of DNA inside the capsid. DISCUSSION: We developed and applied an IB imaging technique using a high angle dark-field detector (HAADF) and the STEM-EELS analytical approach. Phosphorus mapping by EELS and cryo-electron microscopy revealed a protein formation as IB within the phage phiEL capsid. The size of IB was estimated using theoretical calculations. CONCLUSION: The developed technique can be applied to study the distribution of phosphorus in other DNA- or RNA-containing viruses at relatively low concentrations of the element sought.
Subject(s)
Bacteriophages , Caudovirales , Bacteriophages/genetics , Capsid , Capsid Proteins/genetics , Cryoelectron Microscopy , DNA, Viral/genetics , Microscopy, Electron , Myoviridae/chemistry , PhosphorusABSTRACT
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.
Subject(s)
Drug Resistant Epilepsy , Epilepsy , Pharmaceutical Preparations , Radiosurgery , Drug Resistant Epilepsy/surgery , Electroencephalography , Epilepsy/surgery , Humans , Retrospective Studies , Treatment OutcomeABSTRACT
Since 2013, neurosurgeons have been guided by the RUANS recommendation protocol for surgical management of patients with acute cervical spine fractures in Russia. However, there are no studies devoted to interobserver agreement between specialists with different experience. OBJECTIVE: To evaluate the role of the RUANS recommendation protocol for decision-making in patients with acute traumatic cervical spine injuries. MATERIAL AND METHODS: Twenty-one neurosurgeons from 5 hospitals estimated data of 64 patients with cervical spine fractures. The study implied choosing an option for patient treatment (conservative therapy; anterior, posterior and circular fusion surgery). Two evaluations of CT and MR scans with an interval of 1.5 months were conducted. In the main group (9/21), neurosurgeons strictly followed the RUANS recommendation protocol during re-evaluation. In the control group (12/21), neurosurgeons analysed data considering their own knowledge and experience. Interobserver agreement was evaluated using a Fleiss' or Cohen's Kappa (K). RESULTS: Among the junior neurosurgeons (up to 5 years of experience), change in consent level during re-evaluation was greater in the main group (∆K=0.25) compared to the control group (∆K= -0.17). Among neurosurgeons with medium level of experience (5-10 years), ∆K was 0.19 in the main group and -0.15 in the control group. Among experienced neurosurgeons (over 10 years of experience), the main group showed an increase in Kappa (∆K=0.24), while level of consent remained almost the same in the control group (∆K=0.05). CONCLUSION: The RUANS recommendation protocol can significantly improve interobserver agreement between specialists with various levels of experience regarding management of acute cervical spine injury.
Subject(s)
Spinal Diseases , Spinal Fractures , Cervical Vertebrae/diagnostic imaging , Cervical Vertebrae/surgery , Humans , Neurosurgeons , RussiaABSTRACT
Based on a clinical case, the authors consider the problem of the optimal choice of an antidepressant, taking into account not only the psychopathological structure of depression, the severity and characteristics of its triad, but also the presence of somatic symptoms. This determines the need for a comprehensive analysis of the pharmacological profile of prescribed antidepressants, their psychotropic and somatotropic effects. The switch of the patient to brintellix, which has polymodal neuroreceptor activity, at a dose of 20 mg per day, made it possible to achieve remission and reduce adverse reactions caused by SSRIs.
Subject(s)
Antidepressive Agents , Depression , Antidepressive Agents/therapeutic use , Depression/drug therapy , Humans , Selective Serotonin Reuptake Inhibitors/therapeutic useABSTRACT
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.
Subject(s)
Brain Injuries, Traumatic , Brain Injuries , Status Epilepticus , Brain Injuries, Traumatic/diagnosis , Electroencephalography , Humans , Monitoring, PhysiologicABSTRACT
High-grade gliomas have a diffuse and infiltrative nature of the growth of tumor cells, due to which the achievement of radical resection is difficult. Surgical resection completeness of brain tumors is an important factor in prolonging the life of patients. An accurate definition of tumor boundaries and residual fluorescent regions is impossible due to imperfections of the equipment used for fluorescent imaging. 5-aminolevulinic acid (5-ALA) is a precursor of protoporphyrin IX (PpIX) in humans and is clinically used to detect and treat tumors. Currently, fluorescence-guided surgery with PpIX used a surgical microscope with an excitation wavelength in the blue spectrum range. Because of its low ability to penetrate into biological tissue, blue light is ineffective for providing high-quality fluorescent navigation. Also, when performing an operation using radiation in the blue spectrum range, the photosensitizer's surface layer (PS) often bleaches out, which leads to frequent errors. The use of red light emission makes it possible to slow down the PS bleaches out due to the absorption properties of PpIX, but this task is technically more complicated and requires highly sensitive cameras and specialized optical filters. The new two-channel video system for fluorescent navigation has a radiation source in the red range of the spectrum, the penetration depth of which is greater than the blue light, which makes it possible to increase the depth of probing into biological tissues. The study's clinical part involved 5 patients with high grade glioma and 1 patient with low grade glioma: grade III oligodendrogliomas (2), grade IV glioblastomas (3), and grade II diffusion astrocytoma (1).
ABSTRACT
The polysaccharide mannan is the main surface antigen of the cell wall of Candida fungi, playing an important role in the pathogenesis of diseases caused by these mycopathogens. Mannan has a complex, comb-like structure and includes a variety of structural units, with their combination varying depending on the Candida species and strain. Glucomannan, a polysaccharide from Candida utilis, contains terminal α-d-glucose residues attached to oligomannoside side chains. This paper describes the first synthesis of a pentasaccharide structurally related to C. utilis glucomannan fragment, which is an α-(1â2)-linked tetramannoside terminated at the non-reducing end by an α-d-glucopyranosyl residue. The pentasaccharide was obtained as a 3-aminopropyl glycoside, which made it possible to synthesize also its biotinylated derivative, suitable for various glycobiological studies. The most complicated step in the pentasaccharide synthesis was stereoselective 1,2-cis-glycosylation to attach the α-d-glucopyranosyl residue. This was accomplished using a glucosyl donor specially developed in our laboratory, the protecting groups of which provide the necessary α-stereoselectivity. The target biotinylated pentasaccharide thus obtained will be used in the future as a model antigen for the detection of immunodeterminant epitopes of Candida mannans.
ABSTRACT
BACKGROUND: Assessment of rupture risk for intracranial aneurysms (IA) is a particular challenge in cases of so-called complex aneurysms due to their variable morphometric characteristics. Arterial branch arising from the dome or the neck of IA is one of the least explored features of complex aneurysms. The methods of computational fluid dynamics may be valuable to determine the influence of arterial branches of IA on local hemodynamics. OBJECTIVE: To analyze local hemodynamics in IA with arterial branch arising from the cupola or the neck depending on the structure of the aneurysm and blood flow rate in the parent vessel. MATERIAL AND METHODS: CT angiography data of 4 patients with IA were estimated in this study. Modifications of the baseline 3D models of the aneurysms resulted 12 patient-specific models included into analysis. Hemodynamic calculations were made by using of ANSYS Workbench 19 software package. RESULTS: Wall shear stress (WSS) was characterized by the most significant variability, especially in case of sidewall aneurysms. Small cross-sectional area of additional branch in relation to the neck of IA was not followed by considerable changes of blood flow patterns inside IA after «virtual¼ removal of the vessel. Otherwise, the intensity of flows was drastically reduced. Simulation of high inlet flows demonstrated substantial variation of WSS in the area of jet. CONCLUSION: Additional arterial branch arising from the dome or the neck of IA significantly influences local hemodynamics. This influence depends on the localization of IA in relation to the parent vessel and the diameter of additional arterial branch.
Subject(s)
Imaging, Three-Dimensional , Intracranial Aneurysm/diagnostic imaging , Hemodynamics , Humans , Hydrodynamics , Stress, MechanicalABSTRACT
AIM: The study was aimed at developing a surgical policy for patients presenting with acute ischaemic stroke induced by lesions of the intra- and extracranial arteries. PATIENTS AND METHODS: The patients were enrolled into the study resulting from the current practice of the Department of Emergency Neurosurgery of the Research Institute of Emergency Medicine named after N.V. Sklifosovsky. Sampling of patients was carried out from 1st January, 2014 to 10th October, 2017, eventually comprising all those (n=160) operated on for verified pathology of brachiocephalic arteries and acute impairment of cerebral circulation. RESULTS: During the examination, 101 (63.1%) patients were found to have unilateral or bilateral stenosis of the internal carotid artery, 22 (10.7%) patients were diagnosed with occlusion of the internal carotid artery, and 36 (17.6%) had acute thrombosis of the internal carotid artery. All this was the cause of acute impairment of cerebral circulation. Also, 1 patient was found to have occlusion of the 1st segment of the vertebral artery. Depending on the type of the lesion to the internal carotid artery, the patients were subdivided into 3 groups: 1) patients with internal carotid artery stenosis who received carotid endarterectomy; 2) patients with occlusion of the internal carotid artery, subjected to creation of an extra-intracranial microanastomosis, and 3) those with thrombosis of the internal carotid artery, who depending on the degree of occlusion of the internal carotid artery and patency of the intracranial arteries underwent thrombintimectomy or an extra-intracranial microanastomosis. The indications for and contraindications to interventions were defined based on the existing symptomatic pathology of brachiocephalic arteries, the terms of acute impairment of cerebral circulation, perfusion of the brain, the risk for the development of malignant stroke and cerebral oedema, possible haemorrhagic transformation of the focus of ischaemia, the rehabilitational potential of the patient and the analysis of the current literature. The results of our work demonstrated that surgical treatment of patients in the cute period of ischaemic stroke makes it possible to improve the neurological outcomes in patients as compared with the preoperative status and is not accompanied by a high risk of surgical complications (with the haemorrhagic complication rate amounting to 0.6%). CONCLUSION: Surgical revascularization of the brain in the acute period of ischaemic stroke is a safe and effective method of treatment in patients with different haemodynamically significant damage of brachiocephalic arteries, once the patients were correctly selected for the operation.
Subject(s)
Brain Ischemia/etiology , Carotid Stenosis/surgery , Cerebral Revascularization/adverse effects , Endarterectomy, Carotid/adverse effects , Stroke/etiology , Brain/diagnostic imaging , Carotid Artery, Internal/surgery , HumansABSTRACT
Infections caused by Enterococcus spp. are a major concern in the clinical setting. In Enterococcus faecalis, the capsular polysaccharide diheteroglycan (DHG), composed of ß-d-galactofuranose-(1 â 3)-ß-d-glucopyranose repeats, has been described as an important virulence factor and as a potential vaccine candidate against encapsulated strains. Synthetic structures emulating immunogenic polysaccharides present many advantages over native polysaccharides for vaccine development. In this work, we described the synthesis of a library of DHG oligomers, differing in length and order of the monosaccharide constituents. Using suitably protected thioglycoside building blocks, oligosaccharides up to 8-mer in length built up from either Galf-Glcp or Glcp-Galf dimers were generated, and we evaluated their immunoreactivity with antibodies raised against DHG. After the screening, we selected two octasaccharides, having either a galactofuranose or glucopyranose terminus, which were conjugated to a carrier protein for the production of polyclonal antibodies. The resulting antibodies were specific toward the synthetic structures and mediated in vitro opsonophagocytic killing of different encapsulated E. feacalis strains. The evaluated oligosaccharides are the first synthetic structures described to elicit antibodies that target encapsulated E. faecalis strains and are, therefore, promising candidates for the development of a well-defined enterococcal glycoconjugate vaccine.
Subject(s)
Opsonin Proteins , Vaccines , Antibodies, Bacterial , Antigens, Bacterial , PolysaccharidesABSTRACT
OBJECTIVE: To establish the psychopathological characteristics of depersonalization disorders in patients with depressive states of varying severity and nosological affiliation. MATERIAL AND METHODS: Fifty-five patients (39 women, mean age 36.89±12.9 years and 16 men, mean age 37.11±13.7 years) were studied using a psychopathological method and psychometric scales. RESULTS: There is a certain syntropy between the various variants of depressive and depersonalization disorders. Depersonalization of change, the mildest variant of the disorder of self-consciousness, is observed both in so-called endogenous affective disorders (phases of recurrent depressive disorder (DDR) and bipolar affective disorder (BAR)), and in predominantly psychogenic depressive disorders (impaired adaptation). Depersonalization of loss is characteristic of the more severe phases of DDR and BAR, as well as periods of exacerbation of dysthymia. CONCLUSION: The synergism between depressive affect and depersonalization disorders determines the choice of therapeutic tactics.
Subject(s)
Bipolar Disorder , Depressive Disorder , Adult , Depersonalization/epidemiology , Depressive Disorder/diagnosis , Depressive Disorder/epidemiology , Female , Humans , Male , Middle Aged , Mood Disorders , Psychopathology , Young AdultABSTRACT
In this article we present the clinical case of 63 y.o. man with chronic occlusion of the right common, internal, and external carotid arteries, and critical stenosis of the left internal carotid artery, with complaints of muscle weakness and decreased sensitivity of the left limbs. The patient underwent a staged brain revascularization, the left carotid endarterectomy was performed at the first stage and followed by bonnet bypass, which consists in anastomosing the contralateral superficial temporal artery with the ipsilateral intracranial artery by autograft interposition. In the postoperative period, the patient's neurological symptoms regressed. This case demonstrates the possibility of using bonnet bypass as an alternative revascularization method in patients with cerebral blood circulation insufficiency.