Evaluation of the Effectiveness of Systemic Therapy of Spinal Cord Injury of Moderate Severity with Human Umbilical Cord Placental Blood Mononuclear Cells Using Indicators of Dispersion of Articular Angles in the Swimming Test.

Female Sprague-Dawley rats were used as models of moderate contusion spinal cord injury to evaluate the efficiency of single systemic (intravenous) infusion of human mononuclear cord blood cells for restoration of the motor function of hind limbs. The dynamics of recovery of hind limb motor function was assessed using a specially designed method based on calculation of selective dispersion and amplitude-dependent dispersion of hind limbs joint angles measured in the swimming test. The obtained data suggest that systemic application of human mononuclear cord blood cells significantly (p<0.05) promoted recovery of hind limb motor function in the animal models of contusion spinal cord injury of moderate severity in comparison with control animals (without cell therapy).

[The frequency of vertebral artery sulcus ossification, grades III and IV, in patients with Kimmerle's anomaly: A systematic review and meta-analysis]. / Opredelenie chastoty vstrechaemosti III i IV stepenei ossifikatsii borozdy pozvonochnoi arterii u patsientov s anomaliei Kimmerle: sistematizirovannyi obzor i metaanaliz.

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.

[Role of the RUANS recommendation protocol for decision-making in patients with acute traumatic cervical spine injuries]. / Rol' rekomendatel'nogo protokola Assotsiatsii neirokhirurgov RF pri vybore optimal'noi taktiki lecheniya patsientov s ostrymi travmaticheskimi povrezhdeniyami sheinogo otdela pozvonochnika.

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.

[Long-term EEG monitoring in patients with acute traumatic brain injury]. / Dlitel'noe monitorirovanie elektroentsefalogrammy u bol'nykh s tyazheloi cherepno-mozgovoi travmoi.

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.

[Guidelines for the management of severe traumatic brain injury. Part 3. Surgical management of severe traumatic brain injury (Options)].

Traumatic brain injury (TBI) is one of the main causes of mortality and severe disability in young and middle age patients. Patients with severe TBI, who are in coma, are of particular concern. Adequate diagnosis of primary brain injuries and timely prevention and treatment of secondary injury mechanisms markedly affect the possibility of reducing mortality and severe disability. The present guidelines are based on the authors' experience in developing international and national recommendations for the diagnosis and treatment of mild TBI, penetrating gunshot wounds of the skull and brain, severe TBI, and severe consequences of brain injury, including a vegetative state. In addition, we used the materials of international and national guidelines for the diagnosis, intensive care, and surgical treatment of severe TBI, which were published in recent years. The proposed recommendations for surgical treatment of severe TBI in adults are addressed primarily to neurosurgeons, neurologists, neuroradiologists, anesthesiologists, and intensivists who are routinely involved in treating these patients.

[Guidelines for the diagnosis and treatment of severe traumatic brain injury. Part 2. Intensive care and neuromonitoring].

Traumatic brain injury (TBI) is one of the major causes of death and disability in young and middle-aged people. The most problematic group is comprised of patients with severe TBI who are in a coma. The adequate diagnosis of primary brain injuries and timely prevention and treatment of the secondary injury mechanisms largely define the possibility of reducing mortality and severe disabling consequences. When developing these guidelines, we used our experience in the development of international and national recommendations for the diagnosis and treatment of mild traumatic brain injury, penetrating gunshot wounds to the skull and brain, severe traumatic brain injury, and severe consequences of brain injuries, including a vegetative state. In addition, we used international and national guidelines for the diagnosis, intensive care, and surgical treatment of severe traumatic brain injury, which had been published in recent years. The proposed guidelines concern intensive care of severe TBI in adults and are particularly intended for neurosurgeons, neurologists, neuroradiologists, anesthesiologists, and intensivists who are routinely involved in the treatment of these patients.

[International multicenter studies of treatment of severe traumatic brain injury].

Despite the introduction of new diagnostic and therapeutic methods, traumatic brain injury (TBI) remains one of the leading cause of death and disability worldwide. Standards and recommendations on conservative and surgical treatment of TBI patients should be based on concepts and methods with proven efficacy. The authors present a review of studies of the treatment and surgery of severe TBI: DECRA, RESCUEicp, STITCH(TRAUMA), CRASH, CRASH-2, CAPTAIN, NABIS: H ll, Eurotherm 3235. Important recommendations of the international group IMPACT are considered.

[Guidelines for the management of severe head injury. Part 1. Neurotrauma system and neuroimaging].

Traumatic brain injury is one of the main causes of mortality and disability in young and middle-aged individuals. The patients with severe traumatic brain injury who are in coma are the most difficult to deal with. Appropriate diagnosis of the primary brain injuries and early prevention and treatment of secondary damage mechanisms largely determine the possibility of reducing mortality and severe disabling consequences. The authors compiled these guidelines based on their experience in development of international and Russian recommendations on the diagnosis and treatment of mild traumatic brain injury, penetrating gunshot injury of the skull and brain, severe traumatic brain injury, and severe consequences of brain injuries, including a vegetative state. In addition, we used the materials of international and Russian recommendations on the diagnosis, intensive care, and surgical treatment of severe traumatic brain injury published in recent years. The proposed recommendations are related to organization of medical care and diagnosis of severe traumatic brain injury in adults and are primarily addressed to neurosurgeons, neurologists, neuroradiologists, anesthesiologists, and emergency room doctors, who are routinely involved in management of these patients.

[Cerebrolysin in the treatment of brain injuries of moderate severity].

OBJECTIVE: To assess the efficacy of cerebrolysin in patients with cranial/brain injury of moderate severity. MATERIAL AND METHODS: The main group included 30 patients treated with cerebrolysin from the first day of disease, the comparison group included 32 patients matched for age, sex and disease severity. RESULTS AND CONCLUSION: Cerebrolysin promoted the early and complete reduction of common symptoms of brain injury as well as autonomic and asthenic disorders, restoration of cognitive functions, normalization of emotional condition, improvement of spontaneous bioelectrical activity. The drug was well-tolerated.

[Levels of S100ß protein in patients with mild traumamic brain injury].

The prospective study of plasma S100ß protein levels in 19 patients with mild traumamic brain injury treated with conservative methods was carried out. The S100ß protein levels were measured on the admission of the patient and after 24 and 48 h. The level of S100ß increased above normal values (>0,105 mkg/l) in 11 patients (58%) in the first 6 h after the trauma. The CT analysis revealed brain matter lesions in 8 patients (42%), MRI - in 11 (58%) cases. The increase of baseline S100ß levels above normal values was found in all patients with brain matter lesions seen in CT and in 27% of patients with the normal CT. CT revealed brain lesions in 73% and MRI in 100% of patients with mild traumamic brain injury and increased plasma S100ß levels. There was no correlation between the S100ß level and the type of brain lesion, its localization or volume and the fracture of cranial bones. Also, no correlation was found between S100ß levels and EEG changes (p>0,05).

[Actovegin in the treatment of brain injuries of mild and moderate severity].

Sixty-eight patients, including 32 patients of the main group who received aktovegin in addition to standard therapy and 36 patients of the control group with standard therapy only, have been studied. In both groups, various traumatic injuries (small focal injuries, subdural and epidural hematomas, traumatic subarachnoid hemorrhages, a combination of covering hematoma and small focal injuries) have been found. Aktovegin has been used in drops in dosage 400 mg per 200 ml physiological solution for 10 days. A comparative analysis of clinical data and results of instrumental studies (EEG, CT etc) in the main and control groups gives grounds to conclude that the use of aktovegin in the complex with standard therapy improves the course of brain injuries thus promoting the earlier compensation of disturbed functions and shortening the terms of treatment. The regress of asthenic symptoms as well as positive EEG changes are most pronounced.