Multivariate pattern analysis of cooperation and competition in constructive action.

The neural underpinning of cooperative and competitive constructive activity has been investigated using mass-univariate approaches. In this study, we sought to compare the results of these approaches with the results of multivariate pattern analysis (MVPA). In particular, we wanted to test whether MVPA supports the claim made in previous studies that cooperation is associated with the activity of reward-related brain circuits. Participants were required to construct a pattern on the screen either individually or in cooperation or competition with another person during an fMRI scan. Both the MVPA classification methods and the representational similarity analysis indicated the involvement of orbitofrontal and ventromedial prefrontal areas in processes that distinguish between cooperation and competition, and activation analysis showed that these areas are more active during cooperation than during competition. However, a single trial analysis showed that the effect was reversed when only winning trials were considered. In these trials, activation of reward-related areas was higher during competition than during cooperation. Moreover, the contrast between won and lost trials in terms of reward circuits involvement was sharper under competition than under cooperation. Thus, although cooperation can be generally more rewarding than competition, it is associated with smaller difference between trials lost and trials won in terms of reward circuits activation. One may speculate that in cooperation, victory and defeat are shared with the partner and, contrary to competition, are not experienced as personal achievement or failure.

Individual differences in the neural representation of cooperation and competition.

Much evidence links the Big Five's agreeableness to a propensity for cooperation and aggressiveness to a propensity for competition. However, the neural basis for these associations is unknown. In this functional magnetic resonance imaging study, using multivariate pattern analysis of data recorded during a computer game in which participants were required to construct target patterns either in cooperation or in competition with another person, we sought to determine how individual differences in neural representations of cooperative and competitive behavior relate to individual differences in agreeableness and aggressiveness. During cooperation, agreeableness was positively correlated with the consistency of spatial patterns of neural activation in the left temporoparietal junction (TPJ) and showed positive correlations with inter-subject similarity in the dynamics of neural responses in the posterior default mode network hub and areas involved in the regulation of attention, movement planning, and visual perception. During competition, aggressiveness was positively correlated with the consistency of spatial patterns in the left and right TPJ and showed positive correlations with neural dynamics in visual processing and movement regulation areas. These results are consistent with the assumption that agreeable individuals are more involved in cooperative interactions with others, whereas aggression-prone individuals are more involved in competitive interactions.

The frequency of atrial infarction in patients with supraventricular arrhythmias.

Aim      To evaluate the incidence of atrial infarction (AI) based on a retrospective review of 287 case reports of patients with supraventricular arrhythmia and a positive qualitative test for troponin I after pharmacological arrest of arrhythmia; to determine the target localization of lesions and diagnostic signs, that appear in acute ischemic atrial damage, by selective coronary angiography (CA).Material and methods  A retrospective review was performed of 287 case reports of patients admitted to cardiology departments for atrial fibrillation paroxysm with narrow QRS complexes on electrocardiogram (ECG) from 2018 through 2020. At the prehospital stage, verapamil had been administered intravenously with no effect. In the hospital, the sinus rhythm was successfully restored pharmacologically in all patients. Then ECG, repeated qualitative determination of troponin I, echocardiography, and CA were performed.Results 77 (27 %) patients of the study group had AI signs; 27 (9.5 %) of these patients had confirmed AI, and 50 (17.5 %) patients had probable AI. The existence of acute ischemic injury was considered absolutely confirmed in the presence of a combination of ECG changes, positive markers of myocardial damage, and reduced blood flow velocity in the left atrial branch of the sinoatrial nodal artery as shown by CA; in the presence of only ECG and biochemical criteria, acute AI was considered probable. According to selective CA, coronary injuries requiring an intervention were absent, and signs of the above-mentioned artery thrombosis were not visualized. However, the blood flow velocity was reduced to the TIMI II level in 9.5 % of cases; other atrial branches had an extremely small diameter.Conclusion      Atrial infarction needs to be excluded for patients with supraventricular arrhythmias, a characteristic clinical picture, and increased levels of myocardial injury enzymes.

[The Bleeding Safety of Ticagrelor in Patients With ST-Elevation Acute Coronary Syndrome Treated With Fibrinolytic Therapy].

Aim      To compare hemorrhagic safety of ticagrelor and clopidogrel in patients with ST-segment elevation acute coronary syndrome (STEACS) after thrombolytic therapy (TLT).Material and methods  This nonrandomized study included 183 patients followed up for 30 days. Hemorrhagic safety was compared in a group of patients with STEACS (n=71) after a thrombolytic treatment with alteplase and early ticagrelor treatment (180 mg followed by switching to 90 mg twice daily) and in a group of patients (n=112) with STEACS receiving TLT with alteplase and clopidogrel (loading dose, 600 mg followed by switching to 75 mg daily). Primary endpoint was hemorrhage associated with TLT; patients were followed up for 30 days.Results During the follow-up period, TLT-associated hemorrhages were observed in 11.3% of patients in the ticagrelor treatment group and in 10.7% of patients in the clopidogrel treatment group (p=0.9; odds ratio, 1.06 at 95 % confidence interval, from 0.41 to 2.73). Intracranial hemorrhages and fatal hemorrhages were absent in both groups.Conclusion      There were no significant differences in hemorrhagic safety between patients with STEACS after the TLT treatment with alteplase and early treatment with ticagrelor or clopidogrel.

[Successful combination treatment of giant bicameral fusiform partially thrombosed vertebral artery aneurysm at 12-year-old patient (practical case and literature review)]. / Uspeshnoe kombinirovannoe lechenie gigantskoi dvukhkamernoi fuziformnoi chastichno trombirovannoi anevrizmy pozvonochnoi arterii u patsienta 12 let (sluchai iz praktiki i obzor literatury).

Giant cerebral aneurysms are diagnosed more often in children than in adults. Treatment of giant aneurysms is carried out both by endovascular and microsurgical methods. Literature information on combination of microsurgical and endovascular operations of cerebral aneurysms at children is little. A clinical case of the combined treatment of a giant bicameral fusiform partially thrombosed aneurysm of the right vertebral artery at a 12-year-old patient and a literature review on this topic are presented. The patient underwent several complex neurosurgical interventions during two operations: 1) microsurgery including revascularization of the right posterior lower cerebellar artery, thrombectomy and trapping of the larger chamber of fusiform aneurysm of the right vertebral artery, and 2) endovascular, which consists in the installation of redirecting stent from the left vertebral artery to main artery. The uniqueness of the case which we presented lies in the fact that the tactics of stage combined treatment for a complex aneurysm at child was originally planned and successfully implemented. The treatment allowed to ensure a complete shutdown of aneurysm and to exclude postoperative cerebral complications.

[Principles of surgical treatment for patients with asymptomatic aneurysms and cerebral aneurysms in the cold period after spontaneous intracranial hemorrhages]. / Printsipy vybora metoda khirurgicheskogo lecheniia bol'nykh s bessimptomnymi anevrizmami i anevrizmami golovnogo mozga v kholodnom periode posle spontannykh vnutricherepnykh krovoizliianii.

Surgical treatment of patients with cerebral aneurysms still remains one of the most important issues of cerebrovascular neurosurgery, which is associated with both complexity of treatment and risks posed by the disease. The purpose of this publication is to discuss the recommendations and algorithms adopted at the Neurosurgical Institute for choosing surgical treatment of patients with single and multiple intracranial aneurysms based on the clinical course of disease and anatomical morphological classifications of aneurysms. The study was based on a large clinical material: we analyzed treatment outcomes in 1,621 patients (2009-2017); of these, 966 (59.5%) patients were operated on using microsurgical techniques, and 655 (40.4%) patients underwent endovascular surgery. Surgical treatment of patients with cerebral aneurysms has been performed in close cooperation between two vascular (microsurgical and endovasal) departments, using the latest technical innovations.

[The principles for choosing a surgical technique for patients with acute cerebral aneurysm rupture]. / Printsipy vybora metoda khirurgicheskogo lecheniya bol'nykh v ostrom periode razryva tserebral'nykh anevrizm.

The article describes the principles for choosing a surgical technique for patients with cerebral aneurysms in acute subarachnoid hemorrhage. The principles were developed based on the experience gained at the Burdenko Neurosurgical Institute. Microsurgical and endovascular treatment options are considered.

[Results of deconstructive endovascular surgery in treatment of large and giant intracranial aneurysms]. / Rezul'taty dekonstruktivnykh endovaskulyarnykh operatsii pri lechenii krupnykh i gigantskikh intrakranial'nykh anevrizm.

AIM: To clarify the indications for deconstructive endovascular surgery in patients with large and giant intracranial aneurysms and to evaluate short-term and long-term postoperative outcomes. MATERIAL AND METHODS: The study was based on a retrospective analysis of the treatment results in 50 patients with large (15-25 mm) and giant (more than 25 mm) intracranial aneurysms, aged from 18 to 75 years, who were treated at the Burdenko Neurosurgical Institute in 2002-2014. The patients underwent a balloon occlusion test (BOT) in various modifications before stationary occlusion of the carrier artery. For vascular occlusion, we used detachable latex balloon catheters (33 cases) and microcoils (17 cases). The condition of patients in the pre- and postoperative period was assessed by using the modified Rankin Scale. RESULTS: There were no deaths due to occlusion of the internal carotid artery (37 patients). Postoperative complications occurred in 5 patients. On the basis of BOT, revascularization surgery involving placement of an extra-intracranial microanastomosis (EICMA) was performed in 6 cases. In more 4 cases, EICMA was placed in the early postoperative period due to developing signs of ischemia. Two of 7 patients underwent occlusion of both vertebral arteries (VAs) in the vertebrobasilar basin, which led to fatal outcomes. One more patient died of aggravation of brainstem compression after VA occlusion. There was no worsening of neurological symptoms among survivors. There were no deaths and persistent neurological disorders upon occlusion of branches of the main cerebral arteries, starting with the first order arteries (6 patients). Thirty one patients (66%) were followed-up in the period from 1 to 104 months. There were no deaths associated with artery occlusion. Two patients experienced delayed ischemic disorders. CONCLUSION: Occlusion of the carrier artery should be performed in a carefully selected group of BOT-negative patients. This surgery can be indicated for aneurysms with a complicated configuration, the topographic and anatomical features of which exclude reconstructive surgery.

[Combined surgical treatment of cavernous internal carotid artery pseudoaneurysm]. / Kombinirovannoe khirurgicheskoe lechenie lozhnoi anevrizmy kavernoznogo otdela vnutrennei sonnoi arterii.

We describe a clinical case of surgical treatment of a cavernous internal carotid artery (ICA) pseudoaneurysm that developed due to damage to the artery during transsphenoidal resection of pituitary adenoma. Clinically, the aneurysm presented with episodes of profuse epistaxis that required tight nasal packing. Given the presence of an open circle of Willis, the patient underwent staged surgery that included the creation of a high-flow extra-intracranial anastomosis, subsequent endovascular ICA occlusion at the pseudoaneurysm level using balloon-assisted coiling, and endoscopic debridement of the nasal cavity. The combined surgical treatment of this rare complication successfully excluded the pseudoaneurysm from the bloodstream, which led to complete regression of nasal bleeding.

[Severity of depressive symptoms and oscillatory responses to emotional facial expressions].

We studies the differences in oscillatory responses to emotional facial expressions in 40 subjects with different severity of depressive symptoms (19 men and 21 women) aged 18-30 years. In subjects with low severity of depressive symptoms (group 2), the perception of happy facial expressions was marked by lower delta synchronization as compared with angry and neutral expressions; in subjects with high severity of depressive chronization as compared with angry and neutral expression; in subjects with high severity of depressive symptoms (group 1), the perception of happy faces was marked by higher delta synchronization. Since an increase in delta oscillations is usually observed in aversive conditions, we suggest that happy facial expressions are perceived as negative stimuli by the subjects of group 1. The perception of angry facial expressions was accompanied by alpha band desynchronization in Group 2 and by alpha synchronization in Group 1. Basing on Klimesch's theory, this effect suggests that the subjects of group 1 are initially set up for the perception of negative emotional information. The effect of emotional stimulus category was significant in group 2, but not significant in group 1, which is an evidence of disorders in the recognition of emotional information in depression-prone individuals.

[Combined treatment of cerebral arteriovenous malformations. Experience of the Burdenko Neurosurgical Institute].

OBJECTIVE: Despite the achievements of recent years, cerebral AVMs continue to pose a challenge to treatment. The objective of this work was the development of recommendations for combined treatment of AVMs based on analysis of the available material and published data. MATERIAL AND METHODS: The study included 93 patients hospitalized at the Neurosurgical Institute for combined treatment of cerebral AVMs in 2010-2014. A group of combined surgery (removal of an AVM with preoperative embolization) consisted of 40 patients, and a group of combined radiotherapy (radiation after partial embolization or partial removal of an AVM) included 53 patients. 36 patients underwent radiosurgery, and 17 patients received stereotactic radiation therapy. Both groups were analyzed in terms of outcomes, complications, and follow-up results. RESULTS: In the group of combined surgery, according to the Glasgow outcome scale, good results (grade 4-5) were achieved in 35 (87.5%) patients at discharge and in 27 (90%) patients during follow-up. Treatment outcomes, surgery duration, and the amount of blood loss were not significantly different from those in the control group. Complete AVM obliteration was achieved in 29 (80.6%) patients 3 years after radiosurgery and in 8 (47%) patients after stereotactic radiotherapy. In discussion, these findings are compared to the published data, and recommendations for AVM treatment are suggested. CONCLUSION: The combined treatment of AVMs is effective management for patients with complex AVMs (Spetzler-Martin grade III-IV AVMs). Successful treatment of AVMs requires careful planning and teamwork of vascular and endovascular neurosurgeons, radiologists, and neurologists.

[Endovascular treatment of large and giant intracranial aneurysms using flow-diverting stents].

OBJECTIVE: The objective was to evaluate the efficacy of treatment of patients with large and giant cerebral arterial aneurysms using flow-diverting stents (FDSs). MATERIAL AND METHODS: The treatment outcomes of 210 patients with large and giant intracranial aneurysms were analyzed. The study included patients with both asymptomatic and symptomatic aneurysms (manifested by SAH or pseudotumorous course). The rate of giant aneurysms was 62.3%. RESULTS: The technical success rate was 96%. In the perioperative period, the rate of clinically significant complications was 2.8%; the postoperative mortality was 3.3%. In the long-term period, total thrombosis of the aneurysm was observed in the majority of cases (80%) in the period from 4 to 12 months. Complete regression of clinical symptoms was observed in 26% of the cases, partial regression in 35%, and deterioration in 6% (of them, 4.9% of the cases were clinically significant). The long-term mortality was 2.5%. CONCLUSION: FDS is a highly efficient device for remodeling of the arterial lumen at the level of large, giant and fusiform intracranial aneurysms that significantly reduces the number of deconstructive operations and decreases the risk of ischemic complications of endovascular treatment for this complex vascular pathology.

[Endovascular treatment of large and giant intracranial aneurysms using stent assistance].

OBJECTIVE: The study objective was to evaluate the efficacy of occlusions of large and giant intracranial aneurysms with microcoils using stent assistance (SA). MATERIAL AND METHODS: The study is based on analysis of treatment outcomes in 37 patients with large (15-25mm) and giant (more than 25mm) intracranial aneurysms, aged 18 to 72 years, who were hospitalized at the Burdenko Neurosurgical Institute in the period between 2004 and 2014. Selection of patients for endovascular treatment using SA was based on the anatomical parameters of the aneurysm and carrier vessel. The main determining factor was the index of the aneurysm body to neck size ratio. Occlusion of aneurysms was performed with microcoils of different configurations, including those with a biologically active coating. Self-expanding stents with both an open-cell and closed-cell design were used for SA. The results of intervention for large and giant aneurysms were evaluated using control angiography immediately after occlusion of the aneurysm. The condition of patients with unruptured aneurysms as well as with ruptured aneurysms in the "cold" period was evaluated using the modified Rankin scale. The condition of patients in the acute period of SAH was evaluated on the Hunt and Hess scale. RESULTS: The technical success (successful implantation of stents and coils with total or subtotal aneurysm occlusion) was 94.5%. The postoperative disability was 2.7%; mortality was 2.7%. 28 patients were followed up for the period of 5 to 84 months (the mean was 20 months.). In the long-term period, the total and subtotal occlusion rate, including the results of re-operations, amounted to 90%. Delayed disability was 10.7%, and mortality was 3.5%. CONCLUSION: Stent assistance enables achieving total or subtotal occlusion of large and giant aneurysms in 90% of cases. In certain clinical situations, it is an alternative to other existing methods.

[Vulnerability to Depression and Oscillatory Resting-State Networks].

Depression is the most commonly observed mood disorder, which is accompanied by changes in emotional processes and the default mode network (DMN) activity. In this study, we aimed to investigate how predisposition to depression shows up in the emotional coloring of spontaneous thoughts and the activity of oscillatory resting-state networks, as revealed by source localization and independent component analysis techniques. Depressive symptoms correlated positively with the prevalence of negative emotion during EEG registration and with delta and theta activity in the orbitofrontal cortex and negatively with theta activity in the DMN. Since an increase of low-frequency oscillations in the orbitofrontal cortex is observed in aversive states, whereas their decrease in the DMN reflects an activation of this network, which is related to self-referenced processing, our results are consistent with the notion that vulnerability to depression is associated with general negative emotional disposition and excessive focus on the self.

[Emotional intelligence and oscillatory responses on the emotional facial expressions].

Emotional intelligence-related differences in oscillatory responses to emotional facial expressions were investigated in 48 subjects (26 men and 22 women) in age 18-30 years. Participants were instructed to evaluate emotional expression (angry, happy and neutral) of each presented face on an analog scale ranging from -100 (very hostile) to + 100 (very friendly). High emotional intelligence (EI) participants were found to be more sensitive to the emotional content of the stimuli. It showed up both in their subjective evaluation of the stimuli and in a stronger EEG theta synchronization at an earlier (between 100 and 500 ms after face presentation) processing stage. Source localization using sLORETA showed that this effect was localized in the fusiform gyrus upon the presentation of angry faces and in the posterior cingulate gyrus upon the presentation of happy faces. At a later processing stage (500-870 ms) event-related theta synchronization in high emotional intelligence subject was higher in the left prefrontal cortex upon the presentation of happy faces, but it was lower in the anterior cingulate cortex upon presentation of angry faces. This suggests the existence of a mechanism that can be selectively increase the positive emotions and reduce negative emotions.

[Stepwise treatment of multiple cerebral aneurysms utilizing surgical and endovascular techniques].

To evaluate results of combined treatment of multiple intracranial aneurysms utilizing microsurgical clipping with endovascular techniques. Study group comprised 60 patients with 230 multiple aneurysms (MA) of different location. Most common were aneurysms of ICA--49% and MCA--24%. Single-side ICA aneurysms were found in 11 (18.3%) patients, two-sides ICA lesions in 25 (41.7%); single-side ICA aneurysm with posterior circulation aneurysm--11 (18.3%) and two-sides ICA aneurysm with posterior circulation aneurysm in 13 (21.7%). All patients were treated with endovascular coiling followed by direct surgery. Eight patients treated in acute stage of SAH. Two-stage surgery was performed in 49 cases, three-stage treatment--in 11 cases yielding 131 operations total. Time break between surgeries was 1 day to 4 month. Total occlusion was achieved in 95.3% cases, 98 aneurysms were clipped, 64 (33.4%) coiled. In 15 (7.8%) patients aneurysms were excluded with stent or balloon assisting techniques. Six aneurysms were treated with flow diverters (Pipeline Embolisation Device). Palliative treatment (ICA occlusion with balloon or coils and aneuryms wrapping) were performed in 4.7%. There were no fatal outcomes or complications required repeated surgery in the group. Multimodal approach that combines endovascular techniques with microsurgery is an effective option in multiple aneurysm treatment. Updated endovascular modalities and direct surgery together become a treatment of choice for MA patient improving radical exclusion rate and outcomes. Combined treatment is specifically indicated for elaborate MA cases requiring multiple approaches.

[Efficasy and safety of the use of risperidone (rispoluxe) in demented patients with psychotic and behavioural disorders].

Based on the comparison of international and Russian studies, authors present a review on the epidemiology, clinical features, diagnosis and treatment of psychotic and behavioral disorders in patients with dementia. Results of the own study on the efficacy of risperidone (rispolux) in dosage 102 mg daily in patients with dementia with psychotic and behavioral disorders are presented. It has been shown that rispolux reduces psychotic and behavioral disorders, improves cognitive functions. It is well-tolerated and rather safe for elderly patients.

[Early symptoms of exacerbation of schizophrenia: views of patients, relatives and psychiatrists].

The study was carried out using focused interviews in three groups of responders - patients with several exacerbations of schizophrenia, their relatives and their psychiatrists. It has been shown that either patients or their relatives do not recognize the early symptoms of the exacerbation of psychosis. Three opposite approaches of responders to the issues related to awareness of disease and medical intervention were singled out: rational (in psychiatrists), autonomic (in patients) and emotional (in relatives). The authors substantiate the necessity of psychoeducational programs for patients aimed at bringing together interests of patients and psychiatrists with the following impact on the relatives who take the dualistic position with conformal readiness.

[Potential endovascular prophylaxis for pulmonary thromboembolism in the combined treatment of cancer patients].

Our study was concerned with the role of ultrasound examination of the lower extremity veins to detect deep venous thrombosis and to evaluate complex prophylaxis of thromboembolism of pulmonary arteries (TEPA). The procedure involved vena cava filter placement in patients with neoplasia and high risk of TEPA as compared with controls receiving conservative therapy alone. A positive correlation was established between surgery and/or polychemotherapy, on the one hand, and higher stage and high risk of TEPA, on the other. Patients with deep venous thrombosis and neoplasia were referred to groups of extremely high risk of that pathology. Angiological history, physical examination and ultrasound check-ups of the lower vein must be carried out in cancer patients. Vena cava filter placement proved to be an effective and safe measure of TEPA prophylaxis. It lowered the risk of lethal outcome in 24 during surgery and polychemotherapy. Lethality rate among controls was 43.5 +/- 0.51%.

[Treatment principles of brain arteriovenous malformations of supratentorial localization in children].

Treatment of arteriovenous malformations (AVM) in children is an important problem of children surgery. An aim of the study was to determine an optimal method of treatment. We analyzed the results of examination and treatment of 300 children, aged from 3 months to 18 years, with brain AVM who were admitted to the Burdenko Neurosurgery Institute in 1995-2010. AVM of large brain hemispheres were found in 223 children and 77 children had AVM of deep brain structures. The results of the following surgeries are reviewed: endovascular surgery (64 patients), dissections of AVM (87), radiosurgery (77), combined treatment (42). Surgeries were not performed in 30 cases. The total post surgery lethality was 0,7%. It has been concluded that the method of AVM treatment in children should be chosen individually for every child on the basis of the complex analysis of several criteria (age of the child, AVM localization and angioarchitectonics as well as a variant of clinical course of the disease).