Dynamics of Cognitive Functions in Patients With Parasellar Meningiomas Undergoing Radiotherapy

This study was focused on neuropsychological analysis of the cognitive functions in patients with parasellar meningiomas undergoing radiation therapy. In these patients, the unilateral hippocampus adjacent to the tumor was partially exposed to irradiation. A novel approach was used to assess particular memory functionsincluding pattern separation, in subpopulations of subjects prior to the course of radiotherapy, immediately after the course, and 1–2 years after therapy. Our results show a tendency for pattern separation decline in the long-term follow-up. A possible association of these disorders with the effect of the hippocampal region irradiation and inhibition of adult neurogenesis is discussed. Keywords: cognitive functions, radiation therapy, hippocampus, parasellar meningioma, pattern separation, adult neurogenesi

Dynamics of Cognitive Functions in Patients with Parasellar Meningiomas Undergoing Radiotherapy

This study was focused on neuropsychological analysis of the cognitive functions in patients with parasellar meningiomas undergoing radiation therapy. In these patients, the unilateral hippocampus adjacent to the tumor was partially exposed to irradiation. A novel approach was used to assess particular memory functionsincluding pattern separation, in subpopulations of subjects prior to the course of radiotherapy, immediately after the course, and 1–2 years after therapy. Our results show a tendency for pattern separation decline in the long-term follow-up. A possible association of these disorders with the effect of the hippocampal region irradiation and inhibition of adult neurogenesis is discussed. Keywords: cognitive functions, radiation therapy, hippocampus, parasellar meningioma, pattern separation, adult neurogenesi

In search of the “I”: Neuropsychology of lateralized thinking meets Dynamic Causal Modeling

Background. Ideas about relationships between “I”, egocentric spatial orientation and the sense of bodily “Self ” date back to work by classics of philosophy and psychology. Cognitive neuroscience has provided knowledge about brain areas involved in self-ref­erential processing, such as the rostral prefrontal, temporal and parietal cortices, often active as part of the default mode network (DMN). Objective and Method. Little is known about the contribution of inferior parietal areas to self-referential processing. Therefore, we collected observations of everyday be­havior, social communication and problem solving in patients with brain lesions local­ized either in the left inferior parietal cortex (LIPC group, n = 45) or the right inferior parietal cortex (RIPC group, n = 58). Results. A key characteristic of the LIPC group was an overestimation of task com­plexity. This led to a prolonged phase of redundant and disruptive contemplations pre­ceding task solution. In the RIPC group, we observed disorders in reflective control and voluntary regulation of behavior. Abilities for experiencing emotions, understanding mental states, and social communication were to a great extent lost. Results are inter­preted within a multilevel framework of cognitive-affective organization (velichkovsky, 2002). In particular, we highlight the role of right-hemisphere mechanisms in self-refer­ential cognition, emotional and corporeal awareness. This is consistent with recent data on a profound asymmetry in connectivity of left and right hippocampi within the DMN (Ushakov et al., 2016) Conclusion. It seems that the center of egocentric spatial representation plays a spe­cial role in accessing self-related data. Normally, the right hippocampus provides a holis­tic representation of surrounding and, thus, an easy-to-find gateway into much of what we used to call “subjective experience”. This heuristics becomes misleading in the case of right-sided brain lesions

How to Choose the Optimal Single-Pill Combination of the First-Line Antihypertensive Drugs? The Benefits of Amlodipine and Telmisartan Combination

In patients with arterial hypertension (AH), an extremely important measure of the effectiveness of antihypertensive drugs (AHD) is not only a direct decrease in blood pressure (BP), but also its stable control throughout the 24 hours, preventing excessive morning surge and increased BP variability, which in turn are recognized cardiovascular risk factors. Currently, in the vast majority of hypertensive patients, the main antihypertensive therapy approach is using single-pill combinations (SPC) of AHD. Among the first-line combinations for a wide range of patients with AH and no special clinical conditions is amlodipine/telmisartan SPC. Distinctive features of these drugs, on the one hand, are unique pharmacological properties, consisting in an ultra-long antihypertensive effects, superior to other AHD in their classes; and on the other hand, there is an large body of evidence from numerous clinical trials confirming their high antihypertensive and target-organ protective potential as well as excellent capabilities in cardiovascular risk reduction. To assess the AHD effectiveness extent, several parameters have been proposed, of which the most rational and useful is the smoothness index, calculated using the ambulatory blood pressure monitoring data. Smoothness index describes both the degree of BP reduction and its distribution during the monitoring period. This index inversely associates with the changes in BP variability, and has predictive value in relation to the hypertension-mediated organ damage regression during different antihypertensive regimens. Amlodipine/telmisartan SPC has also been studied in many trials, including comparative ones with other AHD. In these works its direct powerful antihypertensive effect and a pronounced beneficial impact on the smoothness index have been proved, demonstrating stable BP control throughout the 24 hours (especially in the most dangerous morning hours), and also a decrease in BP variability. Therefore, amlodipine/telmisartan SPC can effectively reduce cardiovascular risk and improve prognosis in patients with AH

Levocarnitine for the Treatment of Polymorbid Patients

Effective and safe treatment of patients with polymorbidity is an urgent task of modern healthcare. Of particular difficulty is the treatment of patients with cardiovascular comorbidity, which requires an integrated approach to the treatment and development of a special, so-called patient-oriented approach. Modern scientific evidence proposes the use of levocarnitine, as part of complex therapy to increase its effectiveness. So, it was shown that levocarnitine can have a beneficial effect on blood pressure in patients with hypertension, especially those who are overweight and obese. Levocarnitine is also effective in the treatment of heart failure, which has been studied in several clinical studies, which demonstrated its ability to increase the ejection fraction of the left ventricle, stroke volume of blood and other indicators. Optimization of the bioavailability of nitrogen oxide (NO) and a decrease in systemic oxidative stress while taking levocarnitine plays an important positive role in complex therapy in patients with coronary artery disease: exertional angina and post-infarction cardiosclerosis, reducing the number of anginal attacks. Since levocarnitine has powerful antioxidant effects, it also has the neuroprotective effect found in in vitro studies in animal experiments. In case of impaired renal function, due to accelerated elimination and impaired reabsorption, a deficiency of levocarnitine in the body tissues develops, and therefore the US Food and Drug Administration (US FDA) decided on the possibility of using levocarnitine in patients on hemodialysis. Thus, taking into account the positive effects of levocarnitine in a number of frequently combined diseases, it can be considered as the drug of choice in the treatment of patients with polymorbidity

The Assessment of Physicians' and Senior Medical Students' Knowledge in the Field of Community-acquired Pneumonia: Preliminary Results of the KNOCAP-II Project (2017-2019).

Community-acquired pneumonia (CAP) is one of the most relevant problems of modern medicine. Today, CAP takes 4th place in the structure of mortality (after cardio­vascular, cerebrovascular diseases and Malignant neoplasms) and 1st place among all deaths from infectious diseases. The aim of the study is to assess the level of general physician' and senior medical students' basic knowledge in CAP treatment. The article represents the results of anonymous prospective surveys within the framework of the second stage of KNOCAP multi-centered research project (full name of the project «The assessment of physician' and students' knowledge of community-acquired pneumonia basics») aimed at accessing the knowledge and preferences of doctors and students on the fundamental issues in diagnosis and treatment of community-acquired pneumonia. The survey conducted in 2017-2019 involved 588 physicians and 394 students from seventeen Russian, Kyrgyzstan and Ukrainian centers. The method of anonymous questioning was used in this study, for which an original questionnaire was developed on the basis of current clinical recommendations. The following fundamental questions caused the greatest difficulties in the respondents: terms for a repeated X-ray examination in positive dynamics of CAP treatment, the choice of main diagnostic criteria of CAP, the choice of the typical mistakes of CAP treatment, the choice of the initial antimicrobial therapy. In general, the respondents' knowledge in CAP patients' management deviates significantly from the current clinical guidelines, as of 2010, and from the new clinical guidelines draft, 2018-2019. Currently, there is a need to increase the level of knowledge and improve the professional activities of therapists and senior medical students, as a multicenter section of the knowledge and preferences of specialists in many issues revealed their insufficient level for the correct management of patients with CAP