Флуоресцентная диагностика с хлорином е6 в хирургии глиом низкой степени злокачественности

Intraoperative fluorescence diagnostics of high-grade gliomas is widely used in neurosurgical practice. This work analyzes the possibilities of fluorescence diagnostics for low-grade gliomas (LGG) using chlorin e6 photosensitizer. The study included patients with newly diagnosed LGG, for whom chlorin e6 was used for intraoperative fluorescence control at a dose of 1 mg/kg. During the operation, the fluorescence intensity of various areas of the putative tumor tissue was analyzed using the RSS Cam – Endo 1.4.313 software. Tissue samples with various degrees of fluorescence intensity were compared with the results of their histopathological analysis (WHO tumor diagnosis, Ki-67 index, P53, VEGF). Fluorescence was detected in more than half of the cases, but in most cases had a focal character and low fluorescence intensity. The fluorescence intensity directly correlated with the data of histopathological examination of tumor tissues (Ki-67 index (p=0.002), expression of P53 (p=0.0015) and VEGF (p=0.001)). The sensitivity of the method for LGG surgery was 72%, the specificity was 56,7%. Intraoperative fluorescence diagnostics with chlorin e6 can be used in LGG surgery, especially to visualize intratumoral areas with a higher degree of anaplasia.Применение интраоперационной флуоресцентной диагностики для глиом высокой степени злокачественности широко используется в нейрохирургической практике. В работе проанализированы возможности флуоресцентной диагностики для глиом низкой степени злокачественности с использованием хлорина е6. В исследование были включены пациенты с впервые диагностированной глиомой низкой степени злокачественности (low-grade glioma, LGG), у которых с целью интраоперационного флуоресцентного контроля применен препарат хлорин е6 в дозе 1 мг/кг массы тела. В процессе операции анализировали интенсивность флуоресценции различных участков предполагаемой опухолевой ткани с использованием программного обеспечения RSS Cam – Endo 1.4.313. Образцы тканей различной степени интенсивности флуоресценции сопоставляли с результатами их гистопатологического анализа (диагностика опухоли ВОЗ, индекс Ki-67, P53, VEGF). Флуоресценция выявлена в более чем половине случаев, но в большинстве случаев имела очаговый характер и низкую интенсивность флуоресценции. Интенсивность флуоресценции напрямую коррелировала с данными гистопатологического исследования тканей опухоли: индекс Ki-67 (p=0,002), экспрессия P53 (p=0,0015), VEGF (p=0,001). Чувствительность метода для хирургии LGG составила 72%, специфичность 56,7%. Проведенное исследование подтвердило, что технология интраоперационной флуоресцентной диагностики с применением хлорина е6 может применяться в хирургии LGG, особенно для визуализации внутриопухолевых участков с более высокой степенью анаплазии

Клинические случаи энцефалопатии Вернике

Abstract This article will discuss the causes of Wernicke encephalopathy, diagnosis, treatment and clinical examples of this disease.Резюме В данной статье будут обсуждены причины возникновения энцефалопатии Вернике, диагностика, лечение и клинические примеры данного заболевания

DIAGNOSTICS AND LONG-TERM OUTCOMES AFTER SURGICAL TREATMENT OF EPILEPSY IN CHILDREN WITH STRUCTURAL BRAIN CHANGES

Objective. To identify predictive factors of favourable outcomes in children with drug resistant epilepsy (DRE) associated with structural brain changes,  who received surgical treatment.  Methods. We performed  a retrospective  analysis of surgical treatment in 239 children with drug resistant epilepsy treated at the Pediatric Neurosurgery Department of the A. L. Polenov Russian Neurosurgical Institute from 2004 to 2014. The age of the patients varied between  2 and 18 years. The follow-up time ranged from 1 year to 10 years (on average 4.3 years). Results. According to magnetic resonance imaging (MRI), 223 (93.3%) patients had different structural brain changes. Among the patients, 47 (21.1%) had cerebral cicatrix, gliosis, cysts  and atrophic changes, 33 (14.8%) had malformations of the cortical development, 43 (19.3%) had benign brain tumors,  47 (21.1%)  had vascular malformations,  21 (9.4%)  had arachnoid cysts,  12 (5.4%)  had hippocampal sclerosis,  11  (4.9%)  had  phacomatosis, 5  (2.2%)  had  Rasmussen’s encephalitis,  and  4  (1.8%)  had  hypothalamic hamartoma.  Positron  emission  tomography  revealed the  areas of gray matter  hypometabolism in the  brain, which correspond to the areas of a metabolic deficiency around the epileptic focus. Favorable long-term outcomes of epilepsy surgery (class I according to Engel scale) were registered in 67.6% of the cases.  The most  favorable results (class I according to Engel scale) were achieved after lesionectomy (81.9%), temporal resections (78.4%), and hemispherectomy (72.7%).Conclusions. The most important predictive factors of favorable outcomes after epilepsy surgery are as follows: detection of epileptogenic morphological changes of the brain, completeness of resection of an epileptic and epileptogenic areas, and absense  of seizures in the early postoperative period

Cold and distant: structural features of the nucleoprotein complex of a cold-adapted influenza A virus strain

Two influenza A nucleoprotein variants (wild-type: G102R; and mutant: G102R and E292G) were studied with regard to macro-molecular interactions in oligomeric form (24-mers). The E292G mutation has been previously shown to provide cold adaptation. Molecular dynamics simulations of these complexes and trajectory analysis showed that the most significant difference between the obtained models was distance between nucleoprotein complex strands. The isolated complexes of two ribonucleoprotein variants were characterized by transmission electron microscopy and differential scanning fluorimetry (DSF). Presence of the E292G substitution was shown by DSF to affect nucleoprotein complex melting temperature. In the filament interface peptide model, it was shown that the peptide corresponding in primary structure to the wild-type NP (SGYDFEREGYS) is prone to temperature-dependent self-association, unlike the peptide corresponding to E292G substitution (SGYDFGREGYS). It was also shown that the SGYDFEREGYS peptide is capable of interacting with a monomeric nucleoprotein (wild type); this interaction’s equilibrium dissociation constant is five orders of magnitude lower than for the SGYDFGREGYS peptide. Using small-angle neutron scattering (SANS), the supramolecular structures of isolated complexes of these proteins were studied at temperatures of 15, 32, and 37 °C. SANS data show that the structures of the studied complexes at elevated temperature differ from the rod-like particle model and react differently to temperature changes. The data suggest that the mechanism behind cold adaptation with E292G is associated with a weakening of the interaction between strands of the ribonucleoprotein complex and, as a result, the appearance of inter-chain interface flexibility necessary for complex function at low temperature