The levels of angiogenic factors were analyzed in eight patients who underwent the embolization of chronic subdural hematoma (CSDH) with non-adhesive liquid embolic agents. Four of these patients had previously undergone surgical treatment for hematoma removal and had recurrences of a similar volume, and four had an increase in hematoma volume due to rebleeding. The levels of vascular endothelial growth factor (VEGF), matrix metallopeptidase 9 (MMP 9), angiopoietin-2 (Ang2), transforming growth factor beta 1 (TGF-β1) and platelet-derived growth factor BB (PDGF-BB) in the arterial and venous blood were analyzed. The most significant results were obtained from the peripheral venous blood samples. The levels of VEGF in the samples of all the patients were close to normal or slightly decreased. There was an increase in the MMP9 levels (the factor that contributes to the disintegration of the vessel wall components) in all the patients. The Ang2 and especially the PDGF TGF-β1 (the factor that plays an important role in the growth of the vessel wall from the already existing blood vessel tissue) levels were distinctly low in most of the cases and slightly elevated only in a number of patients who had previously been operated on. The results obtained show that there is an imbalance in the angiogenesis factors in patients with rebleeding CSDH. At the same time, the factors determining the formation of the vessel wall were reduced, and the levels of factors contributing to the degradation of extracellular matrix components were significantly increased. Such factors could help us to anticipate the increased risk of hemorrhages. Highlights: The levels of VEGF, MMP 9, Ang2, TGF-β1 and PDGF-BB in the arterial and venous blood were analyzed. The most significant results were obtained from the peripheral venous blood samples. The results obtained show that there is an imbalance in the angiogenesis factors in patients with rebleeding CSDH. Such a profile of factors could help us to anticipate the increased risk of hemorrhages.

Метаболом представляет собой полный набор малых молекул в организме: пептиды, липиды, аминокислоты, нуклеиновые кислоты, углеводы, биогенные амины, витамины, минералы, а также любые химические соединения, с которыми человек контактирует, включая пищевые добавки, лекарства, косметические средства, токсины. Метаболомика — это комплексное изучение всех метаболитов, присутствующих в биологической системе. Эта наука стала реальностью благодаря развитию двух современных технологических платформ: масс-спектрометрии по уникальному для каждого метаболита соотношению массы и заряда, позволяющей идентифицировать тысячи соединений в одном образце, и спектроскопии ядерного магнитного резонанса, дающей возможность определять метаболиты в спектральных массивах посредством сдвига их сигнала относительно эталонного сигнала. В обзоре даны понятия метаболомики и метаболома, представлены методы исследования и интерпретации данных, рассмотрены основные применения метаболомики в области диагностики заболеваний ЦНС, поиска прогностических маркеров и новых терапевтических мишеней, описан метаболический состав спинномозговой жидкости в норме и его изменения при патологии.

Introduction: Changes in hormonal status in patients with prolonged disorders of consciousness (PDC) remain poorly understood. There are no studies devoted to the investigation of prognostic value of hormonal changes to predict the outcome which is primarily due to a relatively small number of patients, different variants of structural brain disorders in vegetative state (VS) patients, concomitant somatic pathology including typical complications.The objective: to study the correlation between outcomes in VS patients with hormonal status and the level of natriuretic peptide. Subjects and methods. 275 patients in VS were examined for the time period from 2007 to 2017. 152 patients had sequela of traumatic brain injury (TBI) and 123 patients suffered from hypoxic brain damage. All patients matched the international criteria of VS diagnosis. In all patients, blood samples were collected during the first week after admission to ICU to test hormones and natriuretic peptide levels. ACTH, cortisol, TSH, free T₃ and T₄ , STH, prolactin and natriuretic peptide were tested in the period from 2 to 4 months of staying in VS. In men, the level of total testosterone, LH and FSH was additionally tested. The obtained data were compared with VS outcome.Results. The tested hormones were stably insufficient only in few VS patients. None of the tested hormones of the hypothalamic-pituitary-adrenal axis made a reliable criterion for predicting VS outcome. The tendency of disrupted rhythm of cortisol secretion was found to be most frequent and consistent, with higher rates in the evening hours. The average value of STH was higher in men with sequela of traumatic brain injury who had recovered consciousness versus those who remained in VS. A significant decrease in testosterone levels, regardless of age, was found in the patients with TBI sequela. Mean levels of LH were higher in patients with TBI sequela and hypoxia who remained unconscious versus patients who later restored consciousness. The average level of FSH was higher in patients who had recovered consciousness compared to those who remained in chronic VS. The increased level of natriuretic peptide was observed both in patients who remained in chronic VS and in those who restored consciousness.Conclusions. When investigating levels of certain hormones, no specific endocrine background characterizing this category of patients was found. Abnormal rhythms of some hormones secretion, in particular cortisol, can be considered typical of VS patients especially patients with TBI sequela.

The objective – to evaluate the dynamics and prognostic value of inflammatory markers and other laboratory parameters in the blood of patientswith COVID-19 and to assess the severity of the course and mortality in this disease. Materials and Methods. The clinical and laboratory data of 819 patients with COVID-19 treated in a hospital were retrospectively analyzed. In 700 (85.5 %) patients, the disease occurred in a moderate form, these patients were recovered. Patients with severe course (n = 119) were treated in the intensive care unit, of which 47 (39.5 %) patients had a favorable outcome and 72 (60.5 %) patients died. All patients underwent clinical, biochemical (including IL-6) and coagulological studies at admission and in dynamics. The concentration of IL-1ß, IL-8, IL-10, tumor necrosis factor TNF-α were additionally measured in patients with severe COVID-19. Results. Initially, patients with severe disease, compared with moderate, had higher levels of C-reactive protein (p < 0.001), LDH (p = 0,007), D-dimers (p = 0.028), fibrinogen (p = 0.014), the number of white blood cells (p = 0.018), as well as lower levels of albumin (p < 0.001). In the group of patients with fatal outcome, higher levels of LDH (p = 0.008), creatinine (p = 0.009), urea (p < 0.001), troponin (p = 0.024), D-dimers (p = 0.002), fibrinogen (p = 0.009), the relative content of immature leukocytes (p = 0.004), neutrophil to lymphocyte ratio (p = 0.022) were found than in survivors. On the 7th day of hospitalization, an acute increase in ferritin, urea, D-dimers, LDH, interleukins was noted in the group of deceased patients. Using the observer’s operating curves method, predictors of an unfavorable outcome in COVID-19 were determined: IL-10 above 9.46 pg/ml (area under the ROC curve AUC = 0.902), urea above 6.6 mmol/L (AUC = 0.815), TNF-α above 12.6 pg/ml (AUC = 0.799), C-reactive protein above 59.6 mg/L (AUC = 0.714), LDH above 348 U/L (AUC = 0.702), neutrophil to lymphocyte ratio above 4.94 (AUC = 0.700), IL-6 above 62.2 pg/ml (AUC = 0.686), ferritin above 772 μg/L (AUC = 0.654). Conclusions. Baseline levels of LDH, D-dimers, and fibrinogen have a discriminatory ability to determine both the severity and the outcome of COVID-19. The severity of the inflammatory response upon admission correlates with the severity of the disease, but has no prognostic value. At the time of admission, patients with an unfavorable outcome already have initial manifestations of organ dysfunction (assessed by creatinine, urea, and troponin levels). On the 7th day of hospitalization, the relationship of values and the outcome appears in ferritin and interleukin 6. The presence of a strong correlation between the levels of interleukins IL-6, IL-8, IL-10, TNF-α makes it possible to measure any of them.

The objective was to summarize data from the literature on methods of diagnosis and prevention of nosocomial meningitis.Nosocomial meningitis (NM) and ventriculitis are severe, often life-threatening complications in neurosurgery. Currently, postoperative meningitis, shunt infections, and drainage-associated ventriculitis are distinguished. For each of the above groups of diseases, there are specific diagnostic approaches, etiotropic agents, and treatments that differ significantly from community-acquired infections of the central nervous system. Pathogens are represented by a wide range of opportunistic and pathogenic microorganisms, which differ significantly from community-acquired ones. The diagnosis of NM is based mainly on clinical assessment and laboratory examination of cerebrospinal fluid. In most recommendations, there are no precise laboratory criteria for the diagnosis of NM, which is explained by the variability of shifts depending on the microorganism that caused the infection and on the individual characteristics of the patient, as well as the variety of clinical situations. NM prevention is based on minimizing risk factors, includes measures against endogenous and exogenous infection, and can be divided into three stages: preoperative, intraoperative and postoperative. The development of criteria for NM and ventriculitis, the identification of risk factors remains an important problem that has not been definitively solved to date.

Patients with chronic disorders of consciousness (CDoC) have various variants of the pathological organization of functions including sympathetic hyperactivity and hormonal changes.The objective: to determine the severity of paroxysmal sympathetic hyperactivity (PSH), the function of the pituitary-adrenal system in patients with CDoC.Subjects and Methods. 54 patients with CDoC were enrolled in the study. Patients were randomized in the groups depending on assessment on the Coma Recovery Scale-Revised scale and CRS-R index calculation. PSH severity was assessed 7 times a day for two days. During the first week from the moment of admission, blood sampling was performed 7 times a day to study the levels of ACTH and cortisol.Results. PSH syndrome was detected in all groups, there were no significant dependencies of its severity on the time of day. There were no significant differences in the levels of ACTH and cortisol during the day.Conclusions: PSH syndrome is observed in most patients with CDoC. In patients with CDoC, the daily rhythm of ACTH and cortisol secretion are disrupted.