Back pain (BP) due to degenerative disc disease (DDD) is a severe, often disabling condition. The aim of this study was to determine the association between the expression level of proinflammatory cytokines (IL-1β, IL-6, and IL-17), angiogenesis markers (VEGF-A and CD31) in intervertebral disc (IVD) tissue and IVD degeneration in young people with discogenic BP. In patients who underwent discectomy for a disc herniation, a clinical examination, magnetic resonance imaging of the lumbar spine, histological and immunohistochemical analyses of these factors in IVD were performed in comparison with the parameters of healthy group samples (controls). Histology image analysis of IVD fragments of the DDD group detected zones of inflammatory infiltration, combined with vascularization, the presence of granulation tissue and clusters of chondrocytes in the tissue of nucleus pulposus (NP). Statistically significant increased expression of IL-1β, IL-6, IL-17, VEGF-A and CD31 was evident in the samples of the DDD group compared with the controls, that showed a strong correlation with the histological disc degeneration stage. Our results denote an immunoinflammatory potential of chondrocytes and demonstrates their altered morphogenetic properties, also NP cells may trigger the angiogenesis.

Glioblastoma (GBM) is the most common primary malignant brain tumor in adults and remains highly lethal, with median overall survival rarely exceeding 15 months despite maximal surgical resection, radiotherapy, and temozolomide-based chemotherapy. Therapeutic resistance in GBM is driven by intrinsic tumor cell adaptations, extensive inter- and intratumoral heterogeneity, and microenvironmental constraints. Key mechanisms include enhanced DNA repair, disrupted apoptosis, pathway redundancy, altered drug metabolism, oxidative stress tolerance, and glioblastoma stem cell–mediated plasticity. In vivo, resistance is reinforced by the blood–brain barrier, hypoxia, stromal and immune interactions, and selective expansion of therapy-resistant clones. Current strategies to overcome resistance target DNA repair, oxidative stress, autophagy, and metabolic vulnerabilities; however, their efficacy is limited by tumor heterogeneity and delivery barriers. Precision oncology approaches are hampered by a paucity of validated predictive biomarkers, leaving many patients without actionable targets. Ex vivo functional drug sensitivity testing of patient-derived tumor cells offers a complementary strategy, directly assessing individual tumor responses and guiding rational combination therapies. This review highlights the molecular and cellular mechanisms underlying chemoresistance in GBM, examines emerging therapeutic strategies, and explores the potential of integrating personalized, functionally guided approaches into clinical management. Addressing GBM’s profound heterogeneity and adaptive plasticity is essential to improving outcomes in this aggressive and refractory malignancy.

The study objective is to analyze characteristics of distal aneurysms of the posterior inferior cerebellar artery (PICA) using the results of surgical treatment of 11 patients with this disorder.Materials and methods. Eleven patients with distal PICA aneurysms (7 men and 4 women aged between 32 and 57 years (mean age 44 years)) were operated in N.V. Sklifosovsky Research Institute for Emergency Medicine. Aneurysms were visualized using cerebral angiography in 2 patients and using computed angiography in 9 patients. The aneurysms were classified using the classification system developed by J.R. Lister and A.L. Rhoton. Aneurysms located in the tonsillomedullary segment were most common. Saccular aneurysms were found in 7 (64 %) patients, whereas fusiform aneurysms were observed in 4 (36 %) patients. Two saccular aneurysms had a large neck. The size of aneurysms varied between 2 and 9 mm. The majority of patients (70 %) had aneurysms less than 7 mm.Results. Five patients were operated via median suboccipital approach, while the remaining 6 patients were operated via lateral suboccipital approach. We performed either reconstructive (n = 9) or deconstructive (n = 2) aneurysm clipping depending on the possibility of preserving the PICA lumen and presence of damage to the perforating arteries of the brain stem. Nine patients (82 %) had Glasgow Outcome Score of 5; two patients (18 %) died (one of them was admitted in sopor with occlusive hydrocephalus; another one had grade III–IV obesity and developed purulent septic respiratory complications and secondary purulent meningitis). Two patients (18 %) developed dysarthria and dysphagia in the postoperative period, but these symptoms disappeared by the moment of discharge.Conclusion. Distal PICA aneurysms are quite rare and require tailored approach to treatment. A surgeon should bear in mind specific anatomical characteristics of aneurysms, control arterial patency when isolating the aneurysm from the bloodstream, and use revascularizing methods whenever possible. In addition to that, a surgeon should be extremely careful during manipulations with perforating arteries of the brain stem and distal cranial nerves, because their damage result in a more difficult postoperative period.Conflict of interest. The authors declare no conflict of interest.Informed consent. All patients gave written informed consent to participate in the study and to the publication of their data.

Background. Distal cerebral aneurysms are very rare. To date, there are very few publications on distal cerebral aneurysms and they are mostly limited to clinical case series.Aim. To analyze anatomical characteristics of distal cerebral aneurysms and surgical outcomes, as well as to identify risk factors for a poor outcome and develop a treatment algorithm on this basis; to determine the role of neuronavigation and revascularization in the surgical treatment of distal cerebral aneurysms.Materials and methods. We performed a retrospective analysis of surgical outcomes of 153 patients with distal cerebral aneurysms treated in N.V. Sklifosovsky Research Institute for Emergency Medicine (Moscow Healthcare Department) between January 1, 2000 and December 31, 2019.Results. Distal cerebral aneurysms were identified in 4.5 % cases of all cerebral aneurysms; 81.7 % of patients with distal cerebral aneurysms were admitted to the hospital with ruptured aneurysms. The most frequent locations of distal cerebral aneurysms were pericallosal and middle cerebral arteries. Distal cerebral aneurysms were usually small (77.5 %), had a wide neck (31.8 %), and fusiform structure (15.7 %). Aneurysm clipping was performed in 74.5 % cases; parent artery trapping, in 23.5 % of patients; revascularization, in 5.9 % of patients. The main risk factors for a poor outcome included aneurysm size and location, patient grade on the modified scale of the World Federation of Neurosurgical Societies (mWFNS), and presence of severe vasospasm.Conclusion. The developed surgical algorithm for distal cerebral aneurysms (based on the assessment of a poor outcome risk factors, the use of neuronavigation, arterial patency control, and revascularization) could improve surgical outcomes of patients with distal cerebral aneurysms.

Back pain (BP) due to degenerative spinal injury is a severe, often disabling disease and it tends to decrease age of onset. The cellular and molecular basis of the disc and adjacent structures degradation remains in the focus of pathophysiologists and pathomorphologists close attention. The aim of the study was to determine the expression level of proinflammatory cytokines (IL-1β, IL-6, IL-17) and angiogenesis markers (VEGF-A and CD31) in intervertebral disc (IVD) tissue, their association between each other and between disc degeneration in young people with discogenic BP. In patients who underwent discectomy for a disc herniation, a clinical examination, magnetic resonance imaging (MRI) of the lumbar spine, histological and immunohistochemical analyses of these factors in the disc tissue were performed in comparison with the parameters of healthy group samples (controls). Histology image analysis of IVD fragments of the degenerative disc disease (DDD) group detected zones of inflammatory infiltration, combined with vascularization, the presence of granulation tissue and clusters of chondrocytes in the tissue of nucleus pulposus (NP). Statistically significant expression of IL-1β, IL-6, IL-17 and VEGF-A (especially on the chondrocytes surface) and CD31 (in the disc matrix) was evident in the samples of the DDD group compared with the controls (p < 0.0001), that showed a strong correlation with the histological disc degeneration stage (r > 0.5; p < 0.0001). This denotes a high immunoinflammatory potential of chondrocytes and demonstrates their altered morphogenetic properties. The coincidence of the spatial expression of IL-1β and IL-17 in the perivascular zone endothelium and in the vascular lumen (p < 0.01) was found, which point at the inflammatory synergy of these cytokines. High expression of VEGF-A prevailed on the surface of chondrocytes in cell clusters compared to the matrix (p < 0.0001), indicating that the NP cells trigger the angiogenesis. The absence of CD31 in the cracks of NP with high expression in the disc matrix states the secondary nature of IVD defects due to degeneration, and not due to vascular ingrowth. A high number of patients with Modic changes according to MRI data shown the contribution of cytokines to the formation of reactive spondylitis and the clinical course of BP. These results obtained will help to development molecular/cellular targets and basic strategies for therapy of BP with DDD in the early stages in young people.

Фокусированный ультразвук под контролем магнитно-резонансной томографии (МР-ФУЗ) — новый неинвазивный метод терапии контралатерального дезадаптирующего и резистентного к фармакологическому лечению тремора. В исследованиях подтверждена высокая эффективность и безопасность использования МР-ФУЗ у пациентов с эссенциальным тремором и болезнью Паркинсона, в том числе в длительных исследованиях. В статье освещаются преимущества метода перед другими имеющимися в настоящее время инвазивными и неинвазивными вмешательствами на головном мозге, использующимися для лечения тремора, потенциальные мишени, возможность двустороннего вмешательства, показания и противопоказания к методу.