Search

Background and Aims: Despite evidence that local intracuff alkalinised lignocaine may reduce the incidence of exaggerated laryngeal reflexes after thyroid surgery, its effects on the quality of recovery (QoR) from anaesthesia remain unknown. This study aimed to test if local intracuff alkalinised lignocaine improves the QoR from anaesthesia after thyroid surgery compared to placebo. Methods: Patients over 45 years old scheduled for thyroid surgery with electromyographic monitoring under general anaesthesia were enroled in a randomised, single-centre, double-blind, placebo-controlled trial. They were randomised into three groups (1:1:1 ratio): intravenous lignocaine (IVL), topical and intracuff lignocaine (TL), and placebo. The sample size was initially set at 231, but the study was terminated early after an interim analysis of 110 patients showed no significant difference between groups. The primary outcome was the QoR-40 score 24 hours post-surgery. Secondary outcomes included rates of arterial hypotension, coughing during emergence, bispectral index (BIS) values, and electromyographic monitoring characteristics. Results: An interim analysis after 110 patients showed mean QoR-40 scores of 185 (standard deviation(SD): 11.4) (placebo), 186.1 (SD: 13.6) (IVL), and 185.1 (SD: 14.3) (TL) (P = 0.662). Mean differences were 1.1 (IVL vs placebo, 95%CI: -5.03, 7.15, z = 0.347) and 0.1 (TL vs placebo, 95%CI: -6.02, 6.23, z = 0.035). The study was stopped due to lack of effectiveness as the superiority of IVL and TL was not demonstrated. No differences were found in secondary outcomes. Conclusion: Neither IVL nor TL improved the QoR from anaesthesia and did not affect electromyographic monitoring in low-risk thyroid surgery. Keywords: Anaesthesia, anaesthesia recovery period, intracuff lidocaine, lignocaine, neck pain, neuromuscular monitoring, quality of recovery, thyroidectomy, Author(s): Sergey M. Efremov [1]; Alexey Y. Kulikov [1]; Valeria P. Govorushkina (corresponding author) [2]; Daniil D. Sidorov [3]; Alexey A. Ladutko [4]; Oleg V. Kuleshov [1] INTRODUCTION The quality [...]

BACKGROUND: Depressive symptoms in patients with schizophrenia lead to more frequent exacerbations of the underlying disease, worsen the prognosis, and increase the risk of suicide. Clinical practitioners continue to face challenges in diagnosing this disorder. AIM: This study aims to analyze published material on biological markers of depressive symptoms in patients with schizophrenia. METHODS: The search of literature was conducted using the following electronic search engines (the total number of relevant papers found is also specified): ACCESSSS (n=150), Cochrane Library (n=48), PubMed (n=623), eLIBRARY (n=216), and Google Scholar (n=367). The final discussion included 67 papers consistent with the study aim and were published between January 1, 2018 and December 31, 2023. RESULTS: Based on the available scaterred data, it appears that plasma biomarkers (e.g. C-reactive protein, metabolic parameters, hormones, enzymes, neurotrophic factors) are limited in specificity when it comes to diagnosing depressive symptoms in schizophrenia. Our analysis of the neuroimaging findings showed that depressive manifestations are associated with a decrease in the volume of the gray matter in the parietal, frontal, and temporal lobes (particularly in Broca’s and Wernicke’s areas) and in specific regions of the prefrontal cortex (including the medial right superior frontal, medial orbitofrontal, and superior and middle frontal gyri). It has been suggested that the SIRT1, OXT, CDKAL1, and APOE genes are involved in the development of depressive symptoms in patients with schizophrenia. CONCLUSION: Understanding and identifying depressive symptoms in schizophrenia will improve the quality of care for patients with this disorder.

Objective: to identify the characteristics of the clinical debut of schizophrenia, as well as clinical aspects related to hereditary aggravation within schizophrenic spectrum disorders.Materials and methods: patients with a confirmed diagnosis of F20.0 “Paranoid schizophrenia” selected according to inclusion/non-inclusion criteria participated in the study. Material was collected through clinical interviewing, analysis of medical records and documentation, and self-questionnaires.Results: a total of 264 individuals participated in the study. Hereditary aggravation with schizophrenic spectrum disorders within two generations was detected in 127 of them (48.1%). Our results showed that having a family history of schizophrenic spectrum disorders correlated with earlier age of schizophrenia debut (p=0.018) and higher scores on the Calgary Depression Scale (p=0.013).Conclusions: the findings may serve as an effective tool for developing more accurate diagnostic strategies in individuals at high risk of developing schizophrenia due to hereditary aggravation, as well as for the subsequent treatment of these individuals.

Background. Alcohol slows down the work of the brain and central nervous system, leads to deterioration of memory and concentration, cognitive disorders, and the formation of organic mental disorders. Due to the retirement of elderly people, some of them resort to taking alcohol as an adaptogen to alleviate various social, mental and psychological disorders, which can lead to the emergence of new or exacerbation of existing somatic disorders, the formation of alcoholism, as well as organic mental disorders. Aim. To investigate the risk factors (RF) for the formation of secondary organic mental disorders (SOMD) in elderly people with alcohol dependence (AD), formed in middle and old age. Patients and methods. The study included only male patients for the purity of the study aged 60 to 74 years (average age 67.5±7.2), who were divided into 2 groups depending on the age of occurrence of AD: group 1 – 21 people (36.2%), AD occurred at the age of 51.6±1.2 years, and the symptoms of SOMD at 61.8±2.1 years; group 2 – 37 people (63.8%), AD occurred at the age of 64.5±2.5 years, and SOMD at 71.3±2.8 years. The following methods were used: questionnaire – using the developed "Anamnestic chart", clinical (anamnesis collection), statistical (parametric and nonparametric). Results. The main factors of the formation of SOMD in people with formed AD in middle and old age are combinations of various RF, as well as a monofactor in the form of chronic alcohol abuse, the proportion of which varies depending on the age of AD formation. Conclusion. When AD is formed in old age, combinations of RF have a greater influence on the development of SOMD. And in the formation of AD in middle age, both alcohol, as an exogenous mono-damaging factor, and a combination of RF contribute to the formation of SOMD. Hereditary burden of alcoholism affects the progrediency of alcoholism, but does not play a role in the rate of formation of SOMD. The formation of alcoholism in middle age is combined with a relatively slow rate of formation of SOMD and a smaller number of associated somatic pathology, and when formed in old age – with a relatively fast rate of development of SOMD and a large number of associated somatic pathology.

One of the most common neurological symptoms is cognitive impairment. Cognitive disorders occur especially often in old age. An analysis of cognitive functions in 58 elderly patients with alcohol dependence formed in middle and old age and complicated by secondary organic mental disorders is presented. The identified neurological signs indicate the absence of severe brain lesions. Data are presented showing that the level of alcohol anosognosia for its individual components, as well as the overall score of cognitive function indicators in elderly patients with alcohol dependence, formed in middle and old age and complicated by secondary organic mental disorders, differs.

Актуальность. Клиническая значимость параметров, характеризующих диастолическую функцию левого желудочка после операций на сердце, недостаточно изучена. Цель. Проверить гипотезу о взаимосвязи эхокардиографических параметров диастолической функции левого желудочка и тяжелого периоперационного повреждения миокарда. Методы. В ретроспективное когортное исследование включили 220 пациентов, перенесших изолированное коронарное шунтирование в условиях искусственного кровообращения. Анализировали степень диастолической дисфункции, характеристики трансмитрального кровотока (скорость раннего диастолического наполнения левого желудочка (пиковая Е) и отношение пиковой Е к скорости наполнения в систолу левого предсердия (E/A)), индекс объема левого предсердия, скорость трикуспидальной регургитации, среднюю скорость движения кольца митрального клапана (е’) и соотношение E/e’ согласно данным эхокардиографии до и после операции. Тяжелое повреждение миокарда (первичная конечная точка) определяли как концентрацию высокочувствительного тропонина I более 5 670 нг/л в первые сутки после операции. Результаты. Согласно результатам ROC-анализа, пиковая Е, превышающая 71 см/с, и E/A более 1,3 были ассоциированы с риском тяжелого повреждения миокарда. Кроме того, диастолическую дисфункцию 2-й и 3-й степеней выявили у 13,1 % пациентов с послеоперационным содержанием тропонина I менее 5 670 нг/л и у 42,9 % пациентов с уровнем более 5 670 нг/л (p = 0,009). Заключение. Послеоперационная степень диастолической дисфункции и параметры трансмитрального кровотока ассоциированы с прогностически неблагоприятным уровнем тропонина I. Поступила в редакцию 26 января 2024 г. Исправлена 31 июля 2024 г. Принята к печати 2 августа 2024 г. Финансирование Исследование не имело спонсорской поддержки. Конфликт интересов Авторы заявляют об отсутствии конфликта интересов. Вклад авторов Концепция и дизайн работы: С.М. Ефремов Сбор и анализ данных: С.М. Ефремов, Р.Е. Шмидт, Т.А. Шмидт, А.В. Зырянова Статистическая обработка данных: С.М. Ефремов, Р.Е. Шмидт Написание статьи: С.М. Ефремов, Р.Е. Шмидт, А.В. Зырянова Исправление статьи: все авторы Утверждение окончательного варианта статьи: все авторы

Background. In case of ineffective conservative antiepileptic therapy, surgical treatment aimed at removing the epileptogenic focus may be applied. Resection procedures allow to eliminate seizures in most patients, but in 20–30% cases they persist or recur, thereby proposing to use some neuromodulation.Objective: to assess effectiveness of neuromodulation in patients with drug-resistant epilepsy (DRE) after failed resection surgical interventions.Material and methods. A retrospective data analysis was carried out involving 23 DRE patients who had undergone vagus nerve stimulation (VNS) or deep brain stimulation (DBS) of the anterior nucleus of the thalamus (ANT) or hippocampus (HP) after failed surgeries. The VNS system was implanted in 18 (78.3%) patients, the HP-DBS system – in 3 (13.0%), and the ANT-DBS system – in 2 (8.7%). The results after surgical interventions were assessed according to the Engel scale, VNS therapy – by the McHugh (MH) scale, DBS therapy – by the degree of reduced seizure rate as a percentage. The average follow-up was 56.5 months.Results. Patients with implanted VNS system were found to have the outcome presented as MH Ia–IIb in 3 (16.7%) cases, MH IIIa–IIIb in 10 (55.5%) cases, MH IV–V in 5 (27.8%) cases. In HP-DBS group, 2 out of 3 patients showed a decline in seizure rate by more than 50% from the baseline level, and 1 patient experienced an improvement in seizure severity. In the ANT-DBS group, one patient had a 60% reduction in seizure rate and an improvement in seizure severity, another one showed no change in seizure rate.Conclusion. Neuromodulation in DRE patients can significantly lower seizure rate in more than half of patients after failed surgical treatment.

Climate, building materials, occupancy patterns, and HVAC (heating, ventilation, and air conditioning) systems all interact in complex ways, making it difficult to design low-energy buildings. Thus, innovative architectural and engineering design strategies are required to meet the worldwide need to decrease building energy usage. To improve the calculation of energy consumption of buildings, this work introduces the FCR-BCS (fuzzy clustering rule-based building control systems), which integrates fuzzy logic concepts into computational simulations. FCR-BCS can contemplate real-world uncertainties and fluctuations using linguistic factors and approximate reasoning for more precise and trustworthy results in energy-efficient building design. This method's significance rests in its potential to significantly reduce energy use, advance sustainability, and improve urban residents' quality of life; architects and engineers can thus employ FCR-BCS to enhance the efficiency of HVAC systems and insulation. The outcomes of FCR-BCS simulation assessments show that it is capable of making buildings more energy efficient. The experimental outcomes demonstrate that the suggested model increases the sensitivity analysis by 99.4 %, energy efficiency analysis by 99.8 %, occupancy patterns analysis by 97.5 %, temperature profile analysis by 98.8 %, and energy consumption analysis by 99.6 % compared to other existing models.