Burdenko Neurosurgery Institute

INTRODUCTION: Patients with disorders of consciousness (DoC) represent a complex patient cohort requiring a multidisciplinary approach. Despite the availability of modern national clinical guidelines (2023), real-world clinical practice in Russia continues to be challenged by the use of outdated terminology, insufficient implementation of validated diagnostic scales, and a lack of standardized management approaches, including pain assessment and management. This study was prompted by the need to assess the current situation and identify key issues to improve the quality of care for patients with DoC in Russia. OBJECTIVE: To assess the current practices, awareness, and key challenges faced by Russian healthcare professionals in the diagnosis, treatment, and management of patients with chronic DoC. MATERIALS AND METHODS: In 2024, an anonymous online survey of 204 medical and paramedical professionals (anesthesiologists, neurologists, rehabilitation specialists, psychologists, nursing staff) from various regions of Russia was conducted. The 47-item questionnaire covered demographic data, terminology used, diagnostic scales, treatment and rehabilitation methods, as well as approaches to pain assessment and management. RESULTS: Despite modern clinical guidelines, outdated terminology persists in practice: apallic syndrome (13.3 %), vegetative state. Only 62.9 % of respondents use the validated Coma Recovery Scale-Revised (CRS-R) for DoC diagnosis, while 77.1 % still use non-relevant scales (Glasgow Coma Scale, Full Outline of UnResponsiveness — FOUR). 30 % of respondents, including physicians responsible for diagnosis, use exclusively these non-relevant tools. Significant differences in approaches were identified among specialists of different profiles (intensivists, neurologists, rehabilitation specialists). The majority of respondents (83 %) acknowledge that DoC patients experience pain; however, the assessment methods (autonomic signs, grimacing) are not standardized and can be non-specific. CONCLUSIONS: The study results indicate insufficient awareness and fragmented implementation of modern standards for the diagnosis and management of patients with DoC in Russia. The findings highlight the necessity of developing and implementing educational programs for healthcare professionals aimed at standardizing terminology, promoting the use of validated diagnostic scales (CRS-R), and harmonizing approaches to pain management.

Background. Transformation of the morphology of the post-infarction myocardium changes the electrical characteristics of the heart muscle, increasing the risk of life-threatening arrhythmias. Objective . The aim of the study was to compare the structural and electrical features of the heart muscle in post-infarction patients. Design and methods. The study participants were 105 (85.4 %) patients who had suffered an MI, aged 56.7±8.4 years. Six months after the MI, the patients underwent cardiac magnetic resonance imaging (MRI) (GE SIGNA Voyager tomograph, GE HealthCare, USA) with the introduction of a contrast agent — gadoteric acid. Six and 12 months after the MI, the patients underwent multi-day electrocardiogram monitoring (MMEKG) for 72 hours. Results. According to MMEKG, unstable paroxysms of VT were registered in 9 (6.8 %) patients. Frequent (>30/h) ventricular extrasystoles (VE) were correlated with the percentage of scar zone — r=0.679 (p=0.0101), the mass of the heterogeneous zone — r=0.721 (p=0.00951). An association was established between polymorphic VE with the presence of areas of microvascular obstruction r=0.812 (p=0.0095) and intramyocardial hemorrhage r=0.798 (p=0.0114). Most parameters of autonomic regulation and heart rate turbulence showed a moderate negative relationship with the scar mass. According to the data of univariate regression analysis, risk markers of unstable VT were established: scar zone mass, end-diastolic size, turbulence slope, SDNN variability parameter. Conclusion. Predictors of unstable runs of ventricular tachycardias within 12 months after myocardial infarction are the mass of the scar zone, the values of the left ventricular end-diastolic diameter, the values of the turbulence slope and the SDNN variability parameter.

To analyze research of etiology, pathogenesis and treatment of neurovascular compression syndrome of the upper thoracic outlet. Cervical ribs were described by Galen. However, these ribs have been associated with symptoms of neurovascular compression only in the 18th century. In 1903, F. Bramwell identified the second possible cause of neurovascular compression (structural variations of the first rib). In 1912, T.W. Todd described narrowing of costoclavicular space. In 1920, A.A. Law described fibromuscular bands in costoclavicular space. In 1929, H.C. Naffziger and W.I. Grant pointed out the role of hypertrophy or spasm of anterior scalene muscle. In 1945, I.S. Wright described pectoralis minor muscle syndrome («hyperabduction»). The main treatment was scalenotomy. Less common option was rib or clavicle resection. Modern methods of pathogenetic treatment and less traumatic surgical approaches began to be developed only in the late 20th - early 21st centuries. All above-described entities were considered separately. The common term «thoracic outlet syndrome» does not accurately reflect the mechanism and structures subject to compression. It seems appropriate to group all forms of thoracic outlet pathology causing neurovascular compression into a single unit (neurovascular compression syndrome of the upper thoracic outlet).

Lucy is the first mission to Jupiter Trojan asteroids, primitive bodies preserving crucial evidence of Solar System formation and evolution [1]. En route to its primary science encounters with the L4 swarm Trojans (2027-2028) and L5 swarm (2033), the spacecraft executed a flyby of asteroids (152830) Dinkinesh on November 1, 2023 and (52246) Donaldjohanson (DJ) on April 20, 2025. These Main Belt asteroid flybys function as operational rehearsals for the mission's Trojan targets. This work examines the performance of L'Ralph, a core Lucy science instrument, during these encounters, including data collection, instrument behavior, and analysis of the acquired datasets.L'Ralph integrates two complementary imaging systems spanning visible to near-infrared wavelengths (0.35-4 μm) [2]. The instrument has two focal plane assemblies: the Multi-spectral Visible Imaging Camera (MVIC) operating at 350-950 nm and the Linear Etalon Imaging Spectral Array (LEISA) covering 0.97-3.95 μm. LEISA delivers hyperspectral mapping capabilities with variable spectral resolving power (50-160, Δλ

The NASA Lucy mission was designed to provide the first reconnaissance of Jupiter Trojan asteroids. These primitive bodies hold important clues to the origin and evolution of the Solar System. The Lucy spacecraft is currently en route to its encounters with Trojan asteroids in the L4 swarm in 2027 and 2028, and the L5 swarm in 2033 [1]. On its way through the Main Belt, Lucy flew past the asteroid (52246) Donaldjohanson on April 20, 2025. The main purpose of the flyby was to support mission preparation for the primary science targets, the Trojan asteroids. The Linear Etalon Imaging Spectral Array (LEISA) mapping spectrometer [2,3], part of the L’Ralph instrument, collected multiple spectral datasets during the encounter with Donaldjohanson. LEISA covers the spectral range 0.97 – 3.95 μm with a variable spectral resolving power ranging from ~50 to 160 (Δλ

There is a signifi cant amount of scientifi c data on the clinical course, molecular biology, treatment options for plasma cell tumors and other disorders connected with the secretion of paraproteins. However, the analysis of the infl uence of specifi c clinical and laboratory signs and their combinations on disease progression and prognosis is less represented. The search for other indicators of disease progression is relevant, particularly the determination of the relationship between the type and level of monoclonal immunoglobulin secretion and the severity of the anemic syndrome, which is the focus of our work. Purpose. To determine the correlation between the type of secretion and the amount of monoclonal immunoglobulin in serum and urine with the severity of anemic syndrome in patients with paraproteinemic hemoblastoses (PН). To evaluate the secretion of pathological protein as a possible prognosis factor for the development of anemia in this category of patients. Material and methods. A retrospective analysis was conducted on data from 116 patients with plasma cell neoplasms and Waldenström’s macroglobulinemia. Of these, 104 (87.8%) were diagnosed with multiple myeloma. Eight (6.9%) patients were diagnosed with Waldenström’s macroglobulinemia, two (1.7%) with plasma cell leukemia, and one case each (0.8%) of solitary plasmacytoma and monoclonal gammopathy of undetermined signifi cance. Patients were divided into four groups based on hemoglobin levels: the fi rst group included patients with hemoglobin above 120 g/L, the second group consisted of patients with mild anemia (hemoglobin level from 119 to 100 g/L), the third included patients with moderate anemia (hemoglobin level 99– 80 g/L), and the fourth group comprised patients with severe anemia (hemoglobin level below 79 g/L). Paraproteins were determined in serum in all four groups: Gκ, Gλ, Aκ, Aλ, Mκ, Mλ, Dλ, BJκ, and BJλ proteins, as well as the excretion of BJκ and BJλ proteins in urine. Results. In most patients, paraproteins were detected in blood: Gκ (35.1%), Gλ (24.6%), and BJλ protein (14.9%); in urine: BJλ protein (14.9%) and BJκ (28.1%). The secretion of other types of paraproteins in blood was less frequent: Aκ (9.6%), Aλ (7%), Mκ (3.5%), Mλ (3.5%), Dλ (2.6%), BJκ (4.4%). The absolute majority consisted of patients with paraprotein in blood (Gκ and Gλ), BJλ protein in serum, and excretion of BJλ and BJκ proteins in urine. At the same time, the secretion of other types of paraproteins—Aκ, Aλ, Mκ, Mλ, Dλ, BJκ—was signifi cantly less frequently detected. Anemia of grade I was more frequently diagnosed—in the group with hemoglobin levels of 119–100 g/L, there were more patients (40; 35%). Grade II anemia (hemoglobin 99–80 g/L) was diagnosed in 33 (28%) patients, grade III in 13 (11%) patients. Hemoglobin levels above 120 g/L were found in 30 (26%) patients. No statistically signifi cant relationship was found between the type of paraprotein, its quantitative value in serum and urine, and the severity of anemia in any group. There was a certain correlation between the excretion of BJκ in urine and hemoglobin levels (χ2 = 10.94, p = 0.01 (< 0.05)). This is likely related to a higher number of patients with renal failure among those excreting BJκ in urine. Kidney damage was diagnosed in 18 (54%) out of 33 patients with BJκ excretion in urine. A statistically signifi cant relationship was identifi ed between the number of tumor cells in bone marrow and the severity of anemia, as well as between the level of β-2 microglobulin and the severity of anemia. Conclusions. It has been established that the type and quantitative level of secretion cannot be a prognostic factor for the severity of anemic syndrome in patients with PH. The study revealed a relationship between the severity of anemia and the amount of BJκ protein determined in urine. Since 54% of pati ents in t his group have renal insuffi ciency, we suggest that there is anemia of chronic disease caused by impaired erythropoietin production due to kidney damage. A correlation has also been identifi ed between the severity of anemia and the infi ltration of tumor cells in the bone marrow, which confi rms that the leading cause of anemia in patients with plasma cell disorders is the infi ltration of the bone marrow by tumor cells and their negative impact on erythropoiesis

Endonasal surgery of brain tumors is associated with the risk of cranial nerve and blood vessel damage, leading to reduced quality of life or death. Effective local subsurface detection of neurovascular structures is therefore crucial but remains a challenge due to the limitations of conventional intraoperative techniques such as Doppler ultrasound and electrophysiological techniques, particularly in narrow surgical fields. This study aims to enhance a novel solution for intraoperative identification of subsurface neurovascular inclusions based on frequency domain near infrared spectroscopy combined with machine learning. The key objective is to adapt the detection algorithm to the individual optical properties of each patient’s tissues. The tasks included dataset collection, designing a reference classifier and its adaptation for unseen optical properties. Given the complexity and time required to collect real intraoperative data, synthetic training data were generated using the finite element method. A metric-based few-shot learning method, employing prototypical networks with Mahalanobis distance, was chosen for reference algorithm adaptation. Analysis of results demonstrated that the reference classifier, while accurate on familiar data (recall was 0.88), failed on unseen data. In contrast, the trained prototypical network significantly improved classification performance on unknown optical properties, achieving high precision and recall for inclusions of 1 mm in diameter and greater. Although classification of smaller inclusions (0.5 mm) remains uncertain, but detection was still possible. The results support the feasibility of using few-shot learning with frequency domain near infrared spectroscopy for real-time, intraoperative detection of neurovascular structures, offering a promising alternative to existing methods.

Despite modern advances in neurosurgery, treatment of intramedullary spinal cord tumors is still associated with postoperative neurological impairment and high incidence of adverse outcomes. Intraoperative neurophysiological monitoring allows real-time functional assessment of spinal cord conduction pathways and accurate tumor resection. Currently, concomitant monitoring of somatosensory and motor evoked potentials, as well as D-wave is the most common. This excludes damage to both sensory and motor pathways. In modern literature, there are some differences in methods of intraoperative neurophysiological monitoring, such as sensitivity and specificity of the method, criteria of «alarm» during surgical treatment of intramedullary tumors and correlation of neurophysiological monitoring parameters with postoperative neurological status of patients.