Russian journal for personalized medicine

The search for new ways to solve the problem of obesity is highly relevant, since the effectiveness of obesity treatment worldwide is low. A possible promising target for researchers is brown adipose tissue. Brown adipose tissue is involved in the expenditure of excess energy and the maintenance of metabolic health, unlike white adipose tissue. In the human body, there are 2 subtypes of brown adipose tissue – classic brown and beige. This review attempts to determine whether there are differences in the effects of drugs on these subtypes of brown adipose tissue and in the consequences of activating these subtypes. 

Background. To date, there are no clear recommendations for the physical rehabilitation of children with congenital heart defects (CHD) after surgical correction. Until recently, the focus was on aerobic dynamic endurance exercise in patients with CHD, with intensity determined by peak oxygen consumption (VO2peak). The importance of strength training aimed at strengthening the musculoskeletal system has been less studied and is often overlooked, despite the fact that the amount of muscle strength determined using a wrist dynamometer is a predictor of the severity of the disease in patients with CHD.Objective. To evaluate the effectiveness and safety of strength training in a comprehensive rehabilitation program for children after radical treatment of congenital heart defects. Materials and methods. The clinical status of all patients was analyzed, physical examination, echocardiography (EchoCG), daily monitoring of the electrocardiogram (SMECG), cardiopulmonary exercise testing were performed, grip strength of both hands was measured using a wrist dynamometer, the strength of the muscles straightening the trunk was determined using a standing dynamometer. All participants were randomized into two groups. The first (control) group included patients who underwent early physical rehabilitation 3 months after the radical correction of CHD, which consisted of using only aerobic dynamic physical training. The second (main) group consisted of patients who were recommended a combined workout – aerobic dynamic load with strength exercises with weights, individually selected on the basis of wrist dynamometry. All measurements were collected at the beginning of the program and after its completion.Results. When analyzing the muscle strength estimated using a wrist dynamometer, it turned out that 36 (94.7 %) children showed a decrease in the strength index. There were no intergroup differences in the severity of muscle strength in the compared groups. In patients with CHD, the use of inpatient rehabilitation for 2 weeks and outpatient rehabilitation for 12 weeks, a combination of aerobic dynamic loads with strength training with weights individually calculated for each child led to a more pronounced increase in hand compression strength (p = 0.03) and trunk muscle strength (p = 0.04), estimated using functional testing. When comparing the spiroveloergometry data, children who were engaged in combined physical training showed higher performance compared to children who did not perform strength training. In addition, they demonstrated higher levels of transferable power during physical exertion.Conclusion. The use of combined aerobic dynamic loads with strength training with individually calculated weights during two weeks of inpatient and twelve weeks of outpatient rehabilitation led to a more pronounced increase not only in muscle strength, estimated using functional testing, but also increased the physical performance of children with corrected congenital heart defects in comparison with children who performed only dynamic aerobic loads.

Background. The most important advantage that imaging provides to a patient with ischemic stroke is the rapid identification of those patients who are most likely to benefit from emergency treatment. This group includes patients who suffer from severe neurological symptoms due to occlusion of the main artery, and those who are candidates for recanalization using intravenous thrombolysis or intraarterial intervention to remove a blood clot. Objective. To develop an improved protocol (set of pulse sequences) of magnetic resonance imaging for patients in the acute period of ischemic stroke.Materials and methods. The experience of clinical use of brain MRI at the Almazov National Medical Research Centre in patients with ischemic stroke is analyzed.Results. The most sensitive in the diagnosis of ischemic changes in the most acute stage of development is the DWI regime. The DWI exceeds the value on FLAIR, which indicates greater information content on ADC maps.Conclusion. The developed improved protocol of MR examination of patients in the acute period of ischemic stroke makes it possible to identify the ischemic zone in a short time. The scan time is about 9 minutes, which is comparable to the time of a comprehensive CT scan, and taking into account the average patient’s 5-minute laying time, the relative differences in the «laying+scanning» CT and «laying+scanning» MRI time are only 30 %.

The paper addresses the role of Artificial intelligence (A) in modern drug design and experimental work in biomedicine. It is shown how AI technologies can accelerate discovery and innovations and decrease the time of translational cycle. Advantages of AI and modern approaches are presented.

Background. Aneurysms of the ophthalmic segment of the internal carotid artery are quite rare and account for no more than 5 % of all intracranial aneurysms. Stent-assistance using Laser-cut stents is an important option and before the advent of braided stents was the mainstay in the endovascular treatment of complex aneurysms. The study is aimed at analyzing the peculiarities of assisting stent implantation into the internal carotid artery taking into account the anatomical characteristics of its siphon (the place of typical collapse and under-opening of the stent at acute anterior knee angle), influencing the increase of radicality of aneurysm disconnection from the blood flow, as well as evaluating the safety and efficacy of Laser-cut stent-assistence technique in the treatment of aneurysms of the ophthalmic segment of the internal carotid artery. Design and methods a retrospective analysis of patients from the database from 2013 to 2016 was performed. All patients with ophthalmic segment aneurysms who underwent aneurysm occlusion using any laser-cut self-expanding nitinol assisted stent were included. Stent implantation technique and positioning points, intraoperative and postoperative complications, primary and distant angiographic results (Raymond-Roy Occlusion Classification, RROC) were analyzed. Results. 57 patients with 57 aneurysms of the ophthalmic segment of the internal carotid artery operated using laser-cut stent-assist technique were included in the study (Enterprise I: 53 aneurysms; Neuroform: 4 aneurysms). Primary total (RROC I) — 37 (64.9 %), subtotal (RROC II) — 14 (24.6 %) and partial (RROC III) — 6 (10.5 %) were switched off from blood flow. Radical aneurysm disconnection from the blood flow was achieved in all cases using a modified stent implantation technique (proximal-edge position n = 24) — when using a short 14 mm Enterprise stent (n = 8), as well as when positioning the Enterprise stent from the middle cerebral artery into the internal carotid artery up to the natural bend of the artery in the anterior knee of the siphon (the proximal end of the stent corresponds to the aneurysm neck regardless of the length of the stent itself) (n = 16). Similar results in terms of radicalization were achieved with the Neuroform stent (n = 4). At standard implantation (middle third of the stent corresponds to the aneurysm neck) of the Enterprise stent (n = 29), only in 9 observations radical disconnection of the aneurysm from the blood flow was achieved. On control angiography at the term not earlier than 6 months aneurysms were radically excluded (RROC I) in 43 (75.4 %) patients, subtotally (RROC II) in 5 (8.8 %) and partially (RROC III) in 9 (15.8 %) patients. Conclusions. Endovascular surgical interventions using stent-assistance in the treatment of patients with aneurysms of the ophthalmic segment of the internal carotid artery are effective, but due to the stent design, the shape of the internal carotid artery siphon plays a key role in achieving a radical treatment result. Personalized assessment of anatomical and morphometric features of the aneurysm and the aneurysm-bearing artery, in particular, the analysis of the curvature of the natural curvature of the siphon, when choosing the type and length of the assisting stent are the key points for achieving the optimal result of the operation and reducing the risks of complications. The proposed method of implantation using proximal-edge position allows to achieve a radical result of aneurysm occlusion regardless of the stent length and minimize the risks of stent collapse and ischemic complications. A personalized approach to the choice of short assisting stents is a consequence of the proximal-edge position technique, as it is notnecessary to lead the excessive stent length into the middle cerebral artery.

The most common primary tumors of the central nervous system in the adult population are meningiomas. There is a group of patients with aggressive meningiomas with a recurrent type of disease, even after radical removal of the tumor and radiotherapy. Recurrence of meningiomas occur in every 4th patient. Repeated neurosurgical treatment of these patients is associated with a high risk of developing or exacerbating neurological deficits, and radical removal is not always possible. Currently, there are no generally accepted standards for the treatment of patients with recurrent meningiomas. The decision to choose the right treatment strategy is made in about half of patients with recurrent meningiomas, the process leading to such a decision remains complex and often relies on simple logical and empirical approaches of specialist doctors based on available data, which, as a rule, have a large volume. The constant growth of the volume of multimodal data in neuro-oncology outstrips the possibilities of their analysis by experts using traditional approaches. It is quite difficult for a neurosurgeon to predict how the neoplastic process in the central nervous system will behave. Thus, neurosurgeons need to seek help from modern artificial intelligence (AI) technologies.