APOE3 gene therapy has therapeutic potential in the treatment of severe TBI.

Stroke is a global medical and socio-economic problem and a great demand for alternative therapies, the leading one being stem cell (SC) therapy. Pathogenetic processes in ischemic stroke (II) trigger the mechanisms of necrotic and apoptotic death of neurons with the formation of the central infarct zone («core of ischemia») and the ischemic «penumbra» zone; the severity and reversibility of the injury directly depends on the duration of ischemia. In parallel with pathogenetic processes, endogenous neurogenesis occurs – the proliferation of neurogenic stem and progenitor cells (NSC/NPC) and their migration into the ischemic focus; however, most NSCs and newly formed neurons undergo apoptosis and recovery of lost functions does not occur. Significant efforts are being made to find ways to control neurogenesis, in particular through the transplantation of exogenous SCs. The main factors preventing the use of SCs in humans are moral, ethical, religious and legal aspects related to the source and method of obtaining cells, as well as possible immunocompromised complications due to incompatibility of donor cells with the recipient of the main histocompatibility complex antigens. The safest is the use of autologous SCs (the patient’s own cells), as it does not require the use of immunosuppressive protocols. Due to the relative safety and ease of production, the most common are multipotent mesenchymal stem cells (MSCs), namely MSCs of the bone marrow (BM). Numerous preclinical studies in experimental animals with modeled II, as well as clinical trials conducted over the past 15 years, have shown the safety and feasibility of transplantation of autologous MSCs in patients with severe neurological deficits after II. Two different approaches to the use of MSCs are discussed: neuroprotection in the acute phase and neurorestoration in the chronic phase II. Proposals are currently being developed for phase II/III clinical trials in acute and chronic stroke using BM MSCs, the results of which will form the basis for certified standardized II treatment protocols.

Статья посвящена проблеме восстановления пациентов, перенесших нейрохирургическую операцию по поводу грыжи межпозвоночного диска, в частности купированию постоперационного болевого синдрома.

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Any surgical intervention is associated with the possible development of complications. Surgical complications are traditionally an unpopular topic for discussion, but in recent decades they have received increased attention, due to both medical and economic factors. This review discusses the general concepts that characterize the negative consequences of surgical interventions in spinal neurosurgery: complications, adverse events, sentinel events, never events, collateral adverse outcomes. Classifications are given that allow systematizing these negative phenomena. Surgical treatment of the lumbar disk herniation is the most frequently performed spinal surgery. The true number of lumbar discectomies is difficult to estimate because this procedure is often not an isolated surgical intervention, but a step in a larger one. Being a routine surgical procedure, discectomy, performed in one or another way depending on the preferences of the surgeon and available equipment, is characterized by a rather low relative frequency of adverse events and complications compared to other types of spinal surgery. However, due to the significant number of interventions, the absolute figures may present a medical and economic problem. Most authors refer to the classic triad of “wrong level, wrong side, wrong patient” and foreign bodies in the area of surgical intervention as obvious medical errors. Damage to the intestine or peritoneum, trauma to the great vessels and trauma to the nerve roots are considered serious complications, but not always medical errors. The other most commonly reported adverse events of lumbar discectomy are durotomy, neurological complications, surgical wound complications, recurrent disc herniation, and reoperation. Until now, no clear classification of the negative consequences of lumbar discectomy, which would allow to verify the relationship between intraoperative adverse events (both surgical and anesthetic) and postoperative complications has been developed. In addition, it is extremely difficult, based on the criteria available in the literature, to identify a medical error in a number of iatrogenic complications, which requires further comprehensive study of the problem, since it has not only medical, but also legal consequences.

A potential strategy for recovery and regeneration of brain damage due to traumatic brain injury is considered to be the transplantation of neurogenic stem and/or progenitor cells (NSCs/NPCs). The key factors of the regenerative non-targeted effects of NSCs/NPCs (so-called bystander effects) include the signal molecules produced by them into the extracellular environment (secretome). The purpose is to study the regenerative bystander effects of rat fetal brain neurogenic cells (FBNCs) in the in vitro model of neurotrauma. Materials and methods. In cell culture of FBNCs from rat fetuses (E14-16), neurotrauma was modeled in vitro by mechanical scratching of monolayer and conditioned medium obtained from 24-h cultures of rat FBNCs was added. Cell phenotype was evaluated by morphological features and by immunocytochemical staining for Nestin and GFAP. The density and length of processes, migration capacity, the cell growth rate and monolayer density in the scratched area were compared. Morphometric study included analysis of the width of the scratched area, the number of migrating cells, the distance of migration and mitotic activity in the intact monolayer. Results. Under the conditions of the nutrient medium of standard composition in the scratched area the signs of endogenous regeneration are shown during 24-48 h of cultivation. The overgrowth of cell processes from monolayer and short distance migration of single undifferentiated or poorly differentiated cells were shown. In the next 72-96 h of observation, the degeneration of migrated cells and processes in the scratched area was detected. Under the influence of conditioned media from 24-h cultures of FBNCs by single addition immediately after scratching at dose of 0.1 mg/ml for protein content the stimulation of regeneration were detected up to 96 hours of cultivation. The migration of cell processes from the monolayer simultaneously with undifferentiated or poorly differentiated cells at 24 hours was shown. The formation of cell clusters and their differentiation (at 48 h), as well as migration of differentiated cells with partial or complete overgrowth of scratched area (72-96 h) were observed. The morphological signs of degeneration of migrated cells in the scratched area appeared only on the 8th day of cultivation. Conditioned media does not affect qualitative and quantitative properties of the culture of rat FBNCs in the intact area where mitotic activity was average. Conclusions. Conditioned medium from 24-h cultures of rat FBNC can stimulate reparation in the in vitro model of neurotrauma in neural cell culture for at least 7 days at a single addition, without affecting the cellular composition and mitotic activity of the intact monolayer.

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In the book ”Contemporary Endoscopic Spine Surgery”, edited by Kai-Uwe Lewandrowski, Jorge Felipe Ramírez León, and Anthony Yeung, information on the history of spinal endoscopy is provided. A number of aspects of spinal surgery are covered, in particular spinal pain, preoperative examination, indications for endoscopic surgery, anesthesia, outpatient surgery. New endoscopic technologies are described. Leading scientists presented the clinical results of spinal surgery. Information on endoscopic surgery of degenerative diseases of the spine (herniated cervical discs, stenosis, instability, spinal deformities) is provided. The monograph contains three volumes ("Cervical spine", "Lumbar spine" and "Modern technologies"). The volume "Cervical spine" covers the following topics: - endoscopy of the cervical spine: historical perspectives, present and future; - anesthesia for minimally invasive surgery of the cervical spine; - algorithms for choosing between anterior and posterior endoscopy of the cervical spine; - making clinical decisions full endoscopy of the cervical spine; - spine surgery: indications for and results of endoscopic posterior cervical rhizotomy; anterior endoscopic cervical discectomy; anterior transcorporeal approach to percutaneous endoscopy of the cervical spine; - discectomy: anterior endoscopic cervical discectomy and foraminoplasty for disc herniation and cervical spinal stenosis; posterior full endoscopic discectomy and foraminotomy; endoscopic decompression in cervical spondylogenic myelopathy. The publication can be useful for both neurosurgeons-interns and practicing neurosurgeons to expand their understanding of spinal endoscopic surgery.