I V Damulin’s research while affiliated with Federal Medical Research Centre for Psychiatry and Narcology and other places

Pancreatic encephalopathy, characterized by a variety of focal neurological symptoms, develops in 9–35 % of patients with pancreatic diseases. Almost every patient with acute pancreatitis has a risk of developing pancreatic encephalopathy, which significantly deteriorates the course and increases mortality to 54 %. The article provides an example of the effect of extracorporeal detoxification techniques (ECDT) on the course of pancreatic necrosis, a phenomenon with neurological symptoms. The usage of ECDT is an effective method for treating pancreatic necrosis; it allows for the relief of neurological disorders caused by the development of pancreatic encephalopathy, and prevents the development, as well as helps to relieve the phenomenon of dementia of pancreatic genesis.

The article reviews in detail various aspects of the activities of doctors in Nazi Germany, Imperial Japan and the “democratic” USA. It is emphasized that at present, more and more attention is being paid to ethical problems related to medical activity, and the presence of strong moral principles in a doctor should be valued as highly as a high level of professional training. It is concluded that the lessons of history must be remembered in order not to return to this terrible past. The current tendency to keep silent about the terrible events of such a recent past must be stopped. The memory of thousands of victims of these inhuman “experiments” must be preserved. The oblivion of this past lies at the heart of the repetition of unsightly, inhumane “experiments” even in the so-called “democratic” countries. And only a steadfast civil position, including that of doctors, will allow avoiding a repeat of this past.

Bile acids are important physiological agents required for the absorption, distribution, metabolism, and excretion of nutrients. In addition, bile acids act as sensors of intestinal contents, which are determined by the change in the spectrum of bile acids during microbial transformation, as well as by gradual intestinal absorption. Entering the liver through the portal vein, bile acids regulate the activity of nuclear receptors, modify metabolic processes and the rate of formation of new bile acids from cholesterol, and also, in all likelihood, can significantly affect the detoxification of xenobiotics. Bile acids not absorbed by the liver can interact with a variety of cellular recipes in extrahepatic tissues. This provides review information on the synthesis of bile acids in various parts of the digestive tract, its regulation, and the physiological role of bile acids. Moreover, the present study describes the involvement of bile acids in micelle formation, the mechanism of intestinal absorption, and the influence of the intestinal microbiota on this process.

Aim . A review to highlight the bile acids importance as steroid mediators of nervous system activity and show the nervous system involvement in cholesterol metabolism and bile acids production. Key points . Presence of bile acid membrane and nuclear receptors and their activation role in mediating manifold metabolic processes have been established in various organs and tissues. Bile acid transporters are discovered in CNS. The animal brain under physiological conditions was found to contain about 20 bile acid types of likely innate origin suggested by their high contents; the bile acids spectrum in CNS differs significantly from blood plasma. Clinical and experimental works are conclusive about the CNS bile acids influence on mitochondrial membrane, their antioxidative role and, probably, steroid-mediator involvement in indirect regulation of memory, attention, motor functions and appetite. Conclusion . Bile acids act as pleiotropic signalling molecules affecting various tissues. The presence in CNS of various bile acid synthesis-related receptors and enzymes indicates their value in brain functioning and warrants research into their metabolism.

During the pandemic caused by SARS-CoV-2, the ability of this virus to infect the structures of the peripheral and central nervous system becomes increasingly clear. Damage to the nervous system is noted in almost 85% of patients who have had COVID-19, both those who have had this disease in severe form, and in patients with mild or asymptomatic course. COVID-19 worsens symptoms in patients with Parkinson's disease (PD), which potentially increases the risk of death due to pneumonia and respiratory disorders in patients with severe stages of PD. There is a concern that the COVID-19 pandemic may lead to a sharp increase in the incidence of parkinsonism, while the ability of the SARS-CoV-2 virus to cause PD is assumed. The following ways of virus penetration, including the SARS-CoV-2 virus, into the structures of the central nervous system are considered - viremia and endothelial cell damage, as well as retrograde axonal transport. The direct penetration of the COVID-19 virus into the structures of the brain may be due to a disturbance of the blood-brain barrier due to a «cytokine storm» and activation of lymphocytes, which is due to the processes of neuroinflammation. According to some of its manifestations, the extrapyramidal syndrome observed in patients with COVID-19 resembles lethargic encephalitis von Economo. However, the question of the possibility of COVID-19 causing the development of PD is extremely complex and ambiguous. The latency period between viral encephalitis and the onset of parkinsonism can reach 5 years. It is possible that the basis for the development of neurological disorders, including parkinsonism, in this category of patients is an energy deficit that leads to disruption of the functioning of neural networks (human connectome) of the human brain. Based on the currently very limited data concerning the penetration of the COVID-19 virus into the structures of the central nervous system, there is no convincing evidence of this virus causing parkinsonism. The final clarity on this issue will be provided by the results of observations on the condition of patients who have undergone COVID-19.

Objective: To identify possible associations between premorbid personality traits and cognitive impairment and affective symptoms in patients who have recovered from COVID-19. Material and methods: The study included 30 people with the so-called post-COVID syndrome. The diagnosis of COVID-19 was previously confirmed by laboratory tests in each patient. The control group included 15 healthy individuals. The Hospital Anxiety and Depression Scale was used to assess depression and anxiety. Cognitive function was assessed using the Verbal Fluency Test (VF), the Montreal Cognitive Scale (MOCA), and the Wisconsin Card Sorting Test (WCST). The Munich Personality Test (MRT) and the Toronto Alexithymia Scale (TAS-26) were used to assess premorbid personality characteristics. Multiple stepwise regression analysis was used as the main statistical method to identify the relationship between premorbid personality constructs and cognitive test results and affective and anxiety symptoms. Results: The presence of frustration tolerance in the personality structure reduced the number of incorrect answers (beta coefficient -0.811) in WCST and decreased the delay in responses with positive reinforcement (-0.630), and also reduced the level of depression (-0.465). Extraversion decreased the MOCA test score (-0.675) and increased the percentage of perseverative incorrect answers on the WCST test (0.573). The constructs of adherence to social norms and propensity to isolate lowered the final MOCA score (beta coefficients are -0.725 and -0.527, respectively). The esoteric tendencies construct decreased the latency of positive and negative reinforcement responses in WCST (-0.441 and -0.528, respectively). The severity of alexithymia was positively correlated with depression (beta 0.577), while neuroticism was positively correlated with anxiety (0.737). Conclusion: Low levels of frustration tolerance and esoteric tendencies have negative effects on cognition in COVID-19 survivors, while high levels of these constructs are protective against cognitive decline and depression.

The active devoted of the information technologies in medicine significantly facilitates the work of a doctor, but also creates a number of problems. One of them is related to the use in practice of documents on electronic media, including electronic medical records, and is related to personal information about the patient, which is strictly confidential and which can be stolen by unauthorized access using the capabilities of the Internet and especially social networks. Another problem associated with the use of electronic media is the possibility of uncontrolled introduction of false or erroneous information about the patient. One way to avoid mistakes associated with transferring information about one patient to an electronic document of another is to strictly identify each block of information. The importance of modern distance and multimedia teaching methods in the teaching process is emphasized. It is concluded that the future development of medical education in general, and the teaching of nervous diseases in particular, is associated with the combination of traditional methods with the capabilities of modern technical methods. Despite all the objective difficulties, it is vital to correct the situation. And here the professional experience of the doctor plays an important role. Given the fact that the use of these technologies is expanding more and more every year, the understanding of the complexities associated, with the ethical component of these methods, must be taken into account now.

The aim. To systematize contemporary concept about the structural and functional organization of the central nervous system (CNS) and the importance of developing the concept of the human connectome. Main concepts. Signifcant progress in understanding the organization of the CNS in normal and in various pathological conditions was achieved after the introduction of structural and functional neuroimaging methods frst into scientifc and then into clinical practice. Recently, when studying the neuropsychiatric sphere, special attention has been paid to neural networks. One of the achievements in this feld is the construction of the human connectome – a system of structural and functional connections between various cerebral areas, the state of which is assessed using multimodal methods of functional neuroimaging. Thus, the development of brain sciences has reached a completely different level – the level of systemic psychoneurology, when the existing processes are analyzed comprehensively, with the involvement of specialists in various felds – neurology, psychiatry, neuroimaging, mathematics, etc. The human connectome is basically a biological system, therefore, although the analogy with artifcial intelligence can be traced, it does not take the frst place. The functioning of the human connectome is based on the principle of parallel, rather than sequential, information processing. Taking into account the inherent ability of the brain (at least, some of its areas) to generate spontaneous non-rhythmic oscillations, this leads to the implementation of the basic principle of the functioning of the CNS – minimizing energy consumption. In addition, the presence of spontaneous non-rhythmic oscillations (the principle of uncertainty) probably underlies the inherent human ability to intuitively think, develop new ideas. The state of the connectome in a rest is determined by past experience, the duration of external influences, and age. It affects the nature and severity of neuroplastic processes, as well as, in particular, the effectiveness of certain pharmacological drugs in a given individual. At the same time, the fnal result of neuroplastic changes may be of a different nature. It can be favorable for the body (the so-called adaptive plasticity), do not affect the body in any way, or even have a negative result (the so-called maladaptive neuroplasticity). In children, such maladaptive manifestations are less pronounced. Currently, hardware methods of influencing the connectome are being actively studied. For example, it was shown that the structure of the connectome in a rest state can change after transcranial magnetic stimulation. Further studies of this problem will open up new opportunities for studying the activity of such a complexly organized system as the brain – in normal and in various pathological conditions – and to develop more effective methods of neurorehabilitation.

The aim. To characterize the main types of neurological manifestations in inflammatory bowel diseases – Crohn’s disease and ulcerative colitis. Main concepts. Neurological disorders represent an important aspect of extraintestinal inflammatory bowel diseases (IBD) manifestations. According to publications, the incidence of psycho-neurological syndromes varies from 0.25% to 47.50% that apparently depends on the patient’s selection in studies. Neurological signs are not always associated with IBD activity and may precede the manifestation of intestinal inflammation. The most typical include cerebral thromboembolism, peripheral and cranial neuropathies, demyelinating disorders, and cerebral vasculitis. The incidence of ischemic stroke in IBD can reach 6.4%, with approx. 20% of affected persons under 17 y.o. Hemiparesis is the predominant consequence. The risk of intracranial venous thrombosis is increased depending on the activity of intestinal inflammation; this complication can precede manifestation of IBD. Fifty per cent increased risk of multiple sclerosis in IBD patients was shown. The types of peripheral nerves involvement include mononeuropathy, plexopathy, multiple mononeuropathy, compression neuropathy, polyneuropathy and cranial neuropathy. Peripheral neuropathy may be found in 32–37% of IBD patients with a special examination. Demyelinating type, sensory axonal polyneuropathy with thin and thick fibers damage, and motor axonal polyneuropathy with thick fibers damage are observed approximately in equal proportions. It is important to differentiate ‘primary’ neuropathy with vitamin B12 and folic acid deficient, alcoholic, diabetic and drug-induced neuropathy. Clinical improvement is usually seen in the course of immunosuppressive therapy. Cranial neuropathy (mostly of II, VI, VII, VIII of cranial nerves) is described in IBD. Neurological disorders associated with administration of metronidazole, sulfasalazine, cyclosporin A, antibodies to TNF-α and integrins α4 and α4ß7 continue to be highly actual. Conclusion. There is a variety of neurologic syndromes in IBD which represents an important part of extraintestinal manifestations. Mild psychoneurological disorders may be not recognized in time. The majority of symptoms and signs may regress in the course of treatment of IBD and nutrients deficiency correction. The special attention should be paid to neurological status control while the biologic and immunosuppressor agents and metronidazole are administered.

The article discusses the pathogenetic and clinical features of tinnitus. It is emphasized that various causes contribute to the appearance of tinnitus, including somatic diseases, excess body weight, iatrogenies, otological diseases with an outcome in hearing loss. The anatomical and physiological features of the structure of the central part of the auditory system are considered. It is suggested that the occurrence of tinnitus is associated with the processes of maladaptive neuroplasticity caused by pathological changes in the neuronal activity of cortical structures of the CNS, and not with changes in the peripheral part of the auditory analyzer - the structures of the cochlea. The results of recent studies, including those using functional neuroimaging methods, indicate the significance of cortical connection disorders (human connectome) in patients with tinnitus. In patients with tinnitus, there are changes in regional neuronal activity and connections not only in the auditory cortex, but also in areas not directly related to the analysis of auditory afferentation. Thus, tinnitus can be considered as one of the variants of dysfunction of the human connectome, triggered primarily from the «auditory input».