Vol 20, No 1 (2026)

Introduction. Chemotherapy (CT) with platinum and taxane drugs often leads to chemotherapy-induced peripheral neuropathy (CIPN), which significantly impairs patients’ quality of life. CIPN is diagnosed based on symptoms and neurological examination, which underscores the need for objective biomarkers.

Promising criteria for peripheral nerve damage are neurofilaments, in particular the light chain (NfL) and peripherin. NfL is released during axonal damage but is not specific to the peripheral nervous system. Peripherin, in contrast, is expressed exclusively in peripheral neurons and is considered a more specific marker; however, its detection is challenging.

The aim of the study was to evaluate serum levels of neurofilament and peripherin using the ELISA method in patients with solid tumors undergoing CT.

Materials and methods. The study included 66 patients with newly diagnosed solid tumors before starting CT with platinum or taxanes. Patients with known risk factors for polyneuropathy and those taking medications with neurotoxic effects were excluded. After treatment, 51 patients were examined. Neurological examination with assessment using the NCI-CTCAE and NDS scales, nerve conduction study (SRAR index, amplitude of the sural nerve action potential), and assessment of intraepidermal nerve fiber density were performed. Serum levels of NfL and peripherin were measured using ELISA before and approximately 4.5 months after CT. Preanalytical sample processing was standardized.

Results. After the CT course all patients showed a significant increase in NfL levels (p < 0.0003). The most pronounced increase in the indicator (~fivefold) was recorded in male patients (p < 0.001) and in the group of patients with malignant neoplasms in the gastrointestinal tract (p = 0.001). The concentration of peripherin in all analyzed samples was zero, likely due to the low ELISA sensitivity. In patients with developed CIPN, the NfL level after treatment was significantly higher (p = 0.001); however, no prognostic value for predicting neuropathy was found (AUC = 0.526; p = 0.803). At the same time, a moderate negative correlation was found between the NfL level and the density of intraepidermal nerve fibers (r = –0.416; p = 0.012). No statistically significant association was found between NfL concentration and electrophysiological parameters (SRAR index and sural nerve action potential amplitude).

Conclusion. NfL is a promising but insufficiently specific biomarker for monitoring patients with CIPN. The absence of a detectable level of peripherin by ELISA limits its clinical application and suggests the use of more sensitive analytical methods.

Introduction. Ischemic stroke (IS) in young adults remains an unresolved major medical, social, and demographic issue. In a quarter of cases of acute cerebrovascular events in young age their origin remains unknown (i.e., cryptogenic stroke). Obesity and its associated conditions are considered risk factors contributing to premature cerebro-metabolic disorders. Chronic non-specific inflammation (metabolic inflammation) is regarded as a potential key mechanism for vascular events in obesity, though its role in IS among obese individuals is not fully understood. Studying cytokine levels as primary markers of meta-inflammation will help assess its role in IS in young adults.

The study aimed at evaluating the role of inflammatory mediators, biochemical and hemostatic statuses in young patients with IS of unknown etiology and obesity.

Materials and methods. A prospective study included 66 patients aged 18–50 years with IS of unknown etiology, divided into two groups: subjects with obesity (body mass index (BMI) ≥30 kg/m²; n = 34) and subjects with normal BMI (18.5–24.9 kg/m²; n = 32). Anthropometric, blood chemistry (lipid profile — low-density lipoprotein (LDL) and high-density lipoprotein (HDL) cholesterol, glucose, C-reactive protein, uric acid, homocysteine), hemostatic (factors VIII, IX, von Willebrand factor (vWF), antithrombin III, protein C), and immune (tumor necrosis factor-α (TNF-α), interleukins-6, -8, -10) blood parameters were analyzed.

Results. Significant differences were observed in key markers of chronic nonspecific inflammation among obese patients. Homocysteine levels (p = 0.0001), factors VIII (p = 0.024), IX (p = 0.003) and vWF (p < 0.0001), antithrombin III (p = 0.0041), LDL cholesterol (p = 0.0382), HDL cholesterol (p = 0.0112), and uric acid (p = 0.0011) were significantly higher in obese patients. Sex stratification revealed that obesity significantly influenced triglyceride levels (p = 0.021 in men), LDL cholesterol (p = 0.0177 in men), HDL cholesterol (p = 0.0348 in men), uric acid (p = 0.0348 in men and p = 0.0229 in women), homocysteine (p = 0.0013 in women), vWF (p < 0.0001 in both sexes), factor VIII (p = 0.0091 in men), factor IX (p = 0.0209 in women), and antithrombin III (p = 0.0048 in men). Similar changes were detected in inflammatory markers and proinflammatory cytokines (C-reactive protein, neutrophils, tumor necrosis factor-α, interleukin-8, -10) compared to patients with normal BMI.

Conclusion. Adipose tissue-initiated chronic nonspecific inflammation plays a significant role in the IS of unknown etiology in young adults by initiating and exacerbating endothelial dysfunction, prothrombotic, and atherosclerotic changes.

Introduction. The blood-brain barrier (BBB) is a component of the neurovascular unit and a system regulating chemical homeostasis in brain tissue. Assessment of BBB permeability under normal and abnormal states of the central nervous system is of significant interest for experimental research in neuroscience. In recent years, there has been a substantial expansion of protocols that can be used to address such research tasks. Understanding the key differences, advantages, and limitations of each BBB investigation method is crucial for proper experimental design and data interpretation.

The aim of this review is to analyze modern methods for assessing BBB permeability in laboratory animals using fluorescent probes (tracers), provide their comparative characteristics, and evaluate selection criteria for solving experimental tasks.

Conclusion. Fluorescent probes enable real-time monitoring of BBB status in vivo during experimental neuroscience studies when assessing structural and functional integrity of the barrier in neuroinflammation, neurodegeneration, and brain tissue injury. Proper selection of fluorescent probes allows differentiated evaluation of para- and transcellular BBB permeability, vascular wall structure, and processes associated with brain tissue clearance.

Repetitive transcranial magnetic stimulation (rTMS) has been widely used in clinical practice for therapeutic neuromodulation in a number of nervous system disorders. However, current application of this method is limited primarily by its small effect size and high variability. Among promising research directions for improving rTMS efficacy, novel approaches to target identification hold particular importance. Standard approaches involve selecting relatively large anatomical cortical areas as targets, with coil positioning based on external landmarks or craniometric measurements. However, these methods often fail to target the intended cortical area, or account for individual variations in cortical gyral anatomy and functional area localization. Neuronavigation allows high-precision positioning of the coil on the head surface relative to the cortical target based on structural and functional neuroimaging data. In recent years, approaches to rTMS target identification based on resting-state fMRI data have been particularly intensively developed; analysis of such data enables identification of areas with altered connectivity and localization of neuronal network nodes. This enables personalized determination of rTMS targets. This review discusses the main approaches to rTMS target identification, their methodological features, evidence base, key advantages, and limitations. The role of navigation for determining optimal coil orientation relative to the target cortical area and selecting stimulation intensity is separately addressed.

One of the key reasons for the high incidence of adverse outcomes in gunshot wounds to the head is the multifactorial damaging effect of high-energy projectiles. One complication of gunshot wounds to the neck or head is traumatic arteriovenous fistulas (AVFs). The cases of traumatic intracranial AVFs resulting from gunshot wounds to the head, involving the proximal segments of the internal carotid artery (ICA) or other major cerebral arteries are unique if they are accompanied by a favorable clinical outcome. Russian and foreign literature sources do not provide information on clinical observations of traumatic intracranial extradural AVFs. The article describes a clinical case of a patient with traumatic intracranial extradural carotid-jugular fistula resulting from a gunshot fragment through-and-through craniobasal wound to the head in the left occipital region, with a comminuted fracture of the occipital bone, a through-and-through fracture of the pyramid of the left temporal bone, a perforated fracture of the left greater wing of the sphenoid bone, an exit wound in the soft palate, and the formation of brain contusion foci along the wound channel. Clinically suspected and confirmed by ultrasound and computed tomographic angiographic studies of the brachiocephalic vessels, a traumatic carotid-jugular fistula was identified within the wound tract at the defect of the left temporal bone, combined with ICA occlusionat the C2 (petrous) segment, which did not lead to ischemic stroke on the affected side. Selective cerebral angiography was performed, followed by embolization of the left ICA stump in the cervical segment using detachable microcoils, achieving disconnection of the AVF. This case of traumatic carotid-jugular fistula is unique and demonstrates the possibility of a favorable outcome gunshot wound to the head due to timely diagnosis and endovascular intervention. The expediency of computed tomographic angiography for all patients with combat trauma to the head and neck is justified.