Experience of endoscopic transcapsular axillary nerve decompression: а series of clinical cases

Background: Posttraumatic axillary nerve neuropathy is a widely spread pathology, more often seen after a shoulder joint trauma. It can also appear as a complication after orthopedic surgeries, for example, after the Latarjet procedure for shoulder stabilization. The technique of open axillary nerve decompression is very popular but has a number of disadvantages: a large trauma of soft tissue, severe bleeding, a high rate of complications, and also a poor cosmetic effect. The endoscopic surgical technique of decompression is an effective and less traumatic alternative to open procedures. Clinical case description: We present the results of endoscopic transcapsular axillary nerve decompression in 5 patients with a clinical picture of neuropathic pain syndrome, hypoesthesia in the deltoid area, hypotrophy of the deltoid muscle, who were operated from 2018 to 2021. The mean age of patients was 44.414.9. An original surgical technique of decompression was developed and applied to all the patients which included arthroscopy of the shoulder joint with diagnostic and treatment components and transcapsular endoscopic axillary nerve decompression in the beach-chair position. The statistical analysis was performed using the MannWhitney U test. According to the VAS-scale, the severity of pain syndrome before the surgery was 64.6 points, while 6 months after the surgery it decreased to 1.40.5 points (p 0.05). According to the DASH scale, the function of the shoulder joint before the surgery was 77.66.9 points, and 6 months after surgery it increased to 125.2 points (p 0.05). According to the BMRC scale (M0M5), the strength of the deltoid muscle before the surgery was 20.4 points, and after the surgery it increased to 4.40.5 points (p 0.05). The range of motion in the shoulder joint was as follows: before the surgery flexion 10745.6, extension 10249, external rotation 2213.6; 6 months after the surgery flexion 15425.6, extension 15622.4, external rotation 508 (p 0.05). The thickness of the middle portion of the deltoid muscle according to the US was 7.21.04 mm before the surgery, 11.81.44 mm after the surgery (p 0.05). All the patients (100%) at a long-term follow-up noticed complete relief of pain and regression of the neurological symptoms. Conclusion: The achieved results allow us to characterize the method of endoscopic transcapsular decompression as a reproducible, minimally invasive and highly effective technique, providing pain relief to patients, curing neurological and intraarticular pathology, thus promoting early restoration of the upper limb function in the treated group of patients

Опыт эндоскопического транскапсулярного невролиза подмышечного нерва

INTRODUCTION Posttraumatic axillary nerve neuropathy is a widely spread pathology, more often seen after shoulder joint trauma. It can also occur as a complication after orthopaedic surgeries, for example, after Latarjet procedure for shoulder stabilization. The technique of open axillary nerve decompression is very popular but has a number of disadvantages: large trauma of soft tissue, severe bleeding, high rate of complications, poor cosmetic effect. Endoscopic surgical technique of decompression is an effective, less traumatic alternative to open procedures.AIM To improve the outcomes of treatment of patients with axillary nerve neuropathy.MATERIAL AND METHODS We present the outcomes of endoscopic transcapsular axillary nerve decompression in 5 patients with a clinical picture of neuropathic pain syndrome, hypoesthesia in the deltoid area, hypotrophy of the deltoid muscle, who were operated from 2018 to 2021. The mean age of the patients was 44.4±14.9. An original surgical technique of decompression, which included arthroscopy of the shoulder joint with diagnostic and treatment components and transcapsular endoscopic axillary nerve decompression in the beach-chair position, was developed and applied to all the patients. Statistical analysis was performed using the MannWhitney U test.RESULTS According to VAS-scale, the severity of pain syndrome before the surgery was 6±4.6 points, 6 months after surgery it decreased to 1.4±0.5 points (p<0.05). According to DASH scale, the function of the of shoulder joint before surgery was 77,6±6,9 points, 6 months after surgery it increased to 12±5,2 points (p<0.05). According to BMRC scale (M0–M5), strength of the deltoid muscle before surgery was 2±0,4 points, after surgery it increased to 4,4±0,5 points (p<0.05). Range of motion in the shoulder joint before surgery was as follows: flexion 107±45,6°, extension 102±49°, external rotation 22±13,6°; 6 months after surgery: flexion 154±25,6°, extension 156±22,4°, external rotation 50±8° (p<0,05). The thickness of the middle portion of the deltoid muscle according to ultrasound examination before the surgery was 7.2±1.04 mm, after surgery 11.8±1.44 mm (p<0.05). All the patients (100%) during long follow-up noticed complete relief of pain and regression of neurological symptoms.CONCLUSION The achieved results allow us to characterize the method of endoscopic transcapsular decompression as a reproducible, minimally invasive and highly effective technique providing pain relief to patients, curing neurological and intraarticular pathology, thus promoting early restoration of the upper limb function in the treated group of patients.АКТУАЛЬНОСТЬ Посттравматическая нейропатия подмышечного нерва является достаточно распространенной патологией при травмах области плечевого сустава. Стандартным вмешательством в таких случаях является открытый невролиз подмышечного нерва, который в силу анатомического расположения нервного ствола травматичен, сопровождается относительно высокой частотой осложнений, обладает плохим косметическим эффектом. Малоинвазивной альтернативой открытому невролизу является эндоскопическая хирургическая техника.ЦЕЛЬ Улучшить результаты лечения пациентов с посттравматической нейропатией подмышечного нерва.МАТЕРИАЛ И МЕТОДЫ За период с 2018 по 2021 год нами были прооперированы 5 пациентов с клинической картиной посттравматической нейропатии подмышечного нерва. Всем больным была выполнена артроскопия плечевого сустава с диагностическим и лечебным компонентами, транскапсулярный эндоскопический невролиз подмышечного нерва по оригинальной методике. Статистическое сравнение параметров проводилось согласно критерию Манна–Уитни.РЕЗУЛЬТАТЫ Средний возраст пациентов составил 44,4±14,9 года. По шкале ВАШ интенсивность болевого синдрома до операции составила 7±1 балл, через 6 месяцев после операции боль уменьшилась и составила в среднем 1±0,4 балла (p<0,05). По шкале DASH функция плечевого сустава до операции была 77,6±6,9 балла, через 6 месяцев после операции составила 12±5,2 балла (p<0,05). По шкале BMRC (M0–M5) сила дельтовидной мышцы до операции составляла 2±0,4 балла, а после операции увеличилась до 4,6±0,5 балла (p<0,05). Амплитуда движений в плечевом суставе до операции: сгибание 107±45,6°, отведение 102±49°, наружная ротация 22±13,6°, через 6 месяцев после операции возросла до: сгибание 154±25,6°, отведение 156±22,4°, наружная ротация 50±8° (p<0,05). Толщина среднего пучка дельтовидной мышцы, по данным ультразвукового исследования, до операции составила в среднем 7±0,8 мм, через 6 месяцев после операции 10,6±1,1 мм (p<0,05).ЗАКЛЮЧЕНИЕ Полученные результаты позволяют охарактеризовать методику эндоскопического невролиза как воспроизводимую, малотравматичную и эффективную, которая позволяет уменьшить интенсивность болевого синдрома и способствует раннему восстановлению функции верхней конечности

Broad-band dielectric spectroscopy of Ba

Barium sodium niobate (BNN) single crystals are studied by IR spectroscopy, time-domain THz transmission spectroscopy, HF coaxial wave-guide technique and LF dielectric spectroscopy to cover the frequency range 102–1014 Hz in a wide temperature interval. The dielectric response parallel and perpendicular to the polar c-axis is discussed. The ferroelectric transition at $T_{\rm c}=830$ K is driven by a relaxational soft mode coupled with another central-mode type relaxation which both gradually disappear on cooling in the ferroelectric phase. Below Ti the parameters of the expected IR active amplitudon were estimated. The low-temperature permittivity increase on cooling for the ${\vec E}\bot {\vec c}$ field direction has been explained by an incipient proper ferroelectric-ferroelastic transition driven by an IR and Raman active B2-symmetry soft mode

Model of reliability of product of radioelectronic equipment at the stage of extension of the appointed terms of service (resource)

Рассматривается модель надежности изделия радиоэлектронной техники с минимальным восстановлением безотказности и ремонтопригодности, которую предлагается использовать при решении задач продления назначенных сроков службы (ресурсов).Розглядається модель надійності виробу радіоелектронної техніки з мінімальним відновленням безвідмовності і ремонтопридатності, що пропонується використовувати при рішенні задач продовження призначених термінів служби (ресурсів).The model of reliability of a product of radio-electronic technics with the minimal restoration of non-failure operation and maintainability which is offered to be used at the decision of problems of prolongation of the appointed service life (resources) is considered

Topographic anatomy of the brachial plexus and possibilities with endoscopic approach (cadaveric study)

Relevance The brachial plexus is a complex anatomical structure the passes through three narrow anatomical spaces including the interscalene space, the space between the first rib and the clavicle (thoracic aperture), the space between the anterior chest wall and the pectoralis minor muscle. Compression of the brachial plexus and the vascular band can occur at the sites. Endoscopic approach to the brachial plexus is a promising surgical trend to allow neurolysis and decompression of the plexus with minimal trauma and blood loss and a good cosmetic result. The purpose was to explore topographic anatomy of the brachial plexus and surrounding structures and determine the possibility of endoscopic approach to the brachial plexus. Material and methods The shoulder and neck were dissected in 5 fresh cadavers. The study was performed at Trauma and Orthopaedics department of the Russian Peoples Friendship University and Department of pathological anatomy at the Buyanov’s Moscow State City Hospital between 2021 and 2022. Results The pectoralis minor muscle was detached from the coracoid process to endoscopically approach to the subclavian part of plexus. The lateral aspect of the subclavian muscle was detached from the clavicle to endoscopically approach to the thoracic aperture. Portals were produced at the supraclavicular fossa to endoscopically approach to the supraclavicular part of the plexus in the interscalene space considering the topographic anatomy of the jugularis external vein and accessory veins. The mean distance from the coracoid tip to the penetration point of the musculo-cutaneous nerve to the conjoint tendon was 3 cm. The mean distance between the anterior chest wall and the clavicle (width of thoracic aperture) was 1.86 cm. The mean distance between the sternal end of the clavicle to the point of passage of the subclavian artery under the clavicle was 5.7 cm. The mean width of the interscalene space was 1.4 cm. Discussion Aspects of topographic anatomy of the brachial plexus were examined in cadaveric studies of Sidorovich R.R. (2011), Chembrovich V.V. (2019), Anokhina Z.A. (2021), but endoscopic approach to the brachial plexus and possibility with endoscopic surgery were not discussed in the studies. Foreign cadaveric studies of Akaslan I. (2021), Koyyalamudi V. (2021), Costabeber I. (2010), Akboru (2010) were performed to examine topographic anatomy of the brachial plexus. The only study reporting the possibility of endoscopic approach to the brachial plexus and endoscopic anatomy was performed by Lafosse T. (2015). Our cadaveric series reported the possibility of endoscopic approach to the brachial plexus at the three levels for the first time in Russian literature. Conclusion Topographic anatomy of the supraclavicular and infraclavicular portions of the brachial plexus was examined in our series. The study showed the possibility of endoscopic approach to the brachial plexus at the interscalene space, thoracic aperture and subclavian area

Cultivation of Solanum lycopersicum under Glass Coated with Nanosized Upconversion Luminophore

The effect of upconverting luminescent nanoparticles coated on glass on the productivity of Solanum lycopersicum was studied. The cultivation of tomatoes under photoconversion glass led to an increase in plant productivity and an acceleration of plant adaptation to ultraviolet radiation. An increase in the total leaf area and chlorophyll content in the leaves was revealed in plants growing under the photoconversion glass. Plants growing under the photoconversion glass were able to more effectively utilize the absorbed light energy. The results of this study suggest that the spectral changes induced by photoconversion glass can accelerate the adaptation of plants to the appearance of ultraviolet radiation

Plant Photochemistry under Glass Coated with Upconversion Luminescent Film

It has been shown that the cultivation of plants under glass coated with nano-sized upconversion luminophores led to an increase in plant productivity and the acceleration of plant adaptation to ultraviolet radiation. In the present work, we examined the effect of upconversion nanopowders with the nominal composition Sr0.955Yb0.020Er0.025F2.045 on plant (Solanum lycopersicum) photochemistry. The composition, structure and size of nanoparticles were tested using X-ray pattern diffraction, scanning electron microscopy, and dynamic light scattering. Nanoparticles are capable of converting infrared radiation into red and green photons. Glasses coated with upconversion luminophores increase the intensity of photosynthetically active radiation and absorb the ultraviolet and far-red radiation. The chlorophyll a fluorescence method showed that plants growing under photoconversion and those growing under common film demonstrate different ability to utilize excitation energy via photosynthesis. It was shown that under ultraviolet and high light conditions, the efficiency of the photochemical reactions, the non-photochemical fluorescence quenching, and the electron transport remained relatively stable in plants growing under photoconversion film in contrast to plants growing under common film. Thus, cultivation of Solanum lycopersicum under photoconversion glasses led to the acceleration in plant growth due to greater efficiency of plant photochemistry under stress conditions

Plant Photochemistry under Glass Coated with Upconversion Luminescent Film

It has been shown that the cultivation of plants under glass coated with nano-sized upconversion luminophores led to an increase in plant productivity and the acceleration of plant adaptation to ultraviolet radiation. In the present work, we examined the effect of upconversion nanopowders with the nominal composition Sr0.955Yb0.020Er0.025F2.045 on plant (Solanum lycopersicum) photochemistry. The composition, structure and size of nanoparticles were tested using X-ray pattern diffraction, scanning electron microscopy, and dynamic light scattering. Nanoparticles are capable of converting infrared radiation into red and green photons. Glasses coated with upconversion luminophores increase the intensity of photosynthetically active radiation and absorb the ultraviolet and far-red radiation. The chlorophyll a fluorescence method showed that plants growing under photoconversion and those growing under common film demonstrate different ability to utilize excitation energy via photosynthesis. It was shown that under ultraviolet and high light conditions, the efficiency of the photochemical reactions, the non-photochemical fluorescence quenching, and the electron transport remained relatively stable in plants growing under photoconversion film in contrast to plants growing under common film. Thus, cultivation of Solanum lycopersicum under photoconversion glasses led to the acceleration in plant growth due to greater efficiency of plant photochemistry under stress conditions