Voice rehabilitation after surgery for oral and oropharyngeal cancer

The purpose of our study was to improve the quality of life of patients after surgery for oral and oropharyngeal cancer.Material and methods. Voice rehabilitation outcomes in 50 patients with stage II-III oral and oropharyngeal cancer were studied. All patients underwent resection of V> of the tongue. The patients were aged between 33 and 70 years, 70 % of them were up to 60 years. All patients received combined modality treatment and postoperative voice rehabilitation in Cancer Research Institute of Tomsk National Research Medical Center of RAS. The technique of voice rehabilitation included breathing exercises, articulation gymnastics for the muscles of the cheeks, lips, tongue, lower jaw and correc of disturbances in sound pronunciation. A speech function was assessed before and after rehabilitation using speech material that contained a text with semantic load, individual words, syllables and a meaningless set of sounds.Results and discussion. In the postoperative period, all patients experienced a sharp restriction of the mobility of the stump of the tongue, very low speech intelligibility, violation of the pronunciation of sounds, complete or partial absence of intonation pattern, and slowdown in the rate of speech. Postoperative voice rehabilitation aimed at increasing the mobility of tongue stump and correcting sound pronunciation made it possible to improve speech function in the period from 5 to 30 days (median 22.1) by restoring the pronunciation of the velar sounds [K, G] in 78-94 % of cases, alveolar sounds [T, D] in 74-80    I [C] in 56 % of cases. Based on the study, the authors conclude that speech rehabilitation is required for all patients, who underwent surgery for oral and oropharyngeal cancer, taking into account the extent of surgery and individual characteristics of the patients

ВОЗМОЖНОСТИ РЕЧЕВОЙ РЕАБИЛИТАЦИИ БОЛЬНЫХ РАКОМ ПОЛОСТИ РТА И РОТОГЛОТКИ ПОСЛЕ РЕКОНСТРУКТИВНО-ПЛАСТИЧЕСКИХ ОПЕРАЦИЙ

Oral cavity and oropharyngeal cancers usually require extensive surgeries accompanied by damages to anatomical structures and impaired speech function. The use of reconstructive-plastic techniques to replace defects after surgical resection allows the creation of a favorable functional basis for speech restoration.The purpose of the study was to compare the effectiveness and terms of speech restoration in patients with oral cavity and oropharyngeal cancers after surgical treatment using various reconstructive surgery techniques to restore postoperative defects.Material and Methods. Speech rehabilitation results were analyzed in 56 patients with stage II–IV oral cavity and oropharyngeal cancers. The age of the patients ranged from 26 to 70 years. The patients underwent either hemiglossectomy or glossectomy followed by reconstructive surgery. Postoperative speech rehabilitation was performed according to the technique developed in the Department of Head and Neck Tumors of the Cancer Research Institute. Speech function was assessed before starting treatment, at the beginning of treatment and after completion of speech rehabilitation.Results. After surgery, all patients demonstrated impaired speech function, ranging from distorted pronunciation to the complete absence of verbal communication for 5 (71.4%) and 4 (80%) patients from Ib and IIb respectively. Speech rehabilitation started 16 to 32 days after surgery. Restoration of the activity and coordination of the articulatory apparatus muscles, speech exhalation and reconstructed tongue was followed by a sound pronunciation. Postoperative speech rehabilitation allowed improvement of speech function in 100 % of cases (56 patients). A complete speech restoration was achieved for 7 patients (12.5%). The majority of these patients were from the group with hemiglossectomy. In the group of patients with glossectomy, the amplitude and coordination of movements, which could be achieved by performing articulation exercises for the reconstructed tongue, depended on the size of the remaining part of their own tissues.Conclusion. Good values of all studied parameters were observed in patients, who underwent hemiglossectomy followed by reconstruction with a free revascularized flap. No statistically significant differences between the studied parameters were found in patients, who underwent glossectomy. Speech restoration parameters were significantly better in the group of patients with hemiglossectomy and reconstruction with a free revascularized flap than in the group of patients with glossectomy). При оперативных вмешательствах по поводу злокачественных новообразований полости рта и ротоглотки удаляются значительные объемы тканей, что сопровождается нарушением речевой функции. Применение реконструктивно-пластических методик для замещения возникших анатомических дефектов позволяет создать функциональную основу для восстановления речи.Цель исследования – сравнить эффективность и сроки восстановления речевой функции больных раком полости рта и ротоглотки после хирургического лечения с применением различных методик реконструктивно-пластических операций возмещения послеоперационных дефектов полости рта и ротоглотки.Материал и методы. Проанализированы результаты речевой реабилитации 56 больных раком органов полости рта и ротоглотки II–IV стадии в возрасте от 26 до 70 лет, которым выполнено хирургическое вмешательство в объеме гемиглоссэктомии или глоссэктомии с реконструктивно-пластическим компонентом на этапе комбинированного лечения. Реабилитационные мероприятия выполнялись по методике, разработанной в отделении опухолей головы и шеи НИИ онкологии Томского НИМЦ. Состояние речевой функции оценивалось до начала комбинированного лечения, до и после завершения речевой реабилитации.Результаты. После хирургического этапа комбинированного лечения у всех обследованных больных отмечаются нарушения речевой функции, их степень варьировала от искажения произносительной стороны речи до полного отсутствия речевого общения – у 5 (71,4) % и 4 (80 %) пациентов после глоссэктомии. Речевая реабилитация начиналась на 16–32-е сут после операции. На первых этапах целью упражнений являлось восстановление активности и координации работы мышц артикуляционного аппарата, речевого выдоха и реконструированного языка, далее приступали к коррекции звукопроизношения. Послеоперационная речевая реабилитация позволила улучшить состояние речевой функции в 100 % случаев (56 больных). Добиться полного восстановления речи удалось у 7 пациентов (12,5%), чаще всего в группе больных после гемиглоссэктомии с реконструкцией свободным реваскуляризированным лоскутом. В группах больных после глоссэктомии амплитуда и координация движений, которых можно достичь с помощью выполнения артикуляционных упражнений для реконструированного языка, зависят от величины оставшейся части собственных тканей.Заключение. Лучшие показатели по всем исследуемым параметрам были получены в группе больных после гемиглоссэктомии с реконструкцией свободным реваскуляризированным лоскутом. В группах больных после глоссэктомии исследуемые показатели не имели статистически значимых отличий.

Многоуровневые инъекции ботулинического токсина типа А (Абоботулотоксина) при лечении спастических форм детского церебрального паралича: ретроспективное исследование опыта 8 российских центров

Background: The contemporary application of Botulinum toxin A (BTA) in cerebral palsy (CP) implies multilevel injections both in on-label and off-label muscles. However, there is no single international opinion on the effective and safe dosages, target muscles, and intervals between the injections.Objective: Our aim was to analyze the Russian multicenter independent experience of single and repeated multilevel injections of Abobotulinum toxin А in patients with spastic forms of CP.Methods: 8 independent referral CP-centers (10 hospitals) in different regions of Russia. Authors evaluated intervals between the injections, dosages of the BTA for the whole procedure, for the body mass, for the each muscle, and functional segment of the extremities.Results: 1872 protocols of effective BTA injections (1–14 repeated injections) for 724 patients with spastic CP were included. The age of the patients was between 8 months to 17 years 4 months at the beginning of the treatment (with a mean of 3 years 10 months). Multilevel BTA injections were indicated for the majority (n = 634, 87.6%) of the patients in all the centers. The medians of the dosages for the first BTA injection were between 30–31 U/kg (500 U), the repeated injections doses up to 45 U/kg (1000 U) (in most centers). The median intervals between the repeated injections were 180–200 days in 484 (66.9%) patients and 140–180 days in 157 (24.7%) patients. In 2 centers, children with GMFCS IV–V were injected more often than others.Conclusion: Multilevel BTA injections were indicated for the most patients. The initial dose of Abobotulinum toxin A was 30–31 U/kg. The repeated injections dose could increase up to 40 U/kg. The repeated injections were done in 140–200 days after the previous injection.Современная концепция ботулинотерапии при детском церебральном параличе (ДЦП) предлагает использование многоуровневых инъекций в расширенное число мышц. Однако по-прежнему отсутствует консенсус относительно выбора оптимальных доз, мышц и интервалов между инъекциями.Цель исследования: изучить российский опыт применения однократных и повторных многоуровневых инъекций абоботулотоксина при лечении спастичности у пациентов с ДЦП.Методы: в ретроспективном исследовании проанализирован опыт ботулинотерапии при ДЦПв 8 специализированных центрах России. Изучали протоколы клинически эффективных инъекций. Оценивали общие дозы препарата БТА, дозы на единицу массы тела пациентов, на всю инъекционную сессию и отдельные мышцы, а также интервалы между инъекциями.Результаты: изучено 1872 протокола клинически эффективных инъекций, всего от 1 до 14 повторных инъекций, сделанных 724 пациентам в возрасте от 8 мес до 17 лет 4 мес (медиана возраста на момент первой инъекции БТА — 3 года 10 мес) на момент начала ботулинотерапии. Большинство пациентов (n = 634; 87,6% инъекций) получили многоуровневую ботулинотерапию. Во всех центрах при первичных инъекциях БТА медиана доз находилась в пределах 30–31 Ед/кг массы тела (общая — 500 Ед). При повторных инъекциях в большинстве учреждений максимальные дозы превышали 45 Ед/кг (1000 Ед). Средние интервалы между повторными инъекциями колебались в пределах 140–180 сут для 157 (24,7%) и 180–200 сут для 484 (66,9%) пациентов. В 2 из 8 центров пациенты с наиболее выраженными двигательными нарушениями (GMFCS IV–V) требовали более частых повторных инъекций БТА.Заключение: в специализированных центрах большинству пациентов с ДЦП ботулинотерапию проводили по многоуровневой схеме. Общая доза абоботулотоксина при первичных инъекциях составляла 30–31 Ед/кг; при повторных инъекциях она могла быть увеличена до 40 Ед/кг и более. Вопрос о повторном проведении инъекции БТА рассматривался в интервале 140–200 сут после предшествующей инъекции

Following the Results of Research and Practice Session «Theory and Practice of Educational Activity: Tradition and Innovation» to Mark the 85th Anniversary of the Birth of V.V. Davydov.

Research and Practice Session «Theory and Practice of Educational Activity: Tradition and Innovation» was held September 24, 2015 at the Psychological Institute of Russian Academy of Education in Moscow. The event was held in the form of discourse seminar as part of the research Master's program «Culturalhistorical psychology and activity approach to education». Research Master's program is being tested as part of the project "Development and testing of new modules of the basic educational Master's programs in «Education and Pedagogy» enlarged group of disciplines (major focused on Psycho-pedagogical education), involving an increase of research and practice for students in networking with educational institutions of various levels». The program is implemented in the Moscow State University of Psychology & Education and seven other leading pedagogical universities of the Russian Federation. B.D. Elkonin and V.V. Rubtsov held a discussion. The participants were V.A.Bolotov, I.D.Frumin, V.S.Sobkin, V.T.Kudryavtsev, V.S.Lazarev, V.I.Panov, V.Vasilev, E.V.Chudinova, G.A.Tsukerman, N.Yu.Krasavina. After the discussion, we interviewed the participants, who told us about V.V. Davydov. The discussion was supported by the international scientific journal "Cultural-historical psychology.

Evaluation of the biodistribution of mesenchymal stem cells in a preclinical renal tuberculosis model by nonlinear magnetic response measurements.

Bone-marrow derived mesenchymal stem cells (MSCs) exert anti-tuberculosis effects due to their potential to repair damaged tissues and modulate inflammatory immune responses. MSCs were reported to be recruited to the Mycobacterium tuberculosis (Mtb) affected sites in the organism. However, due to limitations of presently applied in vivo imaging techniques the trafficking and biodistribution of MSCs in Mtb-infected organisms is not possible. In the current study MSCs were labeled with superparamagnetic iron oxide nanoparticles (SPIONs) as a negative MR contrast agent for imaging the biodistribution of MSCs in vivo. Trafficking of SPIONs-labeled MSCs was analyzed in a preclinical model of renal tuberculosis in male Chinchilla rabbits (n = 18) following intravenous administration on the days 0, 2, 3, and 7 employing a highly sensitive method of non-linear longitudinal magnetic response (NLR-M-2) measurements. Within 48 h after injection, nanoparticle-labeled MSCs accumulated predominantly in lung, spleen, liver tissues, and paratracheal lymph nodes with subsequent decrease over the observation period of 7 days. The recruitment of MSCs to Mtb-affected organs was further proven by immunohistological analysis. NLR-M-2 allowed the detection of SPIONs-labeled cells at low concentrations in different organs and tissues giving insights of in vivo mesenchymal stem cells trafficking in organism after TB infection

Multilevel Botulinum Toxin A (Abobotulinum Toxin A) Injections in Spastic Forms of Cerebral Palsy: Retrospective Analysis of 8 Russian Centers Experience

Background: The contemporary application of Botulinum toxin A (BTA) in cerebral palsy (CP) implies multilevel injections both in on-label and off-label muscles. However, there is no single international opinion on the effective and safe dosages, target muscles, and intervals between the injections.Objective: Our aim was to analyze the Russian multicenter independent experience of single and repeated multilevel injections of Abobotulinum toxin А in patients with spastic forms of CP.Methods: 8 independent referral CP-centers (10 hospitals) in different regions of Russia. Authors evaluated intervals between the injections, dosages of the BTA for the whole procedure, for the body mass, for the each muscle, and functional segment of the extremities.Results: 1872 protocols of effective BTA injections (1–14 repeated injections) for 724 patients with spastic CP were included. The age of the patients was between 8 months to 17 years 4 months at the beginning of the treatment (with a mean of 3 years 10 months). Multilevel BTA injections were indicated for the majority (n = 634, 87.6%) of the patients in all the centers. The medians of the dosages for the first BTA injection were between 30–31 U/kg (500 U), the repeated injections doses up to 45 U/kg (1000 U) (in most centers). The median intervals between the repeated injections were 180–200 days in 484 (66.9%) patients and 140–180 days in 157 (24.7%) patients. In 2 centers, children with GMFCS IV–V were injected more often than others.Conclusion: Multilevel BTA injections were indicated for the most patients. The initial dose of Abobotulinum toxin A was 30–31 U/kg. The repeated injections dose could increase up to 40 U/kg. The repeated injections were done in 140–200 days after the previous injection

Efficacy and safety of the Russian protease inhibitor narlaprevir at treatment-naive and earlier treated noncirrhotic patients with the 1st genotype chronic hepatitis C (PIONEER study)

Aim of investigation. To estimate efficacy and safety of narlaprevir (NVR) with ritonavir (RTV), pegilated interferon (peg-IFN) and ribavirin (RBV) at treatmentnaïve and earlier treated noncirrhotic patients with chronic hepatitis C caused by the 1st virus genotype in double blind placebo-controlled 3rd phase study (PIONEER). Material and methods. The main group received NVR (200 mg od orally) in combination to RTV (100 mg) and pegIFN/RBV for 12 weeks that was followed by peg-IFN/ RBV for 12 weeks. Comparison group received pegIFN/ RBV for 48 weeks, for the first 12 weeks in combination to placebo. Results. The sustained virologic response in 24 weeks after treatment termination (SVR24) in the main group (NVR/RTV, PEG IFN/RBV)) was achieved in 89.1% (163/183) of treatment-naïve and 69.7% (69/99) of earlier treated patients. SVR24 was achieved in 86.5% (32/37) of patients with relapse after previous peg-IFN/ RBV treatment course. The viral load decreased for the mean of 5.3 log10 in 2 weeks and 5.9 log10 in 4 weeks of treatment in the main group vs 1.5 log10 in 2 weeks and 2.5 log10 in 4 weeks in comparison group. In treatment-naïve patients from the main group SVR24 was achieved in 90.8% at initial METAVIR F0-F2 liver fibrosis stage and in 75% at F3 liver fibrosis stage. In those who were previously treated by peg-IFN/RBV, in the main group SVR-24 was attained in 72.6% at liver fibrosis stage F0-F2 and in 53.3% with F3 liver fibrosis stage. NVR/RTV addition to peg-IFN/RBV treatment did not alter safety profile as compared to peg-IFN/RBV therapy. Conclusions. In PIONEER study the narlaprevir combination therapy was characterized by high efficacy, convenience of administration and favorable safety profile