Latissimus dorsi tendon transposition combined with shoulder joint proximal capsule plasty with peroneal longus tendon autograft in the treatment of patients with massive rotator cuff ruptures and proximal dislocation of the humerus head (clinical case)

The frequency of rotator cuff injuries in people over 45 years of age is 25.6–50 %, and  40  % of these injuries are massive. Shoulder rotator cuff injury causes disorders in biomechanics of the shoulder joint such as anterior-superior dislocation of the humeral head. Injury of the deltoid muscle combined with a massive rupture of the rotator cuff causes proximal dislocation of the humeral head during any active movement. In  the  treatment of these cases, surgical methods of treatment are used, such as transposition of the latissimus dorsi muscle, proximal capsule plasty, and reverse shoulder arthroplasty. We present a successful clinical case of treatment of a patient with chronic massive injury of the right shoulder joint rotator cuff tendons in combination with the injury of shoulder joint proximal capsule, dislocation of the right humerus head, and hypotrophy of the anterior portion of the deltoid muscle. We performed transposition of the latissimus dorsi tendon in combination with shoulder joint proximal capsule plasty with an autograft of the peroneal longus tendon. The check-up X-rays show that the dislocation of the right shoulder joint was eliminated. In the early postoperative period, the patient started physiotherapy exercises of the operated limb using abduction pillow. By the 7th day after surgery, the abduction of the operated limb reached 70°. The described surgical technique allows to restore congruence in the shoulder joint and the function of the injured limb in severe multiple injuries of the shoulder joint structures

Arthroscopically Assisted Transposition of the Latissimus Dorsi in the Treatment of Patients with Massive Ruptures of the Rotator Cuff (Clinical Observation)

Massive rotator cuff tears present a challenging problem for surgeons. According to various authors, from 10 to 40 % of ruptures are massive and more often affect patients over 60 years of age with low-intensity injuries. There is currently no consensus on the classification of rotator cuff injuries. The use of MRI is the gold standard in diagnostics and surgical tactics. Treatment of patients with severe fatty degeneration, muscular atrophy and retraction of the damaged tendon presents certain difficulties. Reinsertion of the damaged rotator cuff tendon is not possible in such patients. There are many different methods of surgical and conservative treatment. In our opinion, transposition of the latissimus dorsi is the method of choice for young and active patients. With the development of new technologies, transposition of the latissimus dorsi muscle began to be performed  arthroscopically. This article presents a clinical case: a woman with chronic total rupture of the supraspinatus tendon, Patte grade 3 and fatty degeneration of grade 3 by Thomazeau. The patient was also diagnosed with a secondary superior subluxation of the humeral head. The patient underwent surgical treatment: arthroscopic- associated transposition of the latissimus dorsi muscle to the greater tubercle of the humerus. There was a positive trend, an improvement in the functional result occurred already in the early postoperative period.  Considering the above, the method of choice in the treatment of patients with massive ruptures of the rotator cuff tendons can be considered as transposition of the latissimus dorsi muscle, performed by the arthroscopic-associated method

Treatment of Patients with Rotator Cuff Injuries (Review of Literature)

The proportion of injuries to the rotator cuff of the shoulder occupies one of the leading places in the structure of injuries to the musculoskeletal system. The history of the study of this pathology began about five centuries ago and continues to the present day. However, attempts to introduce a generally accepted classification of injuries have not been crowned with success. With the development of scientific and technological progress, many methods of conservative and surgical treatment have appeared. Among the conservative methods of treatment aimed at reducing pain and improving the quality of life, injections of corticosteroids, hyaluronic acid, and autoplasma therapy are used. But, unfortunately, these treatment methods are not aimed at restoring the function of the shoulder joint. Surgical treatments for rotator cuff injuries are varied. This includes both the classic reinsertion of the damaged tendon and arthroscopic treatments. In case of massive ruptures, reconstructive plastic surgery is performed with the transfer of the tendons of the infraspinatus, small round or latissimus dorsi muscle, and autografts or allografts are also used. However, despite the large number of treatment methods, there are no clear algorithms for managing patients with this pathology, and the percentage of unsatisfactory treatment outcomes remains high

Assessment of the effectiveness of surgical treatment of patients with massive ruptures of rotator cuff tendons using latissimus dorsi tendon transposition

Rotator cuff ruptures are the most common injuries of shoulder joint with an incidence of about 20 %. This pathology is more common in adults over 60 years of age because it is caused by degenerative changes in the tendon. Massive injuries account for 10–40 % of all rotator cuff injuries. Currently, there is no unified surgical tactics for the treatment of patients with massive ruptures of rotator cuff tendons.The aim. To assess the efficiency of transposition of the latissimus dorsi tendon in patients with massive ruptures of the rotator cuff tendon.Materials and methods. The study included 15 patients with Patte stage III massive ruptures of the rotator cuff who had transposition of the latissimus dorsi tendon.Results. The article presents clinical cases of surgical treatment of patients. The following criteria were assessed: mean age; time since injury; duration of the surgery; blood loss volume; functional results by the ASES (American Shoulder and Elbow Surgeons) Shoulder Score. Taking into account the ASES Shoulder Score indicators 1 year after the surgical treatment, the following results were obtained: excellent results – in 9 (53.3 %) cases; good results – in 1 (13.4 %) case; satisfactory results – in 5 (33.3 %) cases.Conclusion. When preserving the articular cartilage, the method of choice in the treatment of patients with massive ruptures of rotator cuff tendons is transposition of the latissimus dorsi tendon. At the same time, an incomplete restoration of the function of the injured limb was registered in 33.3 % of patients, which requires further study and modification of the known method of transposition of the latissimus dorsi tendon

Assessment of the effectiveness of surgical treatment of patients with massive tears of the rotator cuff tendons using arthroscopically assisted transposition of the latissimus dorsi tendon

Rotator cuff tears are one of the most common musculoskeletal injuries and account for about 20 %. Massive rotator cuff tears account for up to 40 % of all tears. There  is  no  single approach in the treatment of patients with massive rotator cuff tears. We have developed a new method of surgical treatment of these patients – arthroscopically assisted transposition of the latissimus dorsi tendon using 1/2 of the tendon of the long peroneal muscle. The aim of the study. To assess the effectiveness of surgical treatment of patients with massive rotator cuff tears who had arthroscopically assisted transposition of the latissimus dorsi tendon using an autograft of a 1/2 of the tendon of the long peroneal muscle. Materials and methods. The study included 15  patients with Patte stage  III and Thomazeau grade 2–3 massive rotator cuff tears, who had arthroscopically assisted transposition of the latissimus dorsi tendon using 1/2 of the tendon of the long peroneal muscle. Results. The article presents the long-term results of surgical treatment of patients using the developed method. The following criteria were evaluated: average age; time since injury; duration of surgery. Functional outcome was assessed using the ASES (American Shoulder and Elbow Surgeons) scale. Taking into account the indicators on the ASES functional scale 1 year after surgical treatment, the following results were obtained: excellent – in 14 (93.3 %) patients, satisfactory – in 1 (6.7 %) patient. Conclusion. The developed method allows us to restore the function of the shoulder joint as early as it possible, to reduce the severity of the pain syndrome and to improve the quality of life of patients

Raman Scattering:From Structural Biology to Medical Applications

This is a review of relevant Raman spectroscopy (RS) techniques and their use in structural biology, biophysics, cells, and tissues imaging towards development of various medical diagnostic tools, drug design, and other medical applications. Classical and contemporary structural studies of different water-soluble and membrane proteins, DNA, RNA, and their interactions and behavior in different systems were analyzed in terms of applicability of RS techniques and their complementarity to other corresponding methods. We show that RS is a powerful method that links the fundamental structural biology and its medical applications in cancer, cardiovascular, neurodegenerative, atherosclerotic, and other diseases. In particular, the key roles of RS in modern technologies of structure-based drug design are the detection and imaging of membrane protein microcrystals with the help of coherent anti-Stokes Raman scattering (CARS), which would help to further the development of protein structural crystallography and would result in a number of novel high-resolution structures of membrane proteins—drug targets; and, structural studies of photoactive membrane proteins (rhodopsins, photoreceptors, etc.) for the development of new optogenetic tools. Physical background and biomedical applications of spontaneous, stimulated, resonant, and surface- and tip-enhanced RS are also discussed. All of these techniques have been extensively developed during recent several decades. A number of interesting applications of CARS, resonant, and surface-enhanced Raman spectroscopy methods are also discussed

Safety of modified stair climbing test in the early period of rehabilitation of patients with acute myocardial infarction

Aim: safety evaluation of modified stair climbing test in the physical rehabilitation program for patients with old acute myocardial infarction. Materials and methods. Score of physical rehabilitation indices, its effectiveness and safety, comparison of physical rehabilitation indices of patients with AMI without reperfusion treatment and patients who had reperfusion interventions (bare-metal stents - in 21 persons, fibrinolysis - 1 patient, fibrinolysis and percutaneous coronary intervention - 1 patient) were estimated for 43 patients (6 women and 37 men) with old AMI using modified loading tests (stair climbing test and test with six-minute's walk). Results. HR (heart rate) fell short of submaximum values during modified stair climbing test in patient population. The condition was monitored using continuous ECG monitoring apparatus «Kardiotekhnika-04» (СС «Incart», Saint-Petersburg) None of patients showed ischemic changes of ST-segment. No significant differences were revealed in exercise tolerance between patients with old acute myocardial infarction with Q-wave who experienced stenting and patients with acute myocardial infarction without Q-wave. Results of six-minute's step test after the hospital rehabilitation stage completion show exercise tolerance increasing. Conclusion. Modified stair climbing test conducting for intensification of physical rehabilitation using subjective control was safe in examined patient population. According to six-minute's step test results, the exercise tolerance increased during rehabilitation process

Liquid low-level radioactive wastes treatment by using hydrophobized track-etched membranes

In this paper, we present the results of liquid low-level radioactive wastes (LLLRW) treatment by direct contact membrane distillation (DCMD) using polyethylene terephthalate (PET) track-etched membranes (TeMs). PET TeMs were modified by styrene and triethoxyvinylsilane (TEVS) using UV-induced grafting. Modification led to increase in the contact angle to 99° of PET TeMs (pore size from 150 to 300 nm). Hydrophobic PET TeMs were investigated by X-ray photoelectron spectroscopy (XPS), Fourier-transform infrared spectroscopy (FTIR), goniometric analysis, gas permeability test, liquid entry presser (LEP) analysis and scanning electron microscope (SEM). Prepared membranes were tested in treatment of LLLRW by DCMD. The influence of pore size on water flux and rejection degree was studied. Rejection degree was evaluated by conductometry and atomic emission methods. Decontamination factors (evaluated by gamma-ray spectroscopy) for 60Co, 137Cs, and 241Am were found to be 85, 1900 and 5 respectively. In most cases degree of rejection of Cs, Mo, Sr, Sb, Al, Ca, Fe, K, Mg and Na ions were more than 90% and close to 100%. The use of TeMs with a narrow pores size distribution and without tortuous channels allowed us to achieve better purification from radioactive wastes in comparison with hollow-fiber membranes. © 2019 Elsevier LtdMinistry of Education and Science of the Republic of Kazakhstan: AP05132110This study was funded by the Ministry of Education and Science of the Republic of Kazakhstan (grant No AP05132110 “Preparation of track-etched membranes with specified properties for membrane distillation and forward osmosis”)

Ambiguities and completeness of SAS data analysis: investigations of apoferritin by SAXS/SANS EID and SEC-SAXS methods

The method of small angle scattering (SAS) is widely used in the field of biophysical research of proteins in aqueous solutions. Obtaining low-resolution structure of proteins is still a highly valuable method despite the advances in high-resolution methods such as X-ray diffraction, cryo-EM etc. SAS offers the unique possibility to obtain structural information under conditions close to those of functional assays, i.e. in solution, without different additives, in the mg/mL concentration range. SAS method has a long history, but there are still many uncertainties related to data treatment. We compared 1D SAS profiles of apoferritin obtained by X-ray diffraction (XRD) and SAS methods. It is shown that SAS curves for X-ray diffraction crystallographic structure of apoferritin differ more significantly than it might be expected due to the resolution of the SAS instrument. Extrapolation to infinite dilution (EID) method does not sufficiently exclude dimerization and oligomerization effects and therefore could not guarantee total absence of dimers account in the final SAS curve. In this study, we show that EID SAXS, EID SANS and SEC-SAXS methods give complementary results and when they are used all together, it allows obtaining the most accurate results and high confidence from SAS data analysis of proteins