The Effectiveness of Laser Vaporization in the Treatment of Intervertebral Hernias of the Lumbar Spine

The purpose of the study: assessment of the use of laser vaporization of the disc with hernial protrusion on the lumbar spine and its effectiveness in the treatment of pain.Material and methods. We analyzed the effectiveness laser vaporization in 230 patients with degenerative-dystrophic diseases of the lumbar spine (protrusions and hernias of the intervertebral discs) treated in the neurosurgical department of the Irkutsk Scientific Centre of Surgery and Traumatology for the period from 2011 to 2018. There were 122 men and 108 women. The average age of the patients was 41 years. The duration of the disease before surgical treatment is 11 ± 3 weeks. Clinical and neurological examination revealed lumbalgia in 102 patients (44.3 %), lumbar ischalgia in 98 (42.6 %) and radiculopathy in 30 patients (13.1 %). Median hernias of the intervertebral discs were revealed in 130 patients (56.4 %), lateral hernias - in 41 (17.8 %) and protrusions - 59 (23.8 %). The leading localization of the pathological process was the LIV-LV segment (138 patients, 60 %). Assessment of the effectiveness of surgical treatment was carried out using VAS and Macnab scales.Results. In 100 % of cases were laser vaporization was applied a decrease in the intensity of the pain syndrome was achieved in terms of up to 3 months. The analysis of the long-term results of this treatment in 124 patients from 3 months to 3 years by Macnab scale revealed excellent results in 25 (20.1 %) patients, good results - in 50 (40.3 %), satisfactory - in 42 (33.8 %), and unsatisfactory results - in 7 (5.6 %) cases.Conclusion. Thus, laser vaporization of hernias of the intervertebral disc is effective in the treatment of pain, which does not stop with conservative treatment for 4-6 weeks; with a hernia of up to 6 mm; with a median localization and with no signs of sequestration

Surgical Treatment of Stenosis of Spinal Canal and Dural Sac at the Craniovertebral Junction

The paper presents the results of surgical treatment of 12 patients with stenosing processes of the vertebral canal at the craniovertebral transition due to chronic, unstable type 2 injuries of the C odontoid process (classification of fractures of odontoid process proposed in 1974 by Anderson and D’Alonzo). Patient examination included clinical-neurologic examination, review spondylograms of the cervical spine in 2 projections, MSCT, MRI. All patients were admitted to the clinic with external fixators (cervical support collar or Philadelphia collar). In the preoperative period, all patients were divided into 2 groups according to indications and contraindications for the application of the HALO-device. The first group consisted of 7 people, with cervical spine still fixed with the cervical support collar or Philadelphia collar, and the second group consisted of 5 patients with CII fracture fixed and corrected in the preoperative period by the HALO-device. All patients underwent surgical intervention – posterior approach decompression of the spinal canal and dural sack in the craniovertebral passage by CI laminectomy, partial resection of the posterior margin of the occipital aperture followed by the implementation of atlanto-axial occipitospondylodesis (a clamp with shape-memory effect for posterior occipitospondylodesis, OOO “MITS SPF”, Novokuznetsk, Russia). A comparative analysis of the results of surgical treatment of posttraumatic stenoses of the vertebral canal with and without the use of the HALO-traction device was performed. The results was better in the second group, which makes it possible to consider the second variant of surgical treatment more pathogenetically justified. Thus, HALO-traction restors anatomo-topographic relationships in the craniovertebral zone creating hard external fixation, helping to avoid intraoperative complications

Secretory phospholipase A2: a biomarker of inflammation in autoimmune, bacterial and viral diseases

Secretory phospholipases A2 (sPLA2) represent a large superfamily of enzymes with a molecular weight of 14-19 kDa, including 15 groups and more than 30 isoforms belonging to four types: secretory (sPLA2), cytosolic (cPLA2), calcium-independent (iPLA2) and lipoprotein-associated phospholipase A2 (LP-PLA2, PAF-AH). Eleven species of secretory sPLA2s (IB, IIA, IIC, IID, IIE, IIF, III, V, X, XIIA, and XIIB) have been found in mammals, performing versatile functions and participating in the pathogenesis of a wide range of diseases. On the one hand, sPLA2 may promote elimination of damaged, apoptotic cells by hydrolyzing membrane phospholipids, and exerts a strong bactericidal and antiviral properties, including pronounced effects against antibiotic-resistant strains of microorganisms. In this regard, the use of sPLA2 may represent a new strategy for the treatment of bacterial and viral infections. Moreover, due to the action of sPLA2 on its substrates, a number of biologically active molecules (arachidonic, lysophosphatidic acids, lysophospholipids, fatty acids, prostaglandins, leukotrienes, thromboxanes) are formed, which provide strong inflammatory, detergent, coagulating effects and increase vascular permeability. This pro-inflammatory role of sPLA2 may explain its increase levels and activity in cardiovascular, respiratory, autoimmune, metabolic, oncological, bacterial and viral disorders. The review article presents a classification of sPLA2 isoforms, their substrates, regulatory factors, biological significance, and mechanisms of their strong bactericidal, virucidal, and pro-inflammatory activity in the heart and lung disorders, autoimmune, metabolic, bacterial, and viral diseases. In particular, the mechanisms of the selective action of sPLA2 against Gram-positive and Gram-negative microorganisms are discussed. We consider diagnostic and prognostic significance, correlations between elevated levels and activity of sPLA2 and distinct clinical symptoms, severity and outcome in the patients with coronary heart disease (CAD), acute myocardial infarction (AMI), atherosclerosis, acute inflammatory lung injury (ALI), respiratory distress syndrome (ARDS), chronic obstructive pulmonary disease (COPD), rheumatoid arthritis, bronchial asthma, bacterial infections, septicemia and viral (COVID-19) infections. The opportunity of using sPLA2 as a biomarker of the severity and outcome of patients with chronic obstructive pulmonary disease, bacterial infections, sepsis and viral infections, including COVID-19, is also considered

Analytical “Bake-Off” of Whole Genome Sequencing Quality for the Genome Russia Project Using a Small Cohort for Autoimmune Hepatitis

A comparative analysis of whole genome sequencing (WGS) and genotype calling was initiated for ten human genome samples sequenced by St. Petersburg State University Peterhof Sequencing Center and by three commercial sequencing centers outside of Russia. The sequence quality, efficiency of DNA variant and genotype calling were compared with each other and with DNA microarrays for each of ten study subjects. We assessed calling of SNPs, indels, copy number variation, and the speed of WGS throughput promised. Twenty separate QC analyses showed high similarities among the sequence quality and called genotypes. The ten genomes tested by the centers included eight American patients afflicted with autoimmune hepatitis (AIH), plus one case’s unaffected parents, in a prelude to discovering genetic influences in this rare disease of unknown etiology. The detailed internal replication and parallel analyses allowed the observation of two of eight AIH cases carrying a rare allele genotype for a previously described AIH-associated gene (FTCD), plus multiple occurrences of known HLA-DRB1 alleles associated with AIH (HLA-DRB1-03:01:01, 13:01:01 and 7:01:01). We also list putative SNVs in other genes as suggestive in AIH influence

Diagnostic and Treatment Errors in Biliary Cystadenomas and Cystadenocarcinomas: Clinical Cases

Background. Biliary cystadenomas and cystadenocarcinomas are rare cystic tumors of the liver. Complicated differential diagnostics for simple cysts often leads to errors in surveillance of patients with these tumors. Cystadenoma and cystadenocarcinoma should be suspected upon detection of single or multilocular cystic neoplasms of the liver with septa and blood flow loci  in the cyst wall, especially in middle-aged women. The localization of the tumor is critical. The most common localization is segment IV of the liver. Urgent intraoperative biopsy is required to determine the extent of surgery.Case description. Clinical observations with analysis of the examination and treatment data of two female patients aged 38 and 56 were presented. Both clinical observations illustrate the underestimation of the preoperative examination data that served as a ground for diagnosis of liver cysts with inadequate extent of surgery. In the first case, the resection was incomplete, and, as such, the biliary cystadenoma recurred in the resection area, the capsule of the neoplasm was ruptured and an encysted fluid collection was formed. In the second case, lack of histological examination of the excised neoplasm, due to confidence in its morphological verification as a cyst, resulted in cystadenoma recurrence in the resection zone with metastasis to the contralateral lobe of the liver.Conclusion. Hepatic cystadenomas and cystadenocarcinomas are often misdiagnosed as simple cysts. These tumors should be suspected in central localization of the tumor in the liver, especially in young women. The clinical and instrumental symptomatology and radiological semiotics of the disease require careful evaluation. The recurrence of a cystic lesion in the resection zone in a patient previously operated for a hepatic cyst serves as an additional signal for detecting biliary cystadenoma. Rational strategy for surgical management of cystic liver lesions should include hepatectomy within healthy tissues (both anatomical and atypical) with mandatory intraoperative ultrasound and urgent histological examinations

Сложности дифференциальной диагностики дисфункции вокальных хорд и бронхиальной астмы

Aim. Differential diagnosis of vocal cord dysfunction (VCD) and asthma.Methods. 105 patients with partially controlled asthma were examined. We used specific examinations for VCD: psychological scales , questionnaires for monitoring symptoms of VCD, transnasal fiberoptic laryngoscopy, conventional and electronic lung auscultation with the analysis of the amplitude-frequency characteristics (AFC) of wheezing in the chest and in the region of the larynx on the left and right. Spirometry was performed using Vitalograph ALPHA spirometer (England). The patients were divided into three groups: group 1 included patients with asthma; group 2 included patients with asthma and VCD (asthma-plus syndrome); group 3 included patients with VCD.Results. Conventional auscultation revealed wheezing over the lungs with a decrease in its intensity on the neck surface in group 1. In groups 2 and 3, the maximal wheezing was observed on the anterior surface of the neck and less intense wheezing was heard over the lungs. Electronic auscultation found mid-tonal wheezing over the lungs and over the larynx in group 1; high-pitched wheezing over the larynx and mid-tonal wheezing over the lungs in groups 2 and 3. Score of dyspnea according to the Borg scale was highest in the asthma-plus group – 4,8 (5,2 – 6,5) points, and lowest in the 1st group – 4,2 (3,7 – 4,9) points. The sensation of wheezing is maximal in VCD – 7,1 (6,5 – 7,9) points. The scores of symptoms of VCD were strongly correlated with the intensity of wheezing, dyspnea, and AFC of wheezing. Spirometry was close to normal in the group of patients with VCD; obstructive disorders were noted in groups 1 and 2. Transnasal laryngoscopy demonstrated paradoxical movement of the vocal cords during inspiration in groups 2 and 3. The triggers of episodes of VCD in the subjects were numerous; vocal loads predominated. Specific treatment of VCD in groups 2 and 3 improved the respiratory performance significantly.Conclusion. The primary diagnosis of asthma cannot be made without an examination for VCD. Psychological questionnaires and VCD questionnaires should be used. It is important to use electronic auscultation over the larynx for diagnosis. Correction of treatment in accordance with VCD in patients with asthma can significantly reduce the doses of inhaled and oral corticosteroids.Целью исследования явилась дифференциальная диагностика дисфункции вокальных хорд (ДВХ) и бронхиальной астмы (БА).Материалы и методы. Обследованы пациенты (n = 105) с частично контролируемой БА, у которых применялись специфические методы обследования на ДВХ – психологические опросники и анкеты мониторинга симптомов при ДВХ, трансназальная оптическая ларингоскопия, традиционная и электронная аускультация легких с анализом амплитудно-частотных характеристик (АЧХ) хрипов на грудной клетке и в области гортани слева и справа. Проводилась спирометрия при помощи спирометра Vitalograph ALPHA (Англия). Пациенты были разделены на 3 группы: 1-я – пациенты с БА; 2-я – больные БА с ДВХ (синдром «астма плюс»); 3-я – лица с ДВХ.Результаты. При традиционной аускультации у больных 1-й группы выслушивались хрипы над легкими с уменьшением их интенсивности на поверхности шеи; максимум выслушивания хрипов у пациентов 2-й и 3-й групп – передняя поверхность шеи с уменьшением их интенсивности над легкими. При электронной аускультации у больных 1-й группы выслушивались среднетональные хрипы над легкими и гортанью, 2-й и 3-й групп – высокотональные хрипы – над гортанью и среднетональные – над легкими. Наибольшая выраженность одышки по шкале Борга – 4,8 (5,2–6,5) балла отмечена у пациентов группы «астма плюс», наименьшая – 4,2 (3,7–4,9) балла – у пациентов 1-й группы; максимальное ощущение свистящего дыхания при ДВХ – 7,1 (6,5–7,9) балла. Выявлена прямая сильная корреляционная зависимость показателей опросников симптомов ДВХ и степени интенсивности хрипов, одышки и АЧХ хрипов. Близкие к нормальным показатели спирометрии отмечены при ДВХ. Обструктивные нарушения выявлены у пациентов 1-й и 2-й групп. При трансназальной ларингоскопии у больных 2-й и 3-й групп продемонстрировано парадоксальное движение голосовых связок во время вдоха. Триггеры эпизодов ДВХ у обследуемых многочисленны, преобладали голосовые нагрузки. При специфическом лечении ДВХ у больных 2-й и 3-й групп заметно улучшились респираторные показатели.Заключение. Продемонстрировано, что для установления первичного диагноза БА необходимо обследование на наличие ДВХ. Актуально использование психологических опросников и анкет по диагностике ДВХ. Отмечено, что в процессе диагностики важно применять электронную аускультацию над гортанью, а коррекция лечения с учетом наличия ДВХ у пациентов с БА позволяет значительно снизить дозы ингаляционных и пероральных глюкокортикостероидов

Первично-множественный синхронно-метахронный рак почек и предстательной железы (клиническое наблюдение)

Primary multiple tumors are an independent emergence and development two or more neoplasms in one patient. Thus can be the struck not only different bodies of various systems, but pair bodies (mammary glands, lungs, etc.) also, and one body with multicentric defeat. Primary multiple tumors can be synchronous and metachronous. The increase in frequency of multiple neoplasms is noted in recent years.A clinical observation of a 62-year-old patient with synchronous-metachronous primary-multiple cancer of both kidney and prostate gland is presented. A feature of this observation is multiple lesions of both kidneys, as well as the presence of two different morphological forms of renal cell carcinoma in one kidney (papillary and clear cell). The difficulty in identifying and differentiating kidney tumors with a cystic structure was due to the presence of multiple cysts of both kidneys of different types according to Bosniak. Первично-множественные опухоли – это независимое возникновение и развитие у одного больного двух или более новообpазований. При этом пораженными могут быть не только разные органы различных систем, но и парные (молочные железы, легкие и др.), а также мультицентрически один орган. Первичномножественные опухоли могут быть синхронными и метахронными. В последние годы отмечено увеличение частоты множественных новообразований.Представлено клиническое наблюдение пациента 62 лет с синхронно-метахронным первично-множественным раком обеих почек и предстательной железы. Особенностью представленного наблюдения является множественное поражение обеих почек, а также наличие двух различных морфологических форм почечноклеточного рака в одной почке (папиллярного и светлоклеточного). Сложность в выявления и дифференциации опухолей почки, имеющих кистозную структуру, была обусловлена наличием множественных кист обеих почек различных типов по Bosniak.

Первично-множественный синхронный рак почки и щитовидной железы у больного с удвоением нижней полой и почечных вен с обеих сторон (клиническое наблюдение)

Renal cell carcinoma – the third on occurrence frequency tumor of urinogenital system and the most widespread renal tumor which makes about 2–3% of malignancies at adults. Doubling of inferior vena cava (IVC) is anomaly in case of which two inphrarenal segments of IVC are defined. Left IVC after lockin in it the left renal vein crosses an aorta in front, connects to the right renal vein and the right IVC. Combination of renal cell carcinoma and doubling IVC is rather seldom. The presented clinical case of a combination of renal cell carcinoma and doubling of IVC has the feature existence at the patient of metachronous multiple primary neoplasms that does necessary more careful inspection of the patient. Also a doubling of renal veins on both sides and a doubling of the left renal artery have been revealed. Possibilities of presurgical non-invasive diagnostics (ultrasonography and computer tomography) of retroperitoneal space vessels anomaly at the patient with transmural localization of kidney tumor allowing to plan and execute difficult surgery – an ex vivo resection of a left kidney in the conditions of pharmacological cold ischemia was shown. Performance of an ex vivo nephrectomy in the conditions of pharmacological cold ischemia allows to dilate indications to organ-preserving treatment of patients with the localized kidney cancer. However long cold ischemia and the subsequent vascular reconstruction demand dynamic observation over kidney’s functional conditions.Почечно-клеточный рак – третья по частоте встречаемости опухоль мочеполовой системы и наиболее распространенная опухоль почки, которая составляет приблизительно 2–3% злокачественных образований у взрослых. Удвоение нижней полой вены (НПВ) – аномалия, при которой определяются два инфраренальных сегмента НПВ, левая НПВ после впадения в нее левой почечной вены пересекает аорту спереди, соединяется c правой почечной веной и правой НПВ. Сочетание почечно-клеточного рака и удвоения НПВ достаточно редко. Представ ленное клиническое наблюдение сочетания рака почки с удвоением НПВ имеет своей особенностью наличие у пациента первично-множественного метахронного рака, что делает необходимым более тщательное обследование пациента. Также было выявлено удвоение почечных вен с обеих сторон и удвоение левой почечной артерии. Продемонстрированы возможности дооперационной неинвазивной диагностики (ультразвуковое исследование и компьютерная томография) аномалии сосудов забрюшинного пространства у пациента с опухолью почки трансмуральной локализации, позволяющей спланировать и выполнить сложное оперативное вмешательство – экстракорпоральную резекцию левой почки в условиях фармакохолодовой ишемии. Проведение экстракорпоральной резекции почки в условиях фармакохолодовой ишемии позволяет расширить показания к органосохраняющему лечению больных с локализованным раком почки. Однако длительная ишемия почки и последующие сосудистые реконструкции требуют динамического наблюдения за функциональным состоянием почки

Prediction of inter-particle adhesion force from surface energy and surface roughness

Fine powder flow is a topic of great interest to industry, in particular for the pharmaceutical industry; a major concern being their poor flow behavior due to high cohesion. In this study, cohesion reduction, produced via surface modification, at the particle scale as well as bulk scale is addressed. The adhesion force model of Derjaguin-Muller-Toporov (DMT) was utilized to quantify the inter-particle adhesion force of both pure and surface modified fine aluminum powders (∼8 μm in size). Inverse Gas Chromatography was utilized for the determination of surface energy of the samples, and Atomic Force Microscopy was utilized to evaluate surface roughness of the powders. Surface modification of the original aluminum powders was done for the purpose of reduction in cohesiveness and improvement in flowability, employing either silane surface treatment or dry mechanical coating of nano-particles on the surface of original powders. For selected samples, the AFM was utilized for direct evaluation of the particle pull-off force. The results indicated that surface modification reduced the surface energy and altered the surface nano-roughness, resulting in drastic reduction of the inter-particle adhesion force. The particle bond number values were computed based on either the inter-particle adhesion force from the DMT model or the inter-particle pull-off force obtained from direct AFM measurements. Surface modification resulted in two to three fold reductions in the Bond number. In order to examine the influence of the particle scale property such as the Bond number on the bulk-scale flow characterization, Angle of Repose measurements were done and showed good qualitative agreements with the Bond number and acid/base surface characteristics of the powders. The results indicate a promising method that may be used to predict flow behavior of original (cohesive) and surface modified (previously cohesive) powders utilizing very small samples