The classifications of subaxial cervical spine traumatic injuries. Part 3. The Cervical Spine Injury Severity Score (CSISS)

Cervical spine traumatic lesion occurs in 3  % of injured patients. These lesions are often associated with a neurological deficit, ranging from radiculopathy to incomplete or complete spinal cord damage. High rates of mortality and permanent disability determine not only the medical but the socio-economic component of the problem.Since the advent of the first methods of instrumental diagnosis to the present time, the development and improvement of classification systems for traumatic injuries of the cervical spine have been ongoing. This is caused by the necessity to briefly and concisely describe the nature of the damage within the staged treatment of the injured person, perform gradation depending on the severity of the injury, provide understanding and prediction of the clinical scenario, and assist in the selection of the optimal treatment tactics.The introduction of more advanced and informative diagnostic methods into clinical practice determines the evolution of classification systems. Radiographic results of the cervical spine, despite the indisputable screening value, are no longer leading in the formation of classification categories.Studies of spine biomechanics allowed forming the ideas about the stability of injury, that, along with the severity of neurological disorders, have a leading tactical and prognostic value. Whereas, absolute unified criteria for stable or unstable damage have not yet been developed.This review analyses the Cervical Spine Injury Severity Score, based on computed tomography data, that allows quantifying the severity of damage and determining the optimal treatment tactics. The classification system has an exclusively morphological basis. It is the most detailed scale for assessing the stability of the damaged vertebral-motion segment developed so far. A high level of evidence allows using CSISS both in clinical practice and in the development and evaluation of the effectiveness of new methods of surgical and non-surgical treatment of patients with traumatic damage to the subaxial cervical spine

Variations and anomalies in the structure and branching of lumbosacral spinal nerve roots: a case report and global insights

Aim. The objective of this study is to analyze the clinical course of lumbosacral spinal nerve root anomalies / variants Type I according to the A. Neidre and I. MacNab’s classification, along with a retrospective MRI data analysis before surgery, focusing on the unique branching and topography of the spinal nerve roots. Additionally, we aim to address the relevance of correlating preoperative visualized features with the presence of anatomical anomalies attributed to these spinal nerve root variations, and their implications on the clinical presentation. Our study aims to compare our findings with the global diagnostic experience, classification, and specific aspects of performing discectomies based on individual anatomical characteristics of the lumbosacral region. Results. We present data from our own observation, when during surgery, a probable verification of a Type I lumbosacral spinal nerve root anomaly / variation according to the A. Neidre and I. MacNab’s classification was discovered in a patient. The anomaly appeared as a dense mass resembling a nerve root in the structural characteristics but with a significantly larger diameter. It emerged from the dural space at the level of the upper third of the L5 arch and then divided into two parts. A thinner bundle, comparable in diameter to a normal nerve root, exited through the L5-S1 intervertebral foramen, while a considerably thicker bundle followed a path parallel to the axis of the dural sac and exited through the S1-S2 intervertebral foramen. Comparison with global clinical observations revealed that despite the significant clinical and surgical implications, several aspects of this anomaly remain poorly studied and require further exploration and systematization. Conclusions. The lumbosacral nerve root anomalies (LSNRA) demonstrate a variety of structural variations and branching patterns, which are reflected in different classifications. Among the professional community, the classification of LSNRA, developed by A. Neidre and I. MacNab in 1983 and supplemented by S. M. Burke et al. in 2013, is recognized as the most relevant and frequently applied. While changes in vertebral bone structures can be easily diagnosed using modern imaging methods, preoperative diagnosis of LSNRA proves to be challenging, and the informativeness of standard MRI is limited, as confirmed by the clinical case presented. The dissonance between prominent neurological symptoms and relatively minor disc protrusion allows for the potential presence of a root variation/anomaly when planning the lumbar spine discectomy. The most informative diagnostic method for LSNRA is MR neurography. Among the radiological signs of Type I lumbоsacral nerve root anomalies, the following are considered valid: “corner sign”, “fat crescent sign”, and “parallel sign”. The verification of LSNRA is predominantly intraoperatively based on a series of characteristic topographicanatomical features, including atypical locations of the root’s origin from the dural sac, “unusual” nerve root exit angle, even up to a right angle, and technical challenges in root mobilization during routine lumbar discectomy procedures

Устойчивый к метициллину Staphylococcus aureus зоонозного происхождения - новая угроза здоровью населения

MRSA is the polyphyletic group into Staphylococcus aureus species. In accordance to the hostal preference, this group is divided, to three subgroups, i.e hospital-associated. MRSA, HA-MRSA, which, includes nosocomial staphylococci variants, community-associated MRSA, CA-MRSA, that is related to human environment and livestock-associated MRSA, LA-MRSA, that has zoonotic origin and commonly is associated with livestock. LA-MRSA is widespread in most countries. The serious problem, is the spread, of LA-MRSA carriage in humans that work in closely contact with livestock. Interaction between populations of CA-MRSA and LA-MRSA leads to acquisition, of human pathogenicity-associated, genes in zoonotic MRSA. The variants of LA-MRSA, that can spread between human arises as the result of this process. These staphylococci may be the cause of human diseases, including hospital-acquired, infections. Intensification of animal husbandry determined massive and uncontrollable antibiotic usage and resulted to development and ubiquitous spread of LA-MRSA, that is, in contrast to CA-MRSA, is characterized, by multiple drug resistance. This circumstance make practically impossible to eliminate LA-MRSA in human and livestock environment. In such considerations, monitoring of ecologic, epizootic and epidemiologic situation in human and. livestock becomes one of the main ways to control the spread of MRSA and diseases, associated with it.MRSA представляет, собой неоднородную группу в рамках вида Staphylococcus aureus. В составе данной группы, выделяют, в зависимости от. объекта паразитирования, три подгруппы: внутрибольничные варианты MRSA (hospital-associated MRSA, HA-MRSA), внебольничные MRSA (community-associated MRSA, CA-MRSA), MRSA, ассоциированные с сельскохозяйственными животными (livestock-associated. MRSA, LA-MRSA), распространённые среди сельскохозяйственных животных. LA-MRSA широко распространены, во многих странах. Существенной проблемой является распространение носительства LA-MRSA среди лиц, контактирующих с сельскохозяйственными животными. Взаимодействие популяций CA-MRSA и LA-MRSA приводит, к получению LA-MRSA генов, ассоциированных с патогенностью для человека. В результате этого процесса возникают, варианты. LA-MRSA, способные распространяться среди людей. Эти стафилококки обладают, способностью вызывать заболевания человека, в том. числе внутрибольничные инфекции. Интенсификация животноводства, обусловливающая массовое и бесконтрольное применение антибиотиков, привела к формированию и повсеместному распространению LA-MRSA, характеризующегося, в отличие от. CA-MRSA, множественной лекарственной резистентностью. Это обстоятельство делает. практически невозможным, элиминацию LA-MRSA из среды, обитания человека и животных. Данное положение даёт, основание признать, что одним, из основных способов контроля за распространением LA-MRSA и вызываемых им. заболеваний является мониторорова-ние экологической, эпизоотической и эпидемиологической ситуаций среди поголовья сельскохозяйственных животных и населения

Частота выявления антител к белку core+1 вируса гепатита с у «наивных» пациентов С хроническим вирусным гепатитом С в зависимости от стадии фиброза печени и субтипа вируса гепатита С

Objective: The goal of this study was to examine the prevalence of anti-core+1 in “naive” patients with chronic hepatitis C and different stages of liver fibrosis infected by HCV subtypes 1b and 3a.Materials and methods: A total of 86 “naive” patients (37 men and 49 women) with CHC observed in the Botkin infectious disease hospital in 2017, were included in this study. The average age was 50,7±2,7. Laboratory tests included ALT and bilirubin. In 53 patients, the fibrosis stage in the liver tissue was evaluated by the TE method using Fibroscan (Echosens, France). The presence of antibodies to the core+1 protein in blood serum samples was determined by the “inhouse” indirect ELISA method using synthetic peptides F10 and F13, which amino acid sequences correspond to the antigenic determinants of core+1 protein of the HCV subtypes 1b and 3a, respectively.Results: In total, anti-core + 1 were detected in 27 (31,4%) subjects. It has been shown that the detection rate of anticore+1 does not depend on the HCV subtype. The study has indicated no statistically significant dependence between the presence of anti-core+1 and biochemical activity es of the infectious process (ALT, bilirubin). Anti-core+1 were detected in patients with all stages of fibrosis, however, the detection rate of anti-core+1 was statistically higher in patients with stage F4 fibrosis than in patients without liver fibrosis.Conclusion: The obtained results suggest a possible role of the core+1 protein in the development of fibrosis. In the natural course of HCV infection, the detection of anti-core+1 can be considered as a prognostic marker for the progression of fibrosis in the liver tissue.Цель: изучить распространенность анти-core+1 у «наивных» больных хроническим гепатитом С, инфицированных субтипами вируса гепатита С 1b и 3а, с различной стадией фиброза.Материалы и методы: исследованы образцы сыворотки крови, полученные от 86 пациентов с ХГС (37 мужчин и 49 женщин) в возрасте от 24 до 80 лет (средний возраст 50,7±2,7), наблюдавшихся в поликлиническом отделении Клинической инфекционной больницы им. С.П. Боткина в 2017 г. Лабораторное обследование пациентов включало определение в крови активности АЛТ и уровня билирубина. Степень выраженности фиброза ткани печени по шкале METAVIR была оценена методом транзиентной эластографии (ТЭ) на аппарате Fibroscan (Echosens, Франция) у 53 пациентов. Наличие антител к белку core+1 в образцах сыворотки крови определяли непрямым методом ИФА «in-house» с использованием синтетических пептидов F10 и F13, содержащих антигенные детерминанты core+1 белка вируса гепатита С субтипов 1b и 3а соответственно.Результаты: антитела к белку core+1 ВГС были выявлены у 27 (31,4%) обследованных. Было показано, что частота выявления анти-core+1 не зависит от субтипа вируса гепатита С. Статистически достоверных отличий между наличием анти-core+1 и уровнями АЛТ и общего билирубина не установлено. Анти-core+1 определялись у пациентов со всеми стадиями фиброза, однако частота обнаружения анти-core+1 была достоверно выше у пациентов с фиброзом стадии F4 по сравнению с пациентами, у которых фиброз в печени отсутствовал. Заключение: полученные результаты позволяют предположить возможную роль белка core+1 в развитии фиброза. При естественном течении ВГС-инфекции определение анти-core+1 можно рассматривать как прогностический маркер прогрессирования фиброза в ткани печени.

Dermatoglyphic patterns in children with chronic constipation

Analysis of the fine ridge configurations on the digits of the palms and soles (dermatoglyphics) may sometimes help in the diagnoses of certain medical disorders. Dermatoglyphic patterns have been reported to be associated with congenital anomalies, such as congenital heart disease, duodenal ulcer, abdominal pain, and constipation. The palmar dermatoglyphic patterns of 77 children with constipation (39 functional and 38 organic constipation) were recorded. The control group consisted of 84 children with inguinal hernia. Those patients with at least one arch identified on any digit of either hand were termed arch positive. There was no significant correlation between arch positivity and constipation (functional or organic), or inguinal hernia (chi square, P =0.9211). Therefore, the presence of palmar arches cannot be used as a screening device for children with chronic constipation, especially of organic etiology.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/44424/1/10620_2005_Article_BF02285186.pd

Comparative constructions of similarity in Northern Samoyedic languages

The purpose of this paper is to analyze the suffixes which are used in Northern Samoyedic languages to build comparative constructions of equality. Depending on the language, the suffixes may perform three functions: word-building, form-building, and inflectional. When they mark the noun, they serve as simulative suffixes and are employed to build object comparison. In the inflectional function, these suffixes mark the verb and are a means of constructing situational comparison. In this case, they signal the formation of a special mood termed the Approximative. This paper provides a detailed description of the Approximative from paradigmatic and syntagmatic perspectives