Current principles of management of massive cholesteatoma and temporal bone pyramid defect

Objectives - to present a modern approach to the diagnosis and treatment of chronic suppurative otitis media with cholesteatoma, which led to a defect in the upper wall of the temporal bone pyramid. The case presented emphasizes the importance of timely diagnosis and treatment of this disease. Material and methods. Complaints, anamnesis, data from objective examination, additional methods of examination (high-frequency tone threshold audiometry multispiral computed tomography of temporal bones, diffusion-weighted magnetic resonance imaging of the brain). Conclusion. An innovative integrated approach, using radiological methods for studying the temporal bone (temporal bone multispiral CT, diffusion-weighted MRI of the brain), allows to diagnose cholesteatoma, the presence of bone-destructive changes in the structures of the middle and inner ear, as well as to determine the boundaries of the formed structure, which is important for planning modern surgical intervention

Preoperative 3D modeling splenectomy in patients with primary immune thrombocytopenia

СПЛЕНЭКТОМИЯТРОМБОЦИТОПЕНИЯ /ХИРТОМОГРАФИЯ РЕНТГЕНОВСКАЯ КОМПЬЮТЕРНАЯ3D МОДЕЛИРОВАНИЕГЕМОСТАЗВАСКУЛЯРИЗАЦИЯЦель. Изучить эффективность предоперационного 3-D моделирования на основе анализа данных мультиспиральной компьютерной томографии при выполнении лапароскопической спленэктомии по поводу первичной иммунной тромбоцитопении. Материал и методы. Пациентка, 55 лет с диагнозом идиопатическая тромбоцитопеническая пурпура, рецидивирующее течение. В течение 10 лет она наблюдалась и проходила неоднократные курсы консервативного лечения, принимала ежедневно до 60 мг преднизолона. Уровень тромбоцитов крови снижался ниже 30?109 /л. В связи с неэффективностью консервативного лечения была показана спленэктомия. Выполнена мультиспиральная компьютерная томография с болюсным контрастированием. На основе полученных данных в системе "Автоплан" была построена цветная 3-D модель области оперативного вмешательства. Система по планированию оперативного вмешательства объединяет медицинское оборудование, внутристационарную сеть архивирования и обмена данными с рабочими станциями врачей с возможностью использования на компьютерах и мобильных устройствах непосредственно в операционной. Пациентке выполнена лапароскопическая гибридная спленэктомия. Результаты. Согласно 3-D модели, у пациентки выявлен магистральный тип васкуляризации селезенки. Дистальная часть хвоста поджелудочной железы не доходила до ворот селезенки на 1,5 см. Добавочные селезенки и перипроцесс отсутствовали. Данные модели 3-D подтвердились интраоперационно и позволили выполнить лапароскопическую гибридную спленэктомию без технических трудностей прецизионно с минимальной кровопотерей. Послеоперационный период протекал без осложнений. Пациентка выписана на 5 сутки в удовлетворительном состоянии. Показатели уровня тромбоцитов достигли референтных значений (356?109 /л). Заключение. Предоперационное 3-D моделирование позволяет хирургу заранее планировать оперативное вмешательство с учетом знания индивидуальных топографо-анатомических особенностей области предстоящей операции. Знание индивидуальных особенностей васкуляризации селезенки и топографии поджелудочной железы в ее воротах позволяет прецизионно выделять и легировать сосуды, что повышает качество гемостаза, а также уменьшает вероятность травмы поджелудочной железы. Дооперационная визуализация добавочных селезенок повышает радикальность операции.Objectives. To explore the possibilities of preoperative 3D modelling and analysis system based on multislice computed tomography data, to evaluate its effectiveness in performing laparoscopic splenectomy for the primary immune thrombocytopenia. Methods. A female patient, (55 yrs) with the diagnosis of idiopathic thrombocytopenic purpura, recurrent course. For 10 years she had been observed and underwent the numerous courses of conservative treatment; she also took daily 60 mg of prednisolone. The blood platelet levels reduced below 30?109/l. The splenectomy was indicated due to the failure of conservative treatment. Multislice computed tomography with contrast bolus was performed. For preoperative planning a color 3D model of the surgical site was created on the basis of the obtained data in the "Autoplan" system. Systems giving the ability to plan surgical intervention combines the medical equipment, PACS system (picture archiving and communication system) available onsite advanced image-viewing workstations that can guide physicians; the ability to view images from various workstations via the network including the navigation enabling physicians to create the accurate and realistic models from stereo cameras, and to use computers as well as mobile computing devices directly in the operating room. The patient was underwent laparoscopic hybrid splenectomy. Results. According to the 3D model a main type of vascularization of the spleen was revealed. The distal part of the pancreatic tail did not reach (1.5 cm) the gate of the spleen. Accessory spleens and periprotsess were absent. The data of 3D model were confirmed intraoperatively and allowed performing a laparoscopic hybrid splenectomy without technical difficulties precisely with a minimal blood loss. The postoperative period was uneventful. The patient was discharged on the 5th day in a satisfactory condition. The parameters of platelet level have reached the reference values (356?109/l). Conclusion. Preoperative 3D modelling permits the surgeon to make pre-operative planning and provides him with important information on individual topographic and anatomic features in forthcoming operation sites. The information about the individual characteristics of the splenic vascularization and pancreatic topography in its gate lets to allocate and ligate vessels precisely, that improves the quality of hemostasis and also reduces the probability of the pancreatic injury. Preoperative visualization of accessory spleens increases the radicalism of the surgery

A phylogenetic hypothesis for the origin of hiccough

Summary The occurrence of hiccoughs (hiccups) is very widespread and yet their neuronal origin and physiological significance are still unresolved. Several hypotheses have been proposed. Here we consider a phylogenetic perspective, starting from the concept that the ventilatory central pattern generator of lower vertebrates provides the base upon which central pattern generators of higher vertebrates develop. Hiccoughs are characterized by glottal closure during inspiration and by early development in relation to lung ventilation. They are inhibited when the concentration of inhaled CO 2 is increased and they can be abolished by the drug baclofen (an agonist of the GABA B receptor). These properties are shared by ventilatory motor patterns of lower vertebrates, leading to the hypothesis that hiccough is the expression of archaic motor patterns and particularly the motor pattern of gill ventilation in bimodal breathers such as most frogs. A circuit that can generate hiccoughs may persist in mammals because it has permitted the development of pattern generators for other useful functions of the pharynx and chest wall muscles, such as suckling or eupneic breathing

ОЦЕНКА ЛИМФАТИЧЕСКОГО ОТЕКА НИЖНИХ КОНЕЧНОСТЕЙ ПО ДАННЫМ КОМПЬЮТЕРНОЙ ТОМОГРАФИИ

Lymphedema is a common disease, it is estimated that up to 10% of the population has it in varying degrees. Thus different methods are using in evaluating patients with lymphedema. Computed tomography allows to assess the condition and thickness of various layers of soft tissues, edema spread along the length of the limb and deeper spaces, objectify degree of edema and fibrotic changes in the skin and subcutaneous tissue, to obtain quantitative data of tissue density at any level and level of the limb. Comparison of clinical stage and CT data is not fully studied question. We examined 24 patients, made physical examination and lower limb MSCT. It was found that with an increase of the degree of edema increases limb volume, thickness of subcutaneous fat, increases the X-ray density of subcutaneous adipose tissue due to its edema and fibrosis. Thus, the use of MSCT saves physician's time for examination of patients with lymphedema and allows him to select the optimal treatment strategy.Лимфатический отек является широко распространенным заболеванием, считается, что до 10% населения подвержены ему в той или иной степени. При этом при оценке больных с лимфатическим отеком применяются разнообразные методики. Компьютерная томография позволяет оценить состояние и толщину различных слоев мягких тканей, распространение отека по длине конечности и в подфасциальные пространства, объективизировать степень отека и фиброзных изменений в коже и подкожной клетчатке, получить количественные данные о плотности тканей на любом уровне и участке конечности. Недостаточно изученным является вопрос сопоставления клинической стадии и данных компьютерной томографии. Обследованы 24 пациента, проводился физикальный осмотр и МСКТ нижних конечностей. Установлено, что с нарастанием степени отека увеличиваются объем конечности, толщина подкожной жировой клетчатки, возрастает рентгеновская плотность подкожной жировой клетчатки за счет ее отека и фиброзных изменений. Таким образом, применение МСКТ экономит время врача на обследование больных лимфедемой и позволяет выбрать оптимальную тактику лечения

A practical guide to the simultaneous determination of protein structure and dynamics using metainference

Accurate protein structural ensembles can be determined with metainference, a Bayesian inference method that integrates experimental information with prior knowledge of the system and deals with all sources of uncertainty and errors as well as with system heterogeneity. Furthermore, metainference can be implemented using the metadynamics approach, which enables the computational study of complex biological systems requiring extensive conformational sampling. In this chapter, we provide a step-by-step guide to perform and analyse metadynamic metainference simulations using the ISDB module of the open-source PLUMED library, as well as a series of practical tips to avoid common mistakes. Specifically, we will guide the reader in the process of learning how to model the structural ensemble of a small disordered peptide by combining state-of-the-art molecular mechanics force fields with nuclear magnetic resonance data, including chemical shifts, scalar couplings and residual dipolar couplings.Comment: 49 pages, 9 figure

Association of Calcineurin with the COPI Protein Sec28 and the COPII Protein Sec13 Revealed by Quantitative Proteomics

Calcineurin is a calcium-calmodulin-dependent serine/threonine specific protein phosphatase operating in key cellular processes governing responses to extracellular cues. Calcineurin is essential for growth at high temperature and virulence of the human fungal pathogen Cryptococcus neoformans but the underlying mechanism is unknown. We performed a mass spectrometry analysis to identify proteins that associate with the calcineurin A catalytic subunit (Cna1) in C. neoformans cells grown under non-stress and high temperature stress conditions. A novel prioritization strategy for mass spectrometry data from immunoprecipitation experiments identified putative substrates and proteins potentially operating with calcineurin in common pathways. Cna1 co-purified with proteins involved in membrane trafficking including the COPI component Sec28 and the COPII component Sec13. The association of Cna1 with Sec28 and Sec13 was confirmed by co-immunoprecipitation. Cna1 exhibited a dramatic change in subcellular localization during high temperature stress from diffuse cytoplasmic to ER-associated puncta and the mother-bud neck and co-localized with Sec28 and Sec13