11 research outputs found
IDENTIFICATION OF INDICATIONS TO VERTEBRAL CANAL DECOMPRESSION IN PATIENTS WITH KYPHOTIC DEFORMITIES OF THORACIC AND LUMBAR SPINE
No full textRelevance. Vertebral canal revision and decompression in patients with kyphotic deformities of thoracic and lumbar spine is performed not only in the setting of severe neurological symptoms, but also in the presence of risk of neurological deficiency associated with vertebral canal stenosis at the peak of vertebral deformity. There is no common method of measuring vertebral canal loss at the moment; this significantly complicates identification of indications to vertebral canal revision and decompression. The study was aimed at identifying indications to vertebral canal revision and decompression at operative treatment of long kyphotic deformities of thoracic and lumbar spine based on the method of measuring the relative vertebral canal’s stenotic area at the peak of deformity. Patients and methods. Operative treatment was performed in 108 study subjects with kyphotic deformities of thoracic and lumbar spine. The authors developed an original method of measuring the relative vertebral canal’s stenotic area in order to identify indications to vertebral canal revision and decompression. Measurement results were compared with vertebral canal stenosis thresholds for specific localizations. Results. Vertebral canal stenosis was revealed in 43 out of 108 patients (39.81%). Conclusion. The authors developed the first highly accurate method of measuring the relative vertebral canal’s stenotic area, which takes into consideration not only the anteroposterior dimension of the vertebral canal, but also narrowing thereof along its cross-sectional area. Exceedance of the vertebral canal loss threshold is an absolute indication to vertebral canal revision and decompression
Extirpation of the Thoracic and Lumbar Hemivertebrae from the Dorsal Access Using the Ultrasonic Bone Scalpel in Children: The Result of a Prospective Multicenter Study
No full textBackground. The surgical treatment of congenital spinal deformity caused by hemivertebra is associated with high rate of complications. A research of a new surgery technique for operation time and blood loss decrease could potentially improve outcomes. The purpose — to evaluate the efficacy of ultrasonic bone scalpel in surgical treatment of pediatric congenital spinal deformities caused by monosegmental hemivertebra. Patients and Methods. Level of Evidence III. The study based on the data of 55 consecutively operated pediatric patients who underwent 59 posterior hemivertebra resection provided by ultrasonic bone scalpel from January 2015 to December 2019. The average age was 4 years and 4 months. 36 hemivertebra were located in thoracic spine and 23 were located in lumbar spine. Total duration of surgery, estimated blood loss (ml and % of circulated blood volume, CBV), complications rate and deformity correction were noted. The influence of posterior instrumentation length and patients age at time of surgery on evaluation parameters was analyzed. 5-year (2015–2019) systematic literature review was performed for compare with obtain results. Results. Total operation time was 131 min ± 33 min for thoracic spine and 165 min ± 50 min for lumbar spine (p = 0,005). Estimated blood loss was 105 ml ± 74 ml (Me 80 ml) for thoracic resection and 123 ml ± 59 ml (Me 120 ml) — for lumbar (p = 0,178). The length of posterior instrumentation were not influence on operation time and total blood loss (p = 0,957; p = 0,967), patients age at time of surgery were not influence on operation time (p = 0,458), but correlate with total blood loss (p = 0,023). Intraoperative complications was not observed. Four cases of transpedicular screw malposition without neurological deficit were noted (type C acc. Gertzbein-Robbins). Conclusions. Posterior hemivertebra resection with ultrasonic bone scalpel is safe and effective procedure provides decrease of operation time and estimated blood loss
Biofilms of intestinal microsymbionts in children with reactive arthritis
No full textThe authors present the results of the study of one of the basic physiological properties of microorganisms of intestinal microbiota — the ability to biofilm formation (BF) in children with reactive arthritis. It was shown that BF is a biological marker which determines the arthritogenicity of microorganisms of the intestinal microbiota and can serve as a biological target for the choice of effective therapy in arthritis
ОПРЕДЕЛЕНИЕ ПОКАЗАНИЙ К ДЕКОМПРЕССИИ ПОЗВОНОЧНОГО КАНАЛА У ПАЦИЕНТОВ С КИФОТИЧЕСКИМИ ДЕФОРМАЦИЯМИ ГРУДНОГО И ПОЯСНИЧНОГО ОТДЕЛОВ ПОЗВОНОЧНИКА
No full textRelevance. Vertebral canal revision and decompression in patients with kyphotic deformities of thoracic and lumbar spine is performed not only in the setting of severe neurological symptoms, but also in the presence of risk of neurological deficiency associated with vertebral canal stenosis at the peak of vertebral deformity. There is no common method of measuring vertebral canal loss at the moment; this significantly complicates identification of indications to vertebral canal revision and decompression. The study was aimed at identifying indications to vertebral canal revision and decompression at operative treatment of long kyphotic deformities of thoracic and lumbar spine based on the method of measuring the relative vertebral canal’s stenotic area at the peak of deformity. Patients and methods. Operative treatment was performed in 108 study subjects with kyphotic deformities of thoracic and lumbar spine. The authors developed an original method of measuring the relative vertebral canal’s stenotic area in order to identify indications to vertebral canal revision and decompression. Measurement results were compared with vertebral canal stenosis thresholds for specific localizations. Results. Vertebral canal stenosis was revealed in 43 out of 108 patients (39.81%). Conclusion. The authors developed the first highly accurate method of measuring the relative vertebral canal’s stenotic area, which takes into consideration not only the anteroposterior dimension of the vertebral canal, but also narrowing thereof along its cross-sectional area. Exceedance of the vertebral canal loss threshold is an absolute indication to vertebral canal revision and decompression.
The role of neurogenic feet deformities in the lower limb dysfunction structure in patients with cerebral palsy. Management of surgical treatment. Literature data review
No full textAnalysis of the literature data on the surgical treatment of feet deformities in children with cerebral palsy allowed determining of the first key pathogenesis aspects and management of surgical treatment. The main types of changes occurring in the feet under the influence of spastic disorders and the optimal methods of progressive deformities of feet surgical treatment were studied. The treatment management preference depends on intrapatient habits, age, the pattern of rescue, deformation gravity and mobility, level of the gross motor function (GMFCS). Various «soft tissue surgery» forms are effective provided sufficient deformation mobility for younger children group patients. The bone-cutting feet surgical measures are justified provided rigid deformations in more older children. A differentiated neurogenic feet deformities surgical treatment approach provides obtaining both early and long-term satisfactory treatment results
<i>In vitro</i> effects of intestinal microsymbionts on the cytokine production
No full textThe most important role in homeostasis of intestinal immune belongs to the immunoregulatory properties of the microbiota which activates intracellular signaling systems, cytokine expression, production of protective factors and limits inflammatory reactions in the intestine by interacting with the pattern recognition receptors. The outcome of interactions between the microbiota and host cells (development of an inflammatory process or maintenance of intestinal homeostasis) depends on many factors, including a potential ability of intestinal commensals to influence the cytokine network in human body. Due to disturbances of quantitative and qualitative microbiota profile (dysbiosis), the cytokine balance may be changed by the influence of intestinal microsymbionts and their metabolites on immune and epithelial cells of intestines, thus contributing to the development of various human disorders. The aim of this study was to evaluate the immunoregulatory properties of eubiotic and dysbiotic human intestinal microsymbionts by assessing the effects of their cell-free supernatants on cytokine production in the in vitro system. The study was conducted on 49 eubiotic and 77 dysbiotic strains of microorganisms isolated from conditionally healthy patients examined for colon dysbiosis. To assess immunoregulatory properties of intestinal microsymbionts, we studied the effects of cell-free supernatants from bacterial and fungal cultures up on production of proinflammatory (IFNγ, TNFα, IL-17, IL-8, IL-6) and anti-inflammatory (IL-10, IL-1ra) cytokines secreted by mononuclear cells isolated from peripheral blood of healthy persons. The intestinal microbiota was determined by bacteriological methods. Identification of isolated microbial cultures was performed using MALDI TOF MS Microflex LT series (Bruker Daltonics, Germany). The level of cytokines was determined by enzyme immunoassay using commercial test systems (“Cytokine”, Russia). Statistical evaluation included discriminant analysis, classification decision tree and resultant mapping method. The multivariate statistical analysis enabled us to determine the range of the most informative indexes among cytokines and microbial cultures that changing their production in order to assess the state of homeostasis in eubiosis and intestinal dysbiosis. It was found that the supernatants of eubiotic cultures of intestinal symbionts exhibited a pronounced ability to inhibit the level of pro-inflammatory cytokines (IFNγ, IL-8) and to stimulate the secretion of anti-inflammatory cytokine (IL-10), whereas the dysbiotic cultures predominantly induced pro-inflammatory cytokines (IL-17, IFNγ, TNFα). In maintaining a uniform balance between pro- and anti-inflammatory cytokines during eubiosis, both associations of microsymbionts (in descending order of factor loads): Bacteroides spp. > E. coli > Lactobacillus spp.), and monocultures (Bifidobacterium spp. and Lactobacillus spp.) made a significant contribution via IL-10 induction. In cases of intestinal dysbiosis, we found an increased number of associations between microsymbionts inducing secretion of pro-inflammatory cytokines was. The pro-inflammatory profile of dysbiotic cultures was determined by the influence on IFNγ production (ranged in descending order of factor loads) of Bifidobacterium spp. > Enterococcus spp. > E. coli > Lactobacillus spp. associations, as well as S. aureus > Candida spp associations. The secretion of IL-17 was influenced by the monoculture of Clostridium spp., and by association C. acnes > S. aureus > Klebsiella spp. Monocultures of Bifidobacteria and Escherichia exerted effects upon TNFα production. Thus, during eubiotic state, the normobiota maintains a uniform balance of pro- and anti-inflammatory cytokines, and, in presence of intestinal dysbiosis, a shift in the balance of cytokines towards pro-inflammatory ones may occur due to increased levels of their secretion, an expanded spectrum of cytokines from this group, and increased number of single bacteria and associations of microbial cultures affecting their production
RESTORATIVE TREATMENT OF ORTHOPEDIC PATIENTS IN A MODERN REHABILITATION CENTER
No full textThe rehabilitation of patients after surgery is an integral part of treatment in modern medicine. Restorative treatment is a complex of measures which includes participation of different medical specialists. The goal of child post-surgery rehabilitation is the restoration of physical and social adaptation of the patient. This article covers the main principles of restorative treatment in a multi-profile children’s medical institution. Examples of child rehailitation after reconstructive surgery of most frequent orthopedic pathologies are included
Optimization of the method for predicting clinical outcomes of reactive arthritis in children
No full textThe comparative analysis of content of cytokine and significant local antimicrobial factors (IL-6, IL-8, IL-17, INF-γ, TNF-α, IL-10, CRP, lysozyme, lactoferrin) in the coprofiltrates and serum of patients with acute and chronic reactive arthritis (ReA) made it possible to determine the markers predicting the course and outcomes of arthritis. It is established that the method of predicting ReA involving the analysis of the parameters characterizing coprofiltrates of children is the more accurate and effective method
GUT MICROSYMBIOCENOSIS IN CHILDREN WITH REACTIVE ARTHRITIS
No full textAim. To study the state of gut microsymbiocenosis in children with reactive arthritis (RA), with the assessment of biofilm formation (BFF) of microsymbionts and the ability to change cytokine levels (their anticytokine activity) in vitro. Materials and methods. The investigation of gut microsymbiocenosis by means of bacteriological method was conducted in 34 children with RA and 25 relatively healthy 3 - 16 year- old children. Microorganisms were identified with the help of MALDI-TOF mass-spectrometry, anticytokine activity (АСА) of microsymbionts - according to Bukharin O.V. et al. (2011), biofilm formation - according to O’Toole G.A., Kolter R. (1998). Results. On the ground of species composition differences of gut microbiota discrimination model was created which allowed to separate the group of children with RA from healthy individuals. Microsymbiocenosis of patients with RAwas characterized by increasing number of opportunistic microorganisms (OM) (enterobacteria, clostridia, bacteroides, and Candida), BFF and АСА level. Conclusion. The obtained data greatly contribute to the deciphering of spondylo-arthritis and disclose the role of microbial factor under given pathology. Hypercolonisation of human gut with OM, having pronounced ability to BFF and regulating cytokine level, promotes strengthening of arthritogenic potential and serves as additional marker of arthritis development risk in children
ВОЗМОЖНОСТИ ВОССТАНОВИТЕЛЬНОГО ЛЕЧЕНИЯ ПАЦИЕНТОВ ОРТОПЕДИЧЕСКОГО ПРОФИЛЯ В УСЛОВИЯХ СОВРЕМЕННОГО РЕАБИЛИТАЦИОННОГО ЦЕНТРА
No full textThe rehabilitation of patients after surgery is an integral part of treatment in modern medicine. Restorative treatment is a complex of measures which includes participation of different medical specialists. The goal of child post-surgery rehabilitation is the restoration of physical and social adaptation of the patient. This article covers the main principles of restorative treatment in a multi-profile children’s medical institution. Examples of child rehailitation after reconstructive surgery of most frequent orthopedic pathologies are included.Реабилитация пациентов после оперативного лечения в современной медицине является неотъемлемой частью лечебного процесса. Восстановительное лечение — это комплекс мероприятий, включающий в себя участие врачей разных специальностей. Целью реабилитации детей в послеоперационном периоде является восстановление физической и социальной адаптации пациента. В статье изложены основные принципы восстановительного лечения в условиях многопрофильного детского медицинского учреждения. Приведены клинические примеры реабилитации детей после реконструктивных операций при наиболее распространенной ортопедической патологии.
