DEVELOPMENT OF A MODEL FOR ASSESSMENT OF THE CONDITION OF PATIENTS WITH DISEASES OF THE SPINE BASED ON THE METHOD OF MULTI-CRITERIAL SELECTION OF ALTERNATIVES

Современная медицина имеет два приоритетных направления развития. Первое направление - это создание новейших лекарственных препаратов, а также разработка вакцин против новых вирусов. Второе направление - повсеместное и поэтапное внедрение в медицину информационных технологий. С болью в спине могут столкнуться люди не только пожилого возраста, но и подростки и даже грудные дети. Боль эта может быть вызвана многими причинами: как усталостью, так и всевозможными заболеваниями, которые могли развиться со временем или быть от рождения. По данным статистики ВОЗ, 80% населения страдает клиническими проявлениями остеохондроза позвоночника. В Российской Федерации большая часть амбулаторного приема неврологов и ортопедов занимают болезни позвоночника. Зачастую эксперту сложно однозначно оценить объект по некоторому критерию, возникают сомнения и поиски усредненной оценки. Но нередко затруднения в точном определении значения возникают не из-за недостатка опыта, а как раз, наоборот, из-за интуитивного понимания размытости оценки. Излишняя точность понятия может привести к потере части наилучших альтернатив или неправильному их ранжированию, если таковое применяется. Поэтому возникает необходимость разработки все более гибких по отношению к человеческому восприятию информации методов, позволяющих учитывать неопределенность все в большем количестве измерений. Целью данной работы является изучение методов, позволяющих с большой точностью определить заболевание позвоночника по некоторым жалобам пациента. Задачами работы являются выбор методов для просчета альтернатив, выбор критериев для альтернатив, и собственно, сами расчеты по выбранным методам Modern medicine has two priority areas of development. The first direction is the creation of the latest drugs, as well as the development of vaccines against new viruses. The second direction is the widespread and gradual introduction of information technologies into medicine. Back pain can be experienced not only by the elderly, but also by adolescents and even infants. This pain can be caused by many reasons: both fatigue and all kinds of diseases that could develop over time or be from birth. According to WHO statistics, 80% of the population suffers from clinical manifestations of osteochondrosis of the spine. In the Russian Federation, most of the outpatient visits to neurologists and orthopedists are spinal diseases. It is often difficult for an expert to unambiguously evaluate an object according to some criterion; doubts arise and searches for an average assessment. But often difficulties in accurately determining the meaning arise not because of a lack of experience, but, on the contrary, because of the intuitive understanding of the fuzziness of the assessment. Excessive precision of the concept can lead to the loss of some of the best alternatives or their incorrect ranking, if applicable. Therefore, there is a need to develop more and more flexible methods in relation to human perception of information, allowing to take into account the uncertainty in more and more dimensions. The aim of this work is to study methods that allow to determine with great accuracy the disease of the spine based on some of the patient's complaints. The tasks of the work are the choice of methods for calculating alternatives, the choice of criteria for alternatives, and, in fact, the calculations themselves according to the selected methods

The Preventive Effect of Decorin on Epidural Fibrosis and Epidural Adhesions After Laminectomy

Laminectomy is commonly performed to treat degenerative spinal diseases by reducing compression on the spinal cord and nerve roots. The postoperative epidural fibrosis and epidural adhesions may result in failed back surgery syndrome, which is characterized by the symptoms of lower back pain or leg pain. There is currently no satisfactory treatment for this complication. The pathological processes of epidural fibrosis and epidural adhesions are relevant to the proliferation of fibroblasts, transdifferentiation of fibroblasts into myofibroblasts, and the excessive deposition of extracellular matrix (ECM) protein. According to reports, transforming growth factor-β1 (TGF-β1) played a vital role in the development of fibrosis by promoting aforementioned processes. Decorin, an endogenous proteoglycan and natural inhibitor of TGF-β1, has exhibited prominent anti-fibrosis activity in various scar formation and fibrosis models of many organs. However, the preventive effect of decorin on epidural fibrosis and epidural adhesions requires further investigation. Here, we investigated the therapeutic effects and potential mechanisms of decorin on epidural fibrosis and epidural adhesions. Our results indicated that decorin could significantly suppress the TGF-β1-induced proliferation, transdifferentiation, and extracellular matrix production in primary fibroblasts. Furthermore, Smad2/3 signaling pathway had been demonstrated to be involved in the preventive effect of decorin. Moreover, administration of decorin in vivo could notably inhibit epidural fibrosis and epidural adhesions after laminectomy. To date, there is no approved therapy to target TGF-β1 for the treatment of epidural fibrosis and epidural adhesions after laminectomy. Our research proved the anti-fibrosis effect of decorin, which may provide an effective and promising treatment for epidural fibrosis and epidural adhesions.

Spinal disorders mimicking infection

Spinal infections are very commonly encountered by radiologists in their routine clinical practice. In case of typical MRI features, the diagnosis is relatively easy to interpret, all the more so if the clinical and laboratory findings are in agreement with the radiological findings. In many cases, the radiologist is able to make the right diagnosis, thereby avoiding a disco-vertebral biopsy, which is technically challenging and associated with a risk of negative results. However, several diseases mimic similar patterns, such as degenerative changes (Modic) and crystal-induced discopathy. Differentiation between these diagnoses relies on imaging changes in endplate contours as well as in disc signal. This review sought to illustrate the imaging pattern of spinal diseases mimicking an infection and to define characteristic MRI and CT patterns allowing to distinguish between these different disco-vertebral disorders. The contribution of advanced techniques, such as DWI and dual-energy CT (DECT) is also discussed.

PP209 Analysis Of The Efficacy And Safety Of Robotic Spinal Surgery

IntroductionRobotic surgery (RS) can offer benefits compared to freehand surgery (FS) in the treatment of patients with spinal diseases. The aim of this study was to assess efficacy and safety of RS versus FS in spinal fusion. The outcomes considered were accuracy in the placement of pedicle screws, surgical times, hospital stay, exposure to radiation, and complications.MethodsA systematic review and meta-analysis were performed by researchers at the Instituto de Salud Carlos III (ISCIII). Studies published until June 2019 in the English, Spanish, or French languages were retrieved. The data analyses and risk of bias assessments were undertaken using RevMan 5.3.ResultsEight randomized controlled trials including 610 patients (RS: 308, FS: 302) were found. The mean age of the patients ranged from 56 to 68 years in the FS group and from 55 to 68 years in the RS group. The percentage of women included ranged from 46 to 73 percent undergoing FS and from 33 to 70 percent undergoing RS. The main diagnosis was degenerative spine disease. The number of screws implanted ranged from 22 to 584 for FS and 23 to 532 for RS. The robots used were the SpineAssist and Renaissance Guidance System (Mazor Robotics, Ltd) and the TiRobot® Orthopaedic Robotic System (Beijing Tinavi Medical Technologies Co., Ltd). Pedicle screw placement within the safety zone (Grades A and B on the Gertzbein and Robbins scale) ranged from 93 to 100 percent in FS and from 85 to 100 percent in RS (relative risk 1.0, 95% confidence interval [CI] 0.99–1.03; p = 0.36) (I2=75%; p = 0.0005). Regarding intervention time, the meta-analysis showed a mean difference (MD) of 15.2 minutes (95% CI 5.35–25.05; p = 0.002) (I2 = 0%; p = 0.39) in favor of FS. The MD in hospital stay was 0.36 days (95% CI -1.03–0.31; p = 0.30) (I2 = 62%; p = 0.07), which was not statistically significant. Contradictory results were found for fluoroscopy time, although RS was associated with a lower radiation dose than FS (p < 0.05). In relation to safety, studies only reported on rates of surgical revision, which ranged from 0 to 2 after FS and from 0 to 10 after RS. The risk or bias was unclear in most studies.ConclusionsWe found no conclusive results suggesting benefits for spinal fusion using RS compared with FS. Further research with adequate selection of patients, type of robot, and comparator is needed.

Spine surgery under awake spinal anesthesia: an Egyptian experience during the COVID-19 pandemic

OBJECTIVE Despite tremendous advancements in biomedical science and surgical technique, spine surgeries are still associated with considerable rates of morbidity and mortality, particularly in the elderly. Multiple novel techniques have been employed in recent years to adequately treat spinal diseases while mitigating the perioperative morbidity associated with traditional spinal surgery. Some of these techniques include minimally invasive methods and novel anesthetic and analgesic methods. In recent years, awake spine surgery with spinal anesthesia has gained attention as an alternative to general anesthesia (GA). In this study, the authors retrospectively reviewed a single-institution Egyptian experience with awake spine surgery using spinal anesthesia during the COVID-19 pandemic. METHODS Overall, 149 patients who were admitted to As-Salam International Hospital in Cairo for lumbar and lower thoracic spine surgeries, between 2019 and 2020, were retrospectively reviewed. Patient demographics and comorbidities were collected and analyzed. Visual analog scale (VAS) and Oswestry Disability Index (ODI) scores were assessed at different time intervals including preoperatively, immediately after surgery, and 1 year postoperatively. Patient satisfaction was queried through a questionnaire assessing patient preference for traditional anesthesia or spinal anesthesia. RESULTS Of the 149 patients who successfully received spine surgery with spinal anesthesia, there were 49 males and 100 females. The cohort age ranged from 22 to 85 years with a mean of 47.5 years. The operative time ranged from 45 to 300 minutes with a mean estimated blood loss (EBL) of 385 ± 156 mL. No major cardiopulmonary or intraoperative complications occurred, and patients were able to eat immediately after surgery. Patients were able to ambulate without an assistive device 6 to 8 hours after surgery. Decompression and fusion patients were discharged on postoperative days 2 and 3, respectively. VAS and ODI scores demonstrated excellent pain relief, which was maintained at the 1-year postoperative follow-up. No 30- or 90-day readmissions were recorded. Of 149 patients, 124 were satisfied with spinal anesthesia and would recommend spinal anesthesia to other patients. The remaining patients were not satisfied with spinal anesthesia but reported being pleased with their postoperative clinical and functional outcomes. One patient was converted to GA due to the duration of the procedure. CONCLUSIONS Patients who received spinal anesthesia for awake spine surgery experienced short stays in the hospital, no readmissions, patient satisfaction, and well-controlled pain. The results of this study have validated the growing body of literature that demonstrates that awake spine surgery with spinal anesthesia is safe and associated with superior outcomes compared with traditional GA. Additionally, the ability to address chronic debilitating conditions, such as spinal conditions, with minimal use of valuable resources, such as ventilators, proved useful during the COVID-19 pandemic and could be a model should other stressors on healthcare systems arise, especially in developing areas of the world.

RELIABILITY OF THE GOUTALLIER CLASSIFICATION SYSTEM IN THE EVALUATION OF THE MULTIFIDUS MUSCLE

ABSTRACT Introduction: The paravertebral musculature is essential for the biomechanics and stability of the spine, and its involvement in the pathophysiology of spinal diseases has been demonstrated. Qualitative evaluation of muscle degeneration is usually performed by analyzing the fat infiltration rate proposed by the Goutallier classification system. Objective: The objective of this study is to analyze the intra- and interobserver agreement of the Goutallier Classification for the evaluation of fatty degeneration of the multifidus muscle, using magnetic resonance imaging exams. Methods: The study included 68 patients, all diagnosed with symptomatic disc hernia and indicated for surgery. Preoperative magnetic resonance images were used for the analyses. The images were initially evaluated by two orthopedists and two medical students, and then re-evaluated after two weeks. Intra- and inter-observer reliability analysis was performed using the Fleiss Kappa test and the Landis and Koch criteria. All the analyses were performed using the R statistical environment (R Development Core Team, version 3.3.1, 2016) and the significance level was set at 5%. Results: The percentages of intra- and inter-observer agreement were 86.76% and 61.03%, respectively. The intraobserver agreement was near perfect and the interobserver agreement was moderate. Conclusion: The Goutallier Classification System showed moderate interobserver and intraobserver agreement, being a relevant tool for the evaluation of paravertebral musculature fat replacement. Level of evidence II; Prospective study for diagnostic purposes.

Internet of Things in the Bathroom: Smart Health-Monitoring Bidet System

The Internet of things (IoT) helps our everyday lives such as by monitoring objects and tracking behaviors in various settings, but studies on enhancing the bathroom experience are rare. This article describes full details about development and implementation of a smart health-monitoring bidet based on our study published previously in the conference. A smart bidet system is designed to monitor the users’ health through several contact-type sensors, such as pressure, oxygen, and thermometer. The system is equipped with a built-in artificial intelligence software platform and is designed to detect anal and spinal diseases. The attached sensors normally operate under waterproof conditions: we tested their performances under X6 international protection marking conditions. These devices were designed to operate properly even in extremely waterproof conditions. The temperature, pressure, and oxygen sensors of the bidet system had error rates of about 4.1, 0.6, and 1.1 percent, respectively.

Reducing Inflammation and Vascular Invasion in Intervertebral Disc Degeneration via Cystathionine-γ-Lyase Inhibitory Effect on E-Selectin

The incidence of degenerative spinal diseases, such as cervical spondylosis and thoracic and lumbar disc herniation, is increasing. These health problems have adversely affected human life and work. Surgical intervention is effective when intervertebral disc degeneration (IDD) causes nerve compression and/or severely limits daily activity. Early IDD patients generally do not require surgery. However, there is no effective method of impeding IDD progression. Thus, novel approaches to alleviating IDD deterioration are urgently required. Cystathionine-γ-lyase (CSE) and E-selectin (CD62E) are vital factors regulating vascular function and inflammation. However, their effects on IDD and vascular invasion in intervertebral discs (IVDs) are pending further exploration. Here, bioinformatics and human nucleus pulposus (NP) tissues analyses revealed that CSE was significantly downregulated and CD62E was upregulated in the NP tissues of IDD patients. We demonstrated that CSE overexpression, CD62E downregulation, and NF-κB (P65) inhibition mitigate inflammation and recover metabolic function in NP cells. Similarly, CSE attenuated vascular invasion induced by inflammatory irritation. Using a rat IDD model, we showed that CSE improved degeneration, inflammation, and microvascular invasion in NP tissue, whereas CD62E had the opposite effect. Taken together, our results indicated that the CSE/CD62E pathway could effectively improve the inflammatory environment and vascular invasion in IVD. Hence, the findings of this study propose a promising and valuable strategy for the treatment of patients with early IDD as well as postoperative adjuvant therapy in patients with severe IDD.

НЕКОТОРЫЕ ОСОБЕННОСТИ ЗДОРОВЬЕСБЕРЕГАЮЩЕГО ПОВЕДЕНИЯ НАСЕЛЕНИЯ ПРИГРАНИЧНЫХ РЕГИОНОВ РОССИИ

The relevance of the research stipulated by the fact that health is the most important component of human capital, the quality of realization of human labor activity depends on its condition, and, hence, how useful it will be for both his family and the state as a whole. A significant part of the population in Russia does not have access to basic medical care, for many years there has been a decline in the population, and in terms of life expectancy, our country ranks 96th in the world. The aim of this work is to analyze the condition of health capital and health-saving behavior of the population in six border regions of Russia. The empirical basis is the data of the sociological survey conducted in 2020-2021 by the research team of the Altai State University. The main features of the behavior of the residents of the selected regions in preserving their own health revealed. When assessing their health, the respondents most often indicated average and good health. The majority of the population has chronic diseases, among which gastrointestinal diseases, hypertension and spinal diseases are the commonest. Almost half of the respondents do not consume alcohol and do not smoke, regularly see a doctor and do sports in order to stay healthy. The scientific novelty of the study consists in the assessment of the state of health of the population in the border regions, as well as their strategies of health-saving behavior. The practical value of the study consists in the presentation of actual assessments of the health capital of the population of the selected regions, allowing the state to take measures to improve the situation in the regions on this issue.