COMPREHENSIVE PREOPERATIVE APPROACH AND ENDOVENOUS ELECTRIC WELDING IN THE TREATMENT OF CHRONIC VENOUS INSUFFICIENCY C6 CLINICAL CLASS

The evaluation was done in the sphere of preoperative preparation trophic ulcer in patients with CVI using the proposed tactics of mechanochemical debridement and elimination of vertical venous reflux EVEZ method, in comparison with standard preoperative management tactics and EVLT of saphenous veins. It is established that the proposed tactics of preoperative preparation are more effective than classical approaches. Purpose. The use of the EVEZ method in combination with the proposed preoperative preparation of trophic ulcers in the treatment of CVI was determined to be effective. Materials and methods. An analysis of the treatment of 68 patients with CVI C6 clinical class was performed. The patient of the main group received the EVEZ treatment tributaries and perforating veins with preoperative trophic preparation ulcers, which includes: active mechanochemical debridement and control moisture balance in the wound, installation of negative pressure wound therapy system, platelet rich plasma therapy, application drugs based on diosmin and hesperidin. The proposed scheme of preoperative preparation has the following algorithm: Taking a smear from the sore to determine the bacterial spectrum and subsequent rational antibacterial therapy following the results of the antibioticogram; Active mechanochemical debridement with solutions of 0.1% polyaminopropyl biguanide + 0.1% surfactant, povidone-iodine + ethanol + glycerin + laureate 9 and control of moisture balance in the wound with modern hydrogel sore dressings; Installation of VAC system with a constant negative pressure of 120 mm Hg for 3 days for the first 3 performances of the system. Subsequently, VAC therapy was performed in a constant mode with a pressure of 80-120 mm Hg. in patients with insufficient wound cleanliness; After active cleaning, PRP therapy was performed, which involves the introduction of platelet-enriched plasma along the edge of the wound to a depth of 3 to 5 mm. The amount of PRP used depended on the size of the defect and ranged from 1 to 2 ml. All patients of the main group underwent correction of concomitant pathology with systemic use of capillary stabilizing drugs based on diosmin / hesperidin. Patients in the comparison group received standard preoperative preparation and EVLT. Patients of both groups were outpatient for 6 months. 39 of them (57.35%) were women and 29 (42.65%) were men aged 36 to 78 years. The duration of ulcers ranged from 3 months to 7 years. The following localization of venous trophic ulcers was observed: in the area of the medial bone - in 49 (72%) patients, 10 (14.7%) - on the anterior surface, 9 (13.3%) - on the lateral, posterior, anterior medial or anterolateral surface of the tibia. Results. Tactics of preoperative preparation that is offered allowed to achieve: reduction of redness and swelling in the main group on 7.3 ± 0.8 days (comparison group 10.2 ± 0.7 days); complete cleaning of the wound from fibrin and necrotic tissues at 9.1 ± 0.5 days (15.0 ± 1.1); the appearance of granulation tissues at day 12.6 ± 0.9 (18 ± 0.7); the appearance of marginal epithelialization at 15.3 ±0.7 days (20 ± 1.1). Conclusions. The proposed tactics can reduce the term by 1.7 times the preparation of the ulcer for surgery and 1.6 times the healing time of ulcers. The EVEZ method allows performing ablation efficiently and safely trunk great saphenous vein. The use of phlebotonic drugs, which is called Normoven, allows you to accelerate the healing of ulcers and prevent their recurrence.

A new small soft-bodied non-trilobite artiopod from the Cambrian Stage 4 Guanshan Biota

We describe an extraordinarily preserved non-trilobite artiopod Bailongia longicaudata gen. et sp. nov. from the Cambrian Stage 4 Guanshan Biota in Yiliang, Kunming of the Yunnan Province in China. Its exoskeleton consists of a large semi-elliptical cephalon with paired lateral posterior eyes, nine tapering homonomous tergites and a long slender tailspine. Appendages include paired small antennae, at least three pairs of post-antennal cephalic limbs, and trunk biramous limbs consisting of an endopod and an exopod with lamellae. B. longicaudata does not conform to any taxon within Artiopoda, although the eyes invite comparisons with Xandarella spectaculum, Sinoburius lunaris and Phytophilaspis. Parsimony analyses indicate Bailongia is a member of Artiopoda and cannot be readily accommodated within any of the major artiopod clades.

Three-dimensional morphometric differences of resected distal femurs and proximal tibias in osteoarthritic and normal knees

Background There is a paucity of data concerning the morphological differences of resected distal femurs and proximal tibias in osteoarthritic (OA) and normal knees. The objective of this study was to determine whether morphometric differences in the surfaces of resected distal femurs and proximal tibias exist between OA and normal knees in a Chinese population. Methods Ninety-four OA knees and ninety-five normal knees were evaluated in Chinese individuals. Computed tomography was used to measure the femoral mediolateral (fML), medial anteroposterior (fMAP), lateral anteroposterior (fLAP), medial condylar width (fMCW), lateral condylar width (fLCW), medial posterior condylar curvature radii (fMCR), lateral posterior condyle curvature radii (fLCR), fML/fMAP aspect ratio, tibial mediolateral (tML), middle anteroposterior (tAP), medial anteroposterior (tMAP), and lateral anteroposterior (tLAP) tML/tMAP aspect ratio to determine the morphologic differences between OA and normal knees. Results The average fMCW and tMAP dimensions of OA knees were larger than those of normal knees in both male and female (p <0.05). The fMAP/fML aspect ratio and tMAP/tML aspect ratio were also significantly different in both sexs (p <0.05). OA knees have an oval-shaped distal femur with a wider ML length and more spherical-shaped proximal tibiae with relatively narrow ML dimensions. Conclusions The study revealed the morphological differences in fMCW, tMAP, fMAP/fML and tMAP/tML between OA and normal knees in both males and females. These findings may provide guidelines that can be used to design better knee implants that are more size-matched for OA knees.

Differential-diagnostic approach in assessing the nature of the course of partial atrophy of the optic nerve

Purpose. To determine the diagnostic criteria for the progressive nature of the course of non-glaucomatous etiology of ONA according to the data of electrophysiological and Doppler studies. Material and methods. In accordance with the purpose of the study, 3 groups were formed of 95 patients aged 37 to 72 years, (average age 56±9 years), 53 of them were men and 42 were women. Clinical data of three clinical groups were compared, of which the first group with stationary ONA, the second with progressive ONA, and the third control group, without pathology of the retina and optic nerve. Results. It was revealed that the progressive nature of the course of non-glaucomatous ONA is influenced by changes in indicators such as electrical lability of the optic nerve, maximum systolic and end diastolic blood flow velocity in the ophthalmic artery and in the lateral posterior short ciliary arteries. Conclusion. The results formed the basis for our development of a method for assessing the course of ONA. Key words: partial atrophy of the optic nerve, electrophysiological studies, Doppler studies.

Seeing Minds, Matter, and Meaning: The CEEing Model of Pre-Reflective Subjective Construal

Although subjective construal (i.e. our personal understanding of situations and the people and objects within them) has been an enduring topic in social psychology, its underlying mechanisms have never been fully explored. This review presents a model of subjective construals as a kind of seeing (i.e. pre-reflective processes associated with effortless meaning making). Three distinct forms of ‘seeing’ (visual, semantic, and psychological) are discussed to highlight the breadth of these construals. The CEEing Model characterizes these distinct domains of pre-reflective construals as all being Coherent Effortless Experiences. Neural evidence is then reviewed suggesting that a variety of processes that possess the core CEEing characteristics across visual, semantic, and psychological domains can be localized to lateral posterior parietal cortex, lateral posterior temporal cortex, and ventral temporal cortex in an area dubbed gestalt cortex. The link between subjective construals and gestalt cortex is further strengthened by evidence showing that when people have similar subjective construals (i.e. they see things similarly) they show greater neural synchrony (i.e. correlated neural fluctuations over time) with each other in gestalt cortex. The fact that the act of CEEing tends to inhibit alternative construals is discussed as one of multiple reasons for why we fail to appreciate the idiosyncratic nature of our pre-reflective construals, leading to naïve realism and other conflict-inducing outcomes.

Endoscope-assisted microsurgical retrosigmoid approach to the lateral posterior fossa: Cadaveric model and a review of literature

Background: The advancement of endoscopic techniques in the past decade has improved the surgical management of cerebellopontine angle (CPA) tumors. Endoscope-assisted microsurgery improves the ability to evaluate the extent of resection, achieve safe tumor resection and reduce the risk of surgery-related morbidity. Methods: In this study, we used a cadaveric model to demonstrate a step by step endoscope-assisted microsurgery of the retrosigmoid approach to the lateral posterior fossa. Results: Retrosigmoid craniotomies were performed on four latex-injected cadaver heads (eight CPAs). Microsurgical exposures were performed to identify neurovascular structures in each segment. 0° and 30° rigid endoscope lenses were subsequently introduced into each corridor and views were compared in this manner. The endoscopic images were compared with the standard microscopic views to determine the degree of visualization with each technique. In each case, better visualization was provided by both the 0° and 30° endoscope lenses. Endoscopic views frequently clarified neurovascular relationships in obscured anatomic regions. Conclusion: Endoscope-assisted microsurgery could allow better visualization of various regions of the posterior fossa. Surgical planning for posterior fossa lesions should include consideration of this combined approach.

The effect of gender, age, and body mass index on the medial and lateral posterior tibial slopes: a magnetic resonance imaging study

Background The posterior tibial slope (PTS) is crucial in knee joint stability and in maintaining the natural movement of the knee. An increase in the PTS is associated with various knee pathologic conditions, such as anterior cruciate ligament (ACL) injury and anterior tibial translation (ATT). In the present study, we aimed to establish native medial and lateral PTS values for adult Saudis and to identify any association between PTS and gender, age, and body mass index (BMI). Materials and methods A total of 285 consecutive, normal, magnetic resonance imaging (MRI) studies of the knee were included in the study. The PTS was measured using the proximal anatomical axis of the tibia. The Kruskal-Wallis test was used to compare the medial and lateral PTS angles between age groups. The difference between the medial and lateral posterior tibial slopes was assessed using the Wilcoxon signed-rank test. The Mann-Whitney U test was performed to compare the medial and lateral PTS angles between men and women. Age, gender, and BMI were analyzed by multivariate linear regression to determine whether they positively predict the medial and lateral PTS angles. Results The mean physiological medial PTS was 5.86 ± 3.0° and 6.61 ± 3.32°, and the lateral PTS was 4.41 ± 3.35° and 4.63 ± 2.85° in men and women, respectively. This difference showed no statistically significant gender dimorphism (p > 0.05). The medial PTS was significantly larger than the lateral PTS (p < 0.0001). There was no statistically significant difference in the medial and lateral PTS angles between age groups (p > 0.05). Higher BMI was significantly associated with a steeper medial PTS (p = 0.001). Conclusions This study provided native values for medial and lateral PTS angles in Saudis, which can assist surgeons in maintaining normal knee PTS during surgery. The PTS was not influenced by age. The medial PTS was significantly larger than the lateral PTS in men and women. The PTS showed no significant gender dimorphism. BMI was significantly associated with the medial PTS.

Microsurgical anatomy of the lateral posterior choroidal artery: implications for intraventricular surgery involving the choroid plexus

OBJECTIVE The lateral posterior choroidal artery (LPChA) should be a major surgical consideration in the microsurgical management of lateral ventricular tumors. Here the authors aim to delineate the microsurgical anatomy of the LPChA by using anatomical microdissections. They describe the trajectory, segments, and variations of the LPChA and discuss the surgical implications when approaching the choroid plexus using different routes. METHODS Twelve colored silicone–injected, lightly fixed, postmortem human head specimens were prepared for dissection. The origin, diameter, trunk, course, segment, length, spatial relationships, and anastomosis of the LPChA were investigated. The surgical landmarks of 4 different approaches to the LPChA were also examined thoroughly. RESULTS The LPChA was present in 23 hemispheres (96%), and in 14 (61%) it originated from the posterior segment of the P2 (i.e., P2P); most commonly (61%) the LPChA had 2 trunks, and in 17 hemispheres (74%) it had a C-shaped trajectory. According to its course, the authors divided the LPChA into 3 segments: 1) cisternal, from PCA to choroidal fissure (length 10.6 ± 2.5 mm); 2) forniceal, starting at the choroidal fissure, 8.2 ± 5.7 mm posterior to the inferior choroidal point, and terminating at the posterior level of the choroidal fissure (length 28.7 ± 6.8 mm); and 3) pulvinar, starting at the posterior choroidal fissure and terminating in the pulvinar (length 5.9 ± 2.2 mm). The LPChA was divided into 3 patterns according to its entrance into the choroidal fissure: A (anterior) 78%; B (posterior) 13%; and C (mixed) 9%. The transsylvian trans–limen insulae approach provided the best exposure for cisternal and proximal forniceal segments; the lateral transtemporal approach facilitated a more direct approach to the forniceal segment, including cases with posterior entrance; the transparietal transcortical and contralateral posterior interhemispheric transfalcine transprecuneus approaches provided direct access to the pulvinar segment of the LPChA and to the posterior forniceal segment, including cases with posterior choroidal entrance. CONCLUSIONS The LPChA typically runs in the medial border of the choroid plexus, which may facilitate its recognition during surgery. The distance between the AChA at the inferior choroidal point and the LPChA is a valuable reference during surgery, but there are cases of posterior choroidal entrance. Most frequently, there are 2 or more LPChA trunks, which makes possible the sacrifice of one trunk feeding the tumor while preserving the other that provides supply to relevant structures. The intraventricular approaches can be selected based on the tumor location and the LPChA anatomy.

Preoperative obliteration of choroidal arteries in the treatment of large hypervascular tumors in the lateral ventricle

Background Removal of large hypervascular tumors in the lateral ventricle still poses a surgical challenge. These tumors are usually fed from choroidal arteries, and vascular control is typically performed late during the removal. We aimed to evaluate the clinical efficacy of our strategy for persistent preoperative obliteration of feeders from the choroidal arteries to manage large hypervascular tumors in the lateral ventricle. Methods We retrospectively analyzed six patients with hypervascular tumors in the lateral ventricle. We first attempted to obstruct feeders using endovascular treatment, and, if unavailable, performed initial microsurgical occlusion through the temporal horn for the staged tumor removal. Results In all patients, feeder obliteration was successfully performed; the anterior choroidal arteries were occluded by the endovascular treatment and microsurgical occlusion in one and five patients, respectively, while the lateral posterior choroidal arteries were occluded via endovascular treatment in four patients. No patients had permanent symptoms due to feeder obliteration, and tumor devascularization was achieved at the mean rate of 69.9%. During the tumor removal, the mean blood loss volume was 253 ml. No postoperative hemorrhage had occurred, and all patients scored ≤ 2 on the modified Rankin Scale at six months post-removal. Conclusions Although further studies are warranted, persistent feeder obliteration of choroidal arteries could be an effective treatment strategy against large hypervascular tumors in the lateral ventricle.