HISTORY OF EVOLUTION OF POSTERO-LATERAL APPROACHES TO THE THORACIC SPINE: FROM CURE OF POTT’S DISEASE TO EPIDURAL TUMOR RESECTION

Since the end of the nineteenth century, the wide dissemination of Pott’s disease has ignited debates about which should be the ideal route to perform ventrolateral decompression of the dorsal rachis in case of paraplegia due to spinal cord compression in tuberculosis spondylitis. It was immediately clear that the optimal approach should be the one minimizing the surgical manipulation on both neural and extra-neural structures, while optimizing the exposure and surgical maneuverability on the target area. The first attempt was reported by Victor Auguste Menard in 1894, who described, for the first time, a completely different route from traditional laminectomy, called costotransversectomy. The technique was conceived to drain tubercular paravertebral abscesses causing paraplegia without manipulating the spinal cord. Over the following decades many other routes have been described all over the world, thus demonstrating the wide interest on the topic. Surgical development has been marked by the new technical achievements and by instrumental/technological advancements, until the advent of portal surgery and endoscopy-assisted techniques. Authors retraced the milestones of this history up to the present days, through a systematic review on the topic.

Permanent His-bundle pacing in the right atrium in a patient with a Mobitz II atrioventricular block: a case presentation

Background This case report presents a patient diagnosed with sick sinus syndrome who was successfully treated with permanent His-bundle pacing (PHBP). Case presentation A 36-year-old man was transferred to our hospital due to recurrent syncope. He was diagnosed with sick sinus syndrome based on the 24-h Holter and a history of syncope. He was admitted to hospital and successfully treated with PHBP. The postoperative examination showed that the pacing rhythm, pacemaker pacing and perception function were normal. He was discharged without any complications after a successful pacemaker implantation. Conclusions We described a case in which PHBP may become an optimal approach to the management of patients with sick sinus syndrome. Right ventricular pacing has been attempted with inconsistent efficacy outcomes. HBP provides a promising alternative pacing option that might provide symptom resolution to patients with sick sinus syndrome.

Routine and Innovation in Surgical Therapy of Gallstones

This chapter discusses the anatomy of the gallbladder with the anatomical variations potentially impacting surgical therapy. It is dissertated upon the clinical indication for the surgical therapy with consecutive treatment. The discussion on the surgery focuses on the patient’s safety and strategies for safe cholecystectomy with an optimal approach. Even though the efforts to minimise potential complications are made, the complication may arise, and therefore, the last part of this chapter discusses such cases with optimal clinical management.

Current Concepts about Managing of Trauma Patients.

Background: Managing principles for traumatized patients have continued to evolve with advances in technology. Hemorrhage remains the leading cause of morbidity and mortality in trauma, pre-hospital management by well-trained and well-equipped medical teams at the scene as well as in hospitals have continued to improve treatment outcomes. Although new treatment options continue to be evidence, as well as the implementation of concepts related to the optimal time for the operation. Although the preliminary assessment was performed using the Injury Significance Score (ISS) as an assessment and prognostic element to determine the timing of the intervention The current consensus argues that unnecessary delays in fracture care should be avoided while respecting the complex physiology of certain groups of patients who may remain at increased risk for complications. Using innovative techniques and understanding concepts such as the anatomy of traumatic injuries, the optimal approach to the polytrauma patient continues to evolve day by day.

Anti-Synthetase Syndrome Complicated by Pyogenic Myositis

Background: Anti-synthetase syndrome is a rare autoimmune disorder characterized by autoantibodies against aminoacyl-tRNA-synthetases. Inflammatory myopathy and interstitial lung disease could be present among other manifestations. Anti-Jo-1 is the most common antisynthetase antibody and is the most likely to present with the classic triad (interstitial lung disease, myositis, and arthritis) and have more muscle and joint involvement than patients with other antisynthetase antibodies. Case report: Here, we present a case of a 60-year-old female patient, with a previous diagnosis of myositis, secondary to the anti-synthetase syndrome, with a complication by pyogenic myositis. Conclusion: Diagnosis is made by a multidisciplinary approach, occasionally muscle and/or lung biopsy are needed. Imaging studies, Especially magnetic resonance imaging, based on findings such as muscle and fascial edema, and fatty tissue replacement, allow an optimal approach.

Promoting common ground building in L2 cross-cultural conversations

Teaching culture out of context may not be the optimal approach, yet it could be achieved by immersive technologies. This study uses an immersive theme-based environment and focuses on cross-cultural interactions between learners of different cultures in goal-oriented scenarios. We collected interactions among learners with different cultural backgrounds and annotated common ground formation and conversation breakdowns in those interactions. Next, we recreated the scenarios in a 3D immersive environment using an in-house situation creation toolkit to enable experiencing the situation by using choices to navigate the conversation and observing the consequences. In case the conversation derails, we provide timely scaffolding by offering appropriate communication strategies to rebuild common ground. Learners can be the actors of the scenarios but can also be the observers by switching between roles and points of view. Preliminary experiments with 20 L2 learners of English from different cultures showed that practicing with immersive conversational game-play is effective for raising cultural awareness and learning to choose appropriate strategies for smooth interactions.

Surgical Case-Mix and Discharge Decisions: Does Within-Hospital Coordination Matter?

How to Assess the Benefits of Coordination in Managing Hospital Resources In providing patient care, hospitals rely on multiple types of resources, such as operating rooms, recovery beds, labs, and diagnostic equipment, that are often controlled and managed as separate entities and by different decision makers. In “Surgical Case-Mix and Discharge Decisions: Does Within-Hospital Coordination Matter?” Hessam Bavafa, Lerzan Örmeci, Sergei Savin, and Vanitha Virudachalam focus on the interaction between “front-end’’ resources, such as operating rooms, and “backroom’’ resources, such as recovery beds, and compare hospital profitability under the fully coordinated, optimal approach to hospital resource management and under alternative decentralized approaches often encountered in practice. The paper identifies settings in which the benefits of coordination are likely to be high as well as settings in which those benefits are at best moderate. In a given hospital, only hospital managers are in a position to estimate with any degree of certainty potential costs of coordinated management of hospital resources, and the paper’s analysis of the benefits of coordination empowers hospital managers to make informed decisions on the desirability of replacing the often decentralized “status quo” by centralized resource management.

Technological Aspects of Obtaining Liposomes Containing of a Complex of Biologically Active Substances Isolated from Deer Musk

In order to preserve and increase the biological effectiveness of biologically active substances isolated from deer musk, we studied technological aspects of obtaining a substance of lipid-stabilized stable nanoparticles from deer musk. The stability of the obtained substance was evaluated. It was found that homogenization under high pressure is an optimal approach to obtaining biologically active substances from deer musk. The modes of preparation of a liposomal form of biologically active substances with predetermined dispersion parameters (average particle diameter 250 ± 100 nm, polydispersity index 0.3 ± 0.1, and zeta potential from -5 to -35 mV) were determined. It was found that the high-pressure homogenizer “Donor-5” makes it possible to obtain liposomal dispersions with standard parameters and the degree of inclusion of musk biologically active substances up to 60%, at the same time as providing minimal oxidation and hydrolysis of phospholipids (oxidation index 0.3). Our studies showed that the use of a domestic phosphatidylcholine is economically justified and allows obtaining liposomal forms of proper quality. The quality indicators of the obtained liposomal substance were characterised by conventional analytical methods (dynamic light scattering, electron microscopy, gel chromatography, chromatography-mass spectrometry, etc.). On the basis of the results obtained, a draft specification was developed for a liposomal substance (powder) containing a complex of biologically active substances isolated from deer musk. The developed technology for obtaining a liposomal form of biologically active substances from deer musk can be scaled up in accordance with GMP requirements.

Comprehensive targeting of resistance to inhibition of RTK signaling pathways by using glucocorticoids

Inhibition of RTK pathways in cancer triggers an adaptive response that promotes therapeutic resistance. Because the adaptive response is multifaceted, the optimal approach to blunting it remains undetermined. TNF upregulation is a biologically significant response to EGFR inhibition in NSCLC. Here, we compared a specific TNF inhibitor (etanercept) to thalidomide and prednisone, two drugs that block TNF and also other inflammatory pathways. Prednisone is significantly more effective in suppressing EGFR inhibition-induced inflammatory signals. Remarkably, prednisone induces a shutdown of bypass RTK signaling and inhibits key resistance signals such as STAT3, YAP and TNF-NF-κB. Combined with EGFR inhibition, prednisone is significantly superior to etanercept or thalidomide in durably suppressing tumor growth in multiple mouse models, indicating that a broad suppression of adaptive signals is more effective than blocking a single component. We identify prednisone as a drug that can effectively inhibit adaptive resistance with acceptable toxicity in NSCLC and other cancers.

Malignant neoplasm of the bronchi and lung: Russian clinical guidelines

Lung cancer has the highest morbidity rate among all malignant tumors in men and the highest mortality rate in men and women in Russia. In total, 49 145 new cases of lung cancer were registered (diagnosed) in Russia in 2019. The majority of cases are related to exogenic carcinogens and mainly tobacco smoke. For several decades surgical resection with preoperative cytotoxic therapy was an optimal approach for maximal cure rate. This year recommendations were updated with new strategies including adjuvant anti-PD-L1 atezolizumab following completion of chemotherapy in PD-L1 positive patients and osimertinib for EGFR mutated cases. For this moment available data suggest the increase in disease free survival. Strategic approach to treatment for inoperable patients varies according to the status of driver mutations. New approach includes pretreatment option of testing for a wide spectrum of alterations with NGS based panels. Significant changes were incorporated into treatment of ALK mutated NSCLC with two new options of brigatinib for TKI naive patients and lorlatinib for those who progress on second generation drugs. Treatment strategy for patients without activating mutations is based on PD-L1 status. Tsis year recommendations included atezolizumab as a new monotherapy option for patients with high depression of PD-L1. Also treatment options for pembrolizumab, nivolumab and atezolizimab were widened with prolonged treatment schedules.