Vol 13, No 4 (2022)

Background: The incidence of atypical trigeminal neuralgia (aNTN) varies from 1 to 7 per 100,000 population per year. The main cause of its development is compression of the trigeminal nerve (TN) root by a vein and/or artery in the cerebellar cistern. To date, the final tactics of treatment for patients with aNTN has not been specified. The effectiveness of conservative methods of therapy does not exceed 50%.

The aim of this study was to evaluate the results of microvascular decompression using video endoscopy in the treatment of patients with atypical trigeminal neuralgia.

Methods: In the period from 2014 to 2021, 34 patients with aNTN were operated on, of which 18 (53%) patients had neuropathic pain (more than 4 points on the DN4 scale), and 15 (44%) patients had transformation of classical trigeminal neuralgia into atypical neuralgia. The conservative therapy (carbamazepine, gabapentin, pregabalin), administered to all the patients in the preoperative period, was not accompanied by a significant relief of pain syndrome. The maximum intensity of pain upon admission to the hospital was, according to the visual analog scale (VAS), 10 points, according to the BNI (Barrow Neurological Institute) Pain Intensity Scale — V (severe, persistent pain). All the patients underwent microvascular decompression of the trigeminal nerve root with the use of Teflon; in 12 (35%) patients, in addition to microscopy, video endoscopy was used. The average follow-up period after the surgery was 3.4±1.7 years (from 1 to 5 years).

Results: In all (100%) patients, the pain was completely eliminated (BNI I) after the surgery. A total five-year excellent and good outcome of the disease on the J. Miller and BNI scale (I -II) was noted in 80% (n=27) of patients with aNTN. The risk of pain recurrence after microvascular decompression was 14% (n=3) in the first three years, and 34% (n=4) after 5 years. The use of video endoscopy made it possible to identify the blood vessels compressing the root of the trigeminal nerve with a minimal displacement of the cerebellum and cranial nerves when visualizing the neurovascular conflict.

Conclusion: The microvascular decompression method with video endoscopy is effective in the treatment of patients with aNTN.

Background: Since 2021, transarterial chemoembolization of the hepatic arteries (TACE) has been included in the recommendations of professional communities for the treatment of metastases of neuroendocrine liver tumors (NEO). However, the heterogeneity of both this group of patients and types of chemoembolization with a limited range of cytostatics used in the treatment makes it difficult to analyze the data and introduce the method into the combination therapy regimens.

Aim: to study the effectiveness of transarterial chemoembolization with irinotecan-loaded drug-saturable microspheres for the treatment of patients with neuroendocrine tumors with liver metastases.

Methods: A retrospective, observational, uncontrolled study of 34 patients with liver metastases from neuroendocrine cancer who underwent 52 TACE with irinotecan-loaded drug-saturable microspheres. Group 1 consisted of 15 patients who already had liver metastases at the time of the primary focus detection, group 2 included 19 patients with liver metastases having appeared some time after the detection of the primary focus. To plan and evaluate the effectiveness of chemoembolization, computed tomography and magnetic resonance imaging were used every 10–15 weeks during the systemic treatment. All the patients received systemic NEO therapy before and after the embolization.

Results: An increase in the progression-free time from 101 [57; 120] and 145 [89; 263] days after chemotherapy up to 300 [134; 344] and 304 [240; 342] days after TACE in groups 1 and 2, respectively, with no difference between the groups (p=0.31 and p=0.57, respectively). We did not find a linear relationship between the doubling time of the tumor and the change in the volume of the tumor lesion (R²=0.1085 and R²=0.0265 in groups 1 and 2). When comparing the intragroup scores, there was a statistically significant difference (p=0.009, p=0.046) in the tumor volume reduction and progression-free time between the patients who underwent TACE immediately and those who underwent TACE after chemotherapy. The diagnostic and angiographic images of liver metastases varied within the same organ and depended on the size of metastases. There were no adverse events after TACE.

Conclusions: TACE with irinotecan-loaded drug-saturable microspheres is an effective method for the treatment of liver metastases of neuroendocrine cancer, allowing one to increase the time without progression.

Background: Distal femoral fractures are a widely spread problem in traumatology, which can be caused by both a high-energy trauma and a low-energy trauma in senile patients with osteoporosis. The conservative treatment shows little promise. The surgical treatment of patients is still a challenge for orthopedic surgeons regarding both the technical aspect and a high risk of complications. There are several surgical methods with the use of plates and nails, but there is still no universal conception of the surgical treatment.

Aim: comparative analysis of methods of intramedullary retrograde osteosynthesis and bone osteosynthesis in the treatment of fractures of the distal femur.

Methods: In this study, we evaluated the treatment results of 46 patients who underwent osteosynthesis for intraarticular fractures of the distal femur using an intramedullary retrograde nail. The evaluation was carried out based on such parameters as the duration of the operation and the time from the moment of injury to the operation, the intraoperative blood loss and the function of the knee joint. On average, the operation time using a retrograde femoral nail was 45 minutes. Reducing the duration of the operation improved the functional results of the treatment. Reducing the operation time when installing a retrograde intramedullary nail was achieved with a relatively simple technique for installing this type of a fixator and the use of minimally invasive approaches.

Results: On average, the operation time using a retrograde femoral nail was 45 minutes. Reducing the duration of the operation improved the functional results of treatment. Reducing the operation time when installing a retrograde intramedullary nail was due to a relatively simple technique for installing this type of fixator and the use of minimally invasive approaches. One year after the surgery, the following mean values were achieved: 78 (64–85) points according to the KSS knee score, 85 (68–89) points according to the KSS function score, 3.1 (1.3–4.2) cm for the severity of pain syndrome according to the VAS scale, 105 (88–120) degrees for the flexion in the knee joint. However, a number of post-op complications were observed: deep vein thrombosis of lower extremities was found in 6 (13.1%) patients, formation of a false-joint was seen in 3 (6.5%) patients, 1st grade arthritis of the knee joint was detected in 36 patients (78.2%), 2nd grade arthritis was observed in 10 patients (21.8%). 3rd grade arthritis was not detected. 3.5 years after the operation, none of the patients needed a knee joint replacement.

Conclusion: Retrograde intramedullary osteosynthesis in type C distal femoral fractures promotes early rehabilitation, a complete recovery of the knee joint function and healing of the fracture, and represents an effective method of treatment.

Sarcopenia is a multifactorial syndrome with an insufficiently studied pathogenesis, manifested by a generalized loss of muscle mass and skeletal muscle strength. Despite the fact that sarcopenia is a risk factor for mortality and disability, especially in the elderly, this pathology is rarely diagnosed. The lack of the uniform criteria for the diagnosis and comorbidity of the elderly patients create difficulties in the differential diagnosis of this condition. Sarcopenia is most often combined with endocrine pathologies, such as obesity and diabetes mellitus. An accelerated decrease in the muscle mass leads to a decrease in insulin sensitivity, resulting in insulin resistance, which, in turn, leads to the excessive accumulation of adipose tissue — sarcopenic obesity. The results of the studies indicate a higher risk of metabolic syndrome, type 2 diabetes mellitus and atherosclerosis among individuals with sarcopenic obesity, as opposed to those with simple obesity or sarcopenia. A vicious circle consisting of age-related changes in the skeletal muscles, obesity and impaired glucose regulation leads to a more severe course of diseases and a negative impact on a person's life expectancy. Due to the fact that there are presently no clear criteria for the diagnosis of sarcopenic obesity, there are no unambiguous data on its prevalence. A search for the modern methods of research, prevention and treatment of this condition is required.

The development and viability of an organism relies on tissue-specific gene programs. The genome regulatory elements play a key role in the regulation of such programs, whereas its disfunction can lead to the establishment of various pathologies, including cancer, congenital disorders, and autoimmune diseases. The development of high-throughput approaches in genomics has led to the emergence of massively parallel reporter assays (MPRA), which enable genome-wide screening and functional verification of regulatory elements. Although MPRA was originally used for investigation of fundamental aspects of epigenetics, it also has a great potential for clinical and practical biotechnology. Currently, MPRA is used for validation of clinically significant mutations, identification of tissue-specific regulatory elements, identification of the favorable loci for transgene integration, as well as represents an essential tool for creating highly efficient expression systems, with a wide range of applications from protein production and design of novel therapeutic antibody super-producers to gene therapy. In this review, the basic principles and areas of practical application of high-throughput reporter assays will be discussed.

Background: Neuroaspergillosis has nonspecific clinical manifestations and a severe course. Cases of central nervous system aspergillosis are becoming more frequent. Its lifetime diagnosis is very difficult. At the same time, a timely diagnosis makes it possible to conduct an adequate specific therapy and save the patient's life.

Clinical case description: We report a clinical case of a patient with a lethal damage to the brain by filamentous fungi, who did not have the risk factors described in the literature — human immunodeficiency virus (HIV), neutropenia, organ and tissue transplantation, long therapy with immunosuppressive drugs or corticosteroids.

Conclusion: One needs to consider a possibility of this pathology in patients even in the absence of a fever and immunodeficiency conditions. A specific study of biological fluids for the presence of the galactomannan antigen may allow one to establish a timely correct diagnosis and apply an adequate treatment.

Background: Posttraumatic axillary nerve neuropathy is a widely spread pathology, more often seen after a shoulder joint trauma. It can also appear as a complication after orthopedic surgeries, for example, after the Latarjet procedure for shoulder stabilization. The technique of open axillary nerve decompression is very popular but has a number of disadvantages: a large trauma of soft tissue, severe bleeding, a high rate of complications, and also a poor cosmetic effect. The endoscopic surgical technique of decompression is an effective and less traumatic alternative to open procedures.

Clinical case description: We present the results of endoscopic transcapsular axillary nerve decompression in 5 patients with a clinical picture of neuropathic pain syndrome, hypoesthesia in the deltoid area, hypotrophy of the deltoid muscle, who were operated from 2018 to 2021. The mean age of patients was 44.4±14.9. An original surgical technique of decompression was developed and applied to all the patients which included arthroscopy of the shoulder joint with diagnostic and treatment components and transcapsular endoscopic axillary nerve decompression in the beach-chair position. The statistical analysis was performed using the Mann–Whitney U test. According to the VAS-scale, the severity of pain syndrome before the surgery was 6±4.6 points, while 6 months after the surgery it decreased to 1.4±0.5 points (p <0.05). According to the DASH scale, the function of the shoulder joint before the surgery was 77.6±6.9 points, and 6 months after surgery it increased to 12±5.2 points (p <0.05). According to the BMRC scale (M0–M5), the strength of the deltoid muscle before the surgery was 2±0.4 points, and after the surgery it increased to 4.4±0.5 points (p <0.05). The range of motion in the shoulder joint was as follows: before the surgery — flexion 107±45.6°, extension 102±49°, external rotation 22±13.6°; 6 months after the surgery — flexion 154±25.6°, extension 156±22.4°, external rotation 50±8° (p <0.05). The thickness of the middle portion of the deltoid muscle according to the US was 7.2±1.04 mm before the surgery, 11.8±1.44 mm after the surgery (p <0.05). All the patients (100%) at a long-term follow-up noticed complete relief of pain and regression of the neurological symptoms.

Conclusion: The achieved results allow us to characterize the method of endoscopic transcapsular decompression as a reproducible, minimally invasive and highly effective technique, providing pain relief to patients, curing neurological and intraarticular pathology, thus promoting early restoration of the upper limb function in the treated group of patients.

Editorial board of the journal informs authors about the retraction of the article «Short-Term Results of Two Strategies in Thoracoscopic Ablation for Lone Atrial Fibrillation» published in Journal of Clinical Practice 13(3) 2022 by A.S. Zotov, O.Yu. Pidanov, I.S. Osmanov, A.V. Troitsky, A.A. Silaev, E.R. Sakharov, V.N. Sukhotin, O.O. Shelest, R.I. Khabazov, D.A. Timashkov. The reason for the retraction is the publication ethics violation in terms of authorship criteria. Not all authors whose names appear on the article made substantial contributions to the study drafted/revised the manuscript and approved the version to be published.

Retraction made on January 09, 2023 with approve from the Editor-in-Chief.