The goal of this research is to improve the accuracy of predicting the breast cancer (BC) pro- cess using the original mathematical model referred to as CoMPaS. The CoMPaS is the original mathematical model and the corresponding software built by modelling the natural history of the primary tumor (PT) and secondary distant metastases (MTS), it reflects the relations between the PT and MTS. The CoMPaS is based on an exponential growth model and consists of a system of determinate nonlinear and linear equations and corresponds to the TNM classification. It allows us to calculate the different growth periods of PT and MTS: 1) a non-visible period for PT, 2) a non-visible period for MTS, and 3) a visible period for MTS. The CoMPaS has been validated using 10-year and 15-year survival clinical data con- sidering tumor stage and PT diameter. The following are calculated by CoMPaS: 1) the number of doublings for the non-visible and visible growth periods of MTS and 2) the tumor volume doubling time (days) for the non-visible and visible growth periods of MTS. The diameters of the PT and secondary distant MTS increased simultaneously. In other words, the non-visible growth period of the secondary distant MTS shrinks, leading to a decrease of the survival of patients with breast cancer. The CoMPaS correctly describes the growth of the PT for patients at the T1aN0M0, T1bN0M0, T1cN0M0, T2N0M0 and T3N0M0 stages, who does not have MTS in the lymph nodes (N0). Additionally, the CoMPaS helps to con- sider the appearance and evolution period of secondary distant MTS (M1). The CoMPaS correctly describes the growth period of PT corresponding to BC classification (parameter T), the growth period of secondary distant MTS and the 10-15-year survival of BC patients considering the BC stage (parameter M).
Electrocorticography (ECoG) is a standard procedure for the localization of the epileptogeniczone during the surgical treatment of symptomatic epilepsy. The purpose of this study was to evaluate the diagnostic efficacy of intraoperative pre- and post-resective ECoG for the localization of the epileptogenic zone in patients with symptomatic epilepsy associated with supratentorial brain tumors. 1. In the surgical treatment of symptomatic epilepsy associated with intracerebral neoplasm, intraoperative ECG remains a relatively effective method. 2. The effectiveness of intraoperative pre- and post-resection ECoG is affected by factors associated with the performance of neurosurgical surgery (the influence of general anesthetics, mechanical effects on the brain, repeated electrocoagulation), which significantly alter the index of epileptiform activity.
Ligation of the sphenopalatine and posterior nasal arteries is indicated for posterior epistaxis as initial treatment or when conservative measures fail. In some patients, a transnasal approach or its alternative transantral approach are not possible due to tumor filling the nasal corridor, pterygopalatine fossa, or maxillary sinus. Aim of this study was to evaluate feasibility of endoscopically assisted transoral approach for the ligation of the maxillary artery (MA). Six fresh cadaver specimens (12 sides), previously prepared with intravascular injections of colored latex, were dissected. A combined transnasal and transoral approach exposed the MA from the deep belly of the temporalis muscle laterally to its terminal branches medially. Anatomical relationships of the MA with the deep belly of the temporalis muscle and the lower head of the lateral pterygoid muscle, and feasibility of access to the MA via a transoral approach were assessed. In all specimens, the MA was found at the point where horizontal fibers of the lower head of the lateral pterygoid muscle cross the vertical fibers of the deep belly of the temporalis muscle. In 5 specimens, the artery ran anteriorly and laterally to lower head of the lateral pterygoid muscle, and in 1 specimen, it ran posteriorly and medially to this muscle, diving between its fibers. The modified endoscopically assisted transoral approach is feasible to ligate the MA. It can be used for proximal vascular control in cases when transnasal and transantral approaches are not viable.
Nasal chondromesenchymal hamartoma (NCMH) is a rare benign tumor of the sinonasal tract in children with possible orbit and skull base involvement. We present the 57th published observation of this kind of tumor. A 25-month-old female patient presented with recurrent mass lesion of the sinonasal tract. According to her history, she had feeding difficulties and nasal obstruction since birth. She underwent partial resection at eight months of age via transfacial approach in the local hospital. Due to progression of tumor remnants, a second surgery was performed using an endoscopic endonasal approach resulting in subtotal resection. At 12 months of follow-up, a good postoperative result was observed with no signs of tumor progression despite incomplete resection. Histological and immunohistochemical examination of the biopsy specimens is presented. Comparison of specimens obtained from each of the two surgeries showed a difference in histological patterns. Endoscopic endonasal approach is the mainstay of surgical management. In case of incomplete resection, careful follow-up MRI studies should be recommended.
Objective Removal of brain tissue generating pathological high-frequency oscillations (pHFOs) has been related to better seizure outcome than resection of seizure onset zone. However, there is still a lack of understanding what oscillations are to be considered pathological. Methods A female patient (age 53) with 10 year duration of temporal lobe tumor-related epilepsy was admitted to Polenov’s Neurosurgery Institute for tumor resection. The patient underwent a two-staged surgery with subdural implantation of a grid electrode (4 × 5) over the temporal lobe to identify the epileptogenic zone (EZ). During the second stage wideband intraoperative electrocorticography (iECoG) was recorded (up to 500 Hz, sampling frequency 2000 Hz, Mitsar-EEG 202 amplifier). Results Electrocorticographic monitoring data were subjected to visual analysis in traditional frequency range (0.5–70 Hz). Six of 20 electrodes were marked as EZ electrodes. The distance between tumor margin and EZ electrodes reached 1–2.5 cm. Subpial resection of this zone was arranged. During the surgery iECoG data in 0.5–70 Hz frequency band were uninformative, while in 80–500 Hz range bursts of fast ripples (250–500 Hz, 100 μV, extended up to 3 s) were recorded over the marked EZ electrodes. The tumor and EZ were completely resected. Discussion Observed data demonstrate that HFOs coincide with EZ marked during long-term monitoring. The patient is seizure-free for 5 months at the moment, though a more prolonged follow-up is required. Conclusion Wideband iECoG recordings might give us more essential information in case of tumor-related epilepsy. As is shown, fast ripples may be a valid marker of EZ. Significance Pathological HFOs show promise for optimising epilepsy surgery in tumor-related epilepsy.
The burden of stroke in low- and middle-income countries (LMICs) is large and increasing, challenging the already stretched health-care services.
AIMS AND OBJECTIVES:
To determine the quality of existing stroke-care services in LMICs and to highlight indigenous, inexpensive, evidence-based implementable strategies being used in stroke-care.
A detailed literature search was undertaken using PubMed and Google scholar from January 1966 to October 2015 using a range of search terms. Of 921 publications, 373 papers were shortlisted and 31 articles on existing stroke-services were included.
We identified efficient models of ambulance transport and pre-notification. Stroke Units (SU) are available in some countries, but are relatively sparse and mostly provided by the private sector. Very few patients were thrombolysed; this could be increased with telemedicine and governmental subsidies. Adherence to secondary preventive drugs is affected by limited availability and affordability, emphasizing the importance of primary prevention. Training of paramedics, care-givers and nurses in post-stroke care is feasible.
In this systematic review, we found several reports on evidence-based implementable stroke services in LMICs. Some strategies are economic, feasible and reproducible but remain untested. Data on their outcomes and sustainability is limited. Further research on implementation of locally and regionally adapted stroke-services and cost-effective secondary prevention programs should be a priority.
The Oxford Cognitive Screen (OCS) is a screening tool for the assessment of poststroke deficits in attention, memory, praxis, language, and number processing. The goal of the present study was to develop a Russian version of the OCS (Rus-OCS) via translation of the original battery, its cultural and linguistic adaptations, and reporting preliminary findings on its psychometric properties.
All parts of OCS were translated by native Russian-speaking neuropsychologists. Russian-speaking stroke patients (N = 205) were assessed with the Rus-OCS. Their performance was compared with performance of 60 healthy Russian-speaking adults aged between the ages of 18 and 91 years. The performance of 15 stroke patients and 42 healthy adults were assessed with a parallel version within 7 days of first testing. Convergent validity of the Rus-OCS was established via correlations with comparable tasks. Performance of three stroke groups with different lesion lateralization (right, left, and bilateral) was compared on language and visual attention subtasks. Preliminary normative data based on 5th to 95th percentile were also reported.
Measures of internal consistency and test-retest reliability ranged from acceptable to very good and estimates of convergent validity ranged from moderate to high. Sensitivity and specificity was found to range from .56 to 1 and from .73 to 1, respectively. Significant differences in performance between stroke and healthy groups on all subtasks confirmed the discriminative power of the Rus-OCS was good.
Rus-OCS is a promising cognitive screening instrument for Russian-speaking patients. However, further validation is needed. Constraints of socioeconomic differences between Russian speakers in the wider population should be considered. (PsycINFO Database Record (c) 2018 APA, all rights reserved).
CONTEXT: Mood disorders are prevalent in people after stroke, and a disorder's onset can exacerbate stroke-related disabilities. While evidence supports the mental-health benefits of participation in exercise and yoga, it is unknown whether such benefits extend to a population with poststroke hemiparesis.
OBJECTIVE: The study investigated whether supplementing exercise with participation in a yoga program would provide further improvements in self-reported symptoms of depression and anxiety in a chronic poststroke population, and it also assessed trial feasibility for future studies.
DESIGN: The research team designed a randomized, controlled pilot trial that included an exercise-only group (EX, control) and a yoga-and-exercise group (YEX, intervention).
SETTING: The study took place at the Centre for Physical Activity in Ageing an exercise rehabilitation and activity center at the Royal Adelaide Hospital in South Australia.
PARTICIPANTS: The participants included 14 individuals with chronic poststroke hemiparesis: eight in the intervention group and six in the control group.
INTERVENTIONS: The YEX group participated in a 6-week standardized program that included yoga in weekly group sessions and home practice in addition to exercise in a weekly group class. The EX group participated only in the group exercise class weekly for 6 weeks.
OUTCOME MEASURES: The research team assessed self-reported symptoms of depression using the Geriatric Depression Scale (GDS15) and symptoms of anxiety and negative affect using the State Trait Anxiety Inventory (STAI). The team based the feasibility evaluation on recruitment outcomes, retention of participants, participants' compliance with the intervention program, and the safety of the intervention.
RESULTS: Changes in depression and state and trait anxiety did not significantly differ between intervention groups (GDS15 P=.749, STAI-Y1, P=.595, STAI-Y2, P=.407). Comparison of individuals' case results indicated clinically relevant improvements in both groups, although members of the intervention group had greater improvements. Participants reported no adverse events, and the study experienced high retention of participants and high compliance in the yoga program.
CONCLUSIONS: This pilot study provides preliminary data on the effects of yoga combined with exercise to influence mood poststroke. It is a feasible, safe, and acceptable intervention, and the field requires additional investigations with a larger sample size.
Background. Many tumors of different histologic structure originate from the anterior skull base. These lesions may be highly vascularized leading to limited resection and severe intraoperative blood loss. Midline tumors are primarily supplied by ethmoidal arteries, which are not subject to endovascular embolization. Aim of this study was comparative experimental analysis of different surgical approaches to the ethmoidal arteries.
Materials and methods. The anatomical study was performed on 12 fresh human cadavers without diseases involving the anterior skull base, orbits, and paranasal sinuses (24 sides). In all specimens internal and external carotid arteries were injected by silicone dye. Anatomical dissection was carried on investigating four different minimally invasive endoscopic approaches to the ethmoidal arteries: 1) transorbital approach to the ethmoidal arteries via bicoronal incision; 2) pre/trans/retrocaruncular approach to the ethmoidal arteries; 3) endoscopic endonasal transethmoidal approach to the canals of ethmoidal arteries; 4) endoscopic endonasal transethmoidal-transorbital approach to the ethmoidal arteries in the orbit.
Results. Surgical technique of the mentioned approaches was described, and their advantages and disadvantages were analyzed. We propose the algorithm for selection of direct endoscopic ligation of ethmoidal arteries based on selected surgical approach for tumor resection and its extracranial extension.
Conclusion. Decision making for tumor devascularization must be substantiated by visualization of vasculature (CT or MR angiography). The study has demonstrated advantages and disadvantages of different endoscopic approaches to the ethmoidal arteries for their ligation aiming at early devascularization of anterior skull base lesions. All four are minimally invasive and provide good functional outcome and cosmesis.
The article presents the literature data on the structural variability and age-related features of the midline anatomical structures of the anterior skull base (frontal sinus, ethmoid bone, anterior parasellar region, and medial orbital wall). This is the area of surgical interests of neurosurgeons and rhinosurgeons. The study objective is to analyze the literature data on the individual variability and age-related anatomy of these structures. The work is illustrated with original images from the authors’ personal archive. The individual anatomical features of eloquent structures in the surgical area (structures within the surgical corridor, key anatomical landmarks, optic tract, internal carotid and ethmoidal arteries, etc.) should be considered in planning surgery in patients of all age groups because they can limit the view and the amount of safe manipulations or increase the risk of complications. The presented data may be useful for neurosurgeons and otolaryngologists whose surgical interests are focused on the midline structures of the anterior skull base.
Material and methods. 122 patients had been scheduled for elective lumbar fusion in 2010-2016 was enrolled in a prospective study. Group K (n=19) underwent postoperative analgesia on-demand. Group PMA (n=21) was given preventive multimodal analgesia (PMA) including ketoprofen, paracetamol and morphine. At PMA+PG (n=20) and PMA+N (n=20) groups pregabalin and nefopam were used respectively; at PMA+E (n=22) epidural ropivacaine with morphine was combined; at PMA+I (n=20) continuous wound infiltration by ropivacaine with ketorolac was administered. Results and conclusions. Postoperative analgesia on-demand is not adequate during 5 postoperative days. PMA results in significant pain reduction during 3 postoperative days, enhancement of patient satisfaction, quicker recovery after surgery and fewer days of hospital stay. Patients receiving pregabalin or nefopam as well as epidural analgesia does not lead to better postoperative pain relief than at PMA, but shows a trend to increase the rate of adverse reactions. Wound infiltration with PMA is followed by significant pain relief during 6 postoperative hours, decrease in opioids consumption, rate of adverse reactions and duration of hospital stay (compared to PMA group).
Background. Predicting the efficacy of rGH therapy in patients with GH deficiency, based on the final achieved height (FAH) criterion, is an important tool for the clinician. It enables a personalized approach to the treatment of patients with GH deficiency: to recommend careful adherence to the regimen and dosage of the drug, evaluate the efficacy of therapy in different groups of patients, and clearly demonstrate the factors affecting the FAH indicator. Aim - to develop mathematical models for predicting FAH and its standard deviation score (SDS) in patients with GH deficiency in the Russian population. Material and methods. For simulation, we used the data of 121 patients diagnosed with GH deficiency who received rGH since the time of diagnosis to the time of final height and were followed-up at the Institute of Pediatric Endocrinology of the Endocrinology Research Centre in the period between 1978 and 2016. As model predictors, we used 11 indicators: the gender, chronological age at the time of GH deficiency diagnosis, puberty status, disease form, regularity of rGH therapy, height SDS at birth, height SDS at the time of GH deficiency diagnosis, bone age at the time of GH deficiency diagnosis, bone age/chronological index, SDS of a genetically predicted height, and maximum stimulated GH level in a clonidine test. To generate models, we used multiple linear regression, artificial neural networks (ANNs), and the Statistica 13 software. Results. The developed ANNs demonstrated a high accuracy of predicting FAH (the root-mean-square error was 4.4 cm, and the explained variance fraction was 76%) and a lower accuracy of predicting the FAH SDS (the root-mean-square error was 0.601 SDS, and the explained variance fraction was 42%). Linear regression models that were based on quantitative predictors only had a substantially worse quality. Free software implementation was developed for the best produced ANN. Conclusion. An ANN-based software-implemented model for predicting FAH uses indicators available for any clinician as predictors and can be used for individual prediction of FAH. In the future, the use of larger databases for simulation will improve the quality of predicting the efficacy of rGH therapy.
Objective. To identify the most frequently occurring symptoms resulting from the affection of internal and external skull base in patients with benign tumors of the anterior and middle cranial base. Material and methods. The authors analyzed a complex of history, clinical, and instrumental data as well as results of combined treatment of 642 patients with benign tumors of the anterior and middle cranial base operated Medical Research between 2007 and 2011. Results. Neurological signs and symptoms in patients with benign tumors of the anterior cranial base, parasellar region, and middle cranial fossa were studied. In the majority of cases, the tumor extended extracranially. The most common groups of symptoms were identified and described, the most important groups are presented in the diagrams. The proposed scheme is applicable also for malignant tumors or other mass lesions of the same localization. Conclusion. Effective treatment and selection of the best management of a patient depends on modern medical approaches and techniques including neuroimaging. Careful assessment of symptoms is crucial in detection of tumors in the early stage. Dynamic monitoring of the patient using the proposed scheme will contribute to early detection of tumor recurrence or progression.
This article is devoted to the methodological issues of the application of artificial intelligence techniques in preventive medicine. We showed a specific example of the neural network application allows not only to diagnose cardiovascular diseases, but also on a quantitative basis to predict their emergence and development in future periods of life. This allows you to select the optimal strategy for the prevention and treatment of patients based on their individual parameters. The article concluded: recommendations for the prevention and treatment of cardiac patients should be given strictly individually, taking into account physiological peculiarities of the organism of patients. If for some patients it is useful to give up Smoking, limit the consumption of sweets, take drugs, reduce blood pressure, etc., for other patients, these recommendations may cause harm. Our intelligent system helps to identify such non-standard patients and to avoid incorrect recommendations. The prototype of the proposed system laid out in the "Projects" section on the website www.PermAi.ru.
Description of the statistical analysis of the data contained in original articles. Typical mistakes
Introduction. The concept of health-related quality of life as a key factor in patient-doctor interactions is an important basis for making managerial and medical decisions in many foreign health systems. In Russia, the concept of health-related quality of life is in its infancy: it is required the theoretical, methodological and scientific-practical foundations development.
Aims and objectives. The aim of this study is to assess the health- related quality of life for Russian population based on the EQ–5D questionnaire and to form the average health indicators.
Material and methods. The survey was conducted on a sample of 1,602 people aged 18 to 92 years. The final sample is representative for the country and federal districts. We use using the Russian-language version of the EQ–5D questionnaire which allows us to receive two indicators for each respondent – health profile and index based on visual analog scale EQ–VAS.
Results. The study revealed the following results: (1) the majority of the respondents among all ages have the problems in EQ-5D dimension “anxiety/depression”; (2) women tend to detect moderate problems in all dimensions more often than men; (3) EQ–5D descriptive results are decreased in all components with the respondents age; (4) the most infrequent population’s problems among the all dimensions are found in the "self-care" dimension; (5) the age changes related to a decrease of EQ–VAS are associated with the general tendency of a decrease in the dimensions.
Discussion. To obtain the most accurate and objective assessments from the EQ–5D, it is necessary to conduct a study in accordance with established international protocols, compare the estimates with the average population indices and adhere to a thorough research design.
Conclusion. The study reveals the possibilities of using EQ–5D and the first health-related quality of life Russian population indicators that can be used as a basis for comparing between different population groups and patients.
Objective: to determine the influence of perioperative analgesia methods on the incidence of « failed back surgery syndrome» after intervertebral discal hernia removal. Material and methods: This prospective study was conducted from 2010 till 2013 and included 129 patients who underwent lumbar discectomy regarding intervertebral discal hernia. Patients of group GA+R (n=20) were operated on under general anesthesia (GA) and received «analgesia at request» (R) in postoperative period. Group SA+PMA included patients (n=23) who were operated under spinal anesthesia (SA) with the following usage of preventive multimodal analgesia (PMA) based on ketoprofen, paracetamol and nalbuphine. General anesthesia and PMA was used in GA+PMA (n=21) group; the additional wound infiltration by bupivacaine solution (I) was used in GA+PMA+I (n=21) group; application of corticosteroids (A) in the area of damaged spinal root - in GA+PMA+A (n=20) group; combination of wound infiltration by bupivacaine solution and application of corticosteroids - in GA+PMA+IA (n=24) group. The intensity of acute postoperative pain was assessed within 7 postoperative days. The phone interview was conducted in 6 months after operation with examination of long-term outcomes of surgical treatment. Results: The analgesia was inadequate in all patients of GA+R group within 4 postoperative days comparing with adequate analgesia in patients of GA+PMA group during whole period of observation. The pain syndrome within first 4 postoperative days had significantly lower intensity among patients of GA+PMA group comparing with GA+R group. Patients of SA+PMA group reported that pain intensity was significantly lower only during first 2 hours after operation comparing with GA+PMA group. Patients of GA+PMA+I and GA+PMA+IA groups had lower intensity pain within 2 postoperative days comparing with GA+PMA group. Studying the long-term outcomes of surgical treatment it was revealed that 60% of patients had back and/or lower extremity pain, among them 30% - lower extremity pain in 6 months after operation. The mean pain intensity was assessed as 2,85 (2; 3) according to numeric rating scale, 24% of patients suffered from chronic pain reported about sleep disturbances, 23% - significant reduction in the life quality, 25% of patients were были unable to work. There were no statistically significant differences between examined groups concerning incidence of chronic back and/or lower extremity pain as well as lower extremity pain (p=0,459 и p=0,903 consequently, x2test) and mean pain intensity (p=0,112, Kruskal-Wallis test ANOVA) in 6 months after operation. Conclusion: The usage of preventive multimodal analgesic schemes provides the adequate pain control within 7 postoperative days while the usage of analgesia at request does not allow solving this challenge within first 4 postoperative days after intervertebral discal hernia removal. The spontaneous release of pain intensity is seen after 4th postoperative day. The SA usage in patients with discal hernia provides the pain release only during first several hours after operations (within time of residual subarachnoid block) comparing with patients underwent surgery under GA. The usage of wound infiltration by bupivacaine solution allows achieving the lowering of pain intensity during first 2 postoperative days comparing with patie nts without wound infiltration. The 60% of patients suffered from back and/or lower extremity pain and 30% of patients - from lower extremity pain in 6 months after operation/ More over the chronic severe pain syndrome is observed in 23-25% of patients, accompanied by sleep disturbances, inability to work and significant reduction in the life quality The incidence of failed back surgery syndrome occurrence after intervertebral discal hernia removal is independent of perioperative analgesia schemes.
The risk factors for acute pain as well as chronic pain syndrome (CPS) in spine surgery have not been defined to date. Purpose — to define the prognostic parameters of acute pain severity and the risk of CPS in patients operated on for spinal diseases and injuries. Material and methods. The study included 291 patients operated on for degenerative diseases and injuries of the spine at the Sklifosovsky Research Institute of Emergency Medicine in 2010―2016. Sociodemographic and clinical data and the psychological status of patients were evaluated. A mechanical algometer was used to measure the pain threshold (PT) and pain tolerance. The movement pain intensity was assessed by using a visual analog scale (VAS) on the day of surgery. Pain was considered minor at a median score of 0―4 cm and severe at a median score of 5―10 cm. The presence of CPS was assessed during a telephone survey 5―7 months after surgery. Results. The gender, PT, dynamic pain intensity before surgery, and expectation of postoperative pain are risk factors for severe acute postoperative pain. A multinomial logit regression model (Hosmer—Lemeshow test ― 4.322; p=0.827) predicts minor dynamic pain on the 1postoperative day with an accuracy of 70% (95% CI 63—76). The age and dynamic pain intensity on the 1postoperative are the risk factors for CPS; the multinomial logit regression model (Hosmer—Lemeshow test ― 3.1; p=0.928) predicts CPS with an accuracy of 65% (95% CI 59—71) 5―7 months after surgery. Conclusion. The developed software in the form of MS Excel calculators provides a particular patient with preoperative assessment of the risk for minor acute dynamic pain on the 1postoperative day and CPS 5―7 months after surgery.