Complete Restoration Of Function Research Articles

Long-term Outcomes of Surgical Correction of Ischemic Mitral Regurgitation

Objective: To evaluate long-term outcomes of mitral valve annuloplasty using an autologous pericardial strip (“soft support ring” type) and a rigid support ring in combination with coronary artery bypass graft (CABG) in patients with ischemic mitral regurgitation.Materials and methods: We carried out retrospective and prospective analyses of the treatment outcomes in 90 patients with coronary heart disease (CHD) and ischemic mitral regurgitation. Ischemic mitral regurgitation (grade 2 or above) was an inclusion criterion for patients with CHD. Exclusion criteria were as follows: nonischemic mitral regurgitation, acute myocardial infarction, progressive angina pectoris, and repeated heart interventions. The patients were divided into 2 groups. Patients from group 1 underwent CABG with mitral regurgitation correction using a strip of glutaraldehyde-treated autologous pericardium (“soft support ring” type) according to our own method, whereas patients from group 2 underwent CABG with mitral regurgitation correction using a rigid support ring. The analysis revealed that the groups were comparable in all the studied parameters.Results: There was no statistically significant difference in the number of postoperative complications and hospital mortality between the groups. According to the analyzed data obtained at the time of discharge, all the patients had grade 0-1 mitral regurgitation, which shows a complete restoration of the mitral valve function after annuloplasty. In addition, there was a statistically significant decrease in the end-diastolic volume and an increase in ejection fraction, which is a sign of reverse left ventricular (LV) remodeling. The mean follow-up was 44±7.4 months. No deaths were reported during the follow-up. The results of the examination in the long-term period did not reveal negative dynamics in most patients compared with the findings in the early postoperative period. The LV size also did not change significantly, and the ejection fraction demonstrated an upward trend. One patient in each group had a recurrence of grade 3 mitral regurgitation.Conclusions: The immediate outcomes showed no recurrence of mitral regurgitation, a low number of intraoperative and postoperative complications, and pronounced reverse LV remodeling. We observed stable results in the long-term follow-up: only one patient in each group had a recurrence of mitral regurgitation. Reverse LV remodeling persisted throughout the follow-up. There were no significant differences between the groups in any parameter, which indicates that the developed annuloplasty method is not inferior to the traditional technique with a rigid support ring.

A typical case of miraculous relief from blindness

This article describes a case of hysterical amblyopia in a 10.5-year-old girl. She complained of decreased vision for 4 months. The decrease in vision was a result of infectious mononucleosis and conjunctivitis. During the initial examination, typical signs of hysterical amblyopia were observed: a bilateral decrease in visual acuity, loss of field to tubular, and a corresponding impaired orientation in the surrounding space. Reversible changes in visual evoked potentials (VEP) were noted, indicating functional changes in the visual system, impaired color perception. A complete ophthalmological examination was performed, including standard methods and electrophysiological studies. Upon repeated examination after 1 day, complete relief of signs of hysterical amblyopia was noted, namely, an increase in visual acuity to 1.2, expansion of the boundaries of the visual field to normal values, normal binocular and accommodation functions, and normal trichromasia. This case was unique because of the complete restoration of visual functions that occurred spontaneously within 1 day. For the first time, reversible changes in visual evoked potential that were not previously described in the literature were revealed, and an undifferentiated violation of color perception was described.

Rationale and design of the ELEANOR trial early aortic valve surgery versus watchful waiting strategy in severe asymptomatic aortic regurgitation, ACRONYM: ELEANOR

BackgroundThe optimal treatment of patients with severe symptomatic aortic regurgitation (AR) is state-of-the-art surgery. Asymptomatic patients with advanced left ventricular (LV) dilatation and/or impaired ejection fraction should undergo surgical treatment, but there is no guidelines consensus on cut-off values for this recommendation. Multimodality imaging has brought new tools for the accurate selection of asymptomatic patients at risk of early clinical deterioration, however, prospective and randomized data are pending. Cardiac magnetic resonance (CMR)-derived AR quantification along with LV remodeling assessment appears to be the most accurate tool for a selection of such patients at risk. Trial designThe objective of our prospective and multicenter study is to determine whether patients at risk of early clinical deterioration as per CMR assessment will benefit from early surgical treatment. The study is designed as a superiority trial to demonstrate that early surgical treatment is safe and more effective than the standard treatment. A total of 217 asymptomatic patients with severe AR, but without current guidelines-based surgical indication, will be enrolled across all centers. We expect 24 % of patients identified as high clinical risk and therefore eligible for 1:1 randomization to early surgical treatment within 3 months or a watchful waiting strategy. Follow-up will be annual. We expect a complete restoration of LV size and function along with improved quality of life and physical performance in a short-term follow-up of 12 months. The primary endpoint will be a composite safety and efficacy with all criteria mandatory: 15 % or larger reduction of baseline CMR-derived LV end-diastolic volume index, LV ejection fraction >50 %, and no major adverse cardiovascular events. The annual follow-up will continue for a minimum of 4 years until the required number of endpoints is achieved to show a statistically significant difference in cardiovascular morbidity and mortality in early surgically treated patients. ConclusionThe ELEANOR trial is the first multicenter randomized controlled study to compare early surgical treatment with a watchful waiting strategy in asymptomatic patients with chronic severe AR at high risk of early clinical deterioration as per CMR assessment but without guidelines-based indications for surgical treatment.

Multichannel Conduits with Fascicular Complementation: Significance in Long Segmental Peripheral Nerve Injury.

Despite the advances in tissue engineering approaches, reconstruction of long segmental peripheral nerve defects remains unsatisfactory. Although autologous grafts with proper fascicular complementation have shown meaningful functional recovery according to the Medical Research Council Classification (MRCC), the lack of donor nerve for such larger defect sizes (>30 mm) has been a serious clinical issue. Further clinical use of hollow nerve conduits is limited to bridging smaller segmental defects of denuded nerve ends (<30 mm). Recently, bioinspired multichannel nerve guidance conduits (NGCs) gained attention as autograft substitutes as they mimic the fascicular connective tissue microarchitecture in promoting aligned axonal outgrowth with desirable innervation for complete sensory and motor function restoration. This review outlines the hierarchical organization of nerve bundles and their significance in the sensory and motor functions of peripheral nerves. This review also emphasizes the major challenges in addressing the longer nerve defects with the role of fascicular arrangement in the multichannel nerve guidance conduits and the need for fascicular matching to accomplish complete functional restoration, especially in treating long segmental nerve defects. Further, currently available fabrication strategies in developing multichannel nerve conduits and their inconsistency in existing preclinical outcomes captured in this review would seed a new process in designing an ideal larger nerve conduit for peripheral nerve repair.

Hemiartoplasty of the Hip Joint with a Bipolar Endoprosthesis for Fail Osteosynthesis of the Femoral Neck

Introduction. Hip replacement in the last century was called the most successful operation in orthopedics. Replacement of the destroyed joint tissues with an implant allows to relieve a person from pain, restore motor activity and ensure a long-term improvement in the quality of life without disability. Endoprosthetics is indicated both for diseases of the hip joint, which according to the literature are affected by about 35 % of the adult population, and for fractures of the femoral neck. As a rule, the age of patients undergoing endoprosthetics is older than 60 years.The purpose of this publication is to demonstrate the successful experience of subtotal hip replacement with bipolar endoprosthesis in a patient with an ungrown fracture of the neck of the left hip in conditions of metalosteosynthesis with screws with migration of metal structures and violation of fracture consolidation.Materials and methods. Description of a clinical case and a brief analysis of the literature on this topic. The experience of subtotal endoprosthetics of the left hip joint with a bipolar endoprosthesis is presented. The effectiveness of treatment was evaluated based on the data of X-ray examination methods, as well as when assessing the function of the limb and the amplitude of movement in the hip joint.Results. As a result of hip replacement with a bipolar endoprosthesis, complete restoration of limb function and activity of the patient was achieved.Discussion. The choice of a bipolar endoprosthesis with acetabular roof plasty was due to the need to restore joint function and the desire to maintain a greater potential for revision arthroplasty of the patient, which is very likely given the age. Along with the use of augments and individual implants, the method showed a good result of treatment with less trauma.Conclusion. Based on the given clinical example, it can be concluded that both preoperative planning for femoral neck fractures with risk assessment and expanding the range of metal structures, including the least traumatic for bone tissue, is important, as well as the need to improve continuity in the treatment of patients and individualize the postoperative plan. management, socialization and activation of the patient

Coverage of Congenital Anomalies: Ensuring Lasting Smiles Act (ELSA) in Legislation.

The Ensuring Lasting Smiles Act (ELSA) is a federal bill which would require all health federally regulated insurance products to cover the full treatment of a congenital anomaly or birth defect until complete restoration of normal function or appearance. ELSA has been a key federal priority for the Legislative Advocacy Committee of the American Society of Plastic Surgeons (ASPS) since the 115 th Congress in 2018. Although it has gained momentum, particularly in the 117 th Congress, the bill remains stalled. Congressional Budget Office review, conducted in March 2022, appears to have overestimated this bill's cost for the private sector, secondary to an alleged lack of data on the prevalence of the conditions, extent of treatments and their costs, and the current extent of private sector coverage. The present review highlights the progress of the ELSA bill and serves to illustrate the hurdles involved in passing significant healthcare bills. This review emphasizes the need for healthcare professionals to provide their congressional representatives with accurate information on realistic cost of currently covered treatments of congenital defects, the necessary treatments not currently covered by insurance, and additional out-of-pocket costs covered by patients. A concerted effort by plastic surgeons should provide tools for ELSA legislative champions to re-introduce and pass the bill during the 118th Congress. This process highlights the essential role of organized medicine in advocating for the successful passage of healthcare legislation.

From case to context: A case-driven comprehensive review on Kirschner wire migration to the cervical spine and neck

Introduction Osteosynthesis using Kirschner wires constitutes a fundamental technique within the realms of traumatology and orthopaedics. Despite its widespread application and popularity, it is susceptible to migration of the wires. Case Report A 36-year-old patient presented with neck pain; subsequent radiographic imaging identified two Kirschner wires that had migrated to the cervical spine following failed removal after K-wiring of a fractured left clavicle 16 years previously. Surgical removal was undertaken complicated by a parapharyngeal abscess that needed surgical drainage and neurological symptoms in terms of left shoulder weakness and left arm/hand paraesthesia. All neurological symptoms resolved after many months of rehabilitation excepting some residual paraesthesia on the ulnar border of the left hand. Discussion A thorough literature review reveals 30 other cases of K-wire migration to the cervical spine. Vague symptoms are the norm with &lt;25% presenting focal neurological symptoms, with only 6 penetrating the spinal cord, two of which were left with severe deficits. The other 28 patients had no long-term significant deficits. Conclusion The migration of K-wires into the spinal canal, is a rare but recognised complication. Functional outcomes are contingent on spinal cord injuries arising from the implantation. In the absence of spinal cord injury, a high probability of complete functional restoration and symptom resolution exists.

Virtual planning, guided surgery, and digital prosthodontics in the treatment of extended mandible chondrosarcoma.

Chondrosarcoma is among the most common primary bone tumors in adults. In the mandible, chondrosarcoma is a very uncommon malignant cartilage-producing tumor. This case report shows how virtual planning combined with other digital technologies may improve masticatory function rehabilitation in patients with enlarged mandibular chondrosarcoma. The present study reports a case of a 52-year-old male patient who was initially diagnosed with a mandible chondroma, which was successfully excised with no evidence of malignant transformation. Nevertheless, the patient's symptoms recurred after 10 years, and a subsequent diagnosis of mandible chondrosarcoma was established, prompting the need for subtotal mandible resection and reconstruction with a fibula-free flap. Following a healing period, the patient underwent dental implant surgery to restore the mandibular dental arch, which was performed utilizing computer-aided design and computer-aided manufacturing technology, with fully guided implant placement facilitated by virtual planning. In this case report, the implant position data merging process is described from the digital impression and control model to ensure optimal passive fit of the full-arch zirconia prosthesis and discuss the importance of occlusal adjustments to avoid technical and biological complications. Virtual planning and digital technologies are crucial for the effective management of mandibular defects, allowing for accurate treatment and complete restoration of mandibular function. Their use leads to improved patient outcomes and quality of life. As technology advances, their importance in treating complex medical conditions is only expected to grow.

Сlinical experience with the modified rehabilitation protocol after trapeziometa- carpal joint resection suspension interposition autotendoplasty.

Aim. The aim of this study is to assess the effectiveness of a modified postoperative rehabilitation protocol in patients who underwent their first carpometacarpal joint resection suspension interposition autotendoplasty.Materials and Methods. The study included 52 patients treated for trapeziometacarpal joint osteoarthritis stage II—IV according to the Eaton-Littler and Kellgren-Lawrence classification in the Upper Limbs Surgery Department of the Bauman City Clinical Hospital from 2017 to 2022. All patients underwent trapeziometacarpal joint resection suspension interposition autotendoplasty and a course of rehabilitation. The evaluation of surgical treatment and rehabilitation results was carried out based on indicators on the VAS, DASH, and hand grip strength scales 12 months after surgery.Results. The complex treatment resulted in the complete restoration of hand function. Twelve months after surgery, there was a significant improvement in hand functional parameters. According to the DASH scale, the improvement was 80 % compared to the preoperative level (p = 0.000). The pain syndrome, according to the VAS scale, decreased by 84 % from the baseline (p = 0.000). Affected hand grip strength reached its maximum value of 26.2 kg, exceeding the preoperative level by 67 % (p = 0.006).Conclusion. The modified rehabilitation protocol used after performing trapeziometacarpal joint resection suspension interposition autotendoplasty in clinical practice enabled the full restoration of affected hand function.

Peripheral nerve injury: molecular pathophysiology and prospects for restorative treatment by means of cell transplantation: a literature review

Peripheral nerve injury (PNI) is a fairly common pathology—PNI accounts for 1-5% of all peacetime injuries and 12% of all combat injuries. This injury leads to disability, the development of chronic pain syndromes and a significant deterioration in the quality of life of the victims. Unfortunately, at present, in the case of the most frequent type of combat trauma — damage to the limbs — PNI treatment is mostly done last, "on the residual principle." Modern means of surgical and conservative treatment of PNI do not provide complete restoration of lost functions, therefore, restorative treatment of PNI is an urgent biomedical problem. The article reviews the currently known molecular mechanisms of various stages of PNI, as well as the plasticity of the central parts of the nervous system on the background of this injury. The main reasons for the limitation of autogenous recovery of functions after a sustained PNI are described — the absence of a relevant spatial organization of regrowth of axons in the area of PNI; post-traumatic death of neurons of spinal nodes and central parts of the nervous system; failure of plastic reconstruction of brain and spinal cord neural networks; irreversibility of atrophy of denervated muscles. Based on this, it was established that the means of restorative treatment of PNI should touch not only the epicenter of PNI, but also the central parts of the nervous system and denervated muscles. Mesenchymal stem cells (MSCs) are well-known means of a positive influence on the the restorative process in the focus of PNI, as well as a source of supportive influence/ strengthening effect and an amplifier of the plasticity of brain neural networks, which makes these cells a promising element of bioengineering treatment of PNI. The effect of MSCs on the central parts of the nervous system in case of PNI remains the least studied. Data from the literature indicate that such an effect can provide support for secondarily affected neurons and stimulate the plastic reorganization of brain networks, i.e., in general, significantly improve the results of restorative treatment of PNI.

One-stage reconstruction of four fingers in children using microsurgical autotransplantation of foot tissue complexes

BACKGROUND: Toe-to-hand transfer is still the most promising and relevant method for restoring fingers that are missing from birth or after injury. In cases requiring the restoration of two or more digits, simultaneous transplantation of tissue complexes from both feet, including one or two toes, is possible and necessary. Thus, a maximum of four fingers can be restored during one operation. Such operations, according to the literature, are performed extremely rarely because they are very extensive and time-consuming.&#x0D; AIM: To present the results of simultaneous microsurgical autotransplantation of four toes to the hand in children with congenital and acquired pathologies.&#x0D; MATERIALS AND METHODS: The study used clinical, radiological, and biomechanical methods to assess the results of nine patients with congenital and acquired upper limb deformities who underwent simultaneous microsurgical autotransplantation of two tissue complexes from each foot, including toes II–III. The indications for performing this method of microsurgical reconstruction in children with the absence of four (or all five) fingers have been determined. The results, postoperative complications, and conditions of the donor and recipient zones were analyzed.&#x0D; RESULTS: To date, 914 such operations have been performed in children. In nine cases, four toes were simultaneously transplanted (two from each foot). The average age of the patients was 4.2 years. Two children had congenital malformations of the hand, and seven had consequences of trauma. In eight cases, fingers II–V were restored, and in one case, fingers I–IV were restored. Complications associated with impaired blood circulation in the grafts were observed in 22% of the cases; however, they were temporary. All transplanted grafts survived. All patients required continued surgical treatment after the toe transfer to improve their appearance and function. Biomechanical examination methods showed complete restoration of function on average of 4 months (±1 month) after surgery.&#x0D; CONCLUSIONS: This study showed the possibility and effectiveness of using toes for hand transfer in children with both congenital and acquired hand pathologies that require the restoration of four fingers. Simultaneous microsurgical transplantation of toes ensures the restoration of a good appearance of the hand and its functionality.

Bronchiectasis with Trans Mediastinal Herniation of Left Upper Lobe in 3-Year-Old Child: A Case Report

BACKGROUND: Bronchiectasis is a disorder characterized by destruction of smooth muscle and elastic tissue due to inflammation which leads to permanent dilation of bronchi and bronchioles. It may develop in association with Cystic Fibrosis, a single severe episode or recurrent episodes of pneumonia and exposure to tuberculosis. The principal conditions associated with bronchiectasis are obstruction and infection. Infections primarily originate from issues with airway clearance, which cause bronchi and bronchioles to enlarge irreversibly. Vertical airways are notably affected, while distal bronchi and bronchioles are more severely affected. The degree of disease activity and chronicity may affect the histological findings. Childhood bronchiectasis can proceed to severe consequences including persistent bacterial bronchitis, in developing nations like India due to a lack of effective diagnosis and treatment as a result of poor health care infrastructure in the rural areas as well as limited awareness on the part of general public and health care professionals. THE CASE: A 3.5-year-old Indian boy presented with productive cough and cold for 8 days associated with low grade fever. Patient was admitted through Out Patient Department (OPD) due to respiratory distress and facial swelling. Clinical exam revealed presence of crepitation, wheeze and pectus carinatum. Patient has history of multiple hospital admissions due to pneumonia and respiratory distress. There is history of exposure to tuberculosis. His mother had been diagnosed with tuberculosis when the child was 3 months old. She received anti-tubercular drugs and is now cured. HRCT thorax reveals collapse of basal segment of right lung, trans-mediastinal space shift of left upper lobe and bi-lateral bronchiectatic changes which include unusually thickened enlarged airways exhibiting the characteristic tram-track appearance. Echocardiogram findings show thickened pericardium, mild pericardial collection and trace tricuspid valve regurgitation. The case is unique since it is quite rare for a young child to have such a severe form of bronchiectasis. CONCLUSION: Diagnosis can be done with the help of radiological and clinical examination. However, High Resolution Computed Tomography (HRCT) scan is the investigation of choice. Early management is a key factor in minimizing more serious complication like severe hemoptysis and cor pulmonale. Current treatment modalities include antibiotics, bronchodilators, anti-inflammatory drugs and chest physical therapy. Severe cases may require injectable antibiotics. Bronchiectasis was thought to be an orphan disease that seldom progressed to severe consequences, especially after the introduction of newer antimicrobials. There exist guidelines that advocate treatments for bronchiectasis, and reports of therapy have been shown to be linked with clinical success. However, such guidelines do not exist in India at present. This case is noteworthy as it portrays bronchiectasis in an Indian child that has proceeded to the severe complication of transmediastinal herniation, demonstrating that it is relatively common albeit under-diagnosed in developing countries. Though is an irreversible disease in adults, in children if detected early there is almost complete restoration of pulmonary function and adequate exercise tolerance. Early diagnosis with suitable pharmacological and non-pharmacological management is critical for a positive outcome and prevention of sequelae like persistent bacterial bronchitis.

Fingolimod (FTY720), an FDA-approved sphingosine 1-phosphate (S1P) receptor agonist, restores endothelial hyperpermeability in cellular and animal models of dengue virus serotype 2 infection.

Extensive vascular leakage and shock is a major cause of dengue-associated mortality. At present, there are no specific treatments available. Sphingolipid pathway is a key player in the endothelial barrier integrity; and is mediated through the five sphingosine-1-phosphate receptors (S1PR1-S1PR5). Signaling through S1PR2 promotes barrier disruption; and in Dengue virus (DENV)-infection, there is overexpression of this receptor. Fingolimod (FTY720) is a specific agonist that targets the remaining barrier-protective S1P receptors, without targeting S1PR2. In the present study, we explored whether FTY720 treatment can alleviate DENV-induced endothelial hyperpermeability. In functional assays, in both in vitro systems and in AG129 animal models, FTY720 treatment was found effective. Upon treatment, there was complete restoration of the monolayer integrity in DENV serotype 2-infected human microvascular endothelial cells (HMEC-1). At the molecular level, the treatment reversed activation of the S1P pathway. It significantly reduced the phosphorylation of the key molecules such as PTEN, RhoA, and VE-Cadherin; and also, the expression levels of S1PR2. In DENV2-infected AG129 mice treated with FTY720, there was significant improvement in weight gain, in overall clinical symptoms, and in survival. Whereas 100% of the DENV2-infected, untreated animals died by day-10 post-infection, 70% of the FTY720-treated animals were alive; and at the end of the 15-day post-infection observation period, 30% of them were still surviving. There was a significant reduction in the Evan's-blue dye permeability in the organs of FTY720-treated, DENV-2 infected animals; and also improvement in the hemogram, with complete restoration of thrombocytopenia and hepatic function. Our results show that the FDA-approved molecule Fingolimod (FTY720) is a promising therapeutic intervention in severe dengue.

Effects of aircraft noise cessation on blood pressure, cardio- and cerebrovascular endothelial function, oxidative stress, and inflammation in an experimental animal model

Large epidemiological studies have shown that traffic noise promotes the development of cardiometabolic diseases. It remains to be established how long these adverse effects of noise may persist in response to a noise-off period. We investigated the effects of acute aircraft noise exposure (mean sound level of 72 dB(A) applied for 4d) on oxidative stress and inflammation mediating vascular dysfunction and increased blood pressure in male C57BL/6 J mice. 1, 2 or 4d of noise cessation after a 4d continuous noise exposure period completely normalized noise-induced endothelial dysfunction of the aorta (measured by acetylcholine-dependent relaxation) already after a 1d noise pause. Vascular oxidative stress and the increased blood pressure were partially corrected, while markers of inflammation (VCAM-1, IL-6 and leukocyte oxidative burst) showed a normalization within 4d of noise cessation. In contrast, endothelial dysfunction, oxidative stress, and inflammation of the cerebral microvessels of noise-exposed mice did not improve at all. These data demonstrate that the recovery from noise-induced damage is more complex than expected demonstrating a complete restoration of large conductance vessel function but persistent endothelial dysfunction of the microcirculation. These findings also imply that longer noise pauses are required to completely reverse noise-induced vascular dysfunction including the resistance vessels.

A variant of the course of chronic subdural hematoma (clinical case)

Introduction. Doctors of various specialties face difficulties in diagnosing chronic subdural hematomas (CSDH) at different stages, usually due to the lack of an evident causal relationship between neurological manifestations of subdural hematoma and the head injury sustained several weeks or even months prior to the patient's examination. Clinically, CSDH can mimic multiple neurological disorders, and before the patient is referred to a neurosurgeon, they might be inspected by various specialists such as neurologists, physicians, traumatologists and even psychiatrists. As a results, the patient initially does not receive specialized treatment, which directly affects postoperative mortality and disabi lity in patients with this pathology.Aim. In this paper we aim to describe a rare clinical case of atypical course of CSDH. A clinical case. A 54‑year‑old woman, after falling from a ladder about 2 m high, 1.5 months after the injury, developed depression of consciousness and tetraparesis up to 2–3 points according to the Medical research counsil Weakness scale. After examination, the patient was verified to have a chronic hemispheric subdural hematoma of large volume, transverse dislocation of the median structures of the brain by 16 mm. An injury to the cervical spine was ruled out. The patient was operated on, HSDG was removed from 2 milling holes, achieving complete washing of the hematoma and, subsequently, complete restoration of motor functions in the patient – 5 point by Glasgow outcome scale (5‑point Glasgow scale).Discussion. This paper presents the results of treatment and observation of patients with atypical course of CSDH of traumatic origin. The main method of treatment is the surgical removal of chronic subdural hematoma by a minimally invasive method: the imposition of 2 trefination holes with removal by evacuation of CSDH.Conclusion. The problem of early detection of chronic subdural hematomas is extremely relevant. Careful collection of anamnesis, the alertness of doctors of related specialties on this problem, the mandatory use of neuroimaging methods (computer and magnetic resonance imaging) will often help to correctly and timely diagnose, start treatment on time and increase the patient’s chance of recovery, even in cases of atypical course.

Optimal reperfusion time in patients with non-ST elevation acute myocardial infarction and low ischemic risk

The aim of the study was to identify the optimal time window for performing effective percutaneous coronary reperfusion in patients with non-ST-segment elevation acute myocardial infarction (NSTEMI) who are part of the low ischemic risk group. 252 patients with NSTEMI and low ischemic risk who underwent coronary angioplasty up to 30 days after the onset of the infarction were evaluated the second day post-procedurally and at a distance of 6 months. The general group was randomized depending on the echocardiographic evolution. 131 patients with unfavorable evolution and 121 with more complete restoration of left ventricular contractile function. The time windows from the onset of myocardial infarction symptoms in which percutaneous myocardial reperfusion was applied were studied. Following the study, the time interval of 73 hours -14 days proved to be optimal in which a more favorable clinical and echocardiographic evolution is ensured.

Co-administration of extracellular matrix-based biomaterials with neural stem cell transplantation for treatment of central nervous system injury.

Injuries and disorders of the central nervous system (CNS) present a particularly difficult challenge for modern medicine to address, given the complex nature of the tissues, obstacles in researching and implementing therapies, and barriers to translating efficacious treatments into human patients. Recent advancements in neural stem cell (NSC) transplantation, endogenous neurogenesis, and in vivo reprogramming of non-neural cells into the neuronal lineage represent multiple approaches to resolving CNS injury. However, we propose that one practice that must be incorporated universally in neuroregeneration studies is the use of extracellular matrix (ECM)-mimicking biomaterials to supply the architectural support and cellular microenvironment necessary for partial or complete restoration of function. Through consideration of developmental processes including neurogenesis, cellular migration, and establishment of functional connectivity, as well as evaluation of process-specific interactions between cells and ECM components, insights can be gained to harness and modulate native and induced neurobiological processes to promote CNS tissue repair. Further, evaluation of the current landscape of regenerative medicine and tissue engineering techniques external to the neurosciences provides key perspectives into the role of the ECM in the use of stem cell-based therapies, and the potential directions future neuroregenerative approaches may take. If the most successful of these approaches achieve wide-spread adoption, innovative paired NSC-ECM strategies for neuroregeneration may become prominent in the near future, and with the rapid advances these techniques are poised to herald, a new era of treatment for CNS injury may dawn.

Transient Right Bundle Branch Block with S1Q3T3 Pattern in Pulmonary Embolism

A 69-year-old woman with hypertension, hyperlipidemia, sleep apnea, gastroesophageal reflux disease, and recent knee replacement was brought to the emergency room (ER) for syncope. She had her physiotherapy session earlier in the day and became symptomatic with dizziness, shortness of breath and had loss of consciousness. In the ER, systolic blood pressure (SBP) was noted to be 90 mmHg and an oxygen saturation (O2 sat) of 80% on room air. Patient received fluid bolus with improvement of SBP to 110 mmHg. O2 sat improved to 99% with 10 L of oxygen. A bedside echocardiogram showed right ventricular (RV) distension. A Computerized Tomographic Angiogram (CTA) of the chest showed bilateral main stem pulmonary emboli (PE) with signs of RV strain. Initially EKG showed sinus tachycardia, right bundle branch block, and a S1Q3T3 pattern which resolved rapidly the next day. Patient was admitted, remained hemodynamically stable, and was treated with full dose of Enoxaparin subcutaneously. A follow up EKG was performed the next day, which showed complete resolution of initial findings. Follow up echocardiogram also showed rapid resolution of RV strain and complete restoration of RV size and function. Patient was eventually discharged home on full dose apixaban.

Acute uremic polyneuropathy in a patient with Alzheimer’s disease

The article presents a case of acute uremic neuropathy. Without any visible cause, a 71-year-old patient felt weakness in legs and numbness in feet. Her neurological status assessment on admission to the hospital showed peripheral tetraparesis and impaired sensitivity of the polyneuropathic type. Neurological symptoms appeared due to renal dysfunction, which had been confi rmed with laboratory test. Electroneuromyography revealed signs of acute demyelinating polyneuropathy. Аt the hospital, the patient was diagnosed Alzheimer’s disease. The treatment provided at the hospital led to normalization of her laboratory parameters and complete restoration of motor functions. The peculiarity of the presented clinical case is that the patient started violating drinking regime due to her cognitive impairment which resulted in renal dysfunction and acute uremic neuropathy. The other peculiarity of the case is that it was enough to correct the water-electrolyte disorders to fully restore the patient’s motor functions within a month, without the use of dialysis. Finally, the article discusses the issue of pathogenesis and diff erential diagnosis of other types of polyneuropathies.

Masseter-to-facial nerve transfer for facial nerve reanimation.

Smooth symmetric facial muscle function is important for social interactions. When lesions of the facial nerve occur, achieving complete restoration of balanced and spontaneous facial function can be challenging. In this video, the authors demonstrate the surgical details and long-term follow-up of a masseter-to-facial nerve transfer in a 3-year-old girl who had insidious onset of a left facial palsy due to a facial nerve schwannoma. After resection, she underwent distal nerve repair with a masseter-to-zygomatic branch transfer. She demonstrated decreased lagophthalmos and good activation and excursion on the left side with near symmetry to the right side, but lacked left frontalis function. The video can be found here: https://stream.cadmore.media/r10.3171/2022.9.FOCVID22107.