Fibrous Ring Research Articles

Новый метод создания пути оттока из правого желудочка при тетраде Фалло с сохранением фиброзного кольца клапана легочной артерии

Новый метод создания пути оттока из правого желудочка при тетраде Фалло с сохранением фиброзного кольца клапана легочной артерии

EVALUATION OF LEFT VENTRICULAR REMODELING AFTER SURGICAL RECONSTRUCTION OF POSTINFARCTION ANEURYSM

Objective: To assess the effect of left ventricle reconstruction in patients with postinfarction aneurysm on remodeling and heart failure dynamics in the immediate and long-term postoperative period. Material and methods: 162 patients with IHD who underwent myocardial infarction and chronic left aneurysm were included in the study. All the patients underwent myocardial revascularization and reconstructive intervention in the LV cavity at the National Medical Research Center named after V.А. Almazov. Two groups of patients were formed, depending on the type of surgical intervention performed. Group 1 (n = 116) included patients who underwent linear plastic surgery of the left ventricle aneurysm. Group 2 (n = 46) identified patients who underwent an intraventricular plastic aneurysm of V. Dor. Results: In the early postoperative period, a statistically significant decrease in the volume of the LV cavity was observed and the global ejection fraction changed in both study groups. In patients with a significant degree of mitral insufficiency additionally did the plastic fibrous ring. The con ducted single-factor analysis showed a statistically significant effect of correction of mitral insufficiency on CDD, DAC, and global ejection fraction. The majority of patients in both groups experienced a decrease in LV volumes in the long-term period. Predictors of unfavorable clinical course of heart failure in the long-term period were revealed: violation of contractility at the level of basal parts of the left ventricle with a decrease in the index of violation of local contractility more than 3, ejection fraction less than 35%, uncorrected mitral insufficiency II and more, increased level of natriuretic peptide 4 times from the upper limit of the norm. Conclusions: Combined operation makes it possible to improve the contractive function of left ventricular, to reduce the degree of mitral insufficiency, the functional class of heart failure.

Lipoinjection and Multiple Internal Cuts for Congenital Constriction Bands: A New Treatment Approach

BackgroundTraditional treatment for a congenital constriction band of the limb involves multiple Z-plasties and W-plasties. We propose an alternative surgical procedure for the treatment of congenital constriction bands that obviates the need for Z-plasties and eliminates the constriction band.MethodsWe present the case of a 36-year-old woman with a congenital constriction band of the leg. Using a minimally invasive approach, the skin segment that included the band was dissected from the deep tissues. Afterwards, multiple slices were performed on the internal surface of the fibrous ring. This and lipoinjection were used to reverse the depression that characterizes the “hourglass sign” and homogenize the skin surface.ResultsResults have remained stable in a follow-up period of 18 months.ConclusionsThis surgical alternative can be considered as an option for the treatment of congenital constriction bands. It is a safe, reproducible procedure that does not cause additional scars and has good functional and aesthetic results.Level of evidence VThis journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

Calculation of the strain-deformation condition of the spinal motor segment during loading

A mathematical model is proposed to analyze the spinal strain-deformation condition resulting from axial and lateral g-loads that are generated by changes in the gravity field and/or pilot’s actions during high-performance aircraft maneuvering under flight overload conditions. An algorithm of solution has been developed, which takes into account changes in the intervertebral disk pressure and the fibrous ring shape at the time when loading reaches close-to-critical g-values. Calculation of the spinal-strain deformation condition was implemented using the SPLEN computer system (KOMMEK, Russia). Analysis of the spinal straindeformation condition was made for two types of external loads: normal load and unilateral load with the bending moment. Maximum permissible loads on the spinal segment were evaluated, and a pattern of distribution of strain intensity and mean strains, spinal deformation, and the destruction field was described. The developed computer models can be used as a basis for developing a technique of predicting characteristic spinal injuries due to different extreme loads and pathologies.

Surgical Treatment of Tubular Breast Type II.

Background:Tubular breasts are caused by connective tissue malformation and occur in puberty. The main clinical characteristics of the tubular breast are breast asymmetry, dense fibrous ring around the areola, hernia bulging of the areola, megaareola, and hypoplasia of quadrants of the breast. Pathology causes great psychological discomfort to patients.Methods:This study included 17 patients, aged 18 to 34 years, with tubular breast type II who had bilateral pathology and were treated from 2013 to 2016. They had surgical treatment by method of the clinic. Correction technique consisted of mobilization of the central part of the gland and formation of a glandular flap with vertical and horizontal scorings, which looks like a “chessboard,” that was sufficient to cover the lower pole of the implant. The flap was fixed to the submammary folds with stitches that prevented its reduction and accented a new submammary fold. To underscore the importance of the method and to study the structural features of the vascular bed of tubular breast tissue, a morphological study was conducted.Results:Mean follow-up time was 25 months (range between 13 and 37 mo). The proposed technique achieved good results. Complications (hematoma, circumareolar scarring, and “double-bubble” deformity) were identified in 4 patients.Conclusions:Our morphological study confirmed that tubular breast tissue has increased vascularity due to the vessels with characteristic minor malformation and due to the high restorative potential of the vascular bed. Therefore, an extended glandular flap could be freely mobilized without damaging its blood supply; thus, the flap in most cases covered the implant completely and good aesthetic results were achieved.

Spontaneous Resorption of Intervertebral Disc Herniations

The data on the possibility of intervertebral disc herniation regress at terms from 3 to 12 months are presented. Immune response of the organism and the factor of peripheral fibrous ring neovascularization play an important role in the process of disc herniation resorption. Transligamentous and sequesteredherniations are resorbed better than the subligamentous ones. To intensify the intervertebral disc herniation resorption it is necessary to activate microcirculation of the injured spinal motion segment.

Regeneration of intervertebral disc by way using of allogeneic chondrocytes cultivated in vitro in the light of concept for restabilization of the spine(experimental investigation)

The intervertebral disc (ID) has low reparative capacity. In this regard, researcher aimed at improving the capacity of the re­parative structures are carried out. A variety of growth factors, mesenchymal stem cells, autologous and allogenic chondrocytes, etc are used for this purposes. Objective: to study the structure of the traumatized intervertebral disc after transplantation of allogenic chondroсуtes in combination with spinal restabiliza­tion using method of dynamic spine neutralization of vertebral motion unit (VMU). Methods for optimizing ID regeneration in the rat tail vertebral segment we selected high-density culture of chondrocytes obtained from the limb bud 7–10 day old rat embryos in which cells retain cartilaginous phenotype and gen­otype was confirmed by electron microscopy. Performed four se­ries of experiments: I — intact animals, II — ID injury (control), III — traumatic ID injury with dynamic neutralization (method G. Dubois et al, 1999), IV — ID injury with dynamic neutraliza­tion and transplantation of chondrocytes. One month the opera­tion the animals were euthanized, and a comparative morpho­logical analysis with morphometry was carried out. Results: it found that uncontrolled movements in the injured VMU lead to destructive changes in the ID. In terms of restabilization and dy­namic neutralization of the vertebral motor segment ID has been replaced by connective tissue, its height reduced. Chondrocyte culture is different from the fibrous ring and nucleus pulposus cells. However, with the introduction of chondrocytes in the in­jured ID and maintaining the controlled mobility of the VMU the proliferation of hyaline cartilage in its peripheral parts has been noted. Conclusion: combination of allogeneic chondro­cytes transplantation into disk and dynamic neutralization leads to the formation of hyaline cartilage territories and maintains the height of the injured ID.

Spontaneous Resorption of Intervertebral Disc Herniations

The data on the possibility of intervertebral disc herniation regress at terms from 3 to 12 months are presented. Immune response of the organism and the factor of peripheral fibrous ring neovascularization play an important role in the process of disc herniation resorption. Transligamentous and sequesteredherniations are resorbed better than the subligamentous ones. To intensify the intervertebral disc herniation resorption it is necessary to activate microcirculation of the injured spinal motion segment.

Axon Branch-Specific Semaphorin-1a Signaling in Drosophila Mushroom Body Development.

Correct wiring of the mushroom body (MB) neuropil in the Drosophila brain involves appropriate positioning of different axonal lobes, as well as the sister branches that develop from individual axons. This positioning requires the integration of various guidance cues provided by different cell types, which help the axons find their final positions within the neuropil. Semaphorins are well-known for their conserved roles in neuronal development and axon guidance. We investigated the role of Sema-1a in MB development more closely. We show that Sema-1a is expressed in the MBs as well as surrounding structures, including the glial transient interhemispheric fibrous ring, throughout development. By loss- and gain-of-function experiments, we show that the MB axons display lobe and sister branch-specific Sema-1a signaling, which controls different aspects of axon outgrowth and guidance. Furthermore, we demonstrate that these effects are modulated by the integration of MB intrinsic and extrinsic Sema-1a signaling pathways involving PlexA and PlexB. Finally, we also show a role for neuronal- glial interaction in Sema-1a dependent β-lobe outgrowth.

Automated Method to Analyze Geometry and Topology of Mitral Valve Fibrous Ring

Automated Method to Analyze Geometry and Topology of Mitral Valve Fibrous Ring

An investigation on the distribution of massive fiber granules in rotor spinning units

Rotor spinning is an open-end spinning method that uses air as the medium to transform the fibers into yarn. Nowadays, the properties of its final product—yarn—such as yarn strength and yarn twist, are not satisfied due to the fiber morphology, which greatly depends on the distribution of the massive fibers in the rotor spinning unit (RSU). In this paper, theoretical analysis is given to describe the trajectory of fiber on the slide wall. A numerical study is performed with the massive fibers being simplified into granules to study their distribution characteristics in the RSU. According to our numerical results, the forming process of the fibrous ring is discussed and the effects of two variables, the rotor speed and the angle of the slide wall, on the distribution of fiber granules were also studied. The simulation results indicate that the fiber granules are not evenly distributed during their transport in the fiber transport channel (FTC) and they tend to accumulate on the upper and lower edge of the FTC. The distribution of fiber granules in the groove (fibrous rings) is closely related to the rotor speed. The higher the rotor speed, the longer and thinner the fibrous ring. The distribution of fiber granules on the slide wall is related to the angle of the slide wall such that a smaller angle leads to a scattered distribution on the slide wall, while a larger angle tends to bring a concentrated one. The simulation results show good agreements with our experimental results.

Lamellar and fibre bundle mechanics of the annulus fibrosus in bovine intervertebral disc

The intervertebral disc is a multicomposite structure, with an outer fibrous ring, the annulus fibrosus, retaining a gel-like core, the nucleus pulposus. The disc presents complex mechanical behaviour, and it is of high importance for spine biomechanics. Advances in multiscale modelling and disc repair raised a need for new quantitative data on the finest details of annulus fibrosus mechanics. In this work we explored inter-lamella and inter-bundle behaviour of the outer annulus using micromechanical testing and second harmonic generation microscopy. Twenty-one intervertebral discs were dissected from cow tails; the nucleus and inner annulus were excised to leave a ring of outer annulus, which was tested in circumferential loading while imaging the tissue’s collagen fibres network with sub-micron resolution. Custom software was developed to determine local tissue strains through image analysis. Inter-bundle linear and shear strains were 5.5 and 2.8 times higher than intra-bundle strains. Bundles tended to remain parallel while rotating under loading, with large slipping between them. Inter-lamella linear strain was almost 3 times the intra-lamella one, but no slipping was observed at the junction between lamellae. This study confirms that outer annulus straining is mainly due to bundles slipping and rotating. Further development of disc multiscale modelling and repair techniques should take into account this modular behaviour of the lamella, rather than considering it as a homogeneous fibre-reinforced matrix. Statement of SignificanceThe intervertebral disc is an organ tucked between each couple of vertebrae in the spine. It is composed by an outer fibrous layer retaining a gel-like core. This organ undergoes severe and repeated loading during everyday life activities, since it is the compliant component that gives the spine its flexibility. Its properties are affected by pathologies such as disc degeneration, a major cause of back pain. In this article we explored the micromechanical behaviour of the disc’s outer layer using second harmonic generation, a technique which allowed us to visualize, with unprecedented detail, how bundles of collagen fibres slide relative to each other when loaded. Our results will help further the development of new multiscale numerical models and repairing techniques.

CONSTITUTIONAL FEATURES OF HEART VALVES IN WOMEN AT A MATURE AGE

The researches of morphometric parameters of the heart valves were performed in 315 female corpses of asthenic, normosthenic and hypersthenic constitutions. Statistically meaningful differences were revealed in the perimeter of the fibrous ring circle of the flap valves and noted in the length of the semilunar valve of the aorta and pulmonary trunk in women with different somatotypes. The most significant differences were determined in standard indices of the valves in women with asthenic and hyperstenic constitutions. The data obtained allowed broadening of conception of the constitutional variability of the heart.

Surgical Correction of Esophageal Stenosis by Right Aortic Arch Persistence in Two Cats

Background: Vascular ring anomaly is considered a hereditary change. It occurs when the fourth right aortic arch persists instead of the fourth left aortic arch, forming a vascular ring that compress the esophagus causing esophageal dilatation cranial to the compression site. Diagnosis is based upon anamnesis, physical examination, clinical signs and complementary exams (radiograph, complete blood count and biochemical tests). The clinical treatment is inadequate, since the dilatation persists and tends to progress causing irreversible tissue injury. Surgical correction is indicated and consists of the arterial ligament resection and correction of the esophageal stenosis.Case: The objective of the current study is to report two case of persistence of right aortic arch in two cats referred to the Veterinary Hospital of the Federal University of Santa Maria. On physical examination the patients were alert, in good nutritional status, adequately hydrated and presented normal colored mucous membranes. Each animal underwent radiog­raphy and esophagogram with barium sulphate. The exam demonstrated partial esophageal dilation cranial to the cardiac silhouette, suggestive of vascular ring anomaly. An exploratory thoracotomy was performed in order to achieve the definitive diagnosis. The arterial ligament was resected and esophageal stenosis corrected. Anesthesia, surgery and the postoperative period undergo without any complications. Patients remained hospitalized in the first 24 h for observation and were dis­charged after this period. Ten days surgery they returned for revaluation and removal of the skin suture. Four months after the surgical correction the animals underwent a new radiography and esophagogram examination. Radiographic findings evidenced persistence of esophageal dilation and narrowing of the esophageal lumen. Patients were evaluated periodically up to 10 months after surgery, verifying excellent quality of life and remission of clinical signs.Discussion: Vascular ring anomalies affects both dogs and cats, occurring more commonly in purebred dogs than in mixed breed. The literature reports cases in young Siamese and Persian cats, although the absolute numbers are insufficient to make conclusions about the racial predisposition. This case report enrolled two cases of PRAA in adult mixed breed cats (one male and one female from the same litter). Surgical correction is the recommended treatment for PRAA, either con­ventional or minimally invasive techniques. To assist the dissection of the fibrous ring and correction of esophageal stenosis we utilized a 22 Fr Foley catheter, introduced through the oral cavity to the esophageal stenotic area. The inflation of the balloon on the constricted area allows visualization of residual fiber rings and facilitates its dissection and removal. The PRAA mortality is associated with late diagnosis and the coexistence of aspiration pneumonia. Therefore, surgery should be performed as soon as possible after the onset of clinical signs, in order to reduce damage to the esophageal muscles and nerves. It is estimated that 80% of cases survived the postoperative period. In both cases, no clinical signs were observed, and there was a reduction of the esophageal diameter compared with the previous dilation, as well as better esophageal transit. Ten months after surgery, the animals returned for revaluation, presenting adequate body development and good quality of life. As shown in this case report, surgical intervention allowed for the accurate diagnosis and correction of PRAA in cats, with remission of clinical signs and full recovery of the animal.Keywords: cat, regurgitation, megaesophagus, thoracotomy, anomaly.

EFFECT OF ANTIVIRAL THERAPY ON CARDIOHEMODYNAMIC INDICATORS IN PATIENTS WITH CHRONIC VIRAL HEPATITIS AND LIVER CIRRHOSIS

Aim. To study the effect of antiviral therapy (AVT) on some cardiohemodynamics indicators in patients with chronic viral hepatitis (CVH) and viral liver cirrhosis (VLC). Material and methods. Doppler echocardiography, tissue Doppler echocardiography, 24-hour ECG monitoring, assessment of the blood flow in the portal vein and in the splenic artery were performed in patients with CVH (n=16) and VLC (n=16) initially and after the course of AVT with interferon and ribavirin leading to sustained virological response. Results. The improvement of systolic and diastolic function of the left ventricle (LV), decrease inLV myocardial mass (from 170 [225.5;213.5] to 159 [146;167] g; p<0.001), and size of the left atrium (LA; from 37 [34;40] to 35.5 [33;38] mm; p<0.001) were found in patients with CVH after AVT. Reduction in the autonomic nervous system tonus was also observed. Decrease in the blood flow rate in the splenic artery (from 107 [95;126.2] to 77 [67.2;99] cm/s; p<0.001) and in the portal vein (from 29 [20;31] to 19 [18;23] cm/s; p<0.001) were detected. Reduction inLV myocardial mass, LA size, systolic blood pressure in pulmonary artery (from 34 [29;38] to 30 [26;31] mm Hg; p<0.001), and the autonomic nervous system tonus were also observed after AVT in patients with VLC. The correlations between the maximum speed of the first negative peak (Em) in the mitral valve fibrous ring and increased viral load (r=0.31; p<0.05), as well as between the diameter of the portal vein and pulmonary artery pressure (r=0.77, p<0.05) were found. Conclusion. Results of the study suggest that patients received AVT have better cardiohemodynamic indicators than patients without specific treatment.

Longitudinal deformation of the left ventricle and the left atrium in workers of railway transport with arterial hypertension

The research objective was in studying and evaluating the indicators of longitudinal deformation of the left ventricle and the left atrium in persons with arterial hypertension (AH), and also in persons with risk factors, but without AH, workers of railway transport.Materials and methods. The workers of railway transport under research are: 45 patients with AH, 35 people with risk factors, but without AH and 20 healthy volunteers. All the people under research were exposed the transthoracal echocardiography on ultrasonic Philips iE 33 system (Holland) including two-dimensional impulsive wave tissue Doppler echocardiography.Results. The decrease of a systolic velocity of a fibrous ring of the mitral valve in the region of septal and lateral segments in both groups is observed in comparison with the control. In studied groups deterioration of a diastolic function and significant decline of indicators of global longitudinal deformation of a left ventricle and the left atrium in comparison to healthy people are also registered. Depression of segmental deformation of a left ventricle in both groups has a chaotic character. The more the index of mass of a myocardium of a left ventricle, the lower indicators of global deformation are; the more the index of volume of the left atrium, the lower indicators of deformation of the left atrium are.Conclusion. Depression of diastolic and segmental systolic functions of a left ventricle of workers of railway transport is registered both with AH and without AH, but with risk factors that are reflected in indicators of longitudinal deformation of a left ventricle and a left atrium.

The role of ultrasonography in differential diagnosis of degenerative disk disease of the lumbar spine

Objective: To improve the diagnostics of lumbar degenerative disc disease through the development and implementation of complex of ultrasound criteria into the clinical practice. Methods: There were examined 128 patients aged from 20 to 60 years with degenerative diseases of the lumbar spine, as well as 21 healthy subjects between the ages from 20 and 40 as a comparative group. Results: We in¬vestigated diagnostic capabilities of ultrasonography in patients with degenerative processes in the intervertebral discs (IVD) of different severity. There were defined ultrasound criteria for protru¬sions, IVD herniations, epiduritis, scar-adhesions in the epidural space, and the yellow ligament hypertrophy. The main feature that distinguishes the protrusion from other pathological conditions on the border of IVD and the spinal canal is an absence of the fibrous ring ruptures in the area of protrusions. When rendering ruptures of the disk we diagnosed IVD herniation. To determine the type of herniation using ultrasonography there has been proposed and patented a method of ultrasound diagnostics of the lumbar spine IVD herniation which clearly defined the localization of posterior herniation. There were evaluated and compared the efficiency and informativeness of ultrasonography in different types of IVD protrusions and herniations. Conclusions: An initial stage of the degenerative process in IVD is characterized by increased echo-genicity, heterogeneity in echostructure of the nucleus pulposus, expansion of the boundaries between it and the fibrous ring. Ex¬pressed stages of degenerative disk disease characterize with com¬promising of the integrity of the fibrous ring and the formation of IVD herniations, development of reactive epiduritis and adhesions in epidural space. It was demonstrated a high information content of the ultrasonic method for visualization of localization, direction and size of herniations: sensitivity — 89.2 %; specificity — 66.6 %; accuracy — 87.1 %.

Ivemark syndrome with cor triatriatum, primum ASD, cleft mitrale and pulmonary stenosis

Congenital diseases causing obstruction of the right ventricular outflow tract (RVOT) are common, but the isolated subvalvular pulmonary stenosis is a very rare condition. Its diagnosis is obscure because of difficulty of comprehension of cardiac anatomy. We report a case of a 61-year-old female who presented for increasing shortness of breath on moderate exertion. Echocardiography showed an obstruction in the RVOT during systole by a subpulmonary fibrous ring with a mean gradient of 75mmHg through the ring. Under cardiopulmonary bypass, surgical resection was successfully performed. The patient continued to do well on follow-up in the out-patient clinic, 12 months postoperative.

Retour d’expérience d’une nouvelle technique de préputioplastie comme alternative à la circoncision

Surgery is required for phimosis with a contracted fibrous ring or when the medical treatment with steroids has been unsuccessful. Surgical teams often opt for circumcision when a conservative technique can be used. This surgery could have some psychologic consequences, and when the circumcision in not according to religious convictions, it cannot be live well for the patient and his family. Furthermore, some surgery procedures for prepuce conservation seem to give some unaesthesics aspects with cutaneous excess. The objective of this study was to evaluate our new preputioplasty technique according to the initial diagnosis (phimosis with scarred foreskin or long and narrow foreskin), in situation where circumcision is required currently. Outcome evaluated was: easy and painless foreskin retraction, absence of postoperative phimosis as well as cosmetic aspects of the penis. In this study, 90 children benefited from this technique and subsequent follow-up. The mean age was 7.9 years for the 32 children in the sclerotic phimosis group and 6.8 years for the 58 children in the long and narrow foreskin group. We observed complete foreskin retraction without any recurrence in 100% of children with a phimosis resistant to medical treatment which consisted of progressive foreskin retraction and application of topical steroids, with a mean postoperative follow-up of 1.4 years. Results showed an excellent cosmetic aspect of the penis with absence of enlarged foreskin in all our subjects. This study underlines the relevance of this surgical technique.

Assessment of left atrial volume and mechanical functions using real-time three-dimensional echocardiography in patients with mitral annular calcification.

Objective:Mitral annular calcification (MAC) is degeneration of the fibrous annular ring of the mitral valve. Left atrial (LA) function and volume have been evaluated by many methods; however, none have used real-time three-dimensional echocardiography (RT3DE) in patients with MAC. Our study is the first to evaluate LA volume and mechanical function using RT3DE in patients with MAC.Methods:Our study was a prospective cross-sectional study. In total, 32 patients with echocardiographic evidence of MAC and 30 volunteers without MAC were enrolled in the study. Kolmogorov–Smirnov test, Student’s t-test, Mann-Whitney U test, chi-square test, Pearson’s correlation test, and multiple linear regression analyses were used in this study.Results:LA diameter was significantly higher in patients with MAC (38.5±3.8 vs. 31.1±2.9, p<0.001). Maximum LA volume (49.6±11.2 vs. 35.6±2.5, p<0.001), minimum LA volume (23.8±7.9 vs. 12.6±2.3, p<0.001), and LA volume index (LAVI) (26.9±6.1 vs. 20.5±2.4, p<0.001) were also higher in the MAC group. LAVI was correlated with age (p<0.001), blood urea nitrogen levels (p=0.089), total cholesterol levels (p=0.055), left ventricular systolic myocardial velocity (p=0.048), E/A ratio (p<0.001), and MAC (p<0.001). Multiple linear regression analyses revealed that age (β=0.390, p<0.001) and MAC (β=0.527, p<0.001) were independent predictors of LAVI.Conclusion:We found that LA mechanical function was impaired in patients with MAC. Furthermore, age and MAC were independent predictors of increased LAVI according to our RT3DE examination.