Sclerotic Changes Research Articles

Machine learning localization to identify the epileptogenic side in mesial temporal lobe epilepsy

BackgroundMesial temporal sclerosis (MTS) is the most common pathology associated with drug-resistant mesial temporal lobe epilepsy (mTLE) in adults.Most atrophic hippocampi can be identified using MRI based on standard epilepsy protocols; however, difficulties can arise in cases where sclerotic changes in the hippocampus are subtle or non-epilepsy-specific protocols have been implemented. In such cases, quantitative methods, such as T1-weighted axial series MRIs, are valuable additional tools to complement epilepsy-specific protocols. In the current study, we applied machine learning (ML) techniques to the analysis of brain regions of interest (ROIs), including the hippocampus, thalamus, and cortical areas, to enhance the accuracy of lesion lateralization in MRI. MethodsThis study included 104 patients diagnosed with mTLE, including 55 with lesions on the right side and 49 with lesions on the left side. FreeSurfer software was used to extract features from high-resolution T1-weighted axial brain MRI scans for use in computing lateralization indices (LI) for various brain regions. After using feature selection to pinpoint critical ROIs, the corresponding LI values were used as parameters in training the ML model. ResultsThe proposed ML model demonstrated exceptional performance in the lateralization of mTLE, achieving test accuracy of 92.38 % with an AUROC of 0.97. ConclusionThis study demonstrated the efficacy of ML in detecting instances of MTS from thin-slice T1 images. The proposed method provides valuable insights for surgical planning and treatment. Nonetheless, additional research will be required to enhance the robustness of the model and rigorously validate its effectiveness and applicability in clinical settings.

To study the effect of high blood bilirubin concentrations on the epidermis and dermis in seborrheic dermatitis and seborrheic alopecia

BACKGROUND: Seborrhea is a common problem affecting about 25% of the population. Seborrheic alopecia and seborrheic dermatitis have a negative impact on the quality of life of patients, reducing their self-esteem and social activity. However, the mechanisms underlying these diseases remain poorly understood to this day, which makes it difficult to develop effective treatments for these conditions. AIM: To study the effect of high concentrations of blood bilirubin on the epidermis and dermis in seborrheic dermatitis and seborrheic alopecia. MATERIALS AND METHODS: Seborrheic dermatitis of the scalp was registered in 61 patients, seborrheic alopecia ― in 23. After determining the concentration of bilirubin in the blood (total and direct), formed a group of 16 patients with seborrheic dermatitis (10 people with reference values of total and direct bilirubin and 6 people with hyperbilirubinemia), as well 23 patients as with seborrheic alopecia (9 people with reference values of total and direct bilirubin and 14 people with hyperbilirubinemia) were formed, who A histological examination of the biopsy of the skin of the affected area of the scalp was performed. RESULTS: The formation of a thinner epidermis in seborrheic dermatitis and seborrheic alopecia at high concentrations of bilirubin is associated with the presence of a thinner spiny layer. In conditions of hyperbilirubinemia, pathological changes in the dermis are more associated with the presence of lymphohistiocytic infiltrates and the development of sclerotic changes, especially in seborrheic alopecia. CONCLUSION: Seborrheic dermatitis and seborrheic alopecia against the background of hyperbilirubinemia is a tendency to decrease the thickness of the spiny layer, which affects the thickness of the entire epidermis. The decrease in the thickness of the stratum corneum with an increase in the granular layer, observed in seborrheic dermatitis, is a feature that is not observed in seborrheic alopecia. Manifestations of seborrheic alopecia are manifested by the presence of lymphohistiocytic infiltrates and sclerosis.

The Influence of Experimental Chronic Antenatal and Acute Postnatal Hypoxia on the Morphological State of the Liver Stromal Component

BACKGROUND: At present, the asymptomatic course of liver pathology in early childhood remains an urgent problem. AIMS: The objective of the study was the detection of morphological features of the stromal component of the liver of rats, which were at different stages of postnatal ontogenesis and were exposed to chronic antenatal and acute postnatal hypoxia (APH). MATERIALS AND METHODS: The study material was rat liver tissue of the control group, the APH group, and the chronic antenatal hypoxia (CAH) group. RESULTS: From day 1 to day 35, CAH leads to an increase and growth of the stromal component in the liver of offsprings due to the development of sclerotic changes caused by activation of collagen formation with a predominance of mature collagen Type I over immature collagen Type III on day 1 and day 14 of the experiment and predominance of collagen Type III over collagen Type I on day 35 of the experiment, increasing the expression of fibronectin. Starting from day 14, APH leads to the development of sclerotic changes in this organ which increase to day 35, less pronounced compared to the detected sclerotic changes in CAH, and manifest in increased expression of fibronectin, activation of collagen formation with a predominance of collagen Type I over collagen Type III on days 14 and 35 of the experiment. CONCLUSION: CAH from day 1 and APH from day 14 of postnatal life lead to the development of sclerotic changes in the liver of offsprings, which are more pronounced in cases of simulation of CAH and increase with age.

HEPATOTOXIC EFFECTS DUE TO THE COMBINED CONSUMPTION OF OPIOID DRUGS AND ALCOHOL

Introduction. Over the past 20 years, opioid consumption in the world has reached epidemic proportions, which has led to an increase in premature mortality and significantly changed the epidemiology of liver diseases. Aim. The study of features of liver injury with combined consumption of opioid drugs and alcohol. Materials and methods. A retrospective analysis of the medical data of 1,540 patients with the diagnoses of "Acute narcotic poisoning" and "Acute methadone poisoning" (ICD-10:Т40.0-Т40.3); 42 acts of forensic medical and forensic histological examination of death cases associated with illegal methadone and alcohol were considered. Clinical, biochemical, and pathohistological studies were used. Histological samples were examined using an Olympus CX 41 microscope in transmitted light, at magnifications of 100, 200, and 400 times. The SPSS Statistics 29.0.0.0 program was used, Pearson's correlation analysis was used, p≤0.05. Results. According to the results of forensic and histological studies, pronounced infiltration of the liver tissue by small lymphocytes (r=0.471, р=0.002) was found in persons with a long history of illegal methadone and alcohol consumption, which was combined with portal fibrosis (r=0.333, р=0.021) and, in some cases, moderate proliferation of bile ducts (r=0.203, p=0.047). Morphometric analysis of liver biopsies revealed sinusoidal dilatation, inflammatory and fibrotic changes of the terminal hepatic venules (r=0.501, p=0.017); sclerotic changes were noted from the expansion of the portal tracts due to fibrosis and to the initial signs of a partial structure violation, which indicates the transition to cirrhosis. Conclusions. The progressive spread of the practice of combined consumption of opioid drugs on the example of methadone and alcohol increases the risk of hepatotoxic effects, in particular, accelerating the development of fibrosis and cirrhosis.

Evaluating metrics of circulating tumor DNA response and progression using a high sensitivity tumor-agnostic assay in metastatic HR+/HER2- breast cancer receiving endocrine therapy and a CDK4/6-inhibitor.

1043 Background: CDK4/6-inhibitors (-i) and endocrine therapy (ET) are first-line treatment for HR+/HER2- metastatic breast cancer (mBC). Clinical evaluation and cross-sectional imaging are used for treatment response assessment. The relationship between clinical/radiographic response and ctDNA dynamics using a high sensitivity tumor-agnostic assay is unknown in HR+/HER2- mBC. ctDNA monitoring in mBC may support clinical decision-making, enable new strategies for response assessment in clinical trials, and facilitate enrolment of patients lacking measurable disease (bone-only). Methods: Patients (pts) with HR+/HER2- mBC receiving ET and CDK4/6i were enrolled in a prospective cohort study. Plasma samples were collected at baseline (BL) and regularly on-treatment. Samples were analyzed using Guardant Infinity, a tumor-agnostic genomic and epigenomic platform. ctDNA-response (-R) was defined as a ≥50% decrease (dec) in methylation tumor fraction (mTF) from BL. ctDNA-progression (-P) was defined as a <50% dec in mTF from BL or any subsequent increase in mTF above an absolute mTF of 0.001% (cohort specific definition). Imaging outcomes and dates of treatment discontinuation (TD) were collected. Results: 57 pts with 350 clinical timepoints were evaluated. Median follow up was 28.2m (range: 1.6-66.0m). 42/57 (74%) pts received palbociclib and 40/57 (70%) received an aromatase inhibitor. ctDNA-R/-P was evaluable in 49/57 patients. ctDNA-P identified within the first 90d on CDK4/6i was not prognostic of TD (p=0.7972); when assessed between 90-180d it was prognostic of early TD (med: 6.3m vs. not reached; HR: 5.17, 95%CI: 1.04-25.7; p=0.0003). 156 matched radiographic and ctDNA assessments (blood collected within 30d of CT) were evaluable for ctDNA-R/-P and imaging concordance. Excluding those with clinician-identified sclerotic bone changes suggestive of treatment effect (n=5 events), adjudicated radiographic progression did not occur in the setting of ctDNA-R (NPV: 100%, sensitivity: 100%); no pts had clinical progression in the presence of ctDNA-R. ctDNA rise in the absence of radiographic progression occurred in 13 pts; 7/13 had TD (med: 10.1m, range: 3.0-21.9m) in the follow up period reflecting a molecular lead time. Blood first monitoring, using these metrics, could have avoided 104/150 (69%) staging CT scans in this cohort. Conclusions: ctDNA dynamics are associated with clinical outcomes in HR+/HER2- mBC. The use of a high sensitivity assay permits assessment of response in nearly all patients and suggests the possibility that radiographic surveillance could be reduced in patients with ctDNA-R. Prospective validation of these findings are required. Additional ctDNA-R/-P definitions and relationship with RECIST 1.1 criteria will be presented at the meeting.

Challenge of Clinical Diagnosis and Treatment for Proteus Syndrome: A Case Report

Proteus syndrome (PS) is an extremely rare complex disorder, and caused by PS associated somatic mosaic AKT1 gene mutation. PS is characterized by progressive asymmetric, disproportionate overgrowth of patient’s skin, soft tissue, and bone of the different body parts since infant period. There is diversity in both clinical appearances, and with or without PS associated pathogenic genetic mutation situation can be existed for each patient. That caused clinical challenges for both accurate diagnosis and proper early treatment. We report a case of 17 years-old girl she presented with significant craniofacial dysmorphism, including prominent craniosynostosis and generalized skull bone sclerotic hyperostosis changes, hearing impairment after age of 3 years-old, progressive asymmetric overgrowth of the left lower limb with leg length discrepancy in childhood. Focal lipomatous tumors grow over the abdomen, left thigh and spinal deformity developed around teenage years. Hypermenorrhea with adenomyosis and ovarian cystadenoma lesions after menarche 12 years-old. Patient was fulfilled positive clinical criteria > 17 points for clinical Proteus syndrome diagnosis, clinically strict met (mosaic distribution of lesions, sporadic occurrence, and progressive course) three general criteria for PS diagnosis. Although the whole exome sequencing test from affected thigh lipoma did not identify pathogenic/likely pathogenic variant AKT1, PTEN, PIK3CA gene. Whole genome sequencing test from affected cranial hyperostosis bone revealed MSH6 variant of uncertain significance (NM-000179.3: c.754T>G) gene mutation. The patient has received surgical treated at three different medical centers in Taiwan for craniofacial dysmorphism, hearing loss, leg length discrepancy, and hypermenorrhea problems respectively. All clinical symptoms and problems with postoperative have partial relieved and improvement. Further more complicated surgery was necessary for her. Clinically we are challenged both for early confirming PS clinical diagnosis, and make the differential diagnosis from other clinical mimic overgrowth spectrum disorder.

Diastolic Dysfunction and Atrial Fibrillation: Recognition, Interplay, and Management.

Diastolic dysfunction occurs when the left ventricle loses its ability to relax normally, impairing ventricular filling during diastole. This most commonly occurs as a pathological sequela of left ventricular hypertrophy and remodeling due to chronic hypertension and/or age-related sclerotic changes of the aortic valve. This can subsequently deteriorate to diastolic heart failure or heart failure with preserved ejection fraction. There is a substantive interplay between atrial fibrillation and diastolic dysfunction, as atrial fibrillation can cause, exacerbate, or be a direct result of diastolic dysfunction and vice versa. In this review, we first independently define diastolic heart failure and atrial fibrillation while discussing the diagnostic guidelines, which encompass various modalities such as medical history, electrocardiography, echocardiography, and laboratory tests. We subsequently examine their interplay and pathophysiological links drawing on recent evidence in the literature. Finally, we discuss management approaches, including pharmacological interventions targeting rate and rhythm control, diuretics, and addressing comorbidities.

Pathological Changes in the Gastrocnemius Muscle throughout Hind Limb Ischemia Modeling in Rats.

We present a two-stage model for the study of chronic hind limb ischemia in rats. In the area of ischemia, sclerotic changes with atrophic rhabdomyocytes and reduced vascularization were revealed. CD31 expression in the endothelium increased proportionally to the number of vessels in the ischemic zone, and at the same time, focal expression of βIII-tubulin was detected in the newly formed nerve fibers. These histological features are equivalent to the development of peripheral arterial disease in humans, which allows using our model in the search for new therapeutic strategies.

Evaluation of anorectal function using real-time tissue elastography before and after preoperative chemoradiotherapy

PurposeThis study aimed to clarify the relationship between changes in elasticity and anorectal function before and after chemoradiotherapy.MethodsThis is a single-center prospective cohort study (Department of Surgical Oncology, The University of Tokyo). We established a technique to quantify internal anal sphincter hardness as elasticity using transanal ultrasonography with real-time tissue elastography. Twenty-seven patients with post-chemoradiotherapy rectal cancer during 2019–2022 were included. Real-time tissue elastography with transanal ultrasonography was performed before and after chemoradiotherapy to measure internal anal sphincter hardness as “elasticity” (hardest (0) to softest (255); decreased elasticity indicated sclerotic changes). The relationship between the increase or decrease in elasticity pre- and post-chemoradiotherapy and the maximum resting pressure, maximum squeeze pressure, and Wexner score were the outcome measures.ResultsA decrease in elasticity was observed in 16/27 (59.3%) patients after chemoradiotherapy. Patients with and without elasticity decrease after chemoradiotherapy comprised the internal anal sphincter sclerosis and non-sclerosis groups, respectively. The maximum resting pressure post-chemoradiotherapy was significantly high in the internal anal sphincter sclerosis group (63.0 mmHg vs. 47.0 mmHg), and a majority had a worsening Wexner score (60.0% vs. 18.2%) compared with that of the non-sclerosis group. Decreasing elasticity (internal anal sphincter sclerosis) correlated with a higher maximum resting pressure (r = 0.36); no correlation was observed between the degree of elasticity change and maximum squeeze pressure.ConclusionInternal anal sphincter sclerosis due to chemoradiotherapy may correlate to anorectal dysfunction.

Tissue structure transformations of the gallbladder in chronic calculous cholecystitis

Aim. To determine the morphofunctional characteristics of tissue changes in the structure of the gallbladder in chronic calculous cholecystitis.Materials and Methods. The macro- and microscopic structural walls of the gallbladder were studied using the method of injection anatomical dissection, histology, and morphometry in 61 patients (aged 36 to 60) with chronic calculous cholecystitis.Results and Discussion. The results of a morphological study show that in chronic calculous cholecystitis, changes are always observed in all layers of the gallbladder wall. The most severe dystrophic and sclerotic changes are observed in the mucous membrane and submucosal base, since, this layer has in functional, topographical and quantitative features, as well as a direct contact with stones (mechanical impact).Conclusion. Transformation of the gallbladder in chronic calculous cholecystitis are characterized by vascular tissue restructuring of the structures of the organ wall, accompanied by the phenomena of adaptive, exudative and proliferative transformations, and in the later stages (5-6 years) undergo sclerotic changes in the gallbladder wall.

Differentiating Brown Tumor From Bone Metastasis in Parathyroid Cancer Using 18 F-FDG PET and 99m Tc-MIBI SPECT.

A 69-year-old woman presented with a right clavicle pain. CT revealed a pathological fracture of the right clavicle, multiple osteolytic lesions, and a left cervical mass. 18 F-FDG PET/CT demonstrated a marked FDG uptake in the cervical mass and osteolytic lesions indicative of metastatic parathyroid cancer. 99m Tc-MIBI SPECT/CT revealed either faint or no uptake in the osteolytic lesions. However, a histopathological analysis after a parathyroidectomy and right clavicle biopsy confirmed the diagnosis of parathyroid cancer and the presence of benign brown tumors secondary to hyperparathyroidism. Postoperative imaging showed sclerotic change and a decreased FDG uptake in the bone lesions.

Role of MRI in detection of lumber spine pathologies using 1.5 tesla (MRI)

Background: This study investigates the diagnostic accuracy of MRI in detecting various lumbar spine pathologies in patients with lower back pain. Lower back pain (LBP) is a prevalent issue affecting 80%–85% of the population during their lifetime, contributing significantly to global disability. LBP is nonspecific in 95% of cases but can stem from underlying pathologies such as disc herniation, spinal stenosis, infection, inflammation, tumours, or fractures. Objective: To emphasize the importance of magnetic resonance imaging (MRI) in patients suspected of lumbar spinal examinations. Methods and material: The research focused on adult patients with radicular syndrome, spinal stenosis, spinal tumours, spinal fractures, spinal infection/inflammation, disc herniation, spondylolisthesis, spondylolysis, ankylosing spondylitis, disc displacement, osteoporotic fractures, and other degenerative disc diseases. Utilizing a 1.5 Tesla MRI machine, the descriptive, cross-sectional observational study spanned one year and included 150 patients. Results: revealed that diffuse disc bulge (87.33%) and disc protrusion (87.33%) were the most common pathologies, followed by partial desiccation (34.67%), neural foramina stenosis (16.00%), spondylosis (1.33%), osteoporosis (12.00%), spinal haemorrhage (2.00%), osteophyte spurs (29.33%), and sclerotic changes (3.33%). Discussion and Conclusion: The study's discussion highlighted notable findings, including a higher prevalence of lumbar spine abnormalities in females (51.33%) and a substantial association with a history of lower back pain (40.00%). The conclusion underscores the significance of MRI in diagnosing lumbar spine pathologies, with specific attention to the prevalence of disc bulge and protrusion in the studied population.

МОРФОЛОГИЧЕСКИЕ И УЛЬТРАСТРУКТУРНЫЕ ИЗМЕНЕНИЯ ТКАНИ ПЕЧЕНИ ПРИ БИЛИАРНОЙ ОККЛЮЗИИ РАЗЛИЧНОЙ ДЛИТЕЛЬНОСТИ

An analysis of the morphological state of the liver was carried out in 160 patients with obstructive jaundice of non-tumor etiology who received treatment in the Novgorod Regional Clinical Hospital and Central City Clinical Hospital. The results of liver biopsy during surgery were studied. Pronounced structural and functional changes in liver tissue were revealed, which were further aggravated due to an increase in the duration of occlusion. In cases with long-term chronic jaundice, after decompression of the bile ducts, sclerotic changes, histiolymphocytic infiltration and proliferating biliary epithelium, fibrosis and foci of hepatocyte necrosis remain in the portal tracts. Ultrastructure analysis revealed changes in the cell membrane, cytoplasmic structures, destruction of mitochondrial membranes, formation of secondary lysosomes, disruption of the integrity of the nuclear membrane and signs of karyolysis. The study of puncture and surgical biopsies for obstructive jaundice makes it possible to establish the form and severity of cholestasis and, along with other diagnostic indicators, affects disease prognosis and the tactics of surgical treatment. Taking the different timing and severity of cholestasis into account, it is necessary to use therapeutic technologies in advance that lead to an improvement in liver morphology.

Morphology of the colon wall at different stages of chronic constipation

Introduction. Chronic constipation affects 14–16% of the developed countries population, thus remaining an important problem of modern coloproctology. To substantiate an objective treatment, it is elevant to look at not only clinical, laboratory, and instrumental data, but also at morphogenesis of structural colon changes at different stages of chronic constipation. Materials and methods. We studied postoperative material of 30 patients with drug-resistant chronic constipation at subcompensated (SC) and decompensated (DC) stages. The comparison group (CG) included 30 cases of colon resection for non-recurrent colorectal cancer. Morphometry of mucous membrane structural elements and neuromuscular and lymphoid apparatus was carried out. Results. Quantitative analysis of structural colon elements at SC stage indicates reversible atrophic changes and thickening of submucosal and muscular membranes, mainly due to edema and hypertrophy. Simultaneously, atrophic changes at DC stage are irreversible, with sclerotic, dystrophic, and atrophic changes being observed in submucosal and muscular membranes. As chronic constipation progresses, the number of nerve cells in the neuromuscular apparatus of the colon decreases significantly. Morphogenesis of lymphoid formations is limited to the development of a compensatory adaptive reaction as protective hyperplasia at SC stage, without simultaneous increase in the specific proportion of secondary lymphoid follicles. Although at DS stage, the average number and specific proportion of lymphoid formations in the mucosal and submucosal layers of the colon increase; the average area of lymphoid formations decreases markedly; and no secondary lymphoid follicles are observed. Conclusion. The established patterns of the colon wall morphogenesis in chronic constipation provide us objective causes to confirm the irreversible progression of pathological processes in all its functionally significant structures. This, based on the morphometric criteria obtained, serves as a recommendation for finding the most optimal treatment option for such patients. Keywords: chronic constipation, morphometry

Dogs with Bilateral Medial Coronoid Disease Can Be Clinically Sound after Unilateral Arthroscopic Fragment Removal-Preliminary Study.

The purpose of this study was to assess the outcome of dogs with bilateral medial coronoid disease (MCD) treated with arthroscopic intervention for the clinically more severely affected side and conservative management for the contralateral side. The medical records of dogs with bilateral medial coronoid disease diagnosed using computed tomography (CT) and treated using arthroscopic intervention on one elbow and conservative management on the other elbow were retrospectively reviewed. The outcome evaluation included clinical re-examination; follow-up radiographic-visible osteophytic lesions; as well as sclerotic changes and Liverpool osteoarthritis in a dogs questionnaire. Data from 48 clinically affected elbow joints (24 dogs) with bilateral MCD diagnosed using CT were included. Every dog underwent arthroscopic intervention on the elbow joint, which was clinically more severely affected, and the other side was treated with conservative management. A fragment of the medial coronoid was diagnosed using CT in all elbows, whereas 19 elbows (39.4%) showed a dislocation of the fragment and the other 29 elbows (60.4%) did not. There are no findings regarding the radioulnar Incongruence. Initially, 86% of all radiographs had the same degree of osteophytes. At the time of follow-up, the arthroscopic-treated limbs had more severe radiological changes in comparison to the conservatively treated limbs. Lameness improved after arthroscopic therapy in walking. The conservative group showed a largely unchanged gait pattern. Radiological changes do not necessarily reflect the severity of clinical signs. Arthroscopic intervention showed an improvement of the clinical gait pattern, even though the radiographic changes worsened.

Antiresorptive agent-related osteonecrosis of the jaw risk in cancer patients before bone-modifying agent therapy: A retrospective study of 511 patients.

Antiresorptive agent-related osteonecrosis of the jaw (ARONJ) is a serious adverse event associated with therapies for advanced cancer involving bone-modifying agents (BMAs). Although many studies have investigated the risk factors for ARONJ, none have provided sufficient clarifications. We aimed to determine whether there is a correlation between tooth extraction before BMA therapy and the development of ARONJ. We included 511 patients who were admitted to our department before BMA therapy. The incidence of ARONJ and its risk factors was retrospectively evaluated, focusing on tooth extraction before BMA therapy and radiological findings of the extracted tooth. Of the 511 patients, 135 underwent tooth extraction before undergoing BMA therapy. ARONJ was observed in 17.7% and 7.2% of patients in the extraction and non-extraction groups, respectively (p=0.0002). Regarding the findings of panoramic radiographs before tooth extraction, the incidence of periapical disease was significantly higher in the ARONJ group than that in the non-ARONJ group (50% and 27%, respectively, p=0.034), and the proportion of bone sclerotic changes in the surrounding teeth was significantly higher in the ARONJ group (58.3%) than in the non-ARONJ group (24.4%) (p=0.0004). The presence of a hopeless tooth that requires extraction prior to BMA therapy is a risk factor for MRONJ. However, extraction of such teeth should be considered, as this is known to decrease the risk of MRONJ development after BMA therapy initiation. Moreover, the radiological findings of periapical disease and bone sclerotic changes in the extracted teeth identified in this study can be used as novel predictive factors for ARONJ.

Postoperative Sclerotic Modic Changes After Transforaminal Lumbar Interbody Fusion: The Prevalence, Risk Factors, and Impact on Fusion.

A retrospective cohort study. This study aimed to assess postoperative sclerotic modic changes (MCs) following transforaminal lumbar interbody fusion for lumbar degenerative disc disease, investigating their prevalence, risk factors, and association with clinical outcomes. Sclerotic MCs may occur in patients with lumbar degenerative disc disease after lumbar interbody fusion. The incidence and characteristics of postoperative sclerotic MCs, as well as their clinical impact, are unknown. The study included 467 patients (510 levels) who underwent single or two-level transforaminal lumbar interbody fusion surgery, divided into a postoperative sclerotic MC group (60 patients, 66 levels) and a non-MC group (407 patients, 444 levels). The time of development and location of postoperative sclerotic MCs, fusion rate, cage subsidence, bilateral process decompression, and cross-link usage were recorded. Preoperative, postoperative, and follow-up visual analogue scale and Oswestry disability index scores were collected. Multivariable logistic regression was used to evaluate factors associated with the development of postoperative sclerotic MCs. The prevalence of postoperative sclerotic MCs was 12.8%. The postoperative sclerotic MC group had a higher body mass index (BMI). The postoperative sclerotic MC group demonstrated a fusion rate of 47%, significantly lower than that of the non-MC group (71%) at six months post-operation. At final follow-up, the fusion rate in the postoperative sclerotic MC group was 62%, significantly lower than that of the non-MC group (86%). Postoperative visual analogue scale and Oswestry disability index scores were significantly higher in the group with postoperative sclerotic MCs. BMI and osteoporosis were significantly associated with the development of postoperative sclerotic MCs. Postoperative sclerotic MCs generally appear within the first year after surgery, with a prevalence of 12.8%. The presence of postoperative sclerotic MCs can adversely impact postoperative outcomes. To prevent postoperative sclerotic MCs, the authors postulate extending the immobilization period with external bracing and improving the management of BMI and osteoporosis in the perioperative time window.

Effects of bone mineral density at the lateral sclerotic boundary on the femoral head collapse onset in osteonecrosis of the femoral head: A preliminary study

BackgroundIn the natural course of osteonecrosis of the femoral head, sclerotic changes at the boundary of necrotic lesion gradually occur until femoral head collapse. This study aims to examine the effects of bone mineral density at the lateral boundary of necrotic lesion on a subsequent femoral head collapse. MethodsWe developed patient-specific finite element models of 9 hips with subsequent collapse and 10 hips without subsequent collapse. Cubic regions of interest were selected at both subchondral areas of the lateral boundary and the adjacent necrotic lesion. Bone mineral density values of the regions of interest were quantitatively measured, and a ratio of bone mineral density values (lateral boundary/necrotic lesion) was calculated. Stress values at the lateral boundary were also evaluated. FindingsThe ratio of bone mineral density values was significantly higher in hips with subsequent collapse than that without subsequent collapse (p = 0.0016). The median equivalent stress and shear stress were significantly higher in hips with subsequent collapse than that without subsequent collapse (p = 0.0071, and p = 0.0143, respectively). The ratio of bone mineral density values showed a promising value in predicting the occurrence of subsequent femoral head collapse (AUC = 0.97). InterpretationOur results indicated that bone mineral density value at the lateral boundary of necrotic lesion may be associated with the occurrence of subsequent femoral head collapse in pre-collapse stage osteonecrosis of the femoral head.

EVOLUTION OF MORPHOLOGICAL CHANGES OF THE GALLBLADDER WALL AT DIFFERENT TERMS OF PERFORMANCE OF LAPAROSCOPIC CHOLECYSTECTOMY

Gallstones are present in approximately 10-15 % of the adult population in Western countries, with 1-4 % of patients experiencing symptoms each year. Recent guidelines have confi rmed that laparoscopic cholecystectomy is the mainstay of treatment for acute calculous cholecystitis, but the optimal timing of cholecystectomy is still a matter of debate and research. The purpose of the study is to improve the results of surgical treatment of patients with acute obturation calculous cholecystitis by clinical and morphological substantiation of the optimal terms of laparoscopic cholecystectomy.Material and methods. To increase the safety of laparoscopic cholecystectomy, a histological study of micropreparations of the gallbladder wall after laparoscopic cholecystectomy was conducted in 30 patients, who were divided into 2 groups: 1 group – features of morphological and structural changes in the gallbladder wall up to 7 days after the onset of an attack of biliary colic (18 patients; 60 %) and group 2 – peculiarities of the morpho- structural changes of the gallbladder after 7 days from the onset of an acute attack of biliary colic (12 patients, 40 %);The results. On the basis of microscopic examination of histological preparations, it can be stated that in the early stages of the fi rst attack of cholecystitis, acute infl ammation of various morphological types (non-destructive and destructive) occurs in the wall of the gallbladder. In the late period (after 7 days), sclerotic changes develop both in the organ wall and perivesical. The main role in the pathogenesis of the remodeling of the structural components of the gallbladder is played by deep hemodynamic disorders and the prolongation of the infl ammatory process. Circulatory hypoxia, increasing under such conditions, activates the sclerosing process.

DEPENDENCE OF THE DEVELOPMENT OF HISTOLOGICAL CHANGES IN THE TISSUES OF THE FALLOPIAN TUBES IN ADOLESCENT GIRLS AND YOUNG WOMEN WITH INFLAMMATORY GENITAL DISEASE ON THE TAXONOMIC AFFILIATION OF PATHOGENS

The aim. To conduct a comparative analysis of the fallopian tubes' clinical, microbiological and histological characteristics in adolescent girls and young women with inflammatory genital disease.
 Materials and methods. The etiological diagnosis of inflammatory disease was established with the help of complex microbiological and cytological studies of biomaterial from the vagina of teenage girls and the cervical canal of young women before hospitalization and histological examination fragments of fallopian tube – after surgery. The microbiological examination included the cultural detection of bacteria of various taxonomic groups, fungi, mycoplasmas, and ureaplasmas from the biomaterial. A set of methods described in the article was used to detect chlamydia [13]. The degree of bacterial infection of the fallopian tube fragments was assessed by determining the microbial count. Histological examination of biopsy specimens of fallopian tube tissues removed during surgery was performed by the conventional method [9].
 Results. In the examination of 29 adolescent girls and young women hospitalized for surgical treatment, a comparative analysis was conducted between the clinical manifestations of inflammatory genital disease, identifiable factors, and histological signs of damaged fallopian tubes.When studying the spectrum of factors in the inflammatory focus (fallopian tube biopsies) in adolescent girls (n=12), enterobacteria (33.3%), staphylococci (33.3%), streptococci (8.35%), and Pseudomonas aeruginosa (8.35%) were detected; in 16.7% of adolescent girls, the cultures were sterile. In young women (n=17), microbiological examination of fallopian tube tissues revealed chlamydia (29.4%), mycoplasma (11.6%), ureaplasma (5.8%), gonococci (5.8%), enterobacteria (5.8%), fungi (5.8%); in 6 (35.8%) of the examined women, no bacterial growth was detected. Among young women who had been operated on for tubo-ovarian inflammatory diseases and ectopic pregnancy, chlamydia were most often (29.4%) found in the tissues of the fallopian tubes.
 Conclusions. The studies have shown that in the development of acute purulent salpingitis in young women, sclerotic changes and signs characteristic of the productive process prevailed in the tissues of the fallopian tubes against the background of genital inflammation, and in adolescent girls, an exudative process was observed against the background of genital inflammation. The peculiarities of the course of genital inflammation depend on the biological properties of pathogens of different taxonomic affiliations.