Complex Treatment Research Articles

Osteopathic correction in the complex treatment of patients with panic disorder

Introduction. Panic disorder (PD) is most common in people of the most working age (25 to 64 years). The prevalence of this condition among the population varies from 2 to 5 %. Benzodiazepines and antidepressants, which are included in most international and national clinical guidelines, have proven clinical effi cacy in the treatment of panic disorder. However, the treatment regimens offered to date are far from always helpful in achieving the desired outcome. This necessitates the search for alternative treatment schemes, including the use of non-medication methods.The aim of the study: to substantiate the possibility of using osteopathic correction in the complex therapy of patients with panic disorders.Materials and methods. A controlled randomised study was conducted from December 2020 to December 2021 on the basis of the medical clinic «Anatomy of Health» (Bataysk). There were 32 female patients under observation, aged 25 to 55 years with a previous diagnosis of panic disorder. Depending on the applied treatment, all observed patients were divided into 2 groups using the method of simple randomisation: main group (16 patients) and control group (16 patients). All patients received conventional psychopharmacotherapy and psychotherapy selected according to an individual scheme. In addition to the described therapy scheme, the patients of the main group received three sessions of osteopathic correction lasting about 60 minutes each. The interval between the sessions was from 14 to 21 days. All patients were assessed for osteopathic status, the frequency and severity of panic attacks were investigated using the Panic Disorder Severity Rating Scale.Results. The average age of the examined patients was 38,1±8,7 years. All the patients had comorbid pathology: dorsopathies of nasal localisation (25 people, 80 %), pathology of gastrointestinal tract (17 people, 54 %), cephalgia (12 people, 38 %). Somatic dysfunctions (SD) of global level were less characteristic for the examined patients and were revealed in 7 people [3 (19 %) in the main group and 4 (25 %) in the control group]. All patients had a combination of global rhythmogenic disorder (impaired cranial rhythmic impulse production) and global neurodynamic disorder (psychoviscerosomatic). The patients were found to have regional level SD, with a combination of 2 or more regional biomechanical disorders, and the following regions were characterised by dysfunctions: thoracic [structural and visceral components — 32 (100 %) and 32 (100 %) respectively], pelvis [visceral component — 19 (59 %)], and head [13 (41 %)]. If before the treatment the patients of both groups did not differ statistically signifi cantly in the frequency of detected SDs, after the treatment a statistically signifi cant (p<0,05) decrease in the frequency of detection of regional biomechanical disorders of the thoracic region (structural and visceral component) and pelvis (visceral component) in the patients of the main group was obtained. For the rest of the indicators the differences were not signifi cant. Most of the patients had mild (17 patients, 53 %) and moderate (8 patients, 25 %) panic attacks. The average number of points according to the questionnaire was 10,1±2,5. According to these indicators the groups did not differ statistically signifi cantly. After completion of the course of complex treatment in the patients of the main group in comparison with the control group there is a statistically signifi cant (p<0,05) higher number of people with borderline values and mild panic attack severity, this corresponds to a statistically signifi cant (p<0,05) lower number of scores on the self-questionnaire.Conclusion. The patients with PD are primarily characterised by SD of the thoracic region (structural and visceral components) and pelvis (visceral component). Inclusion of osteopathic correction in the complex therapy of PD patients allows to achieve statistically signifi cant more signifi cant positive dynamics of indicators characterising the severity of the disease (decrease in the number of patients with severe form and increase in mild and borderline forms of the disease). It is reasonable to recommend to profi le specialists to refer patients with PD for consultation to an osteopathic doctor with the purpose of potential inclusion of OC in treatment programmes for this group of patients.

A Stepwise Reaction Achieves Ultrasmall Ag2ZnSnS4 Nanocrystals.

Pirquitasite Ag2ZnSnS4 (AZTS) nanocrystals (NCs) are emergent, lead-free emissive materials in the coinage chalcogenide family with applications in optoelectronic technologies. Like many multinary nanomaterials, their phase-pure synthesis is complicated by the generation of impurities, e.g., binary/ternary chalcogenides and reducedmetals. Here, we develop a stepwise synthetic procedure that controls the size, morphology, and transformations of acanthite-like (Ag2S) and canfieldite-like (Ag8SnS6) intermediates. This reaction scheme grants the production of small AZTS NCs (diameter: 2.1-4.0 nm) that we cannot achieve through established single-injection procedures─expanding the accessible range of quantum-confined AZTS emission to shorter wavelengths (λ: 650-740 nm). We show that the initial sulfur stoichiometry is the key handle for template-size tunability and reveal that temporally separating transformation steps is crucial to obtaining phase-pure AZTS NCs with emission λ < 740 nm. We then use NMR and optical spectroscopies to demonstrate that the installation of thiol ligands improves colloidal stability, while exposure to carboxylic acids does not. Finally, facilitated by this enhanced synthetic control, we show that our ultrasmall AZTS NCs can act as effective, less-toxic sensitizers for red-to-blue triplet fusion upconversion. Our results highlight transferrable insights for the synthesis and postsynthetic treatment of complex, less-toxic quaternary nanocrystalline systems.

Osteopathic correction as part of complex treatment of patients with irritable bowel syndrome

Introduction. According to WHO data from 15 to 20 % of patients seeking gastroenterological care suffer from irritable bowel syndrome. The peak incidence is at the age of 30–40 years and is a frequent cause of disability due to the development of pain syndrome with localisation in the abdomen and changes in stool frequency in the absence of organic pathology. Low effectiveness of treatment of this disease is associated not only with multifactorial formation of gastrointestinal tract dysfunction and the lack of a single standard of therapy, but also with low adherence of patients to treatment due to polypragmasy and the need for long-term use of medications against the background of stressors, urbanisation, low motor activity and changes in diet and diet quality. All this puts before clinicians the task of searching for and including new non-medication methods of treatment of patients with this nosology, which predetermined the purpose of this study.The aim of the study was to investigate the effect of including osteopathic correction in the complex treatment of patients with irritable bowel syndrome on the course of this disease.Materials and methods. A prospective randomised controlled study, conducted between January 2022 and March 2023 at the outpatient clinic of FBUZ MSCh № 32 FMBA of Russia in Zarechny, Sverdlovsk region, included 64 patients of both sexes with an established diagnosis of irritable bowel syndrome. All participants of the study were divided into two comparable groups - main and control groups of 32 people each. Patients of the main group along with standard drug therapy received osteopathic correction, patients of the control group received only drug therapy according to clinical recommendations in gastroenterology. At the end of the treatment course the osteopathic status and the degree of pain syndrome severity were evaluated in patients of both groups.Results. In patients with irritable bowel syndrome the most frequently diagnosed were somatic dysfunctions of global and regional level. Somatic dysfunctions of the global (psychovisceral dysfunction — 23,4 %, rhythmogenic cranial dysfunction — 17,2 %, global biomechanical dysfunction — 6,3 %) and regional levels (lumbar region: visceral component — 35 %, somatic component — 29,7 % and thoracic region: somatic component — 37,4 %) were determined as dominant. The inclusion of osteopathic correction in the complex treatment of patients with irritable bowel syndrome resulted in a statistically signifi cant (p&lt;0,05) decrease in the severity of pain syndrome with localisation in the abdomen.Conclusion. As part of the complex treatment of patients with irritable bowel syndrome, osteopathic correction in combination with the use of standard drug therapy contributes to a signifi cantly more signifi cant reduction in the severity of pain syndrome compared to the use of pharmacological treatment alone in this category of patients.

Analysis of systemic serum vancomycin levels following intraarticular application in primary total joint arthroplasty

IntroductionPeriprosthetic joint infection (PJI) is a serious complication following primary total joint arthroplasty (TJA). PJI accounts for 15–25% of revision surgeries, therefore it is associated with PJI is associated with substantial patient morbidity and mortality as well as increased healthcare expenditures due to complex treatment strategies.Recently, intraoperative local application of vancomycin powder is increasingly being used in primary total hip and knee arthroplasty (THA, TKA) as an additive strategy for PJI prevention. Whereas local vancomycin concentrations have already been investigated in prior studies, evidence on systemic vancomycin levels and potential adverse drug reactions (ADR) is limited. Purpose of this study was to investigate systemic vancomycin levels following intraarticular application in primary TJA.Materials and methodsThis pilot study is a prospective analysis of patients undergoing primary THA and TKA between April and July 2023. One gram of vancomycin powder was applied to the prosthesis prior to wound closure. Serum vancomycin levels were measured at two standardised time points, 24 and 48 h postoperatively.ResultsIn total, 103 patients were included, and the patient collective was further stratified by surgical procedure into a THA subgroup (n = 52) and a TKA subgroup (n = 51). Mean serum vancomycin levels showed a significant group difference at both time points (24 h: p < 0.001; 48 h: p = 0.044) with higher serum vancomycin concentrations in the THA cohort. Mean serum vancomycin levels in THA patients were 1.25 μg/ml (range 0.00–7.00 μg/ml) after 24 h and 0.34 μg/ml (range 0.00–4.80 μg/ml) 48 h postoperatively. In TKA, no systemic vancomycin levels were detected. Vancomycin concentrations did not reach therapeutic levels in any patient. No ADR was detected in the whole study collective.ConclusionFollowing intraarticular administration of vancomycin powder, no systemic vancomycin levels within the therapeutic range were detected, thus it may serve as a safe and cost-effective adjunct to strategies for prevention of PJI.

Use of multipotent mesenchymal stromal cells as part of bone marrow concentrate in the complex treatment of aseptic necrosis of the femoral head: a systematic review

Background. Avascular necrosis of the femoral head (ANFH) is a disabling disease that often leads to hip replacement. Due to the increasing incidence among the young population, various methods of organ-preserving treatment aimed at slowing down the progression of ANFH and preserving the functions of the hip joint have been proposed. Today, there is a lot of controversy and disagreement over the procedure of introducing bone marrow-derived multipotent mesenchymal stromal cells (MMSCs) into the site of osteonecrosis. The aim of the study — a systematic analysis of the accumulated literature data on the effectiveness, safety, advantages and disadvantages of treating patients with aseptic necrosis of the femoral head by the tunneling method using bone marrow-derived MMSCs, as well as their impact on reducing the risk of disease progression and long-term treatment results. Methods. A 10-year literature search (2013-2023) was performed in the PubMed, Scopus and eLIBRARY databases. According to our inclusion criteria, the review included 8 high-quality studies that examined the use of MMSCs as part of bone marrow concentrate for the treatment of ANFH. Results. The surgical outcomes of 368 patients (548 hips) from 8 studies were analyzed. The mean follow-up period was from 24 to 360 months. In most cases, functional indicators improved. In the main group, where mesenchymal stromal cells were used, X-ray progression to the next stage occurred in 31.25% of cases and the need for endoprosthetics was 30.6%; in the comparison group, the progression occurred in 68.75% of cases and the need for endoprosthetics was 69.4 %. Conclusion. The use of multipotent mesenchymal stromal cells in the complex treatment of ANFH in the early (ARCO I, II, IIIA) stages of the disease can improve the hip joint function, slow down the progression of the disease and reduce the need for endoprosthetics.

Complex treatment of patients with chronic non-specific back pain and comorbid disorders: a prospective clinical study

A complex approach including an educational program, ergonomics, kinesiotherapy and pharmacotherapy is effective in the treatment of patients with chronic non-specific back pain (CNBP). The efficacy of complex treatment with personalized kinesiotherapy in patients with CNBP and comorbid disorders has not yet been sufficiently investigated.Objective: to evaluate the efficacy of a complex treatment including special kinesiotherapy, standard pharmacological and non-pharmacological methods in patients with CNBP and comorbid disorders.Material and methods. The study included 60 patients (12 men and 48 women, mean age 38.3±8.7 years) with CNBS and comorbid disorders (neck pain, insomnia, tension type headaches, anxiety and/or depressive symptoms). Patients were randomized into two groups: group 1 received complex treatment, including special kinesiotherapy, standard therapy (educational program, standard kinesiotherapy, non-steroidal anti-inflammatory drugs, muscle relaxers, antidepressants in some patients), group 2 – standard therapy. The clinical and psychological parameters of all patients were analyzed at baseline, and after 1, 3 and 6 months of treatment.Results. After 1 month of treatment, the clinical effect (CE) in terms of CNBS (reduction of back pain (BP) intensity according to the numerical rating scale and Oswestry questionnaire by 30% or more) was achieved in 80% of patients in group 1, which is statistically significantly (p&lt;0.05) higher than in group 2 (46.7% of patients). By month 3 of observation, the number of patients achieving CE increased to 86.7% in group 1 and decreased to 36.6% in group 2. After 6 months, all patients in group 1 maintained the achieved CE, while in group 2 only 30% of patients maintained CE. In group 1, a complete regression of BP was observed in more than one third of patients at month 3 and 6 of observation (33.3 and 36.6%, respectively). In group 2, no regression of BP was observed in any case. In group 1, in contrast to group 2, a statistically significant (p&lt;0.05) decrease in scores on the Beck Pain Catastrophizing Scale, the Kinesiophobia Scale, Beck Anxiety and Depression Scale, the Insomnia Severity Index, Headache Impact Index and Neck Pain Disability Index was observed. The decrease continued until the 6th month of observation.Conclusion. A complex treatment comprising special kinesiotherapy, standard non-drug and drug therapy leads to a rapid (after 1 month) positive effect in patients with CNBP and comorbid disorders that lasts over a long period of time (6 months).

Manual medical technologies in complex treatment and rehabilitation of patients with primary osteoarthritis (literature review)

The review discusses the pathogenetic mechanisms of primary osteoarthritis (OA) formation. The recommendations of the Association of Rheumatologists of Russia on the main principles of rehabilitation for OA are presented, including drug and non-drug methods of pain syndrome correction, improvement of motor activity and quality of life of patients. Particular attention is paid to the mechanisms of osteopathic correction for OA, which are aimed at restoring the impaired biomechanics of the patient’s body, eliminating persistent muscle hypertonicity, peripheral sensitization, and aimed at regulating antinociceptive mechanisms. An important advantage of manual treatment is the possibility of its use before, during or after other types of treatment and the ability to enhance their therapeutic potential.

Pain and cognitive functions – the battle for cognitive reserve

Back pain and headache are the most common pain syndromes and have a significant impact on patients' quality of life. In the process of pain chronification emotional-affective, cognitive and motivational components can be distinguished. Cognitive impairments (CI), such as attention deficits, memory loss, reduced learning and decision-making abilities, are observed in almost one third of patients with chronic pain. The spectrum of CI in patients with chronic back pain is age-dependent. Primary headaches are also associated with the development of CI. An important measure to prevent CI in chronic pain is effective pain relief. Lornoxicam is a non-steroidal anti-inflammatory drug that acts at different levels of pain formation. The mutual influence of back pain and headache on cognitive function and the maintenance of cognitive potential in the complex treatment of patients are discussed.

The possibility of using osteopathic correction in the complex treatment of patient with tinnitus

More than 140 mln people experience the sensation of tinnitus. At the same time, it should be understood that tinnitus is not an independent nosological unit and may be a manifestation of many diseases that may or may not be directly related to the hearing organ. Currently, there is no effective drug for the treatment of tinnitus. The therapeutic process involves specialists of different specialities: neurologists, otoneurologists, surdologists, otolaryngologists, physiotherapists, psychologists and psychotherapists, chiropractors, orthodontists and gnathologists. This is due to the variety and combination of pathologies that cause tinnitus. A clinical case is described to study the possibility of using osteopathic correction in combination with cognitive-behavioural therapy in the treatment of a patient with tinnitus.

Enhancing, Targeting, and Improving Dental Trauma Education: Engaging Generations Y and Z.

Dental trauma is highly prevalent, involving 25% of school-age children and about 12.5% of the general population of the world. Due to the young age of the patients that are usually involved in dental trauma, there are tooth-related complicating factors, such as open apices, thin dentinal walls, and unfavorable crown-to-root ratio, as well as patient-related factors, such as anxiety and cooperation, and other challenges related to the complex diagnosis and treatment. Therefore, it is not surprising that the global status of knowledge for the prevention and emergency management of traumatic dental injuries among dental professionals was often reported as insufficient. Aiming to improve dental trauma education, one should consider that the contemporary educational settings have transitioned to a digital learning ecosystem and that the current students belong to a unique generational cohort. Therefore, this paper examines the challenges educators encounter in contemporary dental school classrooms and the defining characteristics of current generation Y and Z dental student cohorts. Finally, it outlines strategies to optimize dental trauma learning, considering the unique generational characteristics of the current dental students.

Synthetically Reversible, Proton-Mediated Nitrite N-O Bond Cleavage at a Dicopper Site.

A monocationic dicopper(I,I) nitrite complex [Cu2(μ-κ1:κ1-O2N)DPFN][NTf2] (2) (DPFN = 2,7-bis(fluoro-di(2-pyridyl)methyl)-1,8-naphthyridine, NTf2- = N(SO2CF3)2-), was synthesized by treatment of a dicopper acetonitrile complex, [Cu2(μ-MeCN)DPFN][NTf2]2 (1), with tetrabutylammonium nitrite ([nBu4N][NO2]). DFT calculations indicate that 2 is one of three linkage isomers that are close in energy and presumably accessible in solution. Reaction of the μ-κ1:κ1-O2N complex with p-TolSH produces nitrous acid (HONO) and the corresponding dicopper thiolate species via an acid-base exchange reaction. Notably, treatment of 2 with HNTf2 results in N-O bond cleavage in the putative, HONO-ligated complex to form the more thermodynamically favorable nitrosyl-bridged dicopper complex [Cu2(μ-NO)(μ-OH)DPFN][NTf2]2 (4). This scission can be reversed via deprotonation of the hydroxy ligand with KOtBu. X-ray diffraction studies confirmed the solid-state molecular structures of 2 and 4. DFT calculations were used to construct a reaction coordinate diagram detailing formation of the μ-NO complex and to describe its electronic structure. The nitrosyl ligand in 4 is chemically labile, as demonstrated by its ready displacement in reactions with CO or NO2-.

Analyzing and Designing Decision Support Systems for Stroke Patient Daily Treatment

Stroke is one of the neurological diseases that often requires complex management and treatment. Making the right decisions in diagnosing and treating stroke patients can have a significant impact on the recovery process and the quality of life for patients. To assist healthcare professionals and patients in making more informed decisions, this research has developed the "StrokeCare Navigator," a web-based Decision Support System (DSS) that utilizes the Decision Tree C4.5 algorithm. This system allows users, including healthcare professionals and patients, to input symptoms and patient medical information, providing an initial diagnosis of the type and severity of the stroke. Additionally, the system offers personalized treatment guidelines, treatment recommendations, and online patient monitoring services. The Decision Tree C4.5 model used in this system was developed through training with relevant patient data. Evaluation results indicate that the system can provide accurate and beneficial recommendations for healthcare professionals and patients. Testing and patient monitoring in clinical practice also demonstrate the potential to enhance stroke patient care. Therefore, StrokeCare Navigator is expected to be a valuable tool in stroke patient management and treatment, ultimately improving the prospects of patient recovery and providing better guidance for healthcare professionals. This research also provides deeper insights into the implementation of the Decision Tree C4.5 algorithm in the context of Decision Support Systems (DSS) in the medical field.

Topical therapy for psoriasis: algorithms for the use of activated zinc pyrithione

Treatment of any type of psoriasis involves the use of external therapy. Recommended topical preparations include: corticosteroids, calcipotriol in combination with corticosteroids, zinc pyrithione, keratolytics, tar. A special place in the therapy of psoriasis is occupied by a drug containing activated zinc pyrithione (Skin-cap), due to its effectiveness, safety and the availability of various forms (aerosol, cream, shampoo), which allows it to be used in both short-term and long-term therapy at different stages of the disease. Complex treatment, including the use of topical forms containing activated zinc pyrithione, is a highly effective, safe, pathogenetically substantiated method of treating various forms of psoriasis, allowing to achieve rapid regression of rashes, minimize the risk of adverse effects and achieve long-term control over the disease, which significantly improves the quality of life of patients

European Cancer Organisation Essential Requirements for Quality Cancer Care for ovarian cancer: Focus on the multidisciplinary team.

European Cancer Organisation Essential Requirements for Quality Cancer Care (ERQCC) are written by experts representing all disciplines involved in cancer care in Europe. They give patients, health professionals, managers and policymakers a guide to essential care. Here, the essential requirements to treat ovarian cancer patients are described. Ovarian cancer patients continue to have low cure rates with wide variation in treatment and care in Europe and beyond. They require complex treatment that should be carried out in specialised ovarian/gynaecological cancer centres by professionals with the appropriate expertise interacting in a multidisciplinary team. Such centralisation is still not well established in many European countries. A patient-centred pathway from diagnosis through treatment to survivorship, managed in dedicated centres, is key to achieving optimal care and a successful clinical outcome.

Leitlinie der Gesellschaft für Thrombose- und Hämostaseforschung (GTH) zur Struktur- und Prozessqualität von Hämophilie-Zentren.

Since the 1970s, specialized hemophilia centers have been established to optimize the complex and costly treatment of patients with severe bleeding disorders. In 2019, the first GTH guidelines on the structural and process quality of hemophilia centers were published. On this basis, a procedure for the certification of hemophilia centers has been established under the technical leadership of the GTH. These GTH guidelines are essentially based on the European Guidelines for the Certification of Haemophilia Centers published in 2013, created by the European Haemophilia Network (EUHANET). In 2023, this European guideline was revised by the EAHAD Accreditation and Audit of Haemophilia Centers Working Group. On this background, the GTH guidelines have now been revised to take relevant updates to the European guidelines into account.

Enhanced prediction of Cs removal by CST from Hanford tank waste with K accountability

AbstractThe treatment of Hanford tank waste is one of the most challenging environmental cleanup activities to date. To expedite the processing of liquid waste stored in underground tanks in Washington State it is necessary to remove the significant dose contributor, 137Cs. Crystalline silicotitanate ion exchanger is currently used to remove 137Cs from the aqueous phase of Hanford tank wastes in preparation for vitrification at the Waste Treatment and Immobilization Plant (WTP). Improving the understanding of potassium impacts on ion exchange behavior of Cs will help in the operation of a critical component of one of the most complex treatment processes in the world today. Optimization of this process can result in significant cost savings and less waste production. Toward this effort, a series of batch contact tests varied in potassium concentration were conducted to look at the impact of potassium concentration on Cs distribution. Experimental distribution ratios (Kd) were compared to the distribution ratios predicted using the ZAM model. A significant underprediction of Cs capacity in the presence of potassium was seen with the existing model. A revision of the equilibrium constants was determined and provided a statistically better fit for determining the Cs Kd values in tank waste matrices.

Short-term changes in brain networks and cognition in children with frontal lobe lesions treated solely with neurosurgical procedures

Intracranial lesions in children often have good prognoses, allowing long-term survival. Cognitive functions, crucial for life quality, need more attention. Previous research has focused on adults, with pediatric studies limited by varied lesions and complex treatments. This study aims to evaluate cognitive and brain network changes in children with frontal lobe lesions, which significantly impact cognitive function, using a before-and-after comparison. The study enrolled 20 children with frontal lesions who underwent fMRI and cognitive tests before and after surgery, with only surgical treatment initially. Brain network changes were evaluated using functional metrics, and cognitive shifts were measured through test scores. Correlations were analyzed to explore brain mechanisms behind cognitive changes. Additionally, 20 healthy children underwent the same assessments for baseline data. Preliminary evidence of cognitive recovery, notably in social cognition, was observed about three months post-surgery, potentially linked to increased functional connectivity between the right lingual gyrus and right middle temporal gyrus. Children with frontal lobe lesions have demonstrated short-term postoperative cognitive improvement and associated reorganization and repair of brain networks, though this capacity for repair may diminish over time. This underscores the importance of timely rehabilitation interventions. This study offers unique insights into cognitive neuroscience and potential rehabilitation targets.

A qualitative study on the experiences of autologous haematopoietic stem cell transplant for Multiple Sclerosis

AimAutologous haematopoietic stem cell transplant (HSCT) is an effective treatment for people with highly-active relapsing multiple sclerosis (MS), who are not adequately responding to disease-modifying therapies. To date, research has predominantly focused on disease-specific outcome measures. There is a lack of research exploring patient experiences of this complex treatment. The study aims to explore the experience of considering and receiving HSCT treatment for MS. MethodsSemi-structured interviews were conducted online with 12 adults with MS who had undergone HSCT treatment. Interview topics covered the experience of deciding on the treatment, the HSCT process itself, and the patient-reported outcomes following HSCT. Interviews were audio-recorded and transcribed verbatim. A thematic analysis approach was employed. ResultsThree main themes were identified: (1) Balancing hope and fear explores the decision-making experience when considering HSCT as a treatment; (2) Distinct emotional experience, highlights the unique challenges faced on all stages of the treatment journey; and (3) Adjusting to outcomes, explores how participants make sense of the aftermath of the treatment, including managing the ongoing uncertainty of MS and complications arising from HSCT. DiscussionHSCT is a complex treatment, both physically and psychologically for pwMS. A comprehensive and holistic care pathway is required to support people with MS at all stages of the treatment process, to ensure patient-centred planning and care.

Efficiently and consistently energy-stable [formula omitted]-phase-field method for the incompressible ternary fluid problems

Ternary incompressible fluid flows extensively exist in atmospheric science, chemical engineering, and energy and power engineering, etc. The phase-field method is popular in multi-phase fluid modeling thanks to its efficient ability of interface capturing. This work aims to develop an energy dissipation law-preserving and temporally second-order accurate algorithm for a ternary phase-field fluid system. To establish a simple energy estimation, an adapted auxiliary variable approach is used to transform the original model into its equivalent form. Later, a second-order backward difference strategy is used to design the fully decoupled and linear time-marching scheme. To improve the consistency between original and modified discrete energy functionals, a practical energy correction technique is presented. We analytically prove the discrete energy dissipation property and show that the energy estimation can be easily established without considering the complex treatments of nonlinear and coupling terms. To facilitate the interested readers, we briefly describe the numerical implementation in each time step. The numerical tests indicate that the proposed method not only has desired accuracy, but also satisfies the energy stability even if a larger time step is used. Moreover, the proposed method can well simulate various ternary fluid phenomena, such as the liquid lens, phase separation, droplet dynamics, Kelvin–Helmholtz instability, and billowing cloud.

Delayed breast reconstruction with the thoracodorsal flap and endoprosthesis after complex treatment of breast cancer

Breast reconstruction with a thoracodorsal flap (TDF) in combination with a tissue expander/implant is a wellestablished technique.The purpose of the study was to present current data on the results of delayed breast reconstruction with thoracodorsal flap and tissue expander after combined/complex treatment in patients with breast cancer.Material and methods. The search for relevant sources was carried out in the PubMed, Cochrane Library, E-library systems, publications from 2014 to 2022 were studied. Delayed breast reconstruction using TDF in combination with a tissue expander/implant is a reliable method of reconstruction for the group of patients who have previously undergone radical mastectomy or adjuvant external beam radiation therapy in terms of combined/complex treatment of breast cancer, allowing to achieve good and excellent aesthetic results with a low incidence of surgical complications.Results and discussion. The use of the latissimus dorsi flap is a reliable and universal method of breast reconstruction, it allows achieving good and excellent aesthetic results, high patient satisfaction. Patients with a low body mass index or obesity, a history of abdominal surgery, including abdominoplasty, are not candidates for reconstruction using anterior abdominal wall flaps, and therefore the only possible method of breast reconstruction for them is the method using the TDF. In addition, the use of the TDF may be most appropriate for women who are planning a pregnancy in the future and for whom the use of anterior abdominal wall flaps will not be an optimal method of reconstruction due to reduced abdominal wall compliance. Other reasons why the use of TDF is the method of choice for many surgeons are the possibility of closing the donor site regardless of the size of the skin flap taken, the possibility of closing such defects of the mammary gland as extrusions, protrusions, in case of insufficiency of the skin cover after skin-preserving mastectomies.Conclusion. The use of the latissimus dorsi flap is a reliable and universal method of breast reconstruction, it allows achieving good and excellent aesthetic results, a high degree of patient satisfaction.