Autotransplantation of the thoracodorsal flap with complete preservation of its sensitivity is a pressing issue in reconstructive mammoplasty. The aim was to study the structural features and spatial relationships of the lateral cutaneous branches (LCBs) of the intercostal nerves Th 5 , Th 6 , Th 7 , Th 8 , Th 9 and the thoracodorsal nerve (TDN) in women from the perspective of innervation of the thoracodorsal flap. Material and methods. Anatomical dissection of the LCBs of the intercostal nerves Th 5 , Th 6 , Th 7 , Th 8 , Th 9 and the TDN along their entire course was carried out in 39 female cadavers (57–97 years of age). The coordinates of the nerve origin points were determined in relation to the clavicle and topographic landmarks. The diameter, length, direction, and angles of inclination in the anatomical planes were measured. Intrafascicular dissection was performed to identify the number of fascicles in the thoracodorsal nerve, along with their diameter, location, and functional type. Results. In women, the LCBs of the intercostal nerves Th 5 , Th 6 , Th 7 , Th 8 , Th 9 measure 2.6 [1.5; 3.2] cm in length. They arise from the main nerve trunks between the midclavicular and anterior axillary lines, run laterally, and divide into anterior and posterior branches. The anterior branches are directed medially in an oblique downward course at an angle of 50° [42°; 55°], supplying the skin up to the parasternal line. The posterior branches turn posteriorly, follow an oblique upward course at an angle of 44° [36°; 49°] (p<0.001), and supply the skin up to the posterior axillary line. The combined length of the LCBs and their anterior branches is 7.7 [6.4; 8.5] cm; the combined length of the LCBs and their posterior branches is 7.5 [6.6; 8.6] cm (p=0.825); and the combined length of the anterior and posterior branches is 10.3 [10.0; 10.6] cm (p<0.001). The TDN is a mixed nerve. It arises from the posterior cord of the brachial plexus between the midclavicular and anterior axillary lines, located 3.0 [2.2; 3.5] cm below the clavicle and at a depth of 4.3 [3.8; 5.0] cm. In the frontal plane, the nerve deviates laterally from the vertical line at an angle of 40° [30°; 45°]; in the sagittal plane, it deviates posteriorly at an angle of 30° [20°; 35°]. The nerve consists of one motor fascicle with a diameter of 0.3 [0.30; 0.35] mm, located in the posterolateral portion, and one to three sensory fascicles with a diameter of 0.25 [0.25; 0.30] mm (p=0.005), which are situated anteromedially. Conclusion. The differences in size, spatial distribution, and function between the LCBs of the intercostal nerves Th 5 , Th 6 , Th 7 , Th 8 , Th 9 and the thoracodorsal nerve provide the anatomical basis for preserving sensation when the split thoracodorsal flap is used in reconstructive breast surgery.
Chronic rhinosinusitis (CRS) is the most common reason for consulting at the otolaryngologist. Although data on the prevalence of rhinosinusitis are inconsistent, the average global prevalence was 11.61±5.47%, ranging from 1.01% to a maximum of 57.6%. As based on the consensus document EPOS 2020 (European Position Paper on Rhinosinusitis and Nasal Polyposis), CRS is classified into polypous and polyp-free rhinosinusitis. Polypous rhinosinusitis is a special type characterized by inferior response to conservative therapy, and frequent relapses after surgical treatment. These serious medical and social issues are promoting the studies on pathogenesis and development of nasal polyps. This review provides information about immunological features and dysfunction leading to emergence of CRS with or without polyps. The purpose of this literature review is to evaluate the role of the first-line immune defense, congenital and acquired components of immunity in pathogenesis of polyposis versus nonpolypous CRS. The article provides a review of the research articles published worldwide. The authors conducted a search on the significance of immune response in development of CRS with and without polyps. We used appropriate keywords and filters in the PubMed and Google Scholar databases, in Scopus, Web of Science, MedLine, Cochrane Library, EMBASE, Global Health, and CyberLeninka databases. The detailed search has shown that all components of immune system do not fully perform their functions. E.g., the respiratory epithelium and mucociliary clearance present the first-line immune defense of nasal and sinus mucosa which form a mechanical barrier to infectious and other invading agents. At the next stage, the cells of innate immune response, along with complement system, take part in elimination of external pathogenic agents. Presentation of antigen epitopes to lymphocytes generates a specialized adaptive immune response. Tissue remodeling is among the most relevant aspects of the CRS pathogenesis. Production of periostin is found to be increased in polyposis rhinosinusitis, along with progressive tissue eosinophilia, higher production of cystatin SN, IL-25 and fibroblast contents, decreased TLR2, TLR4, TGF-β and collagen production as well as increased extracellular neutrophil traps and M1 macrophage levels. Further studies on the links in immune pathogenesis of CRS could allow us to develop a personalized algorithm for the diagnosis and treatment of such patients.
Objective. To study the prevalence of recurrent pain syndromes and their combinations in adolescents of different ages. Material and methods. The study included 4747 adolescents from Krasnoyarsk aged 12—18 years. There were 2246 (47.3%) boys and 2501 (52.7%) girls. Survey included questions about presence and frequency of pain (headaches, abdominal and back pain). The features of pain structure (rare, frequent) were analyzed. Types of headache (migraine or tension-type headache) were verified according to international criteria (International Classification of Headache Disorders, 3rd edition, 2018). All indicators were compared in two groups: 12—14 (n=2265) and 15—18 years (n=2463). The data were analyzed in Statistica 12 using the Pearson χ2 test. Results. The overall prevalence of recurrent headaches among adolescents was 44.4%, back pain — 21.5%, recurrent abdominal pain — 16.5%. Migraine was the most common primary cephalgia (49.6%), while tension-type headaches were less common (20.9%). The most common localizations of dorsalgia were cervical (27.9%) and lumbar (24.4%) spine, while thoracic spine was less common (13.1%). The prevalence of recurrent pain increases with age: for recurrent headaches — from 41.5% to 47.0% (p=0.0002), for recurrent abdominal pain — from 14.7% to 18.2% (p=0.0011), for dorsalgia — from 18.1% to 24.6% (p<0.0001). Increased prevalence of tension-type headache (from 12.5% to 22.3%) and migraine (from 45.8% to 50.2%) was noted by the age of 15—18 years. Regardless of age, recurrent abdominal pain and dorsalgia were more often associated with recurrent headaches. Conclusion. Unified methodological approaches using generally accepted questionnaires and criteria for assessing the indicators are important for comparable results of epidemiological studies of recurrent pain.
Being one of the leading causes of mortality, sepsis is a global healthcare and social issue. Sepsis is a life-threatening organ dysfunction caused by dysregulated immune response to infection. The current understanding of its pathophysiology has shifted from studying the pathogen to analyzing the patient’s immune response, which is very different and unique. In general, sepsis is the simultaneous or sequential development of hyperinflammation and immunosuppression, which ultimately determines the clinical outcome. This paper emphasizes the need for a personalized approach to sepsis treatment based on the diagnosis of impaired immune status in the patient. We propose the complete blood count assessment using leukocyte analysis matrices allowing to determine the type and nature of immune response as an accessible, reproducible, and pathogenetically substantiated tool, even in a regular hospital setting. The paper presents a method for interpreting leukocyte matrices using the sepsis immunotyping technology allowing to identify the activation of innate or adaptive immunity and the nonimmunity or immunosuppression state. A conclusion is made on the clinical importance of the proposed approach for predicting the course of the disease, timely therapy correction, and the selection of a balanced, immune-oriented therapy. Thus, clinical integration of this approach contributes to the transition from empirical to pathogenetically substantiated therapy.
Objective. To evaluate the parameters of the lipid peroxidation system (POL) and antioxidant protection system (AOP) in adolescents with recurrent headache syndrome (RH). Materials and methods. 104 adolescents (boys and girls) aged 12–17 years were examined, of which 66 adolescents with RH (the main group) and 38 without RH (the comparison group). The presence of RH was verified by a screening questionnaire, the content of the indicators of the POL-AOР system was determined by spectrophotometric methods. The received data is processed in the program Statistica 12. Results. Adolescents with RH had higher levels of malonic dialdehyde (MDA) in blood plasma and red blood cells; decreased activity of plasma and erythrocyte superoxide dismutase (SOD), and lower levels of protein in blood plasma. The presence of RH in adolescents is associated with a larger number of individuals characterized by high plasma and erythrocyte concentrations of MDA, low plasma and erythrocyte SOD activity, and low glutathione-S-transferase activity. The authors highlight the possibilities of correcting oxidative stress using antioxidants. Conclusion. RH in adolescents is associated with a higher content of pro-oxidant – MDA in plasma and red blood cells, a lower activity of the antioxidant enzyme – SOD in plasma and red blood cells, which indicates a greater severity of oxidative stress in this contingent. The group with RH has a higher number of adolescents with the above-mentioned shifts in the gender-AGE system than among their peers without RH. It is advisable to prescribe antioxidants to correct the manifestations of oxidative stress in adolescents with RH.
