Peripheral nerve injuries account for 4 % of all injuries, and the consequences of trauma are a major medical and social problem, since they are characterized by a significant and long-term decline in limb function, and a high level of disability in patients. According to our data, up to 40% of patients sought specialized care for more than 6 months after the injury, and 19.9% were treated conservatively for an unreasonably long period of time. It led to an increase in the portion of unsatisfactory treatment results, since the prognosis of the further functional and useful degree of nerve recovery worsens with increasing time after injury. The main objective was to select the optimal option of biocompatible material for implementation in practice in case of traumatic peripheral nerve damage. Materials and methods. The analysis of medical literature for 2015–2020 was conducted. First of all, it should be noted that modern non-biological resorbable tubes are made of polyglycolic and polylactic acids. Non-resorbable tubes, including silicone, have shown undesirable effects, including axon compression during regeneration and the reaction of a fibrous foreign body. Hollow cylindrical tubes can be manufactured in several ways, such as electrospinning, crosslinking, physical film rolling, injection molding, melt extrusion, and braiding. Adequate surgical treatment of peripheral nerve injuries requires that the surgeon, in addition to an accurate knowledge of the anatomical details of the affected area, would also be familiar with microsurgical methods and had necessary equipment to operate. The main procedure in peripheral nerve surgery is the restoration of nerve continuity, which can be obtained by direct coaptation between the two ends of a severed nerve or by the introduction of nerve grafts to replace a defect in nerve tissue. Polyester is the most common synthetic material used in neural tissue engineering, along with polylactic acid, polycaprolactone, and polyglycolic acid. In combination with mesenchymal stem cells of the bone marrow, polylactic acid showed better results and accelerated the recovery of peripheral nerves. Polylactic acid directed the migration of Schwann's cells and induced the formation of a normal nervous structure. It was proved that the polycaprolactone material had an effect similar to that of autografts in nerve repair, and its characteristics were better than in a polylactic acid tube. Polyglycolic acid also possesses sufficient mechanical properties and can be used to repair a nerve defect. Artificial synthetic materials have good biocompatibility and biodegradability with minimal toxicity. For the production of high-purity polymer monomers, which are necessary for the manufacture of the frame, much time and financial costs are required. Moreover, the elasticity and hardness of such materials are imperfect. Three main natural biomaterials are used in tissue repair: collagen, silk, and gelatin. Collagen tube is the most widely used biological material in clinical practice. Silk materials with the protein fibroin, which promote the release of certain substrates, such as nerve growth factor particles, and provide more nutrients and a more favorable microenvironment for nerve repair, are worth noticing. Silk fibroin has good compatibility with the neurons of the dorsal root ganglia and supports cell growth. Gelatin materials are preferred due to the reduction of micromanipulation during nerve recovery. Natural biomaterials are easy to obtain in sufficient quantities; they have good biocompatibility and biodegradability and are easily absorbed by the body. However, each natural biomaterial has its drawbacks. Some of them are brittle or break down in a humid environment. Some natural materials are insoluble in water and traditional organic solvents, which limits their use. One of the most widely used biopolymers of natural origin is chitosan. Chitosan, derived by chitin deacetylation, plays a supporting, protective, and guiding role in the early stage of recovery of peripheral nerves and can provide a relatively stable, localized microenvironment during regeneration. Chitosan is absorbed and gradually decomposed in the late phase of recovery and regeneration of the nervous system. Issues regarding graphene-based nanomaterials use are considered. Graphene is a two-dimensional carbon nanomaterial with good optical, electrical and mechanical properties. It should be noted that when graphene nanoparticles incorporate into a chitosan or gelatin frame and are used to repair peripheral nerve damage in rats, this has contributed to the regeneration of the damaged nerve more quickly. Graphene also reduced the inflammatory response and accelerated the migration of endogenous neuroblasts. Hence, the use of these materials is not well understood due to the significant duration of recovery of the denervated proximal end of the nerve, so further research is needed to identify the advantages or disadvantages of their use.
To study the association between the plasma level of plasminogen activator inhibitor type-1 (PAI-1) and both body weight and PAI-1-675 4G/5G gene polymorphism in patients with cranio-cerebral trauma (CCT) over the treatment course.
In Ukraine, 2,500–3,000 people sustain peripheral nerve injuries every year. Often these are young people of working age. In the structure of total injuries, peripheral nerve damage in peacetime makes 1.5–6%, and during military operations (taking into account the situation in the east of Ukraine), this value ranges from 9 to 25% due to gunshot injuries. Analysis of medical literature and publications over the past five years was carried out, with due attention to the studies related to modern surgical treatment methods of peripheral nerve traumatic injuries. The problem of surgical treatment has not been thoroughly studied. Peripheral nerve regeneration is a complex process, and therefore the existing treatment methods are limited due to slow nerve regeneration and insufficient spanning of large post-traumatic nerve defects. To overcome these limitations, a cell therapy has been developed that ensures the presence of supporting cells at the site of the lesion in order to accelerate nerve regeneration. Schwann cells play an important role in many aspects of nerve regeneration. Stem cell transplantation for peripheral nerve regeneration represents alternative cell therapy with several regenerative benefits. Various types of stem cell sources are currently being investigated for use for peripheral nerve regeneration in combination with the most optimal nerve guide conduit.
Spinal cord tumors include tumors developing from its parenchyma, vessels, roots and membranes. The main theory of the formation of spinal cord tumors is the polyetiological dysontogenetic theory. According to this theory, hereditary factors, dysembriogenesis, trauma, carcinogenic effects, viral infection, intoxication, radiation, etc. play an important role in the development of tumors. Although scientists keep finding out more about genetic and environmental factors influencing the development of many types of tumors, spinal tumors are still a relatively unknown subject. Spinal tumors partially contain pathological genes, but in many cases, researchers don't know what causes these genetic changes. Tumors of the central nervous system (CNS) make up 12% of all tumors, tumors of the spinal cord – 3% of nervous system disorders, in the structure of malignant lesions of the CNS – 1,4-5%, occur mainly at the age of 20-60 years. In children, as well as in elderly and senile persons, these tumors are rare. Most often, they develop not from the brain matter, but from the surrounding tissue, and when they increase in size, they compress the spinal cord. Spinal tumors are usually divided into primary and secondary. The group of primary tumors include tumors, originating from the brain matter (intramedullar tumors), and those that grow from the membranes of the brain, roots, vessels (extramedullar tumors). Extramedullar tumors are much more common (in 80% of all spinal tumors) than intramedullar tumors. Extramedullar tumors can be both subdural and epidural. The majority of extramedullar tumors are subdural. Occasionally there are tumors, some of which are located inside the dural sac, and some – outside the dura mater, they are subdural-epidural tumors, as well as epidural-extrovertebral tumors. Among extramedullar tumors the most commonly diagnosed are meningiomas and neurinomas, among intramedullar the most common are ependymomas, less common are astrocytomas and oligodendroglioma. Glioblastomas of the spinal cord is extremely rare; the most common metastases from the posterior fossa are medulloblastomas. Intracerebral tumors of the spinal cord are characterized by greater biological benignity, than similar brain tumors. Extracerebral spinal cord tumors have no such differences in their biological properties. In general, spinal cord tumors are more common in elderly patients. Neurinomas and meningiomas predominate in adults, and ependymomas and dysgenetic tumors (teratoma, epidermoid cysts) – in children. Peculiarities of etiopathogenetic aspects, clinical course, influence on socio-economic factors encourage further improvement of diagnosis and more detailed study of this type of tumors. Materials and methods. The analysis of medical records of patients with spinal cord tumors, who were hospitalized in neurological departments of the Sumy Regional and 4th City Clinical Hospitals in 2015-2018 was carried out. 69 clinical cases were processed in order to investigate the prevalence of spinal cord tumors in the Sumy region, the characteristics of the disease in this group of patients, the leading symptoms, methods of diagnosis and treatment. The analysis of statistical data, obtained after processing of the research materials, was carried out using the licensed version of the IBM SPSS Statistics 17 software. Our study significantly established that, according to the histological structure, in 46 patients (28 women and 18 men) meningiomas were predominant and that in 31 patients they were located at the level of Th6-Th12. Mainly in 42 patients (33 women and 9 men, p<0.05) spinal cord neoplasms were localized at the level of Th6-Th12, with extramedular-intradural tumor location – 57 patients (38 women and 19 men). According to our study, pain syndrome significantly prevailed in 42 patients (35 with extramedular-intradural tumor localization). The study of the histological structure of tumors depending on their localization is an integral part of both diagnosis and treatment, and an important component of predicting the quality of life of the patient.
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