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Competing Interests: None disclosed.

Atopic dermatitis (AD) is one of the most common inflammatory skin conditions. The pathogenesis of AD involves skin barrier disruption and immune activation of T-helper (T H )2 and T H 22 and varying degrees of T H 1 and T H 17 activation in various patient subtypes. Although AD is mainly driven by T H 2, the molecular and clinical heterogeneity of AD underscores the need for more efficacious treatments that target multiple immune axes. Janus kinase (JAK) inhibitors are novel therapeutics that broadly block many AD-related proinflammatory cytokines (interleukin [IL]-4, IL-5, IL-13, IL-31, thymic stromal lymphopoietin, interferon gamma, IL-12, IL-23, IL-17) across different immune pathways. Oral JAK inhibitors have been found to be efficacious in AD, with 2 (abrocitinib and upadacitinib) recently gaining US Food and Drug Administration approval and several others under investigation in clinical trials with promising results. These systemic agents have surpassed conventional thresholds of treatment response, with many patients achieving complete or almost complete skin clearance, and provide a fast-acting alternative therapy for patients who are not responsive to biologics or other conventional therapies. However, systemic JAK inhibitors come with health concerns, requiring additional long-term clinical trials to characterize their safety profile in patients with AD. This review summarizes the current literature on the safety and efficacy of oral JAK inhibitors in AD and discusses future directions for research., (Copyright © 2023 American College of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.)

Background: Patients with atopic dermatitis (AD) have systemic biomarker dysregulation that differs by age group; however, the proteomic characteristics of these age-based changes are unknown., Objective: To profile blood proteins of patients with AD across different age groups versus age-appropriate controls., Methods: Using the Olink high-throughput proteomic platform, we profiled 375 serum proteins of 20 infants (age, 0-5 years), 39 children (age, 6-11 years), 21 adolescents (age, 12-17 years), and 20 adults (age, ≥18 years) with moderate-to-severe AD and 83 age-appropriate controls., Results: Each group presented a distinct systemic proteomic signature. Th2-related proteins were increased in infant AD and further intensified with age through adolescence and adulthood (interleukin 4/CCL13/CCL17). In contrast, Th1 axis down-regulation was detected in infants with AD and gradually reversed to increased Th1 products (interferon γ/CXCL9/CXCL10/CCL2) in patients with AD from childhood to adulthood. Despite their short disease duration, infants already had evidence of systemic inflammation, with significant upregulation of innate immunity (interleukin 17C/ interleukin-1RN), T-cell activation/migration (CCL19), Th2 (CCL13/CCL17), and Th17 (PI3) proteins. Adults with AD present unique upregulation of cardiovascular proteins related to coagulation and diabetes., Limitations: Cross-sectional observational study with a single time point., Conclusion: Systemic immune signatures of AD are age-specific beyond the shared Th2 immune activation. These data advocate for precision medicine approaches based on age-specific AD profiles., Competing Interests: Conflicts of interest Dr Guttman-Yassky is an employee of Mount Sinai; has received research funds (grants paid to the institution) from AbbVie, Celgene, Eli Lilly, Janssen, Medimmune/Astra Zeneca, Novartis, Pfizer, Regeneron, Vitae, Glenmark, Galderma, Asana, Innovaderm, Dermira, and UCB; and is a consultant for Sanofi Aventis, Regeneron, Stiefel/GlaxoSmithKline, MedImmune, Celgene, Anacor, AnaptysBio, Dermira, Galderma, Glenmark, Novartis, Pfizer, Vitae, Leo Pharma, AbbVie, Eli Lilly, Kyowa, Mitsubishi Tanabe, Asana Biosciences, and Promius. Dr Krueger has received research support (grants paid to his institution) and/or personal fees from Pfizer, Amgen, Janssen, Lilly, Merck, Novartis, Kadmon, Dermira, Boehringer, Innovaderm, Kyowa, BMS, Serono, BiogenIdec, Delenex, AbbVie, Sanofi, Baxter, Paraxel, Xenoport, and Kineta. Dr Paller has received research funds (grants paid to the institution) from AbbVie, AnaptysBio, Eli Lilly, Incyte, Janssen, KrystalBio, Regeneron, and UCB and is a consultant for AbbVie, Abeona, Acrotech, Almirall, Amgen, Amryt, Arcutis, Arena, Azitra, BioCryst, BiomX, Bridgebio, Bristol Myers Squibb, Castle Biosciences, Catawba, Eli Lilly, Exicure, Galderma, Kamari, Leo, Novan, Novartis, OM Pharma, Pfizer, Pierre Fabre, RAPT, Regeneron, Sanofi/Genzyme, Seanergy, and UCB. Dr Rangel has received research funds (grants paid to the institution) from AbbVie, DermTech, and Galderma. Drs Del Duca, Renert-Yuval, Pavel, Wu, Lefferdink, Fang, and Facheris and authors Mikhaylov, Sheth, Blumstein, and Estrada have no conflicts of interest to disclose., (Copyright © 2023 American Academy of Dermatology, Inc. Published by Elsevier Inc. All rights reserved.)

Alopecia areata/AA is an autoimmune cause of nonscarring hair loss. The pathogenesis of AA involves many immune axes, including Th1/Th2 pathways. Delgocitinib is a pan-Janus kinase/JAK inhibitor that broadly blocks pro-inflammatory cytokines and has been effective in other inflammatory skin conditions. Recent human studies/reports have shown that use of some systemic JAK inhibitors led to hair regrowth, suggesting this medication class as a potential therapy for AA. However, topical treatment is desirable due to potential systemic side effects. To assess the efficacy and safety of topical delgocitinib in AA, we conducted a double-blind, randomized, vehicle-controlled clinical trial in 31 moderate-to-severe AA patients that were randomized 2:1 to receive delgocitinib ointment 30 mg/g (n = 20) or ointment vehicle (n = 11) for 12 weeks. The primary endpoint was change in severity of Alopecia Tool/SALT score from baseline to week 12. The secondary endpoint included safety profile by reported adverse events. Twenty-three subjects completed the trial, with eight discontinuing mostly due to voluntary withdrawal. Ten patients receiving delgocitinib ointment and three patients receiving vehicle showed SALT score improvements after 12 weeks, but the mean percent SALT improvement at week 12 compared to baseline between the two arms was not significant (p = 0.92). Our study suggests that delgocitinib ointment is not effective in moderate-to-severe AA, likely due to its inability to penetrate sufficiently deeply into the dermis of the scalp, but larger studies are necessary to assess whether a different formulation of topical JAK inhibitors may be suitable to treat mild or more localized forms of AA., (© 2022. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Preliminary work suggested upregulation of inflammatory pathways in patients with common forms of ichthyosis. However, a comprehensive characterization of skin from various ichthyosis subtypes is unavailable, precluding the development of targeted treatments. Thus, we sought to characterize the immune and barrier profiles of common and subtype-specific skin transcriptomes in a large group of patients with ichthyosis. We performed a global RNA-sequencing analysis in 54 patients with ichthyosis (7 with Netherton syndrome, 13 with epidermolytic ichthyosis, 16 with lamellar ichthyosis, and 18 with congenital ichthyosiform erythroderma) and 40 healthy controls. Differentially expressed genes were defined on the basis of fold changes > 2 and false discovery rate < 0.05 criteria. We found robust and significant T helper (Th) 22/Th17 skewing in all subtypes (e.g., IL-17A/C/F, S100A7/8/9/12; P < 0.001) with modest changes in Th2 pathway, primarily in Netherton syndrome, and Th1 skewing in congenital ichthyosiform erythroderma. Across all subtypes (less evident in epidermolytic ichthyosis), lipid metabolism and barrier junction markers were downregulated (e.g., FA2H, CDH10/11/12/2; P < 0.05), whereas epidermal cornification and proliferation measures were upregulated (e.g., SPRR1A/1B/2C/2G, EREG; P < 0.05). Our findings suggest that the common ichthyosis variants share aberrations in Th17/Th22 and barrier function, with minimal Th2 modulation. This may help to elucidate the pathogeneses of these subtypes and inform the development of subtype-specific treatments., (Copyright © 2022 The Authors. Published by Elsevier Inc. All rights reserved.)

Background: Patients' expectations are an important determinant in their decision to undergo lumbar spinal surgery-particularly their expectations of recovery after surgery. The Hospital for Special Surgery Lumbar Spine Surgery Expectations Survey (HSS-LSSES) is one tool used to assess this; however, the original version was only available in English. Objective: We sought to evaluate the reliability and validity of a translated and adapted Russian-language version of the HSS-LSSES. Methods: This was a prospective study of 91 patients with degenerative disc disease who underwent lumbar spine surgery with instrumented fixation at a single institution in Saint Petersburg, Russia. Patients were recruited between December 2019 and February 2021 and asked about their expectations of surgery with a translated and adapted Russian version of the HSS-LSSES. To analyze construct validity, participants also completed disease-specific and general quality-of-life scales (Oswestry Disability Index, European Quality of Life-5 Dimensions, and 36-item Short-Form Health Survey). Intraclass correlation coefficients (ICCs; 2-way random effects model, absolute agreement) were used to determine test-retest reliability of the total score of the Russian HSS-LSSES. Internal consistency was evaluated through the estimation of Cronbach's alpha between the test and retest response of the questionnaire. Results: The test-retest stability of the Russian HSS-LSSES evaluated through the estimation of ICC was found to have good stability. The instrument was shown to have high internal consistency. Conclusion: This study demonstrates that a translated and adapted Russian version of HSS-LSSES had good internal consistency, reliability, construct validity, and no floor and ceiling effects. Therefore, we recommend its use as a tool for evaluating Russian-speaking patients' expectations before lumbar spine surgery., Competing Interests: Declaration of Conflicting Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (© The Author(s) 2021.)

Actually, in many medical organizations there is an inexpedient structure of labor costs of medical workers, in many respects associated with large time spent on making up medical documentation. The very important aspect is proper formulation of clinical diagnosis and its coding according to the International Classification of Diseases of the 10th revision that in most cases is performed in tradition mode (so called manual coding). The article presents results of functional and cost analysis of application of automated system of coding support in various departments of the Medical Sanitary Unit of of the Ministry of Internal Affairs of Russia at the Moscow Oblast. The study established significant difference in time spent and cost of coding process before and after implementation of automated system. The automated coding of diagnosis permits to reduce six-fold time and cost of coding process, as well as up to 12.6% reduce number of coding errors. The results of functional and cost analysis serve as an objective justification of economic expediency of implementing automated system of diagnosis coding support in multidisciplinary hospital.

Background: In the SARS-CoV-2/COVID-19 pandemic, we need to understand the impact of immunomodulatory medications on COVID-19 symptom severity in patients with inflammatory diseases, including the type 2/Th2 polarized skin disease, atopic dermatitis (AD)., Objective: Because it is believed that type 1/Th1 immunity controls viral infections and that there is a Th1/Th2 counter-regulation, we hypothesized that Th2 targeting with the IL-4Rα-antagonist, dupilumab, in patients with moderate-to-severe AD would rebalance the Th1/Th2 axis, potentially leading to attenuated COVID-19 symptoms., Methods: A total of 1237 patients with moderate-to-severe AD in the Icahn School of Medicine at Mount Sinai Department of Dermatology were enrolled in a registry. Patients were screened for COVID-19-related symptoms and assigned a severity score (asymptomatic [0]-fatal [5]). Scores were compared among 3 treatment groups: dupilumab (n = 632), other systemic treatments (n = 107), and limited/no treatment (n = 498). Demographic and comorbid covariates were adjusted by multivariate generalized logistic regression models., Results: The dupilumab-treated group showed reduced incidence and severity of COVID-19 symptoms versus other treatment groups. Dupilumab-treated patients were less likely to experience moderate-to-severe symptoms versus patients on other systemics (P = .01) and on limited/no treatment (P = .04), and less likely to experience any symptoms versus patients on other systemics (P = .01). This effect was seen in our entire cohort and in the subgroup of patients with verified COVID-19 or high-risk exposure., Conclusions: Patients on dupilumab experienced less severe COVID-19 manifestations and lesser symptoms compared with patients on other systemics and on limited/no treatment. These results suggest that Th2 modulation with dupilumab may have a protective effect on anti-viral immune response in patients with AD., (Copyright © 2021 American Academy of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.)

Goal: Because of the outbreak of coronavirus infection, healthcare systems are faced with the lack of medical professionals. We present a system for the differential diagnosis of coronavirus disease, based on deep learning techniques, which can be implemented in clinics. Methods: A recurrent network with a convolutional neural network as an encoder and an attention mechanism is used. A database of about 3000 records of coughing was collected. The data was collected through the Acoustery mobile application in hospitals in Russia, Belarus, and Kazakhstan from April 2020 to October 2020. Results: The model classification accuracy reaches 85%. Values of precision and recall metrics are 78.5% and 73%. Conclusions: We reached satisfactory results in solving the problem. The proposed model is already being tested by doctors to understand the ways of improvement. Other architectures should be considered that use a larger training sample and all available patient information.

Background: Tape-strips are a minimally invasive approach to characterize skin biomarkers in atopic dermatitis (AD). However, they have not yet been used for tracking gene expression changes with systemic treatment., Objective: The aim of the study was to evaluate gene expression changes and therapeutic response biomarkers in AD patients before and after dupilumab (interleukin 4Rα antibody) treatment using tape-strips to obtain epidermal tissue for analysis., Methods: Lesional and nonlesional tape-stripped skin was sampled from 18 AD patients before and after dupilumab treatment and from 17 healthy subjects and analyzed by RNA-seq., Results: At baseline, we detected 6745 and 4859 differentially expressed genes between lesional and nonlesional skin versus normal, respectively, whereas 841 and 977 genes were differentially expressed after treatment, respectively (fold change >1.5 and false discovery rate <0.05). Tape-strips captured significant modulation with dupilumab in key AD immune (eg, C-C motif chemokine ligand 13 [CCL13], CCL17, CCL18) and barrier (eg, periplakin, FA2H) biomarkers. Changes in biomarkers (CCL20, interleukin 34, FABP7) were also significantly correlated with clinical disease improvements (Eczema Area and Severity Index; R > 0.5 or R < -0.4, P < 0.05)., Conclusions: This real-life study represents the first comprehensive RNA-seq molecular profiling of tape-strips from moderate to severe AD patients after dupilumab therapy. Analysis of tape strip specimens detected significant gene expression changes in key AD biomarkers with dupilumab treatment, suggesting that this approach may be useful to monitor therapeutic responses in inflammatory skin diseases., Competing Interests: E.G.-Y. is an employee of Mount Sinai and has received research funds (grants paid to the institution) from AbbVie, Celgene, Eli Lilly, Janssen, MedImmune/AstraZeneca, Novartis, Pfizer, Inc, Regeneron, Vitae, Glenmark, Galderma, Asana, Innovaderm, Dermira, and UCB. E.G.-Y. is also a consultant for Sanofi Aventis, Regeneron, Stiefel/GlaxoSmithKline, MedImmune, Celgene, Anacor, AnaptysBio, Dermira, Galderma, Glenmark, Novartis, Pfizer, Inc, Vitae, Leo Pharma, AbbVie, Eli Lilly, Kyowa, Mitsubishi Tanabe, Asana Biosciences, and Promius. T.A. is an advisor/investigator or speaker for Pfizer, Inc, AbbVie, Eli Lilly, LEO Pharma, Regeneron, and Sanofi-Genzyme. The other authors have no funding or conflicts of interest to declare., (Copyright © 2021 American Contact Dermatitis Society. All Rights Reserved.)

The common coding of main diagnosis (so-called "manual coding") is accompanied by quite many errors associated with inobservance of classification algorithm and subjective causes that in statistical morbidity and mortality data corruption. The article presents the results of implementing automated system of diagnosis coding by the ICD-10 in the departments of the Medicosanitary Unit of MVD of Russia in City of Moscow. The functional and time losses and the error rate were studied under manual coding and automated coding system. In case of common coding of complete clinical diagnosis of one discharged patient per day, it takes from 5 to 15 minutes, for coding diagnoses of all discharged patients - about 1 hour. The number of errors in common coding made up to 14.1% (n=2472) and in case of automated coding it made up to 1.5% (n= 63, p>0.05). The application of automated coding system in medical organizations ensures exact correspondence of clinical and statistical diagnosis, unifies wording of clinical diagnosis, minimizes subjective deviations from algorithm of the ICD-10.

Introduction: Poor sleep is a pervasive problem for hospitalized patients and can contribute to adverse health outcomes., Methods: We aimed to improve self-reported sleep for patients on a general medicine ward as measured by the Richards-Campbell Sleep Questionnaire (RCSQ) as well as the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) question addressing quietness at night. We utilized a non-pharmacologic sleep hygiene bundle composed of a short script with sleep hygiene prompts, such as whether patients would like the shades closed or the lights turned off, as well as a sleep package including an eye mask, earplugs, lavender scent pad, and non-caffeinated tea. Relaxing music was played at bedtime and signs promoting the importance of quietness at night were placed around the unit. Front-line champions were identified to aid with implementation., Results: A total of 931 patients received the intervention. In a sample of surveyed patients, we observed an increase in the RCSQ global score from 6.0 (IQR 3.0-7.0) to 6.2 (IQR 4.0-7.8) from the pre- to post- intervention periods (p = 0.041), as well as increases in three of the five individual survey components. Additionally, HCAHPS "quietness at night" score increased on the unit from 34.1% pre-intervention to 42.5% post-intervention., Conclusion: A nonpharmacologic sleep hygiene protocol paired with provider education and use of champions was associated with modest improvements in patients' perceived sleep and unit HCAHPS scores., (Copyright © 2021 The Joint Commission. Published by Elsevier Inc. All rights reserved.)

Introduction : Atopic dermatitis (AD) is a chronic inflammatory skin condition characterized by cutaneous and systemic inflammation and barrier abnormalities. Over the past few decades, proteomic studies have been increasingly applied to AD research to compliment transcriptomic evaluations. Proteomic analyses helped identify new biomarkers of AD, allowing investigation of both the cutaneous AD profile and the systemic inflammation associated with the disease. Areas covered : This review discusses key studies that utilized various proteomic technologies to analyze AD skin and/or blood, which facilitated discovery of biomarkers related to pathogenesis, disease severity, systemic inflammation, and therapeutic response. Moreover, this review summarizes proteomic studies that helped define various AD endotypes/phenotypes. A literature search was conducted by querying Scopus, Google Scholar, PubMed/Medline, and Clinicaltrials.gov up to January 2021. Expert opinion : Use of proteomics in AD has allowed for identification of novel AD-related protein biomarkers. This approach continues to evolve and is becoming increasingly common for the study of AD, in conjunction with other -omics platforms, as proteomics shifts to quicker and more sensitive methods for detection of potential protein biomarkers. Although many biomarkers have been identified thus far, future larger studies are necessary to further correlate these markers with clinical parameters.

Psoriasis is an inflammatory skin disease that is associated with many comorbidities. Several psoriasis treatments approved by the United States Food and Drug Administration have been shown to have beneficial effects on these comorbidities, while others might lead to an exacerbation of these conditions. In this article, we review studies of psoriasis treatments and their level of evidence for use in co-occurring diseases. An awareness of the multifaceted effects of certain psoriasis medications can enable physicians to provide more personalized treatment to their most complicated patients., Competing Interests: FUNDING:No funding was received for this study. DISCLOSURES:Dr. Goldenberg is a consultant and speaker for Abbvie, Celgene, Eli Lilly & Co., Novartis, and SUN and a consultant for Amgen and UCB. The other authors have no conflicts of interest relevant to the content of this article.

Alopecia areata (AA) is a common autoimmune disease that results in non-scarring hair loss. AA pathogenesis is thought to involve multiple inflammatory cytokines. Apremilast is a phosphodiesterase 4 (PDE4) inhibitor that reduces pro-inflammatory cytokine production. Recent studies demonstrate upregulation of PDE4 in human scalp lesions of AA patients and hair regrowth in a humanized AA mouse model upon apremilast treatment, suggesting a possible potential of apremilast in AA. To assess the efficacy and safety of apremilast in AA, we conducted a double-blind, placebo-controlled single-center pilot study in 30 moderate-to-severe AA patients (≥ 50% scalp involvement) that were randomized 2:1 to receive apremilast (n = 20) or placebo (n = 10) orally for 24 weeks. The primary endpoint was the percentage of patients achieving 50% reduction in severity of alopecia tool (SALT) score (SALT 50 ) at 24 weeks compared to baseline, and the secondary endpoints included the percent change in SALT score at weeks 24 and 48. Eight patients in the apremilast arm withdrew prior to week 24 along with two patients in the placebo group, mostly due to lack of efficacy and adverse events. At 24 weeks, only 1 of 12 apremilast-treated subjects achieved SALT 50 , and similarly 1 of 8 placebo-treated subjects achieved SALT 50 . The difference between the mean percent improvement in SALT score at week 24 compared to baseline of the two study arms was not statistically significant (p = 0.38). The lack of treatment response in most of our patients argues against a pathogenic role for PDE4 specifically in moderate-to-severe AA, but targeting this pathway may still be of value in patients with mild AA as there is less of an inflammatory burden in this population. However, future larger studies may be needed to conclude apremilast's lack of efficacy in moderate-to-severe AA.

The incidence of allergic contact dermatitis (ACD) reactions to personal care products has progressively increased, affecting women more so than men. Fragrances and preservatives are the major sensitizers behind cosmetic-induced ACD, due to their ubiquitous presence in these products, though emulsifiers, ultraviolet filters, and botanical allergens have been implicated as well. While patch testing is the standard for diagnosing ACD, many cosmetic-specific antigens are not currently included within the commercially available kits. Therefore, patch testing for potential cosmetic-induced ACD should be supplemented with additional compounds commonly found in personal use products. Effective treatment of ACD must involve accurate identification and removal of the offending agent., (©2018 Frontline Medical Communications.)

Background: The economic burden of cosmetics, such as moisturizers, has been increasing. Despite the high price of some market moisturizers, there have been no studies evaluating the allergenicity of these products., Objective: The aim of this study was to evaluate the potential allergens within moisturizers based on economic value, by analyzing the substances found in moisturizers available online at the largest drugstore chain-CVS Health (CVS Health, Woonsocket, RI)., Methods: In this cross-sectional study, ingredients found in 50 expensive and 50 inexpensive moisturizers were matched with sensitizers within the Core Allergen Series published by the American Contact Dermatitis Society and the North American Contact Dermatitis Group. Student t test was used to compare the mean number of allergens present in each group. A χ test or Fisher exact test, where necessary, was used to compare the rates of specific allergen groups between the expensive and inexpensive products., Results: Twenty-six allergenic substances were present overall in the 100 total products surveyed. The expensive moisturizers averaged significantly more allergens per product (8.28 vs 5.60, P = 0.003) than the inexpensive products., Conclusions: The sensitizing potential of expensive moisturizers may be higher than that of inexpensive moisturizers. Physicians may counsel cosmetic-induced allergic contact dermatitis (ACD) patients that monetary value is not a suitable proxy for evaluating the risk of ACD.

Purpose: This report compares the clinical, radiographic, and functional outcomes of fusion from thoracolumbar region terminating at L5 or at sacrum and pelvis in elderly patients with spinal deformity., Methods: Ninety-four elderly patients who underwent spinal deformity surgery at our institution were evaluated. Patients were divided into two groups. The group L included 43 patients who underwent fusion of lumbar curve from thoracolumbar region to L5. The group P consisted of 51 patients who were treated using fusion from lower thoracic region to S1 extending to the pelvis. Radiographic outcomes, health-related to the quality of life (HRQOL) parameters, and complications with a 3-year minimum follow-up were analyzed and compared between two groups., Results: In the group L, the ideal sagittal balance was not achieved. The group P showed a better restoration of global spinal alignments compared with the group L. The HRQOL scores (VAS, ODI, SRS-24) of the patients after 3 years are slightly higher in the group P, but we did not get significant difference between groups. The total number of complications was higher in the group P., Conclusions: The research showed that fusion of lumbar curve extending to the pelvis provided good sagittal balance, global spinal alignments, and likely HRQOL parameters after 3-year follow-up. But, eventually, we obtained higher number of complications.

Aim: At present, there is no consensus on the approach to treatment of patients older than 60 years of age who have spinal deformity and clinical symptoms. The article describes the effect of two different types of surgery on the quality of life of elderly patients with deformities., Material and Methods: A prospective study included 58 patients operated on at the Verden Russian Research Institute of Traumatology and Orthopedics in the period between 2007 and 2010. The inclusion criteria were as follows: patients older than 60 years of age, having spinal deformity (sagittal modifiers of grade 2(+) and higher according to the SRS-Schwab classification), radicular syndromes, and back pain. The patients were examined in accordance with a general algorithm, including general clinical and neurological examinations and an X-ray examination with evaluation of deformity, spinopelvic relationships, and sagittal imbalance. We compared two groups of patients. The first group included 28 patients who underwent decompressive foraminotomy. The second group consisted of 30 patients who underwent decompressive foraminotomy and deformity correction. The patients were evaluated using the following scales: VAS, ODI, and SRS-24 before surgery and after 3, 6 months, 1, 2, and 5 years., Results: Preoperatively, there was no difference between the groups. We found no differences between the groups 1 year after surgery. After 5 years, the group with isolated decompression had poorer results., Conclusion: Spinal deformity correction is a more aggressive surgical procedure compared to isolated decompression. However, the efficacy of the former operation is higher.

Background: Currently, there is no consensus about how to reduce the intraoperative risk of hemorrhage in spinal decompression surgery of hypervascular spinal tumors, such as aggressive hemangioma, multiple myeloma, plasmacytoma, metastasis of renal cell carcinoma., Methods: A retrospective study of 110 patients, operated in our institute was held in the period between 2003 and 2013. There were 69 male and 41 female patients with extradural hypervascular spinal tumor. The study included 61 patients with metastasis of renal cell carcinoma, 27 with multiple myeloma, 15 with plasmacytoma and 7 with aggressive hemangioma. The first group included 57 patients who underwent preoperative tumor embolization. The second group consisted of 53 patients, which were treated surgically using intraoperative local hemostatic agents. We performed 2 types of treatment options: palliative decompression and total spondylectomy. The first group was divided into two subgroups: 30 patients with palliative decompression (1PD) and 27 with total spondylectomy (1TS). In the second group there were: 28 patients with palliative decompression (2PD) and 25 with total spondylectomy (2TS). The parameters under evaluation were the blood loss volume, drainage loss, operation time, hemoglobin level, possible complications and time of hospital stay., Results: The average intraoperative blood loss for all embolized patients was slightly less than in subgroups with local hemostatic agents. No significant difference in blood loss volume was found between groups 1PD and 2PD (p > 0.05). In groups 1TS and 2TS, we did get significant difference (p < 0.05). Statistically significant difference in the average drainage loss was found between two methods of hemostasis in both subgroups (p < 0.05). The operation time was not significantly different between groups. Postoperative hemoglobin level reduce is almost equal in both groups of patients. Postoperative complications were also nearly equal in the groups. The average hospital stay was significantly less (p < 0.05) in groups with 2PD and 2TS., Conclusions: The research proves that for patients with hypervascular spinal tumors, who underwent palliative decompression, there is no significant difference between two methods of reducing blood loss. Therefore, we do not see reasons to use expensive and risky procedure of embolization for such patients. While for patients with total spondylectomy preoperative embolization is efficient to reduce intraoperative bleeding.

Electrocatalytic generation of nickel catalysts in low oxidation states by reduction of nickel complexes with various ligands (2,2'-bipyridine, 2,2':6',2''-terpyridine, (S,S)-2,6-bis(4-phenyl-2-oxazolin-2-yl)-pyridine) in the presence of olefinic substrates and fluoroalkyl halides leads to new organic products derived from addition-dimerization processes. Due to the presence of two stereocenters in the dimerization products two diastereomers were characterized by a variety of analytical techniques including multi-dimensional NMR methods and X-ray single crystal diffraction. The formation of dimers was prevented by the inclusion of the hydrogen atom donor tributyltin hydride. The cyclic voltammetry study of selected nickel complexes along with fluoroalkyl halides demonstrated that Ni(I)L is the active form of the catalyst.