In this review, we propose a holistic approach to understanding cancer as a metabolic disease. Our search for relevant studies in medical databases concludes that cancer cells do not evolve directly from normal healthy cells. We hypothesize that aberrant DNA damage accumulates over time—avoiding the natural DNA controls that otherwise repair or replace the rapidly replicating cells. DNA damage starts to accumulate in non-replicating cells, leading to senescence and aging. DNA damage is linked with genetic and epigenetic factors, but the development of cancer is favored by telomerase activity. Evidence indicates that telomere length is affected by chronic inflammations, alterations of mitochondrial DNA, and various environmental factors. Emotional stress also influences telomere length. Chronic inflammation can cause oxidative DNA damage. Oxidative stress, in turn, can trigger mitochondrial changes, which ultimately alter nuclear gene expression. This vicious cycle has led several scientists to view cancer as a metabolic disease. We have proposed complex personalized treatments that seek to correct multiple changes simultaneously using a psychological approach to reduce chronic stress, immune checkpoint therapy with reduced doses of chemo and radiotherapy, minimal surgical intervention, if any, and mitochondrial metabolic reprogramming protocols supplemented by intermittent fasting and personalized dietary plans without interfering with the other therapies.

Study Design: Retrospective cohort. Objective: To analyze the outcome of surgical correction of children with caudal regression syndrome. Methods: The study included 12 patients aged 1.5 to 9 years with caudal regression syndrome. In order determine the type of caudal regression, the Renshaw Classification was used. The surgery included correction and stabilization of the kyphotic deformity at the unstable lumbosacral region, with reconstruction of the sagittal balance using a bony block constructed from allograft. Short- and long-term outcomes were evaluated. The study was approved by the local institutional review board. Results: Children with types III and IV caudal regression syndrome underwent spinal-pelvic fusion, with 100% fusion rate, which allows sufficient stabilization of the lumbopelvic segment permitting patient mobilization and standing in type III patients. There were 5 complications needing additional care. Conclusion: Multilevel pedicular screw fixation in combination with spinopelvic fusion with cortical allografts allows reconstruction of the sagittal alignment with solid bony fusion improving the quality of life for these patients.

The present brief review focuses on the features of the Layer-by-Layer (LbL) synthesis of coatings containing hydroxyapatite nanoparticles and assesses their use in solving several biomedical problems. This work provides the state-of-art of this field. This method is based on the sequential chemical adsorption of reagents on the substrate surface that makes it possible to apply nanolayers of the specified composition on the surface of a wide range of substrates of complex shape, to control the thickness of the synthesized layers accurately at the nanometer level. It also enables the modification of surface characteristics, including roughness, hydrophilicity, and surface charge, and allows artificially constructed multilayers consisting of hybrid organic and inorganic substances to be obtained. The experimental material presented in the review demonstrates the effectiveness of LbL synthesis for creating new 3D scaffolds as bone substitutes, coatings on the surface of metal implants, and drug delivery systems. A promising direction for the development of LbL synthesis is the creation of methods that involve ion-substituted hydroxyapatites as reagents. Success in this area can pave the way for significant advances in biomedicine and open new opportunities for creating a new generation of structures that mimic the structural, compositional, and mechanical properties of the bone mineral phase.

Introduction. Rehabilitation of patients with cerebral palsy (CP) remains a very difficult task. Stable and growing movement restrictions in such patients cause a life-long need for treatment and rehabilitation. Neurorehabilitation of children with CP at various stages includes not only traditional physical rehabilitation methods, but also extensive use of robotic mechanotherapy techniques and new technologies in the field of neurophysiology. One of such technology is non-invasive percutaneous electrical stimulation of the spinal cord.Aim of the study: To assess the effect of transcutaneous electrical stimulation of the spinal cord to improve the motor function of children with spastic diplegia using the “Lokomat” robotic mechanotherapy system.Materials and methods. A clinical rehabilitation study of 26 patients aged 6–12 years with CP was conducted. The treatment group included 11 patients who received one course of robotic mechanotherapy using the “Lokomat” system combined with transcutaneous electrical stimulation of the spinal cord. The control group included 15 patients who received one course of robotic mechanotherapy only.Results. A comparative analysis of the two groups based on the results of clinical examinations using specific scales (GMFCS, GMFM-88, Modified Ashworth Scale of Muscle Spasticity), locomotor tests (L-FORCE, L-ROM), and evaluations of muscle activity using electromyography showed that one course of rehabilitation resulted in improvement in motor function in all patients of both groups, but positive dynamics were more significant in the treatment group that underwent percutaneous electrical stimulation of the spinal cord.Conclusion. Based on clinical data, changes in indicators of the locomotor tests L-FORCE and L-ROM, as well as assessment of changes in muscle activity, showed that motor rehabilitation of children with spastic diplegia using the “Lokomat” robotic mechanotherapy system combined with transcutaneous electrical spinal cord stimulation was more effective than robotic mechanotherapy only.

Idiopathic scoliosis is a common orthopedic disease of unknown etiology in childhood that limits the patient’s activity for a lifetime. Treatment of idiopathic scoliosis includes both conservative and surgical methods and requires psychological consideration, which is important for the rehabilitation of patient with chronic disease. Systematic research on the psychological aspects of the treatment and rehabilitation of patients with idiopathic scoliosis in the form of analysis allows us to evaluate the medical and psychological approaches to the problem and to identify the factors contributing to the successful adaptation of the patient to chronic disease situation. Methodology. We selected the articles related to the psychological aspects of scoliosis and its treatment between 2017 and 2018. The primary selection included 16 publications, of which 2 were survey studies. Earlier foreign and domestic publications were also included in the analysis in order to compare the changes in treatment and rehabilitation approaches. Literature analysis. Idiopathic scoliosis was considered as a risk factor for psychological discomfort in the forms of stress, negative emotions, anxiety, distortion of the image of “I,” reduced self-esteem, and communication problems. These increase the risk of mental disorders, such as depression, suicidal tendencies, and psychological disadaptation. Discussion. Analysis allows us to highlight the most important topics in the studies of adolescent idiopathic scoliosis in recent years: topic on mental health/ill health in adolescent idiopathic scoliosis (AIS), theme of the psychological component of pain, topic on clinical psychological and social psychological factors that determine the course of the disease of the patients with AIS, quality of life of a child or adolescent with AIS, issues of psychological resources for adaptation to a chronic disease, topic on parents’ perception of their child’s illness, and topic on the psychological accompaniment of patients suffering from AIS. Conclusions. A modern approach to the study of idiopathic scoliosis suggests a point of view from a biopsychosocial model of the disease; therefore, it is necessary to consider various factors affecting the patient’s quality of life, including the psychological component of the disease. Psychological support of the treatment should focus on the formation of the patient’s active position in relation to his or her own life and active coping strategies with chronic disease.

Background. The natural course of Legg-Calve-Perthes disease (LCPD) in children with subtotal or total lesion, which correspond to group III-IV according to the Catterall classification, it often leads to hip subluxation. Any changes in the vertebral-pelvic complex lead to mutual transformation and aggravation of existing deformities. In the Russian literature, there are no data on the assessment of the state of the frontal and sagittal spino-pelvic ratios in children with hip subluxation in LCPD. Purpose to evaluate the radiological parameters of the frontal and sagittal spino-pelvic relations in children with hip subluxation in LCPD. Materials and Methods. The study is based on the results of radiometry of 20 patients (20 hip joints) at an average age of 8.90.6 years with LCPD. Radiometry of the main frontal and sagittal spino-pelvic indices was performed and the type of vertical posture was determined according to P. Rousoully, as well as correlations between the studied parameters. Results. All patients had a pelvic distortion in the frontal plane. The values of PI had insignificant changes in comparison with similar values in the asymptomatic child population, the values of SS and SSA exceeded them, and the values of PT were significantly lower, which indicates the presence of excessive pelvic anteversion. The GLL values significantly exceeded the average statistical indicators. The global sagittal balance indicator (SVA) had negative values. The correlation analysis showed the presence of a strong positive relationship between PI and SS, SS and GLL, SSA and SS, a moderately pronounced positive relationship between PI and PT and a moderately pronounced negative relationship between PO and SS, PO and GLL. Conslusion. In children with LCPD in the fragmentation stage with subtotal or total epiphysis lesion (Catterall group III-IV) and hip subluxation, excessive pelvic anteversion is characteristic, which is expressed in an increase in the angle of inclination of the sacrum (SS) in combination with hyperlordosis of the lumbar spine and negative imbalance, as well as a pelvic distortion towards the affected limb. The totality of these changes corresponds to the IV type of vertical posture according to R. Roussouly, which can contribute to the development of degenerative-dystrophic processes in the lumbar spine.