Search

Introduction In the current system of providing medical aid to wounded servicemen, along with the conservative primary surgical treatment and minimally invasive extrafocal fixation, high-tech surgical interventions of considerable complexity with the use of additive and tissue-engineering technologies have been coming to the forefront. It is necessary to determine their place in the current algorithm of limb bone defect management, which was the substantiation of our study. The purpose of the study was to improve the algorithm for selecting a treatment method for patients with associated gunshot defects of the forearm based on the literature and clinical observations. Materials and Methods We analyzed scientific articles in PubMed and Scientific Electronic Library (eLIBRARY.ru) platforms, published from 2004 to 2024, on the basis of which we could refine the algorithm of treatment method selection for patients with associated gunshot defects of the forearm. The developed algorithm was used to treat 178 patients with gunshot fractures of the forearm. Results The review of the literature established the main provisions and principles that are applied in the reconstruction of the forearm with an associated defect. When choosing the method of bone defect management, a great number of authors tend to build a “reconstructive ladder”, moving from less severe (one bone) and extended defects (small defect up to 2 cm) to more complex (both bones) and massive defect (more than 10 cm). Upon having considered the revealed regularities, we improved the algorithm of surgical treatment of the latter, which is based on two classification principles: defect extention and location. Reconstruction of the forearm as a dynamic system after diaphyseal fractures requires consider the state of the radioulnar joint. The function of the latter depends on the length ratio of the radius and ulna bones. Therefore, we substantiated small (up to 2 cm) forearm bone defects that can be managed by simple surgical methods. Another fundamental addition to the algorithm was the allocation of a patients’ group with a defect of one forearm bone and a fracture of the other bone (defect-fracture); this combination allows avoiding complex surgical methods for reconstruction and use segment shortening. Discussion The treatment of associated forearm defects is challenging, the choice of reconstruction technique remains uncertain, and the required consensus is lacking. Several forearm reconstruction techniques are available, yet there is no reliable evidence of their effectiveness in terms of treatment time, complications, reoperations, and functional recovery. Conclusion The algorithm proposed for the treatment of extensive gunshot-associated defects of the forearm allows us to consider the change in the anatomy, make a surgical plan based on the reconstruction vector, and select optimal surgical techniques.

Background. Irrational and excessive use of antimicrobials drugs (AMD) creates conditions for the development of a global crisis of health systems around the world associated with antibiotic resistance. Aim. To conduct a retrospective study of the impact of the use of AMD on the change in the microbiological landscape and the sensitivity of microorganisms in the conditions of pandemic of the new coronavirus infection (COVID-19) in 2020–2021 in intensive care departments (ICD) of a multidisciplinary hospital. Materials and methods. In the course of the work, strains of microorganisms isolated from patients and from the surfaces of the hospital environment and changes in their sensitivity to significant groups of AMD in ICD for somatic and infectious patients with COVID-19 were compared. The sensitivity of the isolates was evaluated in accordance with the criteria of requirements of European Committee on Antimicrobial Susceptibility Testing – EUCAST, version 10.0, 2020. Results. A total of 1,394 isolates were studied, including 1,379 clinical and 15 isolates from the surfaces of the hospital environment. It was found that in all ICD in 2020–2021, gram-negative microorganisms prevailed in infectious loci in 70% of cases or more. In 2021, in the ICD in infectious patients with COVID-19, the persistent dominance of the Acinetobacter baumannii microorganism was revealed with an increase in the number of poly- and pan-resistant strains – 48.7%. While in the ICD for somatic patients Klebsiella Pneumoniae prevailed among gram-negative microorganisms – 37.5% in 2020 and 43.7% in 2021. It has been shown that in one department or in adjacent departments of the same medical institution, various nosocomial microorganisms with an unequal set of resistance genes and sensitivity to AMD may appear over time. Conclusion. The necessity of conducting constant microbiological monitoring and a passport of the medical department with mandatory registration of not only isolated strains of microorganisms, but also resistance genes in order to optimize the appointment of timely adequate empirical antimicrobial therapy is substantiated. The period of the latter should be as short as possible, and confirmed by convincing clinical signs of bacterial infection, and subsequently by the isolation of nosocomial flora from the biomaterial of critical loci from patients.

In 2022, the incidence of swine (A/H1N1) influenza markedly increased. It causes acute lung injury similar to that caused by SARS-CoV-2. These practice guidelines focus on the management of patients with severe influenza: from the diagnostic algorithm to the specifics of therapy and the use of respiratory support techniques. The guidelines provide recommendations on the rational pharmacotherapy principles: antiviral, antibacterial, mucoactive, anticoagulant, and symptomatic. The need to avoid prescribing drugs that may worsen the condition of patients with A/H1N1 influenza that are effective in other viral lung diseases, including SARS-CoV-2, has been pointed out. A detailed review of the criteria for initiation and principles of respiratory support is given.

Objective. To assess the effectiveness of the treatment of gunshot wounds of the spine using percutaneous full-endoscopic technique. Material and Methods. Three patients with gunshot shrapnel wounds of the spine were treated using percutaneous full endoscopy. Results. The patients underwent a removal of foreign bodies (metal fragments) at the cervical, thoracic and lumbosacral levels of the spine using percutaneous full endoscopic surgery. The operations were carried out without complications, with minimal additional trauma to soft tissues and the spinal motion segment. In all three cases, there was a positive dynamics in the form of regression of the pain syndrome. There were no infectious complications. Conclusion. The successful use of percutaneous full endoscopy in the surgical treatment of blind shrapnel wounds of the spine is shown. The results indicate the expediency of further research and development of this area to address the issue of introducing the technique into the routine practice of treating gunshot wounds both in peacetime in neurosurgical hospitals and centers of spinal neurosurgery, and in wartime at the stages of specialized care.

The article discusses the behavioral practices of a "new woman" in the conditions of mass famine in the early 1920s. It is noted that this social group was inconsiderable in number, but its influence in public life was very high. The author draws attention to the social origin of the representatives of this social group, the level of their education, the specifics of the worldview formation based on the ideals of universal equality and justice. It was noted that the behavior of the “new women” in conditions of mass starvation significantly differed from the generally accepted patterns, such as seeking help from the authorities, migrating to other regions, selling property, begging and other social deviations. The desire to contribute to the construction of a socialist society led to the ignorance of the problem of hunger and a reorientation from their daily life to social life. This was manifested in the behavior of the “new woman” in the form of collecting funds for the needs of the hungry, selfless work, refusal to relocate to prosperous areas. Social class background – origin from peasants and workers, high involvement in social activities, young age, membership in the Komsomol organisation were the factors that formed non-standard options for survival in the situation of mass famine among the “new women”. It is concluded that the conditions of hunger contributed to the strengthening of the social positions of the “new women”, their further advancement on the social ladder. The downside of strengthening the social position of the “new women” was the further erosion of the foundations of their traditional perception of the world based on family and motherhood.

Introduction Fractures of the distal metaepipheseal fractures of the radius (DMER) have a leading place in the overall structure of upper limb injuries. DMER fractures are frequently associated with soft- tissue injuries of the wrist joint, and namely, the triangular fibrocartilage complex (TFCC). The additional use of arthroscopy of the wrist joint in the treatment of patients with a DMER fractiures reduces the duration of recovery of patients and improves the result of their treatment. The aim of the study was to determine the effect of arthroscopic surgical treatment of TFCC injuries during bone osteosynthesis for DMER fractures on the functions of the upper extremities (extension/flexion of the hand, hand grip strength, pronation/supination of the forearm, DASH index). Materials and methods The study included 68 patients with DMER fractures, who were divided into 2 groups, depending on the treatment of the fracture. After reduction and osteosynthesis, all patients underwent arthroscopy of the wrist joint. If TFCC injury was detected, either a debridement or a TFCC suture was performed. Results TFCC injury was detected in 61.7 % (n = 42). Debridement was performed in 42.9 % (n = 18); suture using the inside-out technique was performed in 47.6 % (n = 20); one patient underwent reinsertion. After 6 months, the function of flexion and extension of the hand was significantly worse in patients with combined TFCC and DMER injuries, but after 12 months, the indicators were similar. The strength of the hand grip and the rotational function of the forearm did not differ between the subgroups. The subjective assessment of DASH after 6 months was worse in the group with TFCC injury, but after 12 months the results were similar. Conclusion Surgical treatment of TFCС injury in intraarticular fractures of the distal radius contributes to the restoration of the upper limb function to a premorbid level 12 months after surgical treatment.

Background. Lung function tests should be performed to patients with penetrating wounds of the lungs to identify lung function disorders, and the data obtained should be taken into account when correcting medical treatment and prescribing individual medical rehabilitation programs. The aim was to study the impact of penetrating lung wounds on the lung function in the early recovery period. Materials and methods. 13 patients were enrolled in the study, 100% male, median age 26 [21; 31] years. Spirometry, body plethysmography, and a diffusion test were performed on an average of 14 days from the injury. Results. A prospective cross-sectional study was performed. A moderate decrease in the vital capacity (VC), the forced vital capacity (FVC), the volume of forced exhalation in the first second (FEV1) was revealed while the total lung capacity (TLCpl) and the FEV1/FVC ratio were within normal values. However, in 2 (15.4%) and 3 (23%) patients, a restrictive ventilation disorders (TLC lower limit of normal) was detected when using Global Lung Function Initiative (GLI) and European Community for Steel and Coal (ECSC) 1993 predicted value system, respectively. The residual lung (RV) and RV/TLCpl were increased. Functional residual capacity (FRC), FRCpl/TLCpl, airway resistance remained within normal values. The diffusion lung capacity impairment was detected in 92.3% and 61.5% cases according to the ECSC 1993 and the GLI system, respectively. Conclusion. In the early period of recovery after penetrating lung wounds, a nonspecific pattern of ventilation disorders was the most often abnormality namely a decrease in VC while TLC and FEV1/FVC were within normal values. Less frequently, the classic restrictive pattern of ventilation disorders was diagnosed. Besides, the diffusion lung capacity impairment was detected. The system of predicted values has a significant impact on the frequency of detection of the lung function disorders. The revealed functional disorders should be taken into account for adjusting medical and rehabilitation interventions.

Objective. To analyze clinical outcomes and complication rates of transforaminal and interlaminar endoscopic decompression and open microsurgical operations performed for lumbosacral spinal canal stenosis. Material and Methods. The data of 60 literature sources selected in accordance with the inclusion and exclusion criteria in the PubMed, Science Direct, Google Scholar and Cochrane Library databases were systematized by evaluating diagnostic methods, clinical pictures and surgical treatment of the lumbar spinal canal stenosis. Original studies, case series and reviews containing information on surgical methods for the treatment of spinal stenosis at the lumbar level were analyzed. Results. The complication rate after transforaminal endoscopic decompression (relapses, infectious complications, damage to the dural membrane and spinal roots) does not exceed 2.7 %, which is significantly lower than that in open microsurgical operation (4.8–8.8 %). Endoscopic decompression and reconstruction of the spinal canal demonstrate good clinical outcomes, lower number of bed-days, readmissions, and good economic benefits. When stenosis is combined with instability of the spinal motion segment, performing only a decompressive operation in any volume does not give a significant clinical result, and stabilization surgery is required. Conclusion. The introduction of endoscopic reconstructive surgery for spinal canal stenosis in the lumbosacral spine is associated not only with technical progress and improvement of endoscopic optics, but also with the search for the causes of unsatisfactory results of open operations. Endoscopic interventions showed good clinical outcomes and a decrease in the complication rate. However, the evidence base needs to be expanded due to the lack of randomized trials to compare open decompression and stabilization, and endoscopic reconstructive surgeries in patients with various manifestations of spinal stenosis.

Introduction Meniscus tear is one of the most common injuries of the knee joint. Medial meniscus tear accounts for 23–31 % of knee joint injuries. The main method of treatment is partial resection. As reported, 13.5 % of patients undergo arthroplasty within 15 years after meniscus resection, what is regarded as an unsatisfactory result. Purpose To evaluate and compare the long-term clinical, functional and radiological results of surgical treatment in patients with medial meniscus tear combined with varus deformity of the tibia and without it. Materials and methods From 2013 to 2020, medial meniscus tear was treated in 245 patients. The patients were divided into 4 groups. Group 1 included patients with a mechanical femorotibial angle (MFTА) from 0º to 3º who had arthroscopic meniscus resection (AMR). In the 2nd group, all patients also underwent AMR, but their MFTА was more than 3º. In group 3, patients with MFTА from 3º to 5º underwent simultaneous AMR and proximal fibular osteotomy (PFO) with the formation of a defect. Group 4 included patients with MFTА more than 5º, who underwent high tibial osteotomy (HTO) and AMR. Changes in the main lines and angles were assessed with telemetry radiography of the lower extremities. Functional results were evaluated before and after surgery using the Lysholm Knee Scoring Scale, 2000 IKDC, KOOS. Results Isolated meniscus resection in patients with MFTА more than 3º without axial correction leads to a gradual increase in the deformity by 1,070 ± 0.50º during the first year after surgery, and by 2.20 ± 0.70º to the fifth year. In groups 1, 3 and 4, there was no statistically significant increase in MFTА during the entire observation period. The clinical treatment results of patients of the four groups in the first three years after surgery did not differ statistically. However, within the period from 3 to 5 years, patients with MFTА greater than 3º who underwent only AMR had poorer clinical results than in the other groups (p < 0.001). Conclusions A personalized approach to the method of surgical treatment for medial meniscus tear based on the MFTА enables to correct the mechanical axis of the lower extremities and MFTА, and thus improve the long-term clinical, functional and radiological results of surgical treatment.

A promising method for improving the functional properties of calcium-phosphate coatings is the incorporation of various antibacterial additives into their structure. The microbial contamination of a superficial wound is inevitable, even if the rules of asepsis and antisepsis are optimally applied. One of the main problems is that bacteria often become resistant to antibiotics over time. However, this does not apply to certain elements, chemical compounds and drugs with antimicrobial properties. In this study, the fabrication and properties of zinc-containing calcium-phosphate coatings that were formed via micro-arc oxidation from three different electrolyte solutions are investigated. The first electrolyte is based on calcium oxide, the second on hydroxyapatite and the third on calcium acetate. By adding zinc oxide to the three electrolyte solutions, antibacterial properties of the coatings are achieved. Although the same amount of zinc oxide has been added to each electrolyte solution, the zinc concentration in the coatings obtained vary greatly. Furthermore, this study investigates the morphology, structure and chemical composition of the coatings. The antibacterial properties of the zinc-containing coatings were tested toward three strains of bacteria—Staphylococcus aureus, methicillin-resistant Staphylococcus aureus and Pseudomonas aeruginosa. Coatings of calcium acetate and zinc oxide contained the highest amount of zinc and displayed the highest zinc release. Moreover, coatings containing hydroxyapatite and zinc oxide show the highest antibacterial activity toward Pseudomonas aeruginosa, and coatings containing calcium acetate and zinc oxide show the highest antibacterial activities toward Staphylococcus aureus and methicillin-resistant Staphylococcus aureus.

Museums today play a pivotal role in creating an environment that follows principles of social inclusion and is accessible for individuals with disabilities including museum visitors with autism spectrum disorders (ASD). Extracurricular activities are an integral part of comprehensive support for children with ASD that require coordinated efforts of museum professionals, psychologists, and educators. However, museum professionals may lack information about autism and appropriate approaches. The Federal Resource Center for Organization of Comprehensive Support to Children with Autism Spectrum Disorders at MSUPE studied this process by conducting a survey about the availability of resources for accommodating individuals with ASD as independent visitors as well as participants in museum programs. The results of the survey attest to a high level of engagement of museum community in creating provisions for visitors with ASD in addition to the demand for consulting centers that would facilitate development of appropriate tools. We present a project that has introduced “social narratives” as an instrument for ASD in a setting that can serve as a model for such a center.

Introduction Correction of the shape of the lower extremities for aesthetic purposes has specific features that are associated with the role of the patient in the treatment process and assessment of results. An important element is the relationship between the appearance of the limb and changes in the axes of the skeleton. Aim of study Assessment of many-years of experience in orthopedic correction of the shape of the lower extremities for aesthetic purposes, discussion of possibilities, analysis of problems and search for possible ways to prevent them. Methods The material of the study was 123 patients who underwent aesthetic surgical correction in the period from 2005 to 2020. Their results were followed in the period from 6 months to 11 years. In all cases, operations were performed simultaneously on both limbs. The total number of operations, thus, amounted to 246. The main indication for surgery was the so-called true O-shaped curvature (varus deformity) of the lower extremities. In all cases, the main elements of the operation were osteosynthesis with the Ilizarov apparatus and osteotomy of the tibia. Wires and half-pins were used as transosseous elements. To assess the main reference lines and angles (RLA), X-ray examination of the lower extremities was performed with the capture of the hip and ankle joints. Results and discussion Corrective manipulations in the group of patients led to a change in the position of the main RLA. Before treatment, MAD value was 15 ± 7 mm, after correction MAD = -2 ± 4 mm, before surgery MPTA = 85 ± 40, after correction MPTA = 91 ± 20. Subjective satisfaction was reported in 114 (92.7 %) cases. Subjectively unsatisfactory results were recorded in 4 (3.3 %) cases; objectively unsatisfactory results were detected in 5 (4.1 %) cases. Conclusions Aesthetic surgery of the lower extremities is a part of orthopedic practice and has its specific features due to the goal of realizing the patient's wishes about changing the appearance of the lower extremities indirectly by performing operations on the skeleton. Corrective interventions should be considered as a preventive measure aimed at preventing the development of gonarthrosis in old age. The key to a good result is careful selection of candidates for surgery and their compliance, along with a thorough explanation of the principles and features of correction.

Introduction Practical application of regenerative medicine to restore structural and functional properties of damaged tissues and organs using bioactive implants could solve complex problems in contemporary traumatology and orthopedics. Objective To improve treatment results in posttraumatic diaphyseal defects of lower extremities. Material and Methods Treatment outcomes of 19 patients with posttraumatic bone defects of the femur and tibia that averaged of 8.8 ± 3.5 cm were studied. In the main group (9 patients), osteosynthesis of fragments was performed sequentially, first with external fixation and then with intramedullary nailing. Bone defect was bridged by a combination of a biomimetic tissue with a spongy autograft from the iliac wing. In the control group (10 patients), the Ilizarov method of non-free bone plasty was used. Results The results were studied after follow-up of two years. Bone defects were covered in all patients of both groups. However, in the main group, the physiological load on the limb was possible, on average, 7.6 months after surgery, which required 61 % less operations as compared to the control group. Also, the rate of complications was 29.2 % lower in the main group. When assessing the functional results using the LEFS questionnaire, the patients of the main group experienced some minor difficulties in performing physical activities, and patients in the control group experienced moderate difficulties (average score 70.3 and 50.4, respectively). Conclusion The combination of biomimetic tissue with a spongy autograft from the iliac wing under the conditions of stable functional osteosynthesis enables to manage extensive defects of the femur and tibia and improve the functional outcomes.

This paper formulates and solves a practical problem of data recovery regarding the distribution of languages on regional level in context of China. The necessity of this recovery is related to the problem of the determination of the linguistic diversity indices, which, in turn, are used to analyze empirically and to predict sources of social and economic development as well as to indicate potential conflicts at regional level. We use Ethnologue database and China census as the initial data sources. For every language spoken in China, the data contains (a) an estimate of China residents who claim this language to be their mother tongue, and (b) indicators of the presence of such residents in China provinces. For each pair language/province, we aim to estimate the number of the province inhabitants that claim the language to be their mother tongue. This base problem is reduced to solving an undetermined system of algebraic equations. Given additional restriction that Ethnologue database introduces data collected at different time moments because of gaps in Ethnologue language surveys and accompanying data collection expenses, we relate those data to a single time moment, that turns the initial task to an ill-posed system of algebraic equations with imprecisely determined right hand side. Therefore, we are looking for an approximate solution characterized by a minimal discrepancy of the system. Since some languages are much less distributed than the others, we minimize the weighted discrepancy, introducing weights that are inverse to the right hand side elements of the equations. This definition of discrepancy allows to recover the required variables. More than 92% of the recovered variables are robust to probabilistic modelling procedure for potential errors in initial data.