2-stage Group Research Articles

A COMPARATIVE ANALYSIS OF 1.5-STAGE AND TWO-STAGE REVISION FOR PERIPROSTHETIC JOINT INFECTION AFTER TOTAL HIP ARTHROPLASTY: IS 1.5-STAGE REALLY EQUIVALENT?

Two-stage exchange arthroplasty is traditionally used to treat periprosthetic hip infection. Nevertheless, particularly in high-risk patients, there has been increased attention towards alternatives such as 1.5-stage exchange arthroplasty which takes place in one surgery. Therefore, we sought to compare (1) operative time, length-of-stay (LOS), transfusions, (2) causative organism identification and polymicrobial infection rates, (3) re-revision rates and re-revision reasons, (4) mortality, and determine (5) independent predictors of re-revision.Retrospective chart review of 71 patients who underwent either 1.5- (n=38) or 2-stage (n=33) exchange hip arthroplasty at a single institution (03/2019-05/2023). Demographics, surgical, inpatient, and infection characteristics were noted. Main outcomes evaluated were re-revision rates, re-revision reasons, mortality, and cause of death. Independent predictors of re-revision were assessed utilizing logistic regression. Mean follow: 675 days (range, 23–1,715).Demographics were not significantly different except for a higher proportion of 1.5-stage patients classified as American-Society-of-Anesthesiologists (ASA) status 3 or 4 (84.2 vs. 48.5%, p=0.002). Length of follow-up was significantly longer in the 2-stage group (924.4 vs. 458 days, p<0.001) as well as operative time (506 vs. 271 minutes, p<0.001). In the 1.5-stage group, there was a higher proportion of polymicrobial infections (23.7 vs. 3.0%, p=0.016), re-revision rates (28.9 vs. 9.1%, p=0.042) and periprosthetic infections as a cause of revision (90.9 vs. 0%, p=0.007). Mortality rates were not significantly different, and no patient died for causes related to infection. Type of surgery (1.5-stage vs. 2-stage) was the only independent predictor of re-revision (odds-ratio 4.0, 95% confidence-interval 1.02–16.16, p=0.046).Our data suggests that patients who undergo 1.5-stage exchange arthroplasty have a significantly higher re-revision rate (mostly due to infection) when compared to 2-stage patients. We acknowledge potential benefits of the 1.5-stage strategy, especially in high-risk patients since it involves single surgery. However, higher re-revision rates must be considered when counseling patients.

Long-Term Results of 2-Stage Turnbull-Cutait Pull-Through Coloanal Anastomosis for Low Rectal Cancer

In patients operated on for low rectal cancer, 2-stage Turnbull-Cutait pull-through hand-sewn coloanal anastomosis provides benefits in terms of postoperative morbidity compared with standard hand-sewn coloanal anastomosis associated with diverting ileostomy and further ileostomy reversal. To compare long-term results of these 2 techniques after ultralow rectal resection for rectal cancer. In this randomized multicenter clinical trial, neither patients nor surgeons were blinded for technique. Patients were recruited in 3 centers. Patients undergoing ultralow anterior rectal resection needing hand-sewn coloanal anastomosis were randomly assigned to 2-stage Turnbull-Cutait pull-through hand-sewn coloanal anastomosis (n = 46) or standard hand-sewn coloanal anastomosis associated with diverting ileostomy (n = 46). All patients underwent ultralow anterior resection. Patients assigned to the 2-stage Turnbull-Cutait pull-through group underwent exteriorization of a segment of left colon through the anal canal. After 6 to 10 days, the exteriorized colon was resected and a delayed hand-sewn coloanal anastomosis performed. For patients assigned to standard coloanal anastomosis, the hand-sewn coloanal anastomosis was performed with diverting ileostomy during the first operation. Ileostomy closure was scheduled after adjuvant treatment was completed in about 6 to 8 months. The study aimed to compare the differences between the 2 groups in terms of long-term surgery-related morbidity, functional, and oncological outcomes at 3 years postoperatively. Data were analyzed from October 1, 2018, through October 31, 2021. The 92 patients randomized in the first study were included for the 3-year follow-up. The overall morbidity rate in the 2 groups showed that 15 patients (16.3%) had complications with a difference of 6.52 (95% CI, -8.93 to 21.79). Nine patients (19.6%) and 6 patients (13.0%) in the 2-stage Turnbull-Cutait pull-through group and hand-sewn coloanal anastomosis group, respectively, had complications without statistically significant differences (P = .57). Oncological results were comparable between the groups. Long-term fecal continence in the CCA and TCA groups, respectively, assessed using the Wexner Incontinence Score was 10.9 (5.50-15.5) vs 13.0 (7.25-16.0; P = .92), Low Anterior Resection Syndrome score was 32.0 (21.0-37.0) vs 34.0 (23.2-38.5; P = .76), and Colorectal Functional Outcome score was 38.5 (23.0-47.1) vs 40.8 (23.3-58.2; P = .30). In this study, after a 3-year follow-up period, 2-stage Turnbull-Cutait anastomosis for ultralow rectal cancer could be considered as a surgical alternative that has the valuable benefit of avoiding a temporary stoma with similar results in terms of morbidity, fecal continence, patient satisfaction, quality of life, and oncological outcomes when compared with hand-sewn coloanal anastomosis with ileostomy. ClinicalTrials.gov Identifier: NCT01766661.

Assessment of the quality of life of children having the treatment for congenital hip dislocation

Long-term surgical treatment outcomes in children with congenital hip dislocation can be various and depend on many factors, including the age in time of surgery. The quality of life assessment systems are modern tools to study the effectiveness of previous treatment, as well as to plan subsequent comprehensive rehabilitation. Material and methods. The study included 68 children divided into the groups according to the age of the primary surgical intervention. There were three groups: group 1 – 21 patients under 1.5 years, group 2 – 22 children aged 1.5–4-years, group 3 – 25 children over 4 years. Objective medical assessment of the clinical outcomes was carried out with the McKay’s criteria. The PedsQL4.0 questionnaire, pediatric and parental forms were used to assess the patients’ quality of life. Results. The majority of children in the 1st age group had excellent results (52.3%), in the 2nd and 3rd groups there were fewer such results (40.9 and 32 %, respectively). Having analyzed the data of the questionnaires for children and their caregivers we found that the both categories from group 3 demonstrated the lowest quality of life parameters. Conclusions. The frequency of consequences such as discomfort, limping, limb length discrepancy was also higher in children underwent surgery at the age of over 4 years old. It correlates with the questionnaire results and demonstrates a lower quality of life in children from group 3.

Predictors of Periodontal Diseases in the Student Population of Caucasus International University: A Study of Risk Factors and Oral Health Optimization

Abstract Introduction: Periodontal diseases cause esthetic and functional disorders having an impact on oral and general health and the psychological and social status of a person. “Unhealthy oral cavity” as a problem is particularly painfully perceived by young patients, having concern predominantly about their appearance and personal social connections. The migration of foreigners to Georgia has made a great impact on dental referrals in Georgia last years. Foreign populations are different in lifestyle, diet, dental practices, and oral hygiene habits. They live, study, or work and are closely integrated into Georgian society; subsequently, their oral health may influence periodontal diseases’ overall prevalence in the country. The Aim of the Study: The aim of this study was to assess the periodontal status of Caucasus International University (CIU) students of different nationalities, study the risk factors, and oral health optimization by planning and implementing preventive measures. Methods: This was randomized research conducted on 820 students aged 18–35 years, including 370 Georgians and 450 foreigners, 369 boys and 451 girls. Results: Unhealthy periodontal tissues were observed in 46.3% of boys and 44.6% of girls. 34.8% of Georgians and 66.4% of foreigners were suffering from gum bleeding. Bleeding on probing of II and III degrees was common in the 1st (18–25) age group (40.5% and 31.0%, respectively) and I and II degrees in the 2nd (26–35) age group (39.4% and 44.9%, respectively). Conclusion: Findings indicate a rather high prevalence of dental plaque-induced gingivitis in the CIU student population. Students do not receive adequate dental care and have negative attitudes toward oral hygiene skills and dental services. Management of periodontal problems with an emphasis on oral hygiene enhancement and promotion of oral prophylaxis accentuated the role of the university dental clinic in providing scientific and clinical experience to the CIU students.

INDICATORS OF CIRCUITAL HEART RHYTHM IN SCHOOLCHILDREN WITH CARDIAC NEUROCERCULATORY DYSTONIA RESIDING IN THE ANDIJAN REGION

Annotation. According to the international systematization of diseases (10th revision), neurocirculatory dystonia (NCD) refers to somatoform autonomic dysfunction that occurs with a violation of the nervous regulation of the circulatory system. Among non-infectious diseases of childhood and adolescence, vegetative-vascular dystonia is considered the most common pathology with a frequency of 4.8 to 29.1%. It is known that vegetative-vascular dystonia or its variant neurocircular dystonia is considered a predictor of arterial hypertension, atherosclerosis and coronary heart disease at a young age. Currently, determination of heart rate variability (HRV) is recognized as the most informative non-invasive method for quantitative assessment of the autonomic regulation of heart rate. The purpose of the study was a comparative assessment of the variability of circadian rhythm and heart rate in adolescents with similar neurocirculatory dystonia living in urban and rural areas. Materials and methods. We examined 77 adolescents aged 12 to 17 years (average age 14.5±0.35 years, boys -31, girls -46), hospitalized with a diagnosis of somatoform autonomic dysfunction, cardiac type NCD, from January 2022 to February 2023. Information is classified by age and place of residence (urban, rural). Taking into account the mechanisms of development of the autonomic nervous system, 2 age groups were identified. 1st age group - children 12-14 years old 49.5±4.99% (average age 13.4±0.24 years), of which 62.5±8.83% lived in Andijan (group IA), 37.5±11.74% of adolescents - in rural areas of Andijan region (group IB). 2nd age group - teenagers 15-17 years old 50.5±4.99% (average age 16.5±0.29), of which 61.2±8.89% of young people lived in Andijan (group IIA), 38.8±11.49% - in rural areas (group IIB). All teenagers live in the Andijan region every day. Results. Among the examined adolescents with NCD of the heart, complaints of pain in the heart area were similar (in age group I - 70.8±6.56%, in age group II - in 83.7±5.28% of those examined). The pain was mostly temporary (lasting a few seconds) and stabbing in nature. Interruptions in heart function were noted by 43.8±7.16% of young people in group I and 55.1±7.11% of young people in age group II. In addition, 31.3±6.69% of adolescents in age group I and 36.7±6.89% of young people in group II complained of headache, dizziness, impotence, and excessive fatigue. Conclusions. When examining adolescents with neurocirculatory dystonia, it is necessary to conduct not only a normal ECG at rest, but also Holter ECG monitoring with determination of heart rate variability; the examination will ensure adequate treatment and monitoring of this group of patients. The detected changes in the circadian rhythm and rhythm variability in urban adolescents compared to rural ones are probably associated with living in an industrial zone, environmental criteria, nutrition, and an even greater information load, which urgently requires further research.

Staged abdominal wall reconstruction in the setting of complex gastrointestinal reconstruction.

Literature on one- versus two-staged abdominal wall reconstruction (AWR) with complex gastrointestinal reconstruction (GIR) is limited to single-arm case series with a focus on patients who complete all planned stages. Herein, we describe our experience with both one- and two-staged approaches to AWR/GIR, with attention to those who did not complete both intended stages. A retrospective review of prospectively collected data was conducted to identify patients who underwent a one- or two-stage approach to GIR/AWR from 2013 to 2020. The one-stage approach included GIR and definitive sublay mesh herniorrhaphy. The two-stage approach included Stage 1 (S1)-GIR and non-definitive herniorrhaphy and Stage 2 (S2)-definitive sublay mesh herniorrhaphy. Fifty-four patients underwent GIR/AWR: 20 (37.0%) underwent a planned 1-stage operation while 34 (63.0%) underwent S1 of a planned 2-stage approach. Patients assigned to the 2-stage approach were more likely to be smokers, have a history of mesh infection, have an enterocutaneous fistula, and a contaminated wound class (p<0.05). Of the 34 patients who underwent S1, 12 (35.3%) completed S2 during the mean follow-up period of 44 months while 22 (64.7%) did not complete S2. Of these, 10 (45.5%) developed hernia recurrence but did not undergo S2 secondary to elective nonoperative management (40%), pending preoperative optimization (30%), additional complex GIR (10%), hernia-related incarceration requiring emergent surgery (10%), or unrelated death (10%). No differences in outcome including SSI, SSO, readmission, and recurrence were noted between the 12 patients who completed the two-stage approach and the 20 patients who completed a one-stage approach, despite increased risk factors for complications in the 2-stage group (p>0.05). Planned two-stage operations for GIR/AWR may distribute operative complexity and post-operative morbidity into separate surgical interventions. However, many patients may never undergo the intended definitive S2 herniorrhaphy. Future evaluation of 1- versus 2-stage GIR/AWR is needed to clarify indications for each approach. This work must also consider the frequent deviations from intended clinical course demonstrated in this study.

Growth Outcomes Audit for Unilateral Cleft Lip and Palate (UCLP) After 2-stage Palate Repair.

To assess the impact of 1 and 2-stage palatoplasty protocol on the dental arch relationships in unilateral cleft lip and palate (UCLP) in a single center. Our study consisted of 349 individuals divided into 2 groups according to the palatoplasty protocol. Two-stage group comprised 169 subjects with UCLP (mean age: 6.9y, 110 male and 59 female) who underwent lip, nasal ala, and anterior palate repair with vomer flap from 3 to 6 months (first surgery stage). Soft palate repair occurred from 12 to 18 months (second surgery stage). The one-stage group comprised 180 subjects with UCLP (mean age: 7.2y, 108 male and 72 female) who underwent 1-stage palatoplasty. Dental models were evaluated by 3 experienced orthodontists applying Goslon Yardstick and the 5-year-old index (FYOI). The influence of the palatoplasty technique and surgeon factor on the interarch relationship was evaluated. The weighted Kappa was used to assess intraexaminer and interexaminer agreements for comparisons of dental arch relationships. Intergroup comparisons were conducted using the χ 2 test ( P <0.05). The intraexaminer reliability was very good (0.81 to 0.98) and interexaminer reliability varied from satisfactory to very good (0.56 to 0.83). The mean occlusal index of the 2-stage and 1-stage groups was 2.77 and 3.03, respectively. The variability of the mean index between surgeons varied from 2.38 to 3.2 in the 2-stage group and 2.91 to 3.2 in the 1-stage group. There were significant differences in the frequency of Goslon 5 index ( P =0.002) between groups, with the 2-stage group presenting less cases (1.18%) than the group 1-stage (11.11%). The interarch relationship was similar for both palate repair protocols. Two-stage palatoplasty showed a decreased prevalence of Goslon index 5.

On the need to increase the age categories of male military personnel for rationing of the nutritional status

Introduction. The purpose of the study is scientific and methodological justification of the need to increase the number of age groups to clarify the standards for assessing the nutritional status of military personnel.&#x0D; Materials and methods. The study involved one thousand three hundred seventy six 18 to 53 years male servicemen under medical examination. The following methods were used: anthropometry, assessing body composition (bioimpedance, caliperometry), the functional state and adaptive reserves. Statistical data analysis was carried out using Microsoft Excel and Statistica 10.0 software products.&#x0D; Results. Based on the results of the analysis of literary sources and own research, for assessing and rationing of the nutritional status there were identified 4 age groups of military personnel, differed from each other at a highly reliable level (p&gt;0.001) for all the studied indicators.&#x0D; It was found that representatives of the 1st age group (18–20 years) were characterized by the best values of adaptation of the cardiovascular system and the body’s resistance to physical exertion, as well as high reserve functionality and recovery rate after physical exertion. Representatives of the 2nd age group (21–27 years old) are objectively the best in most of the indicators studied by us compared to other age groups. In the military personnel of the 3rd age group (28–35 years), in general, with satisfactory results for most of the parameters studied, there was a significant decrease in the indicators of the functional state, compared with the first two groups. Representatives of the 4th age group (36 years and over) had the highest percentage of values of the studied indicators below the norm.&#x0D; Limitations. The medical examination, which included measurements of body size, composition, and assessment of functional status, involved 1,376 18 to 53 years male servicemen, which is a sufficient reference sample. &#x0D; Conclusion. The necessity of increasing the number of age groups to assess the nutritional status in male servicemen is substantiated. Based on the conducted research, 4 age groups of military personnel were identified to assess the nutritional status, which differ from each other at a highly reliable level.

Difference in the outcomes of anterior tenting and wrapping techniques for acellular dermal matrix coverage in prepectoral breast reconstruction

Acellular dermal matrices (ADMs) play an essential role in prepectoral implant-based breast reconstructions; however, the most appropriate method for ADMs is unknown. We conducted a retrospective analysis of our institutional database. Patients who underwent mastectomy and prepectoral breast reconstruction using tissue expanders or breast implants covered with ADMs between March 2018 and June 2021 were included. Patient characteristics, postoperative complications, and long-term outcomes were investigated. In total, 112 patients (126 breasts) were included. The anterior tenting and wrapping techniques were used in the reconstruction of 32 (25.3%) and 94 (74.7%) breasts, respectively. Using propensity score matching, nine breasts were selected for each technique within the direct-to-implant reconstruction group, while 16 breasts were selected for each technique within the 2-stage reconstruction group. The choice of technique (anterior vs. wrapping) in implementing ADM did not generate any significant differences in postoperative complications, including seroma formation and capsular contracture, for the direct-to-implant and 2-stage reconstruction groups. Regarding the direct-to-implant reconstruction group, the average postoperative drain volume was less in the anterior tenting group than that in the wrapping group (anterior tenting vs. wrapping; 495.09±156.118mL vs. 673.43±307.954mL, p=0.006), but the difference was insignificant after propensity score matching. We report our experience with covering prosthetic devices with ADMs during postmastectomy breast reconstruction. No differences in the postoperative drain volume or postoperative outcomes were found between the study groups. Future studies are needed to determine the method that provides the most satisfactory results.

Monitoring of individual determinants of physical performance to submaximal load of men of different age groups during aging

The article presents the monitoring of individual determinants of physical capacity of men of different age groups during aging. The purpose of our study was to find out the individual determinants of physical performance and adaptation of the cardiovascular system to submaximal physical exertion in men of different age groups. 86 men took part in the experimental study, namely: 1st age group: 18-19 years old (n=30); 2nd age group: 60-71 years old (n=31); 3rd age group: 72-76 years old. (n = 25). Physical capacity was determined according to the generally accepted method with the calculation of the absolute and relative values of PWC170 according to the submaximal age level. It has been established that submaximal physical capacity in men likely decreases with aging. It was analyzed that the adaptation of the cardiovascular system to submaximal physical activity worsens with aging. It has been proven that the quantitative determination of physical capacity for most indicators probably correlates with the age of men, so it can be used to estimate the biological age during aging of the body. The correlation coefficients of individual determinants of physical working capacity with chronological age were analyzed by the method of pair correlation, namely: absolute physical working capacity in kgm/min WC1 (r=-0.95), relative physical working capacity in kgm/min/kg WC2 (r= -0.93), and indicators obtained at the height of the submaximal load HR per minute. (r=-0.87), systolic blood pressure in mm Hg. (r=+0.22); diastolic blood pressure in mm Hg (r=+0.28), which are consistent with the results of other authors. It has been proven that physical performance is a tool for assessing changes in the body's adaptive capabilities, which reflects the cardiovascular aspect of health.&#x0D; It is substantiated that individual determinants of physical capacity are necessary for modeling physical load tolerance, prevention of diseases of the cardiovascular system, evaluation of effectiveness for the selection of rehabilitation programs for men of target groups.

Two-Stage Offers No Advantages over Single-Stage Arteriovenous Creation: An Analysis of Multicenter National Data

Traditionally, arteriovenous fistulas (AVF) involving the basilic vein (BV) have been created in 1 or 2 stages to allow time for the vein to enlarge before superficialization for potential better fistula maturation. Previous single institution studies and meta-analyses have found conflicting outcomes between single-stage and 2-stage procedures. Our study aims to use a large national database to assess the difference in outcomes between single-stage and 2-stage procedures for dialysis access. We studied all patients undergoing BV AVF creation in the Vascular Quality Initiative (VQI) from 2011 to 2021. Patients were split into single-stage or a planned 2-stage procedure for dialysis access. Primary outcomes included dialysis use with index fistula, maturity rate, and number of days from surgery to fistula use. Secondary outcomes included patency (defined by physical exam or imaging on follow-up), 30-day mortality, and postoperative complications (bleeding, steal syndrome, thrombosis, or neuropathy). Logistic regression models were used to assess the association between staged dialysis access procedures and primary outcomes of interest. The cohort consisted of 22,910 individuals of which 7,077 (30.9%) had a 2-staged dialysis access procedure and 15,833 (69.1%) had a single-staged procedure. Average follow-up was 345days in the single stage and 420days for 2-stage. Baseline characteristics were significantly different between the 2 groups in terms of medical comorbidities. Primary outcomes were significant for more patients in the 2-stage group undergoing dialysis with the index fistula compared to single stage (31.5% vs. 22.2%, P<0.0001), significant decrease in days to use in current dialysis patients (103.9days single stage versus 141.0days 2-stage, P<0.0001), and no difference in maturity at follow-up (19.3% single-stage and 17.4% 2-stage, P=0.354). Secondary outcomes revealed no difference in 30-day mortality or patency (89.8% single-stage and 89.1% 2-stage, P=0.383), but a significant difference in postoperative complications with a 2-stage procedure compared to 1-stage (1.6% vs. 1.1%, P=0.026). Finally, a spline model was used to determine that a preoperative vein of 3mm or less could be a cutoff in which a 2-stage procedure might be beneficial. This study demonstrates that when dialysis access fistulas are created using the BV, there is no difference in maturity rate or 1-year patency when assessing single-stage versus 2-stage procedures. However, 2-stage procedures significantly delay the time of first use of the fistula and increase postoperative complications. Therefore, we suggest performing single stage procedures when the vein is of appropriate diameter to minimize multiple procedures, complications and expedite time to maturity.

Sero-prevalence of hepatitis-c virus among blood donors in northern Pakistan

HCV is a hepatotropic single strained positive sense RNA virus belongs to family Flaviviridae. HCV is worldwide distributed virus affects about 185 million peoples as a result it causes 500,000 deaths per year. In Pakistan 5-6% of individuals are infected with HCV while in blood donors this ratio varies from 1.05-3.24 in different region of Pakistan. In Peshawar sero-prevalence of HCV was 4 percent. This study focuses on the actual status of HCV among blood donors at district Mardan and to compare the findings with previous study and shows the differences. The data were collected in MMC-MTI Mardan from January 2019 to May 2019. Through CMIA (by architect 1000i) methods the quantitative detection of anti-HCV antibodies takes place and 625 samples diagnosed through EIA methods, in which 9 were positive to HCV antibodies. Overall sero-prevalence of HCV positive donors is 1.44% and high prevalence were founded in the male which was (1.45%), rural area (1.95%), illiterate donors (2.08%), married donors (2.20%), donors belong to lower class economic status (2.21%), 1st time donors (1.72%) and age group 38-47 (3.64%) were positive to HCV. The risk factors of HCV transmission are IVD use, unscreened blood transfusion, contaminated surgical instruments and shaving in barber shop. The findings of this study show that the sero-prevalence of HCV increased 0.24% from 2018 among blood donors at district Mardan. It was recommended that more studies required to explore the seroprevalance of HCV in other cities of Pakistan.

Tarsus and knee setting in children at the final stage of early childhood taking into account the six-month age ranges

Purpose The study aimed to analyze the tarsus and knee setting in 3-year-old girls and boys, taking into account the six-month age ranges. Methods The study involved 800 children (400 girls, 400 boys) recruited from randomly selected preschools in the in the Podkarpackie region. Study group was divided into two age ranges: 1st group (children aged 3.00-3.49 years) and 2nd group (children aged 3.50-3.99 years). Baseline goniometer (Fei Fabrication Ltd., USA) was used as primary research tool. The data were analyzed based on Mann Whitney U test and Student’s t test for independent samples. Results Sex differences concern only the tibio-calcaneal angle in children in the 2nd age group (right: p&lt;0.001) and left p&lt;0.001). Statistically significant differences in both girls (right lower limb: p=0.003; left lower limb: p=0.002), and boys (right lower limb: p=0.001; left lower limb: p=0.001) were found. Conclusions Boys were characterized by greater valgus of the tarsus of the right and left foot than girls. Knees of girls and boys in the 1st age group were characterized by greater valgus, compared to children from the 2nd age group.

Foot Structure of Girls and Boys in the Final Stage of Early Childhood Taking into Account the Half-Yearly Age Ranges

The aim of this study was to analyze the characteristics of foot structure in girls and boys in the final stage of early childhood, taking into account the half-yearly age ranges. The study was carried out among 800 children aged 3. The research tool was the podoscope CQ-ST. The collected research results were analyzed with the use of Student's t-test or Mann-Whitney U test. Statistically significant sex differences in the length of the right and left foot, the width of the right and left foot and Clarke's angle of the right and left foot in each of the identified age groups were found. There were statistically significant differences in the length of the right and left foot, the width of the right and left foot, and the Clarke's angle of the right and left foot were noted separately in girls and boys. Sexual dimorphism in foot length, foot width, and Clarke's angle occurs in 3-year-old children. In each of the age groups, boys are characterized by longer and wider, and lower arched right and left foot. Characteristic features differentiating children in the 1st and 2nd age group are foot length, foot width and Clarke's angle. Girls and boys in the 2nd age group have longer and wider, and higher arched right and left feet. This indicates a high dynamic of increases in the value of these features.

Evaluation Of NLRP3 Inflammasome Activity In Cardiovascular Diseases Patients In Najaf Governorate

Background: The NLRP3 inflammasome is a crucial constituent of innate immunity, mediating caspase-1 stimulation and the production of pro-inflammatory cytokines Interleukin one and Interleukin-18. Still, abnormal activating of the NLRP3 inflammasome is being connected to a number of inflammatory diseases, such as diabetes, and atherosclerotic cardiovascular disease. Cardiovascular diseases are still widespread with significant deaths and morbidity ratios. Most CVDs are caused by vascular damage, including atherosclerosis, aneurysms, and subsequent ischemic heart conditions. Aim of the study: Evaluation of NLRP3 inflammasome activity in cardiovascular diseases.Methodology: This study (cross-sectional study) included 200 individuals with cardiovascular disorders from January 2022 and May . The patients ranged in age from (1 to 80) years old, with 58 females and 142 males among the 200 cases. The serum samples of patients were obtained for screening of the presence of NLRP3 Inflammasome by ELISA using commercial kits (SUNLONG_CHINA).Results: Patients with cardiovascular disease were divided into 4 aging groups as, the following: The 1st age group (&lt;20) yrs. old, The 2nd age group (20-39) yrs. old, The 3rd age group (40-59) yrs. old, and the last group, is(60-79). The results clearly showed that a high percentage of ischemic heart disease was present among all age groups compared to others types followed by structural heart disease. The current study's cardiovascular patients were higher in males compared to females by about 142(71%) vs 58(29%) of all 200 participants. The study indicates that significant results for NLRP3 inflammasome were present among age groups patients with a p-Value equal to 0.03, it also indicates that there are no significant results for NLRP3 inflammasome among sex groups of patients with a p-Value equal to 0.402. And also an association between CVD and study marker showed no significant difference between seropositive NLRP3 inflammasome with cardiovascular disease types.&#x0D; Conclusions: The most common cardiovascular type in the study was ischemic heart disease. Cardiovascular disease affects men more than women, and it gets worse as people get older.

Equine Stomach Development in the Foetal Period of Prenatal Life-A Histological and Histometric Study.

Histological and morphometrical analysis of the stomach wall was performed during the foetal period divided into three age groups (4th-11th month of gestation). The material was taken from non-glandular (the blind ventricular sac) and glandular parts (the plicated edge margin/cardiac part, the body of stomach and the pyloric part) of the stomach. It was preserved and prepared according to the standard protocol. The histological slides were stained (H-E, Masson-Goldner and PAS). The analyses were performed using the light microscope. All measurements were statistically elaborated. The crown-rump length growth rate was estimated as isometric. The blind ventricular sac growth rate was lower than CRL (negative allometric) and the partition of stomach mucosa into non-glandular and glandular part occurred in the 1st age group. The plicated edge margin/cardiac part and the pyloric part shoved similar tendencies. Only the body of stomach demonstrated a higher growth rate than CRL (positive allometric), which can be explained due to the strongest development of fundic glands. Moreover, comparing the adult reference group to the three parts of the foetal period, all metric values were lower than those achieved prenatally. The blind ventricular sac was covered with the multiple plane epithelium. The glandular parts of stomach that formed the superficial concave areas were covered with the simple columnar epithelium in the 1st age group, which developed to the cardiac, fundic, and pyloric glands in the 2rd and 3rd age groups. The propria mucosae was built with the mesenchyme, which differentiated later to the loose connective tissue. The muscular layer of mucosa was not clearly distinguishable in the 1st age group. The muscular layer of the stomach wall was formed with myoblasts in the 1st age group and later in the 2nd and the 3rd age groups built with fusiform myocytes divided into internal and external layers. The non-differentiated cells of glandular epithelium transformed into the parietal and chief cells. The first were visible in the gastric glands of the 2nd age group. Both of them were present in the 3rd age group gastric mucosa. The PAS staining proved a moderate PAS-positive reaction in the 2rd age group, while it was estimated as intense Pas-positive in the gastric glands in the 3rd age group and was comparable to postnatal observation (the adult reference group).

DETERMINATION OF THE NEED FOR SURGICAL TREATMENT OF PATIENTS WITH GENERALIZED PERIODONTITIS BY THE METHOD OF FLAP OPERATIONS

Aim: to study of the need and justification for flap operations in the complex treatment of patients with generalized periodontitis (GP).&#x0D; Materials and methods. 280 people with GP were examined. Patients were divided into the following age groups: Group I - 136 (48.6%) patients aged 30-44 years and Group II - 144 (51.4%) patients aged 45-60 years. The initial state of oral hygiene was assessed using the OHI-S index (Oral Hygiene Index Simplified). In order to determine the degree of disease development and the need for the use of surgical methods of treatment, the depth of periodontal pockets (PC), levels of epithelial attachment loss and gum recession (classification according to P.D. Miller) were determined. The degree of multirooted teeth furcations damage in the horizontal direction was studied according to the Hamp classification (1975). The degree of tooth mobility was determined according to Entin. The obtained data during the examination of patients were entered into specially developed periodontological maps. The diagnosis was made on the basis of a clinical and radiological examination, according to the classification of Danylevsky M.F. (1994).&#x0D; Results. Initial -1st degree of development of GP was diagnosed in 73 (53.7%) examined persons aged 30-44 years and in 59 (41.0%) persons aged 45-60 years. Such patients do not require surgical interventions, therefore conservative treatment was prescribed to them.&#x0D; In the 1st age group, 38 (27.9%) patients were diagnosed with GP of the II degree of development, II-III degree of development – in 25 (18.4 %) patients. In the 2nd age group, 40 (27.8%) people were diagnosed with GP of the 2nd degree of development, 45 (31.3%) of the 2nd-3rd degree of development. The average value of the depth of periodontal pockets , as well as the level of epithelial attachment loss differed in age groups and was higher in patients older than 45 years. Gum recession was observed in all patients with II, II-III stage of development of GP. At the II stage of the development of GP, the average value of the recession of the gums varied between 1.49 ± 0.23 mm in the I age group and 1.98 ± 0.25 mm in the II group, which corresponds to a light degree of recession. With GP II-III stage of development, the average value of recessions was 2.20 ± 0.46 mm in the I age group and 2.43 ± 0.50 mm in the II age group, which also corresponds to a mild degree of gum recession. Class III and IV recessions, which have an unfavorable treatment prognosis, were more often observed in patients of the II age group. Involvement of multirooted teeth furcations in the pathological process was observed in patients with II-III degree of development of GP. In the majority of patients with II, II-III degree of GP, I-II degree of tooth mobility was registered. III degree of mobility was diagnosed in 5 (20%) patients of the I age group and in 12 (26.7%) patients of the II age group.&#x0D; Conclusions. According to the results of our research, the peculiarities of the clinical picture in patients with generalized periodontitis I, II and II-III stages of development aged 30-44 and 45-60 years were established. In particular, the indicators of the OHI-S hygiene index indicate the unsatisfactory state of oral hygiene of the examinees, and the criteria for surgical interventions in complex treatment are the depth of periodontal pockets, the level of loss of epithelial attachment and the type of gum recession.&#x0D; We established that 17.1% of the examined patients require surgical treatment by the method of flap operations, of which 14.0% of patients in the I age group (30-44 years) and 20.1% of the II age group (45-60 years).

Comparison of different sinus augmentation techniques for implant placements

Aim: The purpose of the present research was to evaluate various sinus augmentation techniques for implant placements. Methodology: Four techniques were evaluated: 1-stage bone-added osteotome sinus floor elevation procedure (BAOSFE) with simultaneous implant placement; 2-stage BAOSFE with delayed implant placement; 1-stage lateral window sinus floor elevation with simultaneous implant placement; and 2-stage lateral window sinus floor elevation with delayed implant placement. Patients were followed for 18 to 72 months (mean: 52.5 months) after prosthesis placement. Data were analyzed with cone-beam computed tomography. Results: A total of 96 implants from 71 patients were analyzed; pre-treatment, there were no significant differences between patients. Total implant survival was 98.9%. The mean residual bone height was significantly higher in the 1-stage BAOSFE group than the other groups (P &lt;.01); 1 implant in this group failed at 3 months. There was no significant difference in total bone height gain between groups. However, the bone height gain of 1st sinus lifting with 2-stage BAOSFE was significantly lower than the 2-stage lateral window procedure (P&lt;.01). There was no prosthesis failure. Conclusion: The favorable implant outcomes suggest these 1-stage and 2-stage MSFA procedures should be considered as alternative treatment options for patients with extremely atrophic posterior maxilla.

Features of Liver Damage According to Ultrasound Elastometry in Patients with Chronic Viral Hepatitis C among the Population of Various Regions of Azerbaijan (According to the Results of the Appeal)

The purpose of the study was to establish the frequency of registration of various degrees of liver tissue damage in chronic viral hepatitis C infection. Materials and methods. People who applied to the Medical Center “Medikus clinic” were studied. 1611 people were examined, including 830 males and 771 females. The proportion of people with viral hepatitis C was 972 people, of whom there were 432 men and 540 women. Among the surveyed such age groups were identified: 1st – 18–29 years, 2nd – 30–39, 3rd – 40–49, 4th – 50–59 and 5th – 60 years and older. In order to verify the presence of viral hepatitis C, specific laboratory methods and their evaluation criteria were used, and it was HCV [ifa]. The studies were carried out on the Beckman Coulter Access 2 device according to the ELISA methodology. For hepatitis C virus, the analytical sensitivity was 15/m IU/ml. Polymerase chain reaction was used to confirm the presence of viral hepatitis C in the examined patient. The study was carried out on the device “Rotor Gene Q” (Germany). Elastometry was performed on a 2D-Supersonic Aixplorer SWE (France). The examination of patients was carried out according to the Cut-offs scale, and liver fibrosis was determined by the METAVIR scale. Ultrasound elastometry of the liver made it possible to assess the degree of fibrosis of hepatic tissue in patients with chronic viral hepatitis C, which is important in predicting complications of the disease and their consequences. Results and discussion. In males in all age groups, relatively high indicators characterizing the stiffness of liver tissue were recorded, without significant dynamics (1st – 8.2 ± 1.2 kPa; 2nd – 9.5 ± 0.8 kPa; 3rd – 11.4 ± 0.8 kPa; 4th – 11.8 ± 1.0 kPa; 5th – 11.0 ± 1.1 kPa, p&gt;0.05). Almost all of them corresponded to the compensated stage of liver cirrhosis. Among females in the presence of viral hepatitis C, the indicator characterizing the degree of liver tissue fibrosis showed a statistically significant increase from the minimum value in the 1st age group to the maximum in the 5th (1st – 5.9 ± 0.5 kPa; 2nd – 7.6 ± 0 kPa; 3rd – 8.2 ± 0.7 kPa; 4th – 10.9 ± 0.8 kPa; 5th – 12.9 ± 0.9 kPa, p&lt;0.001) and everywhere it was higher than the standard indicator (5.0 kPa). Conclusion. It is quite obvious that the presence of viral hepatitis C is characterized by a pronounced progressive development of fibrous tissue. The peculiarity lies in the fact that this trend is observed in men starting from 40, and in women from 50 years. In all age groups, it was higher in males. Basically, fibrosis progressed after 50 years. The male sex and age of patients had a significant influence on the development of fibrous tissue in the liver. The highest values of the studied indicator were observed in the regions of the Republic of Azerbaijan. The increase in the degree of liver tissue damage after 50 years is probably due to the development of the atherosclerotic process and the presence of comorbid diseases

Descriptive Characteristics and Outcomes of Patients Undergoing Revision Anterior Cruciate Ligament Reconstruction With and Without Tunnel Bone Grafting

Background: Lytic or malpositioned tunnels may require bone grafting during revision anterior cruciate ligament reconstruction (rACLR) surgery. Patient characteristics and effects of grafting on outcomes after rACLR are not well described. Purpose: To describe preoperative characteristics, intraoperative findings, and 2-year outcomes for patients with rACLR undergoing bone grafting procedures compared with patients with rACLR without grafting. Study Design: Cohort study; Level of evidence, 3. Methods: A total of 1234 patients who underwent rACLR were prospectively enrolled between 2006 and 2011. Baseline revision and 2-year characteristics, surgical technique, pathology, treatment, and patient-reported outcome instruments (International Knee Documentation Committee [IKDC], Knee injury and Osteoarthritis Outcome Score [KOOS], Western Ontario and McMaster Universities Osteoarthritis Index, and Marx Activity Rating Scale [Marx]) were collected, as well as subsequent surgery information, if applicable. The chi-square and analysis of variance tests were used to compare group characteristics. Results: A total of 159 patients (13%) underwent tunnel grafting—64 (5%) patients underwent 1-stage and 95 (8%) underwent 2-stage grafting. Grafting was isolated to the femur in 31 (2.5%) patients, the tibia in 40 (3%) patients, and combined in 88 patients (7%). Baseline KOOS Quality of Life (QoL) and Marx activity scores were significantly lower in the 2-stage group compared with the no bone grafting group (P≤ .001). Patients who required 2-stage grafting had more previous ACLRs (P < .001) and were less likely to have received a bone–patellar tendon–bone or a soft tissue autograft at primary ACLR procedure (P≤ .021) compared with the no bone grafting group. For current rACLR, patients undergoing either 1-stage or 2-stage bone grafting were more likely to receive a bone–patellar tendon–bone allograft (P≤ .008) and less likely to receive a soft tissue autograft (P≤ .003) compared with the no bone grafting group. At 2-year follow-up of 1052 (85%) patients, we found inferior outcomes in the 2-stage bone grafting group (IKDC score = 68; KOOS QoL score = 44; KOOS Sport/Recreation score = 65; and Marx activity score = 3) compared with the no bone grafting group (IKDC score = 77; KOOS QoL score = 63; KOOS Sport/Recreation score = 75; and Marx activity score = 7) (P≤ .01). The 1-stage bone graft group did not significantly differ compared with the no bone grafting group. Conclusion: Tunnel bone grafting was performed in 13% of our rACLR cohort, with 8% undergoing 2-stage surgery. Patients treated with 2-stage grafting had inferior baseline and 2-year patient-reported outcomes and activity levels compared with patients not undergoing bone grafting. Patients treated with 1-stage grafting had similar baseline and 2-year patient-reported outcomes and activity levels compared with patients not undergoing bone grafting.