Adequate Position Research Articles

C-arm free reduction for thoracolumbar fracture: A technical note

BackgroundPercutaneous pedicle screw (PPS) fixation as a minimally invasive surgery (MIS) is becoming the standard method for stabilizing thoracolumbar burst fractures. However, with the conventional PPS percutaneous reduction is difficult, and a great amount of usage of fluoroscopy is necessary. We describe a novel technique of C-arm free PPS with new reduction device for thoracolumbar fractures. MethodsA 22-year-old man presented to our hospital with severe low back pain and impending paraplegia secondary to T12 burst fracture. We performed short-segment fixation and reduction for this patent. The special PPS which have reduction mechanism were inserted under O-arm navigation guidance. The trauma reduction system was applied and the fracture was reduced without fluoroscopy. ResultsPostoperative computed tomography (CT) showed the adequate screws position and complete reduction of the vertebral body. On one-year follow-up, the patient was asymptomatic, with the fracture healed and no implant loosening. ConclusionsC-arm free PPS and reduction is a useful MIS technique for thoracolumbar burst fractures.

APPROACHES TO AGRICULTURAL ENTERPRISES POSITIONING

With the development of market economic relations and the intensification of competition in Ukraine, the problem of adequate positioning of enterprises among competitors, as well as in the consumers` minds becomes relevant. The author summarizes scientific approaches of foreign and domestic scientists to the interpretation of the concept of "positioning", which are reflected in the following: F. Kotler (positioning as a way of identifying goods), J. Trout, E. Reiss (as a certain position of the enterprise among competing goods), Belyaeva N.S. (as an element of the enterprise strategic management system). Three basic components to understanding the essence of positioning are generalized and allocated: positioning as a concept that defines the ideological aspect in its definition (ideas and views), which are the basis of the enterprise product proposal; positioning as a strategy that involves the development of a competitive position of the enterprise product and the relevant marketing complex; positioning as a set of actions that characterizes a set of measures, specific ways to convey the position to the target segment in the implementation of marketing programs; so it is a set of tools to help forming a brand image that should strongly differ from competitors. Due to the fact that the agricultural component is important to the Ukrainian economy development, it is necessary to ensure the effective positioning of agricultural enterprises in foreign markets, which is the source of their sustainable competitive advantage. The opinions of Ukrainian scientists on the agricultural enterprises products positioning were summarized: Kozak L.V., who proposes strategies for the agricultural enterprises development; Kosharna P.S., who offers strategic tools for the agricultural enterprises; Artyukhova K.V. and Bondarenko V.V., who substantiate the necessary market position of agricultural enterprises. Approaches and factors for positioning of agricultural products that should be taken into account in the foreign economic activity of enterprises such as planning, staff, practice, partners that can strengthen opportunities, positioning, protection are analyzed. Peculiarities of agricultural enterprises products positioning were determined: production seasonality, high level of natural and climatic conditions dependence, role and value of products, variety of management organizational forms, time discrepancy in finished products growing and manufacturing, level of state participation in agro-industrial complex development. The author has formed a structural and logistical scheme of agricultural enterprises product positioning, which has the following main elements: purpose, means, conditions of activity, support (including the development of enterprise products positioning strategy) and marketing tools. The main marketing tools that must be used in positioning the products of agricultural enterprises include: the type of product, its quality, functional properties, type of packaging, guarantees; price formation conditions; logistics sales channels used in the delivery of products to the customer; products promotion; qualification of the personnel carrying out marketing support of agricultural enterprises production.

Surgical instrument to improve implant positioning in orbital reconstruction: a feasibility study

Adequate positioning of an orbital implant during orbital reconstruction surgery is essential for restoration of the pre-traumatised anatomy, but visual appraisal of its position is limited by the keyhole access and protruding soft tissues. A positioning instrument that attaches to the implant was designed to provide feedback outside the orbit. The goal of this study was to evaluate the accuracy of placement with the instrument and compare it with the accuracy of placement by visual appraisal. Ten orbits in five human cadaver heads were reconstructed twice: once using visual appraisal and once using the instrument workflow. No significant improvement was found for the roll (5.8° vs 3.4°, respectively, p=0.16), pitch (2.1° vs 1.5°, p=0.56), or translation (2.9 mm vs 3.3 mm, p=0.77), but the yaw was significantly reduced if the instrument workflow was used (15.3° vs 2.9°, p=0.02). The workflow is associated with low costs and low logistical demands, and may prevent outliers in implant positioning in a clinical setting when intraoperative navigation or patient-specific implants are not available.

Proteogenomic Characterization of the Cement and Adhesive Gland of the Pelagic Gooseneck Barnacle Lepas anatifera.

We focus on the stalked goose barnacle L. anatifera adhesive system, an opportunistic less selective species for the substrate, found attached to a variety of floating objects at seas. Adhesion is an adaptative character in barnacles, ensuring adequate positioning in the habitat for feeding and reproduction. The protein composition of the cement multicomplex and adhesive gland was quantitatively studied using shotgun proteomic analysis. Overall, 11,795 peptide sequences were identified in the gland and 2206 in the cement, clustered in 1689 and 217 proteinGroups, respectively. Cement specific adhesive proteins (CPs), proteases, protease inhibitors, cuticular and structural proteins, chemical cues, and many unannotated proteins were found, among others. In the cement, CPs were the most abundant (80.5%), being the bulk proteins CP100k and -52k the most expressed of all, and CP43k-like the most expressed interfacial protein. Unannotated proteins comprised 4.7% of the cement proteome, ranking several of them among the most highly expressed. Eight of these proteins showed similar physicochemical properties and amino acid composition to known CPs and classified through Principal Components Analysis (PCA) as new CPs. The importance of PCA on the identification of unannotated non-conserved adhesive proteins, whose selective pressure is on their relative amino acid abundance, was demonstrated.

Reducing the Risk of Glowing in the Dark; a Protocol to Reduce Patient and Personal Exposure to Ionizing Radiation during Biopsy

<h3>Purpose</h3> Despite rapid progress in non-invasive techniques such as cMRI, endomyocardial biopsy (EMBx) remains the corner stone of the detection of rejection after cardiac transplantation. Since the first publications in the 1960's, the technique has hardly changed. A typical heart transplanted patient will be exposed to 80-120mSv during the first four years after transplantation, 10-20% of this exposition resulting from EMBx. As the risk of malignancy is higher among transplant patients, efforts to reduce the exposition to ionizing energy are mandatory. <h3>Methods</h3> In order to reduce patient and personel exposition to radiation, a set of non-mandatory guidelines were introduced at our institution. This internal protocol is based on ECG guiding to reach the ventricular septum (SVS and VES), followed by a static fluoroscopy image to confirm adequate position. This is combined with a reduced amount of X-ray delivered to the patient by aggressive collimation and reduction of energy (A and KeV) applied to the vacuum chamber. Two months after the adoption of this technique, we conducted an audit of the practice to observe radiation exposure and complication rates in comparison with the preceding 2 months. <h3>Results</h3> 143 biopsies were observed before, and 154 biopsies after implementation of the guidelines. The median radiation dose decreased from 1.2mGy to 0.1mGy (p<0.001). This difference was due to a reduction of the duration of radiation per biopsy (from 18 to 1.4sec., p<0.001) and a reduction of the dose per second (from 0.06mGy/sec. to 0.04mGy/sec., p<0.001). The two patient cohorts had comparable BMIs (26kg/m2 (+/-4.9), p=0.84). No complications were observed. <h3>Conclusion</h3> A reduction of radiation exposition to radiation is achievable with minimal changes in the procedure, and without posing additional risks. Adoption of such radiation reduction policies could result in a long-term reduction of neoplasia in transplant patients and treating interventionalists.

Open reduction and navigated Iliosacral screws for vertically unstable pelvic fractures

AimsTo evaluate clinical and radiological results of vertically unstable pelvic fractures managed by open reduction and navigated iliosacral screws. Patients and MethodsThe study included eleven patients with complex posterior ring fractures with vertical instability admitted to our hospital and managed with CT navigated iliosacral screws. There were 7 type C1, 2 C2 and 2 C3, according to Tile classification. Three patients presented a spino-pelvic dissociation and four a vertical sacral fracture affecting the foramina (Denis 2). Vertical displacement, pelvic deformity and asymmetry were measured. Tornetta and Matta criteria were used to assess the quality of pelvic reduction. ResultsAn excellent reduction was achieved in 9 fractures and a good reduction in two. Asymmetry index improved from 13.18 to 2.72. Deformity index improved from 0.049 to 0.010. Only two patients with a Denis 2 fracture showed secondary displacement during follow-up. Four patients presented neurological complications due to their initial injuries. Seven patients were able to resume their previous activities. ConclusionCT navigated IS screws provide enough stability after an anatomic reduction of the fracture. There was no complication related to screw insertion and adequate screw positioning was achieved in all the cases.

Influence of surgical quality (according to postoperative radiography) on mortality, complications and recovery of walking ability in 1425 hip fracture patients

PurposeTo evaluate the influence of surgical quality (as evaluated in the post-surgical radiographic control) on mortality, complications and recovery of walking ability in patients older than 64 years with hip fracture. Patients and methodsRetrospective observational study of a single-center, consecutive cohort of 1425 patients operated from December/2012 to March/2018. Average age was 85.66±7.13 (65-108) years and 966 (67.86%) were female. Extracapsular fractures (811 cases, 56.91%) were fixed with trochanteric nails (Affixus-DePuy / PFNA-Synthes) (795 cases) or sliding-hip-screw-plates (Biomet) (16 patients). Intracapsular fractures (614, 43.09%) were treated with cannulated screws (Smith-Nephew) (134 cases) or with arthroplasty (472 bipolar and 8 total hip, Furlong-JRI or Exeter-Stryker). Postoperative radiographs were used to determine surgical quality (reduction, compression, screw position, tip-apex, stem position, Voss, intraoperative fracture). Patients were followed clinically and radiographically in outpatient clinic after 1, 3, 6, and 12 months. Statistical analysis: Bivariate analysis (Pearson, Fischer, Mann-Whitney, Wilcoxon) was applied to study statistically significant relations, and Relative Risks (RR) were calculated. Results196 patients (13.75%) died along follow-up, and poor reduction was found to be a risk factor for mortality both in trochanteric nail group (p=0.0495) (RR 1.510, 1.01-2.26) and in cannulated screw group (p=0.0023) (RR 6.48, 2.40-17.53); this is a previously non-published risk factor. Surgical complications included 33 infections (2.36%), 12 non-unions (1.27%), 12 cut-outs (1.47%), 7 broken nails (0.86%), 21 hemiarthroplasty dislocations (4.37%), and 8 ischemic necrosis of the femoral head (5.97%). The significant risk factors were: poor reduction for trochanteric nail breakage (p=0.041) (RR 4.47, 1.13-17.67), poor reduction for non-union in cannulated screws (p=0.035) (RR 10.91, 1.70-70.09), as well as "tip-apex distance" over 25mm in trochanteric fractures for “cut-out” type of fixation failure (p=0.0159) (RR 3.84, 1.19-12.40). Previous walking ability was restored in 564 patients (39.58%) and worsened in 581 (40.77%), but statistical relationships were not found, although follow-up data were inadequate in 212 cases (14.88%). ConclusionsAppropriate reduction of hip fractures is a significant step to reduce mortality, nail breakage and non-union. Adequate position of sliding screw (avoiding tip-apex distances over 25mm) is important to reduce "cut-out" in trochanteric fractures.

The Efficiency of a Fence of Tidal Turbines in the Alderney Race: Comparison between Analytical and Numerical Models

Assessing the efficiency of a tidal turbine array is necessary for adequate device positioning and the reliable evaluation of annual energy production. Array efficiency depends on hydrodynamic characteristics, operating conditions, and blockage effects, and is commonly evaluated by relying on analytical models or more complex numerical simulations. By applying the conservations of mass, momentum, and energy in an idealized flow field, analytical models derive formulations of turbines’ thrust and power as a function of the induction factor (change in the current velocity induced by turbines). This simplified approach also gives a preliminary characterization of the influence of blockage on array efficiency. Numerical models with turbines represented as actuator disks also enable the assessment of the efficiency of a tidal array. We compare here these two approaches, considering the numerical model as a reference as it includes more physics than the analytical models. The actuator disk approach is applied to the three-dimensional model Telemac3D in realistic flow conditions and for different operating scenarios. Reference results are compared to those obtained from three analytical models that permit the investigation of the flow within tidal farm integrating or excluding processes such as the deformation of the free surface or the effects of global blockage. The comparison is applied to the deployment of a fence of turbines in the Alderney Race (macro-tidal conditions of the English Channel, northwest European shelf). Efficiency estimates are found to vary significantly from one model to another. The main result is that analytical models predict lower efficiency as they fail to approach realistically the flow structure in the vicinity of turbines, especially because they neglect the three-dimensional effects and turbulent mixing. This finding implies that the tidal energy yield potential could be larger than previously estimated (with analytical models).

Let it be: fate of a lost closure device.

A 76-year-old man with a history of stroke and gastrointestinal bleedings without anticoagulation (CHA2DS2VASc 7, HASBLED 4) was referred to left atrial appendage closure in 2013. Left atrial appendage was tapering and shallow but closure was deemed adequate with a 28 mm Amplatzer cardiac plug (Panel A). Adequate position was confirmed with echocardiography and X-ray before discharge. At 4-month control, the patient had been asymptomatic, but closure device had embolized to aortic arch. Computed tomography angiography (Panel B) or ultrasound (Panel C) images of the aortic arch did not show signs of device thrombosis and blood flow was laminar on both sides of the plug. Percutaneous removal of device was not possible because of severe atherosclerosis and tortuosity of femoral and iliac arteries and surgery was deemed too risky. The patient was treated with aspirin only until 2018 when he...

Upper lid crease approach for margin rotation in trachomatous cicatricial entropion without external sutures

Background: Mostly Upper eyelid cicatricial entropion (UCE) is a common cause of trichiasis which results from pathological process that causes scarring of the tarsus which leads to inward rotation of the lid margin. Objectives: The aim of the present study is to describe the use of lid crease incision for upper eyelid margin rotation in cicatricial entropion combining internal traction on the anterior lamella , tarsotomy , and tarsal overlap without external sutures. Patients and methods: This is a prospective consecutive interventional analytical study that included 40 eyes of 20 patients with age ranging from 40 to 80 years with trachomatous upper eyelid entropion presenting to the outpatient clinic of “Qena ” university hospital , Group patients were randomly selected according to the inclusion criteria to undergo the transcautenous margin rotation operation at qena university hospital &the surgery was explained to the patients . The study was approved by by the scientific and ethical comittees at faculty of medicine ,south valley university Results: The mean patients' age for was (56.0 ± 18.27) and a range of (40.0- 76.0) years , Among the 20 patients recruited, 9 (45%) were males and 11 (55%) were females , In our study, 20% of eyes among the TMR group underwent entropion correction and blepharoplasty for dermatochalasis in the same sitting. Out of 40 eyes in the study, 70% developed grade II and 30% developed grade I post operative lid margin position., Trichiasis recurrence rate was 10% in the studied group Recurrence was seen in four eyelids of four patients despite adequate post operative lid margin position. Conclusion: Upper eyelid cicatricial trachomatous entropion can be effectively managed utilizing the TMR , with no significant incidence in entropion or trichiasis recurrence

Impact of anticoagulation strategy after left atrial appendage occlusion in patients requiring direct current cardioversion.

Current guidelines recommend adequate anticoagulation for at least 3 weeks pre- and 4 weeks post-direct current cardioversion (DCCV) to reduce thrombo-embolic risk in patients with atrial fibrillation (AF) lasting greater than 48 h. No specific recommendations exist for DCCV in patients that have undergone left atrial appendage occlusion (LAAO), many of whom are ineligible for anticoagulation. This study aims to observe the efficacy and safety of DCCV post-LAAO in everyday clinical practice. This prospective multicenter registry included DCCVs in patients post-LAAO. Imaging strategy or anticoagulation treatment around DCCV were analyzed. Complications during 30-day follow-up were registered. DCCVs performed in accordance with current guidelines for the general AF population were compared to DCCVs performed deviating from these guidelines. In 93 patients (age 65 ± 17 years, CHA2 DS2 -VASC 3.0 ± 1.3) 284 DCCVs were performed between 2010 and 2018, in 271 sinus rhythm was restored. A wide variety of imaging or anticoagulation strategies around DCCV was observed; in 128 episodes strategies deviated from current guidelines. No thrombo-embolic events were observed after any DCCV during 30-day follow-up. In 34 DCCVs trans-esophageal echocardiography (TOE) was performed before DCCV to exclude cardiac thrombi and/or (re-)verify adequate device positioning. In two patients without post-LAAO imaging before DCCV, a device rotation or embolization was observed during scheduled TOE after LAAO. DCCV in AF patients after LAAO is highly effective. No thrombo-embolic events were observed in any patient in this observational cohort, regardless of the periprocedural anticoagulation or imaging strategy. Confirmation of adequate device positioning at least once before DCCV seems recommendable.

Stigmatization as a psychological resource for rehabilitation of cardiology clinic patients

Aim. Identify the adaptive level of stigma and describe its characteristics.&#x0D; Methods. Adapted for the cardiology clinic questionnaire of N. Sartorius, symptomatic questionnaire SCL-90-R (Simptom Check List-90-Revised), Schutzs Interpersonal relations questionnaire (1958), Tobol test method of the type of attitude to disease and treatment, and the Personal differential questionnaire. The data obtained were processed using the statistical program SPPS 20.&#x0D; Results. The study determined the optimal degree of stigmatization, which performed a positive role in relation to the state of health, helping patients to adequately assess the severity of the pathology, identify themselves with the disease and realize the necessary measure of their own responsibility in the treatment process (from 48 to 60). Clinical and social factors of optimal degree of stigmatization and successful rehabilitation of cardiology clinic patients are identified (resources): the patients higher education and the familys tendency to low-protecting position potentially contribute to the treatment and rehabilitation of cardiology clinic patients with moderate severity of their somatic condition. Clinical and social factors (anti-resources) that prevent the formation of an optimal degree of stigmatization and successful rehabilitation of patients are identified: the operative type of treatment, the overprotective position of the family, which is not justified by a real need, and the low level of education. It is established that the absence of pronounced pathocharacterological features and difficulties in interpersonal interaction of patients with an average level of stigmatization is an argument for determining this level of stigmatization as a resource. According to the results of the study the tasks for the medical psychologist of the cardiology clinic are set:&#x0D; 1) diagnostic, which consists in determining the level of stigmatization, analyzing the ratio of the degree of stigmatization and the degree of severity of cardiovascular pathology, studying individual resources and anti-resources (attitude to the disease and treatment, pathocharacterological features and interpersonal features);&#x0D; 2) psychocorrective, which consists in forming an adequate position in relation to the disease and treatment of patients and their families, restoring intra-family ties, changing inadequate responses to the disease, creating realistic attitudes to treatment in patients and their family members.&#x0D; Conclusion. The average degree of stigmatization is formed in patients in the absence of a pronounced personal and interpersonal problems, allowing them to receive social support in the conditions of restrictions imposed by the disease, and adapt to it. The average level of stigmatization in this case acts as an additional psychological resource for patients.

Efficacy of a new dispatcher-assisted cardiopulmonary resuscitation protocol with audio call-to-video call transition.

Video call based dispatcher-assisted cardiopulmonary resuscitation (V-DACPR) has been suggested to improve the quality of bystander cardiopulmonary resuscitation. In the current system, dispatchers must convert the audio calls to video calls to provide V-DACPR. We aimed to develop new audio call-to-video call transition protocols and test its efficacy and safety compared to conventional DACPR(C-DACPR). This was a randomized controlled simulation trial that compared the quality of bystander chest compression that was performed under three different DACPR protocols: C-DACPR, V-DACPR with rapid transition, and V-DACPR with delayed transition. Adult volunteers excluding healthcare providers were recruited for the trial. The primary outcome of the study was the mean proportion of adequate hand positioning during chest compression. Simulation results of 131 volunteers were analyzed. The mean proportion of adequate hand positioning was highest in V-DACPR with rapid transition (V-DACPR with rapid transition vs. C-DACPR: 92.7% vs. 82.4%, p=0.03). The mean chest compression depth was deeper in both V-DACPR groups than in the C-DACPR group (V-DACPR with rapid transition vs. C-DACPR: 40.7mm vs. 35.9mm, p=0.01, V-DACPR with delayed transition vs. C- DACPR: 40.9mm vs. 35.9mm, p=0.01). Improvement in the proportion of adequate hand positioning was observed in the V-DACPR groups (r=0.25, p<0.01 for rapid transition and r=0.19, p<0.01 for delayed transition). Participants in the V-DACPR groups performed higher quality chest compression with higher appropriate hand positioning and deeper compression depth compared to the C-DACPR group.

Cooperation between preschool educational institutions and families – modern need and requirement

The proposed publication substantiates the importance and significance of cooperation between preschool educational institutions with the families of pupils during the reformation of preschool education and serious transformations in modern society. The analysis of domestic and foreign research on this problem is carried out, attention is paid to new legislative documents (State standard of preschool education, Concept of education of toddlers and preschoolers) and emphasis is placed on solving the problem of cooperation between preschool and parents in these documents. The process of cooperation between teachers of preschool educational institutions and parents is characterized as a bilateral, cyclical and phased process. The modern tendencies of contact activity of teachers of preschool educational institutions with families are declared. The purpose of interaction between two important social institutions in the life of a child is analyzed. The content of the main stages of cooperation is disclosed, as well as the main forms and methods of work that are implemented at each stage. Emphasis is placed on the need for a dynamic and adequate parental position that would meet the needs as well as the individual and age capabilities of a child. On the example of a specific preschool educational institution, the effective forms of cooperation between teachers and the families of pupils, which have been introduced into the educational process of the preschool institution for a long time, have been demonstrated and described in detail. As an example, the thesis summary of the theatrical quiz for parents and children “Theater experts”, which was held in this preschool institution, is illustrated. Plans for the future of the teaching staff and prospects for further research on this issue have been announced.

Técnica de Eden Hybinette en inestabilidad anterior de hombro con pérdida de stock óseo en paciente con epilepsia: reporte de caso

Shoulder instability is occasionally associated with glenoid bone loss in patients with epilepsy. There have been few articles that describe specific surgical treatments for this type of injury. This case report shows a successful surgical approach used in an epileptic patient with multiple right shoulder dislocations that occurred mainly during seizures, through the Eden Hybinette technique, performed using an iliac crest autograft. The patient has been followed up for one year postoperatively, without new episodes of right shoulder dislocation, without complaints of pain, with good range of movement of the shoulder without limitations for daily or work activities. Different surgical methods have been published for these patients, including soft tissue repair operations, as well as skeletal reconstructions with bone graft, Eden Hybinette being one of these. This surgery is a valid option, since it allows an adequate position of the graft in the glenoid defect, potentially reducing the risk of neurovascular and myotendinous lesions; although, more importantly, it reduces the recurrences of shoulder dislocation in patients with uncontrolled epilepsy and gives them the opportunity for a good quality of life.Evidence Level: IV

Evaluation of Intubating Conditions during Direct Laryngoscopy using Sniffing Position and Simple Head Extension- A Randomised Clinical Trial

Introduction: Optimal laryngeal visualisation during direct laryngoscopy requires adequate positioning of the head and neck. Traditionally, Sniffing Position (SP) is the recommended position to provide superior glottic visualisation. However various studies in recent past have challenged the superiority of SP. Aim: To evaluate whether SP provides better glottic visualisation and ease of intubation {as assessed by total Intubation Difficulty Score (IDS) score as well as its individual components} compared to Simple Head Extension (SHE) during direct laryngoscopy and endotracheal intubation. Materials and Methods: The randomised clinical trial was conducted at GGS Medical College and Hospital, Faridkot, Punjab, India, from May 2019 to October 2020, on 220 patients. Patients undergoing elective surgeries under general anaesthesia were randomly divided into two groups. Laryngoscopy and tracheal intubation in Group I was done in SP, which was obtained by placing a non compressible pillow of height 8 cm under the patient’s head. Patients in Group II underwent laryngoscopy and tracheal intubation in SHE position. Glottic visualisation using modified Cormack and Lehane (CL) grades, IDS and sympathetic responses between the two groups were studied. The data was compared using student’s t-test and Chi-square test. Results: Cormack and Lehane Grade I was seen in 69 (62.7%) of patients in Group I as against 51(46.4%) of patients in Group II (p-value=0.015). Easy intubation (total IDS score=0) was seen in a greater number of patients in Group I (60.9%) as compared to Group II (40.95%) (p-value=0.003). Slight difficulty in intubation (total IDS score=1-5) was encountered in 50.0% of patients in group II (n=55) and 35.5% of patients in group I (n=39) (p-value=0.029). Conclusion: The present study concluded that use of SP resulted in better glottic visualisation and was associated with favourable intubation conditions as compared to SHE position.

Descripción del posicionamiento de una copa monobloque no cementada en el posoperatorio inmediato

BackgroundAppropriate positioning of the acetabular cup in total hip arthroplasty (THA) can improve hip function, reduce wear, impingement and dislocation. The position of the cup is described as the spatial relationship between the centre of rotation of the hip and the pelvis. The aim of this study is to describe the positioning of the uncemented monoblock cup in the immediate postoperative period in patients who underwent a primary THA. MethodsDescriptive observational study. The patients were operated by 4 joints arthroplasty surgeons in 8 different hospitals, from October 2015 to August 2018. The radiological measurements were taken from the AP Pelvis Xrays of the immediate postoperative. The inclination, anteversion, lateralization, percentage of cup uncovered and the space behind the acetabular cup. Results82.05% of the cups were in the range of inclination from 36 to 48 degrees; 85.71% had an anteversion between 5 to 15 degrees, 76.56% presented a lateralization of -2 to +2mm, 94.51% of the patients didnt have a uncover cup, and 92.67% of the cups had a space behind the cup from 0 to 3mm. DiscussionIn our study the highest percentage of cups were implanted with parameters agree to the safety areas reported by various authors. Adequate positioning of the uncemented monoblock acetabular cup can be achieved with a proper indication, a surgical approach that allows an ideal three-dimensional location and an acetabulum with a good peripheral rim that provides the required press-fit.Evidence Level: III

Active foot placement control ensures stable gait: Effect of constraints on foot placement and ankle moments.

Step-by-step foot placement control, relative to the center of mass (CoM) kinematic state, is generally considered a dominant mechanism for maintenance of gait stability. By adequate (mediolateral) positioning of the center of pressure with respect to the CoM, the ground reaction force generates a moment that prevents falling. In healthy individuals, foot placement is complemented mainly by ankle moment control ensuring stability. To evaluate possible compensatory relationships between step-by-step foot placement and complementary ankle moments, we investigated the degree of (active) foot placement control during steady-state walking, and under either foot placement-, or ankle moment constraints. Thirty healthy participants walked on a treadmill, while full-body kinematics, ground reaction forces and EMG activities were recorded. As a replication of earlier findings, we first showed step-by-step foot placement is associated with preceding CoM state and hip ab-/adductor activity during steady-state walking. Tight control of foot placement appears to be important at normal walking speed because there was a limited change in the degree of foot placement control despite the presence of a foot placement constraint. At slow speed, the degree of foot placement control decreased substantially, suggesting that tight control of foot placement is less essential when walking slowly. Step-by-step foot placement control was not tightened to compensate for constrained ankle moments. Instead compensation was achieved through increases in step width and stride frequency.

The Effects of Preoperative Education, Marking and Adequate Positioning of Stoma on Self-Esteem and The Quality of Life of Patients with Intestinal Ostomy and Their Families

Aim. The purpose of this systematic review is to examine all available research studies on quality of life of ostomy patients and their families, which is contingent upon the effects of adequate preoperational education, the best and most acceptable ostomy site marking on the patients’ abdomen, and subsequently, the effect on the ostomy patients’ self-esteem. Methods. A literature search was carried out using scientific electronic databases - Science Direct, PubMed and Medline. Analysed period was from 2010 to 2016 in order to get insight into the most recent findings. Search terms included preoperative education, stoma marking, quality of life, self-esteem, influence on family life. Overview of articles was made in three stages. Results. We found 1440 scientific articles. In the first stage, we eliminated 1271 articles because they were unsuitable. In the second stage, we analysed 34 articles and made a conclusion based on 13 full text available articles. Conclusion. The patient is content while being treated in the hospital; however, only after the patient has been released do the hardships occur, which are often the main cause of discontent, isolation, anxiety, and fear – thus resulting in diminished quality of life. Preoperational education and marking the most acceptable place for ostomy procedure significantly affect the self-esteem and the quality of life of ostomy patients and their families. Ostomy patients need to be followed up, and the home care system, as well as the support systems of public health care for patients with a gastrointestinal ostomy, need to be strengthened.

Treatment of extensive tumors of the jaws by hemimandibuloectomy with simultaniouse reconstruction of the mandible, arthroplasty of temporomandibular joint, orthopedic rehabilitation supported by dental implants

Background. Reconstruction of subtotal and total defects of maxillofacial region after ablative tumor surgery is a challenging task of reconstructive surgery. The “golden rule” is maintaining of radicalism of ablative surgery as well as appropriate surgical reconstruction and prosthodontic rehabilitation, that allows patient return to normal life. Wherein reconstructive procedure is focusing on restoring of mandibular continuity by the means of different flaps and grafts, while prosthodontic rehabilitation is performing after some period of time (usually around year) by the means of removable and non-removable prosthodontic devices. Non-removable device requiring dental implants insertion into grafted material followed by period of osteointegration, that is requiring some time as well. However, within this period of time one could observe significant soft tissue deformity.The objective is to improve the outcomes of surgical reconstruction of extensive defects of the mandible and to carry out rapid prosthodontic rehabilitation supported by dental implants by application of 3D preoperative planning and navigation devices.Clinical case. Forty-nine years-old female patient with recurrent ameloblastoma, that affects vertical and horizontal ramus of the mandible. Within virtual preoperative planning one performed: resection of the mandible associated with exarticulation of condylar head, virtual plate bending according to contours of the mandible (that were determined by application of “mirror” function of virtual planning software), arthroplasty of temporomandibular joint, determination of donor site on fibula bone, osteotomy of fibula free flap, positioning of dental implants, transferring of composite flap and it’s fixation by reconstructive plate. According to acquiring data one performed fabrication of patient specific navigation guides for both fibula flap segmentation and dental implants positioning. Surgical procedure included single-step tumor ablation and exarticulation of condylar head, reconstruction of defect by the means of osseo-myo-cutaneous fibula free flap, that was pre-implanted by dental implants, total joint reconstruction by titanium condylar head and polypropylene fossa, fixation of the flap and condylar head in recipient site by the means of prebended reconstructive plate, as well as insertion of non-removable bridge prosthodontic device. Postoperative result was asses clinically and radiologically. No significant postoperative complications occurred. Restoration of facial contours, mouth opening, I class occlusion, as well as adequate meal and speech were detected. Postoperative radiological investigation revealed adequate positioning of dental implants within neo-mandible, as well as positioning of artificial joint.Conclusion. In cases of extensive tumors of the jaws single-step ablative surgical procedure, reconstruction of missing anatomical structures of the jaws and simultaneous prosthodontic rehabilitation allows to prevent possible deformities of the soft tissues and due to rapid restoration of vital functions has great impact to quality of patient’s life. Adequacy of performing procedures could be reached by implementation of virtual preoperative planning and fabrication of patient-specific surgical guides.