Choice Of Treatment Method Research Articles

Hip Dysplasia in Adults: Surgical Correction vs. Conservative Treatment Options

Introduction: Developmental Dysplasia of the Hip (DDH) is an anatomical deformation resulting from abnormal formation of the structures that make up the hip joint. Due to abnormal biomechanics patients with hip dysplasia usually develop radiographic osteoarthritis. Aim of the study: Despite the introduction of screening tests in children, DDH remains an issue among adults. For this group of patients, it is essential to begin treatment as early as possible to prevent early-onset osteoarthritis of the hip joint. In adults it is often too late to implement non-invasive methods such as braces or orthoses. Therefore, in this study, we aim to describe other treatment options for adults with DDH, considering both surgical and non-surgical methods. In the following work, we present both the advantages and complications associated with these surgical methods. Additionally, we describe the non-surgical alternative method of progressive resistance training (PRT) and consider the possibilities of combining it with surgical techniques. We also discuss the potential for pharmacological treatment. Material and Methods: Review of studies available through open-access sources on PubMed, Google Scholar, and the National Library of Medicine. Conclusions: The decision to quickly implement an appropriate treatment plan is crucial for improving the patient's quality of life. The choice of treatment method should consider the patient's age and the severity of the disease. Adults with DDH are most often qualified for surgical procedures, which include periacetabular osteotomy (PAO) and total hip replacement (THR). However, for some patients, surgical procedures may be contraindicated or impossible, and in such cases, other non-invasive methods, such as resistance training or appropriate pharmacotherapy, should be considered. Keywords: hip joint, osteoarthritis, surgery, conservative therapy, hip, Surgical Correction

PROBLEMS OF CHOOSING A METHOD OF DENTAL TREATMENT OF TEETH AFTER ENDODONTIC INTERVENTION

The optimal way to restore the anatomical structure of teeth after endodontic intervention is a controversial topic. Teeth after endodontic intervention have different properties compared to intact living teeth. Changes in these properties are associated with volumetric loss of hard tissues, caries, final preparation of the cavity taking into account access to endodontic treatment. Choosing the optimal method of dental treatment of teeth requires compliance with many factors, such as: prevention of infection penetration into root canals, restoration of tooth contacts, restoration of chewing functions, protection against further carious and non-carious destruction, restoration of tooth aesthetics. Dentists are now more than ever aware of the interdependence of the endodontic and restorative aspects of dental treatment and how much this will affect achieving the best long-term outcome. Controversies of the clinical relevance of endodontic and restorative treatment choice issues are mostly unanswered based on clinical data and scientific evidence. The modern approach to tooth restoration after endodontic intervention is an important topic. To improve clinical outcomes, it is important to determine the effectiveness of treatment, the importance of preserving tooth structure, the choice of treatment method with restorative materials, and the integration of digital dentistry to improve diagnosis and treatment principles. Research rationale. The purpose of this study is to find and use literature data on the effectiveness of modern methods of dental treatment after endodontic intervention in Ukraine. Materials and methods. Scientific data from a review and systematic analysis of the literature were used. Materials were searched using the Google Scholar, PubMed, Google Scholar databases and open sources of the World Health Organization, the Ministry of Health of Ukraine and other government web portals of Ukraine. Results, Discussion. After conducting a literature analysis to compare the effectiveness of using cast metal inserts and fiberglass posts, we can come to the conclusions that retrospective studies on the relationship between successful restorations and such factors as the type of tooth, the volume of residual hard tissues, the number of occlusal contacts, the type of the final restoration and the position of the tooth in the dental arch are the main criteria for choosing a treatment method. A controversial choice is that metal abutments are associated with a higher risk of root fracture, their manufacture requires laboratory techniques, while the use of fiberglass posts is associated with a higher risk of decementation, and overloading of fiberglass posts leads to their fractures. Conclusions. Decision-making and the choice of methods of dental treatment after endodontic intervention remain difficult. However, the interdependence of endodontic treatment and restoration of the crown part of the tooth is clearly established. Physicians must consider both aspects of treatment equally to ensure the best possible outcomes for their patients. The use of digital scanning enables an accurate volumetric assessment of the residual hard tissues of the tooth, which can be used to provide tangible qualitative results of the analysis and decision-making with the choice of treatment method. The choice of treatment method is not defined in a single protocol and requires further careful study with new experimental developments, based on the latest technologies of world leaders in dentistry.

Surgical treatment of a true diverticulum of the bladder in a patient with aplasia of the left kidney. Case report

A bladder diverticulum (BD) is a blindly terminating sac-like protrusion of the bladder wall with or without involvement of the muscular layer. BDs are categorized into true (congenital) and false (acquired), single and multiple. False diverticula are more common and develop in infravesical obstruction due to urethral stricture, prostate neoplasms, neurogenic disorders and other lower urinary tract diseases. Currently, there are no clear recommendations regarding the tactics of treatment of BD, so the choice of treatment method is based on the determination of the cause of BD, assessment of clinical manifestations and diagnostic results (localization, size, number, etc.), as well as the identification of concomitant anomalies and diseases of the upper urinary tract. The priority in the treatment of BD is surgical treatment. The article presents the observation of a patient with a developmental anomaly in the form of aplasia of the left kidney combined with a large congenital BD in the area of the missing mouth of the aplasic left ureter. The results of examination and treatment in the form of laparoscopic diverticulectomy are presented. A brief review of the literature on the problem of diverticulosis has been carried out.

Supplementary treatment of FDM printed parts. Review

The application of additive technologies to the manufacture of polymer and composite products is now actively expanding. The FDM printing process is popular because of its ability to adapt to specific tasks and to bring products with complex geometries into production quickly and at minimal cost, and is seen as a technology that can compete with injection molding. However, due to the nature of the process, FDM printed parts are significantly inferior in quality to injection molded parts. Much attention is now being paid to research into supplementary treatment methods to improve the properties of FDM printing parts. However, there is no complete and clear description of such methods, nor are there any recommendations on the choice of treatment methods aimed at improving the specific parts properties. The aim of this review is to analyse the research in the field of post-treatment of parts in order to systematise their advantages and limitations, which will allow a more reasoned choice of a post-treatment method to improve specific properties of FDM printing parts. <br> The bibliography includes 120 references.

Features of the use of big data in the financial sector

The purpose of the article is to theoretically comprehend the essence of big data, identify the advantages and risks of its use by financial organisations. The article presents the results of systematisation of knowledge about the nature and features of the big data. It has been revealed that the technology makes it possible to do better analytical research, create models for forecasting economic trends and market changes, study market dynamics, analyse medical data to improve diagnosis and choice of treatment methods, predict failure or breakdown of equipment in production by assessing data from sensors, develop social and economic programmes at the state level, identify fraud and corruption in the financial sector, etc. The relevance of the rapid development of the big data technology and the expediency of its use in this sphere is substantiated. As a result of the analysis of scientific literature, the author’s definition of the technology in the financial sector is presented. Its novelty lies in considering the features and advantages of applying the big data by financial organisations. The study of the modern practice of their usage in these institutions has revealed the main strengths and disadvantages of the technology in question.

Endovascular Treatment of Hepatic Artery Pseudoaneurysm after Pancreaticoduodenectomy: A Literature Review.

Pancreaticoduodenectomy (PD) is a complex surgical procedure performed in patients with periampullary tumors located within the pancreatic head, the papilla of Vater, the distal common bile duct, and the duodenum. In advanced tumors, the operative technique involves the need for dissection and divestment of the arteries located within the pancreaticoduodenal field, including the common hepatic artery (CHA) and the proper hepatic artery (PHA) and its branches. The second most important cause of post-PD visceral aneurysms is irritation of the peri-pancreatic arterial wall by pancreatic juice in a postoperative pancreatic fistula (POPF). Hepatic artery pseudoaneurysm (HAP) is a very dangerous condition because it is usually asymptomatic, but it is a rare and potentially lethal pathology because of the high risk of its rupture. Therefore, HAP requires treatment. Currently, selective celiac angiography is the gold-standard diagnostic and therapeutic management for postoperative bleeding and pseudoaneurysm in patients following PD. Open surgery and less invasive endovascular treatment are performed in patients with HAP. Endovascular treatment involves transarterial embolization (TAE) and stent graft implantation. The choice of treatment method depends on the general and local conditions, such as the patient's hemodynamic stability and arterial anatomy. In patients in whom preservation of the flow within the hepatic artery (to prevent hepatic ischemia complications such as liver infarction, abscess, or failure) is needed, stent graft implantation is the treatment of choice. This article focuses on a review of two common methods for endovascular HAP treatment. In addition, risk factors and diagnostic tools have been described.

O-318 Decline of βhCG concentrations following pregnancy loss: exploring contributing factors

Abstract Study question Which factors impact βhCG decline after a pregnancy loss, thereby inhibiting return of menstrual cycle? Summary answer In pregnancy loss, decline in βhCG levels are influenced by gestational age, BMI, previous losses, and treatment method, impacting menstrual cycle resumption. What is known already Despite one in four pregnancies ending as a pregnancy loss, there is limited knowledge about when to expect reproductive recovery including the decline in βhCG. The placentally produced hormone βhCG binds to luteinizing hormone/hCG-receptors, which, through negative feedback in the pituitary, decreases release of gonadotropins. This limits chances of ovulation, thus inhibiting the onset of menstrual bleeding, however with great individual variability. Therefore, there is an unmet need for a more individualized understanding of the impact of maternal factors on the decline in βhCG concentrations and the relationship between βhCG and reproductive recovery after a pregnancy loss. Study design, size, duration The Copenhagen Pregnancy Loss study (COPL) is a prospective cohort focusing on pregnancy loss. Participants/materials, setting, methods Inclusion criteria required diagnosis of missed, spontaneous or anembryonic miscarriage and hCG results from both day of inclusion and follow-up visit 4-8 weeks later. Primary objective end points were serum-hCG on day of the diagnosis of pregnancy loss and at follow-up. Secondary end points from the follow-up visit included information on return of menstruation. Per laboratory protocol, βhCG > = 5 IU/L is indicative of pregnancy. Analysis was done using a multivariable Bayesian ordinal regression model. Main results and the role of chance Preliminary results, to be updated for presentation at ESHRE 2024: 1,306 women were included in this study between November 2020 - January 2024. Follow-up visits were conducted 6 weeks after pregnancy loss (IQR: 5.6-7.0 weeks). At follow-up, 199 (18.0%) women still had elevated concentrations of βhCG. At the time of pregnancy loss, gestational age (OR: 0.97, 95% CI 0.96-0.98), BMI (OR: 0.98, 95% CI 0.96-0.99), and number of prior pregnancy losses (OR: 1.09, 95% CI 1.01-1.18) were associated with βhCG. βhCG concentration, measured at the follow-up, was strongly influenced by the choice of treatment method, including surgical (OR: 2.74, 95% CI 1.76-4.26) and medical (OR: 1.69, 95% CI 1.11-2.56), compared to spontaneous. Furthermore, Age (OR: 1.02, 95% CI 1.00-1.04) and gestational age (OR: 1.01, 95% CI 1.00-1.01) also affected the decline. βhCG levels at follow-up were correlated with return of menstrual bleeding OR: 0.98, 95% CI 0.96-0.99). Of the women with βhCG levels exceeding 5 IU/L, 145 out of 199 (72.9%) reported the resumption of their menstrual cycle. Among those with βhCG levels above 25 IU/L, 17 out of 33 (52%) reported menstrual cycle return. Limitations, reasons for caution Analysis depicted total-hCG concentrations (intact hCG + free ß-subunit) without distinguishing between the various hCG isoforms. The cohort was gathered at a hospital, reflecting that setting. Wider implications of the findings Our findings are the first step towards a more personalised approach for patients facing pregnancy loss, aiding with counselling and planning of reproductive prospects, including IVF. The evident ßhCG-induced negative feedback, coupled with menstrual bleeding in women with elevated ßhCG, highlights system complexity and hints at additional unidentified factors. Trial registration number not applicable

Factors Affecting Choice of Surgical Treatment of Cartilage Lesions of the Knee: An Analysis of Data From 5143 Patients From the German Cartilage Registry (KnorpelRegister DGOU).

Symptomatic full-thickness cartilage lesions of the knee joint are considered an indication for cartilage repair surgery. Patient- and lesion-specific factors like age, nutritional status, etiology of defect, or integrity of corresponding joint surface remain controversial in indicating cartilage repair surgery. Furthermore, the selection of the most suitable cartilage repair technique for a specific cartilage lesion remains debatable. To evaluate indications and choice of treatment method for cartilage repair surgery, depending on patient- and lesion-specific data from the German Cartilage Registry. Cross-sectional study; Level of evidence, 3. A total of 6305 consecutive patients who underwent cartilage repair surgery of the knee evaluated and 5143 complete datasets were included in the analysis (follow-up rate, 81.5%). Patient-specific (age, body mass index, smoking status, previous operations, clinical leg axis) and lesion-specific (size, grading, location, etiology) data were provided by the attending surgeon at the time of surgery. Appropriate statistical tests were used to compare data depending on type and normality of data. Multivariable logistic regressions were calculated to investigate independent factors for the choice of specific cartilage repair techniques. The median size of treated cartilage lesions was 3.6 cm2, and most defects were of degenerative origin (54.8%). Of the registered patients, 39.2% were categorized as overweight and 19.6% as obese, while 23.3% were smokers. The most prevalently documented operative techniques were the autologous chondrocyte implantation (ACI) (52.4%), bone marrow stimulation (BMS) (17.3%), and BMS augmented with collagen scaffolds (9.3%). Independent factors that made the use of ACI more likely were bigger lesion size, previous surgery at the joint, and lesions located at the trochlea or the patella. On the contrary, BMS or augmented BMS were preferred in older patients, with damaged corresponding joint surface, and with more concomitant surgeries. Cartilage repair surgery was indicated irrespective of nutritional status, smoking status, or etiology of the treated lesion. ACI was the most prevalent technique and was preferred for younger patients and patellar lesions. While older patients with degenerative changes to the joint were not excluded from cartilage repair surgery, the use of ACI was restricted.

COMPLICATIONS OF CONSERVATIVE AND SURGICAL TREATMENT OF FRACTURES OF THE MANDIBULAR CONDYLAR PROCESS (LITERATURE REVIEW)

One of the most pressing problems in modern maxillofacial surgery is the treatment and rehabilitation of patients with fractures of the condylar process of the mandible. According to various statistical data, the incidence of fractures at this site is 19-37%, and these fractures are the most controversial in terms of diagnosis and treatment. In recent years, there has been an increase in severe forms of mandibular condyle fractures: bilateral, combined, intra-articular, leading to serious complications that affect the functioning of the temporomandibular joint. The data obtained indicated the need for a detailed study of this pathology in order to make a qualitative diagnosis and improve the available treatment methods. The aim of the study – to analyse and summarise current data from the scientific literature on possible complications in the treatment of the condylar process fractures of the mandible. Materials and methods. The bibliosemantic method was used to clarify the state of the problem, to study the analysis of the results of previous scientific research based on the literature sources and electronic resources. Results and discussion. The management of patients with mandibular condylar fractures is widely discussed in the literature due to their high prevalence, but there is still no consensus on the optimal management of patients with this pathology. To date, there are many studies that highlight certain complications of conservative and surgical treatment, but they are not generalised or systematised. Conclusions. Summarizing, we can conclude that complications occur during both conservative and surgical treatment of patients with mandibular condyle fractures. Complications are most often associated with incomplete diagnosis, incorrect choice of treatment method, and depend on the method of access and fixation in surgical treatment.

Influence of Method of Treatment of Mandibular Condylar Fractures on Range of Articular Path Measured by Cadiax Device.

Background/Objectives: The aim of this study was to evaluate the function of the treated temporomandibular joint based on the analysis of the image of the articular path using the Cadiax device depending on the choice of treatment method for unilateral condylar fracture of the mandible. Methods: Sixty patients who were treated for condylar fractures of the mandible at the Maxil-lofacial Surgery Department in Katowice were qualified for the analysis of the range of movements of the mandibular heads using the Cadiax device. From the group of patients who suffered fractures of the mandible, including condylar processes, patients were finally qualified for the measurement of the articular path of the injured and healthy joint according to strict criteria. Results: The condylar examination was performed in 20 patients who had conservative condylar fracture treatment and 40 patients who underwent various surgeries in the course of a single condylar fracture. The control group consisted of 20 patients whose mean values for the articular pathway measured for both sides were 12.73 and 12.69 and fell within the standard developed for healthy joints tested with the Cadiax device. Conclusions: We have achieved an almost ideal treatment for condylar fractures. We are also beginning to notice the need for rehabilitation of patients after this type of surgery.

The possibilities of diagnostic radiology for the primary identification of spleen abscesses

The issue on the differential diagnosis of formations of purulent-inflammatory etiology and the choice of treatment method taking into account the visual picture does not lose its relevance. Ultrasound (US) is not less crucial than computed tomography (CT) for the primary diagnosis of spleen abscesses. This article presents clinical observations of patients with suspected spleen abscesses admitted to the emergency room of the Novosibirsk City Clinical Hospital No. 1 with emergency indications for 2017–2022. All patients underwent ultrasound with Philips Affiniti 70G, Mindray M9, and General Electric Logiq P6 devices. While performing ultrasound in In-mode, attention was paid to the main signs: localization (in the parenchyma, subcapsular), quantity, contours (wall thickness), the nature of the abscess contents, dimensions (volume calculated according to the formula for irregularly shaped formations, A × B × C × 0.52), the presence or absence of effusion in pockets the spleen. The formations were classified by volume into small (up to 50 ml), medium (50–100 ml) and large (more than 100 ml). The main ultrasound signs in the seroscale mode have been determined. The presented clinical observations illustrate the possibilities of ultrasound for deciding on the method of treatment: for primary diagnosis (including emergency), it was possible to determine the presence of formations of purulent- inflammatory etiology, to determine the localization, the main signs in which minimally invasive treatment was effective (formed abscess of "medium" volume). Surgical abdominal treatment was preferable in the presence of multiple abscesses (without a formed capsule) of small size.

Long-term outcomes of very low birth weight infants with intraventricular hemorrhage: a nationwide population study from 2011 to 2019.

Advancements in neonatal care have increased preterm infant survival but paradoxically raised intraventricular hemorrhage (IVH) rates. This study explores IVH prevalence and long-term outcomes of very low birth weight (VLBW) infants in Korea over a decade. Using Korean National Health Insurance data (NHIS,2010-2019), we identified3372 VLBW infants with IVH among 4,129,808 live births.Health-related claims data, encompassing diagnostic codes, diagnostic test costs, and administered procedures were sourced from the NHIS database.The results of the developmental assessments are categorized into four groups based on standard deviation (SD) scores.Neonatal characteristics and complications were compared amongthe groups. Logistic regression models were employed to identify significant changes in the incidence of complications and to calculate odds ratios with corresponding 95% confidence intervals for each risk factor associated with mortality and morbidity in IVH.Long-term growth and developmentwere compared between the two groups(years2010-2013 and 2014-2017). IVH prevalence was 12% in VLBW and 16% in extremely low birth weight (ELBW) infants. Over the past decade, IVH rates increased significantly in ELBW infants (P = 0.0113), while mortality decreased (P = 0.0225). Major improvements in certain neurodevelopmental outcomes and reductions in early morbidities have been observed among VLBW infants with IVH. Ten percent of the population received surgical treatments such as external ventricular drainage (EVD) or a ventriculoperitoneal (VP) shunt, with the choice of treatment methods remaining consistent over time. The IVH with surgical intervention group exhibited higher incidences of delayed development, cerebral palsy, seizure disorder, and growth failure (height, weight, and head circumference) up to 72months of age (P < 0.0001). Surgical treatments were also significantly associated with abnormal developmental screening test results. The neurodevelopmental outcomes of infants with IVH, especially those subjected tosurgical treatments, continue to be a matter of concern. It is imperative to prioritize specialized care for patients receiving surgical treatments and closely monitor their growth and development after discharge to improve developmental prognosis. Supplementary file2 (MP4 77987 kb).

Molecular-oriented therapy of lung tumors in animals with BRAF mutations – possibilities and limitations of the method

Lung cancer (LC) is malignant epithelial tumors that differ in origin, histological structure, clinical course, and treatment results. Lung cancer ranks first in terms of male morbidity in Russia, and in terms of mortality in the world. In animals, LC is diagnosed much less frequently, but with an increase in the number of animals kept in cities, the incidence of LC increases, since companion animals are exposed to the same risk factors as humans. We conducted a retrospective analysis of the medical records of 43 animals (28 cats and 15 dogs) admitted to the VEGA veterinary clinics for treatment in the period from 2020 to 2023. The criterion for the inclusion of animals in the study was a tumor process in the thoracic cavity and lungs, diagnosed by instrumental and laboratory methods. High-dose intravenous chemotherapy, which is used in humans, is ineffective in the treatment of LC in animals, therefore, it is necessary to search, develop and introduce into clinical practice targeted drugs that will be effective in animals. Since the most widely used group of targeted drugs in human medicine are low-molecular kinase inhibitors that act on the corresponding molecular target in the tumor, the development of molecular genetic methods available for practical use by veterinary oncologists for the study of tumor cells in animals is relevant in veterinary medicine. The choice of treatment methods and prognosis depend on the stage of the disease, therefore, the issue of introducing biomarkers of various types and stages of oncological processes into veterinary practice deserves research. Also, to improve the effectiveness of treatment, it is recommended to conduct research and develop a lung cancer staging scale for cats.

CLINICAL CASE OF KERATOACANTHOMA

Keratoacanthoma is a common, rapidly growing skin tumour that has long been considered benign due to its staged course and ability to spontaneously regress. However, according to the latest World Health Organization classification, keratoacanthoma is classified as a well-differentiated form of squamous cell carcinoma.&#x0D; Despite its long history keratoacanthoma remains a subject of controversy with regard to epidemiology, diagnosis, prognosis, and treatment.&#x0D; The etiology and pathogenesis of keratoacanthoma are also not clearly defined. However, a number of factors have been identified that are highly likely to lead to the development of a tumour. In particular, these are ultraviolet and X-ray radiation, thermal and traumatic injuries, chemical carcinogens, genetic and immunological predictors, human papillomaviruses and certain drugs (sorafenib, infliximab, etc.).&#x0D; Clinically, keratoacanthoma appears on the skin as a single or multiple crater-like nodule. Dermoscopy can be used for early diagnosis and differentiation from other tumour formations. The choice of therapy varies widely and depends on the location, stage of development, and size of the tumour.&#x0D; The publication presents a number of cases which demonstrate the clinical, dermoscopic, and histological picture of keratoacanthomas.&#x0D; Case presentation. Patient A, 44 years old, skin with signs of photodamage. A single dense nodule, up to 0.5 cm in diameter, on the anterior surface of the right lower leg. It appeared and grew rapidly over the past month.&#x0D; Dermoscopy with photographic fixation was performed. A non-pigmented dome-shaped lesion with central yellow-brown keratinous masses, sporadic haemorrhages, and white structureless areas was observed. The vascular pattern was represented by looped, glomerular and helical vessels in a radial arrangement. The lesion was surgically excised. A pathohistological study was carried out. The conclusion was a well-differentiated squamous cell carcinoma of the skin.&#x0D; In typical cases, the diagnosis of keratoacanthoma is not difficult. However, the combination with other skin lesions can distort the clinical picture. For example, in Patient B, keratoacanthoma developed against the background of seborrheic keratosis. In such cases, the use of dermoscopy can provide additional clues to the diagnosis and, accordingly, influence treatment methods.&#x0D; Considering keratoacanthoma as a well-differentiated squamous cell carcinoma, surgical excision is preferred. The metastatic potential of this tumour is not significant, but in high-risk areas such as the lip or ear, it can reach 30%. At the same time, surgery reduces the risk of local recurrence. Other approaches include electrodissection and curettage, cryodestruction, intratumoural administration of methotrexate, 5-fluorouracil, bleomycin, and photodynamic therapy. These methods are appropriate in cases where the size or location of the tumour do not allow achieving the desired aesthetic effect.&#x0D; Conclusions: 1. Keratoacanthoma is a well-differentiated squamous cell carcinoma with a low potential for metastasis. 2. Central yellow-brown keratinous masses, sporadic haemorrhages, white structureless areas, in combination with looped and glomerular vessels in radial disposition seen during dermoscopy of a nodule, may be a sign of keratoacanthoma. 3. The choice of treatment method for keratoacanthoma depends on its location and size; surgical excision of the tumour should be preferred.

Pilonidal disease: comparative analysis of leading professional organizations clinical guidelines

pilonidal disease is an inflammatory disease that is most often localized in the sacrococcygeal area and is characterized by the formation of a cyst or abscess with the possible secondary formation of fistulas. Pilonidal disease is a fairly common disease, according to individual studies, the incidence ranges from 26 cases per 100,000 people (USA) to 48 per 100,000 people (Germany). Men are three times more likely to suffer than women. Most often, the disease manifests itself between the ages of 18 and 30. The risk factors for developing the disease are: excess weight, increased hair growth, chronic trauma to the sacrococcygeal area and anatomical features of the gluteal cleft (its shape, depth, configuration). The occurrence and development of the disease in persons of working age often leads to a sharp decrease in work capacity and quality of life. There is still no single, generally accepted classification of pilonidal disease in the world. Today, there are 3 clinical guidelines created by professional associations (USA, Germany, Italy), based on the principles of evidence-based medicine. The purpose of the study is to perform a comparative analysis of the main points of the clinical guidelines of leading professional organizations (German National Guideline on the management of pilonidal disease, The American Society of Colon and Rectal Surgeons' Clinical Practice Guidelines for the Management of Pilonidal Disease, Consensus statement of the Italian society of colorectal surgery: management and treatment of pilonidal disease) regarding the clinical-diagnostic approach and the choice of optimal treatment tactics for patients with certain forms of pilonidal disease. In the study, a review and comparative analysis of literary sources from the scientific databases of medical literature PubMed Central (U.S. National Institutes of Health's National Library of Medicine), ScienceDirect (Elsevier publishing house), Wiley online library, Springer Link, Cochrane library, materials of the 3rd International Pilonidal Conference ( 2023, Copenhagen, Denmark) and clinical guidelines of specialized organizations of the USA, Germany and Italy. The following issues of diagnosis and treatment of diseases are selected for comparative analysis: choice of prevention method and non-surgical procedures that reduce the risk of disease recurrence; choice of treatment method and assessment of its necessity for asymptomatic pilonidal cysts; the choice of a surgical method of treatment for symptomatic pilonidal cysts; the choice of a method of surgical treatment for a recurrent form of PC. According to the performed analysis, it can be concluded that the diagnostic and therapeutic strategies reflected in the clinical guidelines are based on the evidence base and the analysis of research data conducted in the field of treatment of pilonidal disease, which leads to the existence of an essential correlation between the recommendations related to the choice of a method of prevention and non-surgical procedures that reduce the risk of recurrence of the disease, the method of treatment and assessment of its necessity for the asymptomatic form of the disease, methods of surgical treatment of the recurrent form of the disease. There are differences between clinical guidelines due to varying general consensus structures and main questions chosen to form a list of general provisions.&#x0D;

Ochrona interesów małoletniego w prawie medycznym

The purpose of this article is to discuss issues related to the protection of the interests of a minor in the procedure of medical law. Using a dogmatic-legal research method, the case law of the Supreme Court, the provisions of the Family and Guardianship Code and the provisions of the Act of November 6, 2008, on Patients’ Rights and the Ombudsman for Patients’ Rights, were analysed. According to the jurisprudential line, “one of the manifestations of an individual’s autonomy and freedom of choice is the right to decide for oneself, including the choice of treatment method. A reflection of this right is the institution of consent to the performance of a medical procedure, which is one of the prerequisites for the legality of therapeutic activities”. A person’s health and life are personal goods under the special protection of civil law. Equally protected is the personal good of autonomy of decision-making, which is the basis for the “disposal” of one’s own body and, consequently, health and life. The situation of minor patients, who are deprived of the right to decide on the health services provided to them, as well as minors, who have no influence on the decision on the choice of treatment, should also be considered. How are their interests protected? What if the minor and his parents have different opinions about the treatment, or if they do not consent to his treatment at all? How far can the legislature interfere in the exercise of parental authority and how is the minor patient protected? Can the guardianship court make decisions concerning life or health? The issues raised are extremely interesting not only legally, but also ethically and socially, for as a rule it is the parent who decides what is good for their child. It happens, however, that his decisions may contradict both the protected good and the principles of social coexistence themselves harm the interests of the minor.

Importance of injury severity in the choice of treatment and its impact on prognosis in gunshot fractures.

The management of femur and tibia fractures resulting from gunshot injuries is a challenge for orthopedic surgeons. One-stage and two-stage treatments are applied according to the anatomical location and severity of the injury. In this study, the importance of injury severity and anatomical location was evaluated in the choice of treatment method and its impact on prognosis in cases of lower extremity gunshot fractures. A total of 124 patients who met the study criteria were evaluated. They were grouped separately according to the anatomical location of the injury (femur, n = 73; tibia, n = 51) and the surgical method (one-stage, n = 77; two-stage, n = 47). The demographic characteristics of the patients, fracture classification, presence of neurological or vascular damage at the time of diagnosis, anatomical location of the injury, surgical procedure, and follow-up time were recorded. The time of union and the presence of malunion were evaluated radiologically. Finally, patients were assessed clinically with the New Injury Severity Score (NISS) and leg length discrepancy (LLD) calculated through measurements made on lower extremity orthoroentgenograms. The rate of vascular injury and the number of Gustilo-Anderson type IIIB and IIIC cases were significantly higher in the two-stage treatment group (p = 0.001 and p = 0.000, respectively). The infection rate was also higher in the two-stage group; therefore, time to union was significantly longer (p = 0.004 and p = 0.05, respectively). LLD was higher among patients who received two-stage treatment (p = 0.015). According to the NISS scale used in clinical assessment, better scores were obtained for the one-stage group (p = 0.002). In comparisons made according to anatomical location, no significant difference was found between femur and tibia injuries. Regardless of anatomical location and treatment method, injuries of higher severity such as Gustilo-Anderson type IIIB and IIIC are correlated with higher rates of complications such as vascular injury, postoperative infection, delayed union, and LLD. Furthermore, in cases of severe injuries, a two-stage approach is commonly favored.

Biliary atresia: the development, pathological features, and classification of the bile duct.

Biliary atresia is an occlusive biliary disease involving intrahepatic and extrahepatic bile ducts. Its etiology and pathogenesis are unclear. There are many manifestations of bile duct involvement in biliary atresia, but little is known about its occurrence and development. In addition, different classification methods have been proposed in different periods of biliary atresia, each with its advantages and disadvantages. The combined application of biliary atresia classification will help to improve the survival rate of patients with native liver. Therefore, this article reviews the development, pathological features, and classification of intrahepatic and extrahepatic bile ducts in biliary atresia, to provide a reference for the study of the pathogenesis and the choice of treatment methods.

Universal Long Bone Nonunion Classification.

The management of bone union disorders is a complex problem in orthopaedics, requiring a reliable and comprehensive classification system for accurate diagnosis and treatment. Despite advances in understanding pathophysiology, diagnosis, and treatment in this area, there is no generally accepted classification system. The aim of our work was to create a comprehensive classification, which will systemize the vast majority of bone union disorders, underline their differences and form the basis for their treatment. The key criteria for nonunion evaluation and treatment were identified based on the conducted literature review: Time from the initial event (delayed union or nonunion), location, type of pathology (A, Hypertrophic; B, Normotrophic; C, Oligotrophic) and the presence of hardware. Based on these criteria the ULBNC has been developed. Atrophic nonunions were excluded from this classification as they are considered segmental bone defects with special classification. The ULBNC is based on the same principles of coding as the "gold standard" AO/OTA Fractures Classification system with alpha-numeric coding "from simple to complex." The choice of treatment method depends on the type, group, and subgroup of the nonunion as described. Universal Long Bone Nonunion Classification (ULBNC) is an alphanumeric system that describes the localization, type of pathology and morphologic characteristics of a nonunion. The use of ULBNC in practice and research will optimize and standardize the treatment of various types of bone healing disorders and eventually improve clinical outcomes. Solomin LN, Semenistyy AA, Komarov AV, et al. Universal Long Bone Nonunion Classification. Strategies Trauma Limb Reconstr 2023;18(3):169-173.

Використання КПКТ черепа в ортодонтії

Actuality. Diagnostics in orthodontics is one of the most important stages, because the establishment of the final diagnosis and the choice of treatment methods directly depend on it. According to the diagnostic protocols of orthodontic patients, CBCT is currently not the gold standard, and is the method of choice. The goal is to analyze the available publications on the study of indications for CBCT and the impact of the information obtained on the choice of treatment method and/or control of the treatment. Materials and methods. Retrospective analysis of available publications on the resources https://pubmed.ncbi.nlm.nih. gov/ and https://www.sciencedirect.com/ and https://scholar.google.com/ and the formation of categories of indications for conducting CBCT in orthodontic practice and possible development trends in diagnostics based on CBCT The results. More than 200 publications were analyzed and 82 published in scientific publications in the period from 1998 to 2023 were selected, and the obtained data were systematized into the main groups of indications for conducting CBCT, namely: (1) assessment of the volume of the alveolar process for planning the possibility of tooth movement; (2) accurate determination of the localization of retained and overcomplete teeth; (3) assessment of the degree of ossification of the palatine suture for choosing a method of maxillary expansion; (4) study of angulation, morphology or root resorption; (5) quantification of nonunion defects of the lip and palate; (6) evaluation of the selection of TADs sizes and optimal areas for their installation; (7) help in determining the possible etiological factors of the occurrence of a pathological bite, for example, anomalies of the TMJ. Conclusions. The development of technologies and diagnostics of patients does not stand still, including 3D technologies in orthodontics as well, and the information that the doctor receives from CBCT influences the choice of treatment method and the evaluation of the conducted, which helps to improve the provision of orthodontic care and treatment, and we hope that in soon CBCT as a diagnostic method will take its place in diagnostic protocols and replace the gold standard, which is currently OPTG and TRG (cephalometry). Key words: cone-beam computed tomography, CBCT, orthodontics, diagnosis, canine retention, repid palatal expiation (RME), temporo-mandibular joint (TMJ), occlusion, articulator, treatment planning, treatment outcames.