Choice Of Treatment Method Research Articles

The glymphatic system and biomarkers of the cerebrospinal fluid in idiopathic normotensive hydrocephalus

Idiopathic normotensive hydrocephalus is one of the most common brain diseases in older people. The most urgent issue in the study of normotensive hydrocephalus is its differential diagnosis with other neurodegenerative and vascular pathologies of the brain. Currently, more studies have examined the concentration of biomarkers in the cerebrospinal fluid of patients with idiopathic normotensive hydrocephalus and other brain diseases to understand the pathophysiological processes in the pathogenesis of neurodegenerative diseases. The overwhelming majority of these studies have focused on the biomarkers of the cerebrospinal fluid in only one anatomical area: the ventricles of the brain or the lumbar subarachnoid space. However, only a few studies have conducted a comparative assessment of the composition and concentrations of biomarkers in ventricular and lumbar cerebrospinal fluid in the same patients. We believe that the difference in the content of biomarkers in different areas may be crucial in the choice of treatment methods for patients with idiopathic normotensive hydrocephalus. The lumbar cerebrospinal fluid is more pollutedthe content of nearly all biomarkers in the lumbar subarachnoid space is higher than that of the cerebrospinal fluid in the ventricles of the brain. Of the two most commonly used basic surgical techniques for the treatment of idiopathic normotensive hydrocephalus, ventriculoperitoneal and lumboperitoneal bypass surgery, preference is given to lumboperitoneal bypass surgery, which avoids complications associated with damage to the parenchyma of the brain and, most importantly, drains the dirtier cerebrospinal fluid with a higher concentration of proteins from the lumbar space. Instead of lumboperitoneal bypass surgery, we proposed a new combination of two surgical proceduresthe combination of endoscopic triventriculocysternostomy and ventriculoperitoneal bypass surgery. With such a combination, we believe that drainage of the cerebrospinal fluid from the ventricles and the subarachnoid space of the cisterns of the base of the brain will be more effective than the traditional ventriculoperitoneal shunting because the concentration of proteins involved in the progression of degenerative diseases of the brain will decrease more actively.

Medical or Common Knowledge? Knowledge of Medical Professionals on Obesity Diagnosis Criteria and Treatment

Introduction: Proper diagnosis of obesity, its severity, and complications and their effective treatment requires an interdisciplinary healthcare approach. Nevertheless, obesity remains under-identified and undertreated. Academic knowledge concerning obesity pathology, diagnosis, and treatment is advancing. It is not clear whether this translates into clinical practice. The goal of the study was to assess the knowledge of healthcare professionals (HCPs) on obesity and particularly on the criteria for diagnosis as well as for conservative and surgical treatment. Methods: This cross-sectional study was conducted among active HCPs (N = 184), including physicians, nurses, physiotherapists, and paramedics who had contact with adult patients with obesity. The proprietary research survey, implemented in an online tool, was used to assess knowledge on the diagnosis and treatment of obesity and self-assessment of that knowledge. The analysis was limited to the following: body mass index (BMI) definition, BMI values, visceral obesity definition, bariatric surgery indications, choice of treatment method, role of diet and physical activity, knowledge of obesity pharmacotherapy, length of obesity pharmacotherapy, financing of bariatric procedures, and goals of bariatric treatment. The correct answers were determined according to the Polish guidelines for the diagnosis and treatment of obesity. Results: Half of the respondents (52.2%) were doctors, 20.7% were nurses and midwives, 19.0% were physiotherapists, and 8.2% were other medical professionals. Among questions related to knowledge on obesity, 67.1% of respondents provided correct answers, with respondents answering questions concerning obesity diagnosis correctly more frequently (70.1%) than those concerning methods of treatment (64.6%). The largest number of correct answers was related to the definition of BMI and normal BMI values. The smallest number of correct answers pertained to the diagnostic criteria for visceral obesity and pharmacological treatment of obesity. There was no statistically significant impact of a responder's knowledge levels on the obesity of different HCPs. Workplace and participation in training sessions were found to have the largest impact on the level of knowledge on obesity. HCPs’ own assessment of their knowledge on obesity was negatively correlated with their actual level of knowledge. Conclusion: The prevalence of overweight and obesity implies that essentially every HCP has daily contact with patients with excessive body weight. Knowledge of BMI values cannot be considered as exclusively medical knowledge: these values were established years ago and are present in widely available sources. Our research showed that 32.9% of HCPs did not have sufficient knowledge about how to diagnose and treat obesity.

РЕДКАЯ МЕТАСТАТИЧЕСКАЯ ФОРМА БАЗАЛЬНО-КЛЕТОЧНОГО РАКА КОЖИ: СОВРЕМЕННЫЕ КРИТЕРИИ ФАКТОРОВ РИСКА И АНАЛИЗ КЛИНИЧЕСКИХ СЛУЧАЕВ ПО НОВОСИБИРСКОЙ ОБЛАСТИ

Despite the high prevalence of basal carcinoma (BCC) of skin, the metastatic form is extremely rare. The development of metastasis largely determines the clinical course, the prognosis of the disease, the choice of treatment methods and, given the poor prognosis in patients with this form of BCC, confirms the relevance of the topic. The management of such patients requires a clinically applicable classification of risk factors for BCC metastasis which can help a specialist to form an assessment of the disease severity and obtain a prognosis of its course. However, due to the rare occurrence, the study of the treatment and diagnosis of metastatic form of BCC is difficult. This article describes a clinical case of lung metastases in BCC, as well as an analysis of such cases on the basis of the Novosibirsk Regional Clinical Oncology Dispensary from the standpoint of the most relevant concepts of risk factors for BCC metastasis.

Clinical and Pathological Research Status of Multiple Pulmonary Nodules

With the changes in disease spectrum and the popularization of screening of low-dose spiral CT (CT) in the chest, more and more pulmonary nodules have been detected, most of which are bipulmonary multiple nodules. The existence of multiple pulmonary nodules means that it may be a pathological state of benign and malignant co-existence. The origin and evolution of pulmonary nodules in different histopathological states have a great impact on the choice of treatment methods. In recent years, the rise of immunotherapy has brought a breakthrough in the treatment of refractory lung cancer. However, some patients are still ineffective in immunotherapy, which may be related to the immune microenvironment where nodules are proportioned in different components in different pathological states. This review article mainly predicts the development process of nodules by analyzing the origin of multiple pulmonary nodules and the immune microenvironment of nodules in different pathological conditions, so as to provide guidance for clinical treatment.

СТАНДАРТИЗАЦІЯ МЕДИЧНОЇ ДОПОМОГИ В ПАЦІЄНТ ЦЕНТРИЧНІЙ МОДЕЛІ ПРИЙНЯТТЯ КЛІНІЧНОГО РІШЕННЯ: ПИТАННЯ ПРАВОВОЇ ДОКТРИНИ ТА СУДОВОЇ ПРАКТИКИ

The article is devoted to the study of the problem of the legal balance of imperative and dispositive means of legal regulation of relations with the application of medical and technological standards. An analysis of the modern methodology of evidence-based medicine and medical-technological standards was carried out in terms of their role in the modern legal model of the choice of treatment methods. Peculiarities of legal regulation of relations with the use of medical-technological documents are determined. The role of medical discretion in the process of making a clinical decision and choosing treatment methods for an individual patient is substantiated. The legal assessments of Ukrainian courts on the issue of the legal significance of standards in the system of clinical decision-making based on evidence-based medicine are disclosed. The main conclusions of the study are the following provisions. The modern legal model of the choice of treatment methods is a complex multifactorial process that takes place in the coordinate system "medical standard – medical discretion – patient's choice". The basic information ground for making a clinical decision is the available modern technologies of evidence-based medicine, however, the influence of other factors can adjust the decision around the main one, which is legitimate clinical guidelines and recommendations. The legal position of the Supreme Court of Ukraine in resolving disputes about the application of medical-technological standards in the professional activity of a doctor moves towards recognizing the significant role of medical discretion in making a clinical decision. Thus, in the modern conditions of standardization of service provision processes in the field of health care, quality clinical recommendations, patient-oriented approach and critical thinking of the doctor play an objectively important role. Key words: methodology of evidence-based medicine, standards of medical care, clinical decision, doctor’s discretion.

Orthodontic diagnostics in children with congenital cleft lip and palate with dentognathic deformities

Objective: To increasing the efficiency of orthodontic treatment by developing and implementing an examination record for children with congenital cleft lip and palate with dentognathic deformities. Methodology. In this study, records of examination of a patient with congenital cleft lip and palate with dentognathic deformities was performed. The advantage of the proposed record is its informativeness and ergonomics A pilot examination has been conducted to correct the form and content, to add information. Results. We developed methods of determining the sagittal and transverse dimensions of the defect and fragments of the cleft upper jaw, the specifics of quality control of hygienic care. We used hygienic index for determining the indicator of individual oral hygiene adjusted to account for hygiene of various qualities on the upper and lower dentition (DIOH) and speech therapy diagnostics. Conclusion: The record of examination of patients with congenital cleft lip and palate with dentognathic deformities is advisable to use when planning and conducting orthodontic treatment. This provides an opportunity to take into account and describe all peculiarities of the dental status, justify the choice of treatment methods and trace the dynamics of rehabilitation.

Peculiarities of rehabilitation of patients after combat craniocerebral trauma

Introduction: The urgency of the situation on the territory of Ukraine has taken on an exceptionally crucial character. After a large-scale invasion and deployment of military operations, there has been a noticeable increase in the number of cases of mine-explosive injuries, shrapnel wounds, and gunshot injuries. Specifically, combat traumatic brain injury (combat TBI) has emerged as one of the most pressing issues. According to statistical data, combat TBI constitutes half of all reported injuries and holds paramount significance for public health. It arises due to mechanical damage to the skull or its internal components (vessels, nerves, brain membranes, and the brain itself). Importantly, the severity of combat TBI consequences depends on the degree and nature of the injury, potentially causing disruptions in the functioning of vital body systems. Accompanying traumatic brain injuries can lead to serious complications, such as disruptions in cerebral blood circulation, cerebrospinal fluid circulation, brain swelling, and more. The choice of treatment methods depends on the severity of the injury. For milder cases, like concussions, conservative treatment is applied. Severe injuries, including open head injuries, might require surgical intervention. After the surgical procedure, patients necessitate rehabilitation measures to restore bodily functions. During the postoperative period, rehabilitation interventions take on special significance, aiming to restore physical and psychological functions of the affected individual. This may encompass physiotherapy, speech therapy sessions, psychotherapy, and other methods of gentle therapy. Thus, combat traumatic brain injury poses a serious threat to the health and lives of individuals who have been affected during military operations. Achieving effective treatment and rehabilitation within this context stands as a crucial task for the medical community.

Results of clinical developments of early triple negative breast cancer drug treatment: ASCO - 2022

Introduction. This article continues the series of reviews of innovative clinical developments related to drug therapy for leading cancers following the ASCO-2022 Annual Congress. This time we are seeing the results of therapy for early triple negative breast cancer (hereinafter referred to as TNR) is a consequence of the fact that TNR accounts for 15–20% of cases of all breast cancers, while it is the subtype of breast cancer (hereinafter referred to as BC), for which the choice of treatment methods
 is significantly limited. In Russia, state tasks have been set within the framework of the Federal project “Fight against cancer”,
 which provide for a significant reduction in mortality from neoplasms, including by improving the quality
 and effectiveness of drug treatment.
 Materials and methods. This scientific review is based on the results of a search in the databases of the digital educational platform MEDtalks.nl, PubMed/Medline and Google. Dictionary forms were used in the search strings: "kanker", "vroeg stadium", "triple negatief", "mammacarcinoom", "clinical trials", "ASCO-2022" and others in Dutch and English.
 Results and conclusion. The results presented in this article once again substantiate the prospects for further determination of algorithms for biomarker-personalized immunotherapy (in particular, pembrolizumab) as part of the combined antitumor treatment of RMZHER–/PR–/HER2– at early stages. Radiogenomics/radioproteomics technologies are a prime example of low-cost diagnostic tools that allow promptly suggesting a personalized tumor portrait in the period before biopsy. Further improvement of clinical oncoinformatics technologies (rather large arrays of omics data have already been accumulated) will contribute to a better understanding of programs for individualized choice of differentiated therapy for cancer patients, including patients with RMZHER–/PR–/HER2–.
 For citation: Andreev DA, Zavyalov AA. Results of clinical developments of early triple negative breast cancer drug treatment: ASCO-2022. City Healthсare. 2022;3(4): 122–131 doi: 10.47619/2713-2617.zm.2022.v.3i4;122–131

Treatment of full-layer skin defects using decellularized pig skin dermal matrix

The choice of treatment methods for complex skin defects poses certain technical and medical difficulties related to the choice of material for filling the wound defect and its antigenic compatibility. A promising direction in the treatment of skin defects is the use of decellularized (celluless) pig skin, the composition and structure of which is as close as possible to the patient's dermis.
 The aim of the study was to analyze the clinical case of a patient with a basal cell carcinoma in the right wing of the nose, who was treated with full-layer skin defects using a decellularized dermal matrix from pig skin.
 Material and methods of investigation. Patient P., 94 years old, with a basal cell carcinoma in the area of the right wing of the nose, underwent treatment. As a material applied directly to the wound, a flap of acellular dermal matrix (ADM) of pig skin with preservation of the native structure was used.
 Results. 6 weeks before the visit to the dermatologist, the patient developed a pea-sized papule on the skin in the area of ​​the wing of the nose, which increased in size and became painful on palpation. When examining the skin in the area of ​​the right wing of the nose, a tumor-like formation was observed, 1x1 cm in size, flesh-colored, with peeling on the surface and vascularization, firm consistency, painful. Regional lymph nodes are not enlarged. The formation is clearly separated from healthy skin. The oncologist made a diagnosis: basal cell carcinoma. The tumor was removed, resulting in a full-layer skin defect measuring 1x1.5 cm with connection to the nasal cavity. Acellular dermal matrix was used to close the defect on the 3rd day after surgery. The flap was placed so that it did not cover the skin around the wound. With the help of "Levomykol" ointment, a moist chamber was created over the dermal flap. The dressing was changed every 2-3 days. On the 14th day, the flap peeled off, a granulating wound with signs of marked marginal epithelization formed in its place. The bottom of the wound was located almost at the same level as the intact skin. On the 21st and 26th day, active marginal epithelization of the wound and wound healing under the scab were noted. The bandage was not used during this period. On the 32nd day, the wound closed.
 Conclusions. Decellularized dermal matrix of pig skin when closing a full-layer postoperative skin defect creates optimal conditions for reparative wound regeneration. The effectiveness of its use is due to the presence of a collagen matrix in it, from which the nuclear elements of cells have been removed, which does not lead to immune aggression. The clinical case proves the expediency of using the decellularized dermal matrix of pig skin in the treatment of full-layer skin defects of various genesis.

ПЕРВИЧНЫЙ АЛЬДОСТЕРОНИЗМ: СОВРЕМЕННЫЕ ПОДХОДЫ К ДИАГНОСТИКЕ

Primary aldosteronism is characterized by aldosterone secretion that is independent of renin and angiotensin II. The deleterious effects of primary aldosteronism are mediated by excessive activation of the mineralocorticoid receptor that results in the hypertension, hypokalemia, and it also increases the risk for cardiovascular and kidney disease, as well as death. Current evidence suggests that the prevalence of primary aldosteronism is much greater than previously recognized and milder forms of renin-independent aldosterone secretion may be common. These forms may be missed. This review focused screening in those at increased risk of primary aldosteronism. An approach to evaluating screening results was presented. Family aldosteronism should be considered in young hypertensive patients with a family history of primary aldosteronism. Genetic testing is appropriate in these patients. Careful interpretation of screening data, recent achievements in hormone assays and sampling methods and their clinical relevance are discussed. Confirmatory tests and evaluation of their results are considered. The optimal approach to distinguish unilateral from bilateral primary aldosteronism is by adrenal vein sampling that is the only reliable method to select patients for surgery. More effective strategy to diagnose PA should lead to early detection of PA and could decrease the cardiovascular complications of the patients.

Adult dural arteriovenous fistulas in Galen region: More to be rediscovered.

Dural arteriovenous fistulas (DAVFs) in the Galen region are the most deeply located and most complex type of dural arteriovenous fistulas. However, cases of DAVFs in this region have not been well described. Thus, we aimed to summarize the characteristics of Galenic DAVFs involving clinical symptoms, anatomical architecture, and drainage patterns, providing experientially therapeutic strategies for these lesions based on our 20 years of clinical experience. We retrospectively examined 31 patients with Galenic DAVFs between January 2000 and June 2021. A comprehensive analysis was carried out based on the symptoms, imaging features, feeding arteries, draining veins, number and location of the fistulas, choice of treatment methods, and prognosis assessment. Twenty-nine patients received endovascular embolization, and no perioperative deaths occurred. A transarterial approach was performed in 27 patients, and a combined transarterial and transvenous approach in one. And in one case, access was established by surgical drilling and embolization was done via the venous route. Twenty-four cases were completely obliterated after first embolization, and another five cases received a second period treatment. Only one patient developed cognitive dysfunction after embolization, and the outcomes of the remaining patients were improved at long-term follow-up. The understanding of symptoms of non-hemorrhagic neurological deficits in DAVF needs to be further clarified. Lesions with pial feeders may be considered first when determining surgical orders. Multi-approach and multi-stage embolization would be safe and effective. Excessive embolization and deep-vein system obstruction should be avoided. Approach creation by surgery would be an innovative interventional therapy.

ГЕМОРРОЙ У ДЕТЕЙ

Expansion of hemorrhoidal veins in children is a rather rare pathology. The authors conducted a comparative analysis of the clinical picture and treatment results of 46 children aged 1 to 18 years. The main causes of hemorrhoids were persistent constipation in 39,1% of patients, diarrhea in 21,7%, a two-stage act of defecation in 13%, sports overload in 13%, coughing attacks in 6.5%, and intense urination, due to urinary tract disorders – in 6,5% and others.
 In the group of children under 3 years of age, conservative therapy was more effective in 70,2%, relapses were noted in 5,5% of children.
 In 9 children (24,3%), the failure of conservative treatment was an indication for hemorrhoectomy. After surgical correction, relapses were not observed. The choice of treatment methods taking into account the age characteristics of children allowed the authors to get good results.

The choice of treatment method for recurrent inguinal hernias after laparoscopic hernioplasty

The aim of the work: to determine the optimal method of reoperation for recurrent inguinal hernias after laparoscopic hernioplasty.
 Materials and Methods. The research was conducted on the basis of the Regional Clinical Hospital (Odesa). During the period from 2012 to 2021, 36 patients with relapses after previous laparoscopic interventions for inguinal hernias were operated on in our clinic. Among these patients, there were 29 men and 7 women. Bilateral inguinal hernias were observed in 9 patients. Relapse occurred on one side in 6 patients, bilateral recurrence was in 3 patients. The results were evaluated according to the following criteria: the severity of postoperative pain, the number of postoperative complications, the length of stay in the hospital, recovery time after surgery and the patient's return to work.
 Results and Discussion. The duration of repeated laparoscopic interventions was (82±10) min and significantly exceeded the duration of open operations (p<0.05). The severity of pain in 12 patients after repeated operations that could be performed laparoscopically was significantly lower than in open interventions (VAS 4.8 vs 8.7, p < 0.05). Severe seromas in the area of the installed mesh were observed in 5 patients operated on by the laparoscopic method and in 4 patients operated on using the Liechtenstein method. Suppuration of the postoperative wound was observed in 3 patients, two of them underwent conversion. Patients started work after laparoscopic operations in 14–18 days, after open operations in 19–27 days (p>0.05).
 The choice of the method of repeated interventions for recurrent inguinal hernias depends on many factors. The main method of repeated interventions should be considered an open operation according to the Lichtenstein method. Under certain conditions, a second laparoscopic hernioplasty can be performed.

COVID-19 impact on hospitalization outcomes of patients with circulatory system diseases

Background: The study is devoted to the impact of a new coronavirus infection in combination with other diseases on the hospitalization outcomes. Features of mortality in the population during COVID-19 pandemic, including from blood circulatory system diseases, have been studied. However, there are few studies based on the large amount of data on the cases and outcomes of providing specialized hightech medical care to patients with cardiovascular diseases (CVD) and concomitant diagnosis of COVID-19.Objective: The analysis of impact of a new coronavirus infection on the outcomes of hospitalization for circulatory system diseases.Material and methods: Information about more than 350 thousand cases of hospitalization of patients with blood circulatory system diseases in the context of the COVID-19 pandemic has been analyzed, of which in 1875 cases a concomitant diagnosis of COVID-19 was established. The sources of information are the depersonalized registers of compulsory health insurance accounts. For assessment of the obtained data methods of descriptive statistics, simple (unweighted) arithmetic mean values, mean values, specific weights of indicator values, a mean square (standard) deviation from mean values were used. The analysis and descriptive part of the work were carried out by means of the Microsoft Excel spreadsheet software package.Results: The outcomes of hospitalization of patients with suspected or confirmed diagnosis of COVID-19 were significantly worse than in other patients. Moreover, the frequency of lethal outcomes increases significantly in correlation with the age of patients and does not depend on the choice of treatment method – surgical or therapeutic.Conclusion: COVID-19 significantly complicates provision of medical care in conditions of the round-the-clock hospital for blood circulatory system diseases. The risks of surgical interventions for circulatory system diseases in combination with COVID-19 are as high as with the use of therapeutic technologies. It is necessary to unify the indications and contraindications to surgical treatment of conditions related to acute coronary syndrome in cases of the presence of such concomitant pathology as COVID-19.

Բուժտարհանման համակարգում վիրաբուժական օգնության խնդիրների օպերատիվ կազմակերպման առանձնահատկություններին վերաբերող ռազմադաշտային վիրաբուժություն առարկայի դասավանդման մեր փորձի մասին

In modern curricula the usage of "case, innovation, interactive, simulation, information" technologies certainly creates a sufficient environment and opportunity for the general preparation of the doctors (communication with the patients, diagnosis, choice of treatment methods), but does not cover the entire scope of necessary knowledge and skills required during military operations, in difficult conditions for providing medical care. To solve such extremely complex problems as the provision of step-by-step medical care during emergencies, military operations, natural disasters and the return of a significant number of casualties to service, the MFS Chair offers a teaching and training method developed during many years of teaching experience. The proposed teaching method is a variant of training games developed in the armed forces and organized for training the personnel, which is preliminarily agreed with the goals of the subject under study and is close to the real conditions of the military situation. The proposed method is implemented and carried out in the classrooms, operating and dressing rooms, in wards and military units, in the open field conditions and without restriction at any place. The aim of the proposed method is to develop, integrate the skills of quick orientation and appropriate decision-making, ability to provide emergency medical care in war and various emergencies. To make this important mission realistic, it is necessary to develop high moral, military, psychological and strong-willed professional qualities among the students using the methods of professional and clinical skills.

Comparison of two surgical treatments for proximal femur fracture in elderly obese patients

The choice of treatment methods for patients with fractures of the trochanteric region of the femur, as well as specific surgical tactics, is justified. According to a number of researchers, hip arthroplasty is an alternative to osteosynthesis in such injuries, especially in patients with limited functional capacity and a poor medical history. The primary results of endoprosthesis and intramedullary blocked fixation constructions in elderly patients with obesity were compared. Purpose of the study. To evaluate the clinical efficacy of intramedullary osteosynthesis and endoprosthesis in obese patients with vertebral fractures of the proximal femur. Materials and methods. The study was carried out on the basis of the Republican Clinical Hospital of the Ministry of Health of the Republic of Tatarstan. A total of 76 patients aged 66 to 91 years were operated on. Two techniques were used in the treatment. 46 patients who underwent primary hip arthroplasty (THA) and 30 patients who underwent blocked intramedullary osteosynthesis (BIOS) with proximal femoral nail of gamma-nail type. Results. 1. A comparative study with a relatively small sample showed that there was no statistically significant difference in the duration of surgery between patients with normal BMI and obese patients with different surgical approaches. 2. Blood loss rates in both groups were less than the critical level (p < 0.05). The study expectedly confirmed that the higher the patient's BMI, the longer the duration of surgery and the greater the blood loss. 3. The presented material suggests that arthroplasty can be used for vertebral fractures of the proximal femur if there are no relevant surgical contraindications. 4. The relative difficulty of performing blocked intramedullary pinning, difficulty in activating and rehabilitating obese patients, and risks of early loading of the injured limb lead to the search for alternative methods of surgical treatment of acetabular femoral fractures. Using the advantages of hip arthroplasty is the most important factor of favorable outcome of treatment and life preservation for this complex group of patients.

Experience of implementing a value-based approach in oncodermatology

Objective: implementation of value-based approach and development of adherence to treatment in patients with non-melanoma cancer.Material and methods. The observational, single-arm, prospective, long-term single-center study of the quality of life and patients’ experience was performed. It included 42 patients aged from 42 to 82 years. Validated questionnaires were used: Patient-Reported Outcome Measures (PROMs) (as a decision support tool), Patient-Reported Experience Measures (PREMs) (3 months after treatment to assess the patient's experience).Results. Mean concern about appearance was 43.5 points (Rasch psychometric model). Younger patients (r=–0.398, p=0.009) and female patients (r=–0.475, p=0.001) were more concerned about appearance. In 10 cases (24%), the involvement was estimated as 4 points, in 18 cases (43%), it was 3 points, in 14 cases (33%), it was 2 points. Older patients were less involved in the choice of treatment method (r=–0633, p<0.001). The level of satisfaction with communications was more than 50 points. The use of a patient-oriented algorithm of communication has a positive effect on a patient's experience.Conclusion. The heads of oncological care are recommended to evaluate the patient's experience on a regular basis, create conditions for patients to choose treatment methods according to their individual needs, analyze the outcomes obtained by the introduction of validated questionnaires on the appropriate nosological profile and take these results into account in treatment. Further studies of the degree of influence of different factors on a patient’s choice of treatment method are needed, as well as conducting studies among other groups of patients with non-melanoma skin cancer (located in other parts of the body, larger than 2 cm).

Objectification of the treatment choice in children with isolated abdominal trauma, ruptured spleen

BACKGROUND: The risk of vital homeostasis disorders and the likelihood of death in patients with spleen injury is determined by organ damage, acute intra-abdominal bleeding, and often hemorrhagic shock.
 AIM: This study determines the validity of the clinical criteria for the syndrome of intra-abdominal bleeding, shock, and the argumentation of indications for surgical treatment in the first six hours from the moment of hospital admission in children with an isolated injury, rupture of the spleen.
 MATERIALS AND METHODS: The study included 89 patients aged 6 to 12 years with spleen injuries treated at the Republican Childrens Clinical Hospital of the Donetsk Peoples Republic from 2014 to 2021. The first subgroup included 61 (68.5%) patients treated conservatively, and the second subgroup comprised 28 (31.5%) operated patients (splenectomy) who initially underwent conservative therapy. Blood pressure and heart rate were controlled, and hemoglobin, hematocrit, erythrocyte, and leukocyte counts were determined. Abdominal echography was performed every three hours.
 RESULTS: In assessing the severity of the condition, there were changes in peripheral hemodynamic parameters, such as arterial hypotension and hemoperitoneum with hemorheological disorders (posthemorrhagic anemia of III degree, a tendency to thrombocytopenia). In the first six hours from hospital admission, the most objective clinical and laboratory indicators of bleeding and the choice of treatment method were the value of the hemoperitoneum, the level of arterial pressure system, hematocrit, and hemoglobin. No decrease in blood pressure in patients below 100.0 mm Hg, blood hemoglobin of 95.0 g/l with a hemoperitoneum volume of less than 275.0 ml dictated the expediency of continuing conservative therapeutic measures. In cases of deterioration in the condition of patients due to ongoing bleeding with the ineffectiveness of intensive therapy, surgical intervention (laparotomy, splenectomy) is recommended to stop the bleeding.
 CONCLUSIONS: In the first hours after injury, the most accurate predictor of the choice of treatment method is the volume of the hemoperitoneum (according to echography), associated with the impaired hemodynamic status of the patient, namely arterial hypotension, which affects choosing a conservative or surgical treatment option.

The rick factors of the occurrence and development of intranasal neoplasms in cats

Intranasal neoplasms in cats are less common than in dogs and, according to the literature, account for up to 1% of all neoplasms in cats. Most often, carcinoma and sarcoma develop in cats of the middle age group, and intranasal lymphomas are more common in younger animals.The etiological factors causing intranasal neoplasms in cats are diverse. The algorithm for diagnosing nasal neoplasms in cats depends on the clinical manifestations of the process and includes diagnostics aimed at determining the clinical stage of cancer and making a final diagnosis based on a morphological conclusion. And also a diagnostic algorithm is necessary for the choice of treatment methods. The determination of the clinical stage directly depends on the visualization of the neoplasm in the nasal passages, the involvement of one or two nasal passages in the oncological process, the degree of spread of the tumor into the surrounding tissues – using visual diagnostic methods such as MRI and CT aimed at determining the localization of pathology, the spread, the degree of invasion and the degree of involvement of blood vessels in a specific oncological process. Diagnostic methods such as palpation of regional lymph nodes, chest X-rays and ultrasonography of abdominal organs are aimed at determining the clinical stage of oncopathologies.

Trends in Diagnosis and Surgical Treatment of Bone Metastases among Orthopedic Surgeons.

Background: The proper diagnosis and treatment of bone metastases are essential for patient survival. However, several strategies for the treatment are practiced. Therefore, the aim of the study was to analyze what factors influence the choice of a method of treatment. Methods: An online survey was conducted within the Polish Society of Orthopedics and Traumatology. It consisted of 45 questions and was divided into four main parts: Participant Characteristics, Diagnosis and Qualification, Treatment, and Clinical Cases. Results: A total number of 104 responses were collected. The most frequently chosen methods were: Intramedullary nail (IMN) + Resection + Polymethyl methacrylate (PMMA) (30.47%) and IMN without tumor resection (42.13%), and in third place, modular endoprosthesis (17.25%). The less experienced group of orthopedic surgeons more often (47.5% vs. 39.5%) decided to perform IMN without tumor resection than the more experienced group (p = 0.046). Surgeons from district hospitals less frequently (13.7% vs. 23.1%) would decide to use modular endoprosthesis than surgeons from university hospitals (p = 0.000076). Orthopedists who performed ≥ 11 bone metastases surgeries per year would more often use modular endoprosthesis (34.8% vs. 13.2%) than those who performed ≤ 10 operations per year (p = 0.000114). Conclusion: Experience, place of work, and the number of metastasis surgeries performed during a year may influence the choice of treatment method in patients with bone metastases.