Surgical orthopaedic management of cerebral palsy in adults: literature review and preliminary analysis of our treatment experience

Introduction Improving the quality of care has led to an increase in the life expectancy of patients with cerebral palsy and in the number of adult patients suffering from cerebral palsy. However, functional motor limitations aggravate after their physiological growth completion and the risk of pain increases. The aim of this work was to study the literature on the problem of surgical orthopedic treatment in adolescents and adults with cerebral palsy belonging to GMFCS levels I-IV of motor disorders as well as to make a preliminary analysis of the surgical orthopedic treatment performed in this category of patients at our institution. Materials and methods The results of multi-level single-event interventions were studied in 165 patients older than 16 years. The sample for analysis included cases that met the following criteria: age of 16 years and older, spastic types of cerebral palsy, GMFCS levels I–IV. In addition, some patients underwent botulinum therapy during the stages of surgical treatment. Results The maximum functional effect was manifested 12–24 months after the surgery if proper early and subsequent rehabilitation was provided. According to the Gillette Functional Assessment Questionaire, motor abilities improved in 81.3 %. Multilevel interventions included 2.3–3.5 elements on average during one surgical session. Current literature postulates the implementation of multi-level single-event interventions and indications for surgery and follow-up control are studied at a motion analysis laboratory. Conclusion Multi-level orthopedic interventions are indicated for patients who have completed physiological growth. Techniques of such interventions should provide early functional activity. Surgical orthopedic treatment in adult patients with cerebral palsy should be performed by the staff and at an institution that specialize in neuro-orthopedic

Epidemiology, education, and care for patients with diabetes in Belarus

More than 64 million people in the World Health Organization European Region are living with diabetes, and Belarus is no exception to the diabetes epidemic. This study was conducted as a part of the Joint Usage/Research Projects program for promoting collaborative research in regions affected by environmental radiation exposure. We reviewed locally available documents on the epidemiology and management of diabetes in Belarus. Over the past 20 years, there has been a 2.8-fold increase in the number of patients with diabetes mellitus in Belarus, and in response, an integrated approach for prevention and treatment has been implemented. Strategies unique to Belarus include the establishment of a diabetes registry, the monitoring of patients at local outpatient units called dispensaries, and the upgrading of diabetes education provided at Diabetes Schools. Despite the strategic developments made to diabetes services, further improvements are warranted, including better quality assurance of services at dispensaries, revision of patient education to take into consideration new treatments and technologies, and more epidemiological research

Magneto-optic properties of ultrathin nanocrystalline ferrite garnet films in the 8K to 300K temperature interval

A study of the initial stages of crystallization in RF magnetron-sputtered ferrite garnet films is reported, in which a series of ultrathin Bi2Dy1Fe4Ga1O12 layers is fabricated and characterized. The spectral and temperature dependencies of magnetic circular dichroism (MCD) of these films are studied in the temperature range from 300 K down to 8 K. Measured magneto-optical properties are reported in the spectral range between 300 and 600 nm. In ultrathin garnets at temperatures below 160 K, we found that between 360 and 520 nm, the spectral MCD dependencies were typical of bismuth-substituted garnets with high levels of gallium dilution in the tetrahedral sublattice. The MCD signal strength measured at its 440 nm peak grows linearly with reducing temperature between 160 K and 8 K. This observed temperature dependency of MCD differed dramatically from these measured in thicker (3.7 nm) nanocrystalline garnet films. The peak MCD signal at 440 nm in these 3.7 nm-thick samples grows linearly from 215 K down to 100 K, resembling the same dependency seen in 1.7 nm films. In thinnest layers of thickness 0.6 nm, no MCD signals were observed at any temperature in the range between 8 and 300 K

Influence of the initial state of ZrO2 on genesis, activity and stability of Ni/ZrO2 catalysts for steam reforming of glycerol

The effect of the initial state of ZrO2 on properties of Ni/ZrO2 catalysts for hydrogen production in steam reforming of glycerol was investigated. The catalysts were synthesized by impregnating the supports obtained by varying the  treatment temperature of  ZrO2‧nH2O  and  introducing Y2O3 as  a  promoter. All  materials were characterized by thermal analysis, X-ray diffraction, N2 physisorption, scanning electron microscopy, H2-TPR, NH3-TPD and transmission electron microscopy. The mutual influence of NiO and ZrO2 on the genesis of the phase composition, pore structure and reducibility was demonstrated. Different catalytic behavior is explained by influence of the initial form of the support on the size, morphology of Ni particles, and the support thermal stability. The initial activity of Ni/ZrO2is proportional to the monoclinic phase content. The catalysts based on tetragonal ZrO2 displayed the best stability. For the first time, the presence of the aldol condensation products in glycerol steam reforming was demonstrated</p

Commodity and Financial Networks in Regional Economics

The article discusses the relationship between commodity-production and financial network structures in the regional economy as dual conjugate systems. Material flows (raw materials, goods and so on) circulate in the commodity network as shown by Leontiev’s input-output balance model. Nonmaterial flows of property rights, money, and so on circulate in the financial network and reflect the movement of material objects in commodity networks. A network structure comprises closed and open circuits, which have fundamentally different characteristics: locally closed circuits meet local demand by supplying locally produced goods, thus ensuring self-reproduction of the local economy; open (or transit) circuits provide export-import flows. The article describes the mechanism of ‘internal’ money generation in closed circuits of commodity-production networks. The results of the theoretical study are illustrated by the calculations of closed and open circuit flows in the municipal economy model. Mutual settlements between the population and manufacturing enterprises are given in matrix form. It was found that the volume of the turnover in closed circuits of the municipal economic network model is about 28.5 % of the total turnover and can be provided by ‘internal’ non-inflationary money. The remaining 71.5 % of the total turnover correspond to the flows in the network’s open circuits providing export and import. The conclusion is made that in the innovation-driven economy, main attention should be given to the projects oriented towards domestic consumption rather than export supplies. The economy is based on internal production cycles in closed circuits. Thus, it is necessary to find the chains in the inter-industrial and inter-production relations which could become the basis of the production cycle. Money investments will complete such commodity chains and ‘launch’ the production cycle

Operative treatment of orthopedic complications in upper limb in children and adults with cerebral palsy

Introduction The benefits of surgical treatment of orthopaedic complications in the upper limb caused by cerebral palsy have been debated by some researchers. Secondary complications developed due to muscle spasticity and retraction are a serious obstacle to a significant improvement in healthrelated quality of life of CP patients. Objective To explore outcomes of CP patients who underwent surgical treatment at the Russian Ilizarov Scientific Centre “Restorative Traumatology and Orthopaedics” between 2014 and 2016. Material and methods Total 23 operative interventions were produced for 21 patients aged from 11 to 36 years (mean age of 16.6 years) using an authors’ technique. We used integral scales of the Gross Motor Function Classification System (GMFCS) and the Manual Ability Classification System (MACS). Classification systems intended for differential evaluation of upper extremity motor and functional impairment included Van Heest’s deformity assessment test, the House upper extremity assessment test and Gshwind and Tonkin classification. Results Spastic diplegia was diagnosed in 6 cases including 4 GMFCS III and 2 GMFCS IV. Manual ability was assessed as MACS IV in 3 cases and MACS V in 3. Fifteen patients with hemiparethic spastic CP underwent surgical treatment of upper limbs. Manual ability was assessed as MACS III in 4 cases, MACS IV in 8 and MACS V in 3. The use of the limb by the House’s scale showed level 1 in 2, level 2 in 5, level 3 in 10 and level 4 in 6 cases. The Gschwind and Tonkin classification for pronated forearm revealed level 1 in1, level 2 in 8, level 3 in 10 and level 4 in 4 cases. There was correlation between an extent of pronation contracture and impaired function of the thumb. Improved functional abilities of the upper limb, the cosmetic appearance and comfort with the use were recorded in all the cases. Conclusion Results of multilevel interventions on upper limbs in CP patients allow us to conclude that differential approach to the choice of technique and extent of surgery to ensure efficacious surgical treatment

Intrauterine bone fractures in fetuses with osteogenesis imperfecta: a literature review and a case report

The article presents a literature review on intrauterine bone fractures in fetuses suffering from osteogenesis imperfecta. Prenatal ultrasound investigation of the condition is made to identify pathologically changed bone tissue including shortened and deformed limb segments and ribs, bone fractures and callus formation and widened intracranial sutures. Comprehensive clinical, paraclinical and radiological evaluations are produced after the birth to determine treatment strategy. Skeletal fractures in newborns are treated conservatively. With diagnosis of osteogenesis imperfect established medical treatment with bisphosphonates is administered to inhibit osteoclast-mediated bone resorption, facilitate bone mineralization and lower fracture incidence. The case report describes fractures of both femurs and left tibia in a female newborn suffering from osteogenesis imperfecta type III diagnosed in utero with ultrasonographic screening. The case presented highlights infant’s trauma-focused status, radiological findings and the treatment performed

Use of sliding transphyseal flexible intramedullary nailing in pediatric osteogenesis imperfecta patients

Introduction. In our country the sliding Flexible Intramedullary Nailing is used alone or in combination with Ilizarov frame in children with osteogenesis imperfecta. The study assesses the results of sliding intramedullary nailing in deformity correction in severe types of osteogenesis imperfecta.Materials and Methods. We retrospectively reviewed 17 consecutive cases (mean age 5.2 y.o.) of types III, IV and VII of osteogenesis imperfecta.In group I (9 patients) the transphyseal FIN was performed using titanium nails. Sliding flexible intramedullary nailing was associated with Ilizarov frame in group II in 8 children.Results. Patients in group I had overall complication rate of 88.9%: proximal nail migration (3), early secondary torsional displacement (4), non-telescoping (12), angular deformity (2), delayed or non-union (2). The reoperation rate was 100%.In group II we observed complications in 6 patients: nail migration (2), bowing of femur (2), non-telescoping (3). The reoperation rate was 87.5%.Conclusion. Flexible intramedullary nailing allows realignment and good functional outcomes. Its major disadvantage is an important complication rate and related reoperation rate. The use of Ilizarov frame provides additional stability and allows early weight-bearing.