Использование подхода DDD для построения модели предметной области проекта

Объектом исследования является возможность автоматизации процесса заключения страхового договора и создание приложения для применения в области страхования. Предмет исследования – методологии и подходы к разработке приложения. Цель работы – применение подходов предметно-ориентированного проектирования в рамках которых принимаются проектные решения и формирование единого языка для группы разработки программного обеспечения. В процессе исследования проводились выбор методологии разработки, сбор и формирование требований к приложению, разработка и тестирование модели предметной области, формирование единого языка группы разработки. В результате выполнения работы реализовано приложение согласно построенной модели предметной области.The object of research is a ability to automate the process of concluding the insurance contract and create application for use in the field of insurance. Subjects of research are methodologies and approaches of application development. The goal of the work is using approaches of domain-driven design which help to make project decision. Research consists of choosing methodology, getting and formulating requirements, developing and testing domain model, creating ubiquitous language. In the result, application has been developed according to domain model

The effectiveness of extra corporeal shock wave therapy for plantar heel pain: a systematic review and meta-analysis

BACKGROUND: There is considerable controversy regarding the effectiveness of extracorporeal shock wave therapy in the management of plantar heel pain. Our aim was to conduct a systematic review of randomised controlled trials to investigate the effectiveness of extracorporeal shock wave therapy and to produce a precise estimate of the likely benefits of this therapy. METHODS: We conducted a systematic review of all randomised controlled trials (RCTs) identified from the Cochrane Controlled trials register, MEDLINE, EMBASE and CINAHL from 1966 until September 2004. We included randomised trials which evaluated extracorporeal shock wave therapy used to treat plantar heel pain. Trials comparing extra corporeal shock wave therapy with placebo or different doses of extra corporeal shock wave therapy were considered for inclusion in the review. We independently applied the inclusion and exclusion criteria to each identified randomised controlled trial, extracted data and assessed the methodological quality of each trial. RESULTS: Six RCTs (n = 897) permitted a pooled estimate of effectiveness based on pain scores collected using 10 cm visual analogue scales for morning pain. The estimated weighted mean difference was 0.42 (95% confidence interval 0.02 to 0.83) representing less than 0.5 cm on a visual analogue scale. There was no evidence of heterogeneity and a fixed effects model was used. CONCLUSION: A meta-analysis of data from six randomised-controlled trials that included a total of 897 patients was statistically significant in favour of extracorporeal shock wave therapy for the treatment of plantar heel pain but the effect size was very small. A sensitivity analysis including only high quality trials did not detect a statistically significant effect

Antibacterial effects of extracorporeal shock waves.

Despite considerable knowledge about effects of extracorporeal shock-wave therapy (ESWT) on eukaryotic tissues, only little data are available concerning their effect on prokaryotic microorganisms. The objective of the present study was to determine the bactericidal activity as a function of energy flux density and shock-wave impulse number. Standardised suspensions of Staphylococcus aureus ATCC 25923 were exposed to different impulse numbers of shock waves with an energy flux density (ED) up to 0.96 mJ mm(-2) (2 Hz). Subsequently, viable bacteria were quantified by culture and compared with an untreated control. After applying 4000 impulses, a significant bactericidal effect was observed with a threshold ED of 0.59 mJ mm(-2) (p < 0.05). A threshold impulse number of more than 1000 impulses was necessary to reduce bacterial growth (p < 0.05). Further elevation of energy and impulse number exponentially increased bacterial killing. ESWT proved to exert significant antibacterial effect in an energy-dependent manner. Certain types of difficult-to-treat infections could offer new applications for ESWT

The minimally invasive anterolateral approach combined with hip onlay resurfacing.

OBJECTIVE: Minimally invasive anterolateral approach in hip resurfacing with complete preservation of muscular integrity. INDICATIONS: Primary or secondary osteoarthritis of the hip. CONTRAINDICATIONS: Approach: None. Onlay implant: Females>55 years with osteoporosis. Males>60 years with osteoporosis. Severe varus deformity (CCD [collodiaphyseal] angle1 cm in diameter. SURGICAL TECHNIQUE: Supine position with possible overextension of the hip, longitudinal incision along the intermuscular septum and blunt intermuscular dissection between gluteus medius and tensor fasciae latae, partial resection of the anterior capsule and anterior dislocation of the hip with complete proximal release of the capsule. Dislocation of the femoral head and dorsal positioning, reaming of the acetabulum to implant the cementless acetabular component, exposition and reaming of the femoral head in extension/adduction and external rotation, implantation of the cemented onlay endoprosthesis. POSTOPERATIVE MANAGEMENT: Prophylaxis of thromboembolism and periarticular ossification. Rehabilitation with weight bearing as tolerated starting on the day of surgery, ergometer training from day 4 after surgery. RESULTS: 31 patients with osteoarthritis underwent onlay resurfacing via a minimally invasive approach. The Harris Hip Score improved from 43.9 to 97.1 at 12 months after surgery. Adverse events such as fracture, dislocation, nerve or muscle lesions did not occur, and clinically significant thromboembolism or infection was not observed

[Chronic radiculopathy. Use of minimally invasive percutaneous epidural neurolysis according to Racz]

Treatment of chronic low back pain exhibiting radicular symptoms poses a clinical problem that has not yet been solved. The technique of percutaneous minimally invasive neurolysis described by Racz is being performed increasingly to treat chronic radiculopathy. A total of 61 patients with corresponding symptomatology after screening for inclusion and exclusion criteria in the region of the lumbar spinal nerve were treated with the Racz catheter technique. Distinct clinical improvement was observed at the 3- and 6-month follow-ups after percutaneous minimally invasive epidural neurolysis. Subjective pain perception, quantified by the McNab score, clearly improved after 3 as well as 6 months. With the exception of partial catheter shearing in two cases and one occurrence of infection, no relevant side effects were noted. The Racz catheter technique for treatment of chronic radiculopathy following disk surgery is suitable with minimal side effects

[Minimally invasive percutaneous epidural neurolysis in chronic radiculopathy. A prospective controlled pilot study to prove effectiveness]

The treatment of chronic back pain with sciatica is still an unsolved therapeutic challenge. Percutaneous minimally invasive neurolysis according to the Racz technique is increasingly applied and discussed controversially. So far there is no prospective randomized controlled study for evaluation of a possible treatment effect. In a prospective pilot study, 25 patients with monosegmental radiculopathy of the lumbar spine were treated with minimally invasive percutaneous epidural neurolysis according to Racz's technique. They all suffered from chronic disc herniations or failed back syndromes after surgery, all with radiculopathy. The average age of the patients was 51+/-16 years, the average duration of the symptoms was 28 months.Twelve weeks after the procedure patients had significant clinical improvement. The Oswestry score increased from 64+/-17 to 22+/-12 points. Subjective pain sensation according to the McNab score showed improvement too. None of the patients had worsening of the situation compared to preoperative findings. No clinically relevant complications were observed. The results are being used to design a clinical trial in accordance with good clinical practice guidelines to analyze the therapeutic efficacy of the procedure. The described technique is still a clinically experimental procedure. However, due to a low probability of side effects and due to the good results reported so far by most authors, the Racz catheter technique may be applied in certain patients with chronic radiculopathy refractory to conservative treatment

[Surgical approaches in hip resurfacing]

A large variety of approaches are described for standard total hip arthroplasty. All of them are technically based on three different approaches: anterior, anterolateral, or posterior. In recent hip resurfacing, the posterior approach is common, due to large instruments used to ream the femur. Better exposure of the acetabulum is achieved by the posterior approach, but this technique puts the important extraosseous blood supply to the femoral head at risk. The anterior approach preserves blood supply and gives better options to treat the femoroacetabular impingement. If specific surgical modifications and instruments designed for minimally invasive surgery are used, hip resurfacing can be performed with an anterolateral technique. Excellent functional and clinical outcomes have been reported after all three approaches

[Leading symptom elbow pain. Differential diagnosis]

Pain affecting the elbow joint may be caused by a number of different pathologies. In principle, these can be grouped by causality criteria into degenerative causes, inflammatory causes, tumor disease, congenital disease and the sequelae of trauma. The majority of these latter are associated with typical clinical symptoms that can be established with the aid of a systematic clinical examination, history-taking, inspection, palpation, an examination of joint mobility, and finally radiography. In this way, the diagnosis can rapidly be established

[Reconstruction of the extensor mechanism in revision total knee arthroplasty and tumor surgery.]

Reconstruction of the extensor mechanism in extended revision after total knee replacement and tumor surgery remains a clinically relevant problem. Due to large tibial bone defects with resection of the extensor insertion area, the specific problem of patella ligament refixation frequently arises.Several biological approaches and augmentation techniques have been published. Most of these are associated with a high rate of revision surgery because of failed replacement of the extensor mechanism and unsatisfactory functional outcome. Surgical reconstruction of these tendon defects is complicated by the difficulty of completely neutralizing tensional force across the repair. To overcome this problem, methods have been developed to reinforce the reconstruction with overlapping flaps; in addition, artificial materials are being increasingly used for tension neutralization. These artificial strips need special fixation mechanisms on the tibial component and specific technical modifications of the prosthesis.The present study gives an overview of reconstruction modalities of the extensor mechanism and provides an improved technology for better reconstruction by using artificial strips combined with specific modifications of the tibial component