Конструктивний перфекціонізм майбутньої медичної сестри: концепція й емпірична верифікація

У статті обґрунтовано концептуальні засади дослідження проблеми й емпірично встановлено особистісно-поведінкові та особистісно-комунікативні характеристики прояву конструктивного перфекціонізму майбутніх медичних сестер. Поглиблено наукові уявлення щодо розгляду конструктивного перфекціонізму в межах конкретизації професійної норми як інтегрального критерію професійно-психологічної адаптованості майбутніх фахівців; на емпірико-діагностичному рівні верифіковано зміст деонтологічно-професійного й ідентифікаційно-професійного статусів професійно-психологічної адаптованості за градацією інтенсивності прояву перфекціонізму майбутніх медичних сестер. За результатами емпіричного дослідження обґрунтовано положення щодо закономірної таксономії трансформацій базових особистісно-поведінкових і особистісно-комунікативних властивостей під впливом фактору рівня прояву перфекціонізму майбутніх медичних сестер (адаптивно-активний, продуктивнопрактичний та компетентнісно-вимогливий типи); визначення механізмів (послаблення (інгібіції), змін (інверсії) та посилення (гіпертрофії)) трансформації базових особистісно-поведінкових і особистісно-комунікативних властивостей майбутніх медичних сестер під впливом чинника перфекціонізму. Ключові слова: перфекціонізм, конструктивний перфекціонізм, професійно-психологічна адаптованість, професійна норма, деонтологічно-професійний статус, ідентифікаційно-професійний статус, медична сестра

Experience of endoscopic transcapsular axillary nerve decompression: а series of clinical cases

Background: Posttraumatic axillary nerve neuropathy is a widely spread pathology, more often seen after a shoulder joint trauma. It can also appear as a complication after orthopedic surgeries, for example, after the Latarjet procedure for shoulder stabilization. The technique of open axillary nerve decompression is very popular but has a number of disadvantages: a large trauma of soft tissue, severe bleeding, a high rate of complications, and also a poor cosmetic effect. The endoscopic surgical technique of decompression is an effective and less traumatic alternative to open procedures. Clinical case description: We present the results of endoscopic transcapsular axillary nerve decompression in 5 patients with a clinical picture of neuropathic pain syndrome, hypoesthesia in the deltoid area, hypotrophy of the deltoid muscle, who were operated from 2018 to 2021. The mean age of patients was 44.414.9. An original surgical technique of decompression was developed and applied to all the patients which included arthroscopy of the shoulder joint with diagnostic and treatment components and transcapsular endoscopic axillary nerve decompression in the beach-chair position. The statistical analysis was performed using the MannWhitney U test. According to the VAS-scale, the severity of pain syndrome before the surgery was 64.6 points, while 6 months after the surgery it decreased to 1.40.5 points (p 0.05). According to the DASH scale, the function of the shoulder joint before the surgery was 77.66.9 points, and 6 months after surgery it increased to 125.2 points (p 0.05). According to the BMRC scale (M0M5), the strength of the deltoid muscle before the surgery was 20.4 points, and after the surgery it increased to 4.40.5 points (p 0.05). The range of motion in the shoulder joint was as follows: before the surgery flexion 10745.6, extension 10249, external rotation 2213.6; 6 months after the surgery flexion 15425.6, extension 15622.4, external rotation 508 (p 0.05). The thickness of the middle portion of the deltoid muscle according to the US was 7.21.04 mm before the surgery, 11.81.44 mm after the surgery (p 0.05). All the patients (100%) at a long-term follow-up noticed complete relief of pain and regression of the neurological symptoms. Conclusion: The achieved results allow us to characterize the method of endoscopic transcapsular decompression as a reproducible, minimally invasive and highly effective technique, providing pain relief to patients, curing neurological and intraarticular pathology, thus promoting early restoration of the upper limb function in the treated group of patients

Results of the surgical treatment of intra-articular fractures of the distal femur using a retrograde intramedullary technique

Background: Distal femoral fractures are a widely spread problem in traumatology, which can be caused by both a high-energy trauma and a low-energy trauma in senile patients with osteoporosis. The conservative treatment shows little promise. The surgical treatment of patients is still a challenge for orthopedic surgeons regarding both the technical aspect and a high risk of complications. There are several surgical methods with the use of plates and nails, but there is still no universal conception of the surgical treatment. Aim: comparative analysis of methods of intramedullary retrograde osteosynthesis and bone osteosynthesis in the treatment of fractures of the distal femur. Methods: In this study, we evaluated the treatment results of 46 patients who underwent osteosynthesis for intraarticular fractures of the distal femur using an intramedullary retrograde nail. The evaluation was carried out based on such parameters as the duration of the operation and the time from the moment of injury to the operation, the intraoperative blood loss and the function of the knee joint. On average, the operation time using a retrograde femoral nail was 45 minutes. Reducing the duration of the operation improved the functional results of the treatment. Reducing the operation time when installing a retrograde intramedullary nail was achieved with a relatively simple technique for installing this type of a fixator and the use of minimally invasive approaches. Results: On average, the operation time using a retrograde femoral nail was 45 minutes. Reducing the duration of the operation improved the functional results of treatment. Reducing the operation time when installing a retrograde intramedullary nail was due to a relatively simple technique for installing this type of fixator and the use of minimally invasive approaches. One year after the surgery, the following mean values were achieved: 78 (6485) points according to the KSS knee score, 85 (6889) points according to the KSS function score, 3.1 (1.34.2) cm for the severity of pain syndrome according to the VAS scale, 105 (88120) degrees for the flexion in the knee joint. However, a number of post-op complications were observed: deep vein thrombosis of lower extremities was found in 6 (13.1%) patients, formation of a false-joint was seen in 3 (6.5%) patients, 1st grade arthritis of the knee joint was detected in 36 patients (78.2%), 2nd grade arthritis was observed in 10 patients (21.8%). 3rd grade arthritis was not detected. 3.5 years after the operation, none of the patients needed a knee joint replacement. Conclusion: Retrograde intramedullary osteosynthesis in type C distal femoral fractures promotes early rehabilitation, a complete recovery of the knee joint function and healing of the fracture, and represents an effective method of treatment

Опыт эндоскопического транскапсулярного невролиза подмышечного нерва

INTRODUCTION Posttraumatic axillary nerve neuropathy is a widely spread pathology, more often seen after shoulder joint trauma. It can also occur as a complication after orthopaedic surgeries, for example, after Latarjet procedure for shoulder stabilization. The technique of open axillary nerve decompression is very popular but has a number of disadvantages: large trauma of soft tissue, severe bleeding, high rate of complications, poor cosmetic effect. Endoscopic surgical technique of decompression is an effective, less traumatic alternative to open procedures.AIM To improve the outcomes of treatment of patients with axillary nerve neuropathy.MATERIAL AND METHODS We present the outcomes of endoscopic transcapsular axillary nerve decompression in 5 patients with a clinical picture of neuropathic pain syndrome, hypoesthesia in the deltoid area, hypotrophy of the deltoid muscle, who were operated from 2018 to 2021. The mean age of the patients was 44.4±14.9. An original surgical technique of decompression, which included arthroscopy of the shoulder joint with diagnostic and treatment components and transcapsular endoscopic axillary nerve decompression in the beach-chair position, was developed and applied to all the patients. Statistical analysis was performed using the MannWhitney U test.RESULTS According to VAS-scale, the severity of pain syndrome before the surgery was 6±4.6 points, 6 months after surgery it decreased to 1.4±0.5 points (p<0.05). According to DASH scale, the function of the of shoulder joint before surgery was 77,6±6,9 points, 6 months after surgery it increased to 12±5,2 points (p<0.05). According to BMRC scale (M0–M5), strength of the deltoid muscle before surgery was 2±0,4 points, after surgery it increased to 4,4±0,5 points (p<0.05). Range of motion in the shoulder joint before surgery was as follows: flexion 107±45,6°, extension 102±49°, external rotation 22±13,6°; 6 months after surgery: flexion 154±25,6°, extension 156±22,4°, external rotation 50±8° (p<0,05). The thickness of the middle portion of the deltoid muscle according to ultrasound examination before the surgery was 7.2±1.04 mm, after surgery 11.8±1.44 mm (p<0.05). All the patients (100%) during long follow-up noticed complete relief of pain and regression of neurological symptoms.CONCLUSION The achieved results allow us to characterize the method of endoscopic transcapsular decompression as a reproducible, minimally invasive and highly effective technique providing pain relief to patients, curing neurological and intraarticular pathology, thus promoting early restoration of the upper limb function in the treated group of patients.АКТУАЛЬНОСТЬ Посттравматическая нейропатия подмышечного нерва является достаточно распространенной патологией при травмах области плечевого сустава. Стандартным вмешательством в таких случаях является открытый невролиз подмышечного нерва, который в силу анатомического расположения нервного ствола травматичен, сопровождается относительно высокой частотой осложнений, обладает плохим косметическим эффектом. Малоинвазивной альтернативой открытому невролизу является эндоскопическая хирургическая техника.ЦЕЛЬ Улучшить результаты лечения пациентов с посттравматической нейропатией подмышечного нерва.МАТЕРИАЛ И МЕТОДЫ За период с 2018 по 2021 год нами были прооперированы 5 пациентов с клинической картиной посттравматической нейропатии подмышечного нерва. Всем больным была выполнена артроскопия плечевого сустава с диагностическим и лечебным компонентами, транскапсулярный эндоскопический невролиз подмышечного нерва по оригинальной методике. Статистическое сравнение параметров проводилось согласно критерию Манна–Уитни.РЕЗУЛЬТАТЫ Средний возраст пациентов составил 44,4±14,9 года. По шкале ВАШ интенсивность болевого синдрома до операции составила 7±1 балл, через 6 месяцев после операции боль уменьшилась и составила в среднем 1±0,4 балла (p<0,05). По шкале DASH функция плечевого сустава до операции была 77,6±6,9 балла, через 6 месяцев после операции составила 12±5,2 балла (p<0,05). По шкале BMRC (M0–M5) сила дельтовидной мышцы до операции составляла 2±0,4 балла, а после операции увеличилась до 4,6±0,5 балла (p<0,05). Амплитуда движений в плечевом суставе до операции: сгибание 107±45,6°, отведение 102±49°, наружная ротация 22±13,6°, через 6 месяцев после операции возросла до: сгибание 154±25,6°, отведение 156±22,4°, наружная ротация 50±8° (p<0,05). Толщина среднего пучка дельтовидной мышцы, по данным ультразвукового исследования, до операции составила в среднем 7±0,8 мм, через 6 месяцев после операции 10,6±1,1 мм (p<0,05).ЗАКЛЮЧЕНИЕ Полученные результаты позволяют охарактеризовать методику эндоскопического невролиза как воспроизводимую, малотравматичную и эффективную, которая позволяет уменьшить интенсивность болевого синдрома и способствует раннему восстановлению функции верхней конечности

Сравнение реологических и вязкоупругих свойств медицинских изделий гиалуроновой кислоты для внутрисуставного введения

Osteoarthritis (OA) is the most common joint disease that affects more than 80% of people over 55 years and in its final stages leads to disability. One of the safe non-surgical methods of OA treatment is intra-articular injections of hyaluronic acid (HA).Objective: to compare the viscoelastic rheological properties of HA medical products with different concentrations of sodium hyaluronate (SH) available in the Russian Federation.Material and methods. The study was carried out using a modular rheometer MCR 302 (Anton Paar, Austria). All measurements were carried out at a temperature of 25.0±0.1 °C using the measuring system "cone-plane" (angle – 2 ˚ , cone diameter – 40 mm, gap height – 0.169 mm). The determination of the elastic moduli (G’) and viscosity (G”) was carried out depending on the frequency in the linear region of the shear stress, and the dynamic viscosity was determined at a shear rate of 1 sec-1.Results. The evaluation of the rheological properties of the studied samples revealed a positive relationship with the concentration of SH and no relationship with the molecular weight of SH. The highest viscoelastic properties were possessed by medical products in the 1% SH group: Armaviscon and Ripart; in the group with SH concentration of 1.5–1.6%, all the studied samples, except for Hyalubrix, showed similar higher results compared to the previous group; in the group with SH concentration of 2–3%, Armaviscon Platinum had the highest results and Flexotron Ultra and Armaviscon Forte – somewhat lower results.Conclusion. The study of the rheological viscoelastic properties of HA medical products is the most accessible method, on the basis of which it is possible to predict the clinical effect.Остеоартрит (ОА) – наиболее распространенное заболевание суставов, которое поражает более 80% лиц старше 55 лет и на последних стадиях приводит к инвалидности. Одним из безопасных неоперативных методов лечения ОА является использование внутрисуставных инъекции медицинских изделий гиалуроновои кислоты (ГлК).Цель исследования – сравнение вязкоупругих реологических свойств медицинских изделий ГлК с различной концентрацией гиалуроната натрия (ГН), доступных для использования в Российской Федерации.Материал и методы. Исследование проводилось с помощью модульного реометра MCR 302 (Anton Paar, Австрия). Все измерения выполнялись при температуре 25,0±0,1 °С с использованием измерительной системы «конус-плоскость» (угол – 2°, диаметр конуса – 40 мм, высота зазора – 0,169 мм). Определение модулей упругости (G’) и вязкости (G”) осуществляли в зависимости от частоты в линейной области напряжения сдвига, а динамической вязкости – при скорости сдвига 1 с-1.Результаты и обсуждение. Оценка реологических свойств исследуемых образцов выявила положительную связь с концентрацией ГН и отсутствие связи с молекулярной массой ГН. Самыми высокими вязкоупругими свойствами обладали медицинские изделия в группе с концентрацией ГН 1%: Армавискон и Рипарт; в группе с концентрацией ГН 1,5–1,6% все исследуемые образцы, кроме Хиалубрикса, показали схожие, более высокие по сравнению с предыдущей группой, результаты; в группе с концентрацией ГН 2–3% наиболее высокие показатели имел Армавискон Платинум и несколько меньшие – Флексотрон Ультра и Армавискон Форте.Заключение. Изучение реологических вязкоупругих свойств медицинских изделий ГлК является наиболее доступным методом, на основании которого можно прогнозировать клинический эффект

Хирургическое лечение заднелатеральной ротационной нестабильности локтевого сустава: систематический обзор

Posterolateral rotational instability (PLRI) of the elbow joint can occur acutely as a result of dislocation of the bones of the forearm, and also be chronic, for example, after inadequate healing of a previous rupture of the lateral ligamentous complex, in particular the lateral ulnar collateral ligament (LUCL). It is necessary to take into account that, as a result of repeated microtraumas, persistent pain syndrome and recurrence of dislocation develop, which can lead to disability. We conducted a systematic review of the literature according to the protocol outlined in the PRISMA guidelines. From 1,903 publications, 11 studies were selected that met our criteria and assessed the results of treatment of 181 patients. The main reason for the development of PLRI was simple traumatic dislocation of the forearm bones (37.5%). Of the studies that assessed the elbow joint using the MEPS, 86.5% of patients had excellent or good results, with a mean MEBS score of 91 points. Before surgery, pain syndrome was present in 131 patients (87.3%) out of 150, and in the postoperative period it was observed in 55 (36.6%) out of 150 (p=0.01). The incidence of recurrent instability after surgery was observed in 6.6% of patients. A review of the literature on the problem of the elbow joint shows that this problem has not been fully studied, treatment strategies differ and should be performed based on the surgeon’s experience and available data, however, it has been proven that the key to the stability of the elbow joint is the LUCL, which requires its restoration through its refixation or plastic surgery.Заднелатеральная ротационная нестабильность (ЗЛРН) локтевого сустава может возникать остро в результате вывиха костей предплечья, а также быть хронической, например, после неадекватного заживления ранее произошедшего разрыва латерального связочного комплекса, в частности латеральной локтевой коллатеральной связки (ЛЛКС). Необходимо учитывать то, что вследствие повторяющихся микротравм развивается стойкий болевой синдром, рецидив вывиха, что может приводить к инвалидности. Нами был проведен систематический обзор литературы в соответствии с протоколом, изложенным в рекомендациях PRISMA. Из 1903 публикаций были отобраны 11 исследований, соответствующих нашим критериям и оценкой результатов лечения 181 пациента. Основной причиной развития ЗЛРН был простой травматический вывих костей предплечья (37,5%). Из исследований, в которых проводили оценку локтевого сустава по шкале MEPS, у 86,5% пациентов были отличные или хорошие результаты со средним значением MEBS=91 балл. До операции болевой синдром присутствовал у 131 пациента (87,3%) из 150, а в послеоперационном периоде у 55 (36,6%) из 150 (р=0,01). Частота рецидивирующей нестабильности после операции отмечалась у 6,6% пациентов. Анализ литературы по проблеме ЗЛРН локтевого сустава показывает, что данная проблема до конца не изучена, стратегии лечения различаются и должны выполняться на основе опыта хирурга и имеющихся данных, однако доказано, что ключом к стабильности локтевого сустава является ЛЛКС, которая требует своего восстановления путем ее рефиксации или пластики

Study of 124^{124}Sn+136^{136}Xe fusion-evaporation: analysis of a rare-event experiment

7 pages, 4 figuresFusion-evaporation in the $^{124}$Sn+$^{136}$Xe system is studied using a high intensity xenon beam provided by the Ganil accelerator and the LISE3 wien filter for the selection of the products. Due to the mass symmetry of the entrance system, the rejection of the beam by the spectrometer was of the order of $5times10^8$. We have thus performed a detailed statistical analysis to estimate random events and to infer the fusion-evaporation cross sections. No signicant decay events were detected and upper limit cross sections of 172~pb, 87~pb and 235~pb were deduced for the synthesis of $^{257}$Rf, $^{258}$Rf and $^{259}$Rf, respectively

Thermal properties comparison of hybrid CF/FF and BF/FF cyanate ester-based composites

[EN] Insights within thermal expansion, conductivity, and decomposition dependencies with temperature on symmetrical and unsymmetrical layered carbon (CF) or basalt (BF) fabrics in combination with flax fibers (FF) were approached. Driven by commercial application and environmental concerns, the paper draws attention on a modified formula of cyanate ester with a common epoxy resin under an optimized ratio of 70:30 (vol%) as well as on the hybrid reinforcements stacking sequences. Synergetic effects were debated in terms of the CF and BF stacking sequences and corresponding volume fraction followed by comparisons with values predicted by the deployment of hybrid mixtures rules (RoHM/iRoHM). CF hybrid architectures revealed enhanced effective thermophysical properties over their BF counterparts and both over the FF-reinforced polymer composite considered as a reference. Thermal conductivities spread between 0.116 and 0.299 W m-1 K-1 from room temperature up to 250 C on all hybrid specimens, giving rise to an insulator character. Concerning the coefficient of thermal expansion, CF hybrid architectures disclosed values of 1.236 10-6 K-1 and 3.102 10-6 K-1 compared with BF affine exhibiting 4.794 10-6 K-1 and 6.245 10-6 K-1, respectively, with an increase in their volume fraction.The corresponding author gratefully acknowledges the financial assistance of German Academic Exchange Service-DAAD that enabled and supported the internship with Fraunhofer Research Institution for Polymeric Materials and Composites-PYCO, Germany. Many thanks go to Dr. Christian Dreyer and Dr. Maciej Gwiazda for the resin formula and access to the composite manufacturing technology.Motoc, DL.; Ferrándiz Bou, S.; Balart, R. (2018). Thermal properties comparison of hybrid CF/FF and BF/FF cyanate ester-based composites. 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Treatment of damage of the rotary cuff of the humeral joint with use of art roskopichesky technics

The trauma was the basic provoking factor in development of the given pathology. Patients were treated is out-patient at the traumatologist, the surgeon or the neurologist on a residence with the diagnosis a bruise of a humeral joint, a cervical osteochondrosis, arthrology. For the purpose of elimination and preventive maintenance of an impingement-syndrome and subacromion bursitis operation with application artroskopichesky technicians is spent. At damage of a rotary cuff arthroscopies a humeral joint spent for diagnostics with the subsequent open surgical intervention for the purpose of restoration of integrity of a rotary cuff