Вивчення факторів розвитку ускладнень після первинного тотального ендопротезування кульшового суглоба у хворих з ревматоїдним артритом

Мета. Виявити кореляційні зв’язки між мікробною контамінацією і регенераторним потенціалом кісткової тканини та визначити їх взаємний вплив на розвиток ускладнень після первинного тотального ендопротезування (ТЕП) кульшового суглоба у хворих з ревматоїдним артритом (РА). Матеріали і методи. Результати мікробіологічних досліджень операційного матеріалу порівнювали з результатами клонування стовбурових стромальних клітин кісткового мозку. У дослідження було залучено 85 хворих з РА та ураженням кульшового суглоба ІІ стадії ІІІ фази  та ІІІ стадії за Скляренком. Проаналізовані дані проведених згідно з чинними методиками мікробіологічних досліджень 147 зразків операційного матеріалу хворих, яким виконали первинне ТЕП кульшового суглоба. Результати. Культури мікроорганізмів було виділено з операційного матеріалу 29,2% хворих з РА, яким виконали ТЕП кульшового суглоба. Серед виділених 59 штамів мікроорганізмів переважали стафілококи та корінеформні палички – відповідно у 54,2 та 22,2% зразків. У 5,1% виділених культур ідентифіковано Streptococcus spp., у 22,0%  – Corynebacterium spp., у 13,5% – неспороутворюючі анаероби, у 5,1% - грамнегативні мікроорганізми. Висновки. Проведеним комплексним дослідженням з вивчення впливу мікробної контамінації тканин оперованих кульшових суглобів на активність регенераторних процесів після ТЕП у хворих з РА встановлено пригнічення остеогенного потенціалу в середньому на 30,4%, або майже у 2 рази, що можна вважати одним із механізмів виникнення ймовірних ускладнень та вживати заходи щодо їх профілактики

Modeling of wound ballistics in biological tissues simulators

Modern weapons cause severe damage, accompanied by high rates of complications and mortality. The investigation of such kinds of weapons is in high demand considering the ongoing active phase of russia's war against Ukraine since February 2022. In order to understand the pathological processes that occur in and outside the gunshot wound, we conducted an experimental study using mathematical simulation. The results presented in the article will help to choose the appropriate surgical management and improve the results of treatment. The aim of this study was to investigate and evaluate the damaging effect of a 5.45 mm 7N6M bullet and a 5.45 mm V-max expansive bullet using numerical modeling of wound canals in ballistic plasticine. The Ansys Explicit Dynamics engineering complex was used to simulate the dynamics of the bullet’s motion. The basic equations, solved by the explicit dynamic analysis, express the conservation of mass, momentum, and energy in Lagrange coordinates. Together with the material model and the set of initial and boundary conditions, they determine the complete solution to the problem. Taking into account that the initial velocity of the bullet is 1185 m/s at a mass of 3.9 g, we obtain energy 2740 J. All this energy acts at the area of the wound canal with a depth of 150 mm. Injury with a conventional 7N6M bullet is characterized by the fact that it passes through the block and loses only part of the kinetic energy. The simulation results showed that the velocity of the bullet at the outlet is 220 m/s. Taking into account the initial velocity of the bullet 918 m/s with a mass of 3.4 g, we obtain the kinetic energy acting on the walls of the wound canal with a depth of 200 mm of about 830 J. Mathematic analyses showed that the expansive bullet has a soft core that deforms and transfers all the kinetic energy to the tissues immediately after penetration into the tissues. The loss of kinetic energy of the bullet (ΔE, J) is defined as the difference between the kinetic energy at the time of injury (Ec, J) and the residual energy of the bullet when leaving the material (Er, J). Numerical modeling of wound ballistics in biological tissue simulators allows us to determine with high accuracy the features of wound canal formation and tissue response to damage of bullets having different kinetic energy, which contributes to the choice of adequate surgical management during surgery for gunshot wounds

АКТУАЛЬНІ ПИТАННЯ ФОРМУВАННЯ МОТИВАЦІЇ ДО НАВЧАННЯ У СТУДЕНТІВ ХАРКІВСЬКОГО НАЦІОНАЛЬНОГО МЕДИЧНОГО УНІВЕРСИТЕТУ

The aim of the work – to analyze formation conditions of study motivation of students of Kharkiv National Medical University (hereinafter the KhNMU); to study methods of formation of students’ learning motivation in studying the discipline of Hygiene and Ecology; to determine peculiarities of the formation of motivation for the students’ educational activity. Particular attention should be paid to the issue of risk factors for the formation of academic motivation of foreign students studying at the KhNMU. The main body. Experimental testing of the conditions for the formation of motivation for cognitive activity among students showed a low level of that parameter in foreign students. Data of study show worse level of mastery of discipline knowledge. The relevant situation is due to the insufficient level of awareness of the acquired knowledge’s significance in further professional activities. The main reasons for this situation are the low level of knowledge of the significance of the knowledge gained during the study of the discipline of Hygiene and Environment in future professional activities; as well as problems during the studies that are associated with a lack of knowledge of the Russian language. Conclusions. Conditions for the formation of educational motivation of foreign students need to improve existing teaching methods, which will increase the level of mastering the discipline of Hygiene and Environment. It is necessary to note that special attention should be paid to the general specificity of foreign students, which requires more attention of teachers to educational and educational activities.Мета роботи – провести аналіз умов формування мотивації до навчання студентів Харківського національного медичного університету (далі – ХНМУ) з вивченням методичних підходів до її формування. Визначити особливості формування мотивації до навчальної діяльності студентів, які засвоюють дисципліну “Гігієна та екологія”. Окрему увагу  приділити питанню факторів ризику формування навчальної мотивації іноземних студентів, які навчаються в ХНМУ. Основна частина. Експериментальна перевірка умов формування мотивації до пізнавальної діяльності в студентів показала низький рівень сформованості мотивації до пізнавальної діяльності в іноземних студентів, які навчаються російською мовою під час оволодіння знаннями з дисципліни “Гігієна та екологія”. Наслідком цього є нижчий бал поточної успішності студентів, що свідчить про гірший рівень засвоєння знань з дисципліни. Відповідне становище обумовлене недостатнім рівнем усвідомлення значущості набутих знань у подальшій професійній діяльності, а також недостатнім рівнем володіння мовою навчання. Висновки. Умови формування мотивації до пізнавальної діяльності у студентів-іноземців ХНМУ, які навчаються російською мовою, потребують удосконалення традиційних методів формування мотивації до навчання та впровадження новітніх педагогічних методик при вивченні дисципліни “Гігієна та екологія”, що сприятиме зростанню рівня засвоєння навчального матеріалу. Слід зазначити, що окремої уваги потребує загальна специфіка студентів-іноземців, яка вимагає більшої уваги викладачів до навчальних та виховних заходів

The Ecosystem of Human Resources of Organizations as a Conceptology and an Applied Platform for Human-Centeredness

The article provides argumentation regarding the the essence, composition and structure of the ecosystem of human resources of organizations in the contour of human-centeredness. The factors of paradigm changes in the management of human resources of organizations in the third decade of the XXI century are disclosed. Factual data of asymmetries and contradictions in the current state of the social and labor sphere in the global dimension, that become a threat to national security, are presented. The main drivers of the global economy have been allocated as evidence of the unattainability of social quality standards. The relevance of the ecosystem of human resources of organizations as the main focus of economic activity is substantiated. The understanding of the theoretical construct is revealed and the fundamental foundations of the conceptology of the ecosystem of human resources in the context of human-centeredness are outlined. Within the framework of the genesis, the components and semantic characteristics of the concept of «ecosystem» are highlighted. A comparative parallel is drawn between the ecosystem of human resources of organizations and traditional HR management. The innovations in social and labor relations, also in the in social and labor interaction of economic agents in the ecosystem are defined. The mental model of the ecosystem of human resources as one of the local components of the socioeconomic system and the «product» of economic convergence is disclosed. The actualization of new, non-standard, hybrid forms of relationships and interactions between socioeconomic agents is underlined. Emphasis is placed on the post-industrial type of social and labor convergence. A comprehensive map has been proposed, which clearly reflects the authors? own vision of the structure and component saturation of the ecosystem of human resources of organizations. The primacy and dominance of social policy in a human-oriented society are substantiated. The complex dimension of the human-centeredness model is emphasized and the components of this model are allocated. The authors? assessments of the future of man in the era of digitalization against the background of pessimistic forecasts of the gurus of modern economic thought are presented. The authors express the conviction of the need to establish a new worldview and human-oriented thinking for the sake of a balanced and agnostic perspective of sustainable socioeconomic, including socio-labor, development

The use of low-invasive surgical procedures in the treatment of gunshot wounds of the liver.

The problem of diagnostics and stage surgical treatment of a combat trauma of the abdomen with liver damage is actual in conditions of increasing specific gravity of liver damage, accompanied by its severe functional insufficiency. The aim of the study was to improve the results of surgical treatment of gunshot wounds of the liver using minimally invasive surgical techniques. The analysis of surgical treatment of 23 men aged 19 to 49 years with gunshot liver damage at II-IV levels of medical care was carried out. Shock of I st. was observed in 5 (21.7%), II st. - in 8 (34,8%), III st. - 9 wounded (39.2%), IV st. - 1 woun­ded (4.3%), admitted in an agonizing condition. At the second level of medical care, 12 wounded underwent lapa­roscopic operations (52.1%). 11 wounded underwewnt laparotomy (47.9%) with the use of mechanical, physical and chemical methods of bleeding stopping. In 17 wounded (73.9%), concomitant lesions of other organs of the abdominal cavity and retroperitoneal space (stomach, small and large intestine, kidneys, spleen) were observed. Correction of concomitant damages was carried out according to generally accepted methods. At the IV level of medical care, three wounded (12.9%) underwent puncture and drainage of intrahepatic abscesses using ultrasound navigation. Ultrasound examination allowed to determine the degree of liver damage, localization of a foreign body and safe access to its removal. In the structure of gunshot wounds of the abdomen, liver damage makes up 19.2% and the most often is observed in combined shrapnel wounds. In 30.4% of cases of gunshot liver damages, the condition of the wounded is regarded as severe and critical, which requires immediate surgical and resuscitative measures. The use of minimally invasive techniques (video laparoscopy, interventional sonography) in the surgical treatment of gunshot liver injuries can improve results and avoid unreasonable laparotomies

Application of the method of ultrasound imaging in the removal of foreign bodies in gunshot wounds.

Data on the possibility of using ultrasound diagnostics when removing foreign bodies - bullets and fragments from body tissues during primary or repeated surgical treatment are rather limited. The aim of the research – improving the results of treatment of victims with gunshot fragmentation and bullet wounds by using a complex of ultrasound and X-ray navigation in the process of removing injurious elements during primary and repeated surgical treatment. The study included 214 wounded. In group I, the main group (122 wounded), the removal of fragments was carried out using a complex of X-ray and ultrasound navigation. In group II, the control group (92 wounded), only X-ray navigation was used. In group I during primary surgical treatment, foreign objects were removed in 101 (82.8%) of 122 injured and during secondary – in 17 (13.9%). In group 4 (3.3%) patients, the fragments were not visualized: in 1 - in the lateral region of the neck, in 1 - in the muscles of the leg, in 2 - in the chest wall. Complications were not observed. In group II, during primary surgical treatment, foreign objects were removed in 59 (64.1%), and in the secondary – in 18 (19.6%). The reasons for the failures were: deep lieying of fragments - in 6 (6.5%), location near large vessels - in 5 (5.4%), non-X-ray contrast foreign bodies - in 4 (4.3%). Among the complications, bleeding was observed in 2 wounded. The use of ultrasound navigation allows by 18.7% to increase the frequency of detection and removal of foreign bodies - bullets and fragments during the primary surgical treatment of a wound and to reduce the need for repeated interventions by 5.7%. The advantages of the method are: mobility, high information content in structural damages to soft tissues and verification of foreign bodies, the possibility of performing real-time, the absence of exposure to radiation

Особливості хірургічного лікування вогнепальних поранень живота

Особливості хірургічного лікування вогнепальних поранень живот

Application of the method of ultrasound imaging in the removal of foreign bodies in gunshot wounds.

Data on the possibility of using ultrasound diagnostics when removing foreign bodies - bullets and fragments from body tissues during primary or repeated surgical treatment are rather limited. The aim of the research – improving the results of treatment of victims with gunshot fragmentation and bullet wounds by using a complex of ultrasound and X-ray navigation in the process of removing injurious elements during primary and repeated surgical treatment. The study included 214 wounded. In group I, the main group (122 wounded), the removal of fragments was carried out using a complex of X-ray and ultrasound navigation. In group II, the control group (92 wounded), only X-ray navigation was used. In group I during primary surgical treatment, foreign objects were removed in 101 (82.8%) of 122 injured and during secondary – in 17 (13.9%). In group 4 (3.3%) patients, the fragments were not visualized: in 1 - in the lateral region of the neck, in 1 - in the muscles of the leg, in 2 - in the chest wall. Complications were not observed. In group II, during primary surgical treatment, foreign objects were removed in 59 (64.1%), and in the secondary – in 18 (19.6%). The reasons for the failures were: deep lieying of fragments - in 6 (6.5%), location near large vessels - in 5 (5.4%), non-X-ray contrast foreign bodies - in 4 (4.3%). Among the complications, bleeding was observed in 2 wounded. The use of ultrasound navigation allows by 18.7% to increase the frequency of detection and removal of foreign bodies - bullets and fragments during the primary surgical treatment of a wound and to reduce the need for repeated interventions by 5.7%. The advantages of the method are: mobility, high information content in structural damages to soft tissues and verification of foreign bodies, the possibility of performing real-time, the absence of exposure to radiation

The use of low-invasive surgical procedures in the treatment of gunshot wounds of the liver.

The problem of diagnostics and stage surgical treatment of a combat trauma of the abdomen with liver damage is actual in conditions of increasing specific gravity of liver damage, accompanied by its severe functional insufficiency. The aim of the study was to improve the results of surgical treatment of gunshot wounds of the liver using minimally invasive surgical techniques. The analysis of surgical treatment of 23 men aged 19 to 49 years with gunshot liver damage at II-IV levels of medical care was carried out. Shock of I st. was observed in 5 (21.7%), II st. - in 8 (34,8%), III st. - 9 wounded (39.2%), IV st. - 1 woun­ded (4.3%), admitted in an agonizing condition. At the second level of medical care, 12 wounded underwent lapa­roscopic operations (52.1%). 11 wounded underwewnt laparotomy (47.9%) with the use of mechanical, physical and chemical methods of bleeding stopping. In 17 wounded (73.9%), concomitant lesions of other organs of the abdominal cavity and retroperitoneal space (stomach, small and large intestine, kidneys, spleen) were observed. Correction of concomitant damages was carried out according to generally accepted methods. At the IV level of medical care, three wounded (12.9%) underwent puncture and drainage of intrahepatic abscesses using ultrasound navigation. Ultrasound examination allowed to determine the degree of liver damage, localization of a foreign body and safe access to its removal. In the structure of gunshot wounds of the abdomen, liver damage makes up 19.2% and the most often is observed in combined shrapnel wounds. In 30.4% of cases of gunshot liver damages, the condition of the wounded is regarded as severe and critical, which requires immediate surgical and resuscitative measures. The use of minimally invasive techniques (video laparoscopy, interventional sonography) in the surgical treatment of gunshot liver injuries can improve results and avoid unreasonable laparotomies