Artificial dermatitis and its complications: features of diagnosis and therapy

The article highlights the problem of artificial dermatitis (pathomimia) as a manifestation of a mental disorder. A direct correlation is shown between the severity of mental illness and the severity of injuries inflicted on the skin. It is shown that it is necessary to manage such patients with the participation of a psychiatrist and a dermatologist. Positive results of treatment of infected skin lesions using Levomekol® ointment are presented.Materials and methods. We observed 19 patients, 7 women and 12 men. All patients, even with shallow, but extensive excoriations, Levomekol® ointment was prescribed under a bandage with a superficial additional fixation with a Band-Aid bandage in order to prevent self-removal of the bandage.Results. All 19 patients had epithelialization of existing erosions and healing (the beginning of scarring) of ulcers. The healing time of self-injuries was as follows, depending on the depth of the lesion: surface erosion and excoriation‑2 days, deep excoriation – 5 days, surface ulcers: on the upper extremities and neck – 9 days, on the lower extremities‑11 days.Conclusions. 1) Psychosomatic disorders, most often encoded by dermatologists under the heading ‘artificial dermatitis (ArD)’, are one of the pressing problems of modern medicine at the intersection of psychiatry and dermatology. 2) The severity and depth of destructive manifestations of ArD on the skin directly correlates with the severity of mental disorders. 3) With deep and multiple skin injuries, already at the level of impulsive disorders, there is a high probability of secondary infection. With ulcerative defects, such infection occurs inevitably. 4) Levomekol® ointment is a drug not only with a proven antimicrobial and regenerating effect, but also with a proven possibility of use in wounds with a pronounced exudative component, with excoriations of any depth. 5) When applying Levomekol® ointment on a large surface or on deep ulcers, the possibility of systemic effects should be taken into account, according to the instructions (such effects were not recorded in the presented study).

Shaft Fractures in Patients Requiring Primary or Revision Total Knee Arthroplasty Can Be Successfully Treated with Long-Stemmed Implants without Additional Fixation

The aim of this study was to evaluate the bone union, complication rate, clinical and functional outcomes of long-stemmed total knee arthroplasty (TKA) in patients with periprosthetic femoral or tibial shaft fractures and in patients with femoral or tibial shaft fractures with coexisting advanced knee osteoarthritis (OA). This retrospective study comprised 25 patients who underwent surgery due to tibial or femoral shaft fractures: (1) with coexisting severe knee OA or (2) with a periprosthetic fracture requiring implant exchange. In all cases, fracture stabilization was performed intramedullary with the use of long-stemmed implants without the use of additional fixation material (plates, screws, or cerclage). Bone union was achieved in 22/25 patients (88%). One patient required revision with additional plate stabilization due to non-union, and asymptomatic partial bone union was observed in two cases. The group with periprosthetic fractures demonstrated good clinical (mean 73.1 ± 13.3) and moderate functional (mean 59.2 ± 18.8) outcomes in the Knee Society Scoring system (KSS). In the group with shaft fracture and coexisting OA significantly higher clinical (excellent results, mean 84.1 ± 11; p = 0.03) and functional (good results, mean 76.2 ± 20.6; p = 0.04) results were noted. There were no statistically significant differences in terms of range of motion (ROM) or complication rate between these two groups. One-stage TKA with a long-stemmed implant without the use of additional fixation material is an effective method for the treatment of femoral or tibial shaft fractures in patients who require joint replacement. Despite being technically demanding, the approach yields bone union and moderate to excellent clinical and functional outcomes with a relatively low complication rate.

Mathematical modeling of the osteosynthesis of the lower leg bones using a titanium mesh for their congenital pseudoarthrosis in the lower third

Background. Congenital pseudarthrosis of the lower leg bones belongs to the group of orphan diseases and manifests itself in non-union (pseudarthrosis) of the lower leg bones, which leads to the formation of deformity and shortening of the limb, and, as a result, is accompanied by a persistent violation of the limb’s supportability. To date, the question of choosing a surgical technique and optimal fixation in the surgical treatment of congenital pseudarthrosis of the lower leg bones remains unresolved. The purpose was to investigate the stress-strain state of the shin model with pseudarthrosis of its bones in the lower third during their osteosynthesis using a titanium mesh. Materials and methods. Osteosynthesis was simulated with an intramedullary nail, wires, and a block of bone grafts on both shin bones with the imposition of a titanium mesh over the grafts under the influence of two types of compression and torsion loads. Results. Studies have shown that additional fixation of the bone graft block with a titanium mesh allows reducing the stress level at almost all control points of the model of osteosynthesis of the lower leg bones in their congenital pseudarthrosis, both under compression and torsion. As the most positive changes, we can note a decrease in the stress values on the tibia around the nonunion line. This can be explained by the fact that the bone graft block reinforced with a titanium mesh takes on a great load. The same fact contributes to the increase in the level of stress at the lower border of the graft block and tibia. The negative factors include an increase in the level of stress along the line of non-union of the fibula. This is also explained by an increase in the modulus of elasticity of the bone graft block, which further loads the fibula. Conclusions. The use of a titanium mesh for additional fixation of the shin bones in the treatment of their congenital pseudarthrosis has a positive effect on the stress-strain state of the model, which is confirmed by a decrease in the stress level at almost all control points of the model, both under compression and torsion loads. The most positive changes are observed along the line of non-union of the tibia.

Organizational and methodological aspects of the selection of a wheelchair for children with cerebral palsy

The article gives definitions to the concepts of "rehabilitation", "habilitation", "individual rehabilitation program", "technical means of rehabilitation". The statistical data on primary disability of children with cerebral palsy in the city of Khabarovsk for the period 2016–2020 are presented. The characteristics of a wheelchair with additional fixation for patients with cerebral palsy are given. The requirements for the provision of disabled people with technical means of rehabilitation (wheelchairs) are noted, the principles of selection and the tasks that must be solved when using them are indicated. The method of correct determination of the parameters of the wheelchair is presented to help doctors of medical organizations in the preparation of referral documents for medical and social examination

Osteoporosis Delimit the Indication for Additional Fixation in Oblique Lumbar Interbody Fusion

Study design: A retrospective cohort study.Objective: To detect the boundary of indications of fixation in OLIF surgery.Methods: Review patients undergoing stand-alone or combined OLIF. Measure the disc height increment (ΔDH), foraminal height (FH), cage subsidence (CS). VAS and the ODI was used to evaluate low back pain and functionality. Multiple linear regression were used to determine the risk factors of CS.Results: A totle of 66 consecutive patients included. The BMD in combined group was significantly lower than that of stand-alone group(p=0.005). The combined group showed better FH maintenance at 6 months (p= 0.049) and last follow-up (p= 0.019). In combined group, tCS was significantly lower at all post-operation point (p≤0.001). BMD was a mild negative correlated factor for CS in combined group (r= -0.602, p= 0.001)and a strongly negative correlated factor in stand-alone group (r= -0.797, p< 0.001). Greater mCS significantly associated with worse VAS (r=0.685, p<0.001) and ODI (r=0.616, p<0.001) in stand-alone group, and this effect was significantly weakened in the combined group as VAS (r=0.427, p=0.033) and ODI (r=0.594, p=0.002). Patients with stand-alone OLIF were at risk of severe CS when BMD <-1.38, while those with combined OLIF had an equal risk when BMD < -4.77.Conclusions: The long-term fusion rates and functionality improvements of OLIF with or without fixation are comparable. Patients with BMD < -1.38 may not suitable for stand-alone procedure due to higher risk of severe CS and worse clinical outcomes. Additional fixation can extends the applicable boundary to a BMD = -4.77.

Verbalization of gender stereotypes as parts of language image of a holiday (based on the material of Ukrainian Soviet and modern journalism)

The article is devoted to the consideration of the stereotype phenomenon linguo-cognitive and linguo-pragmatic aspects. We define a stereotype in connection with the notion of a frame in cognitive linguistics and note its features such as substantial simplification and significant stability. The study was carried out on the material of two chronologically and qualitatively different segments of Ukrainian media discourse (Soviet and modern). The thematically outlined segment was selected for analysis: the texts about the holidays and written for the holidays, which usually have a wide audience and potentially affect the formation of public consciousness via recording the proclaimed evaluations in the world language picture. Therefore, attention is paid to the functional aspect of the studied linguistic units. It was found that gender stereotypes, that is, those that determine the characteristic roles of men and women, occupy the most prominent place among the stereotypes verbalized in holiday journalism. Their use is usually a representation of one of two basic strategies. The first one is the strategy of stereotype assertion, which is a verbal confirmation of its existence and at the same time serves for its additional fixation in the world language picture. The second is a strategy of disproving, or deconstruction of a stereotype, which at the linguistic level is realized through direct negation or antithesis. We come to the conclusion that the majority of gender stereotypes in Soviet texts are purely propagandistic, in line with ideology, that is, they form stereotypical images in the world picture according to the first named strategy, while in modern writings we see attempts to get free from totalitarian influence, which is clearly shown by the functioning of these cognitive structures in the strategy of deconstruction.

Additional fixation using a metal plate with bioresorbable screws and wires for robinson type 2B clavicle fracture

Simple clavicle shaft fracture typically achieves satisfactory union after treatment and does not result in complication with conservative treatment. Non-union or malunion can occur in displaced clavicle fractures or comminuted shaft fractures. Treatment of displaced comminuted clavicle shaft fractures is performed by holding together the free fragments with interfragmentary screws or wires and fixing them to the clavicle with a plate. Therefore, we performed interfragmentary fixation using open reduction and internal fixation with bioresorbable screws (Mg-Ca alloy, Resomet Bioresorbable bone screw; U&I Corp.) and bioresorbable wires (Mg-Ca alloy, Resomet Bioresorbable K-wire and pin, U&I Corp.) for displaced comminuted clavicle fractures (Robinson type 2B) and additionally used a metal plate. We expected decreased irritation and infection due to absorption after surgery. We report four cases that were treated in this way.

Biomechanical Analysis of Allograft Spacer Failure as a Function of Cortical-Cancellous Ratio in Anterior Cervical Discectomy/Fusion: Allograft Spacer Alone Model

The design and ratio of the cortico-cancellous composition of allograft spacers are associated with graft-related problems, including subsidence and allograft spacer failure. Methods: The study analyzed stress distribution and risk of subsidence according to three types (cortical only, cortical cancellous, cortical lateral walls with a cancellous center bone) and three lengths (11, 12, 14 mm) of allograft spacers under the condition of hybrid motion control, including flexion, extension, axial rotation, and lateral bending,. A detailed finite element model of a previously validated, three-dimensional, intact C3–7 segment, with C5–6 segmental fusion using allograft spacers without fixation, was used in the present study. Findings: Among the three types of cervical allograft spacers evaluated, cortical lateral walls with a cancellous center bone exhibited the highest stress on the cortical bone of spacers, as well as the endplate around the posterior margin of the spacers. The likelihood of allograft spacer failure was highest for 14 mm spacers composed of cortical lateral walls with a cancellous center bone upon flexion (PVMS, 270.0 MPa; 250.2%) and extension (PVMS: 371.40 MPa, 344.2%). The likelihood of allograft spacer subsidence was also highest for the same spacers upon flexion (PVMS, 4.58 MPa; 28.1%) and extension (PVMS: 12.71 MPa, 78.0%). Conclusion: Cervical spacers with a smaller cortical component and of longer length can be risk factors for allograft spacer failure and subsidence, especially in flexion and extension. However, further study of additional fixation methods, such as anterior plates/screws and posterior screws, in an actual clinical setting is necessary.