[Possible routes of infection in hip replacement]. / Vozmozhnye puti infitsirovaniya pri endoprotezirovanii tazobedrennogo sustava.

OBJECTIVE: To evaluate the probability of direct inoculation of pathogens into the bone bed by surgical instruments and implants. MATERIAL AND METHODS: The study included 22 patients who underwent surgery at the Vreden National Medical Research Center of Traumatology and Orthopedics. Mean age was 73.3±3.7 years. These patients underwent total hip replacement. Intraoperative skin scrapings within the wound edge were made. Pressure on the scalpel was applied in two fashions. In 10 cases, scraping was performed by minimally pressure on the skin (superficial contact). In 12 cases, scalpel was pressed with force (skin deformation to a depth of 3-4 mm). Next, microbiological analysis of scrapings was performed. RESULTS: There was no growth of microorganisms in samples obtained by minimal pressure on the scalpel. Analysis of 12 scrapings in the second group (tight contact simulating damage to the skin with surgical instruments) revealed growth of microflora in all cases. CONCLUSION: Contact of cutters, rasps and implants with skin can be a mechanism for direct inoculation of pathogens into the bone tissue and potentially cause periprosthetic infection.

Early outcomes of using custom-made augments in revision total hip arthroplasty.

INTRODUCTION: The continuing high demand for revision total hip arthroplasty (RTHA) requires not only additional economic costs, but also the search for new, effective methods to manage the reconstruction of acetabular bone loss. This study focuses on the assessment of the clinical and radiographic outcomes after RTHA using custom-made augments (CMA) in the short-term follow-up period. MATERIALS AND METHODS: We retrospectively analyzed the results of using CMAs in 19 patients (20 hips). The average follow-up period was 41.3 months. All surgery was performed on defect types III and IV as per the Gross and Saleh classification. RESULTS: There was a statistically significant difference when comparing the Oxford Hip Score before RTHA of 15.0 (Std. deviation-5.9) and after RTHA of 36.3 (Std. deviation-6.3) (p = 0.01). All implants were radiologically stable. CMA has demonstrated a good ability to restore position of hip centre of rotation (HCOR). In the postoperative period, two patients (2 hips) had dislocations. Only one of two patients underwent re-revision due to dislocation. CONCLUSION: Treatment of uncontained loss of bone stock in RTHA using CMA shows promising clinical and radiographic results at short-term follow-up period; however, dislocation rate is 10% in this study.

Probing Gluon Spin-Momentum Correlations in Transversely Polarized Protons through Midrapidity Isolated Direct Photons in p

Studying spin-momentum correlations in hadronic collisions offers a glimpse into a three-dimensional picture of proton structure. The transverse single-spin asymmetry for midrapidity isolated direct photons in p^{↑}+p collisions at sqrt[s]=200 GeV is measured with the PHENIX detector at the Relativistic Heavy Ion Collider (RHIC). Because direct photons in particular are produced from the hard scattering and do not interact via the strong force, this measurement is a clean probe of initial-state spin-momentum correlations inside the proton and is in particular sensitive to gluon interference effects within the proton. This is the first time direct photons have been used as a probe of spin-momentum correlations at RHIC. The uncertainties on the results are a 50-fold improvement with respect to those of the one prior measurement for the same observable, from the Fermilab E704 experiment. These results constrain gluon spin-momentum correlations in transversely polarized protons.

Millisecond dynamics of deformation bands during discontinuous creep in an AlMg polycrystal.

Formation of bands of macroscopic strain localization during staircase creep in an AlMg polycrystal is studied by the acoustic emission (AE) technique and high-speed video recording with an image acquisition rate up to 50 000 frames per second. The simultaneous measurements by two methods allow us to distinguish different types of embryo deformation bands and concomitant AE signals, and to establish correlations between the band evolution and the acoustic response. It is found that the fastest stages of band formation, associated with its emergence to the surface and subsequent accelerated expansion, generate complex AE bursts in the frequency band ∼0.05-1 MHz. The correlations hidden in the complex structure of an individual acoustic burst are investigated by methods of statistical and fractal analysis. On the other hand, relationships between average parameters of various physical responses to discontinuous creep are assessed. Particularly, a close correspondence is found between the envelope of the acoustic burst and the rate of stress change during formation of a single deformation band. Evolution of dynamical behavior of embryo bands with increasing creep stress is discussed. Notably, a qualitative change in the AE waveform observed on approaching the ultimate stress is considered from the viewpoint of anticipation of the oncoming fracture.

[Mechanism of formation and morphological features of a gunshot injury to the chest and abdomen arising from the use of body armor]. / Mekhanizm obrazovaniya i morfologicheskie osobennosti ognestrel'noi travmy grudi i zhivota, voznikayushchei pri ispol'zovanii bronezhileta.

The features of a gunshot injury arising in the presence of body armor on the injured person are considered. The purpose of the work is to reveal the mechanisms of damage formation during non-penetration of an armored composition, during its penetration, as well as during external or internal rebound. The characteristic of damages arising with this is given. It was shown that injuries due to non-penetration of body armor are characterized mainly by local closed injuries, not only of integumentary soft tissues, but also of internal organs in the projection of impact of a wounding projectile. With through penetration of body armor, the severity and volume of gunshot damage increase due to the introduction of fragments of bullets, fragments of armored panels and pieces of equipment into the wound channel. Rebounding of elements of dismantled bullets from the outer or inner surface of the body armor can cause severe gunshot damage to both the wearer of body armor and other persons. Knowledge of the mechanisms of formation and morphological features of injuries that occur when using body armor are prerequisites for a full forensic medical assessment of the investigated incident.

[Features of an explosive lower extremities injury protected by sapper shoes]. / Osobennosti vzryvnoi travmy nizhnikh konechnostei, zashchishchennykh obuv'yu sapera.

The purpose of the work is to conduct experimental studies that reveal the characteristic features of explosive injuries of the lower extremities using various samples of sapper protective shoes of domestic and foreign production. The subjects of experiment were the amputated by medical reasons lower extremities of a person. The severity of explosive damage during contact blasting and the parameters of shock accelerations acting on the lower extremities, as well as approximate periods of disability and the forecast of possible disability, are determined. The results of the study can serve as initial data when testing safety shoes. In addition, using the proposed modeling technique, it is possible to compare the protective properties of various samples of anti-mine shoes, assess the presence (or absence) of signs of aggravation of damage during an anti-personnel mine detonation, and carry out a forensic medical assessment of an explosive injury.

[Mid-term and long-term results of metal-on-metal total hip arthroplasty]. / Srednesrochnye i otdalennye rezul'taty éndoprotezirovaniia tazobedrennogo sustava s ispol'zovaniem pary treniia metall-metall.

OBJECTIVE: To assess mid-term and long-term results of metal-on-metal total hip arthroplasty. MATERIAL AND METHODS: There were 349 operations for the period 2006-2012 in our clinic. Sixty-four patients underwent a full examination. All patients underwent X-ray examination of the pelvis, MRI of hip joint with metal artifact reduction sequence (MARS). The concentration of cobalt and chromium metal ions was determined in blood serum. Each patient completed a questionnaire (Harris, Oxford, Womac, SF-36). 'Survival' of endoprostheses was calculated using the Kaplan-Meier method. RESULTS: According to the Oxford scale, 76.6% of patients had excellent clinical and functional outcomes, 10.9% - good, 9.4% - satisfactory, 3.1% - unsatisfactory. According to the Harris scale, 57.9% of patients had excellent results, 15.6% - good, 7.8% - satisfactory, 18.7% - unsatisfactory. Inclination less than 45 degrees was noted in 77.2% of acetabular components. It is optimal installation angle. According to MRI data, effusion was the main type of periprosthetic changes (16 cases). There were no periprosthetic changes in 33 cases. Pseudotumor was diagnosed in 5 cases. Mean concentrations of cobalt and chromium ions were 1.27 (13.57-0.12) and 0.59 (0.4-0.87) µg/l, respectively. Normal concentration of chromium ions was observed in all cases. Kaplan-Meier survival rate of endoprostheses was 89% (80-97%). CONCLUSION: There was no correlation between female sex, young age of patients and incidence of complications. It is necessary to exclude pseudotumor in case of pain syndrome and no signs of aseptic loosening of the components of the endoprosthesis.

Nuclear Dependence of the Transverse Single-Spin Asymmetry in the Production of Charged Hadrons at Forward Rapidity in Polarized p+p, p+Al, and p+Au Collisions at sqrt[s_{NN}]=200 GeV.

We report on the nuclear dependence of transverse single-spin asymmetries (TSSAs) in the production of positively charged hadrons in polarized p^{↑}+p, p^{↑}+Al, and p^{↑}+Au collisions at sqrt[s_{NN}]=200 GeV. The measurements have been performed at forward rapidity (1.4<η<2.4) over the range of transverse momentum (1.8

[Additive technologies for complete recovery of joint function in revision endoprosthesis surgery (experimental trial)]. / Additivnaia tekhnologiia v polnom vosstanovlenii funktsii sustava pri éndoprotezirovanii (éksperimental'noe issledovanie).

AIM: Experimental analysis of the strength properties of integration of muscle tissue, tendons and ligaments, bone tissue into titanium highly porous materials prepared by using of additive technologies. MATERIAL AND METHODS: The study included 9 mature rabbits of the Chinchilla breed. Both posterior paws and latissimus dorsi muscles (36 specimens) were used. Titanium models (Ti-6-Al-4-V, 'Rematitan', Germany) were made by additive technologies with preliminary prototyping, the prototypes had a highly porous mesh structure. RESULTS: It was developed experimental model of functional bone defect involving points of attachment of the muscle and ligaments. Strength of attachment of muscles to highly porous implants was 145 H vs. 31 H for standard models. Tensile strength for fixation to bone tissue was 84 H vs. 152 H in the main group. CONCLUSION: It was found integration of soft tissues and bones into highly porous titanium implants prepared with additive technologies. Fixation strength significantly exceeds that for standard models.

[Clinical aspect of diagnostics of gastroesophageal reflux disease in elderly patients.]

Insufficient knowledge age peculiarities of gastroesophageal reflux disease (GERD) in the elderly against the background of its prevalence determine the high demand for studies on the topic. In an open study cohort by cross-sectional analysis was conducted clinical features GERD patients older age groups. By continuous sampling of 90 patients taken away: the main group - 45 persons 60-86, comparison group - 45 persons 25-59 years. Found that for GERD in patients older than 60 years has its own characteristics. Maximum observed incidence of GERD in the range of 60-69 years (57%) with a further reduction. More typical is a decrease in the frequency of heartburn (p<0,05) with increasing retrosternal pain (p<0,001) and dysphagia (p<0,05) and coughing (p<0,001) with simultaneous increase in the number of complaints from various organs and systems. In this case, deterioration of health associated with a statistically significant reduction in quality of life parameters when compared with the young. When survey by questionnaire SF-36 in elderly patients reported a more marked reduction of scales that characterize the physical and psychological health of the component against high polymorbidity. Identified features of the flow of GERD in the elderly, may be useful for streamlining diagnosis and therapy.

Measurements of Multiparticle Correlations in d+Au Collisions at 200, 62.4, 39, and 19.6 GeV and p+Au Collisions at 200 GeV and Implications for Collective Behavior.

Recently, multiparticle-correlation measurements of relativistic p/d/^{3}He+Au, p+Pb, and even p+p collisions show surprising collective signatures. Here, we present beam-energy-scan measurements of two-, four-, and six-particle angular correlations in d+Au collisions at sqrt[s_{NN}]=200, 62.4, 39, and 19.6 GeV. We also present measurements of two- and four-particle angular correlations in p+Au collisions at sqrt[s_{NN}]=200 GeV. We find the four-particle cumulant to be real valued for d+Au collisions at all four energies. We also find that the four-particle cumulant in p+Au has the opposite sign as that in d+Au. Further, we find that the six-particle cumulant agrees with the four-particle cumulant in d+Au collisions at 200 GeV, indicating that nonflow effects are subdominant. These observations provide strong evidence that the correlations originate from the initial geometric configuration, which is then translated into the momentum distribution for all particles, commonly referred to as collectivity.

Nuclear Dependence of the Transverse-Single-Spin Asymmetry for Forward Neutron Production in Polarized p+A Collisions at sqrt[s_{NN}]=200 GeV.

During 2015, the Relativistic Heavy Ion Collider (RHIC) provided collisions of transversely polarized protons with Au and Al nuclei for the first time, enabling the exploration of transverse-single-spin asymmetries with heavy nuclei. Large single-spin asymmetries in very forward neutron production have been previously observed in transversely polarized p+p collisions at RHIC, and the existing theoretical framework that was successful in describing the single-spin asymmetry in p+p collisions predicts only a moderate atomic-mass-number (A) dependence. In contrast, the asymmetries observed at RHIC in p+A collisions showed a surprisingly strong A dependence in inclusive forward neutron production. The observed asymmetry in p+Al collisions is much smaller, while the asymmetry in p+Au collisions is a factor of 3 larger in absolute value and of opposite sign. The interplay of different neutron production mechanisms is discussed as a possible explanation of the observed A dependence.

Resuscitative endovascular balloon occlusion of the aorta: what is the optimum occlusion time in an ovine model of hemorrhagic shock?

PURPOSE: The aim of this study is to evaluate the early survival and organ damage following 30 and 60 min of thoracic resuscitative endovascular balloon occlusion of the aorta (REBOA) in an ovine model of severe hemorrhagic shock. METHODS: Eighteen sheep were induced into shock by undergoing a 35 % controlled exsanguination over 30 min. Animals were randomized into three groups: 60-min REBOA 30 min after the bleeding (60-REBOA), 30-min REBOA 60 min after the bleeding (30-REBOA) and no-REBOA control (n-REBOA). Resuscitation with crystalloids and whole blood was initiated 20 and 80 min after the induction of shock. Animals were observed for 24 h with serial potassium and lactate measurements. Autopsy was performed to evaluate organ damage. RESULTS: Two animals of the n-REBOA group died within 90 min of shock induction; no hemorrhagic deaths were observed in the REBOA groups. Twenty-four-hour survival for the 60-, 30-, and n-REBOA groups was 0/6, 5/6, and 4/6 (P = 0.002). In 60-REBOA, potassium and lactate were increased at 270-min time point: from 4.3 to 5.1 mEq/l and from 3.7 to 5.1 mmol/L, respectively. Both these values were significantly higher than in the n-REBOA group (P = 0.029 for potassium and P = 0.039 for lactate). Autopsy revealed acute tubular necrosis in all died REBOA group animals. CONCLUSIONS: In this ovine model of severe hemorrhagic shock, REBOA can be used to prevent early death from hemorrhage; however, 60 min of occlusion results in significant metabolic derangement and organ damage that offsets this gain.

[Comparative characteristics of patients with gastroesophageal reflux disease in the age aspect]. / Sravnitel'naia kharakteristika patsientov s gastroézofageal'noi refliuksnoi bolezn'iu v vozrastnom aspekte.

AIM: To compare the characteristics of patients with gastroesophageal reflux disease (GERD) by age groups, a wide range of clinical signs, including life-of-quality (QOL) indicators, and instrumental findings. SUBJECTS AND METHODS: A total of 110 patients aged 18 to 86 years with GERD were examined in accordance with the standard protocol. Two groups with equal numbers of patents were formed. A study group included elderly and senile patients and a control group consisted of young and adult ones. RESULTS: The elderly patients with GERD were observed to have a number of age-related clinical features and age-unrelated symptoms. The scores in the scales characterizing the physical health component and those in the general health and vital activity scales were markedly decreased in patients older than 60 years of age. No age-related statistically significant differences were found in the esophageal, gastric, and duodenal mucosae. Daily pH-metry in the elderly showed indirect evidence for esophageal hypomotor dyskinesia in the predominance of alkaline refluxes. CONCLUSION: The cohort of elderly patients with GERD was ascertained to have statistically significant clinical characteristics, and QOL and pH-metry indicators, which will be able to improve methods for diagnosis and early prevention in this age group.

[A paradigm of early gonarthrosis: a review of the current diagnostic and treatment options (Part 1)]. / Paradigma rannego gonartroza: obzor sovremennykh vozmozhnostei diagnostiki i lecheniia (Chast' 1).

The prevalence of chronic joint diseases, among which osteoarthritis (OA) prevails, continues to grow worldwide. So far, many OA patients starting to get any kind of treatment only at the stage of organ failure, when the progression of the pathological process cannot be considerably delayed. The long-felt need for a change in thinking how to effectively diagnose and treat OA patients at early stage induced to prepare this review. Its first part is devoted to discussion of the limitations of traditional approaches and to analysis of the current diagnostic capabilities, particularly the clinical features of early OA, its morphological characteristics based on the magnetic resonance imaging and arthroscopic criteria, as well as the perspectives of biochemical and genetic markers implementation.

[Management of complex acetabulum fractures and their consequences]. / Lechenie slozhnykh perelomov vertluzhnoi vpadiny i ikh posledstvii.

In the structure of pelvic bone injuries, acetabular fractures are the most complex type and, according to different authors, account for up to 20% [1]. The severity of these injuries is confirmed by the fact that early descriptions of acetabular fracture were based only on the results of autopsies of patients who had suffered a combined injury. Thus, as early as 1788, Callisen reported an acetabular fracture, but without a detailed description of the nature of the injury. In 1909, Schroeder provided a detailed report of 49 cases of acetabular fractures reported in the literature. Most of them were described during autopsies of patients who died from complications associated with hemorrhagic shock or the onset of sepsis [2]. Fractures of the acetabulum in most observations are the result of high-energy impacts, usually as a result of traffic accidents; therefore, the mechanism of injury determines the combined and multiple nature of the injuries in the victims. A significant proportion of acetabular fractures (up to 60%) are accompanied by fragment displacement and dislocation of the femoral head, in which the most severe tissue changes occur [3].

[Comparative evaluation of effectiveness and safety of the local hemostatic agents in the experiment].

Comparative evaluation of effectivennes and safety of the local hemostatic agents in the experiment. On the model side damage the femoral artery of pigs we performed a comperative test of modern local hemostatic agents (LHA): bandages on the basis of chitosan <> (TG), eGemofleks Combat> (GC), (GB) bandages on kaolin-based <> (CG), and the usual bandage 10 cm x 3 m (control group). 25 animals were divided equally into 5 groups. After 45 seconds of bleeding from 6-mm side wound of femoral artery was used LHA with a three-minute external compression and wound edges approximation. In the case of the continuation-bleeding wounds performed re-tamponade with the second package of the LHA. Hemostasis after applying the first packet never recorded in the CG group, occurred in I out of 5 animals in the groups TG and GC, 2 of 5 animals in the group GB and the control group (p>0,05). Application of two packages LHA in the TG group, GB and the control group was effective in 3 of 5 animals and in groups CG and GC - in 2 of 5 animals (p>0,05). Mortality did not differ significantly between the groups. Thus, the conventional bandage wound with ordinary tamponade in this model is not less effective than current LHA.

[A NATURAL PLAGUE FOCUS. IN GORNYI ALTAI: FORMATION, DEVELOPMENT, AND FUNCTIONING].

The paper gives the results of analyzing the data of long-term studies of the natural focal pattern of plague in the Gornyi Altai natural focus. It describes a wide range of biological processes occurring in the focus and shows the most important patterns of its functioning as a complex multilevel ecological system. The key features of the formation of the focus have been revealed. The plague focus in South-Western Altai has formed relatively, recently, about half a century ago, then it has intensively developed and its enzootic area and the activity of epizootic manifestations have considerably increased. This process is due to the space-time transformations of the basic ecological and population characteristics of Pallas' pika (Ochotoma pallasi), the principal vector of the pathogen of plague and fleas parasitizing the mammal, which is in turn related to the aridization of mountain steppes in South-Western Altai.

PREVENTION OF VENOUS THROMBOEMBOLIC COMPLICATIONS IN REPLACEMENT ARTHROPLASTY PERFORMANCE IN PATIENTS WITH ASSOCIATED CHRONIC DISEASES OF LOWER EXTREMITIES VEINS.

A number of patients with problems of major joints increases every year. These patients need the replacement arthroplasty. The rate of thrombotic complications rises in given category of patients simultaneously with the increase of the number of performed operations. There weren't well-defined instructions of management of the patients with associated chronic vein diseases at the preparation period for arthroplasty performance in spite of the presence of clinical recommendations for prevention of thromboembolic complications. The authors analyzed the experience of management of such patients and presented these data for doctors from polyclinic and hospitals in order to apply the common treatment strategy.

POSSIBILITIES OF MODERN TECHNOLOGIES OF VISUALIZATION AND MODELING IN ORTHOPEDICS AND THEIR ROLE IN DEVELOPMENT OF INDIVIDUAL CONSTRUCTIONS IN HIP ARTHROPLASTY.

The article presents the authors' experience. Medical visualization is applied in orthopedics on all stages such as diagnostics, treatment planning and control of the results. Modern approaches in instrumental diagnostics and specialized application-dependent software allowed a new qualitative level of orthopedics and medical care in different areas of medicine. Modern technologies gave a lot of opportunities to doctors in order to improve diagnostics at higher level, make an individual planning of operations and built individual implants, when it wasn't possible to use standard constructions.