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Analysis of hardware methods of treatment of patients with temporomandibular joint dysfunction 颞下颌关节功能障碍患者的硬件治疗方法分析
Pub Date : 2024-01-15 DOI: 10.17816/pmj411120-131
A. A. Dolgalev, D. Y. Khristoforando, Ya. N. Garus, V. N. Ivensky, A. N. Brazhnikova, O. Y. Khorev, E. A. Bulycheva, P. N. Geletin, Z. V. Kerefova, Yu. V. Chepurko, O. A. Uspenskaya
Objective. To conduct a comparative analysis of effectiveness of treatment of patients with dysfunction of temporomandibular joint (DTMJ) using hardware methods of treatment with occlusive mouthguards of various types. Materials and methods. 99 patients (88 females and 11 males aged 41,2 ± 10,7) with different combinations of revealed and confirmed signs of DTMJ were examined from 2013 to 2023. According to the personal clinical picture, complaints revealed, aetiology and pathogenesis of the disease all the patients of the comparison group and 2 main groups (99 patients) were administered individual complex treatment for DTMJ. The treatment was aimed at the elimination of pain, relief of masticatory muscles spasm, improvement of the extent of opening of mouth, correction of the lower jaw position, occlusive interference elimination and restoration of height of the lower third of the face. While carrying out the hardware treatment, occlusive mouthguards of 3 types were made based on the jaw model of the patients. The models were got from the silicone imprints of the jaw. Results. MR images of temporomandibular joints of the 99 patients showed that ventral dislocation of articular disk occurred most frequently (in 88 patients). Less frequently (4 % of cases) it was combined with dislocation of the disk laterally. Rarely distal dislocation of the articular disk occurred – 1,9 % of cases (2 patients). Study of the results of the appliance of different types of occlusive mouthguards demonstrates the necessity to work out the types of occlusive devices allowing decompression of temporomandibular joint elements, centering lower jaw position and orthodontic elimination of dentofacial abnormalities and deformities which lead to occlusive interference. Conclusions. Analysis of occlusive devices used in the diagnosis and treatment of patients with DTMJ shows that the most effective devices are those that successfully combine elements of splints with a narrower purpose.
目的对颞下颌关节功能障碍(DTMJ)患者使用各种类型的闭塞性护齿的硬件治疗方法的疗效进行比较分析。材料和方法。自 2013 年至 2023 年,对 99 名具有不同颞下颌关节功能障碍显露和确诊体征组合的患者(88 名女性和 11 名男性,年龄为 41.2 ± 10.7 岁)进行了检查。根据个人临床症状、主诉、病因和发病机制,对对比组和两个主要组的所有患者(99 名患者)进行了 DTMJ 的个体综合治疗。治疗的目的是消除疼痛、缓解咀嚼肌痉挛、改善张口程度、矫正下颌位置、消除咬合干扰和恢复面部下三分之一的高度。在进行硬件治疗时,根据患者的下颌模型制作了 3 种类型的闭塞性护齿。这些模型来自颌骨的硅胶印模。结果99 名患者的颞下颌关节核磁共振图像显示,关节盘腹侧脱位发生率最高(88 名患者)。与关节盘侧向脱位同时发生的情况较少(4% 的病例)。很少发生关节盘远端脱位,占病例总数的 1.9%(2 名患者)。对不同类型的闭锁性护齿器使用效果的研究表明,有必要确定闭锁性护齿器的类型,以便对颞下颌关节元素进行减压,使下颌位置居中,并通过正畸消除导致闭锁性干扰的颌面部异常和畸形。结论对用于诊断和治疗 DTMJ 患者的咬合器械的分析表明,最有效的器械是那些成功结合了夹板元素的器械,其用途较窄。
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引用次数: 0
Clinical and morphological features and unsolved issues in diagnosis of aggressive forms of papillary thyroid carcinoma 侵袭性甲状腺乳头状癌的临床和形态特征以及诊断中的未决问题
Pub Date : 2024-01-15 DOI: 10.17816/pmj41190-107
D. V. Korotovsky, S. Sergiiko, S. A. Lukyanov
Differentiated thyroid cancer (DTC) is a disease with a favorable clinical course and high survival rate compared to other epithelial tumors. The majority of DTC (up to 85 %) is represented by various subtypes of papillary thyroid cancer (PTC). Aggressive forms of PTC characterized by early lymphogenous and hematogenous metastasis, low avidity to radioiodine therapy (RIT), low relapse-free survival rates and high mortality rate compared to other types of PTC occur among them. Preoperative diagnosis of PTC is based on the results of ultrasound (US) examination and fine-needle aspiration biopsy (FNA) with cytological examination of the aspirate. At the same time, the capabilities of cytological examination in determining the histological type of PTC are limited and it does not allow to predict its aggressiveness and plan adequate treatment. Molecular genetic tests of the tumor cytological and morphological material are effective in prognosis of aggressiveness of PTC due to the determination of specific mutations in the BRAF, TERT, RAS genes and the quantitative expression of oncogenic and tumor suppressive microRNAs. Some of these indicators are already used in the morphological classification of tumors of the endocrine system. At the same time, there are contradictory data concerning the connection of the molecular genetic portrait of PTC, the clinical manifestations of its aggressiveness (extrathyroidal invasion, early metastasis, and radioiodine resistance) and its pathomorphological structure. We tried to summarize and analyze the literature data regarding the diagnosis of aggressive variants of PTC.
与其他上皮性肿瘤相比,分化型甲状腺癌(DTC)的临床病程较长,存活率较高。大多数分化型甲状腺癌(高达85%)由甲状腺乳头状癌(PTC)的各种亚型构成。与其他类型的甲状腺乳头状癌相比,PTC具有侵袭性,其特点是早期淋巴转移和血行转移、对放射性碘治疗(RIT)的敏感性低、无复发生存率低和死亡率高。PTC 的术前诊断基于超声(US)检查和细针穿刺活检(FNA)的结果,并对穿刺物进行细胞学检查。同时,细胞学检查在确定 PTC 组织学类型方面的能力有限,无法预测其侵袭性和制定适当的治疗计划。通过对肿瘤细胞学和形态学材料进行分子遗传学检测,可以确定 BRAF、TERT、RAS 基因的特异性突变,以及致癌和抑癌 microRNA 的定量表达,从而有效预测 PTC 的侵袭性。其中一些指标已用于内分泌系统肿瘤的形态学分类。与此同时,关于 PTC 的分子遗传学特征、其侵袭性的临床表现(甲状腺外侵犯、早期转移和放射性碘耐药)及其病理形态学结构之间的联系,存在着相互矛盾的数据。我们试图总结和分析有关 PTC 侵袭性变异诊断的文献数据。
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引用次数: 0
Influence of vaccine prevention on the spread and serotype composition of Streptococcus pneumoniae in military collectives 疫苗预防对军队集体中肺炎链球菌的传播和血清型组成的影响
Pub Date : 2024-01-15 DOI: 10.17816/pmj411141-147
I. S. Mukhachev, A. S. Blagonravova, I. V. Feldblyum, Maia Kh. Alyeva
Objective. Study of the effect of vaccination against pneumococcal infection on the prevalence and serotype composition of S. pneumoniae in military personnel.Materials and methods. The study was conducted among 369 military personnel of the military unit of the Sverdlovsk region. Determination of the frequency and serotype of S. pneumoniae was carried out upon admission and after 1.5 months of stay in the military collective using the multiplex PCR method.Results. After 1.5 months of stay of servicemen in the military collective, a significant activation of pneumococcal circulation was established (χ2McNemar=24.038; p0.001). The risk of S. pneumoniae infection among unvaccinated military personnel was 1.39 times higher compared to vaccinated military personnel (RR=1.39; 95% CI 1.209–1.596). In the group of unvaccinated military personnel, the frequency of occurrence of vaccine serotypes was 2.6 times higher than in vaccinated ones (χ2 = 6.25; p = 0.01).Conclusions. The proactive influence of immunization against pneumococcal infection on the prevalence and serotype landscape of S. pneumoniae has been established: A low prevalence of vaccine serotypes and a predominance of non-typeable serotypes have been revealed among vaccinated individuals.
目的研究接种肺炎球菌疫苗对军人肺炎球菌感染率和血清型组成的影响。研究对象为斯维尔德洛夫斯克地区军队的 369 名军人。采用多重 PCR 方法对入院时和在军队集体居住 1.5 个月后的肺炎双球菌频率和血清型进行了测定。军人在军队集体居住 1.5 个月后,肺炎球菌循环明显活跃(χ2McNemar=24.038;P0.001)。未接种疫苗的军人感染肺炎球菌的风险是接种疫苗军人的 1.39 倍(RR=1.39;95% CI 1.209-1.596)。在未接种疫苗的军人群体中,疫苗血清型的出现频率是接种疫苗军人的 2.6 倍(χ2 = 6.25; p = 0.01)。肺炎球菌感染免疫接种对肺炎球菌流行率和血清型分布的积极影响已经得到证实:在接种疫苗的人群中,疫苗血清型的流行率较低,非类型血清型占主导地位。
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引用次数: 0
The organization of emergency medical care for the children's population during the COVID-19 pandemic 在 COVID-19 大流行期间为儿童组织紧急医疗服务
Pub Date : 2024-01-15 DOI: 10.17816/pmj411132-140
Maya V. Bogdanyants, Galina M. Minakova
Objective. To analyze the work of the emergency medical care department (EMCD) of the largest children's polyclinic of the city in 2020-2022 and to evaluate the organization of the EMC for the attached children during the Covid-19 pandemic. Materials and methods. Mathematical and statistical analysis of quantitative and qualitative indicators of EMCD activity based on a continuous sample of primary accounting and reporting medical documentation. Results. A significant increase in the number of EMCD visits was demonstrated. In 2022, the growth was 40,96 % and 28,12 % compared to 2020 and 2021. It was found out that in 97,4–98,0 % of all cases provided with EMC, were the children with respiratory diseases. Their number in 2022 increased 1,3 times compared to 2021, and 1,43 times compared to 2020. In this group of patients, the number of children with pneumonia increased by 63.5 % in 2021 compared to 2020. Conclusions. The proper organization of the work of the EMCD made it possible to provide children with available, timely and rapid primary medical social and emergency medical care during an increased workload in the context of the COVID-19 pandemic.
目的分析 2020-2022 年该市最大的儿童综合医院急诊科(EMCD)的工作,并评估 Covid-19 大流行期间急诊科对就诊儿童的组织情况。材料和方法根据原始记录和报告医疗文件的连续样本,对 EMCD 活动的定量和定性指标进行数学和统计分析。结果。EMCD就诊次数大幅增加。与 2020 年和 2021 年相比,2022 年的增长率分别为 40.96 % 和 28.12 %。研究发现,97.4%-98.0%的儿童患有呼吸道疾病。2022 年,他们的人数比 2021 年增加了 1.3 倍,比 2020 年增加了 1.43 倍。与 2020 年相比,2021 年患肺炎的儿童人数增加了 63.5%。结论在COVID-19大流行的背景下,EMCD工作的适当组织使得在工作量增加的情况下,能够为儿童提供可用、及时和快速的初级医疗社会和紧急医疗护理。
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引用次数: 0
The concentration of serum neopterin in patients with surgical treatment of spondyloarthrosis complicated byfacet syndrome 手术治疗脊柱关节病并发乙酰综合征患者的血清蝶呤浓度
Pub Date : 2024-01-15 DOI: 10.17816/pmj4115-12
Artur Yu. Pronin, Yulia Karakulova, D. Sosnin
Objective. To study the concentration of serum neopterin in patients before and after surgical treatment of pain syndrome caused by the formation of facet syndrome associated with spondyloarthrosis. Materials and methods. The study involved 52 patients (32 men and 20 women) hospitalized to the neurosurgical department of the City Clinical Hospital No. 4. The main group consisted of 26 patients with spondyloarthrosis complicated by chronic pain associated with facet syndrome. The comparison group (n=26) consisted of patients with pain syndrome in radiculopathy. The control group (comparable in gender and age) consisted of 10 people who underwent periodic examination. The concentration of neopterin in blood serum was determined by solid-phase enzyme immunoassay (ELISA) using the Neopterin ELISA kit (cat. No. 59321; lot ENO230) ("IBL", Germany). Results. Statistically significant differences in the level of serum neopterin concentration (p = 0.0016) were revealed between the studied groups. The highest concentration of neopterin was noted in the comparison group, where it was 10.31 ± 2.02 nmol/l, exceeding the results of the control group (p=0.02256) and the main group (p=0.04996). Three months after surgical treatment of patients in the main group, the median content of serum neopterin decreased by 1.161 times (p = 0.049029). Conclusion. Further studies to clarify the influence of pain on metabolic processes and neopterin in particular are required.
目的研究脊柱关节病相关面综合征形成引起的疼痛综合征手术治疗前后患者血清蝶呤的浓度。材料和方法。研究涉及在市第四临床医院神经外科住院的 52 名患者(32 名男性和 20 名女性)。主组包括 26 名脊柱关节病并发慢性疼痛且伴有面综合征的患者。对比组(n=26)由患有根病变疼痛综合征的患者组成。对照组(性别和年龄相当)由接受定期检查的 10 人组成。血清中蝶呤的浓度通过固相酶免疫测定法(ELISA)测定,使用的是蝶呤酶联免疫测定试剂盒(订货号:59321;批号:ENO230)("IBL",德国)。检测结果研究组之间的血清蝶呤浓度水平存在明显的统计学差异(p = 0.0016)。对比组的蝶呤浓度最高,为 10.31 ± 2.02 nmol/l,高于对照组(p=0.02256)和主要组(p=0.04996)。主要组患者手术治疗三个月后,血清蝶呤中位含量下降了 1.161 倍(p=0.049029)。结论是需要进一步研究疼痛对新陈代谢过程的影响,尤其是对胰岛素的影响。
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引用次数: 0
Predictors of changes in the course of breast cancer: the results of longitudinal study 乳腺癌病程变化的预测因素:纵向研究的结果
Pub Date : 2024-01-15 DOI: 10.17816/pmj41150-58
A. Vazhenin, Y. N. Pakhomova, I. Ponomareva, D. Tsiring, A. O. Ryazhkin
Objective. To investigate the predictors of changes in the course of breast cancer in a longitudinal study. Materials and methods. Women with the diagnosis of breast cancer underwent psychological diagnostics at the stage of diagnosis (n=201 at the first section of the longitudinal study, n=149 at the second section, n=94 at the third section, n=81 at the fourth section five years after the diagnosis). Methods of research: scale of basic beliefs, life orientations test, questionnaire “Ways of coping behavior”, test of vitality, questionnaire of subjective control, personal helplessness questionnaire, quality of life questionnaire. Results. Predictors of changes in the course of cancer are the basic belief “I-Image”, the level of vitality, the locus of control in relation to health, the course and stage of the disease. Conclusions. While conducting the study, it was found out that the course of the disease is associated with medical and psychological indicators. The data obtained as a result of the study are necessary for solving practical problems of increasing life expectancy and providing psychological care to women with breast cancer who are a socially vulnerable category of the population of the Russian Federation.
研究目的在一项纵向研究中调查乳腺癌病程变化的预测因素。材料和方法。确诊为乳腺癌的妇女在确诊阶段接受心理诊断(纵向研究第一阶段人数为 201 人,第二阶段人数为 149 人,第三阶段人数为 94 人,确诊五年后第四阶段人数为 81 人)。研究方法:基本信念量表、生活取向测试、"应对行为方式 "问卷、活力测试、主观控制力问卷、个人无助感问卷、生活质量问卷。研究结果预测癌症病程变化的因素包括 "我的形象 "基本信念、活力水平、与健康有关的控制感、病程和病期。结论在研究过程中发现,癌症的病程与医疗和心理指标有关。研究获得的数据对于解决延长预期寿命和向乳腺癌妇女提供心理护理等实际问题非常必要,因为乳腺癌妇女是俄罗斯联邦人口中的社会弱势群体。
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引用次数: 0
Dynamics of formation of anti- bodies to SARS-CoV-2 after coronavirus infection in children 儿童感染冠状病毒后 SARS-CoV-2 抗体形成的动态变化
Pub Date : 2024-01-15 DOI: 10.17816/pmj41113-23
I. K. Bogomolova, V. N. Peregoedova
Objective. To estimate the level of antibodies to SARS-CoV-2-IgM and SARS-CoV-2-IgG in children with COVID-19 in acute period and during 1 year period of follow-up after coronavirus infection. Materials and methods. Blood samples for the presence of IgM and IgG antibodies to SARS-CoV-2 were analyzed in 119 children aged 11.0 [10.1; 11.2] with COVID-19 in the acute period (29.4 % asymptomatic, 51.3 % mild and 19.3 % moderate), and SARS–CoV-2-IgG in the dynamics of the follow-up after 1 (n=55), 6 (n=33) and 12 (n=32) months from the moment of discharge from the hospital in a prospective cohort study. The levels of SARS-CoV-2 surface glycoprotein S, including the receptor-binding domain – RBD were measured at different time by using enzyme-linked immunosorbent assay. Results. The level of IgM positive rate for SARS-CoV-2 was initially negative in 86.6 % of children with COVID-19. The original seroconversion (on admission to the hospital) was 38.7 % and it increased to 96.7 % in 1 month and to 100 % in 12 months of observation. There were no statistically significant differences in IgG persistence depending on the age and course of COVID-19. Conclusions. The new coronavirus infection causes a long-term response of IgG antibodies to SARS-CoV-2 which persists for one year of observation and increases by 12 months after the infection regardless of the severity of COVID-19.
目的估计冠状病毒感染后急性期和 1 年随访期间 COVID-19 儿童的 SARS-CoV-2-IgM 和 SARS-CoV-2-IgG 抗体水平。材料和方法在一项前瞻性队列研究中,对 119 名年龄为 11.0 [10.1; 11.2]岁、急性期感染 COVID-19(29.4 % 无症状、51.3 % 轻度和 19.3 % 中度)的儿童进行了血样分析,以确定是否存在 SARS-CoV-2 的 IgM 和 IgG 抗体,并在出院后 1 个月(n=55)、6 个月(n=33)和 12 个月(n=32)的动态随访中检测 SARS-CoV-2-IgG 抗体。采用酶联免疫吸附法测定了不同时间的 SARS-CoV-2 表面糖蛋白 S(包括受体结合域 - RBD)水平。结果显示86.6%的 COVID-19 患儿最初的 SARS-CoV-2 IgM 阳性率为阴性。最初的血清转换率(入院时)为 38.7%,1 个月后上升到 96.7%,12 个月的观察后上升到 100%。在统计学上,不同年龄和COVID-19病程的IgG持续率没有明显差异。结论无论COVID-19的严重程度如何,新冠状病毒感染都会引起SARS-CoV-2 IgG抗体的长期反应,这种反应会持续观察一年,并在感染后12个月内增加。
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引用次数: 0
On applying “economical technologies” in children’s polyclinic 浅谈“经济技术”在儿童综合诊所的应用
Pub Date : 2023-06-02 DOI: 10.17816/pmj402100-107
E. A. Kochergina, R. N. Trefilov, I. G. Shinkarik, N. V. Minaeva
Objective. To analyze the work of childrens polyclinic within the framework of the projects Economical Production. An active prevalence and introduction of economical production concerns different spheres of human productive activities including office processes, service, management, social sphere and healthcare service. Materials and methods. The project Organization of entering stream of patients, visiting a district pediatrician at reception days for conditionally ill children was realized as the first one aimed at improvement of work of childrens polyclinic. Results. In April 2017, economical technologies in the sphere of community health protection were introduced in Perm Krai to improve the most problematic processes in the activity of polyclinics. Economic technologies help to raise the availability, quality and safety of medical care at the expense of creating optimal logistics of patients streams, organization of ergonomics of working space, effective use of medical technique and equipment. An important element of success regarding the economical production is involvement of workers in improvement of processes as well as devotion of the head of organization to design work. It was shown at the example of childrens polyclinic how the improvement projects were realized; the standards of the improved processes of other medical institutions were introduced. Conclusions. One of improvement projects, its stages and the list of countermeasures for elimination of the causes of the revealed problems is described in details; the results of the other realized projects are presented. The major part of solutions regarding the improvement within the framework of economical production in the sphere of public healthcare are organizational and do not require additional material costs.
目标。分析在经济生产项目框架下儿童综合诊所的工作。经济生产的积极普及和引入涉及人类生产活动的不同领域,包括办公流程、服务、管理、社会领域和医疗保健服务。材料和方法。“组织病人进入队列,在接待有条件患病儿童的日子拜访地区儿科医生”项目是第一个旨在改善儿童综合诊所工作的项目。结果。2017年4月,在彼尔姆边疆区引入了社区卫生保护领域的经济技术,以改善综合诊所活动中最棘手的流程。经济技术有助于提高医疗保健的可得性、质量和安全性,但代价是为病人流建立最佳后勤、组织工作空间的人体工程学、有效利用医疗技术和设备。经济生产成功的一个重要因素是工人参与改进工艺,以及组织负责人对设计工作的投入。以儿童综合医院为例,说明了改进工程是如何实现的;介绍了其他医疗机构改进流程的标准。 结论。详细介绍了其中一项改进工程、改进阶段及发现问题原因的消除对策清单;文中还介绍了其他已实现项目的结果。在公共保健领域的经济生产框架内改进的解决方案的主要部分是组织性的,不需要额外的物质成本。
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 Materials and methods. The project Organization of entering stream of patients, visiting a district pediatrician at reception days for conditionally ill children was realized as the first one aimed at improvement of work of childrens polyclinic.
 Results. In April 2017, economical technologies in the sphere of community health protection were introduced in Perm Krai to improve the most problematic processes in the activity of polyclinics. Economic technologies help to raise the availability, quality and safety of medical care at the expense of creating optimal logistics of patients streams, organization of ergonomics of working space, effective use of medical technique and equipment. An important element of success regarding the economical production is involvement of workers in improvement of processes as well as devotion of the head of organization to design work. It was shown at the example of childrens polyclinic how the improvement projects were realized; the standards of the improved processes of other medical institutions were introduced.
 Conclusions. One of improvement projects, its stages and the list of countermeasures for elimination of the causes of the revealed problems is described in details; the results of the other realized projects are presented. The major part of solutions regarding the improvement within the framework of economical production in the sphere of public healthcare are organizational and do not require additional material costs.","PeriodicalId":490955,"journal":{"name":"Perm Medical Journal","volume":"2 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-06-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136000937","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
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Perm Medical Journal
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