bluuebunny/crossref_metadata_2025 huggingface dataset:
Esofagitis eosinofílica: historia natural, diagnóstico y tratamiento
Authors: Riggioni Benavides Valeria , Gómez Hernández Cinthya , Alfaro Herrera José Carlos
Published: August 2020

La esofagitis eosinofílica es una enfermedad crónica mediada por el sistema inmune, que se basa principalmente en infiltración eosinofílica del esófago. Se presenta principalmente en sexo masculino. El factor de riesgo mayormente identificado es la atopia. Sus síntomas se encuentran relacionados a la enfermedad por reflujo gastroesofágico como la pirosis, náuseas,y dolor retroesternal asociado principalmente al ejercicio, epigastralgia y a la disfunción esofágica. Se identifica mediante biopsia por la presencia de 15 o más eosinófilos por campo de alto poder. Su complicación más frecuente es la estenosis esofágica. El tratamiento farmacológico, la dieta y la dilatación encapsulan los paradigmas de tratamiento.
Tumor de Klatskin en el adulto
Authors: González Chavarría Andrey , Rivera Fumero Silvana , Chacón González Constanza
Published: August 2020

El colangiocarcinoma hiliar, comúnmente conocido como tumor de Klatskin, es una neoplasia poco frecuente. Su etiopatogenia no es completamente conocida, pero se encuentra una fuerte asociación entre la inflamación crónica de la vía biliar, la colestasis y el desarrollo de colangiocarcinoma. Los principales factores de riesgo son la colangitis esclerosante primaria, las enfermedades fibroquísticas del hígado, infecciones hepáticas, hepatolitiasis, drogas y toxinas. Este tumor se caracteriza por presentar un cuadro clínico asintomático hasta estadíos avanzados. Su diagnóstico se realiza por medio de laboratorios e imagenología. El tratamiento se basa principalmente en cirugía, ya que no hay beneficios terapéuticos demostrados con el uso de radiación y/o quimioterapia.
Osteomielitis aguda: clasificación, fisiopatología y diagnóstico
Authors: Brenes Méndez Marco , Gómez Solorzano Natasha , Orozco Matamoros Dennis
Published: August 2020

La osteomielitis aguda es un proceso infeccioso e inflamatorio del hueso que puede involucrar desde la medula hasta la corteza. Se caracteriza por un periodo de evolución no mayor a dos semanas desde el inicio de los síntomas hasta el diagnóstico. Se clasifica frecuentemente según su etiología, anatomía y comorbilidades. La osteomielitis aguda se puede originar desde un foco infeccioso adyacente al hueso, por vía hematógena o inoculación directa. Suele ser unifocal, afectando frecuentemente a las metáfisis de huesos largos, especialmente fémur, tibia y húmero .El agente etiológico identificado en la mayoría de los casos independientemente del grupo de edad es el Staphylococcus aureus. La presentación clínica depende del grupo de edad y la etiología. El diagnóstico se basa en la historia clínica, exámenes de laboratorio y técnicas de imagen.
Fisiopatologia de la cascada isquemica y su influencia en la isquemia cerebral
Authors: Lizano Salas Marco , Mc Donald Molina Christa , Tully Sancho Stephanie
Published: August 2020

El accidente cerebrovascular isquémico es desencadenado por una serie de procesos bioquímicos producto de la interrupción del flujo sanguíneo cerebral. Involucra una mezcla compleja de diferentes acontecimientos biomoleculares que se originan y desarrollan a través de la cascada isquémica, generando excitotoxicidad, que en conjunto desencadenan la lesión celular irreversible. El estudio y comprensión de los diferentes procesos fisiopatológicos que ocurren en esta cascada permite conocer la síntesis de esta patología para poder desarrollar herramientas que le faciliten al clínico el diseño de estrategias de neuroprotección y detección anticipada para prevenir las consecuencias de la misma.
Inteligencia artificial y aprendizaje automático en medicina
Authors: Álvarez Vega Marianella , Quirós Mora Laura María , Cortés Badilla Mónica Valeria
Published: August 2020

El aprendizaje automático es una poderosa rama de la Inteligencia Artificial que se ha utilizado con éxito en distintas industrias. En los últimos años con la creciente disponibilidad de información clínica almacenada electrónicamente el campo médico se ha convertido en un ambiente ideal para el desarrollo y aplicación de estas nuevas tecnologías. El aprendizaje automático posee el potencial de mejorar los sistemas de salud, mediante el análisis de millones de datos clínicos se logran crear modelos pronósticos, de tamizaje y diagnósticos. Sin embargo, a pesar de ser evidente que el uso de métodos algorítmicos puede mejorar la calidad de los sistemas de salud y la vida de los pacientes, aún es necesario un adecuado proceso de validación para la implementación de estas tecnologías.
Actinomicosis pélvica asociado al uso de dispositivos uterinos
Authors: Palma Espinoza Marianela , Salas Jiménez Edwin
Published: August 2020

Actinomyces israelii es una bacteria anaerobia, gram positivo, no esporulada, ácido-resiste, comensal normal del aparato gastrointestinal, pero puede estar relacionado con infecciones y abscesos pélvicos. La mayoría de las pacientes se encuentran colonizadas y son asintomáticas. Produce síntomas inespecíficos y un cuadro ambiguo por lo que su diagnóstico es complejo. La actinomicosis pélvica es una de las presentaciones más infrecuentes existiendo pocos reportes en la literatura. La infección por Actinomyces israelii se describe como una complicación asociada al uso crónico (mayor de 5 años) del dispositivo intrauterino.
Fascitis necrotizante perineal
Authors: Rockbrand Campos Leyla Priscilla , Koutsowris Sáenz Stefanos , Carrillo Chavarría Alberto Carrillo
Published: August 2020

La fascitis necrotizante perineal, o gangrena de Fournier, es una entidad rara, sumamente grave, progresiva y con una importante tasa de mortalidad. Esta patología debe ser de manejo interdisciplinario donde se abarca terapia farmacológica y quirúrgica. Se presenta un adulto joven con historia de paraplejia, que ingresa con datos de shock séptico asociado a una amplia infección de tejidos blandos en área perineal, el cual se maneja con antibioticoterapia dirigida y abordaje quirúrgico temprano.
EXPERIMENTAL STUDY OF INFORMATION TECHNOLOGY OF INTEGRATED INDUCTION MOTORS CONDITION MONITORING
Authors: Chornyi Oleksii , Olga Chorna  , Mykola Guchenko  , Oleg Bisikalo  , Artem Artemenko
Published: August 2020

The article is devoted to study the process of  induction motors monitoring. In industry conditions, at real technological equipment the experimental researches of information technology were carried out to determine possible induction motors malfunctions, as well as to calculate their operation resource. The alternating current magnetic field induction, measured at induction motor stator, as well as acoustic signals accompanying its work were used as information features.
INVESTIGATION OF FACTORS, DETERMINING DISPERSITY OF COATING PARTICLES AT ARC SPUTTERING WITH PULSATING SPRAYING STREAM
Authors: Vyacheslav Royanov  , Irina Zakharova  , Mykyta Kriuchkov  , Valeriy Chigarev
Published: August 2020

The essence of the process of electric arc spraying, consists in melting the electrodes with an electric arc and continuous separation of the liquid metal formed at the ends of the electrodes, a stream of compressed air and dispersing it on the sprayed surfaceTo use the periodic removal of pulsating air flow of liquid metal from the ends of the electrodes, it is important to solve the problem of guaranteeing the exclusion of short circuits of electrodes in the complete absence of spray flow and constant continuous supply of electrodes to the combustion zone of the arc. short circuit and when the spray flow is turned on after a pause will ensure the separation and transportation of liquid metal from the ends of the electrodes on the sprayed surface.It is important to determine the optimal mass of liquid metal and the time of formation of a drop of liquid metal depending on the technological parameters of the sprayed electrodes and the energy level of the arc that melts the electrodes.Studies of the determining factors of this process, namely the parameters of the electric arc mode, diameter, material and feed rate of the electrodes are presented.
HYDROCHEMICAL AND SANITARY MICROBIOLOGICAL RESEARCH OF THE ELENA HILL SPRING WATERS IN THE NAKHUNAO COMMUNITY OF MARTVILI MUNICIPALITY
Authors: Manuchar Chiqovani  , Manoni Gabelashvili  , Marisabel Zarqua  , Nana Megrelishvili
Published: August 2020

Hydrochemical and sanitary microbiological research of the Elena Hill spring waters in the Nakhunao community of Martvili Municipality was done for the first time.The content of Mg2+, Ca2+, Fe3+, HCO3-, Cl-, I- ions was determined. Relatively simple and quick chemical and physico-chemical methods of good repeatability were selected for determination. Biogenic substances were determined by photometric method.Carbon dioxide, oxygen BOD5 and dry remains were also identified. Sanitary-microbiological studies were performed using the following methods: mesophilic aerobes and facultative anaerobes: МУК, 2.1.4 1184-03, common coliform bacteria − МУК 4.2. 1018-01 and Escherichia coli − 18963-73. Based on the experimental data, it was found that the spring water that being researched is low-mineralized, which is why their reaction is almost neutral. The above-mentioned ionic content in the studied spring waters is within the norm, and in some samples (mesophilic aerobes and facultative anaerobes, common coliform bacteria) are established that microbiological, such a marginal concentration of pollution that is harmless for human health and its use in drinking and agricultural terms is within the norm.
СУЧАСНІ ПІДХОДИ ДО РОЗРОБКИ НАНОСИСТЕМ ДОСТАВКИ ЛІКІВ
Authors: Bilan Olga , Brubaker Iryna , Marchenko-Tolsta Kateryna
Published: August 2020

The review investigates the latest developments in the field of application of nanotechnologies in the transportation of therapeutic agents, features and the advantages of using nanoscale drug delivery systems for the treatment of diseases, as well as further prospects of using this field in medicine. Modern drug delivery systems are characterized by target orientation, rapid response to the environment and the use of biocompatible and biodegradable nanomaterials which allow for the development of the next generation of more effective drugs. Interdisciplinary research in this fast-growing field provides opportunities to design and develop multifunctional devices that can accurately target and successfully administer the release and distribution of active ingredients in the body.
STAGES OF THE CURRENT STATE OF LAND FORESTRY PURPOSES AND FEATURES OF THEIR USE IN THE CONTEXT OF THE LEGAL REGIME
Authors: Bondar Volodymyr Nalkovych
Published: August 2020

The article analyzes the structure of the land fund, the distribution of Ukraine's forest area by predominant tree species, and states that the division of land by categories is a dynamic process, whenever in the course of economic activity on land there may be a need to change its purpose. Determining and changing the ownership of a land plot to a certain category of land is the prerogative of public authorities - state and local self-government, which are endowed with such powers. The analysis of forest cover in Ukraine in terms of natural zones and structure of land for forestry purposes in Ukraine, where from the total area of forestry lands and forests on other categories of lands is 10.8 million hectares, of which 9.7 million hectares are covered with forest vegetation. The analysis of the given data testifies to an uneven arrangement of the specified category of lands of the territory of Ukraine. In particular, they are concentrated mainly in Polissya and the Ukrainian Carpathians.The stages of legal regulation and use of forest lands are proposed. Regarding the solution of these two problems lies in the plane of decision-making on land use, establishing a socially optimal purpose of land, compliance with land legislation, promoting reforestation and afforestation; stimulating the preservation and increase of forest land productivity, which requires the use of levers of influence on land and forest users; irrational use of forest lands, which leads to loss of potential benefits of the landowner.
LESIONS OF RESPIRATORY SYSTEM IN PATIENTS WITH SYSTEMIC LUPUS ERYTHEMATOSUS:
Authors: Abrahamovych Ulyana , Abrahamovych Orest , Dutka Roman , Farmaha Marta , Romaniuk Olha
Published: August 2020

Introduction. The respiratory system lesions in patients with systemic lupus erythematosus have not been properly addressed by both clinicians and scientists yet, since the progression of these lesions is often asymptomatic. Objective. To identify and determine the nature and prevalence of respiratory system lesions in patients with systemic lupus erythematosus; to distinguish syntropic comorbid lesions, to determine their prevalence and their relationship with the age of patients, disease duration, and the severity of respiratory failure. Materials and methods. 370 patients (331 women and 39 men) with SLE were enrolled. They underwent comprehensive examinations and were stratified by age, duration, and the activity of SLE. The obtained data were processed in Microsoft Excel by means of descriptive statistics, χ2 test, and z-test for comparisons of two proportions; the relationships were considered to be statistically significant when p < 0.05. Results. 67.57% of patients with SLE had respiratory system lesions. Pneumosclerosis, pulmonary hypertension, pneumonitis, and pulmonary fibrosis were found to be syntropic comorbid lesions, i.e. pathogenetically associated with SLE. The prevalence of syntropic comorbid respiratory system lesions in patients with systemic lupus erythematosus depends on the age of patients, duration of the disease, and the severity of respiratory failure. Pneumosclerosis is more prevalent in elderly patients and patients with the SLE duration of more than 6 years. It was the cause of respiratory failure in 43.02% of patients; the condition was of the first degree of severity. Pulmonary hypertension is more prevalent in elderly patients and patients with the SLE duration of less than one year. It led to respiratory failure in 16.13% of patients; the respiratory failure was predominantly mild. Pneumonitis is more prevalent in young patients and patients with SLE duration of more than 10 years. It led to respiratory failure in 52.00% of patients, while 64.10% out of them had degree I respiratory failure. Pulmonary fibrosis is more prevalent in elderly patients and patients with the SLE duration of 1-5 years. It led to respiratory failure in 62.50% of patients, while 80.00% out of them had the first degree of this condition).
QUALITY ASSESSMENT, SPECIFICS OF ORGANIZATION AND PROVISION OF MEDICAL CARE TO STROKE PATIENTS ACCORDING TO THE HOSPITAL REGISTER OF VRCPH NAMED AFTER ACADEMICIAN O. I. YUSHCHENKO OF VRC AND VCCH EMS FOR THE PERIOD 2017-2019
Authors: Moskovko Serhiy Petrovych  , Fiks Dmytro Oleksandrovych  , Shayuk Alla Volodymyrivna  , Cherkasova Lyubov Anatoliyivna
Published: August 2020

Currently, one of the most important tasks is to improve the quality of medical services, which becomes possible in retrospective register analysis of medical and organizational technologies, which include algorithms for providing medical care, continuity of medical institutions, protocols for diagnosis and treatment of diseases. The stroke register was created on the basis of medical documentation of hospitals, which are the most typical for the Podillia region of Ukraine. Statistical processing of the results was performed using the licensed statistical package "Statistica 5.5" using parametric evaluation methods. Significant differences in the organization of the medical-diagnostic process and approaches to treatment have been established between the two medical institutions of Vinnytsia in the dynamics of time. There was a positive trend in the time of stroke treatment, the use of drugs with a high degree of evidence and the coverage of patients with specialized, multidisciplinary care in a stroke
ОСОБЕННОСТИ ФУНКЦИОНАЛЬНОГО СОСТОЯНИЯ ЭРИТРОЦИТОВ В УСЛОВИЯХ ГИПОКСИИ СМЕШАННОГО ГЕНЕЗА ПРИ ПОЛИТРАВМЕ
Authors: Matvieienko Mariia , Baranova Nadiia , Boiko Olena Volodymyrivna , Arora Sukesh
Published: August 2020

Остается открытым и актуальным вопрос изменений маркеров метаболизма эритроцитов исходя из патогенетических особенностей течения травматической болезни при политравме. Целью данного исследования явилось изучение функционального состояния эритроцитов в условиях развития гипоксии смешанного генеза у больных травматической болезнью. Для этого было проведено проспективное рандомизированное контролируемое клиническое исследование 120 пациентов на базе отделения политравмы. В крови определяли основные маркеры функционального состояния эритроцитов – лактат, пируват, 2,3-ДФГ, АТФ спектрофотометрическим. Выявлено то, что течение острого и раннего периодов травматической болезни сопровождается изменениями функционального состояния эритроцитов, о чем свидетельствуют снижение уровня АТФ и увеличение уровней лактата, 2,3-ДФГ, индекса лактат/пируват в остром периоде. Установлена связь между маркерами функционального состояния эритроцитов в момент поступления и развитием инфекционно-воспалительных осложнений, постгеморрагической анемии, посттравматической нефропатии.
МАРКЕРИ ОБМІНУ СПОЛУЧНОЇ ТКАНИНИ У ХВОРИХ З ДІАБЕТИЧНИМИ АРТРОПАТІЯМИ
Authors: Ivaskiva K. Yu.  , Orlenko V. L.  , Dobrovynska O. V.
Published: August 2020

The aim of study was to investigate markers of connective tissue metabolism (COMP level) and indicators that reflect the synthetic and catabolic phases of the metabolism of the main components of connective tissue - collagen and glycosaminoglycans in patients with diabetic arthropathy.The study involved 87 patients with diabetes. Patients were examined using a visual analogue scale of the Leken index and WOMAK. Cartilage oligomeric matrix Protein (COMP) was determined using enzyme immunoassay.Results. The presence of diabetic arthropathy was detected in 78% of patients with type 1 diabetes and in 80% of patients with type 2 diabetes. In the vast majority of patients, the joints of the upper extremities were involved in the pathological process. A direct correlation was established between the presence of arthropathy and the COMP level (r = 0.76, p = 0.001), the Leken index (r = 0.76, p = 0.001), YOUR scale (r = 0.88 , p = 0.001) and WOMAK (R = 0.88, p = 0.001). Patients with type 1 diabetes with joint damage are characterized by a compensatory increase in the synthesis of subchondral bone in response to increased collagen breakdown. For patients with type 1 diabetes with joint damage is characterized by a compensatory increase in subchondral bone synthesis in response to increased collagen breakdown.Conclusions: The results suggest that arthropathy in patients with type 1 and type 2 diabetes is characterized by an increase in the cartilage degradation marker in direct proportion to the severity and number of affected joints.
НАВИЧКИ ПРОТИДІЇ НАСИЛЬСТВУ В УЧНІВСЬКОЇ МОЛОДІ
Authors: Lavrentieva Iryna , Khomych Olena , Vorontsova Tetyana
Published: August 2020

У статті розглядається проблема насильства у середовищі сучасної учнівської молоді. Наводяться визначення понять «насильство», «булінг» та «насильство серед учнівської молоді», розглядаються психологічні портрети основних учасників насильства (кривдник, жертва, спостерігач). Описано види насильства (фізичне, психологічне, сексуальне) та найпоширеніші форми їх проявів серед учнівської молоді. Визначено основні фактори виникнення насильства в учнівському середовищі. Акцентується увага на тому, що проблема насильства має вирішуватися за умови співпраці представників державних органів, місцевої громади, закладів освіти та родин учнів. На підставі аналізу успішних превентивних практик, сформовано перелік ознак, які мають поєднувати успішні профілактичні  програми із практиками протидії насиллю. Зокрема, орієнтування таких програм і практик на формування та розвиток життєвих навичок, які спонукають до позитивних поведінкових зрушень. У статті визначено перелік життєвих навичок, які сприяють протидії та попередженню насильства.
МОТИВАЦІЙНО-ЦІННІСНА СКЛАДОВА ПІДГОТОВКИ МАЙБУТНЬОГО ВЧИТЕЛЯ ФІЗИЧНОЇ КУЛЬТУРИ ДО ЗДІЙСНЕННЯ ЗДОРОВ'ЯЗБЕРЕЖУВАЛЬНОЇ ДІЯЛЬНОСТІ
Authors: Tanasiichuk Iuliia
Published: August 2020

У статті здійснено аналіз мотиваційно-ціннісної складової підготовки майбутнього вчителя фізичної культури фізичної культури до здійснення здоров'язбережувальної діяльності. Встановлено, що її характеризує: зрілість і ієрархія мотивів в здоровому способі життя на основі ціннісних орієнтацій, ставлення майбутніх фахівців до здорового способу життя і своєї майбутньої професії як цінності. Звідси мотивуючі діяльність фактори розділені на три групи: потреби, мотиви, ціннісні орієнтації (установки). Можна вважати, що потреби (як джерело мотивації), мотиви (як причини мотивації) і установки (як механізм мотивації), є елементами першого рівня ієрархічної структури мотиваційної готовності. Доведено, щосі інші елементи є похідними від них. Зокрема, до похідних віднесено волю, емоції, цінності, потреби.Показниками мотиваційно-ціннісної сфери обрано: мотиваційну переконаність та ціннісне ставлення до професійної діяльності (націленість на формування ціннісного ставлення до власного здоров’я учнів засобами фізичної культури; переконання в необхідності формування здорового способу життя учнів), усвідомлення соціальної значущості здоров'я та способу життя, необхідного для формування, збереження і зміцнення здоров'я особистості; ціннісне ставлення до здоров'я своїх вихованців і власного здоров'я, усвідомлення здоров'я як цінності, можливості реалізувати свої потреби в здоров'ї в конкретній діяльності, формування позитивного ставлення і ціннісно-смислових установок, переконання в необхідності здорової життєдіяльності для самовдосконалення, самоствердження, для реалізації життєвих і професійних цілей; емоційно-ціннісне ставлення до здорового способу життя; дієвість вольових зусиль для прояву здоров’ятворчості в практичній діяльності, формування якостей, що характеризують психоемоційну стійкість особистості: витримки, тактовності, доброзичливості, акуратності і старанності у зміцненні здоров'я.
СОВРЕМЕННЫЙ НЕЙМИНГ В УКРАИНЕ В ЛИНГВОПРАГМАТИЧЕСКОМ ОСВЕЩЕНИИ
Authors: Syniavska Olga , Slukhai Nataliia
Published: August 2020

Коммерческая номинация в период глобализации, виртуализации, ускорения и симулякризации информационного потока, а также при учете влияния локальных условий становится средством отражения и одновременно активного воздействия на языковую и концептуальную картины мира потребителя, поэтому требует изучения в лингвопрагматическом аспекте, особенно в странах с нестабильной социо-политической ситуацией, к числу которых сегодня относится Украина. Статья посвящена изучению современного русскоязычного нейминга в Украине в аспекте лингвопрагматики. Представлены основные направления изучения нейминга и актуальные лингвистические проблемы в рамках каждого направления. В работе предложены лингвистические критерии создания адекватных неймов с учетом украинских реалий и рассмотрены типичные ошибки в области современного русскоязычного нейминга в Украине. Описаны основные методы определения лингвопрагматической эффективности коммерческих наименований: параметрический, метод факторного анализа, ассоциативного эксперимента, метод мотивационного анализа, социально-психологического анализа, имиджевый метод, метод оценки лояльности потребителей, метод формирования / оценки эмоциональной привязанности потребителя к бренду и другие. С целью определения лингвопрагматического потенциала неймов представлен параметрический анализ номинаций с учетом ряда приемов: определения субъективных ожиданий, выявления зрительных образов, определения субъективных предпочтений.
PARTICULARITIES OF THE SOCIO-PROFESSIONAL REHABILITATION OF PEOPLE AFTER STROKE
Authors: Glavan Aurelia
Published: August 2020

Stroke is the most representative pathology generating long-term disability, negatively influencing personal, social and professional life. Even if the vast majority of people acquire the autonomy of movement and self-service after stroke, the number of those who can be socio-professionally reintegrated remains very low. While for healthy people, work offers the satisfaction of material achievements, for a person with disabilities, work is a way of social inclusion. For these reasons, a study was conducted to monitor the process of socio-professional inclusion of post-stroke individuals.
SPECIFIC EDUCATIONAL INTERVENTIONS IN THE REHABILITATION OF COGNITIVE CAPACITIES OF ADULTS DUE TO A CEREBROVASCULAR ACCIDENT (EXPERIMENTAL INVESTIGATION)
Authors: Glavan Aurelia
Published: August 2020

An optimal cognitive functionality ensures the efficiency of day-to-day activities and a person's integration into the socio-economic environment. Cognition is not a unitary concept, it incorporates several domains: attention, memory, executive functions, perception and praxis, language. Cognitive functions are affected as a result of a cerebrovascular accident (CVA), manifested by a prevalence of 20% to 80% after a stroke. We have proposed an experimental investigation - the use of the Reuven Feuerstein theory in the cognitive rehabilitation of post-stroke individuals, thus overcoming the social disadvantage and contributing to improving their quality of life, through social inclusion. The principle of mediated learning has proven to be effective in improving the cognitive abilities of post-stroke individuals in addition to medical treatment, representing an alternative service offered by the specialists in cognitive therapy, thus being a quick and cost-effective way of recovering.
АДАПТАЦІЯ ТА ВАЛІДАЦІЯ АНГЛОМОВНОЇ ВЕРСІЇ ОПИТУВАЛЬНИКА ВІНЦЕНТА ВАН БРЮГГЕНА «ВИДИ ЕКЗИСТЕНЦІЙНОЇ ТРИВОГИ»
Authors: Kuchyna Valerie
Published: August 2020

У статті пропонуються результати адаптації української версії англомовного опитувальника В. Ван Брюггена (університет Твенте, Нідерланди) Existential Concerns Questionnaire (ECQ). На сьогодні в Україні (та серед російськомовних опитувальників також) не існувало інструменту для диференціації базових видів екзистенційної тривоги. Українська версія опитувальника отримала назву «Види екзистенційної тривоги». У теоретичній частині статті розглянуто природу і особливості екзистенційної тривоги із найдавніших часів до найсучасніших світових досліджень у сфері нейроекзистенціалізму та нейробіології екзистенціалізму, а також зроблено огляд основних англомовних опитувальників екзистенційної тривоги. Факторна структура англомовної версії опитувальника складається з п’яти шкал: страху смерті, самотності, ідентифікації, сенсу життя та провини. Проте, українська версія  була модифікована і скорочена до чотирьох шкал (страху смерті, самотності, ідентифікації та сенсу життя). Крім цього, в українській версії було запропоновано нову модель видів екзистенційної тривоги, що склалася із двох нових шкал (об’єктивна екзистенція та суб’єктивна екзистенція). Адаптацію методики здійснено згідно із стандартними алгоритмами роботи з іншомовними психодіагностичними інструментами: перекладено англомовну версію, перевірено внутрішню узгодженість, факторну структуру, конструктну, дискримінантну та конкурентну валідності. У досліджені взяв участь 251 респондент віком від 18 до 65 років. Опитувальник складається із 22 запитань.
Lumbar disc height and vertebral Hounsfield units: association with interbody cage subsidence
Authors: Pisano Alfred J. , Fredericks Donald R. , Steelman Theodore , Riccio Cory , Helgeson Melvin D. , Wagner Scott C.
Published: August 2020

OBJECTIVE

Postoperative subsidence of transforaminal lumbar interbody fusion (TLIF) cages can result in loss of lordosis and foraminal height, and potential recurrence of nerve root impingement. The objectives of this study were to determine factors associated with TLIF cage subsidence. Specifically, the authors sought to determine if preoperative disc height compared to cage height could be used to predict TLIF interbody cage subsidence, and if decreased postoperative vertebral Hounsfield units (HUs) predisposed to cage subsidence.

METHODS

The authors retrospectively reviewed all patients undergoing instrumented TLIF from two institutions between July 2004 and June 2014. The preoperative disc height was measured for the operative and adjacent-level disc on MRI. The difference between cage and disc heights was measured and compared between the subsidence and nonsubsidence groups. The average HUs of the L1 vertebral body were measured on CT scans.

RESULTS

Eighty-nine patients were identified with complete imaging and follow-up information. Forty-five patients (50.6%) had evidence of interbody cage subsidence on follow-up CT. The average cage subsidence was 5.5 mm (range 2.2–10.8 mm). The average implant height was significantly higher in the subsidence group compared to the nonsubsidence group (12.6 vs 11.2 mm). Additionally, the difference between cage height and preoperative adjacent-level disc height was also significantly larger in the subsidence group (3.8 vs 1.2 mm). First lumbar vertebral body (L1) HUs were significantly higher in the nonsubsidence versus the subsidence group (167.8 vs 137.71 HUs, p = 0.002). Multivariate logistic regression analysis identified suprajacent disc height and L1 HUs to be independent predictors of interbody cage subsidence. Receiver operating characteristic curves identified a suprajacent to cage height difference > 1.3 mm to have a 93.3% sensitivity for cage subsidence.

CONCLUSIONS

This study is the first of its kind to demonstrate the association between vertebral body HUs and suprajacent disc height with the development of interbody cage subsidence after TLIF. The authors found that patients with lower HUs in the L1 vertebral body were more likely to experience subsidence, regardless of surgical level. Additionally, the study demonstrated that interbody cage height > 1.3 mm above the height of the suprajacent level is an independent risk factor for cage subsidence, with 93.3% sensitivity. These findings suggest that these factors may be utilized to create a template preoperatively for intraoperative cage selection.
The association between lower Hounsfield units on computed tomography and cage subsidence after lateral lumbar interbody fusion
Authors: Xi Zhuo , Mummaneni Praveen V. , Wang Minghao , Ruan Huibing , Burch Shane , Deviren Vedat , Clark Aaron J. , Berven Sigurd H. , Chou Dean
Published: August 2020

OBJECTIVE

One vexing problem after lateral lumbar interbody fusion (LLIF) surgery is cage subsidence. Low bone mineral density (BMD) may contribute to subsidence, and BMD is correlated with Hounsfield units (HUs) on CT. The authors investigated if lower HU values correlated with subsidence after LLIF.

METHODS

A retrospective study of patients undergoing single-level LLIF with pedicle screw fixation for degenerative conditions at the University of California, San Francisco, by 6 spine surgeons was performed. Data on demographics, cage parameters, preoperative HUs on CT, and postoperative subsidence were collected. Thirty-six–inch standing radiographs were used to measure segmental lordosis, disc space height, and subsidence; data were collected immediately postoperatively and at 1 year. Subsidence was graded using a published grade of disc height loss: grade 0, 0%–24%; grade I, 25%–49%; grade II, 50%–74%; and grade III, 75%–100%. HU values were measured on preoperative CT from L1 to L5, and each lumbar vertebral body HU was measured 4 separate times.

RESULTS

After identifying 138 patients who underwent LLIF, 68 met the study inclusion criteria. All patients had single-level LLIF with pedicle screw fixation. The mean follow-up duration was 25.3 ± 10.4 months. There were 40 patients who had grade 0 subsidence, 15 grade I, 9 grade II, and 4 grade III. There were no significant differences in age, sex, BMI, or smoking. There were no significant differences in cage sizes, cage lordosis, and preoperative disc height. The mean segmental HU (the average HU value of the two vertebrae above and below the LLIF) was 169.5 ± 45 for grade 0, 130.3 ± 56.2 for grade I, 100.7 ± 30.2 for grade II, and 119.9 ± 52.9 for grade III (p < 0.001). After using a receiver operating characteristic curve to establish separation criteria between mild and severe subsidence, the most appropriate threshold of HU value was 135.02 between mild and severe subsidence (sensitivity 60%, specificity 92.3%). After univariate and multivariate analysis, preoperative segmental HU value was an independent risk factor for severe cage subsidence (p = 0.017, OR 15.694, 95% CI 1.621–151.961).

CONCLUSIONS

Lower HU values on preoperative CT are associated with cage subsidence after LLIF. Measurement of preoperative HU values on CT may be useful when planning LLIF surgery.
The association between lower Hounsfield units of the upper instrumented vertebra and proximal junctional kyphosis in adult spinal deformity surgery with a minimum 2-year follow-up
Authors: Duan Ping-Guo , Mummaneni Praveen V. , Rivera Joshua , Guinn Jeremy M. V. , Wang Minghao , Xi Zhuo , Li Bo , Wu Hao-Hua , Ames Christopher P. , Burch Shane , Berven Sigurd H. , Chou Dean
Published: August 2020

OBJECTIVE

Patients undergoing long-segment fusions from the lower thoracic (LT) spine to the sacrum for adult spinal deformity (ASD) correction are at risk for proximal junctional kyphosis (PJK). One mechanism of PJK is fracture of the upper instrumented vertebra (UIV) or higher (UIV+1), which may be related to bone mineral density (BMD). Because Hounsfield units (HUs) on CT correlate with BMD, the authors evaluated whether HU values were correlated with PJK after long fusions for ASD.

METHODS

The authors performed a retrospective study of patients older than 50 years who had undergone ASD correction from the LT spine to the sacrum in the period from October 2007 to January 2018 and had a minimum 2-year follow-up. Demographic and spinopelvic parameters were measured. HU values were measured on preoperative CT at the UIV, UIV+1, and UIV+2 (2 levels above the UIV) levels and were assessed for correlations with PJK.

RESULTS

The records of 127 patients were reviewed. Fifty-four patients (19 males and 35 females) with a mean age of 64.91 years and mean follow-up of 3.19 years met the study inclusion criteria; there were 29 patients with PJK and 25 patients without. There was no statistically significant difference in demographics or follow-up between these two groups. Neither was there a difference between the groups with regard to postoperative pelvic incidence (PI), sacral slope (SS), lumbar lordosis (LL), PI minus LL (PI-LL), thoracic kyphosis (TK), or sagittal vertical axis (SVA; all p > 0.05). Postoperative pelvic tilt (p = 0.003) and T1 pelvic angle (p = 0.014) were significantly higher in patients with PJK than in those without. Preoperative HUs at UIV, UIV+1, and UIV+2 were 120.41, 124.52, and 129.28 in the patients with PJK, respectively, and 152.80, 155.96, and 160.00 in the patients without PJK, respectively (p = 0.011, 0.02, and 0.018). Three receiver operating characteristic (ROC) curves for preoperative HU values at the UIV, UIV+1, and UIV+2 as a predictor for PJK were established, with areas under the ROC curve of 0.710 (95% CI 0.574–0.847), 0.679 (95% CI 0.536–0.821), and 0.681 (95% CI 0.539–0.824), respectively. The optimal HU value by Youden index was 104 HU at the UIV (sensitivity 0.840, specificity 0.517), 113 HU at the UIV+1 (sensitivity 0.720, specificity 0.517), and 110 HU at the UIV+2 (sensitivity 0.880, specificity 0.448).

CONCLUSIONS

In patients undergoing long-segment fusions from the LT spine to the sacrum for ASD, PJK was associated with lower HU values on CT at the UIV, UIV+1, and UIV+2. The measurement of HU values on preoperative CTs may be a useful adjunct for ASD surgery planning.
Minimally invasive spinal fixation in an aging population with osteoporosis: clinical and radiological outcomes and safety of expandable screws versus fenestrated screws augmented with polymethylmethacrylate
Authors: Gazzeri Roberto , Panagiotopoulos Konstantinos , Galarza Marcelo , Bolognini Andrea , Callovini Giorgio
Published: August 2020

OBJECTIVE

The goal of this study was to compare the clinical and radiological outcomes between fenestrated pedicle screws augmented with cement and expandable pedicle screws in percutaneous vertebral fixation surgical procedures for the treatment of degenerative and traumatic spinal diseases in aging patients with osteoporosis.

METHODS

This was a prospective, single-center study. Twenty patients each in the expandable and cement-augmented screw groups were recruited. Clinical outcomes included visual analog scale (VAS), Oswestry Disability Index (ODI), and satisfaction rates. Radiographic outcomes comprised radiological measurements on the vertebral motion segment of the treated levels. Intraoperative data including complications were collected. All patients completed the clinical and radiological outcomes. Outcomes were compared preoperatively and postoperatively.

RESULTS

An average shorter operative time was found in procedures in which expandable screws were used versus those in which cement-augmented screws were used (p < 0.001). No differences resulted in perioperative blood loss between the 2 groups. VAS and ODI scores were significantly improved in both groups after surgery. There was no significant difference between the 2 groups with respect to baseline VAS or ODI scores. The satisfaction rate of both groups was more than 85%. Radiographic outcomes also showed no significant difference in segment stability between the 2 groups. No major complications after surgery were seen. There were 4 cases (20%) of approach-related complications, all in fenestrated screw procedures in which asymptomatic cement extravasations were observed. In 1 case the authors detected a radiologically evident osteolysis around a cement-augmented screw 36 months after surgery. In another case they identified a minor loosening of an expandable screw causing local back discomfort at the 3-year follow-up.

CONCLUSIONS

Expandable pedicle screws and polymethylmethacrylate augmentation of fenestrated screws are both safe and effective techniques to increase the pullout strength of screws placed in osteoporotic spine. In this series, clinical and radiological outcomes were equivalent between the 2 groups. To the authors’ knowledge, this is the first report comparing the cement augmentation technique versus expandable screws in the treatment of aging patients with osteoporosis.
Hounsfield units of the vertebral body and pedicle as predictors of pedicle screw loosening after degenerative lumbar spine surgery
Authors: Xu Fei , Zou Da , Li Weishi , Sun Zhuoran , Jiang Shuai , Zhou Siyu , Li Zhuofu
Published: August 2020

OBJECTIVE

The authors aimed to compare the efficacy of lumbar vertebral body Hounsfield units (HUs) and pedicle HUs at predicting pedicle screw loosening.

METHODS

The authors retrospectively assessed 143 patients with L3–5 instrumentation. The patients were classified into one of two groups based on the status of their L3 screws (a screw loosening group or a control group). The pedicle HUs and vertebral HUs of L3 were measured using preoperative lumbar CT scans, and the pedicle HUs were measured in two ways: by excluding or by including cortical bone.

RESULTS

The screw loosening rate was 20.3% (n = 29/143) at the 12-month follow-up. The vertebral body HUs and pedicle HUs in the screw loosening group were lower than those in the control group (vertebral body group: 98.6 HUs vs 121.4 HUs, p < 0.001; pedicle excluding cortical bone: 208.9 HUs vs 290.5 HUs, p = 0.002; pedicle including cortical bone: 249.4 HUs vs 337.5 HUs, p < 0.001). The pedicle HUs tended to have a higher area under the receiver operating characteristic curve value in predicting screw loosening, compared with that of vertebral body HUs, but the difference was not statistically significant (p > 0.05). Among patients with low vertebral body HUs of ≤ 130, the loosening rate was much lower in patients with pedicle HUs of ≤ 340 than in those with pedicle HUs of > 340 (31.0% vs 13.0%, respectively; p < 0.05).

CONCLUSIONS

Vertebral body HUs alone are insufficient to accurately evaluate the risk of pedicle screw loosening. Therefore, it is important to collect both the pedicle HU and vertebral body HU measurements for surgical planning.
Do we underdiagnose osteoporosis in patients with pyogenic spondylodiscitis?
Authors: Bettag Christoph , Abboud Tammam , von der Brelie Christian , Melich Patrick , Rohde Veit , Schatlo Bawarjan
Published: August 2020

OBJECTIVE

Pyogenic spondylodiscitis affects a fragile patient population. Surgical treatment in cases of instability entails instrumentation, and loosening of this instrumentation is a frequent occurrence in pyogenic spondylodiscitis. The authors therefore attempted to investigate whether low bone mineral density (BMD)—which is compatible with the diagnosis of osteoporosis—is underdiagnosed in patients with pyogenic spondylodiscitis. How osteoporosis was treated and how it affected implant stability were further analyzed.

METHODS

Charts of patients who underwent operations for pyogenic spondylodiscitis were retrospectively reviewed for clinical data, prior medical history of osteoporosis, and preoperative CT scans of the thoracolumbar spine. In accordance with a previously validated high-fidelity opportunistic CT assessment, average Hounsfield units (HUs) in vertebral bodies of L1 and L4 were measured. Based on the validation study, the authors opted for a conservative cutoff value for low BMD, being compatible with osteoporosis ≤ 110 HUs. Baseline and outcome variables, including implant failure and osteoporosis interventions, were entered into a multivariate logistic model for statistical analysis.

RESULTS

Of 200 consecutive patients who underwent fusion surgery for pyogenic spondylodiscitis, 64% (n = 127) were male and 66% (n = 132) were older than 65 years. Seven percent (n = 14) had previously been diagnosed with osteoporosis. The attenuation analysis revealed HU values compatible with osteoporosis in 48% (95/200). The need for subsequent revision surgery due to implant failure showed a trend toward an association with estimated low BMD (OR 2.11, 95% CI 0.95–4.68, p = 0.067). Estimated low BMD was associated with subsequent implant loosening (p < 0.001). Only 5% of the patients with estimated low BMD received a diagnosis and pharmacological treatment of osteoporosis within 1 year after spinal instrumentation.

CONCLUSIONS

Relying on past medical history of osteoporosis is insufficient in the management of patients with pyogenic spondylodiscitis. This is the first study to identify a substantially missed opportunity to detect osteoporosis and to start pharmacological treatment after surgery for prevention of implant failure. The authors advocate for routine opportunistic CT evaluation for a better estimation of bone quality to initiate diagnosis and treatment for osteoporosis in these patients.
Regional improvements in lumbosacropelvic Hounsfield units following teriparatide treatment
Authors: Flanigan Patrick M. , Mikula Anthony L. , Peters Pierce A. , Oushy Soliman , Fogelson Jeremy L. , Bydon Mohamad , Freedman Brett A. , Sebastian Arjun S. , Currier Bradford L. , Nassr Ahmad , Kennel Kurt A. , Anderson Paul A. , Polly David W. , Elder Benjamin D.
Published: August 2020

OBJECTIVE

Opportunistic Hounsfield unit (HU) determination from CT imaging has been increasingly used to estimate bone mineral density (BMD) in conjunction with assessments from dual energy x-ray absorptiometry (DXA). The authors sought to compare the effect of teriparatide on HUs across different regions in the pelvis, sacrum, and lumbar spine, as a surrogate measure for the effects of teriparatide on lumbosacropelvic instrumentation.

METHODS

A single-institution retrospective review of patients who had been treated with at least 6 months of teriparatide was performed. All patients had at least baseline DXA as well as pre- and post-teriparatide CT imaging. HUs were measured in the pedicle, lamina, and vertebral body of the lumbar spine, in the sciatic notch, and at the S1 and S2 levels at three different points (ilium, sacral body, and sacral ala).

RESULTS

Forty patients with an average age of 67 years underwent a mean of 20 months of teriparatide therapy. Mean HUs of the lumbar lamina, pedicles, and vertebral body were significantly different from each other before teriparatide treatment: 343 ± 114, 219 ± 89.2, and 111 ± 48.1, respectively (p < 0.001). Mean HUs at the S1 level for the ilium, sacral ala, and sacral body were also significantly different from each other: 124 ± 90.1, −10.7 ± 61.9, and 99.1 ± 72.1, respectively (p < 0.001). The mean HUs at the S2 level for the ilium and sacral body were not significantly different from each other, although the mean HU at the sacral ala (−11.9 ± 52.6) was significantly lower than those at the ilium and sacral body (p = 0.003 and 0.006, respectively). HU improvement occurred in most regions following teriparatide treatment. In the lumbar spine, the mean lamina HU increased from 343 to 400 (p < 0.001), the mean pedicle HU increased from 219 to 242 (p = 0.04), and the mean vertebral body HU increased from 111 to 134 (p < 0.001). There were also significant increases in the S1 sacral body (99.1 to 130, p < 0.05), S1 ilium (124 vs 165, p = 0.01), S1 sacral ala (−10.7 vs 3.68, p = 0.04), and S2 sacral body (168 vs 189, p < 0.05).

CONCLUSIONS

There was significant regional variation in lumbar and sacropelvic HUs, with most regions significantly increasing following teriparatide treatment. The sacropelvic area had lower HU values than the lumbar spine, more regional variation, and a higher degree of correlation with BMD as measured on DXA. While teriparatide treatment resulted in HUs > 110 in the majority of the lumbosacral spine, the HUs in the sacral ala remained suggestive of severe osteoporosis, which may limit the effectiveness of fixation in this region.