Наблюдение пациентов после эндопротезирования тазобедренного и коленного суставов: обзор литературы и доклад о пилотном проекте Национального медицинского исследовательского центра травматологии и ортопедии им. Р.Р. Вредена

Background. Today in our country, the follow-up of patients after arthroplasty is carried out in accordance with clinical guidelines, the wording of which is based on monographs from 2006, 2008, and 2014, in addition, clinical guidelines for follow-up do not take into account the results of treatment assessed by the patient himself. The purpose of this study was to examine existing systems and develop a proprietary follow-up system for patients after hip and knee arthroplasty. Results. A review of the literature revealed that follow-up of patients after arthroplasty is an unsolved problem, within which there is low coverage, reluctance or forgetfulness of the asymptomatic patient, the problem of accessibility of medical examinations, and an excessive financial burden on the health care system. Since 2022, fixed recommendations for follow-up after arthroplasty have been used in the clinical practice of our center in discharge epicrisis. Recommendations for the frequency of follow-up were formulated by experts based on a comprehensive review of the literature and their own experience. In the first three months, 221 hip and 235 knee evaluation questionnaires were collected through the proposed mechanism, with a progressive increase in the number of questionnaires based on weekly monitoring data. Conclusion. Unfortunately, the outpatient clinic system is not always able to provide qualitative monitoring of patients after arthroplasty due to various reasons, therefore, in our opinion, the implementation of the mechanism of remote monitoring of patients will allow detecting various complications at the stage of early diagnosis, which will contribute to prompt solution of these problems. The remote monitoring system is also an important source of scientific data.Актуальность. На сегодняшний день в России диспансерное наблюдение за пациентами после эндопротезирования осуществляется в соответствии с клиническими рекомендациями, формулировки из которых основаны на монографиях 2006, 2008 и 2014 гг. Кроме того, клинические рекомендации по диспансерному наблюдению не учитывают результаты лечения, оцененные самим пациентом. Целью данного исследования было изучение существующих систем и разработка собственной системы наблюдения за пациентами после эндопротезирования тазобедренного и коленного суставов. Результаты. Обзор литературы выявил, что наблюдение за пациентами после эндопротезирования представляет собой нерешенную проблему, составляющими которой являются низкий охват, нежелание или забывчивость асимптомных пациентов, проблема доступности медицинских осмотров, избыточная финансовая нагрузка на систему здравоохранения. С 2022 г. в клинической практике НМИЦ ТО им. Р.Р. Вредена в выписных эпикризах используются рекомендации по наблюдению после эндопротезирования. Рекомендации по периодичности наблюдений были сформулированы экспертами на основе всестороннего обзора литературы и собственного опыта. За первые три месяца собрана 221 анкета по оценке тазобедренного сустава и 235 коленного сустава, причем число анкет по данным еженедельного мониторинга прогрессивно возрастает. Заключение. К сожалению, поликлиническая система не всегда может обеспечить качественное наблюдение за пациентами после эндопротезирования в силу различных причин, поэтому реализация механизма удаленного наблюдения за пациентами, на наш взгляд, позволит выявлять на этапе ранней диагностики различные осложнения, что будет способствовать оперативному решению данной проблемы. Также система удаленного наблюдения представляет собой важный источник научных данных

Peculiarities of the volume magnetostriction in La₁₋xSrxMnO₃ in the Curie point region

The parallel λ∥ and perpendicular λ⊥ magnetostriction (with respect to the applied magnetic field) and the thermal expansion Δl/l are studied on La1−xSrxMnO₃ single crystals with x=0.1, 0.15, and 0.3. For the conducting sample with x=0.3 and the semiconducting sample with x=0.15 the volume magnetostriction (ω=λ∥+2λ⊥) is negative and the |ω|(T) curves go through a maximum at the Curie point TC. At T>TC its Δl/l temperature dependence is stronger than linear. For the semiconducting sample with x=0.1, ω is negative at T<TC and |ω|→0 at T∼TC. Its Δl/l is linear at T<=TC. The behavior of ω and Δl/l are explained by a magnetic two-phase state, due to strong s−d exchange.This paper was supported by grants from INTAS, #97-0253, NATO #HTECH LG 972942, and the Russian Basic Investigations Foundation #00-15- 96695, #00-02-17810. We are grateful by A.M. Balbashov for preparation of the samples and their analysis

Off-Centering of Pb and Sn Impurities in GeTe Induced by Strong Local Stress

The local environment of large Pb and Sn substitutional impurities in GeTe was found to be strongly distorted compared to that in binary PbTe and SnTe compounds. For both impurities the neighboring Te atoms were found at two different distances, the shortest of them being by 0.16-0.17 Å less than that in corresponding binary compound. The off-centering of Pb and Sn impurities is explained by participation of their 6s2 and 5s2 unshared electron pairs in chemical bonding in the condition of strong local stress created by these impurities in the lattice

Peculiarities of the volume magnetostriction in La₁₋xSrxMnO₃ in the Curie point region

The parallel λ∥ and perpendicular λ⊥ magnetostriction (with respect to the applied magnetic field) and the thermal expansion Δl/l are studied on La1−xSrxMnO₃ single crystals with x=0.1, 0.15, and 0.3. For the conducting sample with x=0.3 and the semiconducting sample with x=0.15 the volume magnetostriction (ω=λ∥+2λ⊥) is negative and the |ω|(T) curves go through a maximum at the Curie point TC. At T>TC its Δl/l temperature dependence is stronger than linear. For the semiconducting sample with x=0.1, ω is negative at T<TC and |ω|→0 at T∼TC. Its Δl/l is linear at T<=TC. The behavior of ω and Δl/l are explained by a magnetic two-phase state, due to strong s−d exchange.This paper was supported by grants from INTAS, #97-0253, NATO #HTECH LG 972942, and the Russian Basic Investigations Foundation #00-15- 96695, #00-02-17810. We are grateful by A.M. Balbashov for preparation of the samples and their analysis