<p>UVOD: Artroza &scaron;aka predstavlja jednu od najče&scaron;ćih mi&scaron;ićno-skeletnih bolesti. Manifestuje se bolom, nekada otokom, deformacijom i gubitkom funkcije &scaron;aka. Postoje različita mi&scaron;ljenja o povezanosti osteoartroze (OA) i osteoporoze (OP) kao dva najče&scaron;a skeletna poremećaja. CILJ: istraživanja je da se utvrde faktori rizika za nastanak OA &scaron;aka, uporedi mineralna ko&scaron;tana gustina kod pacijenata sa OA &scaron;aka sa kontrolnom grupom i utvrdi značaj metaboličkog sindroma kod pacijenata sa OA &scaron;aka. MATERIJAL I METODE: Istraživanje je obavljeno u periodu od jedne godine kod bolesnika sa OA &scaron;aka &ndash; eksperimentalna grupa, i u kontrolnoj grupi bez OA. OA &scaron;aka je definisana na osnovu bola, klinički prisutnih deformiteta &scaron;aka kod žena u postmenopauzi starosne dobi od 60-70 godina i radiografskih promena ( drugog do četvrtog stepena prema Kellgren-Lowrencovoj skali). Analizirani su faktori rizika odgovorni za nastanak OA &scaron;aka, povezanost OA &scaron;aka sa snagom stiska &scaron;ake, mineralnom ko&scaron;tanom gustinom i metaboličkim sindromom. Analazirirana je i funkcija &scaron;ake pomoću tri validirana upitnika: Michigan Hand Outcomes Questionnaire (MHQ, Duruoz Hand Indeks (DHI), Health Assessment Questionnaire (PROMIS HAQ). Statistička obrada podataka rađena je u programu SPSS verzija 25. REZULTATI: Prosečna starost pacijentkinja je bila 65,89&plusmn;3,67 godina. Eksperimentalna i kontrola grupa se statistički razlikuju prema porodičnoj anamnezi o strukturnim promenama zglobova &scaron;aka, prema bolnosti &scaron;aka u miru, bolnosti &scaron;aka pri palpaciji, uzdržavanju od pokreta prstiju &scaron;aka, snage stiska &scaron;ake, metaboličkom sindromu( p&lt;0,001). Kao značajni prediktori za nastanak osteoartroze &scaron;aka su se izdvojili pozitivna porodična anamneza o strukturnim promenama za zglobovima &scaron;aka i metabolički sindrom ( p&lt;0,001). Utvrđen je veći broj ispitanica sa normalnom ko&scaron;tanom gustinom u kontrolnoj grupi. Eksperimentalna grupa bolesnica imala je lo&scaron;iju funkciju &scaron;ake, odnosno lo&scaron;iji skor primenom validiranih upitnika ( p &lt;0,001). ZAKLJUČAK: Pacijentkinje sa izraženom osteoartrozom &scaron;aka imaju smanjenu funkciju &scaron;ake, če&scaron;ći metabolički sindrom u odnosu na kontrolnu grupu, ali ne i značajno nižu ko&scaron;tanu gustinu.</p> / <p>INTRODUCTION: Arthritis of the hand is one of the most common musculoskeletal disorders. It manifests as pain, sometimes accompanied by swelling and deformities, which may lead to the loss of hand function. However, there is no consensus on the relationship between osteoarthritis (OA) and osteoporosis (OP) as the two most common skeletal disorders. AIMS: The study aim was to determine the risk factors related to the development of OA in the hand, as well as compare the bone density in patients with hand OA (HOA) with that measured in the control group and establish the significance of metabolic syndrome in the HOA group. MATERIAL AND METHODS: The study was conducted over a 12-month period and included a sample comprising of the experimental (patients affected by HOA) and the control (individuals with no evidence of HOA) group. HOA was diagnosed based on the reported pain, clinical evidence of hand deformities in postmenopausal women aged 60&minus;70, and radiological evidence of physiological changes (Grade II to IV, based on the Kellgren-Lowrence scale). The risk factors for the development of HOA were analyzed, along with the link between HOA and hand grip strength, bone mineral density and metabolic syndrome. Analyses also included had function, as determined by three validated questionnaires: Michigan Hand Outcomes Questionnaire (MHQ), Duruoz Hand Index (DHI), and Health Assessment Questionnaire (PROMIS HAQ). Statistical analyses were performed using the SPSS version 25 computer software. RESULTS: The average age of the sample was 65.89&plusmn;3.67 years. There were statically significant differences between the experimental and the control group with respect to the family history of structural changes in the hand joints, perceived hand pain at rest and when palpated, reluctance to utilize fingers, hand grip strength, and metabolic syndrome (p &lt; 0.001). Family history of structural changes to the hand joints and metabolic syndrome emerged as the strongest predictors of the osteoarthritis of the hand development (p &lt; 0.001). A greater number of the control group members had normal bone mineral density, while the patients assigned to the experimental group had inferior hand function, as determined by the score on the aforementioned validated questionnaires (p &lt; 0.001). CONCLUSION: Postmenopausal women with pronounced osteoarthritis of the hand have reduced hand function, and are more likely to suffer from a metabolic syndrome relative to the control group, while the differences in bone mineral density are not statistically significant.</p>

<p>Uvod: Adenoidektomija sa tonzilektomijom je najče&scaron;će indikovana hirur&scaron;ka intervencija u dečjem uzrastu. Intervencija se izvodi u op&scaron;toj anesteziji. Endotrahealni tubus predstavlja &bdquo;zlatni standard&ldquo; za obezbeđenje disajnog puta u dečjoj otorinolaringolo&scaron;koj hirurgiji. Upotreba endotrahealnog tubusa nosi rizike od nastanka komplikacija koje se mogu javiti pri uvodu u op&scaron;tu anesteziju, u toku hirur&scaron;ke intervencije i nakon ekstubacije deteta. Učestalost komplikacija se može smanjiti upotrebom supraglotičnih sredstava. Fleksibilna laringealna maska spada u prvu generaciju supraglotičnih sredstava, koja omogućava zadovoljavajuću oksigenaciju i ventilaciju bolesnika u ORL hirurgiji. Cilj istraživanja: Utvrditi: efikasnost fleksibilne laringealne maske u za&scaron;titi disajnog puta od aspiracije krvi i sekreta gornjih disajnih puteva u odnosu na endotrahealni tubus u toku adenotonzilektomije; da li primena fleksibilne laringealne maske u zbrinjavanju disajnog puta u toku adenotonzilektomije utiče na učestalost postekstubacionih komplikacija u odnosu na zbrinjavanje disajnog puta endotrahealnim tubusom; da li zbrinjavanje disajnog puta fleksibilnom laringealnom maskom u toku adenotonzilektomije ima uticaj na intenzitet postoperativnog bola u odnosu na zbrinjavanje disajnog puta endotrahealnim tubusom; da li zbrinjavanje disajnog puta fleksibilnom laringealnom maskom u toku adenotonzilektomije ima uticaj na pojavu postoperativne mučnine i povraćanja u odnosu na zbrinjavanje disajnog puta endotrahealnim tubusom. Metodologija: Prospektivnom, randomizovanom, studijom bilo je obuhvaćeno 160 dečaka i devojčica uzrasta od 3 do 8 godina planiranih za elektivnu hirur&scaron;ku intervenciju adenotonzilektomiju u op&scaron;toj anesteziji. Bolesnici su bili podeljeni u dve grupe: 80 bolesnika kod kojih je disajni put bio obezbeđen endotrahealnim tubusum (ET grupa) i 80 bolesnika kod kojih je disajni put bio obezbeđen laringealnom maskom (LMA grupa). Na kraju hirur&scaron;ke intervencije, u obe grupe bolesnika, izvr&scaron;ena je provera prisustva krvi na larinksu i u traheji pomoću fiberoptičkog bronhoskopa. Postekstubacione respiratorne komplikacije vezane za upotrebu fleksibilne laringealne maske odnosno endotrahealnog tubusa (ka&scaron;alj, opstrukcija disajnog puta i laringospazam) bile su praćene neposredno nakon ekstubacije bolesnika. Procena postoperativnog bola bila je vr&scaron;ena pomoću Face, Legs, Activity, Cry, Consolability Scale 2 i 4 sata nakon hirur&scaron;ke intervencije kao i prvog postoperativnog dana u 7 sati ujutro. Postojanje postoperativne mučnine i povraćanja bilo je utvrđivano heteroanamnestički, anketom roditelja, dan nakon hirur&scaron;ke intervencije u 7 sati ujutro. Statistička analiza izvr&scaron;ena je pomoću statističkog paketa Statistical Package for Social Sciences &ndash; SPSS 21. Podaci su predstavljeni tabelarno i grafički, a statistička značajnost je određivana na nivou p&lt;0.05. Rezultati: Ni kod jednog deteta iz ET odnosno LMA grupe bolesnika nakon hirur&scaron;ke intervencije fiberoptičkim bronhoskopom nije uočeno prisustvo krvi, sekreta niti regurgitiranog želudačnog sadržaja na larinksu odnosno u traheji. Bolesnici iz ET grupe su imali statistički značajno vi&scaron;e komplikacija u odnosu na bolesnike iz LMA grupe (&chi;2=4.254; p=0.039; p &lt; 0.05). Ne postoji statistički značajna razlika u distribuciji bolesnika sa i bez respiratornih komplikacija izmeĊu ET i LMA grupe (&chi;2=3.413; p=0.065; p &gt; 0.05). U proceni postoperativnog bola FLACC skalom 2 sata nakon hirur&scaron;ke intervencije postoji statistički značajna razlika u intenzitetu postoperativnog bola kod bolesnika iz ET u odnosu na bolesnike iz LMA grupe (&chi;2=31.316; p=0.000; p&lt;0.05). Četiri sata nakon hirur&scaron;ke intervencije, statistički je značajno vi&scaron;e bolesnika sa umerenim bolom u ET grupi u odnosu na LMA grupu (&chi;2=40.705; p=0.000; p&lt;0.05). Na dan otpusta, statistički je značajno vi&scaron;e bolesnika sa blagim diskomforom u ET grupi bolesnika u odnosu na LMA grupu (&chi;2=8,012; p=0,005; p &lt; 0.05). U LMA grupi bolesnika jedan ili 1.49% bolesnika je imao postoperativnu mučninu i povraćanje, dok je u ET grupi troje ili 3.56% bolesnika imalo postoperativnu mučninu i povraćanje. Zaključak: Fleksibilna laringealna maska pruža podjednaku za&scaron;titu distalnih delova disajnog puta od krvi i sekreta tokom adenotonzilektomije kao i endotrahealni tubus. Učestalost postoperativnih komplikacija i intenzitet postoperativnog bola su manji kada se za obezbeđenje disajnog puta u toku adenotonzilektomije koristi fleksibilna laringealna maska. Primenom fleksibilne laringealne maske smanjuje se učestalost postoperativne mučnine i povraćanja u toku adenotonzilektomije.</p> / <p>Introduction: Adenoidectomy with tonsillectomy is the most indicated surgery in childhood. The intervention is performed under general anesthesia. Endotracheal tube represents the &bdquo;gold standard&ldquo; for airway management in paediatric ENT surgery. The use of endotracheal tube carries the risk of complications that may occur during the induction of general anesthesia, during the surgery and after extubation of the child. The frequency of complications may be reduced by the use of supraglottic airway devices. Flexible laryngeal mask is first generation of supraglottic airway devices, which allows sufficient oxygenation and ventilation of patients in ENT surgery. Aims: To determine the effectiveness of the flexible laryngeal mask which protectes the airway from aspiration of blood and secretions of the upper airways compared to the airway management with endotracheal tube during adenotonsillectomy; to determine does the usage of the flexible laryngeal mask in airway management during adenotonsillectomy affects the frequency of post extubation complications compared to the airway management with endotracheal tube, as wll as does the usage of the flexible laryngeal mask in airway management during adenotonsillectomy has an impact on the intensity of postoperative pain compared to the airway management with endotracheal tube, and does the usage of the flexible laryngeal mask in airway management during adenotonsillectomy has an impact on the incidence of postoperative nausea and vomiting compared to the airway management with endotracheal tube. Methodology: One hundred and sixty boys and girls aged from 3 to 8 years scheduled for elective surgical intervention adenotnosillectomy in general anaesthesia were included in this prospective, randomized study. Patients were divided into two groups: 80 patients in whom the airway was managed with a cuffed endotracheal tube (ET group) and 80 patients in whom airway was managed with a laryngeal mask (LMA group). At the end of surgical procedure, in both groups of patients, fiberoptic bronchoscopy was performed to verify the presence of blood in the larynx and trachea. Immediate respiratory complications associated with the use of flexible laryngeal mask or endotracheal tube (cough, airway obstruction and laryngospasm) were monitored following extubation of patients. Postoperative pain assessment was performed using Face, Legs, Activity, Cry, Consolability Scale 2 and 4 hours following surgery as well as the first postoperative day at 7 o&#39;clock a.m. The presence of postoperative nausea and vomiting was confirmed heteroanamnestically by polling the parents the day after surgery at 7 o&#39;clock a.m. The statistical analysis was performed using Statistical Package for Social Sciences - SPSS version 21. The data were presented in tables and graphs, statystical significance was set at p value of less than 0.05. Results: Following surgery there were no any patient in ET or LMA group in which the presence of blood, secretion or regurgitated stomach contents on larynx or in the trachea could be observed by using the fiberoptic bronchoscope. Patients in the ET group had statistically more significant complications compared to patients in the LMA group (&chi;2 = 4.254; p = 0.039; p &lt;0.05). There is no statistically significant difference in the distribution of patients with and without respiratory complications between ET and LMA groups (&chi;2 = 3.413; p = 0.065; p&gt; 0.05). In the assessment of postoperative pain using FLACC scale 2 hours following surgical intervention, there is a statistically significant difference in the intensity of postoperative pain in ET patients compared to patients in the LMA group (&chi;2 = 31.316, p = 0.000, p &lt;0.05). Four hours following surgical intervention, a statistically significant number of patients had mild pain in the ET group compared to the LMA group (&chi;2 = 40.705; p = 0.000; p &lt;0.05). On the day of release, statistically significant numbers of patients with mild discomfort in the ET group were compared to the LMA group (&chi;2 = 8,012; p = 0,005; p &lt;0.05). In the LMA group, one or 1.49% of the patients had postoperative nausea and vomiting, while in the ET group, three or 3.56% of the patients had postoperative nausea and vomiting. Conclusion: Flexible laryngeal mask provides equal protection of the distal parts of airway from the blood and secretions during adenotonsillectomy as the endotracheal tube. The frequency of postoperative complications and the intensity of postoperative pain are smaller when a flexible laryngeal mask is used for airway management during adenotonsillectomy. The usage of the flexible laryngeal mask reduces the frequency of postoperative nausea and vomiting during adenotonsillectomy.</p>

La compréhension et la modélisation des phénomènes régissant la libération des stimuli orosensoriels durant la consommation d'un aliment doit permettre de respecter des critères de conception à la fois nutritionnels et organoleptiques. Un modèle de libération du sel au cours de la mastication a été développé pour des produits " solides ". La déstructuration du produit a été appréhendée en terme de génération de surface de contact entre le produit et la salive qui gouverne les transferts de sel. La surface de contact a été considérée comme étant le produit de deux fonctions. La première est reliée au sujet et est fonction de son efficacité masticatoire. La seconde est reliée au produit et dépend de ses propriétés de déstructuration qui peuvent être déterminées par des tests in vitro. Durant la phase pharyngée, la biomécanique de la déglutition gouverne l'enduction des muqueuses par le bol alimentaire et ainsi la libération des composés d'arôme présents dans cette couche. Ces phénomènes sont régis par un écoulement en film mince, stationnaire, dans un contact élastohydrodynamique mou dont la cinématique équivaut à un processus d'enduction par des cylindres contrarotatifs lubrifiés par de la salive. Deux régimes ont été distingués. Lorsque le film de salive est fin, la viscosité du bol alimentaire a un grand rôle sur l'enduction et la libération des composés d'arôme. Lorsque le film de salive est épais, le bol est dilué par la salive durant le processus de déglutition et sa viscosité a un faible effet sur l'enduction et la libération des composés d'arôme. Ce second régime permet d'expliquer l'origine physique d'observations in vivo concernant la libération des composés d'arôme.

La question de recherche à la base de cette étude soulève le point de la nature paradoxale du canon de représentation égyptien qui démontre, simultanément, une certaine rigidité dans l’application de règles stylistiques et iconographiques établies, particulièrement dans l’art non commandité par l’État, et des preuves de transformation et d’intégration de motifs nouveaux. Partant de cette problématique, l’étude vise à identifier les mécanismes par lesquels ce canon permet, à la fois, l’innovation et le maintien d’une certaine tradition. L’approche est de nature double et consiste tout d’abord à identifier de grandes tendances et discontinuités stylistiques et iconographiques sur les bols de faïence du Moyen au Nouvel Empire. De plus, elle tente de déterminer si les transformations d’ordre sociopolitique et idéologique, survenant à ces périodes, peuvent être lues dans les variations stylistiques et iconographiques trouvées sur les bols de faïence. Après une description du champ conceptuel de la « représentation » en contexte égyptien, l’auteur effectue l’analyse iconographique exhaustive de ce qui constitue l’apport majeur de son étude, un corpus de 500 bols et fragments de faïence provenant de divers sites égyptiens du Moyen au Nouvel Empire. Les données ont été traitées par le biais de la méthode d’analyse iconologique proposée par Panofsky, qui lui permet de dévoiler un grand nombre de continuités et de transformations d’ordre stylistique et iconographique pour les différentes périodes. Plusieurs facteurs semblent avoir été à l’origine de ces transformations, dont la fluctuation entre un contexte de centralisation et de décentralisation politique de l’État, ainsi que l’intégration de motifs étrangers (proche-orientaux et égéens) résultant d’un contact accru entre l’Égypte et les régions voisines. De plus, les transformations idéologiques apportées par le règne d’Akhénaton et par la « contre-réforme » idéologique à la période ramesside, semblent avoir également contribué à des innovations au sein du canon, même si ce dernier maintient une certaine continuité légitimée par le pouvoir étatique. Le canon de représentation, devient ainsi une forme de langage dont l’État se sert et qui, parfois malgré lui, se transforme et fluctue selon les réalités des différentes périodes. / This study’s research question raises the issue of the paradoxical nature of the Egyptian canon of representation which shows, simultaneously, a certain rigidity in the application of established stylistic and iconographic rules, especially in non-state commissioned art, and evidence for the transformation and integration of new iconographical motifs. The study aims to identify the mechanisms by which the canon permits, at the same time, transformative processes and the maintenance of tradition. The approach is twofold and consists primarily in identifying trends and stylistic/iconographical discontinuities in the iconography found on the faience bowls from the Middle to the New Kingdoms. Furthermore, it aims to determine if the socio-political and ideological transformations taking place in these periods can be discerned in the stylistic and iconographical variations found on the bowls of the Middle to the New Kingdoms. The author discusses the theoretical model of “representation” in Egyptian context, followed by an analysis of what constitutes the major contribution of this study: an exhaustive iconographical analysis of 500 faience bowls and fragments originating from various Egyptian sites dating to the New Kingdom. The data was evaluated by means of the method of iconological analysis proposed by Panofsky, which permits the identification of a number of stylistic and iconographic continuities and changes for all periods. These transformations seem to be the result of a variety of factors, including fluctuations in the centralization and decentralization of the state, as well as the integration of foreign motifs (Near-Eastern and Aegean), which results from increased contacts between Egypt and its neighbouring regions. Furthermore, the ideological transformations taking place under Akhenaton’s reign and the ones resulting from the ideological “counter-reformation” occurring during the Ramessid period, equally seem to contribute to the changes in the representational canon, even though the latter maintained a certain continuity that was legitimized by the state. The canon thus emerges as a form of language used by the state, and sometimes despite it, which can fluctuate and be altered depending on the realities of the different periods.

<p>Hirur&scaron;ka inetrvencija aktivira odgovor organizma na stres, pokreću se neuroendokrine promene u organizmu, &scaron;to rezultira neželjenom hemodinamskom nestabilno&scaron;ću, promenama metabolizma, endokrinog i imunog sistema. Cilj ovog istraživanja je bio da se utvrdi uticaj kaudalnog bloka na nivo perioperativnog stresa i njegova efikasnot u zbrinjavanju intra- i postoperativnog bola. Ovo prospektivno, randomizirano kliničko ispitivanje obuhvatalo je 80 dečaka, uzrasta 2-5godina, kojima su bile indikovane urolo&scaron;ke operacije. Jedna grupa (n = 38) je primila op&scaron;tu anesteziju, a druga (n = 38) op&scaron;tu anesteziju sa kaudalnim blokom. Mereni su intraoperativno hemodinamski parametri u 8 merenja, ukupna potro&scaron;nja svih datih lekova i intenzitet bola u 3 navrata postoperativno. Uzorci krvi uzeti su pre uvoda u anesteziju i nakon buđenja pacijenta, i ispitivan je nivo glukoze, kortizola, leukocita, leukocitarne formule, pH i laktata. Deca koja su primila kaudalni blok imala su, postoperativno, značajno niži nivo glukoze u serumu (p &lt;0,01), koncentracije kortizola (p &lt;0,01), leukocita i neutrofila (p &lt;0,01), laktata i acidoze, a takođe su imali i niže ocene bola u sve tri momenta merenja (p&lt;0,01). Intraoperativno utvrđena je veća hemodinamska stabilnost i manja potro&scaron;nja analgetika perioperativno. Takođe, u toj grupi nije bilo komplikacija. Kombinacija kaudalnog bloka sa op&scaron;tom anestezijom je bezbedna metoda, koja dovodi do manjeg stresa, veće hemodinamske stabilnosti, nižih ocena bola i manje potro&scaron;nje<br />lekova.</p> / <p>Surgery generates a neuroendocrine stress response, resulting in undesirable haemodynamic instability, alterations in metabolic response and malfunctioning of the immune system. The aim of this research was to determine the effectiveness of caudal blocks in intra- and postoperative pain management and in reducing the stress response in children during the same periods. This prospective, randomized clinical trial included 80 patients scheduled for elective urological operations. One group (n = 38) received general anaesthesia and the other (n = 38) received general anaesthesia with a caudal block. Haemodynamic paramethers, drug consumption and pain intensity were measured. Blood samples for serum glucose, cortisol level, leukocytes, pH and lactate level were taken before anaesthesia induction and after awakening the patient. Children who received a caudal block had, postoperativly, significantly lower serum glucose (p &lt; 0.01), cortisol concentrations (p &lt; 0.01), leukocytes (p&lt;0,01), lower lactate level and acidosis,also pain scores were lower at all 3 measurments (p&lt;0,01). Intraoperativly greater haemodynamic stability and lower drug consumption were noticed. Also, there were no side effects or complications identified in that group. The combination of caudal block with general anaesthesia is a safe method that leads to less stress, greater haemodynamic stability, lower pain scores and lower consumption of medication.</p>

<p>U savremenoj hirurgiji imperativ je da hirur&scaron;ka procedura bude efikasna, ali i da obezbedi kvalitetan i brz oporavak. Najbitniji segment operativnog lečenja je obezbediti maksimalan učinak kako bi se osobi omogućio brz i potpun povratak aktivnostima dnevnog života. Posebno je pojačano&nbsp;&nbsp; interesovanje za rekonstrukciju prednjeg ukr&scaron;tenog ligamenta kod mlađe i sporsko aktivne populacije. Trendovi u medicini kao i u ortopedskoj hirurgiji idu u pravcu smanjenja postoperativnog krvarenja, bola i skraćenja postoperativnog oporavka. Supstancija sa antifibrinolitičkim delovanjem, kao &scaron;to je traneksamična kiselina, svakako je na&scaron;la svoje mesto u smanjenju postoperativnog krvarenja. Ciljevi istraživanja su se odnosili na utvrđivanje uticaja lokalno aplikovane traneksamične kiseline tokom rekonstrukcije prednjeg ukr&scaron;tenog ligamenta kolena na postoperativno krvarenje, posmatrane laboratorijske parametre, mere obima kolena, učestalosti postoperativnih komplikacija i kvaliteta postoperativnog oporavka između dve grupe ispitanika (ispitivana i kontrolna grupa). Studija je bila eksprimentalnog karaktera i sprovedena je u Kliničkom centru Vojvodine u Novom Sadu uz odobrenje etičke komisije. U istraživanje, metodom slučajnog izbora, bila su uključena 124 ispitanika oba pola raspoređena u dve grupe (ispitivana i kontrolna), a kod kojih je indikovana operativno zbrinjavanje prekida prednjeg ukr&scaron;tenog ligamenta kolena i koji su dali pristanak da budu uključeni u studiju. Svi prikupljeni podaci su beleženi u protokol, koji je za ovo istraživanje posebno dizajniran. Ispitanici su bili podvrgnuti operativnom zahvatu, uz primenu op&scaron;te ili spinalne anestezije, sa postavljenom pneumatskom poveskom na operisanom ekstremitetu. Ispitivanoj grupi bilo je lokalno aplikovano 20 ml traneksamične kiseline, dok je u kontolnoj grupi na isti način aplikovano 20 ml NaCl 0,9 % rastvora. Postoperativni gubici krvi su praćeni i beleženi tokom 24 h od operacije, dok su laboratorijki nalazi uzorkovani preoperativno i sedmog postoperativnog dana. U posmatranom periodu (preoperativno, sedmog postoperativnog dana, treće i &scaron;este postoperativne nedelje) kod ispitanika je praćen obim kolena i pojava komplikacija (hematom, hemartroza). Nakon sprovedenog istraživanje, prikupljeni podaci su dokumentovani i statistički obrađeni. Rezultati istraživanja jasno ukazuju da postoji statistički značajna razlika (t=7.181, p&lt;0.001) u količni postoperativnog krvarenja između grupa. Prosečno postoperativno krvarenje u ispitivanoj grupi je bilo 71.29&plusmn;40.76 ml, u odnosu na kontrolnu grupu gde je postoperativno krvarenje iznosilo 154.35&plusmn;81.45 ml. U kontrolnoj grupi, postoperativno se beleže niže vrednosti hemoglobina (t=9.608, p&lt;0.001) i hematokrita (t=8.325, p&lt;0.001), i vi&scaron;e vrednosti trombocita (t=2.201, p=0.032) nego u ispitivanoj grupi. Podaci o postoperativnom bolu ispitanika govore u prilog statistički značajnoj razlici u jačini bola prve nedelje nakon operacije između ispitivane i kontrolne grupe (t=2.405, p=0.018) i treće nedelje nakon operacije (t=3.700, p&lt;0.001). U ispitivanoj grupi zabeležena je ređa pojava hematoma 6.45% (n=4), dok je u kontrolnoj grupi 19.35% (n=12). Svi pacijenti u uzorku su popunili upitnik o postoperativnom kvalitetu oporavka. Nije zabeležena statistički značajna razlika u kvalitetu postoperativnog oporavka nakon operacije između dve analizirane grupe ispitanika. Dobijeni rezultati o postoperativnom krvarenju, nakon aplikovane traneksamične kiseline, ukazuju na efikasnost leka i pri lokalnoj primeni tokom rekonstrukcije prednjeg ukr&scaron;tenog ligamenta kolena. S obzirom na insuficijentnost podataka, ovo ispitivanje stvara &scaron;iru osnovu za dalja istraživanja.</p> / <p>In modern surgery, we need an effective surgical procedure, which provides quality and rapid recovery. The most important segment of surgical treatment is to provide maximum impact to allow a person to return quickly and fully to the activities of daily living. There has been particular interest in the reconstruction of the anterior cruciate ligament in the younger and sport active population. Trends in medicine, as well as in orthopedic surgery, are heading towards reducing postoperative bleeding, pain, and postoperative recovery. A substance with antifibrinolytic activity, such as tranexamic acid, has certainly found its place in reducing postoperative bleeding. The objectives of the study were to determine the effect of locally applied tranexamic acid during the reconstruction of the anterior cruciate knee ligament on postoperative bleeding, observed laboratory parameters, measures of knee circumference, frequency of postoperative complications, and quality of postoperative recovery between the two groups of subjects (study and control group). The study was prospective, conducted at the Clinical Center of Vojvodina in Novi Sad with the approval of the ethics committee. The study, by random selection method, included 124 subjects of both sexes, divided into two groups (tested and control), which indicated operative management of the anterior cruciate ligament rupture and gave informed consent for inclusion in the study. All data collected were recorded in a protocol, which was specifically designed for this research. Subjects underwent surgery, with general or spinal anesthesia, with pneumatic attachment placed on the extremity undergoing surgery. The test group was given topically 20 ml of tranexamic acid, while the control group was administered 20 ml in the same way. NaCl 0.9% solution. Postoperative blood losses were monitored and recorded within 24 h of surgery, while laboratory findings were sampled preoperatively and on the seventh postoperative day. During the observed period (preoperatively, on the seventh postoperative day, on the third and sixth postoperative weeks), the knee volume and the occurrence of complications (hematoma, hemarthrosis) were monitored in the subjects. Following the survey, the data collected were documented and statistically processed. The study results indicate that there was a statistically significant difference (t = 7.181, p &lt;0.001) in the amount of postoperative bleeding between groups. The mean postoperative bleeding in the study group was 71.29 &plusmn; 40.76 ml, compared to the control group where postoperative bleeding was 154.35 &plusmn; 81.45ml. In the control group, lower hemoglobin values (t = 9.608, p &lt;0.001) and hematocrit (t = 8.325, p &lt;0.001) were observed postoperatively, and higher platelet counts (t = 2.201, p = 0.032) than in the study group. The data on the postoperative pain of the respondents support a statistically significant difference in the severity of pain on the first week after surgery between the study and the control group (t = 2.405, p = 0.018) and the third week after surgery (t = 3.700, p &lt;0.001). In the study group, the incidence of hematoma was less than 6.45% (n = 4), while in the control group it was 19.35% (n = 12). All patients in the sample completed a questionnaire on postoperative quality of recovery. There was no statistically significant difference in the quality of postoperative recovery after surgery between the two analyzed groups of subjects. The results of post-operative bleeding, after administrated tranexamic acid, indicate the efficacy of the drug and at a local application during the reconstruction of the anterior cruciate ligament. Due to the insufficiency of data, this study creates a broad basis for further research.</p>

<p>Lumbalni bol predstavlja jedan od najučestalijih zdravstvenih problema dana&scaron;njice. Pružanje zdravstvene nege je stresan i težak fizički posao, te spada u grupu visoko-rizičnih poslova za nastanak lumbalnog bola, pa samim tim medicinske sestre &ndash; tehničari predstavljaju vulnerabilnu populaciju. Osnovni ciljevi ovog istraživanja bili su da se utvrdi prevalencija i faktori rizika za nastanak lumbalnog bola kod medicinskih sestara- tehničara, kao i mere prevencije. Istraživanje je sprovedeno u pet zdravstvenih ustanova sa područja Vojvodine u obliku studije preseka, anketiranjem medicinskih sestara &ndash; tehničara. Za ispitivanje je kori&scaron;ćen modifikovani Nordijski upitnik. Rezultati pokazuju veoma visoku prevalenciju lumbalnog bola među medicinskim sestrama- tehničarima, oko 94%. Ispitanici su bili uglavnom ženskog pola, prosečne starosti oko 38 godina. Najveći broj ispitanika ima srednju stručnu spremu. Istraživanjem je utvrđeno da postoji statistički značajna povezanost lumbalnog bola sa porastom godina života i dužine ekspozicionog radnog staža. Takođe, statistički visoko značajna korelacija nalazi se između porasta BMI i lumbalnog bola. Najzastupljeniji poslovi zdravstvene nege koje ispitanici sa lumbalnim bolom obavljaju su: pozicioniranje pacijenata, podizanje i presvlačenje pacijenata u postelji i podela terapije. Statistički značajno veća zastupljenost lumbalnog bola javlja se kod ispitanika koji sami obavljaju negu u odnosu na one koji imaju pomoć. Medicinske sestre &ndash; tehničari koji pripadaju grupi sa vi&scaron;im nivoom stresa na radnom mestu imaju znatno veći rizik za pojavu lumbalnog bola. Smenski rad (naizmenične dnevne i noćne smene od 12 sati) i prekovremeni rad duži od 8 sati dnevno, podizanje tereta većeg od 25 kg i broj pacijenata koje medicinska sestra &ndash; tehničar zbrinjava tokom radnog vremena nemaju značajnu povezanost sa pojavom lumbalnog bola. Oko tri četvrtine ispitanika nije izostajalo sa posla zbog bola. Samo oko 8% ispitanika je promenilo radno mesto zbog lumbalnog bola i ide redovno na periodične lekarske preglede. Kod mera prevencije neophodno je staviti akcenat na smanjenje fizičkog opterećenja donjeg dela leđa i smanjenje ručnog preno&scaron;enja tereta. Primenom adekvatnog ergonomskog pristupa, boljom organizacijom rada, podsticajnom atmosferom na poslu i spremno&scaron;ću nadležnih struktura da iskažu veću brigu prema zaposlenima, smanjila bi se učestalost pojave lumbalnog bola.</p> / <p>One of the today&rsquo;s most frequent health problems is the low back pain. Nursing is stressful and hard physical job which belongs to the group of high-risk jobs that could cause low back pain and therefore medical nurses/technicians represent the vulnerable population. Determination of prevalence, risk factors and prevention of the low back pain were the main goals of this research. The research in the form of cross-sectional study was conducted with nurses filling in the surveys within five medical institutions in Vojvodina. The modified Nordic questionnaire was used for the surveys. The results show very high prevalence of the low back pain, cca 94%, among medical nurses. Most of the respondents were females, who finished high school education, at average age of 38 years. The study showed that there is a statistically significant coherence between low back pain, ageing and working experience as a nurse. There is also a statistically significant coherence between the low back pain and the increase of the BMI. The most common nursing jobs that respondents with the low back pain do are: positioning of patients, lifting patients, dressing patients in bed and giving therapy. The low back pain with the respondents who do the nursing just by themselves is statistically significantly more present then with the respondents who do the nursing with help. Nurses who suffer more stress at their workplaces have a significantly higher risk to develop low back pain. Working 12 hour shifts (alternately day and night shifts), overtime work, more then 25 kg weight lifting and number of patients for nursing per nurse during working hours have no significant correlation with the low back pain occurrence. About three quarters of the respondents had no absence from work caused by the low back pain. Only 8% of the respondents changed their workplace because of the low back pain and have regular health checks. To prevent the low back pain it is necessary to emphasize the physical reduction of the load on the lower back and manual handling of loads. The frequent low back pain with the nurses could be reduced with the appropriate ergonomic access, better work organization, a supportive atmosphere at work and the willingness of responsible authorities to express greater concern about the employees.</p>

<p>Povratak na posao nakon operacije lumbalne diskus hernije determinisan je funkcionalnim stanjem, prisustvom i stepenom tegoba od strane lumbosakralne kičme, zahtevima na radnom mestu bolesnika ali i psihosocijalnim faktorima, koji pri oceni radne sposobnosti zaposlnih zahtevaju individualni pristup. Grupa pacijenata koja se neće vratiti na posao može biti identifikovana putem prognostičkog modela. Cilj ove studije je definisanje prognostičkog modela za povratak na posao bolesnika operisanih zbog lumbalne diskus hernije kao i identifikacija najznačajnijih faktora rizika odgovornih za lo&scaron; ishod operativnog lečenja, posmatrano kroz prizmu povratka na posao. Istraživanje je prospektivna studija koja je obuhvatila ukupno 200 ispitanika, koji su operisani zbog lumbalne diskus hernije na jednom nivou i praćeni su u vremenskom period do 12 meseci nakon operativnog lečenja. U statističku ananlizu je u&scaron;lo 153 bolesnika, koji su ispunili kriterijume selekcije ispitanika studije. Nakon određivanja značaja posmatranih biolo&scaron;kih, profesionalnih i psihosocijalnih faktora rizika za povratak na posao, kreirani su i evaluirani prognostički modeli bazirani na svim i na odabranim atributima desetostrukom kros-validacijom: stablo odlučivanja (DT), model vi&scaron;eslojnih perceptrona (MLP) i model potpornih vektora (SVM). Za predviđanje povratka na posao najveću tačnost, specifičnost i senzitivnost za odabrane atribute postiže model potpornih - podržavajućih vektora (SVM). Najbolju intuitivnu i praktičnu vrednost za predviđanje povratka na posao pruža model stabla odluka (DT). Identifikacijom najznačajnijih faktora rizika za nepovoljan ishod povratka na posao omogućeno je preventivno delovanje na iste, u cilju smanjenja broja pacijenata sa umanjenjem radne sposobnosti i invaliditeta.</p> / <p>Return to work after lumbar discectomy is determinated by functional status, presence and degree of discomfort in the lumbosacral spine, the requirements in the workplace of patients and psychosocial factors that in the assessment of working capabilities require an individual approach. Groups of patients which don&rsquo;t return to work after surgery could be identified by predictive model. The aim of this study is to define prognostic model to return to work patients after lumbar discectomy, as well as the identification major risk factors responsible for the poor outcome of operative treatment viewed through the prism of returning to work. This prospective study included a total of 200 patients, who underwent surgery for lumbar disc herniation on one level and were followed up in period of 12 months following surgery. The statistical analysis included 153 patients who fulfilled all selection criteria of the study subjects. After determining significance of the observed biological, professional and psychosocial risk factors for return to work, prognostic models were designed and evaluated based on all and selected attributes by tenfold cross-validation: decision tree (DT) model of multilayer perception (MLP) model and support vector (SVM). For the prediction of return to work best accuracy, specificity and sensitivity for selected attributes, is achieved by supporting vector model (SVM). The decision tree model (DT) provides the best intuitive and practical value for predicting return to work. By identifying the most important risk factors for adverse outcome for return to work it is made possible for preventive actions, to reduce the number of patients with reduced work ability and disability.</p>

L’objet de la présente étude est le développement, l’application et la diffusion de la technologie associée à divers types d’alliages de cuivre, en particulier l’alliage du plomb-bronze, en Grèce ancienne, dans ses colonies, ainsi qu’en Étrurie. Le plomb-bronze est un mélange de diverses proportions d’étain, de cuivre et de plomb. Le consensus général chez les archéométallurgistes est que le plomb-bronze n’était pas communément utilisé en Grèce avant la période hellénistique; par conséquent, cet alliage a reçu très peu d’attention dans les documents d’archéologie. Cependant, les analyses métallographiques ont prouvé que les objets composés de plomb ajouté au bronze ont connu une distribution étendue. Ces analyses ont aussi permis de différencier la composition des alliages utilisés dans la fabrication de divers types de bronzes, une preuve tangible que les métallurgistes faisaient la distinction entre les propriétés du bronze d’étain et celles du plomb-bronze. La connaissance de leurs différentes caractéristiques de travail permettait aux travailleurs du bronze de choisir, dans bien des cas, l’alliage approprié pour une utilisation particulière. L’influence des pratiques métallurgiques du Proche-Orient a produit des variations tant dans les formes artistiques que dans les compositions des alliages de bronze grecs durant les périodes géométrique tardive et orientalisante. L’utilisation du plomb-bronze dans des types particuliers d’objets coulés montre une tendance à la hausse à partir de la période orientalisante, culminant dans la période hellénistique tardive, lorsque le bronze à teneur élevée en plomb est devenu un alliage commun. La présente étude analyse les données métallographiques de la catégorie des objets coulés en bronze et en plomb-bronze. Elle démontre que, bien que l’utilisation du plomb-bronze n’était pas aussi commune que celle du bronze d’étain, il s’agissait néanmoins d’un mélange important d’anciennes pratiques métallurgiques. Les ères couvertes sont comprises entre les périodes géométrique et hellénistique. / The subject of this study is the development, application and diffusion of the technology of various types of copper alloys, particularly that of leaded bronze, in ancient Greece, its colonies, and in Etruria. Leaded bronze is a mixture of tin, copper and lead in various proportions. The general consensus among archaeometallurgists is that leaded bronze was not commonly used in Greece until the Hellenistic period, and thus this alloy has not received very much attention in archaeological literature. However, metallographic analyses demonstrate that objects composed of leaded bronze had a wide distribution. The analyses also show differentiation in the composition of alloys that were used in the manufacture of various types of bronzes, a tangible indication that metalworkers distinguished between the properties of both tin bronze and leaded bronze. The knowledge of their different working characteristics is what enabled a bronzeworker to choose, in many cases, the appropriate alloy for a specific application. The influence of Near Eastern metallurgical practices produced variations in both the artistic forms as well as alloy compositions of Greek bronzes during the Late Geometric and Orientalizing periods. The use of leaded bronze for particular types of cast objects shows an increasing tendency from the Orientalizing period onwards, culminating in the late Hellenistic period when high-lead bronze became a common alloy. This study analyzes the metallographic data of specific categories of bronze and leaded bronze cast objects, and it will demonstrate that although the use of leaded bronze was not as prevalent as that of tin bronze, it was nevertheless a significant adjunct of ancient metallurgical practices. The periods surveyed range from the Geometric to the Hellenistic periods.

L’objet de la présente étude est le développement, l’application et la diffusion de la technologie associée à divers types d’alliages de cuivre, en particulier l’alliage du plomb-bronze, en Grèce ancienne, dans ses colonies, ainsi qu’en Étrurie. Le plomb-bronze est un mélange de diverses proportions d’étain, de cuivre et de plomb. Le consensus général chez les archéométallurgistes est que le plomb-bronze n’était pas communément utilisé en Grèce avant la période hellénistique; par conséquent, cet alliage a reçu très peu d’attention dans les documents d’archéologie. Cependant, les analyses métallographiques ont prouvé que les objets composés de plomb ajouté au bronze ont connu une distribution étendue. Ces analyses ont aussi permis de différencier la composition des alliages utilisés dans la fabrication de divers types de bronzes, une preuve tangible que les métallurgistes faisaient la distinction entre les propriétés du bronze d’étain et celles du plomb-bronze. La connaissance de leurs différentes caractéristiques de travail permettait aux travailleurs du bronze de choisir, dans bien des cas, l’alliage approprié pour une utilisation particulière. L’influence des pratiques métallurgiques du Proche-Orient a produit des variations tant dans les formes artistiques que dans les compositions des alliages de bronze grecs durant les périodes géométrique tardive et orientalisante. L’utilisation du plomb-bronze dans des types particuliers d’objets coulés montre une tendance à la hausse à partir de la période orientalisante, culminant dans la période hellénistique tardive, lorsque le bronze à teneur élevée en plomb est devenu un alliage commun. La présente étude analyse les données métallographiques de la catégorie des objets coulés en bronze et en plomb-bronze. Elle démontre que, bien que l’utilisation du plomb-bronze n’était pas aussi commune que celle du bronze d’étain, il s’agissait néanmoins d’un mélange important d’anciennes pratiques métallurgiques. Les ères couvertes sont comprises entre les périodes géométrique et hellénistique. / The subject of this study is the development, application and diffusion of the technology of various types of copper alloys, particularly that of leaded bronze, in ancient Greece, its colonies, and in Etruria. Leaded bronze is a mixture of tin, copper and lead in various proportions. The general consensus among archaeometallurgists is that leaded bronze was not commonly used in Greece until the Hellenistic period, and thus this alloy has not received very much attention in archaeological literature. However, metallographic analyses demonstrate that objects composed of leaded bronze had a wide distribution. The analyses also show differentiation in the composition of alloys that were used in the manufacture of various types of bronzes, a tangible indication that metalworkers distinguished between the properties of both tin bronze and leaded bronze. The knowledge of their different working characteristics is what enabled a bronzeworker to choose, in many cases, the appropriate alloy for a specific application. The influence of Near Eastern metallurgical practices produced variations in both the artistic forms as well as alloy compositions of Greek bronzes during the Late Geometric and Orientalizing periods. The use of leaded bronze for particular types of cast objects shows an increasing tendency from the Orientalizing period onwards, culminating in the late Hellenistic period when high-lead bronze became a common alloy. This study analyzes the metallographic data of specific categories of bronze and leaded bronze cast objects, and it will demonstrate that although the use of leaded bronze was not as prevalent as that of tin bronze, it was nevertheless a significant adjunct of ancient metallurgical practices. The periods surveyed range from the Geometric to the Hellenistic periods.