Morphological Assessment of the Anterior Loop in the Region of Mental Foramen Using Cone Beam Computed Tomography / Evaluación Morfológica del Asa Anterior en la Región del Foramen Mentoniano Mediante Tomografía Computarizada de Haz Cónico

SUMMARY: Anterior loop in the mental foramen region is a critical region in the mandible. The non detection of anterior loop leads to inadvertent complications during the surgical procedures in this region. This study aimed to evaluate the morphological assessment of the mental foramen's anterior loop (AL) using (CBCT) cone-beam computed tomography. CBCT data was retrieved from January 2018 to December 2022 and screened for eligibility. Images were viewed using panoramic reconstructed views for initial screening. Further multiplanar reformatted view in axial, coronal and sagittal planes were examined. When anterior loop was detected, the path of inferior alveolar canal was traced and the anterior loop was analyzed. Statistical analysis was carried out on the data. Cross-tabulation was done to associate gender and age with the achieved findings (heights and diameters) using the Chi-square test. In this analysis 519 cases were included and examined for presence of anterior loop. 22 cases were included in the study, out of which 10(45.5%) males and 12(54.5%) females. The prevalence of AL is high among females. AL was found higher on the right side in 14 (68.2%) cases compared to the left side with 7 (31.8%) cases. The mean diameter of AL on the right side was 2.5 mm, and on the left side diameter was 1.96 mm. The prevalence of anterior loop in the region of mental foramen in Saudi Population was found to be 4.24%. Careful evaluation for the anterior loop can prevent hemorrhagic episodes during surgical intervention or implant procedures in the mandibular premolar region.

El asa anterior en la región del foramen mentoniano es una región crítica en la mandíbula. La no detección del asa anterior conduce a complicaciones inadvertidas durante los procedimientos quirúrgicos en esta región. Este estudio tuvo como objetivo evaluar la evaluación morfológica del asa anterior (AL) del foramen mental mediante tomografía computarizada de haz cónico (CBCT). Los datos CBCT se recuperaron desde enero de 2018 hasta diciembre de 2022 y se examinaron para determinar su elegibilidad. Las imágenes se visualizaron utilizando vistas panorámicas reconstruidas para la evaluación inicial. Se examinaron además, vistas reformateadas multiplanares en los planos axial, coronal y sagital. Cuando se detectó el asa anterior, se trazó el trayecto del canal mandibular y se analizó el asa anterior. Se realizó un análisis estadístico de los datos. Mediante la prueba de Chi-cuadrado se realizó una tabulación cruzada para asociar el sexo y la edad con los hallazgos obtenidos (alturas y diámetros). En este análisis se incluyeron y examinaron 519 casos para detectar la presencia de asa anterior. Se incluyeron en el estudio 22 casos, de los cuales 10 (45,5 %) eran hombres y 12 (54,5 %) mujeres. La prevalencia de AL es alta entre las mujeres. Se observó que AL fue mayor en el lado derecho en 14 (68,2 %) de los casos en comparación con el lado izquierdo con 7 (31,8 %) casos. El diámetro medio de AL en el lado derecho fue de 2,5 mm y en el lado izquierdo fue de 1,96 mm. La prevalencia del asa anterior en la región del foramen mental en la población saudí fue de 4,24 %. Una evaluación rigurosa del asa anterior puede prevenir episodios hemorrágicos durante una intervención quirúrgica o procedimientos de implante en la región de los premolares mandibulares.

Analysis of fertility preservation and HPV negative conversion rate of LEEP by separating the vesicorectal space / 复旦学报（医学版）

Objective To explore the eradication rate of human papillomavirus(HPV)and gestational outcome of patients with high-grade squamous intraepithelial disease of the cervix(HSIL)after loop electrosurgical excision procedure(LEEP)by transvaginal dissection of the vesicorectal form the cervix.Methods A total of 53 patients treated with LEEP by transvaginal dissection of the vesicorectal form the cervix in Obstetrics and Gynecology Hospital,Fudan University from Jan to Dec,2019 were investigated.Clinical information of cervical cytological examination,HPV test and cervical biopsy under colposcopy were followed up for 6,12 and 24 months post-LEEP were collected.HPV infection in these 53 patients were compared before and after LEEP surgery.The rate of successful fertility of the cohort,the HPV conversion rate of patients with hysterectomy and LEEP done were compared.The association between the pathological type and positive surgical margin and the association between HPV infection type and positive surgical margin were analyzed.Results HPV infection rate of was 94.3%(50/53)and the proportion of HPV16 and/or 18 infection was 75.5%(40/53).Mono-HPV infection rate(69.8%,37/53)was significantly higher than mixed HPV infection rate(22.7%,13/53).Thirty-eight patients(71.7%)were found with positive surgical margin in previous LEEP operation.Fifteen patients had recurrence(28.3%)and 40 patients(75.5%)successfully delivered baby after surgery.Postoperative pathology was mainly HSIL,accounting for 66%(30/53),and 28.3%patients(15/53)had no pathological change.Forty cases had satisfying fertility-conservative operation outcome with negative surgical margin,and 38 patients eradicated HPV infection after LEEP,which took up 95%of patients with satisfying fertility-conservative operation.There was no significant difference of positive resection margin rate in between groups of HPV16/18 infection and other types.Five cases had successful delivery(12.5%,5/40)with 1 case of vaginal delivery and 4 cases of cesarean section.Among these 5 cases,3 cases undertook preventive cervical cerclage,with 1 case of vaginal delivery and 2 cases of cesarean sections.Conclusion HPV eradication rate and surgical outcome could be significantly improved by LEEP with transvaginal dissection of the vesicorectal from the cervix,which satisfied the fertility preservation of females at reproductive age.

Current situation and quality control of multidisciplinary clinic——a case study of a tertiary hospital in Guangxi / 现代医院

The Multi-disciplinary diagnosis and treatment(MDT)outpatient service is widely used in the diagnosis and treatment of patients with tumors,difficult critical and complex diseases and multiple diseases.The purpose of this paper is to study the one-stop treatment mode of MDT outpatient service in tertiary hospitals and the closed-loop management after diagnosis,which plays an important role in integrating medical resources,optimizing medical treatment process,improving patient medical experience,and ensuring medical quality and safety.In view of the weak links and difficulties in quality control in MDT outpa-tient management,such as insufficient attention from functional departments,low enthusiasm of clinicians,low initiative of pa-tients,imperfect information construction of MDT outpatient service,poor quality improvement effect,etc.,Effective manage-ment methods such as core members'guidance,supporting incentive and assessment mechanism,regular reporting of quality,im-proving information construction,extending service scope,and increasing publicity efforts have been adopted for continuous im-provement,and remarkable results have been achieved in increasing the number of cases and diseases,expanding brand influ-ence,and improving the quality of consultation.

Krackow Locking Loop Technique Combined With the Modified Kessler Suture Technique for the Treatment of Acute Closed Achilles Tendon Rupture / 中国微创外科杂志

Objective To explore the efficacy of Krackow locking loop technique combined with the modified Kessler suture technique in the treatment of acute closed Achilles tendon rupture.Methods From January 2020 to January 2022,162 cases of acute closed Achilles tendon rupture were treated with Krackow locking loop technique combined with the modified Kessler suture technique.The patients were treated with the same postoperative rehabilitation plans.The American Orthopaedic Foot and Ankle Society(AOFAS)hindfoot score and Achilles Tendon Total Rupture Score(ATRS)were collected to evaluate the functions.Results The operation time was 24-40 min(mean,31.9±4.6 min).All incisions healed in one stage without infection or sural nerve injury.Complications occurred in 2 patients,including 1 case of deep venous thrombosis and 1 case of trauma-related re-rupture.The recovery time of ankle flexion and extension motion was4-12 weeks(mean,7.6±1.9 weeks),the recovery time of single-legged heel rise height on the affected side was 10-18 weeks(mean,13.3±1.8 weeks),and the recovery time of fast walking or jogging was 14-26 weeks(mean,19.1±1.8 weeks).The 162 patients was followed up for 14-25 months(mean,19.0 months).The AOFAS hindfoot score increased from(54.4±4.4)points preoperatively to(98.0±4.0)points at the last follow-up(t =-104.402,P =0.000).The ATRS score increased from(52.0±8.3)points preoperatively to(91.2±2.4)points at the last follow-up(t =-62.823,P = 0.000).Conclusions For young and middle-aged patients with acute closed Achilles tendon rupture,Krackow locking loop technique combined with the modified Kessler suture technique can achieve good clinical outcomes.Early functional exercise is required to return to work and life.

Comparison of Therapeutic Effects Between Tightrope Loop Plate and Endobutton Plate in the Treatment of Acromioclavicular Joint Dislocation / 中国微创外科杂志

Objective To compare the efficacy of TightRope loop plate and Endobutton plate in the treatment of acromioclavicular joint dislocation.Methods A retrospective analysis was conducted on 94 patients with acromioclavicular joint dislocation who were treated at this center from March 2021 to February 2023.They were divided into two groups based on different admission date.The Group E(n =47)received Endobutton plate treatment between March 2021 and February 2022,while the Group T(n =47)received TightRope loop plate treatment between March 2022 and February 2023.At the last follow-up,the perioperative indicators,Visual Analogue Scale(VAS),Constant-Murley shoulder joint function scores,and surgical complications were compared between the two groups.Results The surgical time,intraoperative bleeding,incision length,and VAS scores at 7 days after surgery in the Group T were shorter or lower than those in the Group E(P<0.05).There were no statistical differences in the incidence of perioperative nerve injury,internal fixation displacement,clavicle fracture,vascular injury,and infection between the two groups(P>0.05).The subjective and objective scores of Constant-Murley shoulder joint function in both groups at9 months after surgery showed significant improvement compared to preoperative scores(all P =0.000).There was no significant difference in the subjective and objective scores of Constant-Murley shoulder joint function between the two groups at 9 months after surgery(P>0.05).Conclusions The treatment of acromioclavicular joint dislocation with TightRope loop plate ot or Endobutton plate has a significant effect and can effectively improve shoulder joint function.Compared with Endobutton plate,use of TightRope loop plate has minor surgical trauma,less bleeding,and significantly reduced postoperative pain,being more conducive to early functional exercise for patients.

Research on the value of double closed-loop management mode in maintenance and fault control of hemodialysis machine / 中国医学装备

Objective:To construct a double-closed-loop management model for medical equipment and explore its application value in hemodialysis machine maintenance and fault management.Methods:Based on the closed-loop management of clinical operation of medical equipment and the closed-loop management of technical support,a dual closed-loop management model of equipment was constructed.65 hemodialysis machines in clinical use in Huashan Hospital Fudan University from January 2021 to January 2023 were selected and divided into a conventional mode and double-closed-loop mode according to different management modes.The conventional mode adopted conventional equipment management methods,and the double-closed-loop mode adopted a double-closed-loop management model.The cost-effectiveness,social benefit,failure occurrence,effective management quality matters,disinfection status,average patient waiting time and satisfaction were compared between the two groups.Results:The hemodialysis machine operating profit growth rate,diagnosis and treatment cost growth rate,service life index,scientific research service growth rate,diagnosis and treatment service growth rate,startup rate and operation rate of the double-closed-loop mode were(3.95±1.04)%,(3.80±0.58)%,(1.58±0.31)%,(4.30±0.95)%,(7.91±1.58)%,(96.58±2.76)%and(89.90±5.58)%,which were higher than those of the Conventional mode,the difference was statistically significant(t=5.418,10.070,7.490,17.570,11.820,8.849,6.840,P<0.05).The technical support expenses growth rate,bacterial colony count,bacterial endotoxin content and average patient waiting time of patients in the Double-closed-loop mode were(2.60±0.33)%,(0.370±0.008)cfu/ml,(0.0063±0.0011)EU/ml and(0.76±0.13)h,which were less than those of the conventional mode,the difference was statistically significant(t=23.040,82.985,14.482,19.530,P<0.05).The incidence rate of hemodialysis machine failure in the double-closed-loop mode was 9.23%(6/65),which was lower than that in the conventional mode,the difference was statistically significant(x2=6.392,P<0.05);among the 120 items of management data collected,quality control testing,maintenance and repair,clinical operation,information data,and scrap processing effectiveness rates were 95.83%(115/120),89.17%(107/120),96.67%(116/120),95.00%(114/120),and 97.50%(117/120),respectively,which were higher than those of the conventional mode,the difference was statistically significant(x2=15.238,16.596,9.808,15.585,16.119,P<0.05).Conclusion:The application of closed-loop management model to hemodialysis machine maintenance and fault management can effectively improve equipment cost-effectiveness,social benefits,management quality and patient satisfaction,and reduce the incidence of faults.

A novel anchor-loop internal fixation system in coracoclavicular ligament reconstruction for acromioclavicular dislocation: a biomechanical study / 中华创伤骨科杂志

Objective:To explore the biomechanical stability of a novel anchor-loop internal fixation system in the treatment of acromioclavicular joint dislocation using cadaveric specimens.Methods:The acromioclavicular ligaments were severed in 12 complete shoulder joint specimens, in which the quasi-static non-destructive cycle experiment was performed until the coracoclavicular ligaments failed. The failure intensities of the coracoclavicular ligaments were recorded. Next, the 12 specimens were randomly divided into groups A, B, C and D ( n=3), in which 4 different internal fixation materials were used respectively to reduce and fix the acromioclavicular joint. Group A was subjected to 3.5 mm clavicular hook locking compression plate, group B to 5 mm soft tissue with wire anchor, group C to 10 mm Endobutton steel plate, and group D to the novel anchor-loop internal fixation system (5 mm soft tissue with wire anchor + 10 mm Endobutton steel plate). An X-ray machine was used to evaluate the reduction and internal fixation of the acromioclavicular joint. After the shoulder specimens were securely fastened by a homemade fixation jig to a 100 KN electronic universal mechanical testing machine, each experimental specimen was subjected to a destructive static tensile mechanic determination in the vertical direction at a loading speed of 100 mm/min. The load-displacement curves were recorded and drawn by a computer connected with the biomechanical testing machine. The failure strength and failure causes were recorded for each internal fixation. Results:The fracture strength of the coracoclavicular ligament in 12 cadaver specimens was (374.6±0.8) N. The mechanical load of internal fixation failure was (409.5±2.6) N in group A, (297.8±3.4) N in group B, (375.2±3.1) N in group C and (376.2±3.1) N in group D. The internal fixation failure was due to clavicular fracture in 2 specimens and to acromial fracture in 1 specimen in group A, to anchor protrusion in all the 3 specimens in group B, to coracoid base fracture in all the 3 specimens in group C, and to anchor protrusion in all the 3 specimens in group D. The mechanical loads of internal fixation failure were significantly different among the 4 experimental groups ( P<0.05). The mechanical load of internal fixation failure in group D was significantly different from that in groups A and B ( P<0.05). Conclusions:Our self-developed novel anchor-loop internal fixation system can effectively reposit the acromioclavicular joint to treat acromioclavicular joint dislocation, because it conforms to the biomechanical characteristics of the acromioclavicular joint, and is easy to handle. Therefore, its feasibility is high.

Effect of anterograde lavage via ileal double-loop stoma on preoperative colonoscopy and postoperative recovery of bowel function / 中国现代医生

Objective To investigate the effect of anterograde lavage via ileal double-loop stoma on preoperative colonoscopy and postoperative bowel function.Methods A total of 191 patients who underwent laparoscopic anterior rectal resection plus prophylactic double-loop ileal stomy in Quanzhou First Hospital Affiliated to Fujian Medical University from January 2019 to December 2021 were selected and divided into anterograde group(n=97)and retrograde group(n=94)according to different lavage methods.Patients in anterograde group underwent temporary double-loop ileal stomy with distal lavage.Patients in retrograde group underwent anal lavage.The qualified rate of colonoscopy,external damage rate of intestinal mucosa,exhaust time,defecation time,fluid intake time,total hospitalization time,total hospitalization cost and satisfaction of two groups of patients were compared.Results The qualified rate of preoperative colonoscopy in anterograde group was significantly higher than that in retrograde group,and the external damage rate of intestinal mucosa was significantly lower than that in retrograde group(P<0.05).The postoperative exhaust time,fluid intake time and total hospitalization time in anterograde group were significantly shorter than those in retrograde group(P<0.05).The total hospitalization cost in anterograde group was significantly lower than that in retrograde group(P<0.05).The satisfaction of patients in anterograde group was significantly higher than that in retrograde group(89.69%vs.52.13%,Z=-7.165,P<0.001).Conclusion Anterograde lavage via ileal double-loop stoma can improve the qualified rate of preoperative colonoscopy,is conducive to postoperative intestinal function recovery,reduce patients'pain,and improve patients'satisfaction and comfort,which is worthy of clinical application.

Clinical application of LAMP in rapid detection of pathogens in lower respiratory tract infections / 中国现代医生

@#Objective Loop mediated isothermal amplification(LAMP)was used to detect the distribution of pathogens in sputum samples,namely combined nucleic acid detection of respiratory pathogens(13 pairs),so as to provide provide reference for clinical accurate diagnosis and treatment.Methods A total of 1642 patients with lower respiratory tract infection admitted to Tongren City People's Hospital from January to December in 2022 were selected.Each patient collected sputum specimens/bronchoalveolar for detection by using LAMP(13 pairs).The detection of pathogenic bacteria in respiratory tract and the relationship with sex,age and season were analyzed.Results The overall detection rate of 13 respiratory pathogens was significantly higher in males than in females(P<0.01);In different age groups,the detection rates of Haemophilus influenzae and Streptococcus pneumoniae in patients aged 3-6,Mycoplasma pneumoniae in patients aged 6-18,and methicillin-resistant Staphylococcus aureus,Streptococcus maltophilus,and Klebsiella pneumoniae in patients aged over 60 were significantly higher than those in other groups(P<0.05);In different seasonal groups,Streptococcus pneumoniae and Chlamydia pneumoniae were more prevalent in spring,while Mycoplasma pneumoniae had the highest infection rate in autumn,and the differences were statistically significant(P<0.05).Conclusion LAMP can be used to detect the pathogen rapidly and provide the basis for clinical diagnosis and treatment.

Construction of a closed-loop management model of drugs in operating room based on intelligent Internet of Things system / 中国药房

OBJECTIVE To provide reference for improving the level of hospital pharmaceutical management for operating room drugs. METHODS The operating room pharmacy of our hospital utilized the concept and means of the Internet of Things （IoT） to build an intelligent IoT system for operating room drugs （hereinafter referred to as the “IoT system”）， and optimized and improved it. The quality of drug management in the operating room of our hospital during the initial phase of the IoT system （Q1 2022） and after optimization and improvement （Q1 2023） were compared by setting indicators from four aspects： quality， efficiency， cost， and satisfaction. RESULTS After more than a year of optimization and improvement， our hospital has built a traceable IoT system for the entire drug process that integrated surgical anesthesia systems and hospital information systems， with the direction of drug circulation in the operating room as the axis， using intelligent drug vehicles as the hardware foundation， and anesthesia doctor’s order information system as the software medium. After the optimization and improvement of the IoT system， the standardized score of anesthesia orders in the operating room increased from （68.5±3.5） points in the initial period to （97.0± 2.7） points； the consistency rate between accounts and materials increased from （82.40±8.85）% to （96.50±4.80）%； the time of taking medicine was shortened from （40±8） min to （12±3） min； the frequency of drug withdrawal was reduced from （36.0± 6.5） times/day to （15.5±3.0） times/day； the cost of loss drugs was decreased from （1 292.61±305.90） yuan to （594.24±195.05） yuan； the satisfaction was increased from （80.5±6.5） points to （96.0±3.0） points. All indicators were significantly improved with statistically significant differences （P＜0.05）. CONCLUSIONS The intelligent IoT system constructed by our hospital effectively ensures the accessibility， timeliness， and safety of intraoperative medication， which is conducive to improving the quality of drug management in the operating room.

Mitochondrial DNA diversity and maternal origins of Pakistani donkey

Abstract Domestic donkey plays a key role as a draft animal in rural economy of Pakistan where its population is increasing every year. The complete mtDNA control region of forty randomly sampled donkeys was PCR- amplified and sequenced bi-directionally using specific primers. Distinct mtDNA haplotypes obtained in the current study (KY446001KY446011) were subjected to haplotype (h) and nucleotide diversity () measures using DnaS as well as to phylogenetic, Network, and AMOVA analyses. There were a total 27 polymorphic sites present within 11 unique mtDNA haplotypes from the studied 40 animals from different regions. Neighbor-joining network and median-joining network both illustrated the splitting of all these haplotypes into two well-defined Nubian and Somali lineages, confirming African maternal origin of Pakistani domestic donkey. Diversity parameters h (0.967± 0.037) and (0.02917± 0.00307) were found to reveal high levels of genetic diversity in Pakistani donkeys. AMOVA demonstrated only 1% of genetic differences between two mtDNA maternal lineages, pointing to lack of population substructure in Pakistani donkeys as is the case with worldwide domestic donkey population. Pakistani donkeys have African maternal origin and high levels of mtDNA diversity. High genetic diversity may be due to non-selective breeding and heteroplasmy. We herein provide the first report on mtDNA diversity of control region in Pakistani domestic donkey.

Resumo O burro doméstico possui um papel fundamental como animal de tração na economia rural do Paquistão, onde a população desse animal está aumentando a cada ano. A região de controle de mtDNA completa de 40 burros amostrados aleatoriamente foi ampliada por PCR e sequenciada bidirecionalmente por intermédio de primers específicos. Haplótipos distintos de mtDNA obtidos no estudo atual (KY446001 KY446011) foram submetidos a medidas de haplótipo (h) e diversidade de nucleotídeos () por meio de DnaS, bem como análises filogenéticas, de rede e AMOVA. Havia um total de 27 sítios polimórficos presentes em 11 haplótipos de mtDNA exclusivos dos 40 animais estudados de diferentes regiões. A rede de união de vizinhos e a rede de união mediana ilustram a divisão de todos esses haplótipos em duas linhagens núbias e somalis bem definidas, confirmando a origem materna africana do burro doméstico do Paquistão. Os parâmetros de diversidade h (0,967 ± 0,037) e (0,02917 ± 0,00307) revelaram altos níveis de diversidade genética em burros paquistaneses. AMOVA demonstrou apenas 1% de diferenças genéticas entre as duas linhagens maternas de mtDNA, apontando a falta de subestrutura populacional em burros paquistaneses, como é o caso da população mundial de burros domésticos. Os burros paquistaneses têm origem materna africana e altos níveis de diversidade de mtDNA. A alta diversidade genética pode ser por causa da reprodução não seletiva e de heteroplasmia. Aqui, fornecemos o primeiro relatório sobre a diversidade do mtDNA da região de controle em burros domésticos do Paquistão.

Mitochondrial DNA diversity and maternal origins of Pakistani donkey / Diversidade de DNA mitocondrial e origens maternas do burro do Paquistão

Domestic donkey plays a key role as a draft animal in rural economy of Pakistan where its population is increasing every year. The complete mtDNA control region of forty randomly sampled donkeys was PCR- amplified and sequenced bi-directionally using specific primers. Distinct mtDNA haplotypes obtained in the current study (KY446001−KY446011) were subjected to haplotype (h) and nucleotide diversity (π) measures using DnaS as well as to phylogenetic, Network, and AMOVA analyses. There were a total 27 polymorphic sites present within 11 unique mtDNA haplotypes from the studied 40 animals from different regions. Neighbor-joining network and median-joining network both illustrated the splitting of all these haplotypes into two well-defined Nubian and Somali lineages, confirming African maternal origin of Pakistani domestic donkey. Diversity parameters h (0.967± 0.037) and π (0.02917± 0.00307) were found to reveal high levels of genetic diversity in Pakistani donkeys. AMOVA demonstrated only 1% of genetic differences between two mtDNA maternal lineages, pointing to lack of population substructure in Pakistani donkeys as is the case with worldwide domestic donkey population. Pakistani donkeys have African maternal origin and high levels of mtDNA diversity. High genetic diversity may be due to non-selective breeding and heteroplasmy. We herein provide the first report on mtDNA diversity of control region in Pakistani domestic donkey.

O burro doméstico possui um papel fundamental como animal de tração na economia rural do Paquistão, onde a população desse animal está aumentando a cada ano. A região de controle de mtDNA completa de 40 burros amostrados aleatoriamente foi ampliada por PCR e sequenciada bidirecionalmente por intermédio de primers específicos. Haplótipos distintos de mtDNA obtidos no estudo atual (KY446001 − KY446011) foram submetidos a medidas de haplótipo (h) e diversidade de nucleotídeos (π) por meio de DnaS, bem como análises filogenéticas, de rede e AMOVA. Havia um total de 27 sítios polimórficos presentes em 11 haplótipos de mtDNA exclusivos dos 40 animais estudados de diferentes regiões. A rede de união de vizinhos e a rede de união mediana ilustram a divisão de todos esses haplótipos em duas linhagens núbias e somalis bem definidas, confirmando a origem materna africana do burro doméstico do Paquistão. Os parâmetros de diversidade h (0,967 ± 0,037) e π (0,02917 ± 0,00307) revelaram altos níveis de diversidade genética em burros paquistaneses. AMOVA demonstrou apenas 1% de diferenças genéticas entre as duas linhagens maternas de mtDNA, apontando a falta de subestrutura populacional em burros paquistaneses, como é o caso da população mundial de burros domésticos. Os burros paquistaneses têm origem materna africana e altos níveis de diversidade de mtDNA. A alta diversidade genética pode ser por causa da reprodução não seletiva e de heteroplasmia. Aqui, fornecemos o primeiro relatório sobre a diversidade do mtDNA da região de controle em burros domésticos do Paquistão

Efficacy of the hybrid closed-loop insulin delivery system in children and adolescents with type 1 diabetes: a meta-analysis with trial sequential analysis

ABSTRACT The aim of this study was to assess the efficacy and safety of hybrid closed-loop (HCL) systems for insulin delivery in children and adolescents with type 1 diabetes (T1D). We searched Embase, PubMed, and Cochrane Library for randomized controlled trials (RCTs) published until March 2023 comparing the HCL therapy with control therapies for children and adolescents with T1D. We computed weighted mean differences (WMDs) for continuous outcomes and risk ratios (RRs) with 95% confidence intervals (CIs) for binary endpoints. Four RCTs and 501 patients were included, of whom 323 were randomized to HCL therapy. Compared with control therapies, HCL significantly improved the period during which glucose level was 70-180 mg/dL (WMD 10.89%, 95% CI 8.22-13.56%) and the number of participants with glycated hemoglobin (HbA1c) level < 7% (RR 2.61, 95% CI 1.29-5.28). Also, HCL significantly reduced the time during which glucose level was > 180 mg/dL (WMD -10.46%, 95% CI -13.99 to -6.93%) and the mean levels of glucose (WMD -16.67 mg/dL, 95% CI -22.25 to -11.09 mg/dL) and HbA1c (WMD -0.50%, 95% CI -0.68 to -0.31). There were no significant differences between therapies regarding time during which glucose level was < 70 mg/dL or <54 mg/dL or number of episodes of ketoacidosis, hyperglycemia, and hypoglycemia. In this meta-analysis, HCL compared with control therapies was associated with improved time in range and HbA1c control in children and adolescents with T1D and a similar profile of side effects. These findings support the efficacy of HCL in the treatment of T1D in this population.

Accuracy of closed-loop and open-loop propofol delivery systems by bispectral index monitoring in breast surgery patients: a prospective randomized trial

Abstract Background: This randomized and controlled prospective study tested the hypothesis that closed-loop Target-Controlled Infusion (TCI) of propofol would be associated with better system performance when compared with open-loop controlled delivery of propofol. Methods: Patients scheduled for elective breast surgery were randomly assigned to two groups: a closed-loop group, in which propofol infusion was performed by a closed-loop TCI system that used the Bispectral Index (BIS) as a feedback parameter to titrate the rate of propofol infusion, and an open-loop group, in which propofol infusion was performed manually and guided by the bispectral index. Results: A total of 156 patients were recruited for this study (closed-loop group n = 79; open-loop group n = 77). The Global Score (GS) of the closed-loop group was lower than that of the open-loop group (34.3 and 42.2) (p = 0.044). The proportions of time with a BIS value between 40 and 60 were almost identical in the closed-loop group and the open-loop group (68.7 ± 10.6% and 66.7 ± 13.3%) (p = 0.318). The individuals in the closed-loop group consumed more propofol compared with those in the open-loop group (7.20 ± 1.65 mg.kg−1.h−1 vs. 6.03 ± 1.31 mg.kg−1.h−1, p < 0.001). No intraoperative recall, somatic events or adverse events occurred. No significant difference in heart rate was observed between the two groups (p = 0.169). Conclusion: The closed-loop protocol was associated with lower BIS variability and lower out-of-range BIS values, at the cost of a greater consumption of propofol when compared to the open loop group. Register number:ChiCTR-INR-17010399.

Ileostomy: early and late complications

Introduction: Ileostomy formation is performed for multiple purposes related to intestinal pathology, such as obstructive malignant or benign tumors, inflammatory bowel diseases, intestinal ischemia, and, for the most part, as a protective stoma in high-risk anastomosis. The creation of this surgical opening, despite being considered a simple procedure, is undoubtedly followed by complications in certain cases. Materials and Methods: We conducted an electronic literature search in the MEDLINE database using the PubMed search engine. A total of 43 articles were included in the present review. Results/Discussion: Over the course of the present work, we were able to explore different types of complications that can arise in patients with an ileostomy. High-output stomas were found to be associated with dehydration and electrolyte imbalance. Skin-related morbidity was shown to be present in a great percentage of patients. More severe complications, such as peristomal pyoderma gangrenosum and necrosis, are less frequent and require urgent management. Several risk factors were identified in cases of retraction, obstruction, prolapse, and parastomal herniation. Conclusion: Even though ileostomies may present numerous benefits in certain patients, they are also associated with many complications, which should be avoided and quickly managed, because they can severely affect the quality of life of the patients. Surveillance and follow-up by a multidisciplinary team is strongly advisable, bearing in mind that a good performance on the part of the responsible surgeon is also a key factor. (AU)

Early vs. Standard Loop Ileostomy Closure: An Unmatched Case-Control Study / Cierre Temprano vs Estándar de Ileostomía en Asa. Estudio de Casos y Controles no Emparejado

SUMMARY: Early closure of a loop ileostomy (ECI) is a relatively new practice, for which there is insufficient evidence regarding its effectiveness in relation to closure at conventional times. The aim of this study was to report postoperative complications (POC) and hospital mortality in patients with loop ileostomy (LI) who underwent ECI, compared with patients with LI who underwent late closure. Un- matched case-control study. Patients with LI who underwent surgery at Clínica RedSalud Mayor Temuco (2010-2022) were included. Cases were defined as patients with LI who underwent early closure and controls as subjects who underwent closure at the usual times. No matching was performed, but a 1:1 relationship between cases and controls was considered. Outcome variables were postoperative complications and hospital mortality. Other variables of interest were surgical time and hospital stay. Descriptive statistics were applied with calculation of proportions and measures of central tendency. Subsequently, t-test and Pearson Chi2 for comparison of averages and proportions was applied, and odds ratios and their respective 95 % CI were calculated. In this study 39 patients with AI were operated on (18 cases and 21 controls). Age and BMI average of the studied subjects was 71.3±7.1 years and 27.3±19.8 kg/m2 respectively. Mean LI closure time, surgical time, and hospitalization were: 10.0±0.7 months; 62.5±10.6min; 3.8±0.1 days respectively. POC were only surgical site infections. Three in cases (16.7 %) and 3 in controls (14.3 %). No anastomotic dehiscence or hospital mortality was observed in either cases or controls. There were no differences in comorbidities or surgical site infection between cases and controls (OR of 0.6 and 1.2 respectively) In this experience, the results of performing the CTI were similar to the late closing in relation to the variables studied.

El cierre temprano de una ileostomía en asa (IA), es una práctica relativamente nueva, sobre la que no hay suficiente evidencia respecto de su efectividad en relación con el cierre en tiempos convencionales. El objetivo de este estudio fue verificar diferencias en la tasa de complicaciones postoperatorias (CPO) y de mortalidad hospitalaria en pacientes con IA sometidos a cierre temprano comparados con pacientes con IA sometidos a cierre tardío. Estudio de casos y controles sin emparejamiento. Se incluyeron pacientes con IA que fueron sometidos a cirugía en la Clínica RedSalud Mayor Temuco (2010-2022). Los casos se definieron como pacientes con IA sometidos a cierre temprano y los controles como sujetos con IA sometidos a cierre en tiempos habituales. No se realizó emparejamiento. Se consideró una relación 1:1 entre casos y controles. Las variables de resultado fueron CPO y mortalidad hospitalaria. Otras variables de interés fueron: tiempo quirúrgico y hospitalización. Se aplicó estadísticas descriptivas (cálculo de proporciones y medidas de tendencia central). Posteriormente, se aplicó prueba t-test y Chi2 para comparación de promedios y proporciones; y se calcularon odds ratios e intervalos de confianza del 95 %. Se operaron 39 pacientes con IA (18 casos y 21 controles). El promedio de edad e IMC fue 71,3±7,1 años y 27,3±19,8 kg/m2, respectivamente. El tiempo promedio de cierre de IA, tiempo quirúrgico y hospitalización fueron: 10,0±0,7 meses; 62,5±10,6 minutos; 3,8±0,1 días, respectivamente. Las CPO fueron infecciones del sitio quirúrgico (3 casos; 16,7 % y 3 controles; 14,3 %). No se observó dehiscencia anastomótica ni mortalidad hospitalaria en casos ni controles. No hubo diferencias en comorbilidades ni en infecciones del sitio quirúrgico entre casos y controles (OR de 0,6 y 1,2, respectivamente). No se evidenciaron diferencias entre realizar cierre temprano o tardío de IA, respecto de las variables CPO y de mortalidad hospitalaria.

Estudio de la prevalencia del nacimiento y de la presencia de bucle caudal extracraneano de arterias cerebelosas posteroinferiores en una población estudiada por angiografía cerebral / Study of the prevalence of origin and the presence of an extracranial caudal loop of the posterior inferior cerebellar arteries in a population studied by cerebral angiography

Introducción. La arteria cerebelosa posteroinferior (ACPI) nace de la arteria vertebral en la cara anterolateral del tronco cerebral, generalmente a la altura de la oliva inferior, transcurriendo en forma rostral a través de las raíces de los nervios glosofaríngeo, vago y accesorio. El objetivo del trabajo es determinar la prevalencia del nacimiento de la arteria cerebelosa postero inferior a nivel extracraneano, la presencia de bucle caudal extracraneano y las relaciones con estructuras oseas adyacentes, en una población estudiada por angiografía de vasos supraaórticos. Material y métodos. Estudio prospectivo, descriptivo, de una muestra consecutiva realizada durante un año (septiembre 2021 a agosto 2022) de todos los pacientes a los que se les realizó un cateterismo de vasos de cuello y cerebrales en Neurointervencionismo del Hospital de Alta Complejidad en Red "El Cruce", Buenos Aires, Argentina.Los estudios se realizaron en dos angiógrafos digitales en forma indistinta en incidencia perfil, con y sin digitalización de imagen, focalizadas en la unión craneo-cervical en todos los pacientes estudiados entre 18 y 80 años. Se objetivó el lugar de nacimiento de las arterias ACPI y la presencia de bucles extracraneanos por visión directa en los estudios sin y con sustracción. Se definió como bucle o loop extracraneano a la presencia de un segmento curvo de la arteria con dirección caudal que se extiende por debajo del foramen magno. Se buscó la concordancia interobservador entre 2 profesionales en forma independiente. Resultados. De los 404 procedimientos realizados en el período estudiado ingresaron 288 pacientes al estudio, de los cuales 152 fueron mujeres. La edad promedio fue de 49,2 años. Se analizaron 422 ACPI, 214 derechas y 208 izquierdas. Se observaron un total de 102 ACPI con bucles extracraneanos, representando un 24,1% del total: 49 derechos (48%) y 53 izquierdos (52%). En relación a arterias con origen extracraneal, se observaron en total 58 (13,7%) de las cuales 29 fueron derechas (50%). En 10 casos se observó en la misma arteria nacimiento y loop extracraneano (10%) y en dos casos nacimiento y loop extracraneano bilateral (3.9%). En 13 casos la arteria vertebral fue terminal en ACPI, de las cuales 5 presentaron un loop extracraneano, representando el 38,5 % de su población, siendo en su totalidad del territorio derecho. Conclusión. La prevalencia del nacimiento extracraneano de la ACPI en la población estudiada por angiografía fue de 13,7% y la prevalencia de bucle extracraneano fue del 24%. Ambos porcentajes se encuentran dentro de los resultados hallados en estudios previos, anatómicos y por imágenes: 0,7 al 20% y 9,5 al 35% respectivamente. La prevalencia de bucle extracraneano en arterias vertebrales con terminación en ACPI fue del 38,5%, siendo significativamente superior a los estudios reportados

Background. The posteroinferior cerebellar artery (PICA) arises from the vertebral artery on the anterolateral aspect of the brain stem, generally at the level of the inferior olive, running rostrally through the roots of the glossopharyngeal, vagus and accessory nerves. The objective of the work is to determine the prevalence of the origin of the posterior inferior cerebellar artery at the extracranial level, the presence of an extracranial caudal loop and the relationships with adjacent bone structures, in a population studied by angiography of supra-aortic vessels. Methods. Prospective, descriptive study of a consecutive sample carried out for one year (September 2021 to August 2022) of all patients who underwent catheterization of neck and cerebral vessels in the "Hospital de Alta Complejidad en Red El Cruce", Buenos Aires, Argentina. The studies were carried out in two digital angiographers indistinctly in profile incidence, with and without image digitization, focused on the cranio-cervical junction in all patients studied between 18 and 80 years of age. The birthplace of the ACPI arteries and the presence of extracranial loops were observed by direct vision in the studies without and with subtraction. An extracranial loop was defined as the presence of a curved segment of the artery with a caudal direction that extends below the foramen magnum. Interobserver agreement was sought between 2 professionals independently. Results. Of the 404 procedures performed in the studied period, 288 patients entered the study, of which 152 were women. The average age was 49,2 years; 422 PICA were analyzed, 214 right and 208 left. A total of 102 PICA with extracranial loops were observed, representing 24.1% of the total: 49 right (48%) and 53 left (52%). In relation to arteries with extracranial origin, a total of 58 (13.7%) were observed, of which 29 were right (50%). In 10 cases birth and extracranial loop were observed in the same artery (10%) and in two cases birth and bilateral extracranial loop (3.9%). In 13 cases the vertebral artery was terminal in PICA, of which 5 presented an extracranial loop, representing 38.5% of its population, being entirely in the right territory. Conclusions. The prevalence of extracranial origin of the PICA in the population studied by angiography was 13.7% and the prevalence of extracranial loop was 24%. Both percentages are within the results found in previous anatomical and imaging studies: 0.7 to 20% and 9.5 to 35% respectively. The prevalence of extracranial loop in vertebral arteries ending in PICA was 38.5%, being significantly higher than the reported studies

Bilateral Variation of the Vertebral Artery: Report of a Case and its Clinical Implication / Variación Bilateral de la Arteria Vertebral; Reporte de un Caso y su Implicancia Clínica

SUMMARY: There are many reports on anatomical variations of the vertebral arteries, which may be related to origin, trajectory, caliber, and side. Bilateral variations are less frequent, however, and less common are bilateral variants that differ from each other. The aim of this work was to report the presence of a bilateral variation of the vertebral artery and its functional and clinical implications. Dissection of a female cadaver, fixed in 10 % buffered formaldehyde, which had not undergone any previous surgeries in the study area and had anatomical variations in both vertebral arteries. In each one, follow-up was done from its origin to its end, determining its trajectory, diameters, branching, and anatomical relations. A left vertebral artery was found, starting in the aortic arch and making a sinuous trajectory of 4 curvatures to enter the transverse foramen of C4. The right vertebral artery began as the first branch of the subclavian artery. Its initial trajectory was rectilinear, followed by a right concave curve, a 360° loop that included a second ascending curve, and ended straight before entering the transverse foramen of C6. The coexistence of bilateral variations in the vertebral arteries is possible. This atypical situation can potentially generate vascular and neurological pathologies, but with different symptoms and causes. Knowing these variations and deliberately searching for them will enable the specialist to make a suitable differential diagnosis.

Existen múltiples reportes sobre variaciones anatómicas de las arterias vertebrales, las que se pueden relacionar con origen, trayecto, calibre y lateralidad. Sin embargo, las variaciones bilaterales son menos frecuentes, y menos común es que las variantes bilaterales sean diferentes entre ellas. El objetivo de este trabajo fue reportar la presencia de una variación bilateral de la arteria vertebral y su implicancia funcional y clínica. Disección en un cadáver de sexo femenino, fijado en formaldehido tamponado al 10 %, el cual no presentaba intervenciones quirúrgicas previas en la región de estudio y que tenía variaciones anatómicas en ambas arterias vertebrales. En cada una se realizó seguimiento desde su origen hasta su terminación, pudiendo determinar su trayecto, diámetros, ramificaciones y relaciones anatómicas. Se encontró una arteria vertebral izquierda originada en el arco aórtico, que realizaba un trayecto sinuoso de 4 curvaturas e ingresaba al foramen transverso de C4. La arteria vertebral derecha se originaba como primera rama de la arteria subclavia. Su trayecto inicial era rectilíneo seguido por una curva de concavidad derecha, un loop (giro) de 360° que incluía una segunda curva ascendente y terminaba en dirección recta antes de ingresar al foramen transverso de C6. La coexistencia de variaciones bilaterales en las arterias vertebrales es posible. Esta situación atípica, potencialmente puede generar en la persona patologías neurológicas de origen vascular, pero con sintomatología y causas diferentes. Conocer estas variaciones y realizar una búsqueda intencionada de ellas permitirá el especialista realizar un adecuado diagnóstico diferencial.

QUALITATIVE STUDY: DERMATOGLYPHIC PATTERN IN PATIENTS WITH TYPE II DIABETES MELLITUS

Aims and objectives: To study the dermatoglyphic patterns in healthy and Type II diabetes mellitus subjects. To study the arches, Ulnar loop, Radial loop and Whorl patterns The present study was conducted i Methods: n the Department of Anatomy, Index Medical College, Indore (M.P.), India. Subjects of the age group 35-65 years was chosen from North Indian Population. Patients and controls were selected randomly from Index Medical College and Hospital, Indore (M.P.) India. The bilateral rolled finger and palm prints of 100 Diabetes Mellitus II patients were compared to 100 controls. Results: Shows that the comparison of right ulnar loop, right whorl, left ulnar loop, left radial loop, and left whorl in male between healthy subjects and type II diabetes mellitus patients, which are statistically significant. (p <0.001). whereas right arch, right radial loop, and left arch is not statistically significant. Fingertip ridge count of right ulnar loop, Conclusions: right radial loop and left ulnar loop, is increased in healthy male subjects as compared to type II diabetes mellitus. While right arch, right whorl, left arch, left radial loop, and left whorl is decreased.

Observation of the curative effect of scleral suture fixation technique with four-loop foldable intraocular lens

The objective of the study was to evaluate the curative effect of a modified technique of scleral suture fixation with a four-loop foldable intraocular lens (IOL) for eye with inadequate capsule support. This was a retrospective study of 22 eyes with inadequate capsule support of 20 patients who underwent the scleral suture fixation technique with 9-0 polypropylene suture and foldable four-loop IOL implant. Preoperative and follow-up data were collected for all patients. The mean follow-up was 5.08 ± 0.48 months (range: 3–12 months). The mean pre- and postoperative log of minimum angle of resolution (logMAR) uncorrected distance visual acuity was 1.11 ± 0.32 versus 0.09 ± 0.09 (P < 0.001). The mean pre- and postoperative logMAR best corrected visual acuity was 0.37 ± 0.19 versus 0.08 ± 0.07 (P < 0.001). The intraocular pressure (IOP) increased briefly (range: 21–30 mmHg) in eight eyes on the first day postoperatively and returned to normal within 1 week. No IOP drops were used postoperatively. The IOP was 12–19.3 (13.72 ± 1.28) in this follow-up, which had no significant difference compared to the preoperative IOP (t = 0.34, P = 0.74). At this follow-up, there was no hyperemia, local hyperplasia, obvious scar, suture knots, or segment ends observed under the conjunctiva, as well as no pupil deformation or vitreous hemorrhage. The mean postoperative IOL decentration degree was 0.22 ± 0.08 mm. At the 7-day follow-up postoperatively, one side of the IOL was dislocated to the vitreous cavity in one case, which was resolved by reimplantation of a new IOL in time with the same technique. Scleral suture fixation technique of a four-loop foldable IOL was a feasible operation method for an eye with inadequate capsular support.