Abordagem cirúrgica em fratura de sínfise e côndilo mandibular bilateral em paciente pediátrico: um relato de caso / Surgical approach for syphysis and bilateral mandibular condyle fracture in a pediatric patient: a case report

As indicações de tratamento das fraturas mandibulares em paciente pediátrico variam em conservador, fixação não rígida e interna rígida. Alterações no crescimento ósseo, disfunções na articulação temporomandibular e assimetrias faciais podem ser decorrentes ao insucesso do tratamento. O objetivo deste trabalho consiste em relatar abordagem cirúrgica em fratura de sínfise e côndilo mandibular bilateral em paciente pediátrico. Paciente gênero feminino, 09 anos de idade, foi encaminhada ao Hospital Geral do Estado - Bahia vítima de queda de nível, cursando com trauma em face. Apresentou queixa principal, referida pela progenitora, de dificuldades em fechar a boca. Ao exame físico, a paciente apresentou mobilidade atípica à manipulação da mandíbula, mordida aberta anterior, equimose sublingual, ausência das unidades dentárias 74 e 75, com abertura bucal regular e suturas em posição em região de mento. Ao exame de imagem de tomografia computadorizada da face, pôde-se notar sinais sugestivos de fratura em região de sínfise e côndilos mandibulares bilateral. Após diagnóstico das fraturas, a paciente foi submetida à cirurgia sob anestesia geral para redução e fixação das mesmas. Realizou-se acessos em ferimento na região mentual e retromandibular bilateral com posterior síntese das fraturas utilizando fixação interna rígida com placas do sistema 2.0mm, associada a odontossíntese na fratura de sínfise. Ao acompanhamento periódico, a eleição do tratamento cirúrgico para fraturas mandibulares em pacientes pediátricos, pode permitir segurança no crescimento ósseo mandibular e facial(AU)

The indications for treatment of mandibular fractures in pediatric patients vary from conservative, non-rigid fixation and rigid internal fixation. Changes in bone growth, temporomandibular joint disorders and facial asymmetries may be due to treatment failure. The objective of this work is to report a surgical approach to bilateral symphysis and mandibular condyle fractures in a pediatric patient. Female patient, 9 years old, was sent to the State General Hospital - Bahia, victim of a fall in level, suffering from trauma to the face. She presented a main complaint, mentioned by her mother, of difficulties in closing her mouth. On physical examination, the patient presented atypical mobility when manipulating the jaw, anterior open bite, sublingual ecchymosis, absence of dental units 74 and 75, with regular mouth opening and sutures in position in the chin region. When examining the computed tomography image of the face, signs suggestive of fracture in the region of the symphysis and bilateral mandibular condyles were noted. After diagnosis of the fractures, the patient underwent surgery under general anesthesia to reduce and fix them. Access was performed on a wound in the mental and bilateral retromandibular region with subsequent synthesis of the fractures using rigid internal fixation with 2.0mm system plates, associated with odontosynthesis in the symphysis fracture. With periodic monitoring, the choice of surgical treatment for mandibular fractures in pediatric patients can allow for safe mandibular and facial bone growth(AU)

FLEXIBLE VERSUS RIGID ESOPHAGOSCOPY IN THE MANAGEMENT OF ESOPHAGEAL FOREIGN BODY IMPACTION

Background: Foreign body(FB) impaction accounts for 4% of emergency endoscopies in clinical practice. Flexible endoscopy(FE) is a recommended therapeutic option because it can be performed under local anesthesia, it is cost effective and is well tolerated. Rigid endoscopy (RG) under general anesthesia is another option and is advantageous in some circumstances. The aim of the study is to compare ef?cacy and safety of ?exible and rigid esophagoscopy in esophageal foreign body removal. It is a prospective study done in E.N.T department in KIMS Methods: MEDICAL COLLEGE, Amalapuram, which includes 50 patients with impacted foreign body esophagus. Parameters like type of foreign body, location of impacted foreign body are included. The study analyzies the type of procedure the patient have undergone, the intra operative and post operative complications. This prospective cohort study includes 50 patients Results: who have undergone surgical procedure for removal of impacted foreign body. Flexible esophagoscopy is performed in 30 patients and rigid esophagoscopy is performed in 20 patients . The most frequent complications are mucosal erosion, mucosal edema, and ulceration. Flexible esophagoscopy and rigid esophagoscopy are equally safe and effective for Conclusion: removal of impacted esophageal foreign body

Accurate Reconstruction of Traffic Accident Based on Multiple Optimization Algorithms and Evaluation of Craniocerebral Injury Risk / 医用生物力学

Objective To investigate the effect of different optimization algorithms on accurate reconstruction of traffic accidents. Methods Non-dominated sorting genetic algorithm-II ( NSGA-II), neighborhood cultivation genetic algorithm (NCGA) and multi-objective particle swarm optimization (MOPSO) were used to optimize the multi-rigid body dynamic reconstruction of a real case. The effects of different optimization algorithms on convergence speed and optimal approximate solution were studied. The optimal initial impact parameters were simulated as boundary conditions of finite element method, and the simulated results were compared with the actual injuries. Results NCGA had a faster convergence speed and a better result in optimization process. The kinematic response of pedestrian vehicle collision reconstructed by the optimal approximate solution was consistent with the surveillance video. The prediction of craniocerebral injury was basically consistent with the cadaver examination. Conclusions The combination of optimization algorithm, rigid multibody and finite element method can complete the accurate reconstruction of traffic accidents and reduce the influence of human factors.

A Case of Myocardial Infarction with Both Ventricular Thrombi Undergoing Thrombectomy and Coronary Artery Bypass / 日本心臓血管外科学会雑誌

A 48-year-old man was treated for heart failure at a nearby hospital, and echocardiography revealed thrombi in both ventricles. He was referred to our hospital for a detailed examination and treatment. Coronary angiography was performed, and the results were #2-3 50%, #5 50%, #6 100%, and #11 75%. Echocardiography revealed diffuse hypokinesis with an ejection fraction (EF) of 31%, which was indicative of old myocardial infarction. The left intraventricular thrombus was floating and adherent to the apex of the heart, and we judged that immediate surgical intervention was necessary to remove the thrombus and perform coronary artery bypass grafting. The right ventricular thrombus was removed through the tricuspid valve with an incision in the right atrium using a rigid endoscope to ensure that no thrombus remained behind. There were no perioperative embolic complications, and oral administration of direct oral anticoagulants (DOAC) was continued for one year after the operation. However, no recurrence of thrombosis was observed, and the prognosis was good.

Application of flexible ureteroscope in the treatment of middle and upper ureteral calculi complicated with lower ureteral stricture / 现代泌尿外科杂志

【Objective】 To explore the safety and efficacy of flexible ureteroscope in the treatment of upper and middle ureteral calculi complicated with lower ureteral stricture after the failure of rigid ureteroscopy. 【Methods】 Clinical data of 36 patients with middle and upper ureteral calculi and lower ureteral stricture treated with rigid ureteroscopy but failed during Oct.2019 and Oct.2021 were retrospectively analyzed. The patients’ average age was (46.2±13.2) years, and the maximum diameter of calculi was (1.3±0.3) cm. The intraoperative, postoperative and follow-up data were recorded. 【Results】 All 36 patients successfully completed first-stage operation. Intraoperatively, the stenosis degree was F6-8 and could be dilated to F9-11. The mean length of stenosis was (1.1±0.34) cm. No serious postoperative complications such as infection or bleeding occurred. Two patients were lost and 34 patients were followed up. There was no obvious hydronephrosis on ultrasound examination. The stone removal rates were 76.5%, 88.2% and 97.1%, respectively, in months 1, 2 and 3 after operation. One patient with residual stones underwent secondary ureteroscopy in month 3 and large stones were removed with stone removal basket. 【Conclusion】 In patients with middle and upper ureteral calculi and lower ureteral stricture, after the failure of rigid ureteroscopy, flexible ureteroscope is safe and effective, and can significantly increase the success rate of first-stage surgery.

Non-rigid registration for medical images based on deformable convolution and multi-scale feature focusing modules / 生物医学工程学杂志

Non-rigid registration plays an important role in medical image analysis. U-Net has been proven to be a hot research topic in medical image analysis and is widely used in medical image registration. However, existing registration models based on U-Net and its variants lack sufficient learning ability when dealing with complex deformations, and do not fully utilize multi-scale contextual information, resulting insufficient registration accuracy. To address this issue, a non-rigid registration algorithm for X-ray images based on deformable convolution and multi-scale feature focusing module was proposed. First, it used residual deformable convolution to replace the standard convolution of the original U-Net to enhance the expression ability of registration network for image geometric deformations. Then, stride convolution was used to replace the pooling operation of the downsampling operation to alleviate feature loss caused by continuous pooling. In addition, a multi-scale feature focusing module was introduced to the bridging layer in the encoding and decoding structure to improve the network model's ability of integrating global contextual information. Theoretical analysis and experimental results both showed that the proposed registration algorithm could focus on multi-scale contextual information, handle medical images with complex deformations, and improve the registration accuracy. It is suitable for non-rigid registration of chest X-ray images.

Rapid prediction of G protein-coupled receptor structures using nanoluciferase assay / 药学学报

Using beta-2 adrenergic receptor, 5-hydroxytryptamine and angiotensin II type 1 receptor as control, we here established a method for rapid prediction of the initial position amino acids of N-terminal, C-terminal, intracellular loops, extracellular loops and transmembrane (TM) regions in G protein-coupled receptors (GPCRs), and successfully predicted the structure of Mas-related G protein-coupled receptors X3 (MRGPRX3). To achieve this purpose, nanoluciferase (Nluc) was inserted into the different sites of these GPCRs′ sequence by sequence and ligation-independent cloning (SLIC) method, and the luminescence value were measured to distinguish the different parts of GPCRs. The results showed that luminescence values of NLuc luciferase at TM region were less than 100 000, and the values were higher than 1 000 000 at N terminal, C terminal, or extracellular loops and intracellular loops, and the values were between 100 000 and 500 000 at junction. The predicted MRGPRX3 structure was analyzed in detail and was compared with AlphaFold predicted structure. In conclusion, this method could provide useful information of GPCR structure model for the ligand virtual screening, and could provide certain experimental basis for structural pharmacology.

Evolución de la osteosíntesis de los huesos largos: fijación por enclavado intramedular con clavos rígidos

Se presenta la evolución histórica y científica de la osteosíntesis de huesos largos realizada con clavos rígidos. Mediante una revisión bibliográfica retrospectiva en revistas de Traumatología nacionales y extranjeras, así como libros relevantes de esta especialidad, se pudieron establecer tres momentos claves en la osteosíntesis intramedular con clavos rígidos y caracterizar las diferentes generaciones que aportaron a este procedimiento en la historia de la Ortopedia y la Traumatología. Destacan las innovaciones tecnológicas incorporadas a la práctica quirúrgica y el desarrollo de biomateriales para mejorar la reparación de lesiones e incorporar al paciente a su vida cotidiana. El trabajo demuestra cómo ha avanzado la técnica quirúrgica de fijación intramedular y la consolidación ósea; y gracias a ello los problemas de las fracturas han quedado prácticamente solucionados.

The historical and scientific evolution of osteosynthesis of long bones performed with rigid nails is presented. Through a retrospective bibliographic review in national and foreign Traumatology journals, as well as relevant books of this specialty, it was possible to establish three key moments in intramedullary osteosynthesis with rigid nails and characterize the different generations that contributed to this procedure in the history of Orthopedics and Traumatology. The technological innovations incorporated into surgical practice and the development of biomaterials to improve the repair of injuries and incorporate the patient into their daily lives stand out. The work demonstrates how the surgical technique of intramedullary fixation and bone consolidation has advanced; and how thanks to this the problems of fractures have been practically solved.

Evolución de la osteosíntesis de los huesos largos y fijación por enclavado intramedular flexible / Evolution of Long Bone Osteosynthesis and Flexible Intramedullary Nail Fixation

Introducción: Se presenta la evolución histórica y científica de la osteosíntesis de huesos largos realizada con dos tipos de implantes intramedulares: Pines o varillas flexibles y clavos rígidos. Objetivo: Publicar un artículo científico que sirva de soporte teórico y práctico al personal en formación y, como punto de referencia y consulta a los ortopédicos y traumatólogos. Métodos: Se realiza una revisión bibliográfica retrospectiva de artículos sobre fracturas de los miembros publicadas en revistas de traumatología nacionales y extranjeras indexadas en las bases de datos MEDLINE y certificadas por el organismo de Ciencia Tecnología y Medio Ambiente, así como libros de relevancia sobre este tema y experiencias de los autores. Dadas las diferencias entre los dos tipos de implantes se estudiaron por separado la osteosíntesis con pines flexibles (Rush) y la realizada con clavos rígidos (Küntscher). Se seleccionaron las siguientes variables para el estudio: reducción, vía de acceso, penetración del implante, estabilidad, bloqueo, metal usado y consolidación. La fecha de incorporación de las innovaciones tecnológicas a la práctica quirúrgica fue enmarcada en tres momentos generacionales en el período de tiempo comprendido desde 1939 hasta la actualidad. Conclusiones: Esta revisión permitió identificar dos tipos de implantes intramedulares: los pines flexibles y los clavos rígidos. El estudio de sus características permitió organizarlos en generaciones para poder ubicar en el tiempo su contribución a los conocimientos que permiten devolver al paciente su vida activa(AU)

Introduction: This article discuses the historical and scientific evolution of long bone osteosynthesis performed with two types of intramedullary implants, flexible pins or rods and rigid nails. Objective: To publish a scientific article that serves as theoretical and practical support for staff in training and, as a point of reference and consultation for orthopedists and traumatologists. Methods: A retrospective bibliographic review of articles is carried out on limb fractures published in local and foreign trauma journals indexed in the MEDLINE databases and certified by CITMA, as well as relevant books on this topic and experiences of the authors. Given the differences between the two types of implants, we separately studied the osteosynthesis with flexible pins (Rush) from that performed with rigid pins (Küntscher). The variables selected for the study were reduction, access route, implant penetration, stability, locking, metal used, and consolidation. The inclusion of technological innovations to surgical practice was framed in three generational moments from 1939 to the present. Conclusions: Thow types of intramedullary implants were identifies from this revision: flexible pins and rigid nails. The study of their characteristics allowed to organize them into generations in order to locate their contribution to the knowledge allowing the patient to return to an active life over time(AU)

Open safety pin in the pediatric airway: Our experiences at a tertiary care teaching hospital

Background: Aspiration of an open safety pin in the airway is an extremely rare and critical condition that needs immediate and safe removal of the foreign body (FB). An open safety pin in the airway of the pediatric patient requires urgent recognition. Imaging will confirm the exact site of the open safety pin in the airway. Rigid bronchoscopy with optical forceps or grasping forceps is an ideal tool for the removal of the open safety pin from the airway. Objective: This study aims to evaluate the clinical details, management, and outcome of pediatric patients with an inhaled open safety pin in the laryngotracheal airway. Materials and Methods: This is a retrospective descriptive study done between November 2016 and December 2021. There were six children with inhaled open safety pins in the laryngotracheal airway. The diagnosis was done through proper history taking, clinical examination, and the X-ray of the neck and chest of the children. All children underwent rigid bronchoscopy with optical forceps to remove the open safety pin. Results: Out of the six children, four were boys and two were girls. Out of the six cases, four were in the proximal part of the airway and two were seen in the distal airway. The most common clinical presentation was coughing. In this study, open safety pins of the pediatric airway were removed successfully under general anesthesia with the help of a rigid bronchoscope. Conclusion: Open safety pin is rarely found in the laryngotracheal airway. Open safety pin may cause a life- threatening complication. During the removal of the open safety pin, the surgeon should maintain maximum care to not injure the surrounding structures by the sharp end of the open safety pin.

Is there a precise correlation between the lengths of the peritoneal reflection and the middle rectal valve?

Introduction: Pelvic anatomy remains a challenge, and thorough knowledge of its intricate landmarks has major clinical and surgical implications in several medical specialties. The peritoneal reflection is an important landmark in intraluminal surgery, rectal trauma, impalement, and rectal adenocarcinoma. Objectives: To investigate the correlation between the lengths of the middle rectal valve and of the peritoneal reflection determined with rigid sigmoidoscopy and to determine whether there are any differences in the location of the peritoneal reflection between the genders and in relation to body mass index (BMI) and parity. Design: We prospectively investigated the location of the middle rectal valve and of the peritoneal reflection via intraoperative rigid sigmoidoscopy in colorectal cancer patients undergoing elective colorectal surgery. Results: We evaluated 38 patients with a mean age of 55.5 years old (57.5% males) who underwent colorectal surgery at the coloproctology service of the Hospital Santa Marcelina, São Paulo, state of São Paulo, Brazil. There was substantial agreement between the lengths of the middle rectal valve and of the peritoneal reflection (Kappa = 0.66). In addition, the peritoneal reflection was significantly lower in overweight patients (p = 0.013 for women and p < 0.005 for men) and in women with > 2 vaginal deliveries (p = 0.009), but there was no significant difference in the length of the peritoneal reflection between genders (p = 0.32). Conclusion: There was substantial agreement between the lengths of the peritoneal reflection and of the middle rectal valve, and the peritoneal reflection was significantly lower in overweight patients and in women with more than two vaginal deliveries. (AU)

Cuerpo extraño de presentación tardía en bronquiotronco izquierdo. Caso clínico

RESUMEN Introducción: la introducción fortuita de un cuerpo extraño en las vías respiratorias es un accidente dramático que puede provocar complicaciones, aunque raro en los adultos, y sobre todo su presentación tardía, y en bronquio izquierdo. Caso clínico: se reporta el caso de un paciente de 71 años con un cuerpo extraño de presentación tardía en bronquiotronco izquierdo, que consultó por un cuadro de sepsis respiratoria, sin otros síntomas asociados, cuatro meses posteriores a referir haberse tragado un hueso de pollo, ocasión ésta en que el examen físico y los estudios radiológicos fueron negativos. Se realizó estudio con TAC de tórax y broncoscopia flexible evidenciándose una imagen sugerente de un cuerpo extraño en el bronquiotronco izquierdo. Discusión: después de realizar broncoscopia rígida y extracción de cuerpo extraño, presenta varias complicaciones, que requieren ingreso en terapia intensiva, la evolución clínica posterior fue favorable, con radiografía de tórax de control con adecuada reexpansión pulmonar y dándose de alta a los 55 días después del diagnóstico. Conclusiones: en presencia de un paciente con sepsis respiratoria después de un cuadro de broncoaspiración se debe tener en cuenta el diagnóstico de aspiración de un cuerpo extraño. La extracción del cuerpo extraño resulta la solución definitiva.

ABSTRACT Introduction: the fortuitous introduction of a foreign body in the respiratory tract is a dramatic accident that can cause complications, although rare in adults, and especially its late presentation, and in the left bronchus. Clinical case: we report the case of a 71-year-old patient with a late-onset foreign body in the left bronchial trunk, who consulted for respiratory sepsis, with no other associated symptoms, four months after reporting having swallowed a chicken bone. On which occasion the physical examination and radiological studies were negative. A CT scan of the chest and flexible bronchoscopy were performed, revealing an image suggestive of a foreign body in the left bronchial trunk. Discussion: after performing rigid bronchoscopy and extraction of a foreign body, he presented several complications, which required admission to intensive care, the subsequent clinical evolution was favorable, with a control chest X-ray with adequate lung re-expansion and being discharged 55 days later. of the diagnosis. Conclusions: in the presence of a patient with respiratory sepsis after a picture of bronchoaspiration, the diagnosis of aspiration of a foreign body should be taken into account. Extraction of the foreign body is the definitive solution.

RESUMO Introdução: a introdução fortuita de corpo estranho no trato respiratório é um acidente dramático que pode causar complicações, embora raras em adultos, e principalmente sua apresentação tardia, e no brônquio esquerdo. Caso clínico: relatamos o caso de um paciente de 71 anos com corpo estranho de início tardio no tronco brônquico esquerdo, que consultou por sepse respiratória, sem outros sintomas associados, quatro meses após relatar ter engolido osso de galinha. ocasião em que o exame físico e os estudos radiológicos foram negativos. Realizou-se TC de tórax e broncoscopia flexível, revelando imagem sugestiva de corpo estranho em tronco brônquico esquerdo. Discussão: após realização de broncoscopia rígida e extração de corpo estranho, apresentou diversas complicações, que exigiram internação em terapia intensiva, a evolução clínica posterior foi favorável, com radiografia de tórax de controle com reexpansão pulmonar adequada e alta hospitalar 55 dias depois do diagnóstico. Conclusões: na presença de um paciente com sepse respiratória após quadro de broncoaspiração, deve-se levar em consideração o diagnóstico de aspiração de corpo estranho. A extração do corpo estranho é a solução definitiva.

A rare case of food bolus impaction on top of stricture formation secondary to a 12- year retained foreign body (denture) in the esophagus of a 34-year old male: A case report

OBJECTIVES@#This paper aims to present a rare case of a 34-year old male who had esophageal food bolus impaction on top of stricture formation secondary to a retained 12-year esophageal foreign body (denture). It also aims to state the significance of proper and comprehensive history taking, physical examination and corresponding ancillary procedures to arrive at its diagnosis and to highlight the importance of a multidisciplinary team in the prevention and management of complicated foreign body (FB) impaction.@*DESIGN@#Case Report@*SETTING@#Government Tertiary Hospital@*PATIENT@#One@*RESULTS@#A 34-year old male presented with one day history of dysphagia after ingesting a chunk of pork. He had no other symptoms and was not in any respiratory distress. Physical examination was unremarkable except for missing dentition (teeth #8, #9 by universal notation system). Radiographic imaging, esophagogram and contrast-enhanced chest CT scan revealed partial proximal esophageal obstruction probably secondary to retained foreign body at the level ofT5 vertebra. Rigid esophagoscopy with removal of foreign body (food bolus) was done. However, there was difficulty insinuating the scope beyond this level. Further investigation and the use of multispecialty collaboration eventually led to the retrieval of a 12-year denture covered by a bimucosal flap with surrounding stricture formation.@*CONCLUSION@#Foreign body impaction, while more commonly found in the pediatric population, may also occur in adults especially those with edentulism, psychiatric disorders, alcoholism and preexistent esophageal pathologies. In rare cases, patients may be asymptomatic resulting to a delay in its diagnosis. In addition to a well-taken history and physical examination, direct visualization and computed tomography are vital for evaluation. A multidisciplinary approach is critical in its management especially when anticipating difficult extraction and considering FB impaction complications.

The Effect of Ankle Brace on Biomechanics of the Lower Extremity During Landing: A Systematic Review and Meta Analysis / 医用生物力学

Objective To examine the effects of ankle brace on biomechanics of the lower extremity during landing, so as to provide a theoretic support to choose ankle brace for people with different sports levels. Methods The key words (ankle brace OR ankle braces OR ankle bracing OR ankle support) AND (landing OR land OR jump OR hopped OR hopping) AND (biomechanics OR kinematics OR kinetics OR electromyography OR neuromuscular) in Chinese and English were searched from different electronic databases (CNKI, Web of Science, EBSCO, PubMed and other databases), for a period of Jan. 2000 to Dec. 2020. Cochrane was used to evaluate the quality of eligible studies. For meta analysis, subgroup analysis was used to assess the impact of ankle braces on ankle biomechanics.Results Thirteen studies with a total of 222 participants were included for mata analysis in this study. The semi-rigid ankle brace reduced the peak of ankle inversion by 25.8% compared with the elastic ankle brace (SMD=-0.562, P<0.001). Moreover, the elastic ankle brace reduced ankle plant flexion during landing among athletes (SMD=-3.42, P=-0.021). As for collagiate students, both elastic ankle and semi-rigid ankle decreased the ankle inversion (elastic ankle brace: 35.4%, SMD=-1.000, P=-0.013; semi-rigid ankle brace: 31.11%, SMD=-0.881, P<0.001) and ankle plant flexion (elastic ankle brace:23.30%, SMD=-1.381, P<0.001;semi-rigid ankle brace: 36.33%, SMD=-1.605, P<0.001).Conclusions Both ankle braces can prevent ankle sprain for athletes (basketball, volleyball, running) who experience training more than 5 years. The elastic ankle brace can limit the inversion and plantar flexion, while the semi-rigid ankle brace can merely decrease the ankle inversion. Therefore, athletes are more suitable for the elastic ankle brace. As for collegiate students without training history, both ankle brace can decrease the ankle inversion and plantar flexion. The elastic ankle brace has greater restriction on inversion, while the semi-rigid ankle brace has more restriction on plantar flexion. Therefore, the elastic ankle brace should be utilized if collegiate students have calcaneofibular ligament injury, while the semi-rigid ankle brace is more suitable for collegiate students who have a history of anterior talofibular ligament injury.

The technigue of lithotripsy on donor kidney stone / 中华器官移植杂志

Objective:To summarize the experience and skills of ex-vivo ureteroscopy that performed on deceased donor kidneys with gifted lithiasis on bench prior to transplantation.Methods:From January 2018 to December 2019, a total of 7 death donors in Capital Medical University Beijing Friendship Hospital were found to have donor gifted lithiasis during pre-donation evaluation, and all of them underwent ureteroscope laser lithotripsy on bench before transplantation. We retrospectively analysied the demographic information of donors, stone size, location, operative complications and stone clearance rate of the total 7 donor kidneys. The mean age of donors was (49.6±6.8) years. The 7 gifted lithiasis consisted of 6 cases of simple pyelolithiasis and 1 case of upper ureteral calculi.Results:The mean diameter of the stones was (1.2±0.5)cm (0.4~2.1 cm). The 5 cases of pyelolithiasis and 1 case of ureteral calculi were examined with semi-rigid ureteroscopy and then underwent holmium laser lithotripsy. The other 1 case had not found the stone during the bench operation. The mean lithotripsy time was (23.0±6.1)min, and all donor kidneys underwent hypothermic machine perfusion after lithotripsy. The initial resistance index (RI) of donor kidney with gifted lithiasis was higher than the other side of the same donor ( P<0.05), but there was no statistical difference in end-point RI between the both sides. None of the 7 recipients had severe hematuria after operation and their renal function recovered well. CT scan at 1 month after the operation showed the clearance of stone was satisfied in all 7 recipients. Conclusions:Bench surgery is a minimally invasive method for donor gifted lithiasis management, and it is relatively safe and effective. For most cases, the semi-rigid ureteroscopy can handle it well, but the long-term effect still needs to be further evaluated.

Biomechanical Study of Posterior Dynamic Fixation at Atlantoaxial Joints / 医用生物力学

Objective To evaluate the influence of dynamic fixation (rotating and sliding pedicle screws) on stability of the atlantoaxial joint. Methods A series of in vitro biomechanical tests were performed using six fresh adult cervical spines (occipital bone-C4 segment) to simulate different conditions in surgery， including the intact state, the injury state, rigid fixation, rotating pedicle screw fixation, sliding pedicle screw fixation. The repeated measurement design was employed, and under intact, injury and different fixation states, the pure moment of 1.5 N·m in flexion-extension, left-right lateral bending, left-right axial rotation directions were applied using the spinal testing machine. The movement of atlantoaxial spine was measured consecutively by three-dimensional （3D） measurement system in order to analyze the range of motion (ROM) and neutral zone (NZ) of atlantoaxial joints. Results Under injury state, ROM of atlantoaxial joints was significantly larger than that under intact state during flexion, extension, lateral bending and rotation, leading to the instability of atlantoaxial joints. ROM of fixation segments was significantly reduced during flexion, extension, lateral bending and rotation after rigid and dynamic fixation. Compared with rigid fixation, dynamic fixation showed a significant ROM increase during lateral bending. NZs of fixation segments after dynamic fixation were significantly reduced. There were no significant ROM differences between rigid fixation and dynamic fixation. Conclusions The stability of atlantoaxial joints by dynamic fixation during flexion, extension and rotation was comparable to that by rigid fixation, but weaker during lateral bending. Dynamic screw fixation can maintain the relative stability of atlantoaxial joints.

Clinical observation on transepithelial rapid cross-linking combined with RGPCL in the treatment of keratoconus / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM: To investigate the clinical effect of transepithelial rapid cross-linking combined with wearing rigid gas permeable contact lens(RGPCL)in keratoconus patients.<p>METHODS: This was a retrospective study of patients with progressive keratoconus diagnosed in the Second Affiliated Hospital of Fujian University of Traditional Chinese Medicine in October 2014, and underwent transepithelial rapid keratoplasty. After surgery 16 patients(25 eyes)used RGPCL. Average age was 25.31±5.92 years old, maximum preoperative corneal curvature was 58.96±6.76D, thinnest corneal thickness was 439.52±53.24μm. Rapid cross-linking was performed using riboflavin and 45mW/cm² ultraviolet light(UV)irradiation with a total energy of 7.2J/cm². RGPCL was used after surgery. Follow up of 3-6a, average follow-up time was 52.44±11.39mo. The best corrected visual acuity \〖(BCVA), in RGPCL\〗, corneal curvature of flat meridian(K₁), corneal curvature of steep meridian(K₂), maximum corneal curvature(Kmax), corneal refractive power(MPP), Baiocchi Calossi Versaci index of anterior and posterior surface(BCVf and BCVb)asymmetry index of anterior surface curvature(SIf), asymmetry index of posterior surface curvature(SIb), the highest point of anterior cone cornea(KVf), the highest point of posterior cone cornea(KVb), the change of corneal thickness(ThkMin), lens opacity, and corneal endothelial cell count were observed.<p>RESULTS: All patients had a successful operation, and no intraoperative complications. On the first day after surgery, all cases felt slight tingling and slight photophobia tears. After 1d of operation, the corneal epithelium was removed in two eyes. While 3d after re-wearing the bandage, the epithelium healed. None of lens in the patients was opacified during follow-up, and there was no significant difference in corneal endothelial cell count compared with preoperative(<i>P</i>>0.05). The BCVA(wearing RGPCL)after operation is obviously improved compared with preoperative. All postoperative Kmax, SIf, KVf, BCVf, BCVb were lower than preoperative(<i>P</i><0.05). <p>CONCLUSION: Transepithelial rapid corneal cross-linking combined with RGPCL is safe and effective in controlling the progress of keratoconus. And the long-term effect is stable.

Disc battery in the pediatric oesophagus

The wide usage of disc batteries in toys, in the late seventies presented a new problem. In the form of accidental lodgements in the pediatric aerodigestive tract. The physico-chemical nature of the disc battery necessitates an early removal, so as to avoid a fatal outcome if missed and retained for a long duration. Management of one such case is reported with radiographic documentation.

Alucinose, hipérbole e a diferenciação neurose/psicose no pensamento de Bion e na teoria do campo analítico / Hallucinosis, hyperbole, and the differentiation neurosis/psychosis in Bion's thinking and in the analytic field theory / Alucinosis, hipérbole y diferenciación de neurosis/psicosis en el pensamiento de Bion y en la teoría del campo analítico

O autor retoma a diferenciação efetuada por Bion entre personalidades neuróticas e psicóticas, discutindo-a à luz dos desenvolvimentos sucessivos do seu pensamento. A hipótese deste trabalho é que Bion tenha mitigado cada vez mais a distinção entre neurose e psicose, uma vez que esta distinção não funciona mais como escudo em relação à busca do desconhecido na psicanálise, mas induz a adotar, de forma apressada, teorias causais. Para demonstrar tal hipótese, o autor enfoca os conceitos de transformação em alucinose como um dos meios ­ assim escreveu Bion ­ das transformações em movimento rígido (neuróticas) e das transformações projetivas (psicóticas). De modo especial, este trabalho põe em destaque o plano metateórico de Transformações: desconstruir as oposições clássicas é tanto uma maneira de tratar o paciente na sala de análise quanto uma forma de tratar a doença da psicanálise (AU)

The author re-approaches the differentiation made by Bion between neurotic and psychotic personalities, discussing them under the light of the subsequent developments of his thoughts. The hypothesis of this paper is that Bion progressively mitigated the distinction between neurosis and psychosis, since this distinction no longer works as a shield for the search for the unknown in psychoanalysis, instead leading to the hurried adoption of causal theories. In order to demonstrate such hypothesis, the author approaches the concepts of transformation in hallucinosis as one of the media, this is how Bion wrote it, for the transformations into rigid motion (neurotic) and into projective transformations (psychotic). Above all, this paper highlights the meta-theoretical role of Transformations: deconstruct the classic oppositions is a way of treating the patient in the analytic space as much as a way of treating the disease of psychoanalysis (AU)

El autor retoma la diferenciación hecha por Bion entre personalidades neuróticas y psicóticas para discutir a la luz de los desarrollos posteriores de su pensamiento. La hipótesis de trabajo es que Bion ha desdibujado cada vez más la distinción entre neurosis y psicosis porque termina funcionando como escudo con relación a la búsqueda de lo desconocido en el psicoanálisis y, en cambio, induce a adoptar precipitadamente teorías causales. Para demostrar la hipótesis, el autor enfoca los conceptos de transformación en alucinosis como uno de los medios, escribe Bion, de transformaciones de movimiento rígido (neurótico) y transformaciones proyectivas (psicótico). Sobre todo, subraya el plan metateórico de Transformaciones: la deconstrucción de las oposiciones clásicas es una forma tanto de tratar al paciente en la sala de análisis como de curar la enfermedad del psicoanálisis (AU)

Reabilitação visual com lentes de contato após transplante de córnea / Visual reabilitation with contact lenses after corneal keratoplasty

Resumo A adaptação de lentes de contato após o transplante de córnea tem sido considerada um desafio na reabilitação visual. Atualmente existe a possibilidade de adaptação de lentes de contato de vários tamanhos, diversos desenhos e com diferentes espessuras e materiais, como por exemplo lentes gelatinosas, lentes corneanas rígidas gás-permeáveis, lentes córneo-esclerais, mini esclerais e esclerais. O objetivo deste estudo foi apresentar uma revisão da literatura atual que possa exemplificar a utilização de alguns dos diferentes tipos de lentes de contato que possam ser usadas após o transplante de córnea. Foi realizada uma revisão integrativa da literatura médica na língua inglesa, utilizando como base de dados para a pesquisa, Pubmed e Mendeley. Como critério de inclusão, foi estabelecido a relevância do artigo de acordo com a experiência da equipe. Foram selecionados 26 artigos, com ano de publicação entre 2001 e 2018. Dentre os artigos selecionados, cinco possuem como principal assunto o transplante de córnea, nove artigos sobre lentes de contato em geral, e 12 artigos sobre lentes de contato esclerais ou mini esclerais. Devido a maior transmissibilidade de oxigênio para a córnea, o uso das lentes corneanas rígidas gás-permeáveis mostrou-se mais seguro e com probabilidade de uso por um período maior de tempo.

Abstract Contact lens fitting after corneal transplantation has been considered a challenge in visual rehabilitation. There is currently the possibility of adapting contact lenses of various sizes, various designs and with different thicknesses and materials, such as gelatinous lenses, gas-permeable rigid corneal lenses, corneal-scleral lenses, mini-scleral and scleral lenses. The objective of this study was to present a review of current literature that may exemplify the use of some of the different types of contact lenses that can be used after corneal transplantation. An integrative review of the medical literature in the English language, using as a database for the research, Pubmed and Mendeley. Twenty six articles were selected, with year of publication between 2001 and 2018, as inclusion criterion, the relevance of articles according to the authors' experience was used. Five articles were selected that have as main subject corneal transplantation, nine articles on contact lenses in general, and 12 articles on scleral or mini scleral contact lenses. Due to the greater transmissibility of oxygen to the cornea, the use of rigid gas-permeable corneal lenses was shown to be safer and more likely to be used for a longer period of time.