Toxina botulínica y neumoperitoneo secuencial en el manejo de hernia inguinoescrotal gigante: Reporte de caso / Botulinum toxin and sequential pneumoperitoneum in the management of giant inguinoscrotal hernia: Case report

Introducción. Las hernias gigantes con pérdida de domicilio son aquellas cuyo saco herniario alcanza el punto medio del muslo en bipedestación y su contenido excede el volumen de la cavidad abdominal. Estas hernias son un reto quirúrgico dada la difícil reducción de su contenido y del cierre primario de la fascia. Tienen mayor riesgo de complicaciones asociadas al síndrome compartimental abdominal, así como mayor tasa de recurrencia y morbilidad en los pacientes. Caso clínico. Paciente masculino de 81 años, reconsultante por hernia inguinoescrotal derecha gigante, de dos años de evolución, sintomática, con índice de Tanaka de 24 %. Se decidió aplicar el protocolo de neumoperitoneo secuencial (hasta 11.000 ml en total en cavidad) además de toxina botulínica en pared abdominal (dos sesiones). Resultados. Se logró la corrección exitosa de la hernia inguinoescrotal gigante, sin recaídas de su patología abdomino-inguinal. El paciente manifestó satisfacción con el tratamiento un año después del procedimiento. Conclusiones. El protocolo de neumoperitoneo secuencial es una alternativa en casos de hernias complejas, con alto riesgo de complicaciones, que requieren técnicas reconstructivas adicionales. La aplicación previa de toxina botulínica es un adyuvante considerable para aumentar la probabilidad de resultados favorables. Sin embargo, debe incentivarse la investigación en esta área para evaluar su efectividad.

Introduction. Giant hernias with loss of domain are those whose hernial sac reaches the midpoint of the thigh in standing position and whose content exceeds the volume of the abdominal cavity. These hernias are a surgical challenge given the difficult reduction of their contents and the primary fascial closure, with a higher risk of complications associated with abdominal compartment syndrome, as well as a higher rate of recurrence and morbidity in patients. Clinical case. A 81-year-old male patient with comorbidity, reconsulting due to a symptomatic giant right inguinoscrotal hernia of two years of evolution, with a Tanaka index of 24%, eligible for a sequential pneumoperitoneum protocol (up to a total of 11,000 cc in cavity) plus application of botulinum toxin (two sessions) in the abdominal wall. Results. Successful correction of the patient's giant inguinoscrotal hernia was achieved using this protocol, without recurrence of his abdomino-inguinal pathology and satisfaction with the procedure after one year. Conclusion. The sequential pneumoperitoneum protocol continues to be an important alternative in cases with a high risk of complications that require additional reconstructive techniques, while the previous application of botulinum toxin is a considerable adjuvant to further increase the rate of favorable results. However, research in the area should be encouraged to reaffirm its effectiveness.

Cosmiatria: Uma análise do mercado brasileiro / Cosmiatry: An analysis of the Brazilian market

Introdução: O mercado de procedimento estéticos cresce exponencialmente no Brasil. Tal crescimento tem despertado o interesse de várias categorias profissionais. A decisão de praticar no setor deve considerar as oportunidades de mercado da localidade na qual se pretende atuar. Entretanto, a área carece de análises comparativas documentando prováveis diferenças regionais no país. O objetivo do estudo é descrever as diferenças de mercado em procedimentos estéticos entre os estados e regiões brasileiras. Um índice de potencial consumo de cosmiatria (IPCC) é calculado para tal análise comparativa. Método: Estudo transversal envolvendo prestadores de procedimentos estéticos não cirúrgicos no Brasil. Buscas no Google®-Google Maps® foram conduzidas usando termoschave e entrevistas telefônicas realizadas para obter informações sobre categorias profissionais, tipo de provedores e serviços oferecidos. Valores preditivos positivos foram obtidos para todas as estratégias de busca e usados para estimar o número total de provedores. O tamanho da população e a renda per capita foram considerados para o cálculo dos IPCCs para os estados brasileiros. Resultados: São Paulo, Minas Gerais e Rio de Janeiro apresentaram os maiores IPCCs, sendo 524, 210 e 180, respectivamente. Roraima teve um IPCC de 14, o mais baixo do país. A Região Sudeste apresentou, em média, o maior IPCC (242) entre todas as regiões brasileiras. Conclusão: Considerando o tamanho da população e a renda, a Região Sudeste apresenta as maiores oportunidades de mercado em procedimentos estéticos não cirúrgicos no Brasil. Nossos achados podem ser de interesse para profissionais de saúde e investidores que atuam ou pretendem atuar no setor.

Introduction: The aesthetic procedure market is growing exponentially in Brazil. This growth has aroused the interest of several professional categories. The decision to practice in the sector must consider the market opportunities in the location in which you intend to operate. However, the area lacks comparative analyses documenting probable regional differences in the country. The objective of the study is to describe market differences in aesthetic procedures between Brazilian states and regions. An index of potential cosmetic consumption (IPCC) is calculated for such a comparative analysis. Method: Cross-sectional study involving providers of nonsurgical aesthetic procedures in Brazil. Searches on Google Maps® were conducted using key terms, and telephone interviews were conducted to obtain information on professional categories, types of providers, and services offered. Positive predictive values were obtained for all search strategies and used to estimate the total number of providers. Population size and per capita income were considered to calculate the IPCCs for Brazilian states. Results: São Paulo, Minas Gerais, and Rio de Janeiro presented the highest IPCCs, being 524, 210, and 180, respectively. Roraima had an IPCC of 14, the lowest in the country. The Southeast Region presented, on average, the highest IPCC (242) among all Brazilian regions. Conclusion: Considering population size and income, the Southeast Region presents the greatest market opportunities for nonsurgical aesthetic procedures in Brazil. Our findings may be of interest to healthcare professionals and investors who work or intend to work in the sector.

Utilização da toxina botulínica para o tratamento de cicatriz queloide: revisão de escopo / Use of botulinum toxin for the treatment of keloid scars: scoping review

Introdução: Cicatrizes visíveis podem acarretar agravos, sejam estéticos, psicológicos, funcionais ou sociais, principalmente de grande extensão e volume, como os queloides. A descoberta de novos tratamentos de queloides não é fácil, visto a presença de alguns entraves metodológicos e éticos, sendo uma área pouco explorada. A toxina botulínica tem sido apresentada como alternativa terapêutica em estudos nacionais e internacionais, sendo necessária uma compilação e destaque dos principais estudos que possam subsidiar a prática clínica. Assim, o objetivo foi apresentar uma revisão de escopo sobre a utilização terapêutica da toxina botulínica para o tratamento de cicatrizes queloides. Método: A revisão foi realizada através da estratégia PICO e utilizando o Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews. Foi realizada nas bases de dados PubMed/ Medline, Biblioteca Virtual em Saúde e SciELO, considerando estudos do período de 2016 até setembro de 2021. Resultados: Foram encontrados 34 artigos no geral relacionados ao tema. Após filtragem e seleção, a revisão foi construída com apoio de 5 artigos. Os estudos variaram entre coorte, relatos de caso, ensaio clínico randomizado e caso-controle. Foi possível observar como principais resultados a ação a curto prazo da toxina botulínica na redução de queloides, maior efetividade na redução dos sintomas e possibilidades de utilização clínica para diferentes populações e manifestações clínicas. Conclusão: O mecanismo de ação da toxina botulínica pode facilitar o tratamento de queloides e redução de sintomas, sendo necessários estudos mais robustos para definição de protocolos cínicos de gestão de cicatrizes.

Introduction: Visible scars can cause problems, whether aesthetic, psychological, functional, or social, mainly of great extension and volume, such as keloids. The discovery of new treatments for keloids is not easy, given the presence of some methodological and ethical obstacles, and it is an area that is little explored. Botulinum toxin has been presented as a therapeutic alternative in national and international studies, requiring a compilation and highlighting of the main studies that can support clinical practice. Thus, the objective was to present a scoping review on the therapeutic use of botulinum toxin for the treatment of keloid scars. Method: The review was carried out using the PICO strategy and using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews. It was carried out in the PubMed/ Medline, Virtual Health Library, and SciELO databases, considering studies from 2016 to September 2021. Results: Overall, 34 articles related to the topic were found. After filtering and selection, the review was constructed with the support of 5 articles. The studies varied between cohorts, case reports, randomized clinical trials, and casecontrol. It was possible to observe as main results of the short-term action of botulinum toxin in reducing keloids, greater effectiveness in reducing symptoms, and possibilities of clinical use for different populations and clinical manifestations. Conclusion: The mechanism of action of botulinum toxin can facilitate the treatment of keloids and reduce symptoms, requiring more robust studies to define effective scar management protocols.

Efficacy of prone positioning ventilation in acute respiratory distress syndrome after acute Stanford type A aortic dissection surgery / 中国胸心血管外科临床杂志

@#Objective     To explore the efficacy of prone positioning ventilation in patients with acute respiratory distress syndrome (ARDS) after acute Stanford type A aortic dissection (STAAD) surgery. Methods     From November 2019 to September 2021, patients with ARDS who was placed prone position after STAAD surgery in the Xiamen Cardiovascular Hospital of Xiamen University were collected. Data such as the changes of blood gas, respiratory mechanics and hemodynamic indexes before and after prone positioning, complications and prognosis were collected for statistical analysis. Results    A total of 264 STAAD patients had surgical treatment, of whom 40 patients with postoperative ARDS were placed prone position. There were 37 males and 3 females with an average age of 49.88±11.46 years. The oxygen partial pressure, oxygenation index and peripheral blood oxygen saturation 4 hours and 12 hours after the prone positioning, and 2 hours and 6 hours after the end of the prone positioning were significantly improved compared with those before prone positioning ventilation (P<0.05). The oxygenation index 2 hours after the end of prone positioning which was less than 131.42 mm Hg, indicated that the patient might need ventilation two or more times of prone position. Conclusion     Prone position ventilation for patients with moderate to severe ARDS after STAAD surgery is a safe and effective way to improve the oxygenation.

Research progress on the prevention and treatment of scars after epicanthus correction / 局解手术学杂志

The epicanthus is mainly manifested by a wide intercanthal distance and a short palpebral fissure,which affects the aesthetics of eyes.The epicanthus correction is of great significance in improving eye shape and facial aesthetics.However,scar formation and hyperplasia after surgery in the surgical area have been bothering doctors and patients,and how to prevent or alleviate scar after epicanthus correction is still a difficult problem to be solved in clinic.Therefore,this article summarizes the prevention and treatment of scar after epicanthus correction based on the current research status at home and abroad,in order to provide a reference for clinic.

Prediction model for the risk of postoperative death in patients with acute type A aortic dissection / 中华胸心血管外科杂志

Objective:Using different machine learning methods to construct and screen the best prediction model for predicting the risk of death within 30 days after surgery in patients with acute type A aortic dissection.Methods:Five hundred and twenty-one patients with acute type A aortic dissection who underwent surgery between 2015 and 2022 were included, after collecting their perioperative date and screening them, 329 patients were retained. two different groups of predictor variables were generated by using Lasso regression and principal component analysis, after that, logistic regression, support vector machine algorithm, random forest algorithm, gradient boosting algorithm, and super learning algorithm were used to develop prediction models for the risk of death within 30 days after surgery. Finally, we compare the models and select the best one. Results:The AUC values for all models rangrd from 0.791-0.959. The model using Lasso regression to determine the predictor variables and built by the super learning algorithm had the best prediction with an AUC value of 0.959. Conclusion:The super learning algorithm better than other algorithms in predicting death within 30 days after acute type A aortic dissection.

Risk factors for gastrointestinal bleeding after type A aortic dissection surgery: A retrospective cohort study / 中国胸心血管外科临床杂志

@#Objective To investigate the risk factors for postoperative gastrointestinal bleeding (GIB) in patients with type A aortic dissection, and further discuss its prevention and treatment. Methods The clinical data of patients with type A aortic dissection admitted to the Department of Cardiovascular Surgery of the First Affiliated Hospital of Naval Medical University from 2017 to 2021 were retrospectively analyzed. Patients were divided into a GIB group and a non-GIB group based on the presence of GIB after surgery. The variables with statistical differences between two groups in univariate analysis were included into a multivariate logistic regression model to analyze the risk factors for postoperative GIB in patients with type A aortic dissection. Results There were 18 patients in the GIB group including 12 males and 6 females, aged 60.11±10.63 years, while 511 patients in the non-GIB group including 384 males and 127 females, aged 49.81±12.88 years. In the univariate analysis, there were statistical differences in age, preoperative percutaneous arterial oxygen saturation (SpO2)<95%, intraoperative circulatory arrest time, postoperative low cardiac output syndrome, ventilator withdrawal time>72 hours, postoperative FiO2≥50%, continuous renal replacement therapy (CRRT) rate, extracorporeal membrane oxygenation (ECMO) rate, infection rate, length of hospital stay and ICU stay, and in-hospital mortality (all P<0.05). In the multivariate logistic regression analysis, preoperative SpO2<95% (OR=10.845, 95%CI 2.038-57.703), ventilator withdrawal time>72 hours (OR=0.004, 95%CI 0.001-0.016), CRRT (OR=6.822, 95%CI 1.778-26.171) were risk factors for postoperative GIB in patients (P≤0.005). In the intra-group analysis of GIB, non-occlusive mesenteric ischemia (NOMI) accounted for 38.9% (7/18) and was the main disease type for postoperative GIB in patients with type A aortic dissection. Conclusion In addition to patients with entrapment involving the superior mesenteric artery who are prone to postoperative GIB, preoperative SpO2<95%, ventilator withdrawal time>72 hours, and CRRT are independent risk factors for postoperative GIB in patients with type A aortic dissection. NOMI is a major disease category for GIB, and timely diagnosis and aggressive treatment are effective ways to reduce mortality. Awareness of its risk factors and treatment are also ways to reduce its incidence.

Risk factors for postoperative delirium after Stanford type A aortic dissection : A systematic review and meta-analysis / 中国胸心血管外科临床杂志

@#Objective To systematically evaluate the risk factors for postoperative delirium after surgery for Stanford type A aortic dissection. Methods We searched the CNKI, SinoMed, Wanfang data, VIP, PubMed, Web of Science, EMbase, The Cochrane Library database from inception to September 2022. Case-control studies, and cohort studies on risk factors for postoperative delirium after surgery for Stanford type A aortic dissection were collected to identify studies about the risk factors for postoperative delirium after surgery for Stanford type A aortic dissection. Quality of the included studies was evaluated by the Newcastle-Ottawa scale (NOS). The meta-analysis was performed by RevMan 5.3 software and Stata 15.0 software. Results A total of 21 studies were included involving 3385 patients. The NOS score was 7-8 points. The results of meta-analysis showed that age (MD=2.58, 95%CI 1.44 to 3.72, P＜0.000 01), male (OR=1.33, 95%CI 1.12 to 1.59, P=0.001), drinking history (OR=1.45, 95%CI 1.04 to 2.04, P=0.03), diabetes history (OR=1.44, 95%CI 1.12 to 1.85, P=0.005), preoperative leukocytes (MD=1.17, 95%CI 0.57 to 1.77), P=0.000 1), operation time (MD=21.82, 95%CI 5.84 to 37.80, P=0.007), deep hypothermic circulatory arrest (DHCA) time (MD=3.02, 95%CI 1.04 to 5.01, P=0.003), aortic occlusion time (MD=8.94, 95%CI 2.91 to 14.97, P=0.004), cardiopulmonary bypass time (MD=13.92, 95%CI 5.92 to 21.91, P=0.0006), ICU stay (MD=2.77, 95%CI 1.55 to 3.99, P＜0.000 01), hospital stay (MD=3.46, 95%CI 2.03 to 4.89, P＜0.0001), APACHEⅡ score (MD=2.76, 95%CI 1.59 to 3.93, P＜0.000 01), ventilation support time (MD=6.10, 95%CI 3.48 to 8.72, P＜0.000 01), hypoxemia (OR=2.32, 95%CI 1.40 to 3.82, P=0.001), the minimum postoperative oxygenation index (MD=−79.52, 95%CI −125.80 to −33.24, P=0.000 8), blood oxygen saturation (MD=−3.50, 95%CI −4.49 to −2.51, P＜0.000 01), postoperative hemoglobin (MD=−6.35, 95%CI −9.21 to −3.50, P＜0.000 1), postoperative blood lactate (MD=0.45, 95%CI 0.15 to 0.75, P=0.004), postoperative electrolyte abnormalities (OR=5.94, 95%CI 3.50 to 10.09, P＜0.000 01), acute kidney injury (OR=1.92, 95%CI 1.34 to 2.75, P=0.000 4) and postoperative body temperature (MD=0.79, 95%CI 0.69 to 0.88, P＜0.000 01) were associated with postoperative delirium after surgery for Stanford type A aortic dissection. Conclusion The current evidence shows that age, male, drinking history, diabetes history, operation time, DHCA time, aortic occlusion time, cardiopulmonary bypass time, ICU stay, hospital stay, APACHEⅡ score, ventilation support time, hypoxemia and postoperative body temperature are risk factors for the postoperative delirium after surgery for Stanford type A aortic dissection. Oxygenation index, oxygen saturation, and hemoglobin number are protective factors for delirium after Stanford type A aortic dissection.

Research progress on the application of botulinum toxin type A in the treatment of myogenous temporomandibular disorders / 口腔疾病防治

@#Myogenous temporomandibular disorder (M-TMD) is one of the main subtypes of temporomandibular disorder (TMD) and typically manifests as masticatory myofascial pain; the incidence of TMD has been increasing annually in recent years. Botulinum toxin type A (BTX-A) is a potent neurotoxin produced by Clostridium botulinum. BTX-A inhibits the release of acetylcholine from the presynaptic membrane, thereby blocking neuromuscular junction signaling. The noncosmetic application of BTX-A in the oral and maxillofacial regions is a prominent research topic. In recent years, an increasing number of studies have focused on the application of BTX-A in the treatment of M-TMD. The results of a literature review revealed that an appropriate dose (10-50 U unilaterally) of BTX-A administered in a single injection into the masticatory muscles can effectively treat myalgia over a period of 3-6 months. Common adverse effects, such as masticatory weakness and facial paralysis, are transient and can be avoided by standardized injection techniques. However, there is a lack of standardized guidelines for injection techniques in clinical practice.

Efficacy and safety of botulinum toxin type A combined with pulsed radiofrequency in the treatment of postherpetic neuralgia / 实用医学杂志

Objective Exploring the efficacy and safety of botulinum toxin type A(BTX-A)combined with pulsed radiofrequency(PRF)in the treatment of postherpetic neuralgia(PHN).Methods A total of 80 patients with PHN were collected.They were randomly divided into experimental group(Group B)and control group(Group C),Group B was treated with BTX-A intradermal injection combined with PRF,and Group C was treated with lidocaine intradermal injection combined with PRF.Numeric pain score(NRS),Simplified McGill Pain Questionnaire(SF-MPQ)and Sleep Quality Score(QS)were used to assess the patients'pain level and sleep quality preoperatively,1,3,and 7 days postoperatively,and 1,2,and 3 months postoperatively.The patients'postoperative adverse reac-tions were collected.Interleukin-1β(IL-1β)and calcitonin gene-related peptide(CGRP)levels in patients'serum were measured preoperatively and 3 days postoperatively.Results The NRS scores,SF-MPQ scores,and QS scores of group B and group C were significantly lower at all postoperative time points compared to preoperative ones(P<0.05).The NRS and SF-MPQ score were significantly lower in group B at 1,2,and 3 months postoperatively compared with group C(P<0.05);and group B had significantly lower QS scores at 2 and 3 months postoperatively(P<0.05).The effective rate of pain relief at 3 months postoperatively in group B(90%)was statistically signifi-cant(P<0.05)compared with group C(56.7%).No serious adverse reactions occurred in either group.The levels of IL-1β and CGRP in serum of patients in both groups were significantly decreased at 3 days after surgery compared with the preoperative period,and the degree of decrease of IL-1β and CGRP in group B was more significant than that in group C(P<0.05).Conclusion BTX-A combined with PRF treatment for PHN can effectively reduce its pain level,improve the quality of sleep,and is safe.

5 Application of botulinum toxin A injection in overactive bladder / 中国现代医生

@#Objective To compare and analyze the efficacy and safety of 5-needle injection and standard 20-needle injection in the treatment of overactive bladder with botulinum toxin type A.Methods A retrospective analysis was performed on 48 patients with overactive bladder who received intravesical injection of botulinum toxin type A in the Department of Urology,Hangzhou Third People's Hospital from January 2015 to December 2022,and they were divided into two groups according to the number of injections,with 24 patients in each group.The observation group received 5-needle injection,and the control group received standard 20-needle injection.Average daily frequency of urination,international consultation on incontinence questionnaire-overactive bladder,international consultation on incontinence questionnaire-overactive bladder(ICIQ-OAB)score,overactive bladder(OAB-Q)score,visual analogue scale(VAS),patient generated index(PGI-I)score,complication rate and willingness to repeat injection were recorded before and after treatment in two groups,respectively.Results There were no significant differences in age,gender,course of disease,average daily frequency of urination before treatment and baseline data of each score between the two groups,which were comparable.All patients completed treatment,and compared with before treatment,the mean daily frequency of urination,ICIQ-OAB and OAB-Q were improved after treatment(P<0.05),there was no significant difference between the two groups(P>0.05).There were no significant differences in scores and incidence of complications between the two groups after treatment(P>0.05).However,patients in the observation group were more willing to receive another injection(P<0.05).Conclusion The efficacy and safety of 5-needle vesical injection of botulinum toxin type A in the treatment of overactive bladder is similar to that of standard 20-needle injection,which is more easily accepted by patients,and is a safe and effective alternative to standard technique.

Type A Acute Aortic Dissection Complicated with Rupture of the External Iliac Artery / 日本心臓血管外科学会雑誌

A 67-year-old man suffered sudden chest pain. Computed tomography with contrast medium revealed dissection from the ascending aorta to the bilateral iliac arteries and hematoma around the left external iliac artery. Type A acute aortic dissection complicated with rupture of the left external iliac artery was diagnosed. Urgent endovascular repair (stent-graft implantation) was first performed for the arterial rupture more critical than the aortic dissection. On the next day after satisfactory hemostasis and hemodynamical stabilization, semi-urgent ascending aortic replacement was achieved, and the patient survived. Acute aortic dissection complicated with rupture of the aortic branch was extremely rare, and only 5 cases have been reported in the English literature.

Urgent Thoracic Endovascular Aortic Repair for Retrograde Type A Acute Aortic Dissection with a Patent Ascending Aortic False Lumen / 日本心臓血管外科学会雑誌

We report a 49-year-old man with retrograde type A acute aortic dissection with patent false lumen in the ascending aorta. The patient successfully underwent urgent thoracic endovascular repair (TEVAR) to cover the primary entry on the onset (admission) day. The false lumen from the ascending aorta to the proximal descending thoracic aorta was completely thrombosed, gradually shrank, and finally disappeared. In conclusion, TEVAR for retrograde type A acute aortic dissection with a patent ascending false lumen is far less invasive than aortic replacement (with cardiopulmonary bypass, cardiac arrest, and circulatory arrest) and may be useful in selected patients with a primary entry located at least approximately 2 cm distal to the origin of the left subclavian artery.

Gait analysis using three-dimensional motion and ground reaction force systems in patients with hemiplegia treated with botulinum toxin type A in ankle plantar flexors / Journal of Rural Medicine

Objective: The efficacy of botulinum toxin type A (BoNT-A) injection on spasticity has usually been measured using the range of motion (ROM) of joints and Modified Ashworth Scale (MAS); however, they only evaluate muscle tone at rest. We objectively analyzed the gait of three patients with hemiplegia using three-dimensional motion analysis and ground reaction force (GRF) systems to evaluate muscle tone during gait.Materials and Methods: We measured passive ankle dorsiflexion ROM with knee extension and the MAS score for clinical evaluation, and gait speed, stride length, single-leg support phase during the gait cycle, joint angle, joint moment, and GRFs for kinematic evaluation before and one month after BoNT-A injection.Results: All patients showed an increase in ankle dorsiflexion ROM, improvement in MAS score, and increase in stride length. Case 1 showed an increase in gait speed, prolongation of the single-leg support phase, increase in hip extension angle and moment, and improvement in the vertical and anterior-posterior components of the GRFs. Case 2 showed an increase in gait speed, improvement in double knee action, increase in ankle plantar flexion moment, and improvement in propulsion in the progressive component of the GRFs. Case 3 exhibited a laterally directed force in the GRFs.Conclusion: We evaluated the effects of BoNT-A injections in three patients with hemiplegia using three-dimensional motion analysis and GRFs. The results of the gait analysis clarified the improvements and problems in hemiplegic gait and enabled objective explanations for patients.

Proximal femoral nail antirotation for femoral intertrochanteric fractures with lateral wall integrity and lateral wall risk / 中国组织工程研究

BACKGROUND:For elderly patients with traumatic hip fractures,the related factors of prognosis are very complex,and the integrity of the lateral wall is one of the influencing factors.It is of important clinical value to understand the effect of lateral wall injury on the prognosis of femoral intertrochanteric fracture. OBJECTIVE:To evaluate the relationship between the integrity of the lateral wall and hip functional recovery and other outcomes in patients with femoral intertrochanteric fractures. METHODS:Totally 82 patients with femoral intertrochanteric fractures were screened and all patients received proximal femoral nail antirotation fixation.According to the thickness of the lateral wall,the patients were divided into the lateral wall intact group(n=31)and lateral wall risk group(n=51).The perioperative indexes,weight-bearing time,fracture healing time,hip joint function and range of motion,postoperative pain and complications were compared between the two groups. RESULTS AND CONCLUSION:(1)The time of hospitalization and the number of fluoroscopies during operation in the lateral wall intact group were significantly lower than those in the lateral wall risk group(P<0.05),but there was no significant difference in other perioperative indexes.(2)Both groups were able to get down to the ground early after surgery and finally complete weight-bearing,but in the lateral wall risk group,the time of fracture healing was longer;the time of complete weight-bearing was significantly delayed;the Harris score of the last follow-up was lower;the range of motion of hip extension and flexion and neck trunk angle on the affected side were smaller(P<0.05).(3)There was no significant difference in the incidence of postoperative complications between the two groups,but the overall incidence of complications in the lateral wall intact group was significantly lower(P<0.05).(4)In summary,after internal fixation of proximal femoral nail antirotation,patients with the intact lateral wall had a relatively better prognosis than those with risk lateral wall.

Análise bibliométrica de pesquisas relacionadas à harmonização orofacial no Brasil / Bibliometric analysis of research related to orofacial harmonization in Brazil

Este estudo teve como objetivo realizar um levantamento bibliométrico das pesquisas realizadas em odontologia na área de harmonização orofacial, com ênfase na bichectomia, ácido hialurônico e toxina botulínica. Utilizou-se como base os anais dos trabalhos apresentados nas Reuniões Anuais da Sociedade Brasileira de Pesquisa Odontológica (SBPqO) entre os anos de 2017 a 2021e todos os resumos que possuíam algumas das palavras-chaves pesquisadas ("bichectomia", "ácido hialurônico" e "toxina botulínica") foram avaliados. Após a seleção informações foram coletadas dos resumos e os dados foram analisados através de estatística descritiva.Foram incluídos neste estudo 65 resumos, estando a maioria relacionado com pesquisas utilizando a toxina botulínica. O ano de 2021 foi o que apresentou uma maior produção de estudos sobre o tema e a região Sudeste do Brasil foi a que mais produziu acerca da harmonização orofacial nos últimos cinco anos. A maioria das pesquisas foram desenvolvidas por instituições privadas e não receberam financiamento. Dentre as áreas da odontologia a desordens temporomandibular, dor orofacial e a periodontia aparecem com maior envolvimento com as pesquisas utilizando, principalmente a toxina botulínica e o ácido hialurônico. Conclui-se que as pesquisas envolvendo temas relacionados a área de harmonização ainda representam um número baixo, entretanto esse número apresentou crescimento nos últimos 5 anos. Se faz necessário mais incentivo em pesquisas nessa área para as regiões norte e centro oeste,bem como um maior em financiamento.

This study aimed to carry out a bibliometric survey of research carried out in dentistry in the area of orofacial harmonization, with emphasis on bichectomy, hyaluronic acid and botulinum toxin. The annals of the works presented at the Annual Meetings of the Brazilian Society for Dental Research (SBPqO) between the years 2017 to 2021 and all abstracts that had some of the searched keywords ("bichectomy", "hyaluronic acid" and "botulinum toxin") were evaluated. After the selection, information was collected from the abstracts and the data were analyzed using descriptive statistics. A total of 65 abstracts were included in this study, most of which related to research using botulinum toxin. The year 2021 was the one that presented the greatest production of studies on the subject and the Southeast region of Brazil was the one that produced the most about orofacial harmonization in the last five years. Most research was developed by private institutions and did not receive funding. Among the areas of dentistry, temporomandibular disorders, orofacial pain and periodontics appear with greater involvement with research using, mainly, botulinum toxin and hyaluronic acid. It is concluded that research involving topics related to the harmonization area still represents a low number, however this number has grown in the last 5 years. More incentives are needed for research in this area for the North and Midwest regions, as well as greater funding.

Facial anatomy applied to live models / Anatomia facial aplicada em modelos vivos

Introduction: Anatomy is one of the foundations in medicine, and choosing a practical and dynamic teaching method is essential for better retention of your learning. The objective is to use facial anatomy applied to live models as an innovative teaching strategy and to evaluate the experience of the learning experience of students assigned to the method. Method: The work analyzes the experience with body painting of 51 students from Instituto Boggio assigned this method (or instructed to use this method) during their classes. Different planes and anatomical structures were represented on live models' faces to simulate and teach the main injectable cosmetic procedures; syringes, needles, cannulas, and ultrasound gel stained with food inks were used. Overlapping latex layers were used for the anatomical study of the temple, middle third of the face, and nose, allowing the reproduction of fillers and biostimulators in these regions. The main muscle groups were represented for the discussion of high-precision botulinum toxin. After the entire demonstration, the students answered a questionnaire via "Google Forms" evaluating the methodology used. Results: According to the answers to the questionnaires, most students considered body painting an innovative methodology that contributed to learning anatomical content and satisfactorily illustrating the demonstrated cosmetic procedures. Conclusion: Practical learning through live models makes this new teaching method something innovative and unique that, in an enjoyable way, enables the study of anatomy and appropriately trains clinical skills.

Introdução: A anatomia é um dos principais alicerces no exercício da medicina e a escolha de um método de ensino prático e dinâmico é fundamental para melhor retenção do seu aprendizado. O objetivo é utilizar a anatomia facial aplicada em modelos vivos como estratégia inovadora de ensino e avaliar a experiência do processo de aprendizagem dos alunos submetidos ao método. Método: O trabalho analisa a experiência vivida com a pintura corporal por 51 alunos do Instituto Boggio submetidos ao método durante as aulas ministradas. Diferentes planos e estruturas anatômicas foram representados nas faces de modelos vivos. Para simulação e ensino dos principais procedimentos cosmiátricos injetáveis, seringas, agulhas, cânulas e gel de ultrassom corado com tintas alimentícias foram utilizados. Camadas de látex sobrepostas foram utilizadas para estudo anatômico da têmpora, terço médio da face e nariz, possibilitando a reprodução do uso de preenchedores e bioestimuladores nestas regiões. Os principais grupamentos musculares foram representados para discussão sobre toxina botulínica de alta precisão. Após toda a demonstração, os alunos responderam a um questionário via "Formulários Google" avaliando a metodologia utilizada. Resultados: De acordo com as respostas dos questionários, a maioria dos alunos considerou a pintura corporal como uma metodologia inovadora e que contribui no aprendizado do conteúdo anatômico, bem como ilustra satisfatoriamente os procedimentos cosmiátricos demonstrados. Conclusão: A aprendizagem prática por meio dos modelos vivos faz deste novo método de ensino algo inovador e único que, de maneira lúdica, possibilita o estudo da anatomia e o treinamento de habilidades clínicas adequadamente.

Treating the face of women with botulinum toxin type A: 7-year review / Tratamento da face de mulheres com toxina botulínica do tipo A: revisão de 7 anos

Introduction: Botulinum toxin type A (BTX-A) is the number one aesthetic procedure worldwide, and the difficulty in standardizing the aesthetic treatment of the face results in a broad range of treatment possibilities. The objective this study aimed to describe the author's experience treating facial wrinkles of women with BTX-A and suggest a standardized initial treatment method. Methods: A documentary retrospective review of all medical records from the main author's clinic from 2010 to 2017 in São Paulo, Brazil, was performed, searching for female patients who required the BTX-A aesthetic treatment to reduce facial wrinkles. The main author obtained, reviewed, and classified photographic data ("Carruthers Grading Scale for Forehead Lines"). Results: The BTX-A used in all patients was Botox® (Allergan Inc., Irvine, CA, USA). A total of 156 female treatments with BTX-A were identified. The average total units of BTX-A used for the referred treatment was 32.43U. The average period between treatments in the same patient was 8.73 months. All patients showed an improved "Grading Scale for Forehead Lines" post-treatment Conclusion: The review suggests a safe and effective technique is possible with even lower complication rates than found in the literature using fewer units, resulting in lower product costs. One should always try to minimize risks in aesthetic treatments.

Introdução: A aplicação de toxina botulínica do tipo A (BTX-A) é o procedimento estético mais realizado no mundo. Não há consenso sobre a forma ideal de realizar essa aplicação, que defina os locais de aplicação e a quantidade ideal necessária para o referido tratamento. O objetivo do estudo tem como objetivos descrever a experiência do autor no tratamento das rugas faciais em mulheres com BTX-A e sugerir uma padronização para o tratamento inicial. Método: Foi realizado um estudo documental retrospectivo de todos os prontuários médicos da clínica do autor principal, em São Paulo - SP, Brasil, desde 2010 até 2017, em busca dos dados de pacientes do sexo feminino que foram submetidas ao tratamento das rugas faciais com BTX-A, por razões estéticas. Os arquivos fotográficos foram obtidos, revisados e classificados pelo autor principal de acordo com a "Carruthers Grading Scale for Forehead Lines". Resultados: A BTX-A utilizada em todas as pacientes foi: Botox® (Allergan Inc., Irvine, CA, USA). Um total de 156 tratamentos com BTX-A foi encontrado. A média de unidade de toxina utilizada para o tratamento foi de 32,43U. O período médio de retorno para nova aplicação, na mesma paciente, foi de 8,73 meses. Todas as pacientes apresentaram melhora da classificação obtida através da "Grading Scale for Forehead Lines" após o tratamento. Conclusão: A revisão sugere que uma técnica efetiva e segura para o tratamento é possível, com menos unidades e menor taxa de complicações, quando comparada à literatura. Devemos sempre minimizar os riscos em tratamentos estéticos.

Medicamentos bioterapéuticos: uso de toxinas botulínicas en la era de biosimilares / Biotherapeutic medicines: use of botulinum toxins in the era of biosimilars

Introducción: Las toxinas botulínicas son medicamentos bioterapéuticos con grandes aplicaciones en el campo de la neurología, como la cefalea y los movimientos anormales. Debido a la importancia médica y al incremento de las indicaciones terapéuticas de la toxina botulínica, este artículo pretende hacer claridad acerca de la terminología básica con respecto a la naturaleza de este medicamento, a las diferencias estructurales con medicamentos convencionales y aspectos importantes en relación con su potencia biológica e inmunogenicidad, para así comprender las potenciales diferencias entre las toxinas disponibles y conceptuar en torno a la no intercambiabilidad o sustitución de una toxina por otra. Materiales y métodos: Revisión no sistemática, según lo recomendado en la Escala para la Verificación de los Artículos Revisiones Narrativas (Sanra). Conclusiones: Los medicamentos biológicos no son intercambiables entre sí, aunque demuestren bioequivalencia. No se pueden evaluar como medicamentos genéricos intercambiables porque son biológicos; no existen estudios comparativos cabeza a cabeza; son diferentes, debido al proceso individual de manufactura.

Introduction: Botulinum toxins are biotherapeutic drugs with great applications in the field of neurology such as headache and abnormal movements. Due to the medical importance and the increase in therapeutic indications of botulinum toxin, this article aims to clarify the basic terminology regarding the nature of this drug, the structural differences with conventional drugs and important aspects in relation to its biological potency and immunogenicity in order to understand the potential differences between the available toxins and conceptualize regarding the non-interchangeability or substitution of one toxin for another. Materials and methods: Non-systematic review as recommended in the Scale for the Verification of Narrative Review Articles (SANRA). Conclusions: Biological drugs are not interchangeable with each other, even if they demonstrate bioequi-valence. They cannot be evaluated as interchangeable generic drugs because they are biologics. There are no head-to-head comparative studies. They are different due to the individual manufacturing process.

Successful Management of Acute Type A Aortic Dissection with Spinal Cord Ischemia: A 3-Case Series / 日本心臓血管外科学会雑誌

Spinal cord ischemia (SCI), a complication of acute aortic dissection, has no established treatment. Here, we report the successful management of three cases of acute type A aortic dissection (ATAAD) with SCI using a multidisciplinary approach. Case 1: A 55-year-old man presented with paraparesis due to ATAAD (non-communicating type), cardiac tamponade, and no loss of consciousness. He underwent emergency surgery for ascending aortic replacement. He awoke 3 h after the surgery; however, as his paralysis was not improved, we initiated multidisciplinary treatment with cerebrospinal drainage, continuous infusion of naloxone, and steroid pulse therapy. These treatments led to the complete resolution of his symptom; he was discharged on Day 32, with no neurological deficits. Case 2: A 50-year-old woman presented with complete paralysis of the left lower limb due to ATAAD (communicating type) but no loss of consciousness. She underwent emergency surgery for ascending aortic replacement. She awoke 2 h after the surgery; however, as her paralysis was not improved, multidisciplinary treatment with cerebrospinal drainage, continuous infusion of naloxone, and steroid pulse therapy were initiated, which led to partial resolution of the symptoms. She could walk with orthotics and was discharged on Day 57. Case 3: A 43-year-old man presented with paraparesis of the left lower limb due to ATAAD (non-communicating type). He was hemodynamically stable, with no loss of consciousness. The ATAAD was conservatively managed, and multidisciplinary treatment with cerebrospinal drainage, continuous infusion of naloxone, and steroid pulse therapy was administered. These therapies led to the complete resolution of his symptoms; he was discharged on Day 46, with no neurological deficits. Hence, for ATAAD with SCI, multidisciplinary treatment, including emergency surgery, is an important therapeutic strategy.