Periodontal therapy for hopeless mandibular anterior teeth: a retrospective case report with a multidisciplinary approach and a 20-year follow-up

Introduction: This case report presents the intentional periodontal maintenance of two periodontal hopeless lower central incisors with a multidisciplinary approach and 20-year follow-up. Case presentation: A 36-year-old male, in 2001, was diagnosed with aggressive periodontitis, gingival swelling, bleeding, and mandibular central incisors with mobility and poor prognosis. Following periodontal therapy (phase I), root canal treatment, and occlusal adjustment, #31 and #41 were gently extracted to remove the granulation tissues, calculus, and infected cementum from the root surface. Then, tetracycline-HCl was applied for 5 minutes on the root surfaces. The teeth were repositioned into the sockets and splinted with a lingual bar. At 3 months, the bar was removed, and a free gingival autogenous graft was done to improve the local keratinized tissue width. Mobility scores, pocket depths, and clinical attachment levels were recorded, and radiographs were taken at 1, 5, and 20 years. The 5-year follow-up showed that the teeth were clinically and radiographically in function. There was a reduction in probing depth and a gain in clinical attachment and radiographic alveolar bone levels. After 20 years, #41 was stable, but #31 had external root resorption, leading to a new treatment plan (dental implants) and extraction. Conclusion: The clinical result of this case was satisfactory for 20 years. Intentional periodontal maintenance of the teeth may be an alternative treatment, even considering the high level of complexity.

Caracterización de la situación problémica en un estudio psicosocial con pacientes con enfermedad renal crónica

Introducción: La enfermedad renal crónica es un problema de salud a nivel mundial, su manifestación más grave, la insuficiencia renal crónica, incide en el contexto cubano y determina el crecimiento de pacientes en hemodiálisis. El objetivo del texto es valorar los principales resultados del diagnóstico y caracterización de la situación problémica en un estudio de carácter psicosocial con pacientes con Insuficiencia Renal Crónica en la sala de Hemodiálisis del municipio Florida, de la provincia de Camagüey. Método: Es una investigación-acción participativa de corte experimental, que se desarrolla entre enero 2023 y diciembre del 2024 la cual constituye salida del proyecto de investigación Sistema de acciones psicosociales para el perfeccionamiento de la atención integral a los pacientes con enfermedades no transmisibles. El universo está constituido por 56 pacientes y la muestra por 22, que reciben tratamiento depurador y conservador, 22 familiares y 12 profesionales del servicio. El instrumento de investigación por excelencia fue la encuesta a participantes. Resultados: La edad de los pacientes no es definitiva de un grupo etario; predominan los hombres; se constata un elevado por ciento de pacientes con poca tolerancia a la adherencia al tratamiento e insuficiente desarrollo de las habilidades psicosociales y declaran la necesidad de poseer conocimientos para lograr estados de salud que conlleven a la sobrevida. Discusión: No existe coincidencia con lo constatado en la determinación de los grupos etarios de prevalencia para la enfermedad, pero los especialistas insisten en que la enfermedad no es privativa de un período de vida específico; reconocen la importancia del conocimiento de los factores de riesgo por el paciente para la prevención, promoción y educación en salud y resaltan la necesidad de la comunicación y la empatía entre el personal de salud y el paciente, para lograr resultados y estados emocionales favorables ante la enfermedad y el tratamiento.

Introduction: Chronic kidney disease is a global health problem. Its most serious manifestation, chronic kidney failure, affects the Cuban context and determines the growth of patients on hemodialysis. The objective of the text is to evaluate the main results of the diagnosis and characterization of the problematic situation in a psychosocial study with patients with Chronic Renal Failure in the Hemodialysis room of the Florida municipality, of the county of Camagüey. Method: It is an experimental participatory action research, which takes place between January 2023 and December 2024, which constitutes the output of the research project System of psychosocial actions for the improvement of comprehensive care for patients with non-communicable diseases. The universe is made up of 56 patients and the sample is made up of 22, who receive purifying and conservative treatment, 22 family members and 12 service professionals. The research instrument par excellence was the participant survey. Results: The age of the patients is not definitive of an age group; men predominate; A high percentage of patients are found to have low tolerance for adherence to treatment and insufficient development of psychosocial skills and declare the need to possess knowledge to achieve health states that lead to survival. Discussion: There is no coincidence with what was found in the determination of the prevalence age groups for the disease, but specialists insist that the disease is not exclusive to a specific period of life; recognize the importance of the patient's knowledge of risk factors for prevention, promotion and health education and highlight the need for communication and empathy between health personnel and the patient, to achieve favorable results and emotional states in the face of the disease and treatment.

Stoppa Intrapelvic Approach Provides Good Functional Clinical Outcomes: Prospective Study with a Minimum Follow-up of One Year and Comparison with the Literature / Acesso intrapélvico de Stoppa proporciona bons resultados clínicos funcionais: Estudo prospectivo com seguimento mínimo de um ano e comparação com a literatura

Abstract Objective To describe the clinical and radiographic outcomes of a cohort of patients with acetabular fractures treated with the modified Stoppa approach. Methods We conducted a prospective analysis of adult patients with acetabular fractures treated using the modified Stoppa approach from June 2020 to June 2021, with a minimum follow-up period of 12 months. The analysis included demographic, epidemiological, and perioperative data, as well as postoperative radiographic and functional outcomes. Results The study included 15 cases, with 14 men (93.3%) and 1 woman (6.67%). A postoperative tomographic evaluation revealed an anatomical reduction in 50%, an imperfect reduction in 13.6%, and a poor reduction in 36.4% of the subjects. Regarding the functional scores, the Harris Hip Score ranged from 56 to 100, with a mean value of 92.5. The Majeed Pelvic Score classified the functional outcome as excellent in 36.5%, good in 40.6%, moderate in 18.7%, and poor in 4.2% of the cases. Conclusion The present case series study demonstrated positive statistical relevance between reduction quality and functional outcomes and between the time until surgery and the reduction quality. The functional outcomes at a one-year of follow-up demonstrate that this approach can be an excellent alternative for anterior acetabulum fractures.

Resumo Objetivo Descrever os resultados clínicos e radiográficos de uma coorte de pacientes com fraturas de acetábulo tratados com o acesso de Stoppa modificado. Métodos Foi realizada uma análise prospectiva de pacientes adultos com fraturas de acetábulo tratados pela via de Stoppa modificada de junho de 2020 a junho de 2021 e com seguimento mínimo de 12 meses. Foram analisados dados demográficos, epidemiológicos e perioperatórios, e resultados radiográficos e funcionais pós-operatórios. Resultados Foram estudados 15 casos, sendo 14 homens (93,3%) e 1 mulher (6,67%). Na avaliação tomográfica pós-operatória, redução anatômica foi observada em 50% dos casos, imperfeita, em 13,6%, e ruim, em 36,4%. Nos escores funcionais, encontramos uma variação de 56 a 100, com média de 92,5 no Harris Hip Score. No Majeed Pelvic Score, o resultado funcional foi excelente em 36,5% dos casos, bom, em 40,6%, moderado, em 18,7%, e ruim, em 4,2%. Conclusão O estudo da série de casos demonstrou relevância estatística positiva entre a qualidade da redução e os desfechos funcionais, assim como entre o tempo até a cirurgia e a qualidade da redução. Os resultados funcionais no seguimento de um ano demonstram que o uso dessa via pode ser uma excelente alternativa para as fraturas anteriores do acetábulo.

Paisagens, caminhadas e lazer: uma abordagem sistêmica do desenvolvimento turístico em Linha Nova/RS / Landscapes, walking and leisure: a systemic approach of tourism development in Linha Nova/RS

O objetivo deste estudo é compreender as correlações e interações entre a paisagem, caminhadas de lazer e o contexto sistêmico de desenvolvimento turístico na cidade de Linha Nova, Rio Grande do Sul. O estudo de natureza aplicada tem abordagem qualitativa. Quanto aos procedimentos, caracteriza-se como um estudo de caso do município de Linha Nova. Foram entrevistados seis organizadores de caminhadas e disponibilizado um questionário online para pessoas que praticam caminhadas de lazer, totalizando 40 participantes. As respostas indicaram dois temas: a) A natureza como principal atrativo; b) Desenvolvimento econômico e turístico através das caminhadas. Os resultados demonstraram que existe uma relação positiva entre eventos de caminhada e o desenvolvimento da cadeia produtiva do turismo, além de uma percepção de "paisagem" associada à natureza, espaços naturais e cenários panorâmicos.

The objective of this study is to understand the correlations and interactions between the landscape, leisure walks and the systemic context of tourist development in the city of Linha Nova, Rio Grande do Sul. The study of an applied nature has aqualitative approach. As for the procedures, it is characterized as a case study of the municipality of Linha Nova. Six walk organizers were interviewed,and an online questionnaire was made available to people who take leisure walks, totaling 40 participants. The responses indicated two themes: a) Nature as the main attraction; b) Economic and tourist development through hiking. The results demonstrated that there is a positive relationship between walking events and the development of the tourism production chain, in addition to a perception of "landscape" associated with nature, natural spaces and panoramic scenarios.

Anatomical Study of the Pterion in a South African Population of KwaZulu-Natal / Estudio Anatómico del Pterion en una Población Audafricana de KwaZulu-Natal

SUMMARY: Morphologically the Pterion marks the location of the four cranial bones, viz. frontal bone, sphenoid angle of the parietal bone, squamous part of the temporal bone and the greater wing of the sphenoid bone. Population-specific differences exists in the position and union of the Pterion. The Pterion is also an important neurosurgical landmark for surgical procedures, viz. Pterional/lateral approach, as it provides wide access to the base of the skull. This study aimed to determine the position and incidence of the various sutural patterns of the Pterion in a South African population of KwaZulu-Natal. This retrospective study was conducted bilaterally on 36 dry human skulls (11 females and 25 males) obtained from the Department of Clinical Anatomy at University of KwaZulu-Natal. Ethical clearance obtained from the Biomedical Research Ethics Committee. The morphometric parameters of the Pterion were measured using a digital Vernier caliper, while the morphological characteristics were examined using Murphy's classification scheme to determine (if any) laterality or sex differences exists. The mean distance of the Centre of the pterion from midpoint of zygoma was 44.4+/-4.1 mm in males and 45.1+/-4.6 mm in females. While the distance from frontozygomatic suture was 32.7+/-4.7 mm and 32.6+/-4.8 mm in males and females, respectively. Sphenoparietal type of pterion was most prevalent at 55.6 %, followed by the frontotemporal, stellate and epipteric type with an incidence of 27.8 %; 11.1 % and 5.6 %, respectively. No statistically significant difference for sex or laterality were documented in this study. The present study concluded that the sphenoparietal type of sutural pattern was most prevalent with an incidence of 55.6 %. While the epipteric type was the least prevalent. The comprehensive data about the position of the Pterion is important to neurosurgeons, forensics scientists and anthropologists.

Morfológicamente, el pterion marca la ubicación de los cuatro huesos craneales: hueso frontal, ángulo esfenoidal del hueso parietal, parte escamosa del hueso temporal y el ala mayor del hueso esfenoides. Existen diferencias específicas de la población en la posición y unión del pterion. El pterion es también un hito neuroquirúrgico importante para los procedimientos quirúrgicos en el bordaje pterional/lateral, ya que proporciona un amplio acceso a la base del cráneo. Esta investigación tuvo como objetivo determinar la posición y la incidencia de los diversos patrones suturales del pterion en una población sudafricana de KwaZulu-Natal. Este estudio retrospectivo se realizó bilateralmente en 36 cráneos humanos secos (11 mujeres y 25 hombres) obtenidos del Departamento de Anatomía Clínica de la Universidad de KwaZulu-Natal. ALa autorización ética fue otorgada porel Comité Ético de Investigación Biomédica. Los parámetros morfométricos del pterion se midieron usando un calibrador Vernier digital, mientras que las características morfológicas se examinaron usando el esquema de clasificación de Murphy para determinar, si existe alguna lateralidad o diferencias sexuales. La distancia media del centro del pterion desde el punto medio del cigoma fue de 44,4+/- 4,1 mm en hombres y de 45,1+/-4,6 mm en mujeres. Mientras que la distancia desde la sutura frontocigomática fue de 32,7+/-4,7 mm y 32,6+/-4,8 mm en hombres y mujeres, respectivamente. El tipo de pterion esfenoparietal fue el más prevalente con un 55,6 %, seguido del tipo frontotemporal, estrellado y epiptérico con una incidencia del 27,8 %; 11,1 % y 5,6 %, respectivamente. En el estudio no se documentaron diferencias estadísticamente significativas para el sexo o la lateralidad. Concluimos que el tipo de patrón de sutura esfenoparietal fue el más prevalente con una incidencia del 55,6 %. Mientras que el tipo epiptérico fue el menos prevalente. Los datos completos sobre la posición del pterion son importantes para los neurocirujanos, los científicos forenses y los antropólogos.

Una Sola Salud. Un Enfoque Multisectorial y Transdisciplinario / One Health. A Multisectoral and Transdisciplinary Health Approach

Una sola salud (USS), es un enfoque integral y unificador diseñado para equilibrar y optimizar la salud tanto de seres humanos, animales y ecosistemas, aprovechando la interrelación entre estos ámbitos para establecer nuevas metodologías de vigilancia y control de enfermedades. Es así como, la forma en que se utiliza el suelo puede influir en el número de casos de malaria; las condiciones meteorológicas y controles artificiales del agua pueden afectar enfermedades como el dengue; el comercio de animales salvajes vivos puede aumentar la probabilidad de que ciertas enfermedades infecciosas se transmitan de animales a humanos (zoonosis), entre otros ejemplos. Es decir, un esfuerzo integrador de múltiples disciplinas que trabajan de manera colaborativa a nivel local, nacional y global en todos los aspectos del cuidado de la salud de los seres humanos, los animales y el medio ambiente. El objetivo de este manuscrito fue reportar y discutir el concepto USS, como nuevo enfoque sanitario inter y transdisciplinario. Debemos adoptar la filosofía de USS desde el nivel global hasta el más local para reducir entre otras, los riesgos de pandemias que pueden ocurrir con mayor frecuencia considerando el crecimiento exponencial de la población mundial y la urbanización.

SUMMARY: One Health (OH) represents a comprehensive and unifying approach designed to balance and optimize the health of humans, animals, and ecosystems. By leveraging the interdependent links among these domains, OH establishes new methodologies for disease surveillance and control. The manner in which land is utilized can influence the incidence of malaria; meteorological conditions and artificial water controls can impact diseases such as dengue, and the trade of live wildlife can escalate the likelihood of certain infectious diseases being transmitted from animals to humans (zoonoses), among other interconnected factors. That is, an integrative effort of multiple disciplines working collaboratively and locally, nationally, and globally in all aspects of health care for humans, animals, and the environment. The aim of this manuscript was to elucidate and discuss the OH concept as an interdisciplinary and transdisciplinary paradigm in healthcare. In conclusion,it is imperative to embrace the OH philosophy from a global to local scale in order to mitigate, among other concerns, the heightened risks of pandemics. This consideration is especially pertinent given the exponential growth of the global population and urbanization trends, which may contribute to an increased frequency of pandemic occurrences.

Enfrentamiento diagnóstico de la rinosinusitis aguda en pacientes adultos ambulatorios / Diagnostic Approach of acute rhinosinusitis in adults outpatients

Acute rhinosinusitis is a common condition, mainly of viral etiology and self-limiting course. There is coexistence of microbiological agents that favor bacterial superinfection. Therefore, it is necessary to know evidence that supports diagnostic approach in adults out- patients. Having reviewed the evidence, we mention the isolated symptoms and signs have such a low performance to guide the diagnostic approach, some with statistical evidence such as hemifacial pain, colored nasal discharge and radiographic alterations suggestive of rhinosinusitis. Also, it is possible to improve clinical performance by combining suggestive findings. The imaging study has little evidence that supports them, because non-specific and non-concordant findings. Finally, empirical management with antibiotics does not statistically or clinically modify the evolution of an acute non-complicated condition.

La rinosinusitis aguda es una condición frecuente, principalmente de etiología viral y de curso autolimitado. Existe coexistencia de agentes microbiológicos que favorece la sobreinfección bacteriana. Por ello, es necesario conocer la evidencia que dirige el enfrentamiento diagnóstico en pacientes adultos ambulatorios. Habiéndose revisado la evidencia, mencionamos que los síntomas y signos aislados poseen bajo rendimiento para guiar el proceso diagnóstico, destacando algunos con mejores atributos diagnósticos, pero de significancia estadística bastante discreta, como lo son el dolor hemifacial, la descarga nasal coloreada y alteraciones de la radiografía sugerentes de rinosinusitis. También, que se puede mejorar discretamente el rendimiento clínico combinando algunos de estos hallazgos sugerentes. El estudio imagenológico posee poca evidencia que lo respalde, dado la presencia de hallazgos inespecíficos o no concordantes, inclusive en pacientes asintomáticos. Finalmente, respecto de manejo empírico con antibióticos, destaca que su uso no modifica estadística ni clínicamente la evolución de un cuadro agudo no complicado.

The Effect of an Educational Intervention Based on the Health Action Process Approach on Nurses' Communication Skills / Efecto de una intervención educativa basada en el enfoque del proceso de acción en salud sobre las habilidades comunicativas de las enfermeras / Efeito de uma intervenção educativa baseada na abordagem do processo de ação em saúde nas habilidades de comunicação do enfermeiro. Estudo quase experimental com grupo controle

Objective. This study aimed to the effects of the Health Action Process Approach (HAPA) in promoting the quality of nurses' communication skills among nurses. Methods.The present quasi-experimental research was conducted on 148 nurses (76 in the intervention and 72 in the control group) in Yazd province (Iran). In this study, the total number of nurses in one hospital was selected as the intervention group, while the nurses from another hospital were chosen as the control group. The participants were recruited from public hospitals in Ardakan and Meibod cities. The data collection instrument was a questionnaire based on the Health Action Process Approach (HAPA) Constructs and a communicative skill questionnaire. The data were collected from the two groups before, one month after, and four months after the intervention. The control group did not receive any educational training during the course of the study. Results. In the pretest, no statistically significant difference was found between the intervention and control groups regarding the behavioral stages of effective communication with patients. In the posttest, the mean task self-efficacy score was significantly increased in the intervention group compared to the control (p<0.001). The mean coping self-efficacy score was also significantly higher in the intervention group than the control in the posttest (p<0.001). Moreover, the mean coping planning score was significantly increased in the post-test intervention group(p<0.001). The mean communicative skill score was also significantly increased in the intervention group compared to the post-test control (p=0.03). Conclusion. The intervention used in the present study based on the target model (HAPA) significantly affected nurses' self-efficacy and communicative skills in the experimental group.

Objetivo. Evaluar el efecto del enfoque del proceso de acción sanitaria (Health Action Process Approach (HAPA), en inglés) en la promoción de la calidad de las habilidades de comunicación de las enfermeras. Métodos. La presente investigación cuasiexperimental se llevó a cabo con 148 enfermeras (76 en el grupo de intervención y 72 en el de control) de la provincia de Yazd (Irán). Los participantes fueron reclutados en los hospitales públicos de las ciudades de Ardakan y Meibod. El instrumento de recogida de datos fue un cuestionario basado en los constructos HAPA y un cuestionario de habilidades comunicativas. Se recogieron datos de los dos grupos antes, un mes después y cuatro meses después de la intervención. El grupo de control no recibió ninguna formación educativa durante el estudio. Resultados. En la preprueba, no se encontraron diferencias estadísticamente significativas entre los grupos de intervención y de control en cuanto a las etapas conductuales de la comunicación eficaz con los pacientes. En la prueba posterior, la puntuación media de autoeficacia en la tarea aumentó significativamente en el grupo de intervención en comparación con el grupo de control (p<0.001). La puntuación media de autoeficacia en el afrontamiento también fue significativamente mayor en el grupo de intervención que en el grupo de control en el postest (p<0.001). Además, la puntuación media en planificación del afrontamiento aumentó significativamente en el grupo de intervención después de la prueba (p<0.001). La puntuación media en habilidades comunicativas también aumentó significativamente en el grupo de intervención en comparación con el grupo de control después de la prueba (p=0.03). Conclusión.La intervención utilizada en el presente estudio basada en el modelo HAPA mejoró significativamente la autoeficacia y las habilidades comunicativas de las enfermeras del grupo experimental.

Objetivo. Avaliar o efeito da Abordagem do Processo de Ação em Saúde (HAPA) na promoção da qualidade das habilidades de comunicação dos enfermeiros. Métodos. A presente pesquisa quase-experimental foi realizada com 148 enfermeiros (76 no grupo de intervenção e 72 no grupo de controle) da província de Yazd (Irã). Os participantes foram recrutados em hospitais públicos nas cidades de Ardakan e Meibod. O instrumento de coleta de dados foi um questionário baseado nos construtos do HAPA e um questionário de habilidades de comunicação. Os dados foram coletados dos dois grupos antes, um mês depois e quatro meses após a intervenção. O grupo de controle não recebeu nenhum treinamento educacional durante o estudo. Resultados. No pré-teste, não foram encontradas diferenças estatisticamente significativas entre os grupos de intervenção e controle em termos de estágios comportamentais da comunicação eficaz com os pacientes. No pós-teste, a pontuação média de autoeficácia na tarefa aumentou significativamente no grupo de intervenção em comparação com o grupo de controle (p<0.001). A pontuação média de autoeficácia de enfrentamento também foi significativamente maior no grupo de intervenção do que no grupo de controle no pós-teste (p<0.001). Além disso, a pontuação média do planejamento de enfrentamento aumentou significativamente no grupo de intervenção após o pós-teste (p<0.001). A pontuação média em habilidades de comunicação também aumentou significativamente no grupo de intervenção em comparação com o grupo de controle no pós-teste (p=0.03). Conclusão. A intervenção usada no presente estudo com base no modelo HAPA melhorou significativamente a autoeficácia e as habilidades de comunicação dos enfermeiros do grupo experimental.

Manejo endovascular de hemoptisis secundaria a pseudoaneurisma de la aorta torácica, mediante un abordaje proximal

Objetivo: Describir un caso clínico y una alternativa de manejo para el tratamiento de la hemoptisis secundaria a patología la aneurismática de la aorta torácica. Materiales y Métodos: Revisión de historia clínica y exámenes complementarios, disponibles en sistema digital del centro asistencial de origen. Resultados: Se presenta el caso de paciente masculino, 56 años, que cursó con cuadro de hemoptisis, posteriormente objetivado como secundario a un pseudoaneurisma de la aorta torácica. Entre sus antecedentes destaca, enfermedad aorto-ilíaca tratada mediante un bypass de aorta torácica. Se decidió la reparación endovascular, mediante un abordaje proximal, utilizando la arteria axilar. Discusión: Las indicaciones para el uso de la reparación torácica endovascular de la aorta (TEVAR) se están expandiendo ampliamente, incluyendo a pacientes previamente intervenidos o aquellos que antiguamente se consideraban con un riesgo prohibitivamente alto para una cirugía. La fístula aorto-bronquial, es una complicación rara, sin embargo, existe correlación entre su desarrollo y la cirugía de aorta torácica. La sospecha diagnóstica debe ser alta. La AngioTC, cumple un doble rol, tanto para el diagnóstico, como para la planificación preoperatoria, hecho fundamental para conseguir una terapia adecuada.

Objective: To describe a clinical case and a management alternative for the treatment of hemoptysis secondary to thoracic aortic aneurysm pathology. Material and Method: Review of clinical history and complementary examinations, available in the digital system of the health care center of origin. Results: We present the case of a male patient, 56 years old, presented with hemoptysis, later found to be secondary to a pseudoaneurysm of the thoracic aorta. History included aorto-iliac disease treated by thoracic aortic bypass. Endovascular repair was decided by a proximal approach using the axillary artery. Discussion: Indications for the use of TEVAR are expanding widely. Including previously operated patients or those formerly considered prohibitively high risk for surgery. Aortobronchial fistula is a rare complication, however, there is a correlation between its development and thoracic aortic surgery. Diagnostic suspicion should be high. AngioCT plays a dual role in diagnosis and preoperative planning, which is essential to achieve adequate therapy.

Dyadic Analysis of the Inventory of Family Integration in Fathers and Mothers in the city of Arequipa

The present study analyzes the psychometric properties of the Inventory of Family Integration (IFI) by means of a dyadic analysis based on the responses of fathers and mothers in families from the city of Arequipa, southern Peru. For this purpose, 264 married couples living with their families were non-probabilistically selected and administered the 52-item IFI. An analysis of dimensionality and reliability was carried out, and a factorial invariance analysis was applied under a dyadic approach and, finally, a comparative analysis using Cohen's d was performed. The results reported moderate correlations between the values of fathers and mothers in each family holon: personal, spousal, parental, sibling and familial. Likewise, the dimensionality fit of each holon in fathers and mothers was adequate with acceptable magnitudes, and the reliability indices calculated with Cronbach's alpha and McDonald's Omega tests were high. The five-factor internal structure and internal consistency in both fathers and mothers were corroborated.

El presente estudio analiza las propiedades psicométricas del Inventario de Integración Familiar (IIF) mediante un análisis diádico en función de las respuestas de padres y madres de conforman una familia procedente de la ciudad de Arequipa, al sur de Perú. Para ello, se seleccionó de manera no probabilística a 264 parejas casadas que viven con sus familias, a quienes se les aplicó el IIF que consta de 52 ítems. Se realizó un análisis de la dimensionalidad y la confiabilidad, y se aplicó un análisis de invarianza factorial bajo un enfoque diádico y finalmente un análisis comparativo mediante la d de Cohen. Los resultados reportaron correlaciones moderadas entre los valores de los padres y madres en cada holón familiar: personal, conyugal, parental, fraternal y familiar. Asimismo, el ajuste de dimensionalidad de cada holón en padres y en madres fue adecuado con magnitudes aceptables, y los índices de confiabilidad calculados con las pruebas alfa de Cronbach y Omega de McDonald fueron elevados. Se corrobora la estructura interna de cinco factores y la consistencia interna tanto en padres como en madres.

Manejo de fractura de platillo tibial medial utilizando placas rim anteromedial y posteromedial / Management of Medial Tibial Plateau Fracture using Antero- and Posteromedial Rim Plates

INTRODUCCION En los últimos años, se ha descrito el uso de placas horizontales para la fijación de fracturas que comprometen el reborde articular de los platillos tibiales, lo que se conoce como placa rim. La mayoría de las publicaciones al respecto describen su uso en columnas posteriores y posterolaterales de los platillos tibiales, y a la fecha hay escasos reportes del uso de este tipo de placa en la columna anteromedial y ninguno para la posteromedial. El objetivo de este artículo es presentar dos casos clínicos de fracturas conminutas del platillo tibial medial mostrando su tratamiento con el uso de placas rim. CASOS CLINICOS El primer caso presentaba compromiso anteromedial y posteromedial, y el segundo, compromiso posteromedial. En ambos casos, se logró la reducción mediante un abordaje posteromedial y su fijación con placa bloqueada de 2,7 mm como placa rim. En cada caso, se detalló la estrategia de reducción y el manejo postoperatorio. RESULTADOS Ambos pacientes consiguieron la consolidación ósea entre las semanas 14 y 18 tras la osteosíntesis definitiva, sin presentar pérdidas de reducción. Ambos lograron rango de movilidad articular completo (0°­125°), y retornaron a sus trabajos a los 4 y 6 meses respectivamente. CONCLUSIONES Estas placas ofrecen una buena opción de tratamiento para fracturas articulares conminutas del borde del platillo tibial, tanto en la columna anteromedial como en la posteromedial. A pesar de la ausencia de grandes series de pacientes con uso de placas rim mediales, el resultado de los casos presentados aquí nos permite plantear su utilidad al momento de enfrentarnos a fracturas del reborde articular

INTRODUCTION In recent years, the use of horizontal plates has been described to achieve fixation of fractures that compromise the articular ridge of the tibial plateau; these plates are known as "rim plates." Most publications report their use in the posterior and posterolateral columns of the tibial plateau, and to date there are few reports of its use for the fixation of the anteromedial column and none for the posteromedial column. The objective of the present article is to report two clinical cases of comminuted fractures of the medial tibial plateau, showing their treatment with the use of medial rim plates. CLINICAL CASES The first case presented with an anteromedial and posteromedial tibial plateau fracture, and the second, a posteromedial fracture. In both cases, reduction was achieved through a posteromedial approach, and the fixation was performed with a 2.7-mm locked rim plate. The reduction strategy and postoperative management were detailed in each case. RESULTS Both patients achieved bone consolidation during the 14th and 18th weeks after the definitive osteosynthesis, without presenting loss of reduction. Both patients achieved full range of joint motion (0°­125°) and returned to work after four and six months respectively. CONCLUSION These plates offer a good treatment option for comminuted fractures of the rim of the tibial plateau, for both the anteromedial and posteromedial columns. Despite the absence of large series of patients with the use of medial rim plates, the results of the two cases herein presented enables us to propose it as a useful tool when dealing with fractures of the medial rim of the tibial plateau

INTRODUCTION In recent years, the use of horizontal plates has been described to achieve fixation of fractures that compromise the articular ridge of the tibial plateau; these plates are known as "rim plates." Most publications report their use in the posterior and posterolateral columns of the tibial plateau, and to date there are few reports of its use for the fixation of the anteromedial column and none for the posteromedial column. The objective of the present article is to report two clinical cases of comminuted fractures of the medial tibial plateau, showing their treatment with the use of medial rim plates. CLINICAL CASES The first case presented with an anteromedial and posteromedial tibial plateau fracture, and the second, a posteromedial fracture. In both cases, reduction was achieved through a posteromedial approach, and the fixation was performed with a 2.7-mm locked rim plate. The reduction strategy and postoperative management were detailed in each case. RESULTS Both patients achieved bone consolidation during the 14th and 18th weeks after the definitive osteosynthesis, without presenting loss of reduction. Both patients achieved full range of joint motion (0°­125°) and returned to work after four and six months respectively. CONCLUSION These plates offer a good treatment option for comminuted fractures of the rim of the tibial plateau, for both the anteromedial and posteromedial columns. Despite the absence of large series of patients with the use of medial rim plates, the results of the two cases herein presented enables us to propose it as a useful tool when dealing with fractures of the medial rim of the tibial plateau

Grupo centrado: experiência com mulheres na vivência do ciclo gravídico puerperal / Centered group: a study with women experiencing pregnancy-puerperal cycle / Grupo focal: experiencia con mujeres en la vivencia del ciclo de embarazo puerperal

OBJETIVO: Compreender experiência de grupo orientado pela Abordagem Centrada na Pessoa (ACP) com mulheres que vivenciam o ciclo gravídico puerperal, no contexto do Sistema Único de Saúde (SUS). MÉTODO: Pesquisa qualitativa, de inspiração fenomenológica, e utilização do referencial da ACP como norteador do estudo. As informações foram coletadas por meio de grupo, em quatro encontros presenciais nos meses de maio e junho de 2022, utilizando-se dos instrumentos Versão de Sentido (VS's) e Entrevista Fenomenológica (EF), sendo as informações organizadas em Eixos de Sentido e compreendidas a partir das premissas da ACP em diálogo com estudos vinculados às temáticas emergidas. RESULTADOS E DISCUSSÃO: Os Eixos elaborados a partir das VS's evidenciaram aspectos e tendências típicas do desenvolvimento de grupo fundamentado pela ACP; descreveram o grupo como espaço de acolhimento e liberdade experiencial, no qual se facilitou a expressão de vivências significativas relacionadas à gestação, parto e puerpério; apresentaram, ainda, o sentido de que a experiência grupal constituiu-se como promotora de trocas e apoio mútuo, de desenvolvimento e aprendizagens significativas. Os Eixos formulados com base na EF revelaram que as mulheres compreenderam a participação no grupo como uma experiência positiva, que propiciou cuidado aos aspectos emocionais, impulsionando autoconhecimento e desenvolvimento; e facilitadora de mudanças construtivas na vivência da maternidade. CONCLUSÃO: O estudo demonstrou a viabilidade de grupo centrado na assistência integral à saúde da mulher no período gravídico puerperal, e as convergências entre os princípios da ACP e os que orientam a prática na assistência do SUS.

OBJECTIVE: Understanding the group guided by the Person-Centered Approach (PCA) with women who experience the pregnancypuerperal cycle, in the Sistema Único de Saúde ­ SUS (Brazilian National Health System) context. METHOD: Qualitative research of phenomenological inspiration using the PCA framework as a guide for the study. Information was collected through groups, in four face-to-face meetings between May and June 2022, using the Sense's Version (SV's) and Phenomenological Interview (PI), with the information organized in Sense Axes and understood from the premises of the PCA in dialogue with studies linked to emerging themes. RESULTS AND DISCUSSION: The Axes created from the SV's showed aspects and tendencies which are typical of the development of a group based on the PCA; described the group as a welcoming space and experiential freedom, in which the expression of significant experiences related to pregnancy, childbirth and puerperium was facilitated; they also presented, the sense that the group experience was constituted as a promoter of exchanges and mutual support, of development and significant learning. The Axes formulated based on the PI, revealed that the women understood participation in the group as a positive experience, which provided care for emotional aspects, boosting self-knowledge and development; and a facilitator of constructive changes in the experience of motherhood. CONCLUSION: The study demonstrated the viability of a group centered on comprehensive care for women's health in the pregnancy-puerperal period between the PCA principles and those that guide the SUS care practice.

OBJETIVO: Comprender la experiencia de grupo orientado por el Enfoque Centrado en la Persona (ACP) con mujeres que vivenciaron el ciclo de embarazo puerperal, en el contexto del Sistema Único de Saúde ­ SUS (Sistema Único de Salud). MÉTODO: Pesquisa cualitativa de inspiración fenomenológica e utilización del referencial de la ACP como guía de estudio. Las informaciones fueron colectadas por medio de un grupo, en cuatro encuentros presenciales en los meses de mayo y junio del 2022, utilizando-se de los instrumentos Versiones del Sentido (VS's) e Entrevista Fenomenológica (EF), siendo las informaciones organizadas en Ejes del Sentido y comprendidas a partir de las premisas de la ACP en dialogo con estudios vinculados a las temáticas emergidas. RESULTADOS Y DISCUSIONES: Los Ejes elaborados a partir de las VS's evidenciaron aspectos y tendencias típicas del desarrollo del grupo fundamentado por la ACP, describieron el grupo como espacio de acogimiento y libertad experimental en lo cual se facilitó expresar las vivencias significativas relacionadas a la gestación, el parto y el puerperio, presentaron todavía, el sentido de que la experiencia grupal e constituyó como promotora de cambios y apoyos mutuos, de desarrollo y aprendizajes significativos. Los Ejes formulados con base en la EF, revelaron que las mujeres comprendieron la participación en el grupo como una experiencia positiva que les proporcionó cuidados a los aspectos emocionales aumentando el autoconocimiento y desarrollo; y facilitadora de cambios constructivos en la vivencia de la maternidad. CONCLUSIÓN: El estudio demostró la viabilidad del grupo enfocado en la asistencia integral a la salud de la mujer en el período del embarazo puerperal, y las convergencias entre los principios de la ACP y los que orientan la practica en la asistencia del SUS.

Perspectiva holística en salud: la contribución de la Homeopatía / Holistic Perspective in Health: The Contribution of Homeopathy

En el panorama de la salud, el cuerpo humano, en su estado natural, se revela como una intrincada unidad que opera en armonía para mantener el equilibrio dinámico. Sin embargo, esta homeostasis puede verse afectada, dando lugar a la dualidad y a trastornos que comprometen la estabilidad vital. Este artículo propone una reflexión sobre la perspectiva homeopática, destacando su enfoque único en comparación con la medicina convencional. Diferenciándose al tratar al individuo como un todo integrado, la Homeopatía reconoce la transitoriedad de la dualidad representada por las enfermedades y enfatiza la importancia de la armonía entre el cuerpo y la mente en la búsqueda de la homeostasis. Inspirada en las ideas de Hahnemann, la Homeopatía se destaca por su visión holística, rechazando el dualismo estricto y proponiendo intervenciones que van más allá de la supresión de los síntomas. Anclada en la ley de los similares, busca sustancias que reproduzcan los síntomas del paciente en un estado saludable, buscando una cura profunda y la restauración de la unidad dinámica del organismo. A pesar de los desafíos, como la resistencia y la falta de métodos de investigación universalmente aceptados, la Homeopatía persiste a nivel mundial, sugiriendo un valor único. Este artículo promueve una reflexión sobre el enfoque homeopático, enfatizando su contribución a la comprensión de la salud y su papel en el panorama terapéutico.

n the landscape of health, the human body, in its natural state, reveals itself as an intricate unity, operating harmoniously to maintain dynamic balance. However, this homeostasis can be disrupted, leading to duality and disturbances that compromise vital stability. This article reflects on the homeopathic perspective, highlighting its unique approach compared to conventional medicine. Distinguishing itself by treating the individual as an integrated whole, homeopathy recognizes the transience of duality represented by diseases and emphasizes the importance of harmony between body and mind in the pursuit of homeostasis.Inspired by Hahnemann's ideas, homeopathy stands out for its holistic view, rejecting strict dualism and proposing interventions that go beyond symptom suppression. Anchored in the Law of Similars, it seeks substances that would reproduce the patient's symptoms in a healthy state, aiming for a profound cure and the restoration of the dynamic unity of the organism. Despite challenges, such as resistance and a lack of universally accepted research methods, homeopathy persists globally, suggesting unique value. This article encourages reflection on the homeopathic approach, emphasizing

Observation on the effect of the treatment of lumbar disc herniation with lateral recess stenosis through the interlaminar approach under the technique of intervertebral foramen / 临床外科杂志

Objective This study explored the clinical effect of using transforaminal technique to treat patients with lumbar disc herniation and lateral recess stenosis.Methods 132 patients with lumbar disc herniation and lateral recess stenosis who were treated by orthopedic surgery in our hospital from July 2018 to December 2022 were selected for retrospective analysis.They were divided into the endoscopic group and the traditional group according to the surgical method.70 patients in the endoscopic group were treated by the inter-laminar approach under the technique of intervertebral foramen,and 62 patients in the traditional group were treated by the traditional open surgery.The operation process indexes of the two methods were compared The clinical symptoms of patients after operation were different.Results The average operation time[(76.1±7.5)min],surgical blood loss[(30.5±8.4)ml],incision length[(0.88±0.12)cm],post-operative drainage[(24.5±4.4)ml],bed time[(26.8±4.4)h],and length of stay[(5.6±1.8)d]in the endoscopic group were significantly lower than those in the traditional group[(88.0±9.3)min,(103.4±18.6)ml,(6.10±1.04)cm,(208.3±34.0)ml,(32.7±6.6)h and(9.4±2.0)d,respectively].The difference was statistically significant(P＜0.05).VAS scores of 3 months and 6 months after surgery were lower than those before surgery,and JO A scores were higher,the difference was statistically significant(P＜0.05).The lumbar function of the endoscopic group was excellent in 43 cases(61.43％)and good in 15 cases(21.43)％),29 cases of lumbar spine function were excellent(46.77％)and 17 cases(21.43％)were good in the traditional group.Overall,there was no statistically significant difference in the recovery of lumbar spine function between the endoscopic group and the traditional group(P＞0.05).2 patients(2.86％)in the endoscopy group had postoperative complications,and 7 patients(11.29％)in the traditional group had postoperative complications,but there was no significant statistical difference in the incidence of surgical complications between the two groups(P＞0.05).Conclusion For the treatment of lumbar disc herniation with lateral recess stenosis under intervertebral foraminal technique,the treatment of lumbar intervertebral disc herniation with lateral recess stenosis can achieve better functional recovery and effectively relieve the clinical symptoms of the patient,but its advantage lies in the operation time.Shorter,less traumatic impact on patients.

Clinical analysis of robotic bilateral modified radical neck dissection through the bilateral axillo-breast approach for thyroid carcinoma / 中华内分泌外科杂志

Objective:To research the efficacy and safety of robotic thyroidectomy and bilateral modified radical neck dissection through bilateral axillo-breast approach (BABA) .Methods:We retrospectively analyzed the clinical data of 37 patients with thyroid cancer who received bilateral modified radical neck dissection through the BABA at the Department of Thyroid and Breast Surgery of the 960th Hospital of the People’s Liberation Army from Jan. 2014 to Jan. 2023. There were 24 females and 13 males, and the average age of the patients was (33,22±10.53) years old. The tumor diameter, number of lymph node dissection and metastasis in the central and lateral regions, average operation time, average hospital stay, complications, and aesthetic score were recorded. SPSS 25.0 software was used for statistical analysis, and the measurement data was calculated using mean ± standard deviation ( ± s), and the counting data was expressed in percentages and numbers. Results:A total of 37 thyroid cancer patients underwent robotic bilateral regional lymph node dissection. The 37 patients received total thyroidectomy, bilateral central compartment and cervical lateral regional lymph node dissection. All the pathological types were papillary carcinoma, with a maximal tumor diameter of (1.47±0.85) cm. The average number of central lymph nodes dissected was 19.46±8.84, and there were (10.24±5.95) metastases; The average number of lymph nodes removed from the bilateral cervical region was 38.92±14.21, and there were (7.92±5.84) metastases. The average operation time was (288.05±77.09) min, the average length of stay in the hospital was (10.76±3.92) days, and the average length of stay in the hospital following surgery was (8.03±2.08) days. These patients had no permanent hypoparathyroidism, permanent recurrent laryngeal nerve palsy, infection, accessory nerve injury and phrenic nerve injury after operation. Transient hypoparathyroidism occurred in 15 patients, transient recurrent laryngeal nerve palsy occurred in 1 patient, and chyle leak occurred in 2 patients. One month after surgery, the aesthetic score was 9.51±0.69.Two patients were found lymph node metastases during the (27.81±15.10) months of follow-up, and received robotic cervical lymph node dissection with BABA.Conclusion:For carefully chosen thyroid cancer patients with bilateral lateral cervical region lymph node metastases, robotic bilateral cervical lymph node regional dissection via BABA is safe and feasible, and good cosmetic results can be obtained.

Experience and learning curve of single-line suspension suction rod-assisted hybrid cavity-building thyroid surgery via the oral vestibular approach / 中华内分泌外科杂志

Objective:To explore the experience and learning curve of single-line suspension suction rod-assisted hybrid cavity-building thyroid surgery via the oral vestibular approach.Methods:Clinical data of 138 patients undergoing single-line suspension suction rod-assisted hybrid cavity-building thyroid surgery via oral vestibular approach from Sep. 2019 to Dec. 2021 in the Department of Thyroid and Breast Surgery of Affiliated Hospital of North Sichuan Medical College were retrospectively analyzed. The cumulative sum (CUSUM) method and best-fit curve analysis were used to compare the differences in each index such as operative time, intraoperative bleeding, number of lymph nodes cleared in the central region and postoperative related complications at various stages of the learning curve.Results:All 138 patients underwent single-line suspension rod-assisted hybrid cavity-building thyroid surgery via the oral vestibular approach, and one patient was converted to open surgery due to large intraoperative bleeding in the mass. There were 14 males and 124 females, mean age (36.07±8.49) years (20-55 years), thyroid tumor size (7.74±6.49) mm (2.4-50mm), 5 cases underwent Subtotal thyroidectomy, 129 cases underwent Unilateral lobectomy + lymph node dissection in the middle region, and 4 cases total thyroidectomy + central zone lymph node dissection. The number of surgical cases corresponding to the apex of the CUSUM learning curve was 45, and the learning curve was divided into two stages: the learning improvement stage (1-45 cases) and the mastery stage (46-138 cases). The operative time, intraoperative bleeding, postoperative hospital stay, and chin numbness were all lower in the proficiency period than in the learning and training period ( P<0.05), and the number of lymph nodes cleared in the central region was larger than that in the learning and improvement stage ( P<0.05), while the differences in other indexes between the two stages were not statistically significant ( P>0.05) . Conclusion:The single-line suspension suction rod-assisted hybrid cavity-building thyroid surgery via the oral vestibular approach has clinical application value and is worth promoting, and the number of surgical cases to be accumulated to master this technique is 45.

Clinical observation of areola approach endoscopic thyroidectomy and gasless axillary approach endoscopic thyroidectomy in the treatment of patients with papillary thyroid carcinoma / 中华内分泌外科杂志

Objective:To explore the clinical efficacy of areola approach endoscopic thyroidectomy (AET) and gasless axillary approach endoscopic thyroidectomy (GAET) in the treatment of papillary thyroid carcinoma (PTC) patients.Methods:A total of 96 PTC patients from the Thyroid Surgery Department of Linyi People’s Hospital from May. 2019 to May. 2022 were selected and randomly divided into 48 patients using a random number table method. The areola group received AET, while the armpit group received GAET. The surgical situation, postoperative recovery, relevant biochemical indicators [white blood cell count (WBC), erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), parathyroid hormone (PTH), blood calcium] before and after surgery, postoperative pain level, discomfort level, neck function, and complications were compared between the two groups.Results:The surgical time and extubation time of the armpit group were (125.71±15.73) minutes and (3.12±0.53) days, respectively, which were shorter than those of the areola group (137.94±20.02) minutes and (3.48±0.46) days. The intraoperative bleeding volume was (14.19±4.16) mL, which was less than that of the areola group (22.65±7.39) mL, and the number of lymph nodes cleaned was 5.06±1.02, which was more than that of the areola group (4.23±1.14) ( P<0.05) ; there was no significant difference in postoperative drainage volume and hospital stay between the two groups ( P>0.05) ; Peripheral blood WBC in the armpit group on the 1st and 3rd day after surgery [ (5.69±0.15) ×10 9/L, (5.52±0.14) ] ×10 9/L, ESR [ (8.21±0.55) mm/h, (7.64±0.60) mm/h], CRP [ (10.06±1.78) ng/L, (8.93±1.33) ng/L] were lower than those in the areola group [ (5.83±0.21) ×10 9/L, (5.70±0.23) ×10 9/L, (8.87±0.74) mm/h, (8.19±0.68) mm/h, (12.45±1.90) ng/L, (10.45±1.50) ng/L] ( P<0.05). There was no significant difference in the levels of the above biochemical indicators 5 days after surgery ( P>0.05). There was no significant difference in peripheral blood PTH and calcium levels between the two groups on the 1st, 3rd, and 5th postoperative days ( P>0.05). The pain level [ (3.25±0.32) scores, (2.53±0.27) scores, (1.82±0.22) scores] and discomfort level [ (6.85±0.71) scores, (5.24±0.66) scores, (3.51±0.57) scores] in the axillary group were lower than those in the areola group [ (3.78±0.40) scores, (2.89±0.34) scores, (2.06±0.26) scores, (7.46±0.84) scores, (6.09±0.73) scores, (4.16±0.60) scores] on the 1st, 3rd, and 5th postoperative days ( P<0.05). The neck flexion, lateral flexion, and extension range of motion in the axillary group on the 3rd day after surgery were (33.16±3.09) °, (27.63±2.57) °, and (30.44 2.73) °, respectively, which were greater than those in the areola group[ (30.08±2.76) °, (25.14±2.30) °, and (27.98±2.54) °], and the swallowing disorder index was (30.16±4.97) points lower than the (34.83±4.13) points in the areola group ( P<0.05). The incidence of complications in the axillary group was 4.17% (2/48), lower than the 16.67% (8/48) in the areola group. Conclusion:GAET treatment for PTC patients can improve the effect of lymph node dissection, reduce the degree of surgical trauma, postoperative pain and discomfort, accelerate early postoperative recovery of neck function, and reduce complications.

Discomfort in the chest wall approach area in patients undergoing endoscopic thyroidectomy by a gasless unilateral axillary approach (GUA) / 中华内分泌外科杂志

Objective:To investigate the discomfort of chest wall approach area in patients undergoing endoscopic thyroidectomy by a gasless unilateral axillary approach (GUA), and to analyze its influencing factors. To provide a basis for the development of targeted improvement measures.Methods:A total of 153 patients with GUA from May. 2023 to Aug. 2023 in the Department of Thyroid Surgery, the First Affiliated Hospital of Zhengzhou University were selected as the study subjects. The general information questionnaire was collected one day before operation, the pain scales were assessed one day and three days after operation, and the pain and numbness scales were assessed one month after operation. The t test or χ2 test was used for comparison of baseline data between groups according to different types of variables. The patients were divided into two groups: less than moderate pain group (two postoperative average VAS scores<4) and more than moderate pain group (two postoperative average VAS scores ≥4). Mild numbness group (postoperative VAS score<4) ; Moderate and severe numbness group (postoperative VAS score ≥4). Multivariate binary Logistic regression was performed with pain discomfort and numbness discomfort as dependent variables to find possible influencing factors. Results:A total of 153 valid questionnaires were collected. There were 125 patients in the moderate pain group; There were 28 patients in the moderate and above pain group. There were 94 patients in the mild numbness group. There were 59 patients in the moderate to severe numbness group. Multivariate binary Logistic regression results showed that, exercise habits ( OR=0.07 95% CI=0.006, 0.409), operation duration ( OR=1.026 95% CI=1.001, 1.054), total drainage volume ( OR=1.122 95% CI=1.07, P<0.05), 1.198), and drainage tube indwelling time ( OR=0.012 95% CI=0.0, 0.187) had an impact on the discomfort of the chest wall approach area, and the difference was statistically significant ( P<0.05). Gender, BMI, marital status, education, occupation, handed-side surgery, handed-side axillary surgery, smokess and alcohol history, intraoperative blood loss, and length of hospital stay had no effect on the discomfort of chest wall approach area, and the difference was not statistically significant ( P>0.05) . Conclusion:Exercise habits, operation duration, total drainage volume, and drainage duration are independent predictors of discomfort in GUA patients.

Comparative study of percutaneous endoscopic treatment of L5/S1 disc herniation by two approaches / 实用医学杂志

Objective To compare the efficacy of percutaneous transforaminal approach and translaminar approach in the treatment of L5/S1 disc herniation(LDH)under endoscopic discectomy.Methods Adopted a retro-spective case-control study,and selected 62 cases of patients with L5/S1 LDH who were treated with percutaneous endoscopic surgery in the spine surgery department of our hospital from June 2020 to December 2022,and the transforaminal approach was used.(TELD)in 32 cases(TELD group),and interlaminar approach(IELD)in 30 cases(IELD group).The observation indicators included intraoperative fluoroscopy times,operation time,hospitaliza-tion days,hospitalization expenses,leg pain VAS score,ODI score,modified MacNab curative effect evaluation and complications.Results All 62 patients successfully completed the operation and follow-up,and no serious complications occurred.There were statistically significant differences in operation time,fluoroscopy times,and hospitalization expenses between the two groups(P<0.001),but there was no significant difference in hospitaliza-tion days between the two groups(P>0.05).The lower extremity VAS scores at the last follow-up and the last follow-up were significantly improved compared with those before operation(P<0.001),and the ODI scores of the two groups were significantly improved at 2 days,1 month and at the last follow-up(P<0.001).At the same time point,there was no statistical difference(P>0.05);there was no significant difference in the excellent and good rate of surgery between the two groups(P>0.05).11 patients with high iliac crest in the TELD group successfully completed the surgery.Conclusions Both the endoscopic surgery through the intervertebral foramen and the inter-laminar approach can achieve satisfactory results in the treatment of L5/S1 LDH.However,local anesthesia through the intervertebral foramen approach reduces hospitalization costs,and patients with high iliac crest can successfully complete the surgery by selecting a suitable puncture path.The translaminar approach has fewer fluoroscopy times and shorter surgical time,but there is a higher risk of dura mater and nerve damage,which requires careful opera-tion for beginners.

Clinical study of lateral cervical approach surgery in the treatment of primary hyperparathyroidism / 西安交通大学学报(医学版)

Objective To explore the feasibility and clinical outcome of lateral cervical incision via sternocleidomastoid intermuscular approach(SMIA)in the treatment of primary hyperparathyroidism.Methods The clinical data of 64 patients with primary hyperparathyroidism who underwent unilateral parathyroid surgery in the First Affiliated Hospital,School of Medicine of Zhejiang University from January 2019 to June 2022 were retrospectively analyzed.They were divided into lateral cervical incision via sternocleidomastoid intermuscular approach group(SMIA group)and linea alba cervicalis approach group(LACA group)based on the surgical incision and access route.The differences in clinical features,surgery-related outcomes and postoperative functions of the anterior cervical region were compared between the two groups.The EQ-5D-5L scale was used to assess the subjective feeling of postoperative neck discomfort,while the Hollander Wound Assessment Scale was used to assess the clinical outcome of incision healing.Results There were no statistical differences between the two groups of patients in terms of age,gender,intraoperative bleeding,parathyroid hormone or blood calcium levels before and after surgery(P＞0.05).The duration of surgery was significantly shorter in the SMIA group than in the LACA group[(39.77±5.69)min vs.(54.41±4.66)min].There was a statistical difference between the two groups in functional protection of the anterior cervical region at 1 month and 12 months after surgery(1 month,84.67±3.74 vs.79.47±5.38,P＜0.001;12 months,93.80±2.52 vs.89.94±2.39,P＜0.001),and the SMIA group was better than the LACA group.The Hollander Incision Assessment Scale scores of the SMIA group were better than those of the LACA group at 6 months and 12 months after surgery,and the difference was statistically significant(6 months,1.93±0.58 vs.2.41±0.66,P=0.003;12 months,1.03±0.67 vs.1.74±0.62,P＜0.001).Conclusion Parathyroidectomy via sternocleidomastoid intermuscular approach through lateral cervical incision is a simple,safe and effective surgical procedure,which makes it easier to search for parathyroid lesions and shortens the surgical time compared with the traditional incision,and has obvious advantages in the protection of anterior cervical region function.