Anatomic barriers to paraspinal blocks: a cadaver case series

Abstract The paraspinal space is intriguing in nature. There are several needle tip placements described in compact anatomical spaces. This has led to an incertitude regarding the appropriate anatomic locations for needle tip positions. Through our cadaver models we try to resolve the issues surrounding needle tip positions clarifying anatomical spaces and barriers. Further we propose an anatomical classification based on our findings in cadaveric open dissections and cross and sagittal sections.

Sham acupuncture and placebo acupuncture in clinical trials / 中国针灸

The commonly used terms "sham acupuncture" and "placebo acupuncture" in clinical acupuncture research is compared and analyzed in this article. In terms of their respective characteristics, sham acupuncture has a wider scope, including various types of acupoints, needle insertion at non-acupoint or non-insertion at acupoints, while placebo acupuncture mainly focuses on non-insertion at acupoints. Sham acupuncture mainly emphasizes the appearance similarity to real acupuncture, while placebo acupuncture emphasizes both similarity in appearance and the absence of therapeutic effects. Properly distinguishing and applying sham acupuncture and placebo acupuncture can help standardize their usage in terminology. Considering the difficulty in setting up qualified placebo acupuncture, it is suggested that researchers use the term "sham acupuncture" to describe the acupuncture control methods used in clinical research.

Distinguishment of XU Qiu-fu's thirteen ghost points / 中国针灸

In addition to the well-known thirteen ghost points in Qianjin Fang (Important Formulas worth a Thousand Gold Pieces), "XU Qiu-fu's thirteen ghost points" is recorded in other medical books. The contents of "XU Qiu-fu's thirteen ghost points" are not exactly same among these medical books, which mainly focus on the nomination and selection of the ghost points. Even though, there are many similarity when compared with the thirteen ghost points in Qianjin Fang in terms of acupoint selection, acupoint location and the sequence of needle insertion, as well as the therapeutic methods. The authors believe that "XU Qiu-fu's thirteen ghost points" is actually adapted based on the framework of the thirteen ghost points in Qianjin Fang.

Application of "Sancai principle" for needle-knife treatment of bi syndrome of neck region / 中国针灸

Under the guidance of the "Sancai principle", based on the understanding of the etiology and pathogenesis of the imbalance of muscles and bones in bi syndrome of neck region, holistic treatment should be used. The needle-knife release therapy is applied at corresponding acupoints in the three parts i.e. head, neck and back including Tiancai points (Naohu [GV 17] and Naokong [GB 19]), Rencai points (neck Jiaji [EX-B 2]), and Dicai points (Dazhui [GV 14], Quyuan [SI 13] and Tianzong [SI 11]). According to the layers of the lesion's meridians and muscles, the needle-knife is inserted into skin, muscle and bone to relax the tendons and treat bone disorders, and restore the normal mechanical balance of neck.

Application status and analysis of Fu's subcutaneous needling in the treatment of peripheral facial paralysis / 中国针灸

This paper summarizes the status of application and research of Fu's subcutaneous needling for peripheral facial paralysis, and the characteristics of different stages of peripheral facial paralysis treated with Fu's subcutaneous needling are analyzed from the aspects of intervention timing, protocol design, needle insertion point, sweeping and reperfusion activity, tube retaining time and acupuncture frequency. It is found that there are no norms and standards in sweeping and reperfusion, tube retention and acupuncture frequency in clinical application，and the exploration of staged treatment is insufficient in the research. In the future, it is necessary to form standardized operation to promote clinical promotion, and improve the research on treatment rules and mechanism according to the characteristics of disease stage.

Development and application of a new digital electric fire needle instrument / 中国针灸

In view of the limitations of the high operational difficulty, safety hazards and adverse reactions of traditional fire needle, and unclear treatment parameters of existing electric fire needles, a new digital electric fire needle instrument was designed and developed in this study. This instrument is a gun type structure, consisting of a gun body, a power supply interface on the gun body, a display unit and a drive unit, a heating unit, a cooling unit, a positioning unit, and a needle inserting unit in the gun body. This instrument can digitally realize the regulation of parameters such as fire needle inserting temperature, depth and speed, and it has the advantageous features of intelligent needle burning, precise positioning, and safe and easy operation. This instrument meets the needs of more patients, medical professionals and scientific researchers, and is conducive to promoting the development of fire needle acupuncture therapy.

The fenrou zhijian theory in The Inner Canon of Huangdi and the stratified treatment of painful bi syndrome of meridian tendons / 中国针灸

The fenrou zhijian is defined as potential gap between different layers in the three-dimensional network structure formed by the twelve meridian tendons. Various pathological changes of the meridian tendons lead to the adhesion and closure of fenrou zhijian, causing abnormal mechanical conduction of the meridian tendon system, which in turn leads to painful bi syndrome of meridian tendons. As such, restarting the fenrou zhijian is the key to acupuncture treatment for painful bi syndrome of meridian tendons. Under the guidance of musculoskeletal ultrasound, the level and the angle of needle insertion of acupuncture at fenrou zhijian could be accurately controlled, the efficacy of acupuncture is improved.

Effect of "Zhibian" (BL 54)-to-"Shuidao" (ST 28) needle insertion on the expression of Fas/FADD/Caspase-8 of death receptor pathway in rats with primary ovarian insufficiency / 中国针灸

OBJECTIVE@#To explore the effect of "Zhibian" (BL 54)-to-"Shuidao" (ST 28) needle insertion on the ovarian function in the rats with primary ovarian insufficiency (POI) and the potential effect mechanism based on the Fas/FADD/Caspase-8 of death receptor pathway.@*METHODS@#Forty-eight female SD rats were randomly divided into a blank group, a model group, a medication group and an acupuncture group, with 12 rats in each group. Except in the blank group, the rats in the other groups were intraperitoneally injected with cyclophosphamide to establish the POI model. In the acupuncture group, after successful modeling, the intervention was given with "Zhibian" (BL 54)-to- "Shuidao" (ST 28) needle insertion, once daily, 30 min in each intervention; and the duration of intervention was 4 weeks. In the medication group, estradiol valerate tablets were administered intragastrically, 0.09 mg•kg-1•d-1, for 4 weeks. The general situation and the estrous cycle of the rats were compared among groups. Using ELISA, the levels of follicle-stimulating hormone (FSH), luteinizing hormone (LH) and estradiol (E2) in the serum were detected. HE staining was adopted to observe the morphological changes of ovarian tissue of rats. The protein expression of Fas, FADD and Caspase-8 in ovarian tissue was detected with immunohistochemistry and Western blot.@*RESULTS@#After modeling, except the rats of the blank group, the rats of the other groups had dry fur, lost hair, low spirits, reduced food intake, increased urination and loose stool. After intervention, the stool became regular gradually in the acupuncture group and the medication group. The percentage of estrous cycle disturbance was increased in the rats of the model group when compared with the blank group (P<0.01); in comparison with the model group, the percentages of estrous cycle disturbance were reduced in the acupuncture group and the medication group after intervention (P<0.01). When compared with the blank group, the body mass and E2 content in the serum were lower (P<0.01), the levels of FSH and LH in the serum and the protein expression levels of Fas, FADD and Caspase-8 were increased (P<0.01) in the model group. Compared with the model group, the body mass and E2 contents in the serum were higher (P<0.01), the levels of FSH and LH in the serum and the protein expression levels of Fas, FADD and Caspase-8 were reduced (P<0.01) in the acupuncture group and the medication group.@*CONCLUSION@#"Zhibian" (BL 54)-to-"Shuidao" (ST 28) needle insertion can effectively improve the ovarian function of POI rats, and its effect mechanism may be related to regulating the serum sex hormone levels, reducing the expression of Fas, FADD and Caspase-8 in ovarian tissue and retarding apoptosis of ovarian cells.

Feasibility analysis of puncture robot technology for the application of acupuncture robot / 中国针灸

The difficulties such as how to accurately locate acupoints and safely insert needles are presented in acupuncture robot. The puncture robot with high technological similarity to acupuncture robot is getting mature, and a large number of human trials and animal experiments have been conducted for the development of puncture robot. Through comparing the similarities and differences between puncture robot and acupuncture robot in the aspects of through-skin puncture, needle insertion and needle removal, the valuable technology of puncture robot is analyzed for the development of acupuncture robot, and the crucial direction of technology migration is determined. ①Integrating the mechanical feedback and medical imaging technology and utilizing the multi-modal perception to achieve the safety of acupuncture operation. ②Emphasizing the integration of the existing designs of chest puncture robot to realize the acupuncture operation with inhalation and exhalation involved. ③Focusing on the development of relevant technology of automatic needle removal through conducting the actual scenario of treatment with acupuncture robot in patients under non-anaesthetic condition.

Application of microneedle-assisted percutaneous drug delivery system in treatment of rheumatoid arthritis:a review / 中国中药杂志

Rheumatoid arthritis(RA) is a chronic degenerative joint disease characterized by inflammation. Due to the complex causes, no specific therapy is available. Non-steroidal anti-inflammatory agents and corticosteroids are often used(long-term, oral/injection) to interfere with related pathways for reducing inflammatory response and delaying the progression of RA, which, however, induce many side effects. Microneedle, an emerging transdermal drug delivery system, is painless and less invasive and improves drug permeability. Thus, it is widely used in the treatment of RA and is expected to be a new strategy in clinical treatment. This paper summarized the application of microneedles in the treatment of RA, providing a reference for the development of new microneedles and the expansion of its clinical application.

Discussion on "sugar needle - comfortable acupuncture and moxibustion" / 中国针灸

The cases of feeling comfort during acupuncture and moxibustion treatment in literature were summarized and its biological basis was explored. A simple classification of comfort was made, and the importance of obtaining comfort in acupuncture treatment was pointed out. Considering the pursuit of less pain and harmlessness in modern clinical treatment, sugar needle should be advocated and popularized in current clinical practice of acupuncture and moxibustion.

"Houxi (SI 3) communicating the governor vessel" verified with the infrared thermal imaging technology / 中国针灸

OBJECTIVE@#To compare the effect on facial acupoint temperature between acupuncture at Houxi (SI 3) and Dazhui (GV 14) so as to verify "Houxi (SI 3) communicating the governor vessel" based on the infrared thermal imaging technology.@*METHODS@#Thirty-five healthy subjects (5 cases dropped off) were collected and before-after study in the same subject was adopted. The subjects were successively assigned into a sham-acupuncture group, a Houxi group, a Wangu group and a Dazhui group. Sham-acupuncture at Houxi (SI 3) on the left, acupuncture at Houxi (SI 3) on the left, Wangu (SI 4) on the left and Dazhui (GV 14) were given respectively. One intervention was given and the needles were retained for 30 min in each group. 30 min before and after acupuncture, the infrared thermal images of the face were collected, and the facial temperature was compared among the following 5 acupoints, i.e. Yintang (GV 24+), Suliao (GV 25), Shuigou (GV 26), Duiduan (GV 27) and Chengjiang (CV 24).@*RESULTS@#After acupuncture, the facial temperature at Yintang (GV 24+) and Chengjiang (CV 24) was increased compared before acupuncture in the sham-acupuncture group (P<0.01, P<0.05). The facial temperature at Suliao (GV 25) in the Houxi group was reduced after acupuncture (P<0.05). In the Wangu group, the temperature at Yintang (GV 24+) was increased compared before acupuncture (P<0.01). The facial temperature was increased at Duiduan (GV 27) and Chengjiang (CV 24) compared before acupuncture in the Dazhui group (P<0.01, P<0.05). The differences of facial temperature at Chengjiang (CV 24) and Suliao (GV 25) after acupuncture were larger than before acupuncture in the Houxi group and the Dazhui group (P<0.01). In comparison with the temperature at Suliao (GV 25) of the same group, the differences of facial temperature before and after acupuncture at Yintang (GV 24+), Shuigou (GV 26), Duiduan (GV 27) and Chengjiang (CV 24) were increased in the Houxi group (P<0.01, P<0.05); while, the increase was also obtained at Yintang (GV 24+), Shuigou (GV 26), Duiduan (GV 27) and Chengjiang (CV 24) in the Dazhui group (P<0.05, P<0.01). The difference of facial temperature at Yintang (GV 24+) before and after acupuncture was increased compared with Suliao (GV 25) in the Wangu group (P<0.05).@*CONCLUSION@#Acupuncture at Houxi (SI 3) generates a similar thermal effect as Dazhui (GV 14). It regulates and dissipates the core temperature to "govern the yang qi of the whole body".

Overview on the modern development of fire needling device: from tradition to innovation / 中国针灸

The appropriate needle device is crucial for obtaining the curative effect of fire needling therapy. The article introduces the material specification, clinical operation, indications, characteristics and advantages of the contemporary traditional fire needling devices (e.g. He's fire needle and Shi 's fire needle) and the contemporary new-type ones (e.g. fire needling with filiform needle and micro-needle); and determines the innovations of modern fire needling. It is anticipated that the needle specifications, production process and operation standard of fire needling devices should be further unified so as to provide the references for the selection of fire needling devices in treatment based on clinical syndrome differentiation and expand the clinical application of fire needling therapy.

Standardized Jin's three-needle therapy for stroke: a randomized controlled trial / 中国针灸

OBJECTIVE@#To observe the effect of standardized Jin's three-needle therapy on limb motor function and nerve function defect in stroke patients, and to evaluate the placebo control method.@*METHODS@#A total of 66 patients with stroke were randomly divided into a Jin's three-needle group (33 cases, 3 cases dropped off) and a placebo needle group (33 cases, 4 cases dropped off). All the patients were treated with conventional medication and rehabilitation treatment. In addition, the patients in the Jin's three-needle group were treated with standardized Jin's three-needle therapy at temporal three points, spirit four points, hand three points, foot three points, upper extremity spasm three points, lower extremity spasm three points, etc.; while the patients in the placebo needle group were treated with placebo needling at identical points. All the treatments were given once a day, 5 days a week, and 3-week treatment was given with an interval of 2 days between weeks. The scores of Fugl-Meyer assessment scale (FMA) and National Institutes of Health stroke scale (NIHSS) were observed before treatment, 10 d and 21 d into treatment, and the blind evaluation was conducted after treatment.@*RESULTS@#On the 10 d and 21 d into treatment, the FMA scores in both groups were higher than those before treatment (P<0.01), and the NIHSS scores were lower than those before treatment (P<0.01). On the 10 d and 21 d into treatment, the FMA scores in the Jin's three-needle group were higher than those in the placebo needle group (P<0.05); on the 10 d into treatment, the NIHSS score in the Jin's three-needle group was were lower than that in the placebo needle group (P<0.05). There was no significant difference between the two groups on judging the type of treatment (P>0.05), and the consistency with the real situation was poor (Cohen's kappa coefficient<0.20).@*CONCLUSION@#The standardized Jin's three-needle therapy could effectively improve the limb motor function and nerve function defect in stroke patients. The placebo control method used in this study shows good clinical operability and masking effect.

Mechanical effects of needle texture on acupoint tissue / 中西医结合学报

OBJECTIVE@#This study aims to clarify how the stimulation of acupuncture points is achieved by needles with different surface texture during acupuncture; it also seeks to lessen injury at the insertion site and increase the therapeutic efficacy of acupuncture, by simulating the mechanical effects of various needle surface patterns on Zusanli (ST36) without changing the radius of acupuncture needles.@*METHODS@#Five acupuncture needle models with different surface patterns, including the smooth needle, the lined needle, the ringed needle, the left-hand threaded needle and the right-hand threaded needle, and a layered model of the Zusanli acupoint were used to investigate how to reduce tissue damage and increase stimulation during acupuncture treatment. Puncturing of the skin as well as lifting-inserting and twisting needle manipulations were simulated using these models, and the degree of damage and force of stimulation caused by the acupuncture needles with different surface patterns during acupuncture were compared.@*RESULTS@#The smooth needle and the lined needle caused the least tissue damage during insertion, while the left-hand threaded and the right-hand threaded needles caused the most damage. The ringed needle, the left-hand threaded needle and the right-hand threaded needle stimulated the acupoint tissue more during lifting-inserting manipulations, while the lined needle and the smooth needle produced less stimulation. The stimulation of the lined needle on the acupoint tissue was the largest during twisting manipulation, whereas the left-hand threaded needle and the right-hand threaded needle had smaller effects. In lifting-inserting and twisting manipulations, both the left-hand threaded needle and right-hand threaded needle provided more stimulation, but the torsion direction in which they produced better stimulation was the opposite.@*CONCLUSION@#According to the simulation results, the ringed pattern enhances stimulation best in the lifting-inserting manipulation, whereas the lined pattern enhances stimulation best in the twisting manipulation. Both the right-hand and left-hand thread patterns have certain enhancing effects in these two operations. Taking the geometric properties of the pattern into account, the left-hand thread pattern and the right-hand thread pattern have the geometric characteristics of both the lined pattern and the ringed pattern. To conclude, a pattern perpendicular to the movement direction during the acupuncture manipulation creates more stimulation. These results have significance for future needle design. Please cite this article as: Sun MZ, Wang X, Li YC, Yao W, Gu W. Mechanical effects of needle texture on acupoint tissue. J Integr Med. 2023; 21(3): 254-267.

Concerns of Technical Evaluation on Registration of Disposable Endoscopic Injection Needle / 中国医疗器械杂志

From the point of the technical evaluation of the registration of medical devices, the technical evaluation focus of the disposable endoscopic injection needle registration are briefly described in the chapters of the application overview documents, risk management data, product technical requirements, research data, toxic substance residues, biocompatibility evaluation, clinical evaluation data, et al. The common terms of technical requirements are specified, risk management and research materials list the project requirements for product characteristics. So as to accurately judge the product quality, improve the review efficiency, promote the development of the industry.

Estrategias no farmacológicas como adyuvantes para manejo del dolor agudo por punción en pediatría / Non-pharmacological strategies as adjuvants in needle associated acute pain management in pediatrics

El dolor en pediatría es un problema de salud pública que afecta al 78 % de pacientes hospitalizados y está frecuentemente asociado a punciones, por lo que es necesario un control rápido y efectivo. Existen en la actualidad estrategias psicológicas y físicas de estimulación sensorial para abordarlo. Se pretende describir el uso de estas como coadyuvantes en el manejo del dolor agudo por punción en pediatría. Se realizó una revisión narrativa de artículos originales y revisiones bibliográficas. El mecanismo del dolor involucra a las fibras C y a las fibras Aδ, que responden al dolor por punción. Entre las estrategias innovadoras se encuentra el dispositivo Buzzy®, que actúa mediante la teoría de compuerta del dolor, desviando la atención del dolor hacia un estímulo sensorial placentero (frío y vibración) que disminuye la intensidad en comparación con anestésicos locales (p < 0,001); así mismo, la realidad virtual desvía la atención del niño hacia un estímulo placentero, visual o auditivo, creando un ambiente tridimensional y produciendo analgesia por distracción en comparación al control (p < 0,05). El uso de estrategias no farmacológicas como coadyuvantes para el manejo de dolor por punción son efectivas para disminuir el dolor en el paciente pediátrico, así como el estrés y la ansiedad, tanto en los padres como en el personal de salud

Pediatric pain is a public healthcare problem present in 78 % of hospitalized patients and it is frequently associated to needles. Fast and effective controls are needed, therefore, sensory stimulation and psychological strategies have been developed. The aim of this study was to describe the use of non-pharmacological strategies as adjuvants in needle associated children pain management. A review was made searching through original articles and other reviews. Pain mechanism involves C fibers and Aδ fibers, which respond to short term needle pain. Buzzy® device is among the innovative physical strategies to relieve pain, which acts according to the pain threshold theory, diverting attention from pain to a pleasurable sensory stimulus (cold and vibration) decreasing its intensity when compared to topical anesthesia (p < 0,001). Meanwhile psychological strategies such as virtual reality divert the child's attention to a pleasant visual and auditory stimulus. It creates a tridimensional environment with an electronic device, decreasing pain while distracting the child when compared to the control group (p < 0,05). The use of innovative non-pharmacological strategies as adjuvants for needle pain management is effective decreasing children pain and reducing stress and anxiety in parents and healthcare workers

Ruptura de aguja dental con migración al espacio pterigomaxilar. Resolución mediante abordaje intrabucal laterofaríngeo / Rupture of dental needle with migration to the pterygomaxillary space. Resolution by intraoral lateropharyngeal approach

Introducción: La ruptura de una aguja dental es una complicación infrecuente y sucede generalmente por el movimiento repentino y/o cierre bucal inesperado del paciente, por doblar la aguja en forma inadecuada, por insertarla completamente o moverla dentro del tejido blando, por elegir agujas de calibre y longitud inadecuados y al realizar técnicas anestésicas inapropiadas. Cuando la aguja no puede ser recuperada al instante, debe establecerse su ubicación imagenológica tridimensional y decidir el manejo. Ante tal situación, su eliminación quirúrgica es la propuesta más recomendable por la posibilidad de que migre y lesione estructuras anatómicas importantes. Objetivo: Realizar una revisión de la literatura y presentar un caso clínico de ruptura de aguja dental localizada en el espacio pterigomaxilar, resuelto con un abordaje intrabucal laterofaríngeo. Presentación de caso: Paciente masculino de 8 años de edad, que acude a consulta por presentar ruptura de una aguja dental. Para obtener su ubicación se utilizó una tomografía computarizada de haz cónico con reconstrucción tridimensional a boca cerrada y abierta. Esta prueba ofreció mayor precisión y correspondencia anatómica, considerando que la eliminación quirúrgica podría realizarse mediante un abordaje intrabucal. Así fue hecho y durante la intervención quirúrgica se advirtió que la aguja había migrado a una ubicación superior y posterior, al espacio pterigomaxilar. Ante tal situación, resultó de mayor complejidad su recuperación, que ya presentaba riesgos por el procedimiento complejo al que se sometió. Conclusiones: La anestesia local intrabucal no está exenta de complicaciones propias como la ruptura de la aguja dental. Cuando este evento se presenta, el resultado puede ser de muy difícil manejo(AU)

Introduction: The rupture of a dental needle is an uncommon complication and usually happens due to the sudden movement and / or unexpected oral closure of the patient, by bending the needle improperly, by inserting it completely or moving it into the soft tissue, by choosing needles of inadequate caliber and length and by performing inappropriate anesthetic techniques. When the needle cannot be recovered instantly, its three-dimensional imaging location must be established and handling decided. In such a situation, its surgical elimination is the most recommended proposal due to the possibility of migrating and injuring important anatomical structures. Objective: Conduct a literature review and present a clinical case of dental needle rupture located in the pterygomaxillary space, resolved with a lateropharyngeal intraoral approach. Case presentation: An 8-year-old male patient, who comes to the consultation for a ruptured dental needle. To obtain its location, a cone-beam computed tomography with three-dimensional reconstruction was used at closed and open mouth. This test offered greater precision and anatomical correspondence, considering that surgical removal could be performed by an intraoral approach. This was done and during the surgical intervention it was noticed that the needle had migrated to an upper and posterior location, to the pterygomaxillary space. Faced with this situation, his recovery was more complex, in addition to the one that this procedure represents by itself. Conclusions: Intraoral local anesthesia is not exempt from its own complications such as the rupture of the dental needle. When this event occurs, the result can be very difficult to manage(AU)

Resíduos de Serviços de Saúde: o que mudou na legislação? / Waste from Health Services: what has changed in the legislation?

Introdução: os Resíduos de Serviços de Saúde (RSS) têm sido uma fonte de preocupação para os gestores hospitalares, pois necessitam atender às exigências legais; nos últimos anos houve mudanças no Brasil com a publicação da atual Resolução de Diretoria Colegiada (RDC) 222/18, que normatiza o gerenciamento interno dos resíduos. Objetivo: comparar a RDC 306/04 com a RDC 222/18 quanto ao gerenciamento de Resíduos de Serviços de Saúde, bem como apresentar as implicações da legislação em vigência. Material e Método: trata-se de uma pesquisa exploratória e descritiva, de abordagem qualitativa do tipo documental; para tal, criou-se um roteiro de análises baseado nas etapas de gerenciamento dos RSS; os resultados foram apresentados em tabelas por grupos (A, B, C, D e E) que foram as categorias documentais para a comparação da legislação RDC 306/04 com a RDC 222/18. Resultados: observou-se importantes mudanças na lei atual, com impacto para os gestores e profissionais que atuam em hospitais, como o descarte de bolsas de sangue e peças anatômicas caracterizadas como A1, liberação de descarte de equipamentos de proteção individual (EPIs) como resíduos do Grupo D comum, seringas e agulhas podem ser desconectadas quando tiverem o dispositivo de segurança, novos critérios para descarte de oito grupos de medicamentos, entre outras. Discussão: as mudanças citadas necessitam ser incorporadas nos planos de gerenciamento, planejamento de novos fluxos de segregação de resíduos e aquisição de novos coletores que em médio prazo podem contribuir na redução de custo financeiro, e diminuição dos impactos ambientais desses resíduos quando descartados de forma segura. Conclusão: ao comparar as duas legislações, o presente estudo contribui para direcionar as adequações necessárias, a fim de atender a atual legislação, com informações diretas para orientar novos critérios de classificação, acondicionamento, tratamento e destinação final para o gerenciamento seguro dos resíduos nos serviços de saúde.

Introduction: Waste from Health Services (RSS) has been a source of concern for hospital managers, as they need to meet legal requirements; in recent years there have been changes in Brazil with the publication of the current Resolution of the Collegiate Board 222/18, which regulates the internal management of waste. Objective: to compare Resolution of the Collegiate Board 306/04 with Resolution of the Collegiate Board 222/18 regarding the management of RSS, as well as present the implications of the legislation in force. Material and Method: this is an exploratory and descriptive research, with a qualitative approach of the documentary type; for this, an analysis script was created based on the steps of managing the RSS; the results were presented in tables by groups (A, B, C, D and E) which were the document categories for the comparison of legislation Resolution of the Collegiate Board 306/04 with Resolution of the Collegiate Board 222/18. Results: important changes were observed in the current law, with an impact on managers and professionals working in hospitals, such as the disposal of blood bags and anatomical parts characterized as A1, release of disposal of Personal Protective Equipment as waste from Group D common, syringes and needles can be disconnected when they have the safety device, new criteria for disposing of eight groups of drugs, among others. Discussion: the aforementioned changes need to be incorporated into management plans, planning new waste segregation flows and acquisition of new collectors that in the medium term can contribute to reducing the financial cost, and reducing the environmental impacts of these wastes when disposed of safely. Conclusion: by comparing the two legislations, this study contributes to direct the necessary adjustments, in order to meet the current legislation, with direct information to guide new classification, packaging, treatment and final disposal criteria for the safe management of waste in the services of health.

New surgical maneuver to position the graft in a descemet stripping with automated endothelial keratoplasty surgery / Nova manobra cirúrgica para posicionar o enxerto em cirurgia de ceratoplastia endotelial com desnudamento automatizado da Descemet

ABSTRACT Objective: To describe a new surgical maneuver to position the graft in a Descemet Stripping with Automated Endothelial Keratoplasty (DSAEK) surgery. Methods: Case series. Results: This technique allows a correct repositioning of the graft in a minimally invasive way. Conclusion: This new surgical maneuver was successful in manipulating the graft in DSAEK surgery and therefore might be effective and safe.

RESUMO Objetivo: Descrever uma nova manobra cirúrgica para posicionar o enxerto em uma cirurgia de ceratoplastia endotelial automatizada com desnudamento da Descemet. Métodos: Série de casos. Resultados: A técnica permitiu o correto reposicionamento do enxerto de forma minimamente invasiva. Conclusão: Esta nova manobra cirúrgica foi bem-sucedida para manipular o enxerto na cirurgia ceratoplastia endotelial automatizada com desnudamento da Descemet e, portanto, pode ser eficaz e segura.