The "weekend effect" does not impact on outcome of trauma laparotomy - Experience from a level 1 trauma centre in New Zealand / 中华创伤杂志(英文版)

PURPOSE@#Trauma centres have been proven to provide better outcomes in developed countries for overall trauma, but there is limited literature on the systematic factors that describe any discrepancies in outcomes for trauma laparotomies in these centres. This study was conducted to examine and interrogate the effect of systematic factors on patients undergoing a trauma laparotomy in a developed country, intending to identify potential discrepancies in the outcome.@*METHODS@#This was a retrospective study of all laparotomies performed for trauma at a level 1 trauma centre in New Zealand. All adult patients who had undergone an index laparotomy for trauma between February 2012 and November 2020 were identified and laparotomies for both blunt and penetrating trauma were included. Repeat laparotomies and trauma laparotomies in children were excluded. The primary clinical outcomes reviewed included morbidity, length of hospital stay, and mortality. All statistical analysis was performed using R v.4.0.3.@*RESULTS@#During the 9-year study period, 204 trauma laparotomies were performed at Waikato hospital. The majority (83.3%) were performed during office hours (170/204), and the remaining 16.7% were performed after hours (34/204). And 61.3% were performed on a weekday (125/204), whilst 38.7% were performed on the weekend/public holiday (79/204). Most of the parameters in office hours and after hours groups had no statistically significant difference, except lactate (p = 0.026). Most of the variables in weekday and weekend groups had no statistically significant difference, except pH, lactate, length of stay, and gastrointestinal complications (p = 0.012, p < 0.001, p = 0.003, p = 0.020, respectively).@*CONCLUSION@#The current trauma system at Waikato hospital is capable of delivering care for trauma laparotomy patients with the same outcome regardless of working hours or after hours, weekday or weekend. This confirms the importance of a robust trauma system capable of responding to the sudden demands placed on it.

Palliative care for Chinese immigrants in New Zealand: experiences and perceptions / Cuidados paliativos para inmigrantes chinos en Nueva Zelanda: experiencias y percepciones / Cuidados paliativos para imigrantes chineses na Nova Zelândia: experiências e percepções

Abstract Over the past several decades, palliative care has seen tremendous development in Western countries, but there is still inadequate access to palliative care among non-dominant ethnocultural groups. The Chinese have been the largest immigrant group in New Zealand since the 19th century(1). They have unique beliefs and practices around illness, death, dying and filial piety(2). These differ greatly from those in Western cultures and have notable implications for hospice palliative care planning and provision. However, immigrant Chinese community remains a relatively marginalised and under-researched group in palliative care(3-5). This results in limited knowledge about its culture and people among health professionals, as well as the lack of experience in providing terminal care to Chinese immigrants. Through the introduction of New Zealand Palliative Care Strategy and the analysis of Chinese immigrants' difficulties and preferences for palliative care, this aims to increase understanding of how cultural values of Chinese affect their acceptance and decision-making with respect to palliative care so that for efficiently providing palliative care to this ethnic minority group in New Zealand.

Resumen En las últimas décadas, los cuidados paliativos han experimentado un enorme desarrollo en los países occidentales, pero el acceso a los mismos sigue siendo insuficiente entre los grupos etnoculturales no dominantes. Los chinos son el mayor grupo de inmigrantes en Nueva Zelanda desde el siglo XIX(1). Tienen creencias y prácticas únicas en torno a la enfermedad, la muerte, el morir y la piedad filial(2). Éstas difieren en gran medida de las de las culturas occidentales y tienen notables implicaciones para la planificación y prestación de cuidados paliativos en los hospicios. Sin embargo, la comunidad china inmigrante sigue siendo un grupo relativamente marginado y poco investigado en el ámbito de los cuidados paliativos(3-5). Esto se traduce en un conocimiento limitado sobre su cultura y su población entre los profesionales sanitarios, así como en la falta de experiencia en la prestación de cuidados terminales a los inmigrantes chinos. A través de la introducción de la Estrategia de Cuidados Paliativos de Nueva Zelanda y el análisis de las dificultades y preferencias de los inmigrantes chinos en materia de cuidados paliativos, este ensayo pretende aumentar la comprensión de cómo los valores culturales de los chinos afectan a su aceptación y la toma de decisiones con respecto a los cuidados paliativos para que para proporcionar de manera eficiente los cuidados paliativos a este grupo étnico minoritario en Nueva Zelanda.

Resumo Nas últimas décadas, os cuidados paliativos tem experimentado um enorme desenvolvimento nos países ocidentais mas ainda há acesso inadequado a cuidados paliativos entre grupos étnico-culturais não dominantes. Os chineses tem sido o maior grupo de imigrantes na Nova Zelândia desde o século XIX(1). Eles tem crenças e práticas singulares em torno de doença, morte, morrer e devoção filial(2). Isso difere grandemente das culturas ocidentais e tem implicações notáveis no planejamento e fornecimento de cuidados paliativos em lares de idosos. Entretanto, a comunidade de imigrantes chineses permanece sendo um grupo relativamente marginalizado e sub-investigado no que diz respeito a cuidados paliativos(3-5). Isso resulta em conhecimento limitado sobre sua cultura e povo entre profissionais da saúde, bem como na falta de experiência em fornecer cuidados terminais a imigrantes chineses. Através da introdução da Estratégia de Cuidados Paliativos da Nova Zelândia e a análise das dificuldades e preferências de imigrantes chineses para cuidados paliativos, esse estudo tente aumentar a compreensão de como valores culturais de chineses afetam sua aceitação e tomada de decisão a respeito de cuidados paliativos, de maneira a eficientemente fornecer cuidados paliativos a esse grupo étnico minoritário na Nova Zelândia.

Performance Appraisal of Select Nations in Mitigation of COVID-19 Pandemic using Entropy based TOPSIS Method / Avaliação de desempenho de nações selecionadas na mitigação de pandemia de COVID-19 usando método TOPSIS baseado em entropia

Abstract The present study was an effort to assess the mitigation interventions carried out, so far, by the nations to fight the pandemic COVID-19. The novelty of the study was that it had considered the issue of pandemic mitigation strategy as a decision making problem. The performances of the twenty nations were to be ranked. The problem considered in the study was essentially a Multi-Criteria Decision Analysis (MCDA) problem. The available alternatives were the 20 countries and the 8 traits were the criteria. The Technique of Order Preference Similarity to the Ideal Solution (TOPSIS) was used in the present study. The study used Entropy method for assignment of weights to all the criteria. The performance score obtained in respect of the countries considered in the study and the corresponding ranks indicated the relative performances of the countries in their efforts to mitigate the COVID-19 pandemic. The results show that New Zealand is the best performing country and India is the worst one. Brazil ranked 17th, while the rank of UK was 15. The performance of the USA stood at 18th position.

Resumo O presente estudo foi um esforço para avaliar as intervenções de mitigação realizadas, até o momento, pelas nações para combater a pandemia COVID-19. A novidade do estudo é que considerou a questão da estratégia de mitigação da pandemia como um problema de tomada de decisão. As performances das vinte nações deveriam ser classificadas. O problema considerado no estudo era essencialmente um problema de Análise de Decisão Multi-Critério (MCDA). As alternativas disponíveis eram os 20 países e as 8 características eram os critérios. A Técnica de Similaridade de Preferência de Pedido com a Solução Ideal (TOPSIS) foi utilizada no presente estudo. O estudo utilizou o método da Entropia para atribuição de pesos a todos os critérios. A pontuação de desempenho obtida em relação aos países considerados no estudo e as classificações correspondentes indicaram os desempenhos relativos dos países em seus esforços para mitigar a pandemia COVID-19. Os resultados mostram que a Nova Zelândia é o país com melhor desempenho e a Índia o pior. O Brasil ficou em 17º, enquanto o Reino Unido ficou em 15. O desempenho dos EUA ficou na 18ª posição.

Medidas de contenção de tipo lockdown para prevenção e controle da COVID-19: estudo ecológico descritivo, com dados da África do Sul, Alemanha, Brasil, Espanha, Estados Unidos, Itália e Nova Zelândia, fevereiro a agosto de 2020 / Medidas de contención tipo lockdown para prevención y control del COVID-19: estudio ecológico descriptivo con datos de febrero a agosto de 2020 en Sudáfrica, Alemania, Brasil, España, Estados Unidos, Italia y Nueva Zelanda / Lockdown-type containment measures for COVID-19 prevention and control: a descriptive ecological study with data from South Africa, Germany, Brazil, Spain, United States, Italy and New Zealand, February - August 2020

Objetivo: Descrever as medidas de contenção de tipo lockdown e a incidência da COVID-19 em sete países: África do Sul, Alemanha, Brasil, Espanha, Estados Unidos, Itália e Nova Zelândia. Métodos: Estudo ecológico descritivo, com dados da incidência diária dos casos confirmados de COVID-19 entre 22 de fevereiro e 31 de agosto de 2020, e informações sobre medidas de lockdown implementadas pelo governo de cada país. Resultados: Os países que implementaram lockdown tiveram diminuição da incidência diária de COVID-19 (casos por milhão de habitantes) no período de três semanas, a contar do início da medida: África do Sul (3,7 a 1,7), Alemanha (37,5 a 33,7), Espanha (176,3 a 82,0), Itália (92,0 a 52,1) e Nova Zelândia (7,5 a 1,7). O Brasil e os Estados Unidos, que não implementaram lockdown, não apresentaram uma diminuição considerável. Conclusão: Após a implementação de lockdown, houve uma diminuição considerável do número de casos confirmados.

Objetivo: Describir las medidas de contención tipo lockdown y la incidencia de COVID-19 en los países de Sudáfrica, Alemania, Brasil, España, Estados Unidos, Italia y Nueva Zelanda. Métodos: Estudio ecológico descriptivo con datos de la incidencia diaria de los casos confirmados de COVID-19, del 22 de febrero al 31 de agosto de 2020 e informaciones sobre medidas de contención lockdown implementadas por los gobiernos de cada uno de los países. Resultados: Los países que implementaron lockdown, desde el inicio de su implementación hasta tres semanas después, tuvieron una disminución en la incidencia diaria (casos por millón de habitantes): Sudáfrica (3,7 a 1,7), Alemania (37,5 a 33,7), España (176,3 a 82,0), Italia (92,0 a 52,1) y Nueva Zelanda (7,5 a 1,7). Brasil y Estados Unidos, que no implementaron lockdown, no tuvieron una disminución considerable Conclusión: Luego de la implementación del lockdown, hubo una disminución considerable en el número de casos confirmados.

Objective: To describe lockdown-type containment measures and COVID-19 incidence in South Africa, Germany, Brazil, Spain, United States, Italy and New Zealand. Methods: This is a descriptive ecological study with data on daily incidence of confirmed COVID-19 cases from February 22 to August 31 2020, as well as information on lockdown measures implemented by the governments of each country. Results: Daily COVID-19 incidence (cases per 1 million inhabitants) decreased within three weeks after lockdown started in the countries that implemented it: South Africa (3.7 to 1.7), Germany (37.5 to 33.7) Spain (176.3 to 82.0), Italy (92.0 to 52.1) and New Zealand (7.5 to 1.7). As for Brazil and the United States, which did not implement lockdown, there was no considerable decrease. Conclusion: After lockdown implementation, there was a considerable decrease in the number of confirmed cases.

Trends in case-fatality rates of COVID-19 in the World, between 2019 - 2020 / Tendência das taxas de letalidade de covid-19 no mundo, entre 2019-2020

INTRODUCTION: CoV infections can potentially cause from a simple cold to a severe respiratory syndrome, such as the Severe Acute Respiratory Syndrome and the Middle East Respiratory Syndrome (MERS-CoV). The COVID-19 created a new reality for global healthcare modelsOBJETIVE: To evaluate trends in case-fatality rates of COVID-19 in the WorldMETHODS: We conducted a population-based time-series study using public and official data of cases and deaths from COVID-19 in Argentina, Australia, Brazil, Chile, China, Colombia, France, Germany, India, Iran, Italy, Japan, Mexico, Morocco, New Zealand, Nigeria, Peru, Saudi Arabia, South Africa, South Korea, Spain, Switzerland, United Kingdom, United States and Russian, between December, 2019 and August, 2020. Data were based on reports from European Centre for Disease Prevention and Control. COVID-19 was defined by the International Classification of Diseases, 10th revision (U07.1). A Prais-Winsten regression model was performed and the Daily Percentage Change (DPC) calculated determine rates as increasing, decreasing or flatRESULTS: During the study period, trends in case-fatality rates in the world were flat (DPC = 0.3; CI 95% [-0.2: 0.7]; p = 0.225). In Africa, Morocco had decreasing trends (DPC = -1.1; CI 95% [-1.5: -0.7]; p < 0.001), whereas it were increasing in South Africa (p < 0.05) and flat in Nigeria (p > 0.05). In the Americas, Argentina showed a decreasing trend in case-fatality rates (DPC = -0.6; CI 95% [-1.1: -0.2]; p = 0.005), the U.S. had flat trends (p > 0.05) and all other American countries had increasing trends (p < 0.05). In Asia, Iran had decreasing trends (DPC = -1.5; CI 95% [-2.6 : -0.2]; p = 0.019); China and Saudi Arabia showed increasing trends (p < 0.05), while in India, Japan and South Korea they were flat (p > 0.05). European countries had mostly increasing trends (p < 0.05): Germany, Italy, Spain, the UK and Russia; France and Switzerland had flat trends (p > 0.05). Finally, in Oceania, trends in case-fatality rates were flat in Australia (p > 0.05) and increasing in New Zealand (p < 0.05CONCLUSION: Trends in case-fatality rates of COVID-19 in the World were flat between December, 31 and August, 31. Argentina, Iran and Morocco were the only countries with decreasing trends. On the other hand, South Africa, Brazil, Canada, Chile, Colombia, Mexico, Peru, China, Saudi Arabia, Germany, Spain, United Kingdom, Russian and New Zealand had increasing trends in case-fatality rate. All the other countries analyzed had flat trends. Based on case-fatality rate data, our study supports that COVID-19 pandemic is still in progress worldwide

INTRODUÇÃO: As infecções por CoV podem causar desde um simples resfriado até uma síndrome respiratória grave, como a Síndrome Respiratória Aguda Grave e a Síndrome Respiratória do Oriente Médio (MERS-CoV). O COVID-19 impôs uma nova realidade em termos de modelos globais de saúdeOBJETIVO: Avaliar as tendências das taxas de letalidade do COVID-19 no mundoMÉTODO: Estudo de séries temporais de base populacional usando dados públicos e oficiais de casos e mortes por COVID-19 na Argentina, Austrália, Brasil, Chile, China, Colômbia, França, Alemanha, Índia, Irã, Itália, Japão, México, Marrocos, Nova Zelândia, Nigéria, Peru, Arábia Saudita, África do Sul, Coreia do Sul, Espanha, Suíça, Reino Unido, Estados Unidos (EUA) e Rússia, entre 31 dezembro de 2019 e 31 agosto de 2020. Os dados foram baseados nos relatórios do Centro Europeu de Prevenção e Controle de Doenças. COVID-19 foi definido pela Classificação Internacional de Doenças, 10ª revisão (U07.1). Para análise estatística, foi realizado o modelo de regressão de Prais-Winsten, a partir do qual foi possível calcular a variação percentual de mudança diária (DPC) das taxas, classificadas como crescentes, decrescentes ou estacionáriasRESULTADOS: Durante o período do estudo, as taxas de letalidade no mundo permaneceram estacionárias (DPC = 0,3; IC 95% [-0,2: 0,7]; p = 0,225). Na África, Marrocos teve tendência decrescente (DPC = -1,1; IC 95% [-1,5: -0,7]; p <0,001), enquanto na África do Sul houve tendência crescente (p < 0,05) e estacionária na Nigéria (p > 0,05). Em relação às Américas, a Argentina revelou tendência decrescente nas taxas de letalidade (DPC = -0,6; IC 95% [-1,1: -0,2]; p = 0,005), os EUA demonstraram tendência estacionária (p > 0,05) e todos os outros países americanos demonstraram tendências crescentes (p < 0,05). Na Ásia, o Irã apresentou tendência decrescente (DPC = -1,5; IC 95% [-2,6: -0,2]; p = 0,019); China e Arábia Saudita apresentaram tendências crescentes (p <0,05), enquanto Índia, Japão e Coreia do Sul mantiveram tendência estacionária (p > 0,05). A maioria dos países europeus apresentaram tendências crescentes (p <0,05): Alemanha, Itália, Espanha, Reino Unido e Rússia; França e Suíça demonstraram tendências estacionárias (p > 0,05). Por fim, na Oceania, a tendência nas taxas de letalidade na Austrália foi estacionária (p > 0,05) e aumentou na Nova Zelândia (p < 0,05CONCLUSÃO: A tendência nas taxas de letalidade por COVID-19 no mundo permaneceu estacionária entre 31 de dezembro de 2019 e 31 de agosto de 2020. Argentina, Irã e Marrocos foram os únicos países com tendências decrescentes. Por outro lado, África do Sul, Brasil, Canadá, Chile, Colômbia, México, Peru, China, Arábia Saudita, Alemanha, Espanha, Reino Unido, Rússia e Nova Zelândia apresentaram tendências crescentes de letalidade. Todos os outros países analisados demonstraram tendências estacionárias. De acordo com dados de letalidade, nosso estudo confirma que a pandemia de COVID-19 ainda está em fase de progressão em todo o mundo

La pandemia de COVID-19, estudio de casos: Australia, Nueva Zelandia y Cuba / COVID-19 pandemic; case studies: Australia, New Zealand and Cuba

Introducción: La COVID-19, enfermedad respiratoria viral, producida por el SARS- CoV- 2, los primeros casos aparecieron en Wuhan, China, en diciembre 2019, evolucionó a pandemia. La OMS declaró emergencia mundial el 30 de enero del 2020. Se presentan los datos generales de la epidemia en Cuba, Australia y Nueva Zelandia. Objetivo: Describir la evolución de la epidemia en dichos países, las medidas tomadas y sus resultados. Material y Métodos: Investigación descriptiva, cuanti - cualitativa, utilizó la revisión documental, para cotejar información publicada sobre la epidemia en los países seleccionados, en revistas médicas, prensa periódica, sitios web oficiales. Se analizó información hasta el 13 de junio. Resultados: Australia tuvo 7 283 casos, 6 888 (94,48 por ciento) recuperados. Realizaron 1 782 651 test diagnósticos (69,91 por 10 000 habitantes) y positividad de 0.4 por ciento. Reportaron 102 fallecidos, mayores tasas entre 70 - 89 años, letalidad de 1,39 por ciento. Nueva Zelandia totalizó 1 515 casos, con 1 483 recuperados (97,8 por ciento), fallecieron 22. Realizaron 310 297 (36 por 10 000 habitantes) pruebas de PCR, con 0,7 por ciento de positivos. La letalidad fue de 1,9 por ciento. Cuba, acumulaba 2 238 casos, recuperados 1 923 (86 por ciento). Fallecieron 84 pacientes, con letalidad de 3,75 por ciento. Realizaron PCR (12,16 x 10 000 hab.), con 1,7 por ciento positivas. Conclusiones: El control resultó de la voluntad política de enfrentar y contener la epidemia con drásticas medidas de distanciamiento social, cierre de fronteras y aislamiento de territorios, aplicación de test diagnósticos, y la existencia de sistemas de salud públicos robustos y gratuitos(AU)

Introduction: COVID-19 is a viral respiratory disease produced by SARS-CoV-2. The first cases were diagnosed in Wuhan, China in December 2019; then the disease became a pandemic. The WHO declared it a global emergency on January 30, 2020. General data on the epidemic in Cuba, Australia and New Zealand are presented. Objective: To present the evolution of the epidemic in these countries as well as the measures taken and their results. Material and Methods: A descriptive, quantitative and qualitative research used documentary review to compare information about the epidemic in the selected countries. The information was obtained from medical journals, periodical press, and official websites and it was analyzed before June 13. Results: Australia had 7,283 cases of which 6,888 (94.48 percent) patients recovered. They performed 1,782,651 diagnostic tests (69.91 per 10,000 inhabitants) and the positivity was 0.4 percent. They reported 102 deaths with higher rates in people aged 70 - 89 years, and a case fatality of 1.39 percent. New Zealand reported 1,515 cases, with 1,483 recovered (97.8 percent) and 22 deaths. They performed 310,297 (36 per 10,000 population) PCR tests, with 0.7 percent positive cases. The case fatality was 1.9 percent. Cuba accumulated 2,238 cases and 1,923 (86 percent) recovered. A total of 84 patients died, with a lethality of 3.75 percent. PCR tests (12.16 x 10,000 inhabitants) were performed reporting 1.7 percent of positive cases. Conclusions: The control resulted from the political will to confront and contain the epidemic with drastic measures of social distancing, closure of borders and isolation of territories, application of diagnostic tests, and the existence of robust and free public health systems(AU)

Evaluation of Bone Repair in the Mandible of Rabbits Using Biphasic Calcium Phosphate Micro-Macroporous Hydroxyapatite Bioceramics and Beta-Tricalcium Phosphate

Objective: To perform a clinical and histological evaluation, characterizing and proving the feasibility of the use of beta tricalcium phosphate (HA/ßTCP) bioceramics as a bone defect repair material, comparing it with autogenous bone and blood clot in terms of osteoinductive, conductive, and genic capacities. Material and Methods: The experiment was based on 3 critical defects in the mandible of 11 New Zealand rabbits. The defects were filled with HA/ßTCP bioceramics and autogenous bone, respectively, collected and ground during the development of defects and blood clots. The animals were euthanized after the 90-day experiment and samples were collected for histomorphological examination. To evaluate differences between the groups, a one-way analysis of variance (ANOVA) was performed with Tukey's post hoc test. An α value lower than 0.05 was considered statistically significant. Results: Microscopy revealed the presence of osteoblasts, osteoclasts, and osteocytes associated or not associated with the presence of mature or immature bone. All the studied materials presented bone neoformation in all cases, with the presence of mature and immature bone. Regarding the presence of HA/ßTCP bioceramic residual material, the same was found in 7 of 11 slides. Conclusion: HA/ßTCP bioceramics were shown to be a biocompatible bone substitute, with osteoinductive and osteoconductive characteristics, accelerating the process of new bone formation when compared with autogenous and blood clotted bone, thereby showing promise for bone defect repair with safety and efficacy.

Current status of application of acupuncture in low back pain guidelines / 中国针灸

OBJECTIVE@#To systematically review the current status of application of acupuncture in low back pain guidelines.@*METHODS@#The computer retrieval was conducted in PubMed, Cochrane Library, EMbase, China Journal Full Text Database (CNKI), China Biomedical Literature Database (CBM), VIP, Wanfang, guidelines databases, and the official websites of WHO and academic organizations (American Pain Society, American College of Physicians, etc.). After screening, the basic information and acupuncture-related issues in the guidelines that met the inclusion criteria were extracted and compared by using Excel software.@*RESULTS@#A total of 35 low back pain guidelines were included. ① One guideline was published before 2000, 16 guidelines were published from 2000 to 2010, and 18 guidelines were published from 2011 to 2017; 17 guidelines were published by the United States, 4 by Canada and China, 2 by New Zealand, the United Kingdom, and Europe, and 1 by Netherlands, Philippines, Denmark and Italy. ② Twenty-three guidelines were evidence-based guidelines, which was developed mainly by system review, meta-analysis and expert consultation, involving diagnosis, treatment, primary care of low back pain. ③ Acupuncture was mentioned in 23 guidelines, of them, 7 guidelines recommended acupuncture, 6 guidelines indicated that acupuncture might be considered under certain conditions such as combined with other therapies or patients were interested in acupuncture, however, 10 guidelines did not recommended acupuncture for low back pain.@*CONCLUSION@#The guidelines of low back pain are mainly developed by Europe countries and the United States, and the majority is published in the last 20 years. Among them, 20% of the guidelines have recommend acupuncture for low back pain.

Primary Ocular Toxoplasmosis Presenting to Uveitis Services in a Non-endemic Setting

PURPOSE: This study sought to describe the different clinical features and presentations of primary ocular toxoplasmosis in a setting not demonstrating an outbreak of disease.METHODS: This was a retrospective review of patients presenting to uveitis management services in Auckland and Hamilton, New Zealand between 2003 to 2018 with uveitis and positive toxoplasmosis immunoglobulin M serology.RESULTS: We identified 16 patients with primary acquired toxoplasmosis infection and ocular involvement. The mean age was 53 years. Systemic symptoms were reported in 56% (9 / 16). Visual acuity was reduced to 20 / 30 or less in 50% of patients (8 / 16). A single focus of retinitis without a pigmented scar was the salient clinical feature in 69% (11 / 16). Optic nerve inflammation was the sole clinical finding in 19% (3 / 16). Bilateral arterial vasculitis was the sole clinical finding in 13% (2 / 16). A delay in the diagnosis of toxoplasmosis of more than two weeks occurred in 38% (6 / 16) due to an initial alternative diagnosis. Antibiotic therapy was prescribed in all cases. Vision was maintained or improved in 69% (11 / 16) at the most recent follow-up visit (15 months to 10 years). Relapse occurred in 69% (11 / 16), typically within four years from the initial presentation.CONCLUSIONS: Primary ocular toxoplasmosis presenting in adulthood is a relatively uncommon cause of posterior uveitis in New Zealand. This condition should be considered in any patient presenting with retinitis or optic nerve inflammation without a retinochoroidal scar. This disease tends to relapse; thus, close follow-up is required.

Pyogenic Vertebral Column Osteomyelitis in Adults: Analysis of Risk Factors for 30-Day and 1-Year Mortality in a Single Center Cohort Study

STUDY DESIGN: Retrospective cohort study. PURPOSE: To describe our experience in the management and outcomes of vertebral column osteomyelitis (VCO), particularly focusing on the risk factors of early and late mortality. OVERVIEW OF LITERATURE: Previous reports suggest a global increase in spinal column infections highlighting significant morbidity and mortality. To date, there have been no reports from our local population, and no previous report has assessed the potential relationship of frailty with mortality in a cohort of patients with VCO. METHODS: We reviewed 76 consecutive patients with VCO between 2009 and 2016 in Waikato Hospital, New Zealand. Demographic, clinical, microbiological, and treatment data were collected. Comorbidities were noted to calculate the modified Frailty Index (mFI). Mortality at 30 days and 1 year was recorded. Univariate and multivariate analyses were used to identify the predictors of mortality. RESULTS: The mean age of patients was 64.1 years, with 77.6% being male. Most patients presented with axial back pain (71.1%), with the lumbar spine most commonly affected (46%). A mean of 2.1 vertebral bodies was involved. Methicillin-sensitive Staphylococcus aureus was the most common organism of infection (35.5%), and 15.8% of patients exhibited polymicrobial infection. Twenty patients (26.3%) underwent surgical intervention, which was more likely in patients with concomitant spinal epidural abscess (odds ratio [OR], 4.88) or spondylodiscitis (OR, 3.81). Mortality rate was 5.2% at 30 days and 22.3% at 1 year. The presence of frailty (OR, 13.62) and chronic renal failure (OR, 13.40) elevated the 30-day mortality risk only in univariate analysis. An increase in age (OR, 1.07) and the number of vertebral levels (OR, 2.30) elevated the 1-year mortality risk in both univariate and multivariate analyses. CONCLUSIONS: Although the mFI correlated with 30-day mortality in univariate analysis, it was not a significant predictor in multivariate analysis. An increase in age and the number of levels involved elevated the 1-year mortality risk.

Study on the Marker Steroids of New Zealand Deer (Cervus elaphus var. scoticus) Velvet Antler by UPLC-MS/MS and HPLC-PDA Methods

Eleven steroid hormones (SHs: androstene-3,17-dione, estrone, β-estradiol, α-estradiol, testosterone, dehydroepiandrosterone, 17á-hydroxyprogesterone, medroxyprogesterone, megestrol acetate, progesterone, and androsterone) were detected from New Zealand deer (Cervus elaphus var. scoticus) velvet antler (NZA, 鹿茸). A method for the quantification of eleven SHs was established by using ultraperformance liquid chromatography (UPLC)-MS/MS. The linearities (R² > 0.991), limits of quantification (LOQ values, 0.3 ng/mL to 23.1 ng/mL), intraday and interday precisions (relative standard deviation: RSD 0.999), LOQ values (30 ng/mL to 350 ng/mL), intraday and interday precisions (RSD < 1.93%), and recovery rates (97.2% to 103.5%) for the three 7-O-CSs were determined. These quantitative methods are accurate, precise, and reproducible. As a result, it is suggested that the five steroid compounds of androstene-3,17-dione, androsterone, 7-ketocholesterol, 7α-hydroxycholesterol, and 7β-hydroxycholesterol could be marker steroids of NZA. These methods can be applied to quantify or standardize the marker steroids present in NZA.

Intra-articular Recombinant Human Growth Hormone Injection Compared with Hyaluronic Acid and Placebo for an Osteoarthritis Model of New Zealand Rabbits

PURPOSE: Up to now, there is no feasible solution for stopping or reversing the degenerative process of osteoarthritis (OA). Our study evaluated the effect of intra-articular injection of growth hormone (GH) in OA-induced rabbit knees compared to hyaluronic acid (HA) and placebo. MATERIALS AND METHODS: A total of 21 male, skeletally mature, New Zealand rabbits received an intra-articular type II collagenase injection for OA induction. Two weeks later, the rabbits were randomized into three groups based on the weekly intra-articular injection to be received: GH, HA, and saline. Injections were done for three consecutive weeks. Evaluation was done at 8 weeks after treatment, clinically using the lameness period, macroscopically using the Yoshimi score and microscopically using the Mankin score. RESULTS: The shortest period of lameness was found in the GH group (15.9±2.12 days), compared to the HA group (19.4±1.72 days) and placebo group (25.0±2.94 days). There was a statistically significant difference in macroscopic scoring between groups (p=0.001) in favor of the GH group. There was also significant difference in the microscopic score between groups (p=0.001) also in favor of the GH group. CONCLUSIONS: Intra-articular injection of GH showed better clinical, macroscopic and microscopic results as compared to HA and placebo.

The effects of saline soaking on the removal torque of titanium implants in rabbit tibia after 10 days / 대한치과보철학회지

PURPOSE: The aim of this study was to confirm if Laser-treated implants were soaked in 0.9% NaCl solution for 2 weeks could increase the surface hydrophilicity, and the Remoal Torque of each implant that inserted in rabbit tibia for initial healing period of 10 days. MATERIALS AND METHODS: Twenty machined titanium surface screws were produced with a diameter 3 mm, length 8 mm. Ten screws had their surface treated with a laser only (laser treated group), and the other 10 were soaked in saline for 2 weeks after surface treatment with a laser (laser treated + saline soaked group). Implants were inserted in rabbit tibia (ten adult New Zealand white rabbits), and the RTQ of each implant was measured after 10 days. The wettability among implants was compared by measuring the contact angle. Surface composition and surface topography were analyzed. RESULTS: After 10 days, the laser treat + soaking group implants had a significantly higher mean RTQ than the laser treated implants (P = .002, < .05). There were no significant morphological differences between groups, and no remarkable differences were found between the two groups in the SEM analysis. CONCLUSION: Saline soaking implants is expected to produce excellent RTQ and surface analysis results.

The use of tissue fiducial markers in improving the accuracy of post-prostatectomy radiotherapy

PURPOSE: The aim of this retrospective study was to investigate the use of a radiopaque tissue fiducial marker (TFM) in the treatment of prostate cancer patients who undergo post-prostatectomy radiotherapy (PPRT). TFM safety, its role and benefit in quantifying the set-up uncertainties in patients undergoing PPRT image-guided radiotherapy were assessed. MATERIALS AND METHODS: A total of 45 consecutive PPRT patients underwent transperineal implantation of TFM at the level of vesicourethral anastomosis in the retrovesical tissue prior to intensity-modulated radiotherapy. Prostate bed motion was calculated by measuring the position of the TFM relative to the pelvic bony anatomy on daily cone-beam computed tomography. The stability and visibility of the TFM were assessed in the initial 10 patients. RESULTS: No postoperative complications were recorded. A total of 3,500 images were analysed. The calculated prostate bed motion for bony landmark matching relative to TFM were 2.25 mm in the left-right, 5.89 mm in the superior-inferior, and 6.59 mm in the anterior-posterior directions. A significant 36% reduction in the mean volume of rectum receiving 70 Gy (rV₇₀) was achieved for a uniform planning target volume (PTV) margin of 7 mm compared with the Australian and New Zealand Faculty of Radiation Oncology Genito-Urinary Group recommended PTV margin of 10 mm. CONCLUSION: The use of TFM was safe and can potentially eliminate set-up errors associated with bony landmark matching, thereby allowing for tighter PTV margins and a consequent favourable reduction in dose delivered to the bladder and rectum, with potential improvements in toxicities.

Origen de epónimos comúnmente empleados en la Unidad de Cuidados Intensivos / Origin of commonly used eponyms in the Intensive Care Unit daily job

Los epónimos reflejan la historia de la medicina, las enfermedades y los médicos en su época. Su uso es controversial, presentando partidarios y detractores. No obstante, el empleo de epónimos persiste en el lenguaje médico contemporáneo en las Unidades de Cuidados Intensivos e incluyen a algunos de frecuente uso como: Foley, Seldinger, Down, Macintosh, Magill, Ringer, Yankauer, Doppler y French. El objetivo de la presente revisión es fomentar el conocimiento biográfico y la época histórica en la cual tomó lugar su quehacer médico o laboral, para así profundizar aspectos de la historia de la medicina.

Eponyms reflect the history of medicine, diseases, and doctors in their time. Their use is controversial, presenting supporters and detractors. However, the use of eponyms persist in the modern medical language in the Intensive Care Units and includes some frequently used ones such as Foley, Seldinger, Down, Macintosh, Magill, Ringer, Yankauer, Doppler, and French. The objective of this review is to promote biographical knowledge and the historical period in which its medical use took place, in order to deepen aspects of medicine history.

Tackling the Wicked Health Problem of Early Childhood Caries

Despite much evidence for a fall in permanent dentition caries experience among children, Early Childhood Caries (ECC) continues tobe a problem in both developed and developing countries. In fact, the prevalence of ECC has increased markedly in the last decade or so, and this is has occurred even in areas with community water fluoridation (although the severity of the disease inthose areas is less marked) [1]. A consequence of that deterioration has been an increase in numbers of preschool children having to undergo dental treatment under general anaesthetic. In New Zealand, those numbers increased by 65% between 2002 and 2014, and similar trends have been observed in England and Australia. The cost of providing that treatment in New Zealand has been estimated to be more than $17 million per year [2]

Combination of Mesenchymal Stem Cells, Cartilage Pellet and Bioscaffold Supported Cartilage Regeneration of a Full Thickness Articular Surface Defect in Rabbits

BACKGROUND: Mesenchymal stem cells (MSCs) and/or biological scaffolds have been used to regenerate articular cartilage with variable success. In the present study we evaluated cartilage regeneration using a combination of bone marrow (BM)-MSCs, Hyalofast™ and/or native cartilage tissue following full thickness surgical cartilage defect in rabbits. METHODS: Full-thickness surgical ablation of the medial-tibial cartilage was performed in New Zealand white (NZW) rabbits. Control rabbits (Group-I) received no treatment; Animals in other groups were treated as follows. Group-II: BMMSCs (1 × 10⁶ cells) + Hyalofast™; Group-III: BMMSCs (1 × 10⁶ cells) + cartilage pellet (CP); and Group-IV: BMMSCs (1 × 10⁶ cells) + Hyalofast™+ CP. Animals were sacrificed at 12 weeks and cartilage regeneration analyzed using histopathology, International Cartilage Repair Society (ICRS-II) score, magnetic resonance observation of cartilage repair tissue (MOCART) score and biomechanical studies. RESULTS: Gross images showed good tissue repair (Groups IV>III>Group II) and histology demonstrated intact superficial layer, normal chondrocyte arrangement, tidemark and cartilage matrix staining (Groups III and IV) compared to the untreated control (Group I) respectively. ICRS-II score was 52.5, 65.0, 66 and 75% (Groups I–IV) and the MOCART score was 50.0, 73.75 and 76.25 (Groups II–IV) respectively. Biomechanical properties of the regenerated cartilage tissue in Group IV closed resembled that of a normal cartilage. CONCLUSION: Hyalofast™ together with BM-MSCs and CP led to efficient cartilage regeneration following full thickness surgical ablation of tibial articular cartilage in vivo in rabbits. Presence of hyaluronic acid in the scaffold and native microenvironment cues probably facilitated differentiation and integration of BM-MSCs.

Diretrizes de saúde bucal nas políticas de atenção primária em cinco países selecionados: uma revisão integrativa / Oral health guidelines in the primary care policies of five selected countries an integrative review

Introdução: Historicamente, a saúde bucal é considerada um componente à parte dos sistemas de saúde. A Atenção Primária à Saúde (APS) oferece uma oportunidade de produzir saúde de forma integral. Para tanto, diretrizes são necessárias a fim de orientar a formulação de políticas capazes de modificar a organização desses sistemas. Objetivo: Produzir uma análise comparativa sobre as diretrizes relativas ao componente saúde bucal das políticas de APS em cinco países com sistemas de saúde universal. Métodos: Foi realizada uma revisão integrativa da literatura científica e cinzenta. Documentos científicos e técnicos referentes a Austrália, Canadá, Nova Zelândia, Reino Unido e Brasil; do ano 2000 a 2016; em inglês, português, espanhol e francês foram considerados. Critérios de exclusão foram definidos. A análise de conteúdo foi realizada nos documentos selecionados baseada em aspectos da saúde bucal na APS. As categorias integralidade da assistência; ações de promoção da saúde e prevenção de doenças; e equipe de saúde bucal foram definidas para analisar aspectos conceituais das diretrizes. Resultados: Quarenta e dois estudos foram selecionados para compor a revisão integrativa. Os resultados indicam que Reino Unido e Brasil encontram-se em estágio mais avançado na integração da saúde bucal na APS que os demais países. Quanto à integralidade da assistência, a dimensão horizontal foi mais destacada, sugerindo sincronia da saúde bucal com outras áreas na provisão da assistência. Ações intersetoriais de promoção da saúde e prevenção de doenças são complexas, no entanto, parecem ser efetivas para expandir a atenção à saúde bucal em outros setores. Fluoretação e ações conjuntas com o setor de educação são consagradas. Equipes multiprofissionais amplas com participação dos profissionais de saúde bucal são preconizadas. Enfoque interdisciplinar, inclusão de profissionais de nível médio e educação permanente foram temas recorrentes. Conclusão: Quarenta anos após a Declaração de Alma-Ata, nota-se esforços para a integração da saúde bucal nas políticas de APS, contudo, esta ainda representa um importante desafio para os sistemas de saúde

Background: Historically, oral health is apart of the health systems. The Primary Health Care (PHC) strategy offers an opportunity for a holistic approach in health. Guidelines are needed to orient the formulation of policies and change the health systems' organization. Objective: To produce a comparative analysis of oral health perspectives in the PHC policies of five selected countries with universal health care systems. Methods: An integrative review of the scientific and grey literature was led. Scientific and technical documents from Australia, Canada, New Zealand, United Kingdom and Brazil were considered. The time limit was defined from the year 2000 until 2016. The documents should be in English, Portuguese, Spanish or French. The findings were analysed and exclusion criteria were defined. Content data analysis was performed based on aspects of oral health in PHC. The categories comprehensiveness of care; health promotion and disease prevention actions; and oral health team were defined for the conceptual analysis of the guidelines. Results: Forty-two studies were selected to compose an integrative review. The results indicate that United Kingdom and Brazil are in a more advanced stage of the integration of oral health in PHC then the other countries. In the description of the comprehensiveness of care, the horizontal dimension was more prominent, suggesting that the provision of oral care should be together with other areas of health. Health promotion and disease prevention actions in intersectoral contexts are complex, but seem to be effective to insert oral health in other sectors of health and beyond. Fluoridation and actions with the education sector are the most established ones. Multiprofessional teams with the participation of oral health professionals are recommended. Interdisciplinary approach, inclusion of mid-level professionals and permanent education were recurrent themes. Conclusion: Forty years after the Declaration of Alma-Ata, it seems that there are advances in the integration of oral health in PHC. Although, it stills represents a major challenge for the health care systems

Nursing Strategy for Use of Seclusion and Restraint in Psychiatric Hospitals / 대한정신분열병학회지

Although seclusion and restraint are required for the treatment of mentally ill patients in psychiatric hospitals, these procedures involve potential violations of human rights and pose a potential risk to patients' physical condition. Nursing staffs in psychiatric hospitals often have to manage psychiatric patients who display aggressive, violent, or challenging behavior. However, the guidelines for the use of seclusion and restraint in Korea are too broad to apply in clinical situations. The guidelines in the United States, Australia, the United Kingdom, and New Zealand emphasize that patients' basic needs have to be met and stipulate that patient–staff interaction must be continued during seclusion and restraint procedures. Mental health workers in psychiatric hospitals should pay close attention to patients' verbal and non-verbal expressions while communicating with them. This study reviews the guidelines for seclusion and restraint used in foreign countries to improve current Korean guidelines and provides strategies of the nursing activities to be implemented when patients require seclusion and restraint.

Spiral scanning imaging and quantitative calculation of the 3-dimensional screw-shaped bone-implant interface on micro-computed tomography

PURPOSE: Bone-to-implant contact (BIC) is difficult to measure on micro-computed tomography (CT) because of artifacts that hinder accurate differentiation of the bone and implant. This study presents an advanced algorithm for measuring BIC in micro-CT acquisitions using a spiral scanning technique, with improved differentiation of bone and implant materials. METHODS: Five sandblasted, large-grit, acid-etched implants were used. Three implants were subjected to surface analysis, and 2 were inserted into a New Zealand white rabbit, with each tibia receiving 1 implant. The rabbit was sacrificed after 28 days. The en bloc specimens were subjected to spiral (SkyScan 1275, Bruker) and round (SkyScan 1172, SkyScan 1275) micro-CT scanning to evaluate differences in the images resulting from the different scanning techniques. The partial volume effect (PVE) was optimized as much as possible. BIC was measured with both round and spiral scanning on the SkyScan 1275, and the results were compared. RESULTS: Compared with the round micro-CT scanning, the spiral scanning showed much clearer images. In addition, the PVE was optimized, which allowed accurate BIC measurements to be made. Round scanning on the SkyScan 1275 resulted in higher BIC measurements than spiral scanning on the same machine; however, the higher measurements on round scanning were confirmed to be false, and were found to be the result of artifacts in the void, rather than bone. CONCLUSIONS: The results of this study indicate that spiral scanning can reduce metal artifacts, thereby allowing clear differentiation of bone and implant. Moreover, the PVE, which is a factor that inevitably hinders accurate BIC measurements, was optimized through an advanced algorithm.