La Economía Circular desde la perspectiva de la empresa estatal cubana: ¿ oportunidad o necesidad en la condiciones actuales? / The Circular Economy from the perspective of the Cuban state enterprise: ¿opportunity o necessity in current condition?

La Economía Circular (EC) se ha posicionado como una alternativa viable ante la insostenibilidad del modelo económico lineal. Hoy este constituye una temática que está en el centro del debate y de todas las agendas de gobierno y Cuba no puede ser la excepción. El presente artículo persigue como objetivo principal diagnosticar el estado de la economía circular en Cuba desde la perspectiva de las empresas estatales. En este sentido se parte de sistematizar las ventajas de la aplicación de modelos circulares en el país. Se particulariza en el estudio por sectores que han avanzado en la aplicación del paradigma circular y se concluye con una propuesta de acciones estratégicas a seguir para expandir las prácticas circulares en el país, las cuales son validadas según criterio de los principales usuarios responsables de su implementación a través de la técnica de IADOV

The Circular Economy (CE) has positioned itself as aviable alternative to the unsustainability of the linear economic model. Today this is an issue that is at the center of the debate and of all government agendas, and Cuba cannot be the exception. The main objective of this article is to diagnose the state of the circular economy in Cuba from the perspective of public enterprises. e study is particularized to analyze separately the advance of the different sectors in the application of the circular paradigm. It concludes with a proposal of strategic actions to be followed to expand circular practices in the country, which are validated according to the criteria of the main users responsible for their implementation through the IADOV technique

Influencia de los revestimientos dentales en la adaptación marginal e interna de las cofias metálicas. Estudio in vitro / Influence of dental investments on the marginal and internal adaptation of metal copings. In vitro study

Objetivo. Evaluar la influencia de diferentes marcas de revestimientos dentales en la adaptación marginal e interna de las cofias metálicas. Método. La investigación fue in vitro, analítico, experimental y transversal; para ello, se confeccionaron 48 cofias metálicas, las cuales fueron cementadas en dientes humanos previamente tallados, luego las cofias fueron cortadas mesio-distalmente para evaluar su adaptación. La adaptación fue evaluada usando un estereomicroscopio Leica DM6000M. Para determinar si hay diferencia en la adaptación marginal e interna se empleó el análisis de varianza, la prueba de comparación múltiple y la prueba de Duncan. Adicionalmente, la prueba de Fisher, se utilizó para evaluar la adaptación total. Resultados. La mejor adaptación marginal e interna de las cofias metálicas lo presenta el revestimiento Fórmula 1 (Whipmix), seguido del Castorit súper C (Dentaurum) y Bellasun (Bego). Conclusión. Los revestimientos dentales no mostraron influencia en la adaptación marginal; sin embargo, si mostraron influencia en la adaptación interna.

Objective. To evaluate the influence of different brands of dental investments on the marginal and internal adaptation of metal copings. Method. The research was in vitro, analytical, experimental and transversal. For this, 48 metal copings were made, which were cemented on previously carved human teeth, then the copings were cut mesio-distally to evaluate their adaptation. The adaptation was evaluated using a Leica DM6000M stereomicroscope. To determine if there is a difference between marginal and internal adaptation; the analysis of variance, the multiple comparison test and the Duncan test were used. Furthermore, Fisher's exact test was used to evaluate the total adaptation. Results. The best marginal and internal adaptation of metal copings is presented by the Formula 1 coating (Whipmix), followed by Castorit super C (Dentaurum) and Bellasun (Bego). Conclusion. Dental investments did not show influence on marginal adaptation; however, they did show influence on internal adaptation.

Experiencia quirúrgica en el Centro Especializado en Tratamiento de Enfermedades de la Piel (CETEP) del Centro Hospitalario Pereira Rossell, desde 1996 hasta 2019

Los tumores cutáneos presentan una alta prevalencia en dermatología en el mundo, siendo los benignos más frecuentes que los malignos; sin embargo, estos últimos son más estudiados debido a su morbimortalidad. El objetivo principal de este estudio fue conocer los principales diagnósticos y técnicas quirúrgicas correspondientes desarrolladas en el Centro de Tratamiento de Enfermedades de la Piel (CETEP) entre 1996 y 2019, evaluando aspectos clínicos y demográficos. Se realizó un estudio retrospectivo y observacional que incluyó todo paciente con lesión cutánea y posterior resolución quirúrgica de la misma. En la muestra analizada (N 6.659) hubo un predominio del sexo femenino (68%) y la media de edad fue 53 ± 21 años. Los pacientes residían mayoritariamente en Montevideo (58%). Los tumores benignos fueron los más frecuentes (41%), seguidos de los malignos (28%), dentro de éstos: carcinoma basocelular (CBC) 66%, carcinoma espinocelular (CEC) 21% y melanoma (MM) 5%. Las técnicas quirúrgicas realizadas fueron cirugías convencionales (57%), principalmente losange (93%), seguidas de procedimientos de cirugía dermatológica (42%), predominando biopsias (52%) y afeitado con electrocoagulación (23%). Se destaca que el CETEP resolvió un número mayor de pacientes de centros externos que del propio Centro Hospitalario Pereira Rossell (CHPR): 59% no CHPR vs 41% CHPR. En conclusión, este trabajo proporcionó información nacional sobre la epidemiología de distintos tumores cutáneos, así como las técnicas quirúrgicas más utilizadas en su resolución. Además, estableció la importancia de la cirugía dermatológica y la capacidad del CETEP en dar respuesta a pacientes propios tanto como referenciados desde otros centros del sistema público.

Cutaneous tumors have a high prevalence in dermatology worldwide, with benign tumors being more common than malignant ones. Nevertheless, the latter are more extensively studied due to their associated morbidity and mortality. The main objective of this study was to identify the primary diagnoses and corresponding surgical techniques developed at the Center for the Treatment of Skin Diseases (CETEP) between 1996 and 2019, while assessing clinical and demographic aspects. A retrospective, observational study was conducted, including all patients with cutaneous lesions and subsequent surgical resolution of the same. In the analyzed sample (N 6659), there was a predominance of females (68%), and the mean age was 53 ± 21 years. The majority of patients resided in Montevideo (58%). Benign tumors were the most prevalent (41%), followed by malignant tumors (28%), with the latter comprising basal cell carcinoma (BCC) at 66%, squamous cell carcinoma (SCC) at 21%, and melanoma (MM) at 5%. The performed surgical techniques included conventional surgeries (57%), primarily using the lozenge method (93%), followed by dermatologic surgery procedures (42%), with a predominance of biopsies (52%) and shave excision with electrocoagulation (23%). It is noteworthy that CETEP resolved a greater number of patients from external centers than from its own hospital, Pereira Rossell Hospital Center (CHPR). 59% non-CHPR vs. 41% CHPR. In conclusion, this study provided national information on the epidemiology of various cutaneous tumors, as well as the most commonly employed surgical techniques in their resolution Furthermore, it emphasized the importance of dermatologic surgery and highlighted the capacity of CETEP to respond to both its own patients and those referred from other centers within the public healthcare system.

Os tumores da pele apresentam alta prevalência na dermatologia em todo mundo, sendo os tumores benignos mais frequentes que os malignos, porém estes últimos são mais estudados devido à sua morbidade e mortalidade. O objetivo principal deste estudo foi conhecer os principais diagnósticos e correspondentes técnicas cirúrgicas desenvolvidas no Centro de Tratamento de Doenças da Pele (CETEP) no período 1996-2019, avaliando aspectos clínicos e demográficos. Foi realizado um estudo retrospectivo e observacional, que incluiu todos os pacientes com lesões cutâneas e com posterior tratamento cirúrgico. Foram estudados 659 pacientes com predomínio do sexo feminino (68%) e média de idade de 53 ± 21 anos. A maioria dos pacientes residiam em Montevidéu (58%). Os tumores benignos foram os mais frequentes (41%), seguidos dos tumores malignos (28%), entre estes: carcinoma basocelular (CBC) 66%, carcinoma espinocelular (CEC) 21% e melanoma (MM) 5%. As técnicas cirúrgicas realizadas foram cirurgias convencionais (57%), principalmente em forma de cunha (93%), seguidas de procedimentos cirúrgicos dermatológicos (42%), predominando biópsias (52%) e shaving com eletrocoagulação (23%). Destaca-se que o CETEP atendeu um número maior de pacientes de centros externos do que do próprio Centro Hospitalar Pereira Rossell (CHPR): 59% não-CHPR vs. 41% CHPR. Concluindo, este trabalho forneceu informações sobre a epidemiologia dos diferentes tumores de pele no país, bem como as técnicas cirúrgicas mais utilizadas no seu tratamento. Além disso, estabeleceu a importância da cirurgia dermatológica e a capacidade do CETEP de atender os pacientes do hospital e também os que foram encaminhados de outros centros da rede pública.

Usefulness and description of the intestinal bypass technique in children with short bowel syndrome: report of a Mexican cohort / Utilidad y descripción de la técnica de puenteo intestinal en niños con síndrome de intestino corto: reporte de una cohorte en México

Abstract Background: Short bowel syndrome (SBS) is one of the most frequent causes of intestinal failure, needing parenteral nutrition to maintain an energy-protein and water-electrolyte balance. At the Hospital Infantil de México Federico Gómez (HIMFG), the formation of two stomas is a technique used for intestinal rehabilitation, where the use of residue through the bypass technique (BT) helps to maintain gastrointestinal functionality, water-electrolyte, and nutritional stability. This study aimed to describe the technique of using intestinal residue through BT as a treatment strategy in intestinal rehabilitation and its effect on the biochemical and nutritional status of pediatric patients with SBS. Methods: An analytical and retrospective cross-sectional study was performed in patients hospitalized at HIMFG with SBS who underwent BT during their hospital stay between 2019 and 2020 and then followed up for 8 weeks. Results: A total of 10 patients were included in this study, with a mean age of 24 months; 50% were female. BT was able to reduce the inflammatory process in the liver caused by the continuous use of parenteral nutrition; enteral caloric intake increased from 25.32 kcal/kg/day to 72.94 kcal/kg/day, but it was insufficient to improve their nutritional status. Conclusions: BT is a safe and effective alternative in intestinal rehabilitation in patients with SBS to stimulate trophism and intestinal functionality, allowing a progression of enteral feeding and a decrease in the hepatic inflammatory process that occurs in these patients with prolonged parenteral nutrition.

Resumen Introducción: El síndrome de intestino corto (SIC) es una de las causas más frecuentes de insuficiencia intestinal que requiere del uso de nutrición parenteral para mantener un balance energético-proteico e hidroelectrolítico. En el Hospital Infantil de México Federico Gómez (HIMFG) la formación de dos estomas es una técnica empleada para la rehabilitación intestinal, donde con el aprovechamiento de residuo mediante la técnica de puenteo (TP) se ayuda a mantener la funcionalidad gastrointestinal, equilibrio hidro-electrolítico y estabilidad nutricional. El objetivo de este estudio fue describir la técnica del aprovechamiento de residuo intestinal mediante TP como estrategia de tratamiento en la rehabilitación intestinal y su efecto en el estado bioquímico y nutricional de pacientes pediátricos con SIC. Métodos: Se llevó a cabo un estudio transversal analítico y retrospectivo en pacientes hospitalizados en el HIMFG con SIC en quienes se realizó la TP durante su estancia intrahospitalaria entre 2019 y 2020. Resultados: Se incluyeron 10 pacientes en este estudio, con una edad promedio de 24 meses, y el 50% de sexo femenino. La TP logró disminuir el proceso inflamatorio hepático ocasionado por el uso continuo de nutrición parenteral; la ingesta calórica por vía enteral incrementó de 25.32 kcal/kg/día a 72.94 kcal/kg/día, pero fue insuficiente para mejorar el estado nutricional. Conclusiones: La TP es una alternativa segura y efectiva en la rehabilitación intestinal en pacientes con SIC para estimular el trofismo y funcionalidad intestinal, permitiendo una progresión de la alimentación enteral y disminución del proceso inflamatorio hepático que se presentan en estos pacientes con nutrición parenteral prolongada.

Comparación Morfométrica de Esqueletos Transparentados de Cuatro Especies de Roedores Myomorfos / Morphometric Comparison of Transparent Skeletons of Four Species of Myomorphic Rodents

Las técnicas de doble tinción y transparentación se han usado desde 1897, pero su utilidad ha sido poco explorada en los estudios anatómicos de micromamíferos adultos. No obstante, la combinación de estas técnicas con el análisis alométrico mutivariado posibilita el estudio de esqueletos poscraneales articulados de tales grupos de micromamíferos como los roedores, los cuales son muy limitados ya que casi siempre se enfocan en los cráneos. En este estudio, analizamos y comparamos la morfometría del esqueleto de Neotomodon alstoni con la de Meriones unguiculatus, Phodopus campbelli y Rattus norvegicus. Usamos la técnica de doble tinción y transparentación para analizar las relaciones morfométricas entre estos roedores utilizando sesenta caracteres esqueléticos. Se encontró que tres especies comparten dos correlaciones comunes y compartieron el mismo tipo de crecimiento isométrico en una de ellas; además se encontraron similitudes aparentes entre los patrones de la morfometría de P campbelli con el patrón de osificación descrito para la especie relacionada Mesocricetus auratus. Las diferencias en el crecimiento alométrico pueden representar también diferencias en el ritmo de desarrollo de acuerdo con el tipo de historia de vida de cada especie. Aquí demostramos que tanto la técnica de preparación como el método de análisis morfométricos son herramientas poderosas pero simples, para realizar estudios anatómicos y morfológicos en el laboratorio. Nuestros resultados reflejan las condiciones del desarrollo ontogenético derivados delpropio patrón de heterocronía para cada especie, y además representan la historia evolutiva de este grupo analizado. Sin embargo, consideramos que es deseable más investigación.

SUMMARY: Clearing and staining techniques have been present since 1897, However, their use in anatomical studies of adult micromammals has been limited. When using such techniques in combination with allometric method, it is possible to study articulated skeletons of micromammals, instead of relying only on the skulls, which is important in morphologically complicated groups as the rodents. Research involving multivariate allometric analysis of postcranial skeleton of rodents has been limited and confined to specific items. In this study, we analyzed and compared the morphometry of the skeleton of Neotomodon alstoni with that of Meriones unguiculatus, Phodopus campbelli and Rattus norvegicus. We applied the double staining and clearing technique in order to determine the morphometric relation between these rodents using sixty skeletal characters. We found that three species share two common correlations and one isometric, with apparent similarities between the morphometry patterns of P campbelli with the ossification pattern described for the related species Mesocricetus auratus. The differences in allometric growth could represent differences in the development stages according to the type of life history for each species. In this analysis we confirmed that both the preparation technique and morphometric analysis method, are simple yet verifiable tools for anatomical and morphological studies. Our results reflect the conditions of ontogenetic development derived from the heterochrony pattern for each species, representing the evolutionary history for this group. Therefore, as this approach continues to be discussed, ongoing research is warranted.

Biomechanical behavior of three maxillary expanders in cleft lip and palate: a finite element study

Abstract: This study evaluated the stress distribution in the dentoalveolar and palatal bone structures during maxillary expansion in a 17-year-old male patient with bilateral cleft lip and palate (BCLP) using expanders with dental (HYRAX) and skeletal anchorage (MARPE). For the generation of the specific finite element models, cone-beam computed tomography was used, and the DICOM files were exported to Mimics 3-Matic (Materialise) and Patran (MSC Software) software. Three specific three-dimensional models were generated: A) HYRAX: conventional four-banded hyrax screw (9 mm); B) MARPE-DS: 3 miniscrews (1.8 mm diameter - 5.4 mm length) and four-banded dental anchorage; and C) MARPE-NoDS: 3 miniscrews without dental anchorage. Maxillary expansion was simulated by activating the expanders transversely 1 mm on the "X" axis. HYRAX resulted in higher levels of deformation predominantly in the dentoalveolar region. MARPE-DS showed stress in the dentoalveolar region and mainly in the center of the palatal region, at approximately 4,000 με. MARPE-NoDS exhibited evident stress only in the palatal region. High stress levels in the root anchoring teeth were observed for HYRAX and MARPE-DS. In contrast, MARPE-NoDS cause stress on the tooth structure. The stress distribution from the expanders used in the BLCP showed asymmetric expansive behavior. During the initial activation phase of expansion, the HYRAX and MARPE-DS models produced similarly high strain at the dentoalveolar structures and upper posterior teeth displacement. The MARPE-NoDS model showed restricted strain on the palate.

Identificación con azul patente de ganglio centinela en cáncer de mama / Patent blue for identification of sentinel nodes in breast cancer

Resumen OBJETIVO: Describir las características sociodemográficas, clínicas y patológicas y los resultados obtenidos con la técnica de ganglio centinela con azul patente en la cirugía de cáncer de mama temprano. Además, reportar la experiencia en la identificación del ganglio centinela en cáncer de mama temprano con la técnica con azul patente al 2.5%. MATERIALES Y MÉTODOS: Estudio retrospectivo y analítico consistente en la evaluación de los expedientes clínicos de pacientes diagnosticadas con cáncer de mama temprano, sin sospecha clínica o radiológica de afectación axilar, atendidas entre junio de 2022 y junio de 2023 en el servicio de Ginecología Oncológica de la UMAE Hospital de Ginecoobstetricia, Centro Médico Nacional de Occidente del IMSS. El sitio de inyección del colorante fue subdérmico periareolar, los ganglios identificados se estudiaron en el transoperatorio. Se analizaron el porcentaje de identificación, las tasas de falsos negativos y el valor predictivo negativo del método. RESULTADOS: Se analizaron 95 procedimientos de biopsia de ganglio centinela. Solo se practicó la linfadenectomía axilar en las pacientes con metástasis en el ganglio centinela comprobada en el estudio transoperatorio y en las que no se identificaron ganglios teñidos por no migración del colorante. La edad promedio de las pacientes fue de 57.1 años límites 25 y 78 años. El tamaño del tumor fue menor a 3 cm. A 64 67% pacientes se les hizo la mastectomía en comparación con 31 a quienes se efectuó cirugía conservadora de mama 33%. Se estadificaron como IA 57 de las 95 pacientes; el subtipo molecular más frecuente fue compatible con luminal A en 49%. CONCLUSIONES: La biopsia del ganglio centinela, con azul patente, es una técnica rápida, sencilla, precisa y de bajo costo para identificar daño axilar en etapas tempranas del cáncer de mama. Lo aquí reportado son resultados que corresponden a una primera evaluación de la técnica en nuestro servicio.

Abstract OBJECTIVE: To describe the sociodemographic, clinical and pathological characteristics and results of the patent blue sentinel lymph node technique in early breast cancer surgery. And to report the experience in identifying the sentinel lymph node in early breast cancer using the 2.5% patent blue technique. MATERIALS AND METHODS: Retrospective and analytical study consisting of the evaluation of the clinical records of patients diagnosed with early breast cancer, without clinical or radiological suspicion of axillary involvement, seen between June 2022 and June 2023 at the Oncological Gynaecology Service of the UMAE Hospital de Ginecoobstetricia, Centro Médico Nacional de Occidente of the IMSS. The dye injection site was subdermal periareolar, and the identified lumps were examined in the transoperative period. The percentage of identification, false negative rates and negative predictive value of the method were analysed. RESULTS: Ninety-five sentinel node biopsies were analysed. Axillary lymphadenectomy was performed only in patients with sentinel lymph node metastasis confirmed at surgery and in those in whom no stained nodes were identified due to non-migration of the dye. The mean age of the patients was 57.1 years range 25 to 78 years. The tumour size was less than 3 cm. Sixty-four patients 67% underwent mastectomy, compared with 31 who underwent breast-conserving surgery 33%. Fifty-seven of the 95 patients were staged as AI; the most common molecular subtype was compatible with luminal A in 49%. CONCLUSIONS: Sentinel lymph node biopsy with patent blue is a rapid, simple, accurate and inexpensive technique for identifying axillary disease in early breast cancer. The results reported here represent an initial evaluation of the technique in our service.

Biomechanical impact of labiolingual diameter on endodontically treated anterior teeth with crown restoration under occlusal loading

Abstract Objective To evaluate the effect of the labiolingual diameter and construction of an endodontically treated (ET) anterior tooth with crown restoration on stress distribution and biomechanical safety under occlusal loading. Methodology Three-dimensional finite element models were generated for maxillary central incisors with all-ceramic crown restorations. The labiolingual diameters of the tooth, defined as the horizontal distance between the protrusion of the labial and lingual surfaces, were changed as follows: (D1) 6.85 mm, (D2) 6.35 mm, and (D3) 5.85 mm. The model was constructed as follows: (S0) vital pulp tooth; (S1) ET tooth; (S2) ET tooth with a 2 mm ferrule, restored with a fiber post and composite resin core; (S3) ET tooth without a ferrule, restored with a fiber post and composite resin core. A total of 12 models were developed. In total, two force loads (100 N) were applied to the crown's incisal edge and palatal surface at a 45° oblique angle to the longitudinal axis of the teeth. The Von Mises stress distribution and maximum stress of the models were analyzed. Results Regardless of the loading location, stress concentration and maximum stress (34.07~66.78MPa) in all models occurred in the labial cervical 1/3 of each root. Both labiolingual diameter and construction influenced the maximum stress of the residual tooth tissue, with the impact of the labiolingual diameter being greater. A reduction in labiolingual diameter led to increased maximum stress throughout the tooth. The ferrule reduced the maximum stress of the core of S2 models (7.15~10.69 MPa), which is lower compared with that of S3 models (19.45~43.67 MPa). Conclusion The labiolingual diameter exerts a greater impact on the biomechanical characteristics of ET anterior teeth with crown restoration, surpassing the influence of the construction. The ferrule can reduce the maximum stress of the core and maintain the uniformity of stress distribution.

Evaluation of water-soluble dyes to mark internal structures of Lepidoptera via larval feeding

ABSTRACT Understanding aspects of insect ecology is a key component for the applicability of control methods or pest resistance management. For instance, the comprehension of insect dispersal is crucial to determining insect gene flow and the maximum distance between refuge areas in Bt (Bacillus thuringiensis) crops. But, for such studies, insects need to be marked prior to release. Seeking to refine the technique of dispersion studies of the genetic material of Spodoptera frugiperda (J.E. Smith) (Lepidoptera: Noctuidae), this study aimed to determine the efficiency of water-soluble dyes for the internal marking of S. frugiperda immatures and adults via larval feeding, with emphasis on marking the spermatophore. Rhodamine B, Methylene Blue, Ponceau, Coomassie, and Eosin-Nigrosin were added to the larval artificial diet at concentrations of 0, 100, 200, 400, 600, 800, and 1000 ppm. Mortality and duration of the larval stage as well as the efficiency of marking internal structures of larvae and adults were evaluated. Rhodamine B and Methylene Blue increased the duration of the larval period, but the former caused higher mortality. The staining of the gut, hemolymph, and imaginal discs, in the larval phase, was observed for Rhodamine B, Methylene Blue, and Coomassie dyes. However, none of the dyes were efficient for marking spermatophores. Thus, the addition of these water-soluble dyes to the larval diet of S. frugiperda can mark internal structures of the larva, but not the adult. Therefore, these dyes have limited application once they may be used only for marking larvae.

Variables biomecánicas del penalti en futbolistas de las categorías sub-12 y sub-17

Introducción: El estudio de los patrones del movimiento técnico deportivo implica analizar sus componentes biomecánicos, teniendo en cuenta el carácter multifactorial del rendimiento deportivo. Objetivo: Describir la mecánica del movimiento del tiro penalti en futbolistas categorías sub-12 y sub-17. Métodos: Estudio cuasi experimental de orden correlativo. Se estudiaron ocho variables biomecánicas: centro de gravedad en sus dos ejes, inclinación corporal, ángulos femorotibial antes del contacto, ángulos femorotibial luego del contacto, velocidad, aceleración y acierto. Se seleccionaron dos grupos independientes de 30 futbolistas del género masculino, se clasificaron por categorías sub-12 y sub-17, y se analizó su rendimiento mediante videoanálisis. Resultados: Hubo diferencias significativas a favor de la categoría sub-17 en las variables centro de gravedad en el eje X (p = 0,000), en inclinación corporal (p = 0,000), en velocidad (p = 0,000), y en aceleración y acierto (p = 0,000); y diferencias no significativas en el resto (centro de gravedad eje Y: p = 0,267; ángulos femorotibial antes del contacto: p = 0,459; ángulos femorotibial luego del contacto: p = 0,446; y aciertos: p = 0,226). Conclusiones: Todos los rangos promedios sobresalieron en la categoría sub-17, excepto en la variable aciertos, lo que implicó una mayor velocidad y aceleración del pie durante la ejecución del tiro a penal. Sin embargo, la precisión, como componente coordinativo, resultó fundamental en la efectividad del disparo.

Introduction: The study of the patterns of technical sports movement involves analyzing its biomechanical components, taking into account the multifactorial nature of sports performance. Objective: To describe the mechanics of the movement of the penalty kick in U-12 and U-17 football players. Methods: Quasi-experimental study of a correlative order. Eight biomechanical variables were studied: center of gravity in its two axes, body inclination, femorotibial angles before contact, femorotibial angles after contact, speed, acceleration and success. Two independent groups of 30 male footballers were selected, classified by U-12 and U-17 categories, and their performance was analysed through video analysis. Results: There were significant differences in favor of the sub-17 category in the variables center of gravity on the X axis (p = 0.000), body inclination (p = 0.000), speed (p = 0.000), and acceleration and accuracy (p = 0.000); and non-significant differences in the rest (center of gravity Y-axis: p = 0.267; femorotibial angles before contact: p = 0.459; femorotibial angles after contact: p = 0.446; and correct answers: p = 0.226). Conclusions: All the average ranges stood out in the U-17 category, except in the variable hits, which implied a greater speed and acceleration of the foot during the execution of the penalty kick. However, accuracy, as a coordinating component, was fundamental in the effectiveness of the shot.

Validación de la técnica de ganglio centinela en cáncer de cuello uterino en el Hospital de la Mujer

Introducción: el cáncer de cuello (CC) uterino representa un problema de salud pública. En Uruguay ocupa el tercer lugar en incidencia en mujeres, provocando 133 fallecimientos anuales. La afectación ganglionar es uno de sus principales factores pronósticos y condiciona el tratamiento. El ganglio centinela (GC) en estadios precoces de cáncer cervicouterino es una técnica segura que permite una adecuada estadificación y reduce la morbilidad asociada a la linfadenectomía convencional. Objetivo: validar la utilización de la técnica de la biopsia GC en estadios precoces de CC como estándar de tratamiento para la detección de metástasis ganglionares en el Hospital de la Mujer. Material y método: se realizó un estudio prospectivo, longitudinal, de casos. Se incluyó a 30 usuarias con CC en estadios iniciales, en el período comprendido entre enero de 2018 y noviembre de 2022. La marcación se realizó con tecnecio 99m (99mTc). En el mismo acto quirúrgico se realizó la linfadenectomía pélvica sistemática. Resultados: se detectó GC de forma bilateral en 29 de 30 pacientes. Con una tasa de detección por región de 98,3%. En cinco pacientes se detectaron GC metastásicos, no encontrando ganglios no centinela positivos. Una de ellas correspondió a una micrometástasis detectada por ultraestadificación. La sensibilidad fue de 100%: IC95% (56,55 -100) con VPN 100% IC95% (86,68 - 100). Conclusiones: de acuerdo con los resultados arrojados por el estudio, el equipo interdisciplinario del Hospital de la Mujer está en condiciones de utilizar la biopsia de GC de cérvix como estándar de tratamiento en el CC uterino en estadio precoz.

Introduction: Cervical cancer (CC) is a public health problem. In Uruguay, it ranks third in incidence in women, causing 133 deaths annually. Lymph node involvement is one of its main prognostic factors and determines treatment. The sentinel lymph node (SLN) in early stages of cervical cancer is a safe technique that allows for adequate staging and reduces morbidity associated with conventional lymphadenectomy. Objective: To validate the use of the SLN biopsy technique in early stages of CC as the standard treatment for detecting lymph node metastases at the Women's Hospital. Method: A prospective, longitudinal case study was conducted. Thirty patients with early-stage cervical cancer between January 2018 and November 2022 were included in the study. The marking was done with Tc99. Systematic pelvic lymphadenectomy was performed in the same surgical procedure. Results: Sentinel lymph nodes were detected bilaterally in 29 out of 30 patients. With a detection rate per region of 98.3%, metastatic SLNs were detected in 5 patients, with no positive non-sentinel nodes found. One of them corresponded to a micrometastasis detected by ultra-staging. Sensitivity was 100% (95% CI 56.55,100) with a negative predictive value of 100% (95% CI 86.68, 100). Conclusions: According to the results of the study, the interdisciplinary team at the Women's Hospital is in a position to use cervical SLN biopsy as the standard treatment for early-stage cervical cancer.

Introdução: O câncer do colo do útero (CCU) representa um problema de saúde pública. No Uruguai, ocupa o terceiro lugar em incidência em mulheres, causando 133 mortes por ano. O acometimento dos linfonodos é um dos principais fatores prognósticos e condiciona o tratamento. O linfonodo sentinela (LS) em estágios iniciais do câncer do colo do útero é uma técnica segura que permite o estadiamento adequado e reduz a morbidade associada à linfadenectomia convencional. Objetivo: Validar o uso da técnica de biópsia por LS em estágios iniciais do CCU como tratamento padrão para a detecção de metástases linfonodais no Hospital da Mulher. Materiais e métodos: Foi realizado um estudo de caso prospectivo e longitudinal. Trinta usuárias com LS em estágio inicial foram incluídas no período de janeiro de 2018 a novembro de 2022. A marcação foi realizada com Tc99. A linfadenectomia pélvica sistemática foi realizada no mesmo ato cirúrgico. Resultados: O LS foi detectado bilateralmente em 29 das 30 usuárias, com uma taxa de detecção por região de 98,3%. Em 5 pacientes foram detectados LS metastáticos e não foram encontrados nódulos não-sentinela positivos. 1 deles correspondia a uma micrometástase detectada por ultrassonografia. A sensibilidade foi de 100% CI 95% (56,55,100) com NPV 100% CI 95% (86,68, 100). Conclusões: Com base nos resultados do estudo, a equipe interdisciplinar do Hospital da Mulher está em condições de usar a biópsia de LS cervical como padrão de tratamento no câncer cervical em estágio inicial.

Fortalecimiento del liderazgo para la gestión educativa en las Américas: una estrategia de investigación-acción / Strengthening leadership for educational management in the Americas: an action research strategy / Fortalecimento da liderança para a gestão educacional na Região das Américas: uma estratégia de pesquisa-ação

RESUMEN La formación de recursos humanos en salud es una preocupación recurrente. El Campus Virtual de Salud Pública (CVSP) es la plataforma educativa de la Organización Panamericana de Salud (OPS) que busca mejorar la accesibilidad a la educación en salud pública, con énfasis en la formación en liderazgo educativo orientado a planificar, implementar y evaluar políticas y acciones educativas. El objetivo de este trabajo es presentar los resultados de una consulta a personas expertas sobre el curso virtual "Liderazgo para la Gestión Educativa en Organizaciones de Salud", como parte de una estrategia de fortalecimiento de las capacidades de liderazgo para la gestión educativa en las Américas propuesta por el CVPS/OPS. Se realizó un estudio cualitativo de investigación-acción, con una metodología Delphi de dos iteraciones de consultas, una virtual y una presencial, a expertos en gestión educativa en organizaciones de salud. Los resultados muestran la relevancia que adquieren ocho dimensiones de análisis: el perfil de los destinatarios, las competencias, el enfoque y los contenidos, las actividades, la evaluación del y para el aprendizaje, la adaptabilidad, la implementación y el seguimiento durante y poscurso. La participación de actores de diferentes ámbitos geopolíticos en el diseño e implementación de una propuesta educativa regional promueve la transformación del contexto de aplicación y mejora su potencial adopción. Se destaca el lugar estratégico del curso como catalizador en la conformación y la consolidación de una red integrada de organizaciones para fortalecer el liderazgo educativo en las Américas, y la conveniencia de la estrategia metodológica empleada para mejorar la calidad de la formación de recursos humanos en salud.

ABSTRACT The training of human resources for health (HRH) is a recurring concern. The Virtual Campus for Public Health (VCPH) - the educational platform of the Pan American Health Organization (PAHO) - seeks to improve access to public health education, emphasizing leadership training for teams that plan, implement, and evaluate policies and educational initiatives. The objective of this work is to present the results of a consultation with experts on the virtual course "Leadership for Educational Management in Health Organizations", as part of a PAHO/VCPH strategy to strengthen leadership capacities for educational management in the Americas. A qualitative action-research study was carried out using the Delphi method with two iterations of consultations (one virtual and one in person) with experts in educational management in health organizations. The results show the importance of eight dimensions of analysis: recipient profiles, competencies, approach and contents, activities, evaluation of and for learning, adaptability, implementation, and monitoring during and after the course. The participation of actors from different geopolitical spheres in the design and implementation of a regional educational initiative fosters adaptations in the context of its implementation and improves the likelihood it will be adopted. This course can play a strategic role as a catalyst in the formation and consolidation of an integrated network of organizations that strengthen educational leadership in the Americas. This study also highlights the value of the methodological strategy used to improve the quality of HRH training.

RESUMO A formação de recursos humanos em saúde é uma preocupação recorrente. O Campus Virtual de Saúde Pública (CVSP) é a plataforma educacional da Organização Pan-Americana da Saúde (OPAS), que busca melhorar a acessibilidade à educação em saúde pública, com ênfase na formação de lideranças educacionais voltadas para o planejamento, a implementação e a avaliação de políticas e ações educacionais. O objetivo deste documento é apresentar os resultados de uma consulta com especialistas sobre o curso virtual "Liderazgo para la Gestión Educativa en Organizaciones de Salud" [Liderança para a Gestão Educacional em Organizações de Saúde], como parte de uma estratégia para fortalecer as capacidades de liderança para gestão educacional na Região das Américas proposta pelo CVPS/OPAS. Foi realizado um estudo qualitativo de pesquisa-ação utilizando o método Delphi com duas rodadas de consultas, uma virtual e outra presencial, a especialistas em gestão educacional em organizações de saúde. Os resultados mostram a relevância de oito dimensões de análise: perfil do público-alvo; competências; abordagem e conteúdo; atividades; avaliação de e para as aprendizagens; adaptabilidade; implementação; e acompanhamento durante e após o curso. A participação de atores de diferentes esferas geopolíticas no delineamento e na implementação de uma proposta educacional regional promove a transformação do contexto de aplicação e aumenta seu potencial de adoção. Destaca-se o posicionamento estratégico do curso como catalisador na criação e consolidação de uma rede integrada de organizações para fortalecer a liderança educacional na Região das Américas e a adequação da estratégia metodológica empregada para melhorar a qualidade da formação de recursos humanos em saúde.

Construção e validação de conteúdo de instrumento de autoavaliação da qualidade do cuidado em instituição de longa permanência para pessoas idosas / Development and content validation for a self-assessment instrument of care quality in long-term care facilities for older adults

Resumo Objetivo Desenvolver e realizar a validação de conteúdo de um instrumento de autoavaliação da qualidade do cuidado em Instituições de Longa Permanência para Idosos (ILPI), denominado QualificaILPI. Método Estudo metodológico realizado entre março e dezembro de 2021. O instrumento foi desenvolvido com base em modelo multidimensional de qualidade, legislação brasileira e pesquisa bibliográfica e contém padrões de qualidade para autoavaliação das ILPI nas dimensões: ambiente, lar, cuidado, envolvimento familiar e da comunidade, equipe de trabalho e gestão. Cada padrão é descrito e seguido por uma escala, com parâmetros para classificar o nível de qualidade da ILPI em incipiente, intermediário, consolidado. A Técnica Delphi modificada foi empregada para validação por um comitê de 10 especialistas quanto a pertinência do padrão para avaliação da qualidade da ILPI, da adequação dos objetivos e da escala de avaliação, clareza, podendo fazer comentários. O padrão foi mantido quando houve 75% de concordância entre os especialistas. O instrumento foi também avaliado pelo público-alvo, constituído por coordenadores de 10 ILPI, selecionadas por conveniência. Resultados No primeiro ciclo de avaliação, foram excluídos três padrões e dois novos foram criados. No segundo, alterou-se a dimensão de um padrão e dois padrões foram unidos. Ao final, permaneceram 29 padrões divididos em seis dimensões. O público-alvo, gestores de ILPI, sugeriu alterações na redação de alguns padrões. Houve consenso de 80% ou superior em todos os padrões. Conclusão O QualificaILPI poderá contribuir para o monitoramento das ILPI favorecendo a melhoria do cuidado ofertado aos residentes.

Abstract Objective To develop and validate the content of a self-assessment instrument for the quality of care in Long-Term Care Facilities for Older Adults (Instituições de Longa Permanência para Idosos - ILPIs), named QualificaILPI. Method A methodological study conducted between March and December 2021. The instrument was developed based on a multidimensional quality model, Brazilian legislation, and literature research. It contains quality standards for self-assessment of ILPIs in the dimensions of environment, home, care, family and community involvement, work team, and management. Each standard is described and followed by a scale with parameters to classify the level of ILPI quality as incipient, intermediate, or consolidated. The modified Delphi Technique was employed for validation by a committee of 10 experts regarding the relevance of the standard for ILPI quality assessment, the appropriateness of objectives, the evaluation scale, and clarity, allowing for comments. The standard was retained when there was 75% agreement among the experts. The instrument was also evaluated by the target audience, consisting of coordinators from 10 ILPIs selected for convenience. Results In the first assessment cycle, three standards were excluded, and two new ones were created. In the second cycle, the dimension of one standard was changed, and two standards were combined. In the end, 29 standards remained, divided into six dimensions. The target audience, ILPI managers, suggested changes in the wording of some standards. There was a consensus of 80% or higher for all standards. Conclusion QualificaILPI has the potential to contribute to monitoring ILPIs, promoting the improvement of care offered to residents.

Clinical longevity of metallic versus fiberglass intraradicular posts: a systematic review / Longevidade clínica de pinos intraradiculares metálicos versus de fibra de vidro: uma revisão sistemática

Objective: This systematic review aims to compare the clinical longevity of metallic and fiberglass intraradicular posts in teeth with severely compromised crowns, utilizing randomized clinical trials and case reports published in the last eleven years. Material and Methods: The research was conducted on PubMed, Medline, Lilacs, and BBO databases using the first search strategy with the descriptors 'dental posts,' 'longevity,' 'fiberglass-reinforced posts' or 'metallic posts.' The second search strategy involved analyzing the references of articles identified by the first search. Both studies were carried out with stringent inclusion and exclusion criteria. Results: No statistically significant and clinically relevant differences in longevity were observed between metallic and fiberglass posts. Conclusion: The clinical success and durability of the restorative procedure using intraradicular posts primarily depend on the remaining amount around the post (ferrule), the type and position of the tooth in the arch (impacting the masticatory forces exerted on the restored tooth), and the correct application of the cementation technique. It is noteworthy that fiberglass posts offer substantial advantages by presenting a modulus of elasticity similar to dental structure, ensuring a more homogeneous distribution of masticatory forces and reducing the risk of fractures. These findings have practical implications for material selection in restorative procedures involving intraradicular posts.(AU)

Objetivo: Esta revisão sistemática visa comparar a longevidade clínica de pinos intrarradiculares metálicos e de fibra de vidro em dentes com coroas severamente comprometidas, através de estudos clínicos randomizados e relatos de casos, publicados nos últimos onze anos. Material e Métodos: A pesquisa foi conduzida nas bases de dados PubMed, Medline, Lilacs e BBO, utilizando a primeira estratégia de busca com os s 'pinos dentais' e 'longevidade' e 'pinos reforçados com fibra de vidro' ou 'pinos metálicos'. A segunda estratégia de busca consistiu na análise das referências dos artigos identificados pela primeira estratégia. Ambos os estudos foram delineados com critérios rigorosos de inclusão e exclusão. Resultados: Não se constataram diferenças estatisticamente significativas e clinicamente relevantes na longevidade entre pinos metálicos e de fibra de vidro. Conclusão: O êxito clínico e a durabilidade do procedimento restaurador empregando pinos intrarradiculares dependem primordialmente da quantidade de remanescente ao redor do pino (férula), do tipo e posição do dente na arcada (o que impacta nas forças mastigatórias exercidas sobre o dente restaurado) e da aplicação correta da técnica de cimentação.Destaca-se que o pino de fibra de vidro oferece vantagens substanciais ao apresentar módulo de elasticidade similar à estrutura dentária, assegurando uma distribuição mais homogênea das forças mastigatórias e reduzindo o risco de fraturas (AU)

Induced sputum testing in chronic airway disease and the prospects for its development / 中国临床药理学与治疗学

Induced sputum testing is a non-invasive test that reflects the nature and extent of airway inflammation and plays an important role in the diagnosis, treatment and prognosis of chronic airway diseases. This article outlines the development history of induced sputum technology, introduces the principle and operation of induced sputum technology, evaluates its safety, summarizes the three main test components, elaborates the role of this technology in various chronic airway diseases, such as reflecting the type of airway inflammation, predicting the efficacy of medication, and combining it with transcriptomics to study disease mechanisms, and briefly summarizes its innovations and makes a vision for the future.

Effect of core muscles training based on spinal fine-tuning manipulation on lumbar spine function and quality of life in patients with lumbar facet joint disorders / 中国康复理论与实践

ObjectiveTo explore the effect of core muscles training based on spinal fine-tuning manipulation on lumbar facet joint disorders. MethodsFrom February, 2021 to February, 2022, 80 patients with lumbar facet joint disorders in Huadong Hospital Affiliated to Fudan University were randomly divided into control group (n = 40) and observation group (n = 40) randomly. Both groups received routine treatment and spinal fine-tuning manipulation, while the observation group received core muscles training in addition, for six weeks. They were assessed with Japanese Orthopaedic Association (JOA) scores, Short-Form of McGill Pain Questionnaire and World Health Organization Quality of Life-BREF before and after treatment. The recurrence rate was observed after three months follow-up. ResultsThe scores of all the scales improved after treatment (t > 5.751, P < 0.001), and improved more in the observation group than in the control group (t > 2.051, P < 0.05). After three months follow-up, the recurrence rate was 7.89% (3/38) in the observation group, less than 28.13% (9/32) in the control group (χ2 = 5.005, P = 0.025). ConclusionCombination of core muscles training may improve lumbar function, reduce lumbar pain, reduce recurrence and improve quality of life for patients with lumbar facet joint disorders.

The Research about the Emerging Body Enhancement Technique from the Perspective of the Physical Care / 中国医学伦理学

The co-development of the technology pointing to the "external nature" and the technology pointing to the "physical nature" promotes the co-evolution of the man and the machine. The emerging body enhancement technique is derived from the "defective existence" of the man, and it changes the "body nature" from the inside of the man. The emerging body enhancement techniques are rapidly spread out driven by the multiple forces. The emerging body enhancement techniques has led to the weakening of the natural body identity and the strengthening of the symbolic body identity, the class solidification and the rise of "cyberpunk", the mixing of the natural person and the technical person. To consciously guide the development and application of emerging human enhancement surgery used human care theory. The physical care is an important reference to judge the good and the evil of the emerging body enhancement technique. The management about the body ethics is the optimal choice about the management of the emerging body enhancement technique. The physical care is the important content of the education of the emerging body enhancement technique.

Research report of living donor kidney harvesting in Bama miniature pigs with six gene modified / 器官移植

Objective To summarize the experience and practical value of living donor kidney harvesting in Bama miniature pigs with six gene modified. Methods The left kidney of Bama miniature pigs with six gene modified was obtained by living donor kidney harvesting technique. First, the ureter was occluded, and then the inferior vena cava and abdominal aorta were freed. During the harvesting process, the ureter, renal vein and renal artery were exposed and freed in sequence. The vascular forceps were used at the abdominal aorta and inferior vena cava, and the renal artery and vein were immediately perfused with 4℃ renal preservation solution, and stored in ice normal saline for subsequent transplantation. Simultaneously, the donor abdominal aorta and inferior vena cava gap were sutured. The operation time, blood loss, warm and cold ischemia time, postoperative complications and the survival of donors and recipients were recorded. Results The left kidney of the genetically modified pig was successfully harvested. Intraoperative bleeding was 5 mL, warm ischemia time was 45 s, and cold ischemia time was 2.5 h. Neither donor nor recipient pig received blood transfusion, and urinary function of the kidney transplanted into the recipient was recovered. The donor survived for more than 8 months after the left kidney was resected. Conclusions Living donor kidney harvesting is safe and reliable in genetically modified pigs. Branch blood vessels could be processed during kidney harvesting, which shortens the process of kidney repair and the time of cold ischemia. Living donor kidney harvesting contributes to subsequent survival of donors and other scientific researches.

Lumbar Core Muscle Stability Training Combined with Kinesiology Taping Technique in Rehabilitation Treatment of Lumbar Disc Herniation / 中山大学学报(医学科学版)

ObjectiveTo investigate the clinical efficacy of lumbar core muscle stability training combined with kinesiology taping technique in the rehabilitation treatment of lumbar disc herniation （LDH）. MethodsA total of 99 LDH patients treated in Ningbo Yinzhou No. 2 Hospital from January 2018 to January 2020 were selected and divided into control group （n=49） and observation group （n=50）. Kinesiology taping technique was applied to patients in the control group and patients in the observation group were treated with lumbar core muscle stability training combined with kinesiology taping technique， then we compared the therapeutic effect， lumbar function and pain degree， surface electromyography of lumbar extensor muscles， lumbar range of motion， LDH recurrence and skin allergies before and after the treatment between the two groups. ResultsAfter 4 weeks of treatment， compared with those in the control group， in the observation group， the visual analogue scale （VAS） and Oswestry disability index （ODI） scores were significantly lower （P<0.05）； the Japanese Orthopaedic Association （JOA） score， mean power frequency of lumbar extensor muscles， integral electromyography value and lumbar function score were significantly higher （P<0.05）. During the treatment， there was no significant difference in the incidence of complications between two groups （P>0.05）. After 4 weeks of treatment， the observation group had a significantly lower LDH recurrence rate than the control group （P<0.05）. ConclusionLumbar core muscle stability training combined with kinesiology taping technique achieves a significantly better therapeutic effect than kinesiology taping technique in the rehabilitation treatment of LDH and can effectively relieve muscle fatigue， help alleviate lumbar spine pain and improve the function of lumbar spine.

Digital repair for a patient with limited mouth opening: a case report and literature review / 口腔疾病防治

Objective@#To explore an accurate method to obtain an intraoral model of patients with specific limited mouth opening (microstomia) due to systemic scleroderma.@*Methods@#This study followed medical ethics, and informed consent has been obtained from patients. A case of Ken's Type I mandibular dentition defect scleroderma with limited mouth opening was addressed with digital technology as the leading method combined with the traditional impression method of segmental impression. Individual trays were made based on the patient's left and right mandibular dentition, and segmented molds were obtained. Simultaneously, intraoral scanning was performed to obtain the morphological data of both the soft and hard tissues of the upper and lower mandibles. After each part of the model was obtained, the mandibular model was scanned and digitally aligned to form the final denture model, and the final removable partial denture was designed and made by computer aided design/computer aided manufacturing (CAD/CAM) technology. At the same time, combined with the literature, the diagnosis and treatment of removable partial denture in patients with limited mouth opening were retrospectively analyzed.@*Results@#The denture was well retained and achieved a good repair effect. The patients expressed satisfaction with the mastication efficiency and other functions of the denture. The findings of the literature review show that the integration of digital technology with the traditional impression method, along with computer fitting, can accurately obtain the patient's oral model and facilitate successful follow-up repairs. However, when the anterior mandibular dentition of the patient is absent, the margin of error is increased in this procedure, which deserves further exploration.@*Conclusion@#Utilizing digital technology as the leading method, combined with the traditional impression method of segmental impression, for the repair of dental defects in patients with limited mouth opening, has proven to be effective. Thus, patients report a positive medical experience with high satisfaction, indicating that this approach is worthy of clinical promotion.