The Relationship of Anatomical Localizations of Hiatal Clamp and Oesophagogastric Junction with Body Mass Index / Relación entre las Localizaciones Anatómicas de la Pinza Hiatal y la Unión Esofagogástrica con el Índice de Masa Corporal

SUMMARY: In our study, we aimed to reveal the relationship between the anatomical localizations measured and the Body Mass Index (BMI) in patients scheduled for upper gastrointestinal endoscopy. In this study, anatomical localizations of the hiatal clamp and oesophagogastric junction in 189 female and 137 male patients who applied to the hospital with different gastrointestinal system complaints and underwent esophagogastroduodenoscopy (EGD) were investigated depending on BMI. In addition, the data were compared with the patients' complaints before EGD and the diagnoses they received after EGD. SPSS Statistics 22 (IBM Corp. Turkey) program was used for statistical analysis and p0.05). On the other hand, it was determined that the hiatal clamp distance and the distance of the oesophagogastric junction increased as the height and weight increased (p38. As a result of the study, it can be said that BMI values, hiatal clamp distance and oesophagogastric junction localizations may change in relation to height and weight.

En este estudio, buscamos revelar la relación entre las localizaciones anatómicas y el Índice de Masa Corporal (IMC) en pacientes programados para endoscopía digestiva alta. Se investigaron las localizaciones anatómicas de la pinza hiatal y la unión esofagogástrica en 189 mujeres y 137 hombres que acudieron al hospital con diferentes problemas del sistema gastrointestinal los cuales fueron sometetidos a una esofagogastro- duodenoscopia (EGD) dependiendo del IMC. Además, los datos se compararon con las quejas de los pacientes antes de la EGD y los diagnósticos que recibieron después de la EGD. Se utilizó el programa SPSS Statistics 22 (IBM Corp. Turquía) para el análisis estadístico y el valor de p0,05). Por otro lado, se determinó que la distancia de la pinza hiatal y la unión esofagogástrica aumentaba con la altura y el peso corporal (p38. Como resultado del estudio, se puede decir que los valores de IMC, la distancia de pinzamiento hiatal y las localizaciones de la unión esofagogástrica pueden cambiar en relación con la altura y el peso.

New development of EU health strategy: Implementation characteristics and policy implications of EU Health / 公共卫生与预防医学

The EU is a joint political and economic community organization of many countries. The formulation and implementation of its health strategy need to take into account the differences in the development level of public health among its member countries. Since 2003, the EU has completed the implementation of the third-generation health strategy and launched the fourth-generation health strategy in June 2021. Compared with previous generations of health strategies, EU4Health not only includes targeted measures to cope with COVID-19, but also analyzes the current health challenges in the EU, pointing out the direction for the future development of health in the EU. By introducing the basic health situation of the EU, sorting out the development process, content, and strategic indicators of the EU health strategy, and analyzing the implementation characteristics of EU4Health in the EU, this article aims to provide inspiration for the implementation and further improvement of the “Healthy China” strategy.

Microtensile bond strength of resin cements to 3-D printed and milled temporary restorative resins / Resistencia de unión en microtracción de cementos resinosos a resinas para provisionales impresas y fresadas

Abstract To evaluate the microtensile bond strength (µTBS) of two resin cements to 3D printed and milled CAD/CAM resins used for provisional fixed partial dentures. Blocks (5 x 5 x 5 mm) of three 3D-printed resins (Cosmos3DTemp / Yller; Resilab3D Temp / Wilcos and SmartPrint BioTemp, / MMTech) were printed (Photon, Anycubic Technology Co.). A milled material (VitaCAD-Temp, VITA) was used as control. Half the specimens were sandblasted and the rest were untreated. Two blocks were bonded with the corresponding resin cement: PanaviaV5 (Kuraray Noritake) and RelyX Ultimate (3M Oral Care). After 24 hours, the bonded blocks were sectioned into 1 x 1 mm side sticks. Half the beams were tested for µTBS and the other half was thermocycled (5000 cycles, 30s dwell-time, 5s transfer time) before µTBS testing. A four way Generalized Linear Model (material*sandblasting*cement*aging) analysis was applied. VITA exhibited the lowest µTBS, regardless of the cement, sandblasting and thermocycling. Sandblasting significantly improved the µTBS of VIT, especially after aging, but did not improve the µTBS of 3D printed resins. Sandblasting was not beneficial for 3D printed resins, although is crucial for adhesive cementation of milled temporary resins. Airborne particle abrasion affects the integrity of 3D-printed resins, without producing a benefit on the microtensile bond strength of these materials. However, sandblasting is crucial to achieve a high bond strength on milled temporary resins.

Resumen Evaluar la resistencia adhesiva en microtracción (µTBS) de dos cementos resinosos a resinas CAD/CAM impresas y fresadas indicadas para restauraciones provisionales. Bloques (5 x 5 x 5mm) de tres resinas impresas (Cosmos3DTemp / Yller; Resilab3D Temp / Wilcos and SmartPrint BioTemp, / MMTech) y una resina fresada (VitaCAD-Temp, VITA) fueron fabricados. La mitad de los especímenes fueron arenados y el resto no recibió tratamiento mecánico. Dos bloques con condiciones de tratamiento iguales fueron cementados con cemento resinoso (PanaviaV5 / Kuraray Noritake y RelyX Ultimate / 3M Oral Care). Después de 24 horas los bloques fueron seccionados en palitos de 1 mm² de área. En la mitad de los especímenes se midió la TBS inmediatamente y el resto fue termociclado (5000 ciclos, 30s remojo, 5s transferencia) antes de la prueba de TBS. Se aplica un análisis estadístico por Modelo Linear General con 4 factores (material*arenado*cemento*termociclado). La resina VITA presentó la menor µTBS, independientemente del cemento usado, el arenado y el termociclado. Sin embargo, el arenado aumentó la µTBS de VIT, especialmente después del termociclado. Por otro lado, el arenado no resultó en un aumento significativo de la µTBS de las resinas impresas. El arenado no fue beneficiosos para las resinas impresas, aunque es un paso crucial para la cementación adhesive de las resinas fresadas. El arenado afecta la integridad de las capas de las resinas impresas, sin generar un beneficio en la TBS.

Esophagogastric Junction Contractile Integral (EGJ-CI) in Various Phenotypes of Gastroesophageal Reflux Disease (GERD)

Introduction: Two parameters of high-resolution esophageal manometry are used to observe the function of the esophagogastric junction (EGJ): the anatomical morphology of the EGJ and contractile vigor, which is evaluated with the esophagogastric junction contractile integral (EGJ-CI). To date, how these parameters behave in different gastroesophageal reflux disease (GERD) phenotypes has not been evaluated. Materials and methods: An analytical observational study evaluated patients with GERD confirmed by pH-impedance testing and endoscopy undergoing high-resolution esophageal manometry. The anatomical morphology of the EGJ and EGJ-CI was assessed and compared between reflux phenotypes: acid, non-acid, erosive, and non-erosive. Results: 72 patients were included (63% women, mean age: 54.9 years), 81.9% with acid reflux and 25% with erosive esophagitis. In the latter, a decrease in EGJ-CI (median: 15.1 vs. 23, p = 0.04) and a more significant proportion of patients with type IIIa and IIIb EGJ (83.3% vs 37.1%, p < 0.01) were found. No significant differences existed in the manometric parameters of patients with and without acid and non-acid reflux. Conclusion: In our population, EGJ-CI significantly decreased in patients with erosive GERD, suggesting that it could be used to predict this condition in patients with GERD. This finding is also related to a higher proportion of type III EGJ and lower pressure at end-inspiration of the lower esophageal sphincter in this reflux type.

Introducción: Para observar la función de la unión esofagogástrica (UEG) se utilizan dos parámetros de la manometría esofágica de alta resolución: la morfología anatómica de la UEG y el vigor contráctil, el cual se evalúa con la integral de contractilidad distal de la unión esofagogástrica (IC-UEG). Hasta el momento, no se ha evaluado cómo se comportan estos parámetros en los diferentes fenotipos de enfermedad por reflujo gastroesofágico (ERGE). Metodología: Estudio observacional analítico en el que se evaluaron pacientes con ERGE confirmado por pH-impedanciometría y endoscopia, llevados a manometría esofágica de alta resolución. Se evaluó la morfología anatómica de la UEG y la IC-UEG, y se comparó entre los diferentes fenotipos de reflujo: ácido, no ácido, erosivo y no erosivo. Resultados: Se incluyó a 72 pacientes (63% mujeres, edad media: 54,9 años), 81,9% con reflujo ácido y 25% con esofagitis erosiva. En este último grupo se encontró una disminución de la IC-UEG (mediana: 15,1 frente a 23, p = 0,04) y una mayor proporción de pacientes con UEG tipo IIIa y IIIb (83,3% frente a 37,1%, p < 0,01). No se encontraron diferencias significativas en los parámetros manométricos de los pacientes con y sin reflujo ácido y no ácido. Conclusión: En nuestra población, la IC-UEG estuvo significativamente disminuida en los pacientes con ERGE erosivo, lo que sugiere que podría ser utilizada como un predictor de esta condición en pacientes con ERGE. Este hallazgo también se relaciona con mayor proporción de UGE tipo III y menor presión al final de la inspiración del esfínter esofágico inferior en este tipo de reflujo.

Determinación de la calidad de imágenes clínicas de proyecciones postero anterior y lateral de tórax / Determination of clinical image quality of posteroanterior and lateral chest images

RESUMEN Los estudios radiológicos son fundamentales en el diagnóstico y tratamiento de diversas patologías. Su calidad depende de múltiples variables, entre las que destacan, los parámetros de adquisición, interpretación, entre otros. Se propone una metodología estandarizada, sencilla, de fácil interpretación, permitiendo la evaluación regular de la calidad de las imágenes, dando indicios de la propiedad del trabajo en el centro de salud y poder realizar comparaciones entre centros y autores, a partir de los criterios anatómicos establecidos por la Unión Europea, definiendo el parámetro de calidad de la imagen (CI), representadas en una escala de Likert para el análisis de frecuencia, demostrando que puede ser una herramienta de utilidad para la evaluación reiterada de los centros de radiología. Evaluando 140 proyecciones postero anterior y 85 laterales de tórax, con una muestra de 225 estudios, realizados en un centro de salud, ubicado en la ciudad de Mérida, República Bolivariana de Venezuela, escogiendo estas proyecciones, ya que, representan el 32% de los estudios de radiología convencional. Permitiendo la comparación entre proyecciones y autores, obteniéndose para la proyección postero anterior un CI de 5,07 ± 1,53 criterios de los ocho establecidos, normalizado un CI de 0,62 ± 0,19; las imágenes excelentes solo representan el 22,78%. Comparado con un CI de 4,91 ± 1,17 criterios de los seis establecidos, normalizado un CI de 0,82 ± 0,19, e imágenes excelentes en un 64,71% para la proyección lateral. Se observa las notorias diferencias entre la calidad de las imágenes clínicas en hombres y mujeres para ambas proyecciones

ABSTRACT Radiological studies are essential in the diagnosis and treatment of various pathologies. Their quality depends on multiple variables, among which the acquisition and interpretation parameters, among others, stand out. A standardized methodology is proposed, simple, of easy interpretation, allowing the regular evaluation of the quality of the images, giving indications of the property of the work in the health center and being able to make comparisons between centers and authors, from the anatomical criteria established by the European Union, defining the parameter of image quality (IQ), represented on a Likert scale for frequency analysis, demonstrating that it can be a useful tool for the repeated evaluation of radiology centers. Evaluating 140 postero anterior and 85 lateral projections of the thorax, with a sample of 225 studies, performed in a health center, located in the city of Merida, Bolivarian Republic of Venezuela, taking these projections, since they represent 32% of the conventional radiology studies. Allowing the comparison between projections and authors, obtaining for the postero anterior projection an IQ of 5.07 ± 1.53 criteria of the eight established, normalized an IQ of 0.62 ± 0.19; the excellent images only represent 22.78%. Compared with an IQ of 4.91 ± 1.17 criteria of the six established, normalized IQ of 0.82 ± 0.19, and excellent images in 64.71% for the lateral projection. It is observed the notorious differences between the quality of clinical images in men and women for both projections

Comportamiento del tiempo de conducción retrógrada al momento de la inducción de las taquicardias supraventriculares y su rol en el diagnóstico diferencial / Behavior of Retrograde Conduction Time at Supraventricular Tachycardia Induction and its Role in Differential Diagnosis

RESUMEN Antecedentes : El diagnóstico diferencial entre la taquicardia reentrante ortodrómica (TRO) y la taquicardia por reentrada nodal atípica (TRNa) puede ser dificultoso. Nuestra hipótesis es que las TRNa tienen más variabilidad en el tiempo de con ducción retrógrada al comienzo de la taquicardia que las TRO. Nuestros objetivos fueron evaluar la variabilidad en el tiempo de conducción retrógrada al inicio de la taquicardia en TRNa y TRO, y proponer una nueva herramienta diagnóstica para diferenciar estas dos arritmias. Métodos : Se midió el intervalo ventrículo-auricular (VA) de los primeros latidos tras la inducción de la taquicardia, hasta su estabilización. La diferencia entre el intervalo VA máximo y el mínimo se definió como delta VA (ΔVA). También contamos el número de latidos necesarios para que se estabilice el intervalo VA. Se excluyeron las taquicardias auriculares. Resultados : Se incluyeron 101 pacientes. Se diagnosticó TRO en 64 pacientes y TRNa en 37. El ΔVA fue 0 (rango intercuartílico, RIC, 0-5) milisegundos (ms) en la TRO frente a 40 (21-55) ms en la TRNa (p < 0,001). El intervalo VA se estabilizó significativamente antes en la TRO (1,5 [1-3] latidos) que en la TRNa (5 [4-7] latidos; p < 0,001). Un ΔVA < 10 ms diagnosticó TRO con 100% de sensibilidad, especificidad y valores predictivos positivo y negativo. La estabilización del intervalo VA en menos de 3 latidos predijo TRO con buena precisión diagnóstica. Los resultados fueron similares considerando sólo vías accesorias septales. Las TRN típicas tuvieron una variación intermedia. Conclusión : Un ΔVA < 10 ms es un criterio simple, que distingue con precisión la TRO de la TRNa, independientemente de la localización de la vía accesoria.

ABSTRACT Background : Differential diagnosis between orthodromic reentrant tachycardia (ORT) and atypical nodal reentrant tachy cardia (ANRT) can be challenging. Our hypothesis was that ANRT presents more variability in retrograde conduction time at tachycardia onset than ORT. Objectives : The objectives of this study were to assess retrograde conduction time variability at the start of tachycardia in ANRT and ORT, and postulate a new diagnostic tool to differentiate these two types of arrhythmias. Methods : The ventriculoatrial (VA) interval of the first beats after tachycardia induction was measured until stabilization. The difference between the maximum and minimum VA interval was defined as delta VA (ΔVA), and the number of beats needed for VA interval stabilization was also assessed. Atrial tachycardias were excluded. Results : In a total of 101 patients included in the study, ORT was diagnosed in 64 patients and ANRT in 37. ΔVA interval was 0 (interquartile range [IQR] 0-5) milliseconds (ms) in ORT vs. 40 (21-55) ms in ANRT (p <0.001). The VA interval significantly stabilized earlier in ORT (1.5 [1-3] beats) than in ANRT (5 [4-7] beats) (p<0.001). A ΔVA <10 ms diagnosed ORT with 100% sensitivity, specificity, and positive and negative predictive values. Ventriculoatrial interval stabilization in less than 3 beats predicted ORT with good diagnostic accuracy. The results were similar considering only accessory septal pathways. Typical NRTs presented an intermediate variation. Conclusion : Presence of DVA <10 ms is a simple criterion that accurately differentiates ORT from ANRT, independently of the accessory pathway localization.

Histological Techniques for the Study of the Dentogingival Junction: A Scoping Review Using the Anatomical Quality Assurance Checklist (AQUA) / Técnicas Histológicas para el Estudio de la Unión Dentogingival: Una Revisión de Alcance Utilizando el Anatomical Quality Assurance Checklist (AQUA)

SUMMARY: The dentogingival junction (DGJ) is an adaptation of the oral mucosa composed of epithelial and connective tissues intimately related with the mineralised tissues of the tooth. The histological evidence available is mainly based on studies in animals, separate evaluations of hard and soft tissues, and studies using conventional histological techniques that eliminate the enamel from preparations. The aim of this study was to carry out a review of the existing evidence on histological techniques available for study of the tooth and periodontium in conjunction in humans. A scoping review was carried out of the available literature referring to study of the tooth and the periodontium in conjunction in humans, in the Web of Science (WoS), EMBASE, Scopus and SciELO databases, using the terms "Histological Techniques"[Mesh]) and "Epithelial Attachment"[Mesh]. One hundred and fifty-nine articles were found, of which 54 were selected for full- text reading. Ten were finally included in the qualitative synthesis, and we applied the Anatomical Quality Assurance (AQUA) checklist for analysis the methodological quality of the selected articles. The results showed that the only articles with a low risk of bias in all five domains according to the AQUA criteria corresponded to Silva et al. (2011) and Agustín-Panadero et al. (2020). Finally, we conclude that the quality of the histological sections to observe tissues that simultaneously contain the tooth and the periodontium, is conditioned by the selected technique and by the care required in certain specific tasks during the histological processing of the samples.

La unión dentogingival (DGJ) es una adaptación de la mucosa oral compuesta por tejidos epitelial y conectivo íntimamente relacionados con los tejidos mineralizados del diente. La evidencia histológica disponible se basa principalmente en estudios en animales, evaluaciones separadas de tejidos duros y blandos y estudios utilizando técnicas histológicas convencionales que eliminan el esmalte de las preparaciones. El objetivo de este estudio fue realizar una revisión de la evidencia existente sobre las técnicas histológicas disponibles para el estudio del diente y el periodonto en conjunto en humanos. Se realizó un scoping review de la literatura disponible referente al estudio del diente y el periodonto en conjunto en humanos, en las bases de datos Web of Science (WoS), EMBASE, Scopus y SciELO, utilizando los términos "Histological Techniques"[Mesh]) y "Epithelial Attachment"[Mesh]. Se encontraron 159 artículos, de los cuales 54 fueron seleccionados para lectura de texto completo. Diez fueron finalmente incluidos en la síntesis cualitativa, y se aplicó la lista de verificación Anatómica Quality Assurance (AQUA) para el análisis de la calidad metodológica de los artículos seleccionados. Los resultados mostraron que los únicos artículos con bajo riesgo de sesgo en los cinco dominios según los criterios AQUA correspondían a Silva et al. (2011) y Agustín-Panadero et al. (2020). Finalmente, concluimos que la calidad de los cortes histológicos para observar los tejidos que contienen simultáneamente el diente y el periodonto, está condicionada por la técnica seleccionada y por el cuidado requerido en ciertas tareas específicas durante el procesamiento histológico de las muestras.

Diagnóstico y tratamiento de los tumores de la unión esofagogástrica. Experiencia en el Instituto Nacional de Cancerología / Diagnosis and treatment of esophagogastric junction tumors. Experience at the National Cancer Institute

Introducción. El diagnóstico adecuado de los tumores de la unión esofagogástrica es esencial para el tratamiento de estos pacientes. La clasificación propuesta por Siewert-Stein define las características propias, factores de riesgo y estrategias quirúrgicas según la localización. El objetivo de este estudio fue describir las características de los pacientes con adenocarcinoma de la unión esofagogástrica tratados en nuestra institución. Métodos. Estudio retrospectivo, descriptivo, de corte longitudinal, que incluyó los pacientes con diagnóstico de adenocarcinoma de la unión esofagogástrica intervenidos quirúrgicamente en el Instituto Nacional de Cancerología, Bogotá, D.C., Colombia, entre enero de 2012 y mayo de 2017. Resultados. Se operaron 59 pacientes (84,7 % hombres), con una edad media de 62,5 años. En su orden de frecuencia los tumores fueron tipo II (57,6 %), tipo III (30,7 %) y tipo I (11,9 %). El 74,6 % recibieron neoadyuvancia y se realizó gastrectomía total en el 73 % de los pacientes. La concordancia diagnóstica moderada con índice Kappa fue de 0,56, difiriendo con la endoscópica en 33,9 %. El 10,2 % de los pacientes presentó algún tipo de complicación intraoperatoria. La supervivencia a tres años en los tumores tipo II fue del 89,6 % y del 100 % en aquellos con respuesta patológica completa. Conclusión. Es necesario el uso de diferentes estrategias para un proceso diagnóstico adecuado en los tumores de la unión esofagogástrica. En esta serie, los pacientes Siewert II, aquellos que recibieron neoadyuvancia y los que obtuvieron una respuesta patológica completa, tuvieron una mejor supervivencia a tres años

Introduction: Proper diagnosis of gastroesophageal junction tumors is essential for the treatment of these patients. The classification proposed by Siewert-Stein defines its own characteristics, risk factors and surgical strategies according to the location. This study describes the characteristics of patients with adenocarcinoma of the esophagogastric junction treated at our institution. Methods. Retrospective, descriptive, longitudinal study, which includes patients diagnosed with adenocarcinoma of the esophagogastric junction who underwent surgery at the National Cancer Institute in Bogotá, Colombia, between January 2012 and May 2017. Results. Fifty-nine patients (84.7% men) were operated on, with a mean age of 62.5 years. In their order of frequency, the tumors were type II (57.6%), type III (30.7%) and type I (11.9%). 74.6% received neoadjuvant therapy and total gastrectomy was performed in 73% of the cases. The moderate diagnostic concordance with the Kappa index was 0.56, differing from the endoscopic one in 33.9%. 10.2% of the patients presented some type of intraoperative complication. Three-year survival in type II tumors was 89.6% and 100% in those with complete pathologic response. Conclusion. The use of different strategies is necessary for an adequate diagnostic process in tumors of the esophagogastric junction. In this series, Siewert II patients, those who received neoadjuvant therapy, and those who obtained a complete pathological response had a better three-year survival

Bond strength comparison among 10-MDP-containing and non-10-MDP-Containing adhesives in different degrees of dental fluorosis / Comparación de fuerza de unión entre adhesivos que contienen y no contienen 10-MDP en diferentes grados de fluorosis dental

Dental fluorosis can cause changes in the enamel surface, conditioning its functionality and esthetics. The application of dental adhesives is a treatment option; however, their use on fluorotic teeth can result in limitations. The aim of this study was to compare the shear bond strength of two different adhesives, one with 10-MDP and one without 10-MDP, in different degrees of dental fluorosis.This is an in vitro study on dental enamel samples, a total of 180 samples with the inclusion criteria were treated, randomly divided into two groups of 90, according to the type of dental adhesive, where each group was again divided into three groups of 30 samples, representing different degrees of dental fluorosis according to the Thylstrup-Fejerskov index (Group I: TF1 and TF2; Group II: TF3; Group III: TF4). Normality tests, two-factor ANOVA, and post-hoc tests were used to determine differences between the groups, with a significance level of 95%. As results, a statistically significant difference was shown between the use of dental adhesive with 10-MDP and the three groups of dental fluorosis (p=0.011), in addition, a Tukey post-hoc test on the groups treated with 10-MDP adhesive revealed a statistically significant difference between group I versus group II, and group I versus group III, (p=<0.05). It is concluded that the use of adhesive systems with 10-MDP presents a better shear bond strength on enamel with dental fluorosis grades I and II in the Thylstrup-Fejerskov index.

La fluorosis dental puede ocasionar cambios en la superficie del esmalte, condicionando su funcionalidad y estética, la aplicación de adhesivos dentales es una opción de tratamiento, sin embargo, su uso en dientes fluoroticos puede resultar en limitaciones. El objetivo de este estudio consistió en comparar la fuerza de adhesión a la cizalladura de dos diferentes adhesivos, uno con 10-MDP y otro sin 10-MDP, en diferentes grados de fluorosis dental. Se trata de un estudio in vitro en muestras de esmalte dental, un total de 180 muestras con los criterios de inclusión fueron tratadas, aleatoriamente divididas en dos grupos de 90, de acuerdo al tipo de adhesivo dental, donde cada grupo fue dividido nuevamente en tres grupos de 30 muestras, representando diferentes grados de fluorosis dental según el índice de Thylstrup- Fejerskov (Grupo I: TF1 y TF2; Grupo II: TF3; Grupo III: TF4). Para determinar diferencias entre los grupos se utilizaron pruebas de normalidad, ANOVA de dos factores, y pruebas post-hoc, con un nivel de significancia de 95%. Como resultados, se mostró una diferencia estadísticamente significativa entre el uso de adhesivo dental con 10- MDP y los tres grupos de fluorosis dental (p=0.011), además, una prueba post hoc de Tukey sobre los grupos tratados con adhesivo 10-MDP revelaron una diferencia estadísticamente significativa entre el grupo I frente al grupo II, y el grupo I frente al grupo III, (p=<0.05) Se concluye que el uso de sistemas adhesivos con 10-MDP presentan una mejor resistencia de adhesión al cizallamiento en esmalte con grados de fluorosis dental I y II en el índice de Thylstrup-Fejerskov

Evaluation of the normal craniocervical junction craniometry in 137 asymptomatic patients / Evaluación de la craneometría de la unión craneocervical normal en 137 pacientes asintomáticos

SUMMARY: To our best knowledge, most of the craniometric studies on the normal craniocervical junction (CCJ), are still poorly studied and based on measurements taken from plain radiographs. In this study, the authors conducted a craniometric evaluation of the CCJ in a population without known CCJ abnormalities. The purpose of the study was to assess the normal CCJ craniometry based on measures obtained from CT scans. The authors examined 137 consecutive CCJ CT scans obtained in patients evaluated at their hospital for treatment of non-CCJ conditions between 2018 and 2019. Twelve craniometrical dimensions were conducted, including the relation of the odontoid with the cranial base, the atlantodental interval (ADI), the clivus length, and the clivus-canal angle (CCA).

Hasta donde sabemos, aun son escasos y pocos los estudios craneométricos respecto a la unión craneocervical normal (UCCN) y estos se basan en mediciones tomadas de radiografías simples. En este estudio, realizamos una evaluación craneométrica de la UCCN en una población sin anomalías conocidas. El propósito del estudio fue evaluar la craneometría UCCN normal en función de las medidas obtenidas de las tomografías computarizadas. Los autores examinaron 137 tomografías computarizadas UCCN consecutivas obtenidas en pacientes evaluados en su hospital para el tratamiento de condiciones no UCCN entre los años 2018 y 2019. Se realizaron doce dimensiones craneométricas, incluida la relación del proceso odontoides con la base del cráneo, el intervalo atlantodental (ADI), la longitud del clivus y el ángulo clivus-canal (CCA).

Ataxia de Friedreich, revisión y actualización de la literatura con búsqueda sistemática de casos en Latinoamérica / Friedreich's ataxia, review and literature update with a systematic search for cases in Latin America

La Ataxia de Friedreich (AF) es una enfermedad neurodegenerativa autosómica recesiva con compromiso multisistémico. En esta revisión, se actualizan aspectos epidemiológicos, fisiopatológicos y clínico-terapéuticos y se conduce una búsqueda sistemática de casos de AF reportados en Latinoamérica. La prevalencia de AF en poblaciones caucásicas es estimada entre 2 y 5 casos por 100 000 habitantes. En Latinoamérica se han publicado 35 estudios que reúnen 1481 casos en 6 países. Causada por la expansión anormal de repeticiones GAA en el gen FXN, la etiopatogenia está asociada a una reducción en los niveles de la proteína frataxina (que altera el metabolismo energético) y el acúmulo de hierro mitocondrial. El fenotipo clásico de AF suele comenzar antes de los 25 años, aunque hay otros de inicio tardío y retención de reflejos. La sintomatología se caracteriza por ataxia progresiva, alteración sensitiva, arreflexia, disartria, y alteraciones oculomotoras, además de compromiso cardiaco, endocrino y musculoesquelético. El diagnóstico requiere evaluación neurológica detallada, estudios neurofisiológicos, neuroimágenes y pruebas bioquímicas pero el enfoque determinante es el estudio genético que demuestre variantes genéticas bialélicas en el gen FXN. El manejo es multidisciplinario, orientado a aminorar los síntomas, prevenir complicaciones y brindar asesoramiento genético apropiado. Recientemente se ha aprobado el primer tratamiento farmacológico para AF con varios más en fases de experimentación.

SUMMARY Friedreich Ataxia (FA) is an autosomal recessive neurodegenerative disease with multisystemic involvement. This update of epidemiological, pathophysiological, and clinico-therapeutic aspects of FA, includes a systematic review of cases in Latin America. The estimated FA prevalence in Caucasian populations is between 2 to 5 cases per 100 000. In Latin America, 1481 cases have been published in 35 articles from six different countries. Caused by an abnormally repeated expansion of GAA trinucleotide inside the FXN gene, FA's etiopathogenesis is associated with reduced levels of the frataxin protein, which disturb the energy metabolism and result in mitochondrial iron accumulation. The classic phenotype usually shows symptoms before the age of 25, although there are others with a later onset. The main symptoms of AF are progressive ataxia, sensory disturbances, areflexia, dysarthria, and oculomotor alterations, in addition to cardiac, endocrine, and musculoskeletal compromise. Diagnostic workup requires a detailed neurological examination, neuroconduction studies, neuroimaging, and biochemical tests. The definitive diagnosis is provided by genetic testing showing biallelic variants within the FXN gene. The management is multidisciplinary, aimed at reducing symptoms, preventing complications, and providing an appropriate genetic counseling. Recently, the first pharmacological treatment for AF has been approved, with several others in clinical assessment trials.

Diferencia de edad entre cónyuges por nivel educativo en América Latina. El caso de Bolivia, Ecuador y Uruguay / Diferença de idade entre cônjuges por nível de escolaridade na América Latina. O caso de Bolívia, Equador e Uruguai / Spousal age difference by education in Latin America. The case of Bolivia, Ecuador and Uruguay

Resumen El objetivo del estudio es hacer un análisis descriptivo de la asociación entre la educación y la diferencia de edad entre los cónyuges en uniones de distinto sexo y conocer cómo ha evolucionado esta relación a lo largo de las cohortes en las últimas décadas a la luz del incremento del nivel educativo de la población en América Latina, en particular de las mujeres. Se hizo un análisis descriptivo utilizando muestras de rondas censales desde 1970 hasta 2010 de tres países de la región, Bolivia, Ecuador y Uruguay, seleccionando a hombres y a mujeres de 25 a 29 años de edad. Tanto en hombres como en mujeres, no se observa en general un descenso significativo de la diferencia etaria a lo largo de las cohortes. Mientras en las mujeres se observó una relación negativa entre la diferencia etaria entre cónyuges y nivel educativo, en los hombres se constató mayor heterogeneidad entre los países.

Resumo O objetivo do estudo é realizar uma análise descritiva da associação entre escolaridade e diferença de idade entre cônjuges em uniões de diferente sexo e como essa relação evoluiu ao longo das coortes nas últimas décadas em função do aumento da escolaridade da população da América Latina, especialmente para as mulheres. Foram utilizadas amostras de rodadas dos censos de 1970 a 2010 de três países da região − Bolívia, Equador e Uruguai −, selecionando homens e mulheres de 25 a 29 anos de idade. Para o total da amostra, não foi observada diminuição significativa na diferença de idade ao longo das coortes. Para as mulheres, verificou--se relação negativa entre a diferença de idade entre os cônjuges e a escolaridade. Para os homens, observou-se maior heterogeneidade entre os países.

Abstract The purpose of this study is to investigate the association between education and the age gap between spouses in heterosexual unions. The study also examines how this association has changed over time in different cohorts, especially among women, in the context of educational expansion in Latin America. The research used the data collected from census rounds conducted between 1970 and 2010 in Bolivia, Ecuador, and Uruguay. The sample included men and women aged between 25 to 29. The findings reveal that there was no significant decrease in the age difference throughout the cohorts for both men and women. However, a negative relationship was observed between the spousal age difference and educational level in women. On the other hand, men showed greater heterogeneity between countries.

Application of union physio-psycho-social assessment questionnaire in screening anxiety and depression in outpatients from general hospital / 中华行为医学与脑科学杂志

Objective:To explore the application of union physio-psycho-social assessment questionnaire (UPPSAQ-70) in screening anxiety and depression in outpatients from general hospital.Methods:A total of 510 outpatients from Peking Union Medical College Hospital from June 2020 to November 2021 were recruited.They were assessed with UPPSAQ-70, self-rating anxiety scale (SAS) and self-rating depression scale (SDS). The internal consistency of the UPPSAQ-70 was tested by Cronbach′s α coefficient.The convergent validity of the UPPSAQ-70 was evaluated by examining correlations with the SAS and SDS.Clinical diagnosis, being considering as the " gold standard" , was used to test criterion validity.Result:The UPPSAQ-70 showed good item characteristics and reliability (Cronbach α=0.947). The UPPSAQ-70 total score showed significant correlations with SAS( r=0.843, P<0.01) and SDS ( r=0.852, P<0.01). The area under the curve (AUC) of the UPPSAQ-70 was 0.875 ( P<0.01), the cut-off value was 65 points with the sensitivity 83.2% and the specificity 75.5%.The AUC of the SAS and SDS was 0.848 and 0.808 respectively(both P<0.001). For the SAS(standard score of 50 as the cut-off value), the sensitivity was 47.3%, and specificity was 92.5%.For the SDS(standard score of 53 as the cut-off value), the sensitivity was 62.9%, and specificity was 86.8%. Conclusion:UPPSAQ-70 has high sensitivity and is more suitable for screening of anxiety and depression in general hospital outpatients.

Clinical efficacy of acupoint application therapy combined with pressing needle in the treatment of acute exacerbation of chronic obstructive pulmonary disease / 中国基层医药

Objective:To investigate the clinical efficacy of acupoint application therapy combined with pressing needle therapy in the treatment of acute exacerbation of chronic obstructive pulmonary disease.Methods:Eighty-six patients with acute exacerbation of chronic obstructive pulmonary disease who received treatment at Lishui Hospital of Traditional Chinese Medicine from February 2022 to August 2022 were retrospectively included in this study. They were randomly divided into Group A ( n = 29), group B ( n = 29), and the combined treatment group ( n = 28) according to different treatment methods. All three groups were treated with conventional Western medicine. Based on this, group A was treated with acupoint application therapy, group B was treated with pressing needle therapy and the combined treatment group with treated with acupoint application therapy and pressing needle therapy. Clinical efficacy was compared among the three groups. Traditional Chinese medicine symptom score, pulmonary function index, blood gas index, and quality of life score pre- and post-treatment were compared among the three groups. Results:There was a significant difference in total response rate among group A [75.86% (22/29)], group B [79.31% (23/29)], and the combined treatment group [96.43% (27/28), H = 6.15, P < 0.05]. After treatment, the scores of cough, expectoration, and dyspnea in the three groups were significantly decreased compared with those before treatment (all P < 0.05). After treatment, the scores of cough, expectoration, and dyspnea in the combined treatment group were (1.79 ± 0.48) points, (2.30 ± 0.32) points, and (1.96 ± 0.43) points, respectively, which were significantly lower than those in (2.32 ± 0.41) points, (2.68 ± 0.42) points, and (2.27 ± 0.36) points in group A and (2.17 ± 0.50) points, (2.91 ± 0.43) points, and (2.33 ± 0.43) points in group B ( F = 9.81, 17.38, 6.72, all P < 0.05). After treatment, forced vital capacity (FVC), forced expiratory volume in the first second (FEV 1), and FEV 1/FVC were increased in each group compared with those before treatment (all P < 0.05). After treatment, FVC, FEV 1, and FEV 1/FVC in the combined treatment group were (3.95 ± 0.47) L, (2.01 ± 0.36) L, and (82.91 ± 13.35)%, respectively, which were significantly higher than (3.63 ± 0.59) L, (1.76 ± 0.21) L, and (73.23 ± 10.85)% in group A and (3.89 ± 0.38) L, (1.64 ± 0.37) L and (73.91 ± 7.62)% in group B ( F = 3.49, 9.80, 7.05, all P < 0.05). After treatment, blood gas indicators in each group were significantly increased compared with those before treatment (all P < 0.05). After treatment, blood oxygen partial pressure in the combined treatment group, group A and group B was (85.76 ± 3.21) mmHg, (81.05 ± 4.23) mmHg, and (80.62 ± 4.03) mmHg, respectively. The partial pressure of carbon dioxide in the three groups was (37.74 ± 5.88) mmHg, (44.32 ± 5.59) mmHg, and (43.22 ± 6.41) mmHg, respectively. There were significant differences in blood oxygen partial pressure and partial pressure of carbon dioxide among the three groups ( F = 15.50, 9.88, all P < 0.05). After treatment, the quality of life score in each group was significantly increased compared with that before treatment (all P < 0.05). After treatment, the quality of life score in the combined treatment group, group B, and group A was (43.97 ± 6.34) points, (39.16 ± 4.45) points, and (40.19 ± 4.67) points, respectively, and there was significant difference among the three groups ( F = 4.12, P < 0.001). Conclusion:In the treatment of acute exacerbation of chronic obstructive pulmonary disease, acupoint application therapy combined with pressing needle therapy is highly effective than monotherapy. The combined therapy can better improve traditional Chinese medicine symptoms and blood gas indicators, effectively enhance pulmonary function, and improve quality of life than monotherapy.

Tratamiento quirúrgico inmediato en niños con perforación espontánea de la vía biliar. Experiencias de 16 años

Introducción: La perforación espontánea de los conductos biliares es una rara enfermedad caracterizada por una disrupción no traumática de la vía biliar en pacientes aparentemente sanos. Se trata de una grave situación potencialmente letal, pero diagnosticada y tratada correctamente tiene un pronóstico excelente. Objetivo: Caracterizar los principales elementos clínico-quirúrgicos expresados en una serie de 5 pacientes operados en un servicio de referencia nacional. Presentación de casos: Se presenta la experiencia con una serie de casos en 16 años en una sola institución. La afección se observó en niñas recién nacidas y lactantes con una edad media de 4 meses, y se presentó desde la clínica como una colestasis acompañada de distensión abdominal, ascitis biliar, acolia, y signos de irritación peritoneal. El 80 % de los casos se intervinieron en el hospital "William Soler", y en un caso se ejecutó el procedimiento después de una laparotomía por una posible apendicitis aguda, en otro hospital. El diagnóstico se basó en el cuadro clínico descrito, la ecografía abdominal, la paracentesis con medición del índice bilirrubina líquido ascítico/bilirrubina sérica, y la colangiografía intraoperatoria. La cirugía definitiva se realizó inmediatamente, y consistió en: lavado peritoneal, colangiografía diagnóstica, reparación hepaticoyeyunostomía en Y de Roux y colocación de drenaje. Conclusiones: El tratamiento realizado resulta eficaz y seguro en todos los casos, con una excelente evolución, sin complicaciones importantes y con una total supervivencia posoperatoria. La colangiografía intraoperatoria permitió identificar el sitio de la perforación y diagnosticar malformaciones asociadas como dilataciones biliares congénitas y anomalías de la unión bilio-pancreática.

Introduction: Spontaneous bile duct perforation is a rare condition characterized by non-traumatic disruption of the bile duct in apparently healthy patients. It is a serious potentially lethal situation, but correctly diagnosed and treated its prognosis is excellent. Objetive: To characterize the main clinical-surgical elements expressed in a series of 5 patients operated in a national referral service. Case presentation: The experience with a series of cases during a period of 16 years in a single institution is presented. The condition was observed mainly in newborn girls and infants with an average age of 4 months, and presented clinically as cholestasis accompanied by abdominal distension, biliary ascites, acholia, and signs of peritoneal irritation. 80% of the cases were operated primarily in the "William Soler" hospital, and in one case the procedure was performed after a laparotomy for a possible acute appendicitis, in another hospital. The diagnosis was based on the clinical picture described, abdominal ultrasound, paracentesis with measurement of the ascitic liquid bilirubin/serum bilirubin index, and intraoperative cholangiography. Definitive surgery was performed immediately and consisted of: peritoneal lavage, diagnostic cholangiography, Roux-en-Y liver and jejunostomy repair and drainage placement. Conclusions: The treatment performed was effective and safe in all cases, with an excellent evolution, no major complications and total postoperative survival. Intraoperative cholangiography made it possible to identify the site of perforation and to diagnose associated malformations such as congenital biliary dilatations and anomalies of the biliary-pancreatic junction.

Avaliação da influência da agitação ultrassônica na resistência de união de dois materiais reparadores utilizados para selar perfurações na furca / Assessment of the influence of ultrasonic agitation on the joint resistance of two repairing materials used to seal perforations in the burning / Evaluación de la influencia de la agitación ultrasónica en la resistencia de la unión de dos materiales de reparación utilizados para sellar otras perforaciones

Avaliou-se a influência da utilização da agitação ultrassônica na resistência de união à dentina, por meio de push-out, proporcionada pelos cimentos MTA-Angelus branco (MTA) e Biodentine (BD), empregados no selamento de perfurações de furca. Foram utilizados 48 primeiros ou segundos molares inferiores, com raízes não fusionadas, distantes cerca de 2 mm entre si na porção cervical das mesmas. Os dentes foram acessados e, em seguida, as raízes foram seccionadas transversalmente abaixo da junção cemento-esmalte. Os dentes foram montados em blocos de silicona de adição e perfurações de furca realizadas em seus assoalhos paralelamente ao longo eixo dos dentes e perpendiculares aos assoalhos dentais. A amostra foi dividida em quatro grupos (n = 12) em função do material reparador e da utilização ou não da agitação ultrassônica (AU). Quando empregada, a AU foi aplicada em 2 ciclos de 20 segundos por meio de inserto cônico liso acionado por ultrassom piezoelétrico. Concluídos os selamentos eles foram protegidos com cimento de ionômero de vidro e os dentes imersos em PBS. Decorridos 7 dias discos com 1 mm de altura foram retirados dos assoalhos dentais com auxílio de cortadora metalográfica e levados à máquina de ensaio universal. Os resultados expressos em MPa foram submetidos aos testes ANOVA dois fatores e de Bonferroni. Os maiores valores de resistência obtidos foram no grupo Biodentine com ultrassom (29,41 MPa), seguidos em ordem decrescente pelos grupos Biodentine sem ultrassom; MTA com ultrassom e MTA sem ultrassom (3,72 MPa). Nas condições do estudo concluiu-se que o BD apresentou maior resistência de união à dentina radicular; ainda, que a agitação ultrassônica influenciou positivamente na resistência de união do material à dentina.

We evaluated the influence of the use of ultrasonic agitation on the resistance to the dentin, by means of push-out, provided by the white MTA-Angelus (MTA) and Biodentine (BD) cements, used in the sealing of drilling holes. 48 first or second lower molars were used, with unfused roots, about 2 mm apart in the cervical portion of them. The teeth were accessed and then the roots were sectioned transversely below the cementenamel junction. The teeth were mounted in addition silicon blocks and hole drills performed on their floors parallel along the axis of the teeth and perpendicular to the dental floorings. The sample was divided into four groups (n = 12) depending on the repair material and whether ultrasonic agitation (AU) was used. When employed, the AU was applied in 2 20-second cycles by means of a smooth conical insert activated by piezoelectric ultrasound. Once the seals were completed, they were protected with glass ionomer cement and the teeth immersed in PBS. After 7 days, 1 mm high disks were removed from the dental floorboards with the aid of a metallographic cutter and taken to the universal test machine. Results expressed in MPa were submitted to two-factor and Bonferroni ANOVA tests. The highest resistance values obtained were in the group Biodentine with ultrasound (29.41 MPa), followed in descending order by the groups Biodentine without ultrasound; MTA with ultrasound and MTA without ultrasound (3.72 MPa). Under the conditions of the study, it was concluded that BD showed greater resistance to root dentin binding; also, that ultrasonic agitation positively influenced the resistance of the material to dentin binding.

influencia del uso de la agitación ultrasónica sobre la resistencia de la unión a la dentina se evaluó mediante un estiramiento, proporcionado por los cementos blancos (MTA) y biodentinos (BD) MTA-Angelus, empleados en el sello de los taladros. Se utilizaron los primeros o segundos molares inferiores, con raíces sin fundir, a unos 2 mm de distancia en la porción cervical de las raíces. Se accedió a los dientes y luego las raíces se seccionaron transversalmente por debajo de la unión cemento-enamel. Los dientes se ensamblaron además bloques de silicona y agujeros de perforación en sus pisos a lo largo del eje de los dientes y perpendiculares al suelo dental. La muestra se dividió en cuatro grupos (n = 12) según el material de reparación y si se utilizó o no la agitación ultrasónica (AU). Cuando se empleó, la UA se aplicó en 2 ciclos de 20 segundos mediante una inserción cónica suave activada por ultrasonido piezoeléctrico. Una vez concluidos los sellos, se protegieron con cemento ionómero de vidrio y los dientes se sumergieron en PBS. Al cabo de 7 días, los discos de 1 mm de altura se retiraron del suelo de corte metálico y se llevaron a la máquina de ensayo universal. Los resultados expresados como MPa se presentaron a las pruebas de dos factores ANOVA y Bonferroni. Los valores de resistencia más altos obtenidos fueron en el grupo de Biodentina con ultrasonido (29,41 MPa), seguidos en orden descendente por los grupos de Biodentina sin ultrasonido; MTA de ultrasonido y MTA libre de ultrasonido (3,72 MPa). En las condiciones del estudio se concluyó que la DB mostró mayor resistencia de la unión a la dentina raíz; y que la agitación ultrasónica tuvo una influencia positiva en la resistencia del material a la dentina.

Coumel tachycardia in children / Taquicardia de Coumel en niños

Abstract Background: Coumel tachycardia is an infrequent form of supraventricular tachycardia (SVT) that usually occurs in infants and children. It is a tachycardia mediated by an accessory pathway with retrograde slow conduction that explains the classic ECG pattern with long RP' interval and negative P waves in leads II, III, and aVF. In this study, we describe the clinical course and management of Coumel tachycardia in children. Case report: We conducted a retrospective review of five consecutive pediatric patients, mean age 11 ± 3 years (range 6 to 14). The first episode of SVT was at a mean age of 10.4 ± 4.8 years (range 2 to 14) with a mean evolution of 7.4 ± 9.4 months (range 1 to 24). Pharmacological therapy was unsuccessful despite the combination of antiarrhythmic drugs. The tachycardia was incessant with a density > 85% by 24-hour Holter monitoring; one patient developed tachycardia-induced cardiomyopathy. All children underwent successful radiofrequency catheter ablation, mean 5 ± 3 applications (range 1 to 8) with a single session and with no complications. After a mean follow-up of 24 ± 16 months, all patients were asymptomatic and recurrence-free without antiarrhythmic treatment. Conclusions: Coumel tachycardia is clinically persistent and usually refractory to antiarrhythmic treatment with substantial risk of tachycardia-mediated cardiomyopathy. Catheter ablation is effective and safe in children; thus, it should be indicated promptly and based on individual selection.

Resumen Introducción: La taquicardia de Coumel es una forma poco frecuente de taquicardia supraventricular que suele presentarse en lactantes. Es una taquicardia mediada por una vía accesoria de conducción lenta retrógrada que explica el patrón ECG clásico con intervalo RP' largo y ondas P negativas en las derivaciones II, III y aVF. En este trabajo se describe el curso clínico y el manejo de la taquicardia de Coumel en niños. Caso clínico: Se llevó a cabo una revisión retrospectiva de cinco pacientes pediátricos consecutivos, con una media de edad de 11 ± 3 años (intervalos 6 a 14). El primer episodio de taquicardia 10.4 ± 4.8 años con evolución de 7.4 ± 9.4 meses. El tratamiento farmacológico fue ineficaz a pesar de la combinación de antiarrítmicos. La taquicardia era incesante con una densidad > 85% por Holter-24h; un paciente desarrolló miocardiopatía inducida por taquicardia. Todos los niños fueron sometidos a ablación con catéter y radiofrecuencia con éxito, y un promedio de 5 ± 3 aplicaciones en una sola sesión y sin complicaciones. Después de un seguimiento de 24 ± 16 meses, todos los pacientes fueron asintomáticos y libres de recurrencia sin tratamiento antiarrítmico. Conclusiones: La taquicardia de Coumel es clínicamente persistente y generalmente refractaria al tratamiento antiarrítmico con un riesgo sustancial de miocardiopatía mediada por taquicardia. La ablación con catéter es eficaz y segura en niños, por lo que debe indicarse de forma temprana y en lactantes de una selección individual.

A exigência do esporte de alta-competição e o desenvolvimento pleno dos atletas: a necessidade de uma relação simbiótica / The demands of high-competition sport and the full development of athletes: the need for a symbiotic relationship / Las exigencias del deporte de alta competición y el desarrollo pleno de los deportistas: la necesidad de una relación simbiótica

RESUMO O presente ensaio discute a Dupla Carreira (DC) em contexto europeu e a natureza simbiótica das habilidades adquiridas ao longo da vida, contribuindo para uma transição saudável ao mercado de trabalho no final da carreira esportiva. Nessa esteira evolutiva do suporte à DC fica evidente a produção conjunta do conhecimento em nível regional, nacional e internacional entre os Estados-Membros da União Europeia, assim como a proposição de políticas de amparo tanto aos atletas estudantes quanto aos atores que participam do processo de DC. A apresentação das Diretrizes para a DC em conjunto com os programas More Than Gold e EMPATIA ressaltam a importância do suprimento a nível micro, meso e macroestrutural, fornecendo experiências que induzem à ampliação do conceito de atleta estudante para sportsperson.

ABSTRACT This essay discusses the dual career (DC) in a European context and its symbiotic nature present in the skills acquired throughout life that contribute to a healthy transition to the job market at the end of the sports career. In this evolutionary path of DC support, the joint production of knowledge at a regional, national and international level, between the member states of the European Union, is evident, as well as the proposal of policies to support student athletes, and actors who participate in the DC process. The presentation of the Guidelines for DC and the More Than Gold and EMPATIA programs highlight the importance of supply at the micro, meso and macro structural level, experiences that induce the expansion of the concept of student athlete to sportsperson.

RESUMEN Este ensayo analiza la carrera dual (DC) en un contexto europeo y su naturaleza simbiótica presente en las habilidades adquiridas a lo largo de la vida que contribuyen a una transición saludable al mercado laboral al final de la carrera deportiva. Por lo tanto, el apoyo al DC destaca la producción conjunta de conocimiento a nivel regional, nacional e internacional, entre los estados miembros de la Unión Europea, así como la propuesta de políticas para apoyar a los estudiantes deportistas y actores que participan en el proceso de DC. La presentación de los Lineamientos para DC y los programas Más Than Gold y EMPATHY resaltan la importancia de ofrecer a nivel micro, meso y macro estructural, experiencias que induzcan a ampliar el concepto de estudiante deportista a sportsperson.

A Case of Paediatric Non-union of Tibia Treated With Tibialization of Fibula

Management of non-union with bone gap in tibia is difficult, especially if superimposed by infection of bone. Various modalities have been described for the treatment of gap non-union, with their own advantages and disadvantages. A case of a paediatric patient with traumatic left tibia fracture which was complicated by subsequent osteomyelitis and non-union presented to tertiary care hospital. After failure of different modalities of treatment, to provide union, the patient was managed with tibialization of fibula with fibula strut graft supported by a rush nail

A comparative study of 30 cases of fracture neck femur in young adult patients treated with partially threaded cannulated screw versus fully threaded cannulated screws

Background: Fracture neck femur (FNF) is important due to its high incidence in general population. In younger patients, trauma is the major cause of fracture neck femur. Displaced fractures are usually treated by fixation with partially threaded cannulated screws (PTS) placed in a parallel pattern. In the present study, we have explored the use of fully threaded cannulated screws (FTS) for fixation of fracture neck of femur. Aim and Objectives: The aim of our study was to analyze and compare the clinical and functional outcomes of fracture neck femur treated in both groups. Materials and Methods: A prospective randomized control analysis was conducted in the Department of Orthopedics of Rajindra Hospital and Government Medical College, Patiala, Punjab between June 2019 and December 2021 on 30 patients who were admitted with neck femur fracture in the age group between 15 and 60 years. Fifteen patients were treated with FTS and 15 were treated with PTS. Subsequent hip radiographs were taken postoperatively and analyzed for various parameters such as fracture fixation, fracture union, and reduction. Regular follow-up was done by clinical examination along with the radiological examination monthly for 3 months, then at 6th month, and 9th month. The functional outcomes of fracture neck femur treated with PTS and FTS were compared in terms of blood loss, radiological union, weight bearing, functional outcomes (in terms of Harris hip score), and post-operative complications. Results: Hip function on the operated side was evaluated and compared with the normal side as per Harris hip score. About 73.3% of patients with FTS group in this study had excellent results compared to 26.6% in PTS group, fair results were found in 13.3% in both groups, 6.6% of patients had good results with FTS group as compared to 13.3% of PTS group, and 6.6% had poor outcome with FTS group as compared to 46.6% with PTS group. In our study, mean Harris hip score was 76.6 in PTS group and 85.5 in FTS group (P = 0.044). The present study indicated that there were statistically significant differences between FTS and PTS in terms of functional outcomes and complication rates such as femoral neck shortening (P < 0.05). However, no significant differences in terms of blood loss, weight bearing, and fracture union time were observed between two groups (P > 0.05). Conclusions: FNF treated with FTS is superior than PTS in terms of functional outcomes and complication rates. Both FTS and PTS are equivalent in terms of average blood loss, weight bearing, and fracture union time.