Mapeamento do Potencial da Superfície Corporal durante a Despolarização Ventricular em Atletas com Intervalo PQ Prolongado após Exercício / Body Surface Potential Mapping during Ventricular Depolarization in Athletes with Prolonged PQ Interval after Exercise

Resumo Fundamento: O prolongamento do intervalo PQ, geralmente associado a um atraso na condução atrioventricular, pode estar relacionado a alterações na propagação do impulso intraventricular. Objetivo: Avaliar, por meio do mapeamento do potencial de superfície corporal (BSPM), o processo de despolarização ventricular em atletas com intervalos PQ prolongados em repouso e após o exercício. Métodos: O estudo incluiu 7 esquiadores cross-country com intervalo PQ superior a 200 ms (grupo PQ Prolongado) e 7 com intervalo PQ inferior a 200 ms (grupo PQ Normal). O BSPM de 64 derivações unipolares do tronco foi realizado antes (Pré-Ex) e após o teste ergométrico de bicicleta (Pós-Ex). Mapas equipotenciais da superfície corporal foram analisados durante a despolarização ventricular. O nível de significância foi de 5%. Resultados: Comparado com atletas com PQ Normal, o primeiro e o segundo períodos de posição estável dos potenciais cardíacos na superfície do tronco foram mais longos, e a formação da distribuição de potencial "sela" ocorreu mais tarde, no Pré-Ex, nos atletas com PQ Prolongado. No Pós-Ex, o grupo PQ Prolongado apresentou um encurtamento do primeiro e segundo períodos de distribuições de potencial estáveis e uma diminuição no tempo de aparecimento do fenômeno "sela" em relação ao Pré-Ex (para valores próximos aos do Normal -Grupo PQ). Além disso, no Pós-Ex, a primeira inversão das distribuições de potencial e a duração total da despolarização ventricular em atletas com PQ Prolongado diminuíram em comparação com o Pré-Ex e com valores semelhantes em atletas com PQ Normal. Em comparação com atletas com PQ Normal, a segunda inversão foi mais longa no Pré-Ex e Pós-Ex em atletas com PQ Prolongado. Conclusão: Atletas com PQ prolongado apresentaram diferenças significativas nas características temporais do BSPM durante a despolarização ventricular, tanto em repouso quanto após o exercício, em comparação com atletas com PQ normal.

Abstract Background: Prolongation of the PQ interval, generally associated with an atrioventricular conduction delay, may be related to changes in intraventricular impulse spreading. Objective: To assess, using body surface potential mapping (BSPM), the process of ventricular depolarization in athletes with prolonged PQ intervals at rest and after exercise. Methods: The study included 7 cross-country skiers with a PQ interval of more than 200 ms (Prolonged-PQ group) and 7 with a PQ interval of less than 200 ms (Normal-PQ group). The BSPM from 64 unipolar torso leads was performed before (Pre-Ex) and after the bicycle exercise test (Post-Ex). Body surface equipotential maps were analyzed during ventricular depolarization. The significance level was 5%. Results: Compared to Normal-PQ athletes, the first and second periods of the stable position of cardiac potentials on the torso surface were longer, and the formation of the "saddle" potential distribution occurred later, at Pre-Ex, in Prolonged-PQ athletes. At Post-Ex, the Prolonged-PQ group showed a shortening of the first and second periods of stable potential distributions and a decrease in appearance time of the "saddle" phenomenon relative to Pre-Ex (to the values near to those of the Normal-PQ group). Additionally, at Post-Ex, the first inversion of potential distributions and the total duration of ventricular depolarization in Prolonged-PQ athletes decreased compared to Pre-Ex and with similar values in Normal-PQ athletes. Compared to Normal-PQ athletes, the second inversion was longer at Pre-Ex and Post-Ex in Prolonged-PQ athletes. Conclusion: Prolonged-PQ athletes had significant differences in the temporal characteristics of BSPM during ventricular depolarization both at rest and after exercise as compared to Normal-PQ athletes.

Liver Size and its Correlation with Anthropometric Parameters and Age / El Tamaño del Hígado y su Correlación con los Parámetros Antropométricos y la Edad

SUMMARY: The liver has over 500 physiological and biochemical roles in our organism so checking of liver size and function is a part of every clinical examination. Aim of our research was to estimate liver size on computed tomography (CT) of the abdomen images and to determinate relations between liver dimensions and anthropometric parameters. The research included 99 patients, 49 men and 50 women, who were referred for CT of abdomen. We measured body height (BH) and body mass (BM), and calculated body mass index (BMI) and body surface area (BSA). Also, on CT images we measured anteroposterior (AP), laterolateral (LL) and two craniocaudal liver diameters (one at the level of midclavicular line - CCmcl, and the other was maximal - CCmax). Liver volume (LV) was calculated with formula. Our results showed that AP diameter positively correlated with BSA (r=0.30) in women. LL diameter positively correlated with BH (r=0.43), and BSA (0.31) in men. CCmcl diameter positively correlated with BH (r=0.33), BM (r=0.31), and BSA (r=0.34) in men, while in women it correlated only with BH (r=0.38). CCmax diameter positively correlated with BH (r=0.33) and BSA (r=0.33) in men. LV positively correlated with BH and BSA in both men (r=0.36, r=0.33, respectively) and women (r=0.42, r=0.31, respectively), and in men also with BM (r=0.34). LL, CCmcl, CCmax, and LV negatively correlated with aging in both sexes After the age of 60, there was a decrease in size of LL, CC diameters, as well as in LV. We concluded that liver dimensions decrease with aging, regardless of sex at the expanse of LL and CC diameters which are related to the size of body parameters, so that for a precise evaluation of liver size all three diameters should be measured, LV as well as BH, BM, and BSA.

El hígado desempeña más de 500 funciones fisiológicas y bioquímicas en nuestro organismo, por lo que comprobar el tamaño y la función de este órgano es parte de cada examen clínico. El objetivo de nuestra investigación fue estimar el tamaño del hígado mediante tomografía computarizada (TC) de imágenes del abdomen y determinar las relaciones entre las dimensiones del hígado y los parámetros antropométricos. La investigación incluyó a 99 pacientes, 49 hombres y 50 mujeres, que fueron remitidos para TC de abdomen. Medimos la altura corporal (BH) y la masa corporal (BM), y calculamos el índice de masa corporal (IMC) y el área de superficie corporal (BSA). Además, en las imágenes de TC medimos los diámetros hepáticos anteroposterior (AP), laterolateral (LL) y dos craneocaudales (uno a nivel de la línea medioclavicular - CCmcl, y el diámetro máximo - CCmax). El volumen del hígado (VI) se calculó con una fórmula. Nuestros resultados mostraron que el diámetro AP se correlacionó positivamente con BSA (r = 0,30) en mujeres. El diámetro de LL se correlacionó positivamente con BH (r=0,43) y BSA (0,31) en hombres. El diámetro CCmcl se correlacionó positivamente con BH (r=0,33), BM (r=0,31) y BSA (r=0,34) en hombres, mientras que en mujeres se correlacionó solo con BH (r=0,38). El diámetro CCmax se correlacionó positivamente con BH (r=0,33) y BSA (r=0,33) en hombres. El VI se correlacionó positivamente con BH y BSA tanto en hombres (r=0,36, r=0,33, respectivamente) como en mujeres (r=0,42, r=0,31, respectivamente), y en hombres también con BM (r=0,34). LL, CCmcl, CCmax y LV se correlacionaron negativamente con el envejecimiento en ambos sexos. Después de los 60 años, hubo una disminución en el tamaño de los diámetros LL, CC y LV. Concluimos que las dimensiones del hígado disminuyen con la edad, independientemente del sexo, en la extensión de los diámetros LL y CC que están relacionados con el tamaño de los parámetros corporales, por lo que para una evaluación precisa del tamaño del hígado se debe medir LV como BH, BM y BSA.

HAS-BLED Score for Prediction of Bleeding and Mortality After Transcatheter Aortic Valve Replacement

ABSTRACT Introduction: Bleeding after transcatheter aortic valve replacement (TAVR) is associated with increased mortality. The predictive value of the HAS-BLED score in TAVR patients is still to be evaluated. We assessed the value of the HAS-BLED score to predict in-hospital bleeding and mortality after TAVR and the impact of diferent renal impairment definitions on the predictive value of the score system. Methods: We retrospectively included 574 patients who underwent TAVR at a single center. Study outcomes were 30-day mortality and the composite endpoint of major and life-threatening bleeding as defined by The Valve Academic Research Consortium-2. The predictive value of the HAS-BLED score was calculated and compared to a modified model. The performance of the score was compared using two definitions of renal impairment. Model discrimination was tested using C-statistic and the Net Reclassification Index. Results: Bleeding occurred in 78 patients (13.59%). HAS-BLED category 3 was a significant predictor of bleeding (OR: 1.99 ]1.18- 3.37], C-index: 0.56, P=0.01). C-index increased to 0.64 after adding body surface area and extracardiac arteriopathy to the model. The Net Reclassification Index showed an increase in the predic tive value of the model by 11.4% (P=0.002). The C-index increased to 0.61 using renal impairment definition based on creatinine clearance. Operative mortality was significantly associated with the HAS-BLED score (OR: 7.54 [95% CI: 2.73- 20.82], C-index: 0.73, P<0.001). Conclusion: The HAS-BLED score could be a good predictor of in-hospital mortality after TAVR. Its predictive value for bleeding was poor but improved by adding procedure-specific factors and using creatinine clearance to define renal impairment.

Microwave sensor for recognition of abnormal nodule tissue on body surface / 生物医学工程学杂志

For the detection and identification of abnormal nodular tissues on the body surface, a microwave sensor structure loaded with a spiral resonator is proposed in this paper, a sensor simulation model is established using HFSS software, the structural parameters are optimized, and the actual sensor is fabricated. The S21 parameters of the tissue were obtained when nodules appeared by simulation, and the characteristic relationship between the difference of S21 parameters with position was analyzed and tested experimentally. The results showed that when nodules were present in normal tissues, the curve of S21 parameter difference with position change had obvious inverted bimodal characteristics, and the extreme value of S21 parameter difference appeared when the sensor was directly above the nodules, which was easy to identify the position of nodules. It provides an objective detection tool for the identification of abnormal nodular tissues on the body surface.

Role of brown adipose tissue in phlegm-dampness metabolic syndrome based on infrared thermal imaging / 中国中药杂志

This study aimed to explore the infrared manifestation and role of brown adipose tissue(BAT) in phlegm-dampness me-tabolic syndrome(MS), and to provide objective basis for clinical diagnosis and treatment of phlegm-dampness MS. Subjects were selected from the department of endocrinology and ward in the South District of Guang'anmen Hospital, China Academy of Chinese Medical Sciences from August 2021 to April 2022, including 20 in healthy control group, 40 in non phlegm-dampness MS group and 40 in phlegm-dampness MS group. General information, height and weight of the subjects were collected and body mass index(BMI) was calculated. Waist circumference(WC), systolic blood pressure(SBP) and diastolic blood pressure(DBP) was measured. Triglyceride(TG), high density lipoprotein cholesterol(HDL-C), fasting blood glucose(FBG), fasting insulin(FINS), leptin(LP), adiponectin(ADP) and fibroblast growth factor-21(FGF-21) were detected. The infrared thermal image of the supraclavicular region(SCR) of the subjects before and after cold stimulation test was collected by infrared thermal imager and the changes of infrared thermal image in the three groups were observed. In addition, the differences in the average body surface temperature of SCR among the three groups were compared, and the changes of BAT in SCR were analyzed. The results showed compared with the conditions in healthy control group, the levels of WC, SBP, DBP, TG and FPG in MS groups were increased(P<0.01), and the HDL-C level was decreased(P<0.01). Compared with non phlegm-dampness MS group, phlegm-dampness MS group had higher conversion score of phlegm dampness physique(P<0.01). According to the infrared heat map, there was no difference in the average body surface temperature of SCR among the three groups before cold stimulation. while after cold stimulation, the average body surface temperature of SCR in MS groups was lower than that in healthy control group(P<0.05). After cold stimulation, the maximum temperature of SCR and its arrival time in the three groups were as follows: healthy control group(3 min)>non phlegm-dampness MS group(4 min)>phlegm-dampness MS group(5 min). The thermal deviation of SCR was increased and the average body surface temperature of left and right sides were higher(P<0.01) in healthy control group and non phlegm-dampness MS group, while the thermal deviation of SCR did not change significantly in the phlegm-dampness MS group. Compared with that in healthy control group, the elevated temperature between left and right sides was lower(P<0.01, P<0.05), and compared with that in non phlegm-dampness MS group, the elevated temperature of left side was lower(P<0.05). The changes of the average body surface temperature of SCR in the three groups were in the order of healthy control group>non phlegm-dampness MS group>phlegm-dampness MS group. Compared with the conditions in healthy control group and non phlegm-dampness MS group, FINS, BMI and FGF-21 levels were increased(P<0.01,P<0.05), while ADP level was decreased(P<0.01, P<0.05) in phlegm-dampness MS group. Moreover, the LP level in phlegm-dampness MS group was higher than that in non phlegm-dampness MS group(P<0.01). It was observed in clinical trials that after cold stimulation, the average body surface temperature of SCR in MS patients was lower than that of the healthy people; the thermal deviation of SCR did not change significantly in the phlegm-dampness MS patients, and the difference in their elevated temperature was lower than that in the other two groups. These characteristics provided objective basis for clinical diagnosis and treatment of phlegm-dampness MS. With abnormal BAT related indicators, it was inferred that the content or activity of BAT in SCR of phlegm-dampness MS patients were reduced. There was a high correlation between BAT and phlegm-dampness MS, and thus BAT might become an important potential target for the intervention in phlegm-dampness MS.

The specificity of body surface temperature of relevant back-shu points in patients with chronic persistent asthma based on infrared thermal imaging technology / 中国针灸

OBJECTIVE@#To detect the body surface temperature of the relevant back-shu points in patients with chronic persistent asthma by infrared thermal imaging technology, and observe the specific changes of the body surface temperature of the relevant back-shu points under the condition of lung disease.@*METHODS@#Forty-five patients with chronic persistent asthma (observation group) and 45 healthy subjects (control group) were selected. The body surface temperature of bilateral Feishu (BL 13), Geshu (BL 17), Pishu (BL 20) and Shenshu (BL 23) were measured by BK-MT02A medical infrared thermography.@*RESULTS@#The body surface temperature of bilateral Feishu (BL 13), Geshu (BL 17), Pishu (BL 20) and Shenshu (BL 23) in the observation group was higher than that in the control group (P<0.01, P<0.05). The body surface temperature of bilateral Feishu (BL 13) and Geshu (BL 17) was higher than that of ipsilateral Pishu (BL 20) and Shenshu (BL 23) in the two groups (P<0.01, P<0.05). There was no statistically significant difference in body surface temperature between ipsilateral Feishu (BL 13) and Geshu (BL 17), between ipsilateral Pishu (BL 20) and Shenshu (BL 23) (P>0.05).@*CONCLUSION@#The pathological increase of body surface temperature of Feishu (BL 13), Geshu (BL 17), Pishu (BL 20) and Shenshu (BL 23) in patients with chronic persistent asthma indicates that above acupoints have specificity in reflecting lung diseases. The Feishu (BL 13) and Geshu (BL 17), which have significantly increased body surface temperature, not only provide objective basis for the pathological pathogenesis of "deficiency in origin and excess in symptom" in patients with chronic persistent asthma, but also reflect the different expressions of different acupoints on the same meridian for the lung diseases.

Risk Factors of Thrombocytopenia After Cardiac Surgery with Cardiopulmonary Bypass

ABSTRACT Introduction: Postoperative thrombocytopenia is common in cardiac surgery with cardiopulmonary bypass, and its risk factors are unclear. Methods: This retrospective study enrolled 3,175 adult patients undergoing valve surgeries with cardiopulmonary bypass from January 1, 2017 to December 30, 2018 in our institute. Postoperative thrombocytopenia was defined as the first postoperative platelet count below the 10th quantile in all the enrolled patients. Outcomes between patients with and without postoperative thrombocytopenia were compared. The primary outcome was in-hospital mortality. Risk factors of postoperative thrombocytopenia were assessed by logistic regression analysis. Results: The 10th quantile of all enrolled patients (75×109/L) was defined as the threshold for postoperative thrombocytopenia. In-hospital mortality was comparable between thrombocytopenia and non-thrombocytopenia groups (0.9% vs. 0.6%, P=0.434). Patients in the thrombocytopenia group had higher rate of postoperative blood transfusion (5.9% vs. 3.2%, P=0.014), more chest drainage volume (735 [550-1080] vs. 560 [430-730] ml, P<0.001), and higher incidence of acute kidney injury (12.3% vs. 4.2%, P<0.001). Age > 60 years (odds ratio [OR] 2.25, 95% confidence interval [CI] 1.345-3.765, P=0.002], preoperative thrombocytopenia (OR 18.671, 95% CI 13.649-25.542, P<0.001), and cardiopulmonary bypass time (OR 1.088, 95% CI 1.059-1.117, P<0.001) were positively independently associated with postoperative thrombocytopenia. Body surface area (BSA) (OR 0.247, 95% CI 0.114-0.538, P<0.001) and isolated mitral valve surgery (OR 0.475, 95% CI 0.294-0.77) were negatively independently associated with postoperative thrombocytopenia. Conclusion: Positive predictors for thrombocytopenia after valve surgery included age > 60 years, small BSA, preoperative thrombocytopenia, and cardiopulmonary bypass time. BSA and isolated mitral valve surgery were negative predictors.

Mapeamento Potencial de Superfície Corporal durante a Despolarização Ventricular em Ratos Após Exercício Exaustivo Agudo / Body Surface Potential Mapping during Ventricular Depolarization in Rats after Acute Exhaustive Exercise

Resumo Fundamento O exercício físico exaustivo pode causar alterações significantes nas propriedades elétricas do miocárdio. Objetivo Avaliar, através do mapeamento potencial de superfície corporal, a atividade elétrica do coração de ratos durante a despolarização ventricular após exercício exaustivo agudo. Métodos Ratos machos com doze semanas de idade foram submetidos a exercício agudo em esteira a 36 m/min até a exaustão. Eletrocardiogramas unipolares (ECGs) da superfície do tronco foram registrados em ratos anestesiados com zoletil três a cinco dias antes (Pré-Ex), 5 e 10 minutos após exercício exaustivo (Pós-Ex 5 e Pós-Ex 10, respectivamente) simultaneamente com ECGs nas derivações dos membros. Os mapas potenciais de superfície corporal instantâneos (BSPMs, body surface potential maps ) foram analisados durante a despolarização ventricular. Os valores de p <0,05 foram considerados estatisticamente significantes. Resultados Comparado com o Pré-Ex, uma conclusão precoce da segunda inversão de distribuições de potencial, uma conclusão precoce da despolarização ventricular, bem como uma diminuição na duração da fase média e a duração total da despolarização ventricular nos BSPMs foram reveladas no Pós-Ex5. Além disso, em comparação com o Pré-Ex, um aumento na amplitude do extremo negativo do BSPM no pico da onda R no ECG na derivação II (pico RII) e uma diminuição na amplitude do extremo negativo do BSPM a 3 e 4 ms após o pico RII foram demonstrados no Pós-Ex 5. No Pós-Ex 10, os parâmetros dos BSPMs não diferiram daqueles do Pré-Ex. Conclusão Em ratos, o exercício exaustivo agudo causa alterações reversíveis nas características temporais e de amplitude dos BSPMs durante a despolarização ventricular, provavelmente relacionadas a alterações na excitação da massa principal do miocárdio ventricular.

Abstract Background Exhaustive physical exercise can cause substantial changes in the electrical properties of the myocardium. Objective To evaluate, using body surface potential mapping, the electrical activity of the heart in rats during ventricular depolarization after acute exhaustive exercise. Methods Twelve-week-old male rats were submitted to acute treadmill exercise at 36 m/min until exhaustion. Unipolar electrocardiograms (ECGs) from the torso surface were recorded in zoletil-anesthetized rats three to five days before (Pre-Ex), 5 and 10 minutes after exhaustive exercise (Post-Ex 5 and Post-Ex 10, respectively) simultaneously with ECGs in limb leads. The instantaneous body surface potential maps (BSPMs) were analyzed during ventricular depolarization. P values <0.05 were considered statistically significant. Results Compared with Pre-Ex, an early completion of the second inversion of potential distributions, an early completion of ventricular depolarization, as well as a decrease in the duration of the middle phase and the total duration of ventricular depolarization on BSPMs were revealed at Post-Ex 5. Also, compared with Pre-Ex, an increase in the amplitude of negative BSPM extremum at the R-wave peak on the ECG in lead II (RII-peak) and a decrease in the amplitude of negative BSPM extremum at 3 and 4 ms after RII-peak were showed at Post-Ex 5. At Post-Ex 10, parameters of BSPMs did not differ from those at Pre-Ex. Conclusion In rats, acute exhaustive exercise causes reversible changes in the temporal and amplitude characteristics of BSPMs during ventricular depolarization, most likely related to alterations in the excitation of the main mass of the ventricular myocardium.

Maternal Vitamin D Status and Its Associated Environmental Factors: A Cross-Sectional Study

Vitamin D deficiency is common among women during pregnancy. This study aims to determine the prevalence of vitamin D deficiency and their shared modifiable environmental factors among pregnant women in Indonesia and Malaysia. METHODS: Blood samples of 844 third-trimester pregnant women (Indonesians: 311; Malaysians: 533) were collected to determine their serum 25(OH) D levels. Information on sun exposure and sun protection behaviours were obtained through face-to-face interviews. Dietary vitamin D intake was assessed by using a semiquantitative food frequency questionnaire. RESULTS: The prevalence of vitamin D deficiency (<30 nmol/L) among Indonesian and Malaysian pregnant women were 42.4% and 72.0%, respectively. Percentage of exposed body surface area was inversely associated with vitamin D deficiency among Indonesian pregnant women (OR = 0.21, 95% CI = 0.09-0.48). Among Malaysian pregnant women, higher intakes of dietary vitamin D were associated with lower risk of vitamin D deficiency (OR = 0.48, 95% CI = 0.29-0.81). Analysis of the combined cohorts revealed a lower risk of vitamin D deficiency among pregnant women who had a daily intake of at least 15 mcg vitamin D (OR = 0.58, 95% CI = 0.38-0.88) and exposure of more than 27% body surface area to the sunlight (OR = 0.30, 95% CI = 0.16-0.60). CONCLUSION: Despite abundant sunshine, vitamin D deficiency is prevalent among pregnant women in tropical countries. The present study suggests that nutrition education on vitamin D intake and sun exposure during pregnancy is necessary for primary prevention of vitamin D deficiency in pregnant women living in the tropical countries

Precisão de réguas endodônticas milimetradas e orifício calibrador, e avaliação da regularidade da superfície do orifício calibrador / Accuracy of endodontic millimeter rulers and calibrator hole, and evaluation of the regularity of the calibrator hole surface

Objetivo: O objetivo desse artigo foi avaliar a precisão das porções milimetrada e calibradora das réguas endodônticas, e avaliar a regularidade da superfície dos orifícios calibradores. Métodos: A porção milimetrada das réguas Angelus, Maillefer, Maquira, Microdont e Prisma foi avaliada com paquímetro eletrônico digital. Os orifícios calibradores da Maillefer, Prisma e Angelus foram medidos com um projetor de perfil. A regularidade da superfície dos orifícios calibradores foi classificada em S1 ­ sem irregularidades ou S2 ­ com regularidades. A análise de precisão das porções milimetrada e calibradora foi realizada com o teste t (p=0,05); e as frequências dos tipos de superfície, com o teste do qui-quadrado (p<0,05). Resultados: A Maillefer foi a única régua endodôntica com precisão em todos os comprimentos e orifícios. A Prisma apresentou estatisticamente mais orifícios do tipo S2, quando comparada com outras réguas endodônticas avaliadas (p<0,05). Não houve diferença estatisticamente significativa entre Angelus e Maillefer (p>0,05). Conclusão: A Maillefer apresentou precisão nas porções milimetrada e calibradora. As réguas endodônticas da Angelus não foram precisas em nenhum comprimento da parte milimetrada e não foram precisas na maioria dos orifícios calibradores. A régua endodôntica Prisma mostrou significativamente mais orifícios calibradores com irregularidades na superfície do que Angelus e Maillefer. Destaca-se a necessidade de controle de qualidade e padrões específicos para fabricação das réguas endodônticas (AU).

Objective: The aim was to evaluate the accuracy of the millimeter and calibration portion and evaluate the regularity of the calibrator orifice surfaces of the endodontic rulers. Methods: The millimeter portion of the Angelus, Maillefer, Maquira, Microdont and Prisma rulers was evaluated with an electronic digital caliper. The calibration holes of the Maillefer, Prisma and Angelus were measured with Profile Projector. The surface regularity of calibration holes was evaluated and classified in S1- without irregularities and S2- with irregularities. The accuracy analysis of the millimeter and calibration was performed with T-Test (p=0.05) and the frequencies of the surface types with Chi-square (p<0.05). Results: The Maillefer was the only rulers with accuracy in all lengths and holes. Prisma presented statistically more S2 type holes when compared with other endodontic rulers evaluated (p <0.05). There was no statistically significant difference between Angelus and Maillefer (p> 0.05). Conclusion: The Maillefer presented accuracy in the millimeter and calibration portion. Angelus endodontic rulers were not accurate at any rated length of the millimeter portion and it was not accurate in most calibration holes evaluated. Prisma endodontic ruler showed significantly more calibration holes with irregular surfaces than Angelus and Maillefer. We emphasize the need for quality control and specific standards for endodontic rulers manufacturing (AU).

Comparison of dialysis dose through real-time Kt/V by ultraviolet absorbance of spent dialysate, single-pool Daugirdas II, and Kt/BSA according to sex and age / Comparação da dose de diálise através do Kt/V em tempo real pela absorbância ultravioleta do dialisato gasto, Daugirdas II de pool único e Kt/BSA de acordo com sexo e idade

ABSTRACT Background: Kt/V OnLine (Kt/VOL) avoids inaccuracies associated with the estimation of urea volume distribution (V). The study aimed to compare Kt/VOL, Kt/V Daugirdas II, and Kt/BSA according to sex and age. Methods: Urea volume distribution and body surface area were obtained by Watson and Haycock formulas in 47 patients. V/BSA was considered as a conversion factor from Kt/V to Kt/BSA. Dry weight was determined before the study. Kt/VOL was obtained on DIALOG machines. Results: Pearson correlation between Kt/VOL vs Kt/VII and Kt/VOL vs Kt/BSA was significant for males (r = 0.446, P = 0.012 and r = -0.476 P = 0.007) and individuals < 65 years (0.457, P = 0.019 and -0.549 P = 0.004), but not for females and individuals ≥ 65 years. V/BSA between individuals < 65 and individuals ≥ 65 years were 18.28 ± 0.15 and 18.18 ± 0.16 P = 0.000). No agreement between Kt/VII vs Kt/BSA. Men and individuals > 65 years received a larger dialysis dose than, respectively, females and individuals < 65 years, in the comparison between Kt/VOL versus Kt/VII. V/BSA ratios among men and women were respectively 18.29 ± 0.13 and 18.12 ± 0.15 P = 0.000. Conclusions: Kt/VOL allows recognition of real-time dose regardless of sex and age.

RESUMO Introdução: O Kt/V OnLine (Kt/VOL) evita imprecisões associadas à estimativa da distribuição do volume de uréia (V). O estudo teve como objetivo comparar Kt/VOL, Kt/V Daugirdas II e Kt/BSA de acordo com sexo e idade. Métodos: A distribuição do volume de uréia e área de superfície corporal foram obtidas pelas fórmulas de Watson e Haycock em 47 pacientes. V/BSA foi considerado um fator de conversão de Kt/V para Kt/BSA. O peso seco foi determinado antes do estudo. Kt/VOL foi obtido através de máquinas DIALOG. Resultados: A correlação de Pearson entre Kt/VOL vs Kt/VII e Kt/VOL vs Kt/BSA foi significativa para os homens (r = 0,446, P = 0,012 e r = -0,476 P = 0,007) e indivíduos < 65 anos (0,457, P = 0,019 e -0,549 P = 0,004), mas não para mulheres e indivíduos ≥ 65 anos. A V/BSA entre indivíduos <65 e indivíduos ≥ 65 anos foi 18,28 ± 0,15 e 18,18 ± 0,16 P = 0,000). Sem concordância entre Kt/VII vs Kt/BSA. Homens e indivíduos > 65 anos receberam maior dose de diálise do que, mulheres e indivíduos <65 anos, respectivamente, na comparação entre Kt/VOL versus Kt/VII. As razões V/BSA entre homens e mulheres foram, respectivamente, 18,29 ± 0,13 e 18,12 ± 0,15 P = 0,000. Conclusões: Kt/VOL permite o reconhecimento da dose em tempo real, independentemente do sexo e idade.

Early hemodynamic profile after aortic valve replacement - a comparison between three mechanical valves

Abstract Introduction: There are scarce data comparing different mechanical valves in the aortic position. The objective of this study was to compare the early hemodynamic changes after aortic valve replacement between ATS, Bicarbon, and On-X mechanical valves. Methods: We included 99 patients who underwent aortic valve replacement with mechanical valves between 2017 and 2019. Three types of mechanical valves were used, On-X valve (n=45), ATS AP360 (n=32), and Bicarbon (n=22). The mean prosthetic valve gradient was measured postoperatively and after six months. Results: Preoperative data were comparable between groups, and there were no differences in preoperative echocardiographic data. Pre-discharge echocardiography showed no difference between groups in the ejection fraction (P=0.748), end-systolic (P=0.764) and end-diastolic (P=0.723) diameters, left ventricular mass index (P=0.348), aortic prosthetic mean pressure gradient (P=0.454), and indexed aortic prosthetic orifice area (P=0.576). There was no difference in the postoperative aortic prosthetic mean pressure gradient between groups when stratified by valve size. The changes in the aortic prosthetic mean pressure gradient of the intraoperative period, at pre-discharge, and at six months were comparable between the three prostheses (P=0.08). Multivariable regression analysis revealed that female gender (beta coefficient -0.242, P=0.027), body surface area (beta coefficient 0.334, P<0.001), and aortic prosthetic size (beta coefficient -0.547, P<0.001), but not the prosthesis type, were independent predictors of postoperative aortic prosthetic mean pressure gradient. Conclusion: The three bileaflet mechanical aortic prostheses (On-X, Bicarbon, and ATS) provide satisfactory early hemodynamics, which are comparable between the three valve types and among different valve sizes.

Effects of individual differences on the pharmacokinetics of capecitabine in cancer patients / 中国临床药理学与治疗学

AIM: To study the effects of individual differences (gender, age, body surface area, and body weight) on the pharmacokinetics of capecitabine in cancer patients in hoping of providing evidence for the rational use of capecitabine in clinic. METHODS: A total of 76 patients with various solid tumors were given a single dose of 0.6 g (0.15 g, 4 tablets) capecitabine in postprandial and blood samples were collected at multiple time points. The plasma concentration of capecitabine and its active metablolite, 5-fluorouracil (5-FU) were analyzed by HPLC-MS/MS and the pharmacokinetic parameters of the drugs were calculated by Phoenix WinNonlin7.0 software. RESULTS: Following oral administration, the C

Cálculo de la superficie corporal quemada ¿Es correcta la estimación que realizamos? / Calculating total body surface area burned: Is the estimate we use correct?

La correcta evaluación de la extensión de las quemaduras influye directamente en la terapéutica inicial instituida y la referencia al centro especializado. El objetivo de este trabajo ha sido cuantificar las diferencias de los porcentajes de superficie corporal quemada (%SCQ) estimados entre los hospitales de derivación y la Unidad de Quemados del Hospital de Pediatría Juan P. Garrahan, correspondientes a los niños internados entre los años 2014 y 2019. Se realizó una revisión retrospectiva de 221 historias clínicas digitalizadas, siendo que 154 de ellas contaban con estimaciones de %SCQ de los hospitales de derivación. Se compararon dichas estimaciones con las reales de la Unidad de Quemados con un nivel de exactitud del 100% y, además, las diferencias se expresaron como un porcentual del %SCQ real como subestimado (<20%), satisfactorio (<20 a 20%) y sobrestimado (>20%). Las variables secundarias (edad, mortalidad y estancia hospitalaria) fueron evaluadas en cada grupo. De los 154 pacientes estudiados, 36 fueron subestimados, 32 estimados satisfactoriamente y 86 fueron sobrestimados, al considerar un nivel de exactitud del 100%. La relación entre sobrestimación y estimación satisfactoria fue de 2.6:1 mientras que la subestimación y estimación satisfactoria fue 1.1:1. La relación entre sobrestimación y subestimación fue de 2.4:1. Se constató una diferencia global significativa de 5% ±10.87 DS (IC95% 3.06­6.96) entre las estimaciones de los hospitales de derivación y la Unidad de Quemados (p<0.00001), con notable inclinación a la sobrestimación. No hubo diferencias estadísticas entre las variables secundarias según los grupos (AU)

Adequate evaluation of the extent of burn wounds directly influences the initial management of the patient and the referral to a specialized center. The aim of this study was to quantify the differences in the estimated percent total body surface area (%TBSA) affected by the burns between the referring hospitals and the Burn Unit at Hospital de Pediatría Juan P. Garrahan of children admitted between 2014 and 2019. A retrospective review of 221 electronic records was conducted, in 154 of whom %TBSA was estimated at the referring hospitals. These estimates were compared with those performed at the Burn Unit with an accuracy level of 100%. In addition, the differences were expressed as a percentage of the actual %TBSA as underestimated (<20%), satisfactory (<20 to 20%), overestimated (>20%). Secondary variables (age, mortality, and hospital stay) were evaluated in each group. Of the 154 patients, %TBSA was underestimated in 36, estimated satisfactorily in 32, and overestimated in 86, considering a 100% level of accuracy. The ratio of overestimation to satisfactory estimation was 2.6:1, while the ratio of underestimation to satisfactory estimation was 1.1:1. The ratio of overestimation to underestimation was 2.4:1. A significant overall difference of 5% ±10.87 SD (95% CI 3.06­6.96) was found between the estimates of referring hospitals and the Burn Unit (p<0.00001), with a marked proclivity to overestimation. No statistical differences were found in secondary variables between the groups (AU)

Initial assessment of mortality rates of burn patients in a tertiary care hospital by total body surface area, depth and facial burns, and its correlation with serial total leucocyte count

Background: The pattern of burns in victims varies with the manner of infliction of burns. Age plays an important role in deciding the mortality and morbidity of burn victims. Other factors that decide the prognosis of burn victims are the total body surface area (TBSA), Depth of burns, and inhalational injury as evidenced by facial burns. Assessment of these epidemiological factors and inhalational injury can be done as a part of the initial evaluation. Such an assessment aid in resuscitation including emergent airway and decision making regarding the need for skin grafts or escharotomy. Serial measurement of total leucocyte count also helps in identifying the onset of infection and progress to septicaemia and increased mortality rates.Methods: As a part of the initial evaluation, we attempt to study the relation between TBSA, Depth of burns, facial burns, and total WBC count with mortality. A background of septicaemia was also noticed in the majority of patients.Results: For analysis, patients were divided into two groups- Survivors and Non-survivors. A fall in total WBC count coincided with the onset of sepsis and mortality. The other three factors also had a direct correlation with mortality rates.Conclusions: A scoring system constituting all the factors is essential as an initial diagnostic step and it will help in deciding early intubation, escharotomy, and aggressive fluid resuscitation.

Fluidoterapia y electrolitos parenterales en pediatría / Fluid therapy and electrolytes in pediatrics

RESUMEN La administración de líquidos y electrolitos parenterales es una terapia fundamental de soporte en niños agudamente enfermos si la vía oral no permite la administración de la cantidad o composición requeridas de fluidos, por ejemplo en enfermedades de tipo gastrointestinal, respiratorio, neurológico, o en el período transoperatorio. Al momento de planificar la administración de líquidos y electrolitos parenterales en niños a partir del mes de edad, se debe considerar componentes relacionados con la cantidad de líquidos a infundir considerando los requerimientos secundarios a pérdidas hídricas habituales o requerimientos para reacciones metabólicas, evaluar el grado de deshidratación para la administración de líquidos que complementen el déficit, corregir las pérdidas que se han producido secundarios a una noxa externa (enfermedad, procedimiento quirúrgico, trauma, etc.) y finalmente aportar la cantidad adecuada de fluido que permita re-establecer la perfusión tisular. Es necesario conocer los cambios instaurados basados en la evidencia actual con la finalidad de incorporar a el manejo frecuente de los pacientes considerando también la toxicidad ya sean cualitativos o cuantitativos de esta terapéutica tan necesaria en el manejo del paciente pediátrico

ABSTRACT The administration of parenteral fluids and electrolytes is a fundamental support therapy in acutely ill children if the oral route does not allow the ad-ministration of the required amount or composition of fluids, for example in gastrointestinal, respiratory, neurological, or transoperative diseas-es. When planning the administration of parenteral fluids and electrolytes in children from one month of age onwards, components related to the amount of fluids to be infused should be considered, taking into account the requirements secondary to habitual water loss or requirements for meta-bolic reactions, evaluating the degree of dehydration for the administration of fluids to supplement the deficit, correcting the losses that have oc-curred secondary to an external noxa (illness, surgical procedure, trauma, etc.) and finally providing the adequate amount of fluid to allow re-es-tablishment of tissue perfusion. It is necessary to know the changes established based on current evidence in order to incorporate to the frequent management of patients, also considering the toxicity, either qualitative or quantitative, of this therapy, so necessary in the management of the pediatric patient.

Blood pressure distribution in relation with age, anthropometric measurements and socio economic status among school children of Warangal city, Telangana, India

Background: Hypertension is the one major global burden disease, causes 7.5 million deaths i.e.12.8%. Coronary Heart Disease Prevails 3-4% rural and 8-10% of urban population under 20 year’s age in India. Two fold rise in rural & six fold rise in urban areas since four decades. Environmental and Genetic factors i.e. Sex, BSA, obesity, family history of hypertension, dietary habits, physical activity, stress, race, ethnicity and socio economic status influence on children and adolescent. Many studies have established normal standards of BP for the children of different ages and races in their countries. Indian children cannot be adopted due to differences in ethnic, socio-economic, dietetic, environmental and emotional factors.Methods: A cross sectional study done with 2422 children of 5 to 16 years age school children, selected from 13 Schools (Government and Private) of Urban and Rural areas of Warangal.Results: A linear increase in mean BP with age, sex, weight, height, social status and locality. DBP has strong negative correlation with sex. i.e. female have high DBP and children of lower class and rural area has high DBP. 54 children <85th and 95th percentile and 5 children >95th percentile has comparatively high mean BP, 27 children with history of Hypertension in parents are >85th and 95th percentiles. Positive correlation with BMI in both sexes studied. A multivariate regression study confers positive strong correlation of Mean SBP and DBP with anthropometry.Conclusions: Observed similar results of SBP and DBP in both sexes, linear Increase in mean SBP and DBP with increasing age, weight, height and BMI. Family history of hypertension and high SES had direct correlation to SBP and DBP; class I SES has higher Mean SBP than class III SES.

Outras tendências na abdominoplastia: novo desenho e importância da lipomidiabdominoplastia na cirurgia do contorno corporal / Other trends in abdominoplasty: new design and importance of lipomid- abdominoplasty in body contour surgery

Introdução: Durante os últimos anos, os princípios cirúrgicos da abdominoplastia permaneceram inalterados. Portanto, muitos resultados observados apresentam desalinhamento, cicatrizes transversais altas e retas do abdome, levando ao posicionamento final da cicatriz umbilical a ser muito próximo da cicatriz transversal, o que dá a impressão de abdome curto. Propomos que a abdominoplastia modifique a concepção básica de sua marcação, pois acreditamos que é importante posicionar a cicatriz transversal mais baixa na região medial e púbica, e mais alta nas extremidades laterais, permitindo, no nível dos flancos, a rotação dos retalhos lombares no sentido anterior em direção inferomedial. Métodos: Foram analisados de forma retrospectiva 146 pacientes portadores de deformidades abdominais e os submetemos a lipomidiabdominoplastia, marcando com forte concavidade superior e orientando os lados da cicatriz em direção à linha transversa inferior do abdômen, 4cm equidistantes da raiz da coxa. Também associamos a lipoaspiração como um tratamento complementar ao contorno corporal. Resultados: Consideramos que os parâmetros da midiabdominoplastia são aplicáveis na maioria dos casos, obtendo resultados igualmente satisfatórios, tanto nos pacientes com flacidez e lipodistrofia abdominal supraumbilical, quanto nos pacientes com abdome em avental com importante flacidez e diástase dos retos abdominais. Conclusão: É importante determinar a área da deformidade abdominal e sua classificação, para estabelecer as estratégias do tratamento e associação de procedimentos complementares. Uma marcação mais baixa, respeitando as áreas de tratamento, permitirá uma melhor cicatriz estética e um contorno corporal harmônico, além de uma adequada colocação dos elementos: cicatriz umbilical, púbis e extremidades laterais da cicatriz abdominal transversa.

Introduction: During the last few years, the surgical principles of abdominoplasty have remained unchanged. Therefore, many patients undergoing this technique have misalignment and high and straight transverse scars of the abdomen, with the final position of the umbilical scar being very close to the transverse scar, making the abdomen seem short. We propose modifying the basic concept of marking in abdominoplasty, because we believe it is important to position the transverse scar lower in the medial and pubic region and higher at the lateral ends, allowing anterior lumbar flap rotation in an inferomedial direction. Methods: We retrospectively analyzed 146 patients with abdominal defects and subjected them to lipo-mid-abdominoplasty, marking with strong upper concavity and guiding the sides of the scar towards the lower transverse line of the abdomen, 4 cm equidistant from the root of the thigh. We also define liposuction as a complementary treatment to body contouring. Results: We consider that midabdominoplasty parameters are applicable in most cases, obtaining satisfactory results both in patients with flatness and supraumbilical abdominal lipodystrophy and patients with an "apron" abdomen with considerable flaccidity and diastasis of the abdominal rectus. Conclusion: It is important to determine the area of the abdominal defect and its classification to establish treatment strategies and association with complementary procedures. A lower marking with respect to the treatment areas will allow a more aesthetic scar and a harmonic body contour as well as an adequate placement of the umbilical scar, pubis, and lateral ends of the transverse abdominal scar.

Measurement of Scars Using Structured-Light 3D Scanning in Forensic Practice / 法医学杂志

Objective To validate the accuracy and reliability of structured-light three-dimensional （SL-3D） scanning in measuring the length and area of the regular and irregular scars on body surface and discuss its value in forensic practice. Methods The lengths of 30 cases of simulated linear scars and 50 cases of linear scars after injury were measured using soft ruler, vernier caliper + thin line method, and SL-3D scanning. The areas of 35 cases of simulated patchy scars and 15 cases of patchy scars after injury were measured using length × width, film tracing with coordinate paper method, pixel method, and SL-3D scanning, and then statistically analyzed. Results The differences between the length of the simulated linear scars measured by SL-3D scanning and standard length had no statistical significance. When simulated patchy scars and patchy scars after injury were measured with high surface curvature and large irregular areas, the differences between the results of SL-3D scanning measurement and the standard area had no statistical significance. When the length of 50 cases of linear scars after injury were measured using SL-3D scanning, the correlation coefficient between the measurement results of two different investigators was 0.998, and the correlation coefficient between the two measurement results by the same investigator was 1.000. The correlation coefficient between the results of SL-3D scanning and that of vernier caliper + thin line method was 0.996. Conclusion The three-dimensional information of the scars on the body surface can be acquired using SL-3D scanning. The measurement of the length and area of the scars is not influenced by the location of scars, curvature of surface, and human factors. The measurement results are accurate, reliable and has unique advantages.