Occurrence and subsequent development of vertical deviations in patients treated surgically for infantile esotropia

Purpose: The purpose of this study was to evaluate the onset of dissociated vertical deviation (DVD) and inferior oblique overaction (IOOA), their subsequent development, and their correlation with pre and postoperative parameters. Methods: Medical records of patients with infantile esotropia who underwent surgery between 2005 and 2017 were retrospectively reviewed. DVD and IOOA were measured before and after surgery. Patients were divided into two groups based on horizontal and vertical deviation at the time of presentation: those with infantile esotropia only (group A) and patients with infantile esotropia who developed vertical deviation (group B). Results: Out of a total of 102 patients, DVD occurrence was seen in 53 patients (51.9%) and IOOA was seen in 50 patients (48.04%). DVD was seen in 22 patients at the time of initial examination and in 31 patients postoperatively. IOOA at presentation was seen in 45 patients (44.1%) and 5 patients (8.8%) postoperatively. No statistical difference was found in the age of surgery, angle of deviation, mean follow?up, and mean refractive error within both groups. The postoperative motor outcome was statistically comparable between the two groups (P = 0.29). Sensory outcomes of fusion (P = 0.048) and stereopsis (P?value = 0.00063) were better in group A. Conclusion: No correlation was found between the age of occurrence and development of vertical deviation with refractive error, angle of deviation, age, or type of surgery. We found that motor outcomes are not affected but sensory outcomes are affected in patients with vertical deviations. This indicates that DVD and IOOA are developed due to inherent disruption of fusion and stereopsis

Effect of dwell time deviation constraint on the three-dimensional brachytherapy plans for cervical cancer / 中华放射肿瘤学杂志

Objective:To investigate the effect of dwell time deviation constraint of inverse optimization on the quality and position error robustness of three-dimensional (3D) brachytherapy plans for cervical cancer.Methods:A total of 20 patients with cervical cancer receiving 3D brachytherapy treatment in Xiangya Hospital Central South University from August 2020 to August 2021 were retrospectively selected. All plans were designed using the Eclipse treatment planning system, and the dwell time deviation constraint parameter smooth value in the system were set to 0.00, 0.25, 0.50, 0.75, and 1.00, respectively. An inverse dose volume optimization algorithm was used to generate plans with various smooth values, and the optimization conditions were the same as the original clinical plans. Key dosimetric metrics and total dwell time differences were comparatively analyzed. The applicators were intentionally subjected to position errors (0.2-1.0 cm) in 6 directions (left-right, anterior-posterior, head-foot), and the effect of various smooth values on plan quality and robustness was assessed. There were 133 plans per case and 2 660 plans for 20 patients. The results were statistically analyzed using the Wilcoxon signed-rank nonparametric test.Results:As the smooth value was increased, the modulation factor was gradually decreased and the D 2 cm3 of the bladder and rectum was increased. Plans with smooth values of 0.25, 0.50, 0.75, 1.00 had modulation factors of 0.72±0.09, 0.63±0.08, 0.55±0.08, 0.51±0.06, respectively, lower than 0.75±0.05 of the plan with the smooth value of 0.00, and all differences were statistically significant ( P=0.004, 0.002, 0.002, 0.002). The bladder D 2 cm3 of plans with smooth values of 0.50, 0.75, 1.00 were (475.4±41.0) cGy, (483.7±46.2) cGy, and (489.0±46.8) cGy, respectively, higher than (469.8±41.8) cGy of the plan with the smooth value of 0.00, with statistically significant differences (all P=0.002). The rectum D 2 cm3 of plans with smooth values of 0.50 and 0.75 plans were (413.2±93.3) cGy and (418.6±96.4) cGy, both higher than (410.2±91.5) cGy of the plan with the smooth value of 0.00, with statistically significant differences ( P=0.006, 0.010). When positional errors were introduced, the high risk clinical target volume (HR-CTV) D 90% was close for different smooth plans at most positional errors, and the differences were not statistically significant. The organs at risk D 2 cm3 of plans with the smooth value of 0.00 was lower than those of plans with other smooth values, and for the bladder and rectum, the differences were statistically significant at most positional errors (all P<0.01). Conclusions:The dwell time deviation constraint parameter exerts significant effect on the plan quality, and the smaller the value of the constraint parameter, the higher quality of the plan. The dwell time deviation constraint parameter has slight impact on the positional error robustness of dosimetric indices of targets and key organs at risk.

A method for sensitivity analysis of deviation factor for geometric correction of cone-beam CT system / 南方医科大学学报

OBJECTIVE@#To propose a sensitivity test method for geometric correction position deviation of cone-beam CT systems.@*METHODS@#We proposed the definition of center deviation and its derivation. We analyzed the influence of the variation of the three-dimensional spatial center of the steel ball point, the projection center and the size of the steel ball point on the deviation of geometric parameters and the reconstructed image results by calculating the geometric correction parameters based on the Noo analytical method using the FDK reconstruction algorithm for image reconstruction.@*RESULTS@#The radius of the steel ball point was within 3 mm. The deviation of the center of the calibration parameter was within the order of magnitude and negligible. A 10% Gaussian perturbation of a single pixel in the 3D spatial coordinates of the steel ball point produced a deviation of about 3 pixel sizes, while the same Gaussian perturbation of the 2D projection coordinates of the steel ball point produced a deviation of about 2 pixel sizes.@*CONCLUSION@#The geometric correction is more sensitive to the deviation generated by the three-dimensional spatial coordinates of the steel ball point with limited sensitivity to the deviation generated by the two-dimensional projection coordinates of the steel ball point. The deviation sensitivity of a small diameter steel ball point can be ignored.

Correlation between spinous process deviation and lumbar disc herniation in young patients / 中国骨伤

OBJECTIVE@#To explore the relationship between spinous process deviation and lumbar disc herniation in young patients.@*METHODS@#From March 2015 to January 2022, 30 treated young (under the age of 30) patients with lumbar disc herniation were included as the young group. In addition 30 middle-aged patients (quinquagenarian group) with lumbar disc herniation and 30 patients with non-degenerative spinal diseases (young non-degenerative group) were selected as control groups. The angle of the spinous process deviation was measured on CT and statistically analyzed by various groups. All the data were measured twice and the average value was taken and recorded.@*RESULTS@#The average angle of spinous process deviation in the degenerative lumbar vertebra of young patients were (3.89±3.77) degrees, similar to the (3.72±2.98) degrees of quinquagenarian patients(P=0.851). The average angle of s spinous process deviation young non-degenerative group were (2.20±2.28) degrees, significantly less than young group(P=0.040). The spinous process deviation angle of the superior vertebral of the degenerative lumbar in the young group was (4.10±3.44) degrees, which similar to the (3.47±2.87) degrees in the quinquagenarian group (P=0.447). A total of 19 young patients had the opposite deviation direction of the spinous process of the degenerative lumbar vertebra and upper vertebra, while only 7 quinquagenarian patients had this condition(P=0.02). The type of lumbar disc herniation in young patients had no significant relationship with the direction of spinous process deflection of the degenerative or upper lumbar vertebra (P>0.05).@*CONCLUSION@#Spinous process deviation is a risk factor of young lumbar disc herniation patients. If the deviation directions of adjacent lumbar spinous processes are opposite, it will increase the incidence of lumbar disc herniation in young patients. There was no significant correlation between the type of disc herniation and the deviation direction of the spinous process of the degenerative or upper lumbar vertebra. People with such anatomical variation can strengthen the stability of spine and prevent lumbar disc herniation through reasonable exercise.

Evaluation of the Results of Septum Extension Batten Graft in Patients Referred for Septorhinoplasty

Abstract Introduction Correction of caudal septal deviations has always been a challenging subject in septorhinoplasty. The septum batten extension graft (SBEG) is a new graft that has potential properties in rhinoplasty. However, few reports have evaluated the surgical outcomes of this technique. Objective The purpose of this study was to evaluate the effectiveness of SBEG in correcting caudal septal deviation. Methods This cross-sectional study was conducted on patients with caudal septal deviation undergoing septorhinoplasty using SBEG at 2 different hospitals in 2019. We then retrospectively reviewed medical records and photographs of 50 patients at the preoperative period, as well as at 1-month, and 12-month postoperatively. Gross changes in nasolabial angle, columellar show, nasal tip projection, and dorsal nasal deviation were evaluated by a photographic analysis method, and nasal obstruction was assessed by patient satisfaction with breathing. Results There was a significant difference between the mean nasolabial angle and columellar show at 1 and 12-months postoperatively, compared with the previous values (p < 0.0001). The nasolabial angles were in a favorable position with an increase of 12 to 15 degrees compared with the preoperative state. The columellar show also improved by an average of 1.2 mm and was in good condition. The postoperative dorsal nasal deviation was significantly reduced, and projection was significantly increased (3.521 ± 0.087 mm vs. 0.719 ± 0.028; p < 0.0001; p < 0.001 ). Moreover, this method had a significant favorable effect on nasal obstruction (p = 0.049). Conclusion Our results showed that septorhinoplasty using SBEG is useful for correcting caudal septal deviation, with favorable surgical outcomes, and it has responded well to all five aforementioned criteria.

Influence des facteurs épidémio-cliniques dans le résultat fonctionnel de la septoplastie: étude de 250 cas / Epidemiological and clinical predictive factors of success in septoplasty: Study of 250 patients

to describe the epidemiological and clinical aspects, to evaluate the surgical result and to identify the prognostic factors for the success of septoplasty. Methods: It was a retrospective study including 250 patients operated on for a septoplasty collected over a 6-yearperiod. The evaluation of our results was made using 2 tools: NOSE scale and the visual satisfaction scale. Results: In our series, there was a male predominance with a sex ratio of 1.4. The mean age of the patients was 32.7 years. The medical history was dominated by allergic rhinitis in 38.4% of cases. Nasal trauma was noted in 45.2% of cases. A subjective quantification of respiratory discomfort by the NOSE score made it possible to divide them into 3 groups:Group 1: Severe ON: 65.2% of cases; Group 2: Moderate ON: 31.6% of cases; Group 3: Mild ON: 3.2% of cases. Our analytical study of the epidemiological and clinical factors that may influence the functional results showed that: Severe or moderate overall discomfort, severe ON (NOSE scale> 50) or moderate (NOSE scale between 26 and 50), DS classified zone I, II, III according to the Cottle classification, a quasi-obstructive deviation were considered as a predictor of the success of septoplasty. Conclusion: Several factors can influence the results of a septoplasty that must be considered before any surgical indication.

Occurrence and influencing factors of medication deviation in elderly patients with chronic diseases / 中华老年医学杂志

Objective:To observe the occurrence of medication deviation in elderly patients with chronic diseases, and analyze the related factors leading to its occurrence.Methods:Convenience sampling method was used to select 164 elderly patients with chronic diseases who were discharged from the hospital after treatment from April 2021 to March 2022 as the study subjects.The pharmacists reviewed the patient's discharge medication and counted the occurrence of medication deviation.The patients were divided into the occurrence group and the non-occurrence group, and the relevant data of the two groups and their attending physicians were analyzed and compared. Logistic regression analysis was used to test the influencing factors of medication deviation in elderly patients with chronic diseases. Results:Medication deviation were identified in 110 of the 164 patients, and the incidence of medication deviation was 67.1%.Compared with the non-occurrence group, the number of diseases, discharge prescriptions of patients were more, the differences were statistically significant( Z=2.552, t=3.063, both P<0.05). The age of attending physicians in the occurrence group were younger, and their working years were shorter, professional title was lower compared with those in the non-occurrence group( Z=3.754, 3.713, Z=2.016, P<0.05 for all); Logistic regression analysis showed that the number of diseases and discharge prescriptions were the risk factors for medication deviation in elderly patients with chronic diseases( OR=1.260, 1.227, both P<0.05); older age and longer working years of attending physicians were the protective factors for medication deviation( OR=0.925, 0.930, both P<0.05). Conclusions:The incidence of medication deviation in elderly patients with chronic diseases in our hospital is high.Number of chronic diseases, discharge prescriptions, younger age and relatively shorter working years of attending physicians may lead to medication deviation.

Masseter muscle flap for reconstruction of intra-oral defects in patients with early cancer of posterior-inferior parts of the oral cavity / Retalho do músculo masseter para reconstrução de defeitos intraorais em pacientes com câncer inicial de partes póstero‐inferiores da cavidade oral

Abstract Introduction Early carcinomas of the oral cavity in the posterior-inferior regions poses a challenge for reconstruction due to the lack of muscle support underneath and the limited space available to use some of the frequently-used flaps. Objective This study was done to evaluate the efficacy of the superiorly based masseter muscle flap in reconstruction of intra-oral post- ablation defects in patients with early oral carcinoma of the posterior-inferior part of the oral cavity. Methods A superiorly based masseter muscle flap were used to reconstruct the post-surgical intra- oral defect in 60 patients with early squamous cell carcinoma (T < 4 cm) of the posterior-inferior part of the oral cavity. The patients were followed up at 1-week and 1-month postoperatively to check for flap viability, complications, change in mouth opening and deviation of the mandible on mouth opening. To rule out any recurrence in the oral cavity masseter flaps, the patients were followed up for 1 year. Results The flap was viable in all patients and underwent mucosalization. 7/60 patients had postoperative infections, while 2/60 patients developed an oro-cutaneous fistula which required a secondary corrective procedure. The mean ± standard deviation of change in mouth opening at 1 week postoperatively was +1.917 ± 3.36 mm, which increased to +2.633 ± 2.95 mm at 1 month after surgery. The Friedman test revealed that there was a statistically significant change in mouth opening from preoperative period to the1 week and 1 month postoperative periods (p = 0.000). Female patients showed better improvement in mouth opening postoperatively. The ipsilateral deviation of the mandible on mouth opening was between 0-5 mm in 39 patients, 5-10 mm in 17 patients and more than 10 mm in 4 patients. There were no recurrences noted in the masseter flaps used. Conclusion The study infers that the superiorly based masseter muscle flap is a reliable method for reconstruction in early oral cancer patients yielding good functional results and acceptable cosmesis with nominal postoperative complications.

Resumo Introdução Os carcinomas iniciais da cavidade oral nas regiões póstero‐inferiores representam um desafio para a reconstrução devido à falta de suporte muscular abaixo da região e ao espaço limitado disponível para o uso de alguns dos retalhos mais empregados. Objetivo Avaliar a eficácia do retalho do músculo masseter de base superior na reconstrução de defeitos intraorais pós‐ablação em pacientes com carcinoma oral inicial da parte póstero‐inferior da cavidade oral. Método Um retalho do músculo masseter de base superior foi usado para reconstruir o defeito intraoral pós‐cirúrgico em 60 pacientes com carcinoma espinocelular inicial (T < 4 cm) localizado na parte póstero‐inferior da cavidade oral. Os pacientes foram acompanhados após uma semana e um mês de pós‐operatório para verificação da viabilidade do retalho, complicações, alteração na abertura bucal e desvio da mandíbula na abertura bucal. Para descartar recidiva nos retalhos do masseter, os pacientes foram acompanhados por um ano. Resultados O retalho foi viável em todos os pacientes e foi submetido à mucolização; 7/60 pacientes tiveram infecções pós‐operatórias, enquanto 2/60 pacientes desenvolveram uma fístula orocutânea que exigiu um procedimento corretivo secundário. A média ± desvio‐padrão da alteração na abertura da boca em uma semana de pós‐operatório foi + 1,917 ± 3,36 mm, que aumentou para + 2,633 ± 2,95 mm em um mês de pós‐operatório. O teste de Friedman revelou que houve uma alteração estatisticamente significante na abertura da boca do período pré‐operatório para os períodos de uma semana e um mês de pós‐operatório (p = 0,000). Pacientes do sexo feminino apresentaram maior melhoria na abertura da boca no pós‐operatório. O desvio ipsilateral da mandíbula na abertura da boca ficou entre 0 a 5 mm em 39 pacientes, 5 a 10 mm em 17 pacientes e mais de 10 mm em 4 pacientes. Não foram observadas recidivas nos retalhos de masseter usados. Conclusão O retalho do músculo masseter com base superior é um método confiável para reconstrução em casos de câncer oral inicial, produz bons resultados funcionais e resultados cosméticos aceitáveis com complicações pós‐operatórias insignificantes.

Relationship between nasal septum morphology and nasal obstruction symptom severity: computed tomography study / Relação entre a morfologia do septo nasal e a gravidade dos sintomas de obstrução nasal: estudo de tomografia computadorizada

Abstract Introduction The impact of the nasal septum morphology on the severity of obstruction symptoms has not been fully explored. Objective This study aimed to investigate whether the morphology of the deviated nasal septum assessed by computed tomography may explain nasal obstruction severity. Methods The study included 386 patients who were referred to the computed tomography examination of the paranasal sinuses. Patient selection criteria were the absence of facial anomalies, facial trauma, nasal surgery, and sinonasal tumors. Computed tomography images were used to estimate deviated nasal septum prevalence, the prevalence of Mladina's seven types of deviated nasal septum, and to measure the deviated nasal septum angle. Nasal obstruction severity was assessed by the nasal obstruction symptom evaluation, NOSE scale. The relationship between NOSE score, deviated nasal septum morphology, and deviated nasal septum angle was performed by a statistical regression model on the reduced sample of 225 patients. Results The prevalence of deviated nasal septum was 92.7%. Type 7 deviated nasal septum was the most frequent (34.2%) followed by type 5 (26.2%) and type 3 (23.6%). The worst NOSE scores were recorded in the type 2 deviated nasal septum (45.00 ± 28.28). The mean deviated nasal septum angle in patients with nasal obstruction was 8.5° ± 3.24. NOSE scores were not significantly associated with deviated nasal septum types and angles. Conclusion Patients with different types of deviated nasal septum have different NOSE scores. Computed tomography morphology of the deviated nasal septum could not fully explain the severity of nasal obstruction.

Resumo Introdução O impacto da morfologia do septo nasal na gravidade dos sintomas obstrutivos nasais ainda não foi totalmente explorado. Objetivo Investigar se a morfologia do desvio do septo nasal avaliada pela tomografia computadorizada pode explicar a gravidade da obstrução nasal. Método O estudo incluiu 386 pacientes encaminhados para exame tomográfico de seios paranasais. Os critérios de seleção dos pacientes foram: ausência de anomalias faciais, trauma facial, cirurgia nasal e tumores nasossinusais. Imagens de tomografia computadorizada foram usadas para estimar a prevalência de desvios do septo nasal, a prevalência dos sete tipos de desvios do septo nasal de Mladina e para medir o ângulo do desvio septal. A gravidade da obstrução nasal foi avaliada pela escala Nasal Obstruction Symptom Evaluation, NOSE. A relação entre o escore da NOSE, a morfologia e o ângulo do desvio septal foi verificada por um modelo de regressão estatística em uma amostra reduzida de 225 pacientes. Resultados A prevalência de desvios do septo nasal foi de 92,7%. O desvio septal do tipo 7 foi o mais frequente (34,2%), seguido do tipo 5 (26,2%) e do tipo 3 (23,6%). Os piores escores da escala NOSE foram registrados nos desvios septais tipo 2 (45,00 ± 28,28). O ângulo médio do desvio em pacientes com obstrução nasal foi de 8,5° ± 3,24. Os escores da escala NOSE não foram significativamente associados aos tipos e ângulos do desvio septal. Conclusão Pacientes com tipos diferentes de desvios do septo nasal apresentam diferentes escores na escala NOSE. A morfologia do desvio septal à tomografia computadorizada não conseguiu explicar totalmente a gravidade da obstrução nasal.

Parks 3-step test

Background: The Parks 3-step test is an important test in the diagnosis of a single cyclovertical muscle palsy. Purpose: This video is presented to provide a simplified and easy understanding of the Parks 3-step test for post-graduate residents. Synopsis: The video contains a description of the steps to perform a 3-step test, the results of the test in a case of superior oblique palsy, the conditions that mimic a positive 3-step test, and how to identify these mimicking conditions. Highlights: This is a simple demonstration of a classic clinical diagnostic procedure.

Correlation of pattern of visual field loss by perimetry and anterior chamber angle parameters by anterior segment optical coherence tomography in primary angle-closure glaucoma

Purpose: To correlate and analyze the pattern of the visual field (VF) defects by perimetry and anterior chamber angle parameters by AS-OCT in primary angle-closure glaucoma (PACG) across varied severity levels on presentation to a tertiary eye care center. Methods: This was a cross-sectional study, which included 323 eyes of clinically diagnosed cases of PACG. Glaucoma severity was categorized according to mean deviation (MD) as mild (-6.00 dB or more), moderate (-6.01 to -12.00 dB), and severe (-12.01 to -30.00 dB). AS-OCT measured the nasal (N) and temporal (T) angle opening distance at 500 ?m (AOD 500) and 750 ?m (AOD 750), anterior chamber angle (ACA), lens vault (LV), and anterior chamber width (ACW). The VF severity was then correlated with the AS-OCT parameters using statistical analysis. Results: The mean age ± standard deviation (SD) of the patients included in the study was 56.03 ± 8.6 years, with a 1:1.2 gender ratio. The number of eyes with mild, moderate, and severe VFs were 140 (43.3%), 88 (27.24%), and 95 (29.41%), respectively. There was no statistically significant correlation in the mean anterior chamber angle parameters (AOD 500, AOD 750, ACA 500, ACA 750, LV, ACW, and axial length (AL)) among the groups. However, the correlation between AOD 500 and LV thickness was found to be significant (P = 0.0000) with a negative Spearman’s rank correlation coefficient (r = -0.3329). Conclusion: The ACA parameters obtained by AS-OCT along the horizontal axis after elimination of pupillary block by laser peripheral iridotomy do not correlate and cannot be used to assess the disease severity of PACG

Effect of septoplasty on left ventricular myocardial performance in patients with nasal septum deviation / Efeito da septoplastia no desempenho miocárdico ventricular esquerdo em pacientes com desvio de septo nasal

Abstract Introduction: Nasal septum deviation is the leading cause of upper airway obstruction. Chronic upper airway obstruction may cause myocardial injury due to chronic hypoxia. Effects of septoplasty on left venticular diastolic and sistolic functions are not well known. The myocardial performance index is an easy-to-apply and reliable parameter that reflects systolic and diastolic cardiac functions. Objective: The present study aimed to investigate the effect of nasal septoplasty on the myocardial performance index in patients with nasal septal deviation. Methods: This prospective study consisted of 50 consecutive patients who underwent septoplasty due to symptomatic prominent C- or S-shaped nasal septal deviation. Transthoracic echocardiogarphy was performed in all patients before and 3 months after septoplasty. Calculated myocardial performance indices were compared. Results: Significantly higher left ventricular myocardial performance index (0.52 ± 0.06 vs. 0.41 ± 0.04, p < 0.001), longer isovolumic relaxation time (95.0 ± 12.5 vs. 78.0 ± 8.6 ms, p < 0.001), longer isovolumic contraction time (45.5 ± 7.8 vs. 39.5 ± 8.6 ms, p < 0.001), longer deceleration time (184.3 ± 32.5 vs. 163.6 ± 45.4 ms, p = 0.004), higher ratio of transmitral early to late peak velocities (E/A) (1.42 ± 0.4 vs. 1.16 ± 0.2, p = 0.006) and shorter ejection time (270.1 ± 18.3 vs. 286.5 ± 25.8 ms, p < 0.001) were observed before septoplasty when compared to values obtained 3 months after septoplasty. Left ventricular systolic ejection fraction was similar before and after septoplasty (63.8±2.8% vs. 64.6±3.2%, p =0.224). Conclusion: Septoplasty surgery not only reduces nasal blockage symptoms in nasal septal deviation patients but also may improve left ventricular performance. Thus, treatment of nasal septal deviation without delay is suggested to prevent possible future cardiovascular events.

Resumo Introdução: O desvio do septo nasal é a principal causa de obstrução das vias aéreas superiores. A obstrução crônica das vias aéreas superiores pode causar lesão miocárdica devido à hipóxia crônica. Os efeitos da septoplastia nas funções diastólica e sistólica do ventrículo esquerdo não são bem conhecidos. O índice de desempenho miocárdico é um parâmetro confiável e fácil de aplicar que reflete as funções cardíacas sistólica e diastólica. Objetivo: Investigar o efeito da septoplastia nasal no índice de desempenho miocárdico em pacientes com desvio de septo nasal. Método: Este estudo prospectivo consistiu em 50 pacientes consecutivos submetidos a septoplastia devido a desvio de septo nasal significativo sintomático em S ou C. A ecocardiogarfia transtorácica foi feita em todos os pacientes antes e 3 meses após a septoplastia. Os índices de desempenho miocárdico calculados foram comparados. Resultados: Um valor de indice de desempenho miocárdico ventricular esquerdo significantemente maior (0,52 ± 0,06 vs. 0,41 ± 0,04, p < 0,001), tempo mais longo de relaxamento isovolumétrico (95,0 ± 12,5 vs. 78,0 ± 8,6 ms, p < 0,001), tempo mais longo de contração isovolumétrica (45,5 ± 7,8 vs. 39,5 ± 8,6 ms, p < 0,001), tempo de desaceleração mais longo (184,3 ± 32,5 vs. 163,6 ± 45,4 ms, p = 0,004), maior razão de pico de velocidade transmitral precoce e tardia (E / A) (1,42 ± 0,4 vs. 1,16 ± 0,2, p = 0,006) e menor tempo de ejeção (270,1 ± 18,3 vs. 286,5 ± 25,8 ms, p < 0,001) foram observados antes da septoplastia quando comparados aos valores obtidos 3 meses após a septoplastia. A fração de ejeção sistólica do ventrículo esquerdo foi semelhante antes e após a septoplastia (63,8 ± 2,8% vs. 64,6 ± 3,2%, p = 0,224). Conclusão: A cirurgia de septoplastia não apenas reduz os sintomas em pacientes com desvio de septo nasal, mas também pode melhorar o desempenho ventricular esquerdo. Assim, o tratamento precoce do desvio de septo nasal é sugerido para prevenir possíveis eventos cardiovasculares futuros.

Allergic rhinitis improvement after septorhinoplasty in a sample of allergic rhinitis patients with septal deviation: a quasi-experimental study

ABSTRACT BACKGROUND: Allergic rhinitis (AR) is a chronic inflammatory disease that affects almost 30% of the adult population. OBJECTIVE: To describe and compare the evolution of symptoms in patients diagnosed with AR and septal deviation prior to and following septoplasty (STP). DESIGN AND SETTING: Quasi-experimental study developed in A Coruña University Hospital. METHODS: Patients aged 18-65 years who had been diagnosed with AR and septal deviation were recruited. Obstruction airflow was evaluated before and after surgery, by means of anterior rhinomanometry (RNM). Severity symptoms and quality of life were assessed using a visual analogue scale (VAS) and the ESPRINT questionnaire, respectively. RESULTS: A total of 50 subjects underwent STP and 42 were included in this study. Their mean age at the time of surgery was 34.16 ± 9.74 years (range 18-64). Significant reductions in mean VAS and ESPRINT were observed after surgery (P < 0.01). These outcomes were considered to represent an overall improvement in quality of life. The RNM results also improved significantly, from mean values of 478.07 ± 165.4 cm3/s before STP to 826.4 ± 175.5 cm3/s afterwards (P < 0.01). CONCLUSIONS: The negative correlations of VAS and ESPRINT with RNM, from before and to after STP, demonstrate the efficacy of scales and questionnaires as objective methods for determining obstruction in the absence of rhinomanometry. Patients with allergic rhinitis and septal deviation showed improvements in obstruction severity and medication use after STP.

Analysis on 59 cases of preparation deviation in our hospital from 2017 to 2019 / 药学实践杂志

Objective To provide direction for the improvement of quality control of hospital preparations and ensure the safety for clinical use by analyzing the hospital preparation deviations in recent three years. Methods A retrospective analysis on 59 minor hospital preparation deviations from 2017 to 2019 was conducted. Brainstorming, fishbone drawing and, Minitab software were used to analyze the root causes of deviations from five aspects: personnel, machine, materials, methods and environment. The preventive and corrective measures were implemented. The results were evaluated. Results 1 significant deviation (1.7%), 24 major deviation (40.7%), and 34 minor deviation (57.6%) were identified among the 59 casses of preparation deviation. With the implementation of preventive and corrective measures, the total number of deviations in 2018 was significantly reduced compared to that in 2017. The total number of deviations in 2019 was about the same as that in 2018. The human factors need to be focused. Conclusion The pharmaceutical preparation deviations in our hospital have been reduced. The further quality improvements for pharmaceutical preparations will be carried out by following the regulations of pharmaceutical production quality management standards and pharmaceutical production supervision and administration measures.

Clinical characteristics of acute acquired comitant esotropia / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM:To describe the clinical characteristics of 20 patients with acute acquired comitant esotropia(AACE). <p>METHODS: This retrospective, observational case series study enrolled patients with AACE examined from June 2018 to May 2021 in Guangdong Jiangmen Central Hospital. The age when attacked, the duration of excessive near work before illness, symptom, refraction, AC/A, deviation and near stereopsis were analyzed. All 20 patients had unremarkable neurological finding by imageological test. <p>RESULTS: Most patients whose mean age was 24.25±5.78 years immersed in near work for more than 6h a day before illness. All patients seeked for medical help because diplopia with normal ocular motility in all directions of gaze and meaningless finding in routine ophthalmologic examinations. They were all nearsightedness whose mean spherical equivalent was -5.73±5.09D, while mean AC/A was 2.65±1.16 within the upper limit. There was no different between the distant and near deviations(<i>P</i>>0.05). Deviations might be correlated with near stereopsis(<i>P</i><0.05), however the duration from onset to treatment was irrelevant(<i>P</i>>0.05).<p>CONCLUSION: The clinical features of AACE in older children and adults who immersed excessive near work are medium myopia, diplopia, normal ocular motility, no neurological finding and limited AC/A. Moreover, it is approximate between distant and near deviations. The deviations affect near stereopsisd more, while the influence of duration from onset to treatment may be less.

Research progress on the structural features, treatments, and association with temporomandibular disorder in patients with skeletal class Ⅲ malocclusion with mandibular deviation / 口腔疾病防治

@#Skeletal angle class Ⅲ malocclusion with mandibular deviation involves the rotation and translation of the cranial base, maxilla, mandible, and soft tissue. It compromises the patients’ appearance and stomatognathic function. The treatment outcome is not satisfactory, and correct evaluation is of great significance. The causal relationship between skeletal Class Ⅲ with mandibular deviation and TMD remains controversial. This review focuses on the structural alterations of hard and soft tissue, the etiology, the choice of treatment methods, and the association with TMD in patients with skeletal class Ⅲ malocclusion with mandibular deviation. The results show that mandibular deviation is a complex disease with unclear etiology. It involves morphological changes, rotation and displacement of the cranial base, maxilla and mandible, morphological changes of the soft tissue, and occlusal changes, which also compromise the temporomandibular joint and mandibular function. Skeletal Class Ⅲ malocclusion is common in patients with mandibular deviation. Early treatment is needed; however, the treatment methods vary. The correct evaluation of the morphological changes of soft and hard tissues leading to facial asymmetry is the premise of treatment. Orthodontic and orthognathic treatment (combined with soft tissue repair when necessary) is an effective method for the treatment of skeletal class Ⅲ malocclusion with mandibular deviation. In addition, there is a close relationship between mandibular deviation and TMD, which needs to be fully considered in the design of treatment.

Influencing factors of drug application deviation in elderly diabetes mellitus patients during hospital-family transition period / 中华老年医学杂志

Objective:To explore the influencing factors of drug application deviation in elderly diabetes mellitus patients during hospital-family transition period.Methods:A total of 278 elderly diabetes mellitus patients in Henan Provincial People's Hospital from March 2019 to March 2021 were selected as the study subjects.All patients were followed up by telephone 1 week after discharge.The drug deviation evaluation tool(MDT)was used to evaluate the drug application deviation in patients during the hospital-family transition period.They were divided into drug application deviation group and non-drug application deviation group.Sociodemographic and disease-related data and medication management data were compared between the two groups.Logistic regression analysis was used to analyze the influencing factors of drug application deviation in elderly patients with diabetes mellitus during hospital-family transition period.Results:Of the 278 elderly patients with diabetes, 162(58.27%)had at least one drug application deviation during hospital-family transition period.The family care index was lower in drug application deviation group than non-drug application deviation group( Z=6.578, P<0.001).As compared with non-drug application deviation group, drug application deviation group had the higher number of drugs at discharge, and had lower scores of Morisky Medication Adherence Scale with Eight-Item(MMAS-8), had lower scores of Summary of Diabetes Self Care Activities(SDSCA)and had lower scores of Self-efficacy for Appropriate Medication Use Scale(SEAMS), with statistically significant differences( Z=10.971, 6.077, t=5.947, 14.105, all P<0.001).Binary Logistic regression analysis and forest map showed that the more number of discharge medication was a risk factor for drug application deviation during hospital-family transition period in elderly patients with diabetes mellitus( OR=4.128, P<0.001); family care index, MMAS-8 score, SDSCA score and SEAMS score were its protective factors( OR=0.343, 0.523, 0.922, 0.568, all P<0.05). Conclusions:The incidence of drug application deviation during hospital-family transition period is higher in elderly patients with diabetes mellitus.The possible protective factors are high scores of family care index, MMAS-8, SDSCA and SEAMS, and the risk factor is large number of drugs ordered by discharged doctors.Therefore, targeted intervention measures can be implemented to reduce the occurrence of drug application deviation during hospital-family transition period.

Common protocol deviations and improvement methods and precautions in drug clinical trials / 中国药房

OBJECTIVE To learn the common proto col deviation （PD）in the process of drug clinical trials and discuss the methods and precautions for preventing and reducing PD so as to provide reference for the standardization of drug clinical trials. METHODS According to Good Clinical Practice ，Notice on Issuing Guidelines for Planning and Reporting of Data Management and Statistical Analysis of Drug Clinical Trials ，Guidelines for Ethical Review of Drug Clinical Trials ，ICH E 3，ICH E 6（R2）and other regulations ，the PD reported in the relevant projects managed by the author from March 2017 to February 2022，as well as the PD found in the submission materials and project quality control ，were sorted out and statistically analyzed. RESULTS & CONCLUSIONS A total of 39 drug clinical trials were included ，and 212 subjects were selected. In all projects ，258 PDs were reported，including 28 major PD （accounting for 10.85％）and 230 ordinary PD （accounting for 89.15％）. The report of PD mainly included missed inspections/tests （93 reports，accounting for 36.05％），lack of visits （36 reports，accounting for 13.95％）， inspection/testing out-of-window （29 reports，accounting for 11.24％），dosage and usage of test drugs （28 reports，accounting for 10.85％），drug over-temperature/missing temperature （21 reports，accounting for 8.14％），etc. Avoiding and reducing the occurrence of PD requires the efforts of multiple parties ：the sponsor designs a reasonable protocol with appropriate interview rate and window period after listening to the opinions of multiple parties ；the investigators and clinical research coordinator should strengthen their own learning and training ，and be familiar with the protocol ，Good Clinical Practice and corresponding regulations；the compliance education of the subjects should be strengthened ；the institutional offices and ethics committees should conduct multi-angle and whole-process supervision and management when a drug clinical trial is approved ，in progress ，and jsyj- concluded，to ensure the safety rights and interests of the zdcxX0079） subjects and the quality of clinical trials. On this basis ，all parties should communicate effectively and timely ，report PD in time ，and conduct special studies on major PD that have com occurred and key links that are prone to PD.

Virtual surgical planning is a useful tool in the surgical management of mandibular condylar fractures / 中华创伤杂志(英文版)

PURPOSE@#The aim of this study is to evaluate the application value of virtual surgical planning in the management of mandibular condylar fractures and to provide a reliable reference.@*METHODS@#This was a prospective randomized controlled study and recruited 50 patients requiring surgical treatment for their mandibular condylar fractures. The inclusion criteria were patients (1) diagnosed with a condylar fracture by two clinically experienced doctors and required surgical treatment; (2) have given consent for the surgical treatment; and (3) had no contraindications to the surgery. Patients were excluded from this study if: (1) they were diagnosed with a non-dislocated or only slightly dislocated condylar fracture; (2) the comminuted condylar fracture was too severe to be treated with internal reduction and fixation; or (3) patients could not complete follow-up for 3 months. There were 33 male and 17 female patients with 33 unilateral condylar fractures and 17 bilateral condylar fractures included. The 50 patients were randomly (random number) divided into control group (25 patients with 35 sides of condylar fractures) and experimental group (25 patients with 32 sides of condylar fractures). Virtual surgical planning was used in the experimental group, but only clinical experience was used in the control group. The patients were followed up for 1, 3, 6 and 12 months after operation. Variables including the rate of perfect reduction by radiological analysis, the average distance of deviation between preoperative and postoperative CT measurements using Geomagic software and postoperative clinical examinations (e.g., mouth opening, occlusion) were investigated for outcome measurement. SPSS 19 was adopted for data analysis.@*RESULTS@#The average operation time was 180.60 min in the experimental group and 223.2 min in the control group. One week postoperatively, CT images showed that the anatomic reduction rate was 90.63% (29/32) in the experimental group and 68.57% (24/35) in the control group, revealing significant difference (X2 = 4.919, p = 0.027). Geomagic comparative analysis revealed that the average distance of deviation was also much smaller in the experimental group than that in the control group (0.639 mm vs. 0.995 mm; t = 3.824, p < 0.001).@*CONCLUSION@#These findings suggest that virtual surgical planning can assist surgeons in surgical procedures, reduce operative time, and improve the anatomic reduction rate & accuracy, and thus of value in the diagnosis and treatment of condylar fractures.

Prevention and treatment strategy for deviation of costal cartilage dorsal onlay graft in rhinoplasty / 中华医学美学美容杂志

Objective:To investigate the prevention and treatment for deviation of costal cartilage dorsal onlay grafts in rhinoplasty.Methods:From January 2010 to October 2020, a total of 588 patients (83 male cases, 505 female cases, age range from 25 years to 55 years, 32±4 years in average) accepted costal cartilage rhinoplasty in Shenzhen Mylike Medical Plastic Aesthetic Hospital. During the operation, various methods were used in the process of catilage selection, water bath, sculpture, treatment of nasal dorsal, graft fixation and fascial modification to prevent and treat the deformation and displacement of the costal cartilage dorsal onlay grafts.Results:The immediate postoperative photograph of 588 cases showed that costal cartilage dorsal onlay graft was put on the middle of dorsum. After a follow-up period of 396 cases from 6 to 60 months, the average follow-up period was 12.1 months, there were 44 cases happened with the deviation of dorsal onlay grafts, and deviation was managed after the second rhinoplasty surgery. There was no prolonged function sequela such as ventilation dysfunction, abnormal sensation, or hyposmia occured. 362 cases were satisfied with the aesthetic effect.Conclusions:It is particularly important to grasp the principles of managing costal cartilage in rhinoplasty and to learn how to prevent and treat postoperative complications of costal cartilage dorsal onlay graft.