Efficacy of Dynamic Magnetic Resonance Imaging in the Diagnosis of Degenerative Cervical Myelopathy: Systematic Review Protocol / Eficácia da ressonância magnética dinâmica no diagnóstico da mielopatia cervical degenerativa: Protocolo de revisão sistemática

Abstract Cervical degenerative myelopathy (CDM) is a cervical spine condition resulting in clinical manifestations of spinal cord compression related to the chronic, non-traumatic, and progressive narrowing of the cervical spinal canal. Conventional magnetic resonance imaging (MRI) is the gold standard test to diagnose and assess the severity of CDM. However, the patient is in a neutral and static position during the MRI scan, which may devalue the dynamic factors of CDM, underestimating the risk of spinal cord injury related to cervical spine flexion and extension movements. Dynamic MRI is a promising technique to change this scenario. Therefore, the present review aims to answer the following question: "Is dynamic MRI of the cervical spine more accurate in diagnosing CDM than conventional MRI?". We will search for studies in the MEDLINE (via PubMed), Embase, Scopus, Web of Science, LILACS, and SciELO databases. The search strategy will contain a combination of terms related to cervical myelopathy and magnetic resonance imaging. Two independent reviewers will select studies, extract data, and assess the risk of bias. The synthesis of results will be descriptive, considering the main findings of the studies about the outcomes of interest.

Resumo A mielopatia cervical degenerativa (MCD) é uma doença da coluna cervical com manifestações clínicas de compressão da medula espinal relacionadas ao estreitamento crônico, não traumático e progressivo do canal vertebral cervical. A ressonância magnética (RM) convencional é o exame padrão-ouro para o diagnóstico e a avaliação da gravidade da MCD. Contudo, o paciente encontra-se em posição neutra e estática durante a realização deste exame, o que pode desvalorizar os fatores dinâmicos da MCD, subestimando o risco de lesão medular relacionados aos movimentos de flexão e extensão da coluna cervical. A RM dinâmica é uma técnica promissora para modificar esse panorama. Portanto, a presente revisão tem o objetivo de responder a seguinte pergunta: "A RM dinâmica da coluna cervical é mais precisa no diagnóstico de MCD em comparação à RM convencional?" As buscas por estudos serão realizadas nas bases de dados MEDLINE (via PubMed), Embase, Scopus, Web of Science, LILACS e SciELO. A estratégia de busca conterá combinação de termos relacionados à mielopatia cervical e à ressonância magnética. Dois avaliadores independentes irão realizar a seleção dos estudos, a extração dos dados e a avaliação dos riscos de viés. A síntese dos resultados será realizada de maneira descritiva, considerando os principais achados dos estudos relacionados aos desfechos de interesse.

Análisis In vitro de yesos dentales de alta resistencia y baja expansión disponibles en Perú / In vitro analysis of high resistance and low expansion dental plasters available in Peru

Objetivo. Comparar la dureza, estabilidad dimensional y resistencia a la compresión de los yesos dentales de alta resistencia y baja expansión disponibles en el Perú. Métodos. Se realizó un estudio descriptivo, observacional y transversal. Se confeccionaron muestras de forma cilíndrica (8) y rectangular (8), de siete yesos dentales de alta resistencia y baja expansión. Se evaluó la dureza utilizando el Durómetro Universal Identec, la estabilidad dimensional con un calibrador digital y la resistencia a compresión con la Máquina de Ensayo Universal. Para determinar si hay diferencia en cada una de estas propiedades se empleó el análisis de varianza, la prueba F y la prueba de Duncan. Además, se empleó la prueba de comparación de medias, t de Student, para evaluar si difieren con los valores de la ADA (Asociación Dental Americana). Resultados. La dureza, estabilidad dimen-sional y resistencia a la compresión promedio de los yesos dentales presentó diferencias significativas (p<0.05) entre cada uno con los promedios estándares establecidos por la ADA. Conclusiones. En relación resistencia a la compresión el 100% de los yesos analizados cumplen con los parámetros establecidos por la ADA, en relación estabilidad dimensional solo el 28.6% y el 100% no alcanzan los estándares de dureza promedio establecidos por la ADA.

Objective. To compare the hardness, dimensional stability, and compressive strength of high-strength, low-expansion dental plasters available in Peru, according to ADA criteria. Methods. A descriptive, observational and cross-sectional study was developed. A selection of 8 cylindrical-shaped samples and 8 rectangular- shaped ones, from seven high-resistance, low-expansion dental plasters were fabricated. The hardness was evaluated using the Identec Universal Durometer. Dimensional stability was evaluated with a digital caliper and compressive strength was evaluated with the Instron Universal Testing Machine. To determine if there is a difference in each of these properties, the analysis of variance, F test, and the Duncan's test were used. In addition, to assess whether these values differ from those of the ADA, the mean comparison test, student's t table, were used. Results. The hardness, dimensional stability and average compressive strength of the high-strength, low-expansion dental plasters showed that there are significant di-fferences (p<0.05) between each of the dental plasters and with the standard averages established by the American Dental Association. (ADA). Conclusions. 100% of the high-strength, low-expansion dental casts meet the parameters established by the ADA in terms of their compressive strength, only 28.6% of these comply with the ADA in terms of dimensional stability and that 100% of these do not meet the average hardness standards established by the ADA.

Comparison of glaucomatous from non-glaucomatous optic neuropathy using Bruch’s membrane opening minimum rim width optical coherence tomography measurements

Purpose: To compare glaucomatous from non?glaucomatous optic atrophy using optical coherence tomography (OCT) based on the measurement values of Bruch’s membrane opening minimum rim width (BMO?MRW), which is a difficult task otherwise due to their varied course of disease progression, treatment protocols, and systemic association to visual impairment. Methods: This study was conducted in 40 eyes, comprising 20 eyes with non?glaucomatous optic neuropathy (NGON) and 20 eyes with glaucomatous optic neuropathy (GON). All patients underwent a complete ophthalmic examination followed by an OCT optic disc scan to calculate the measurement of BMO?MRW. Results: The 5?fold cross?validated area under the curve for GON versus NGON from logistic regression models was 0.95 (95% confidence interval [CI]: 0.86–1.00) using BMO?MRW values from all sectors. The results revealed that the measurements were significantly lesser in GON than in NGON patients. Conclusion: Hence, OCT?based BMO?MRW values could be used as an additional test to compare glaucomatous with non?glaucomatous optic neuropathy patients, especially in cases of high clinical suspicion.

Supracondylar Apophysis of the Humerus: Rare Cause of High Compression of the Median Nerve / Apófise supracondilar do úmero: Causa rara de compressão alta do nervo mediano

Abstract Supracondylar apophysis (SA) is a bony prominence that originates from the anteromedial aspect of the distal humerus with a lower projection and which, although usually asymptomatic, due to the relationship with adjacent structures can cause symptoms. We describe the case of a 42-year-old woman with pain complaints radiating from her elbow to her hand, with 6 months of evolution. On objective examination, the patient had a sensory deficit in the median nerve territory and decreased grip strength. Radiographs of the distal humerus were performed, in which a bone spike was visible, and magnetic resonance imaging showed thickening of the median nerve epineurium. Electromyography showed severe axonal demyelination of the median nerve proximal to the elbow. A median nerve compression caused by a SA was diagnosed. The patient underwent surgery and, 1 year after the operation, she had a complete clinical recovery. Supracondylar apophysis is a rare, but possible and treatable cause of high median nerve compression.

Resumo A apófise supracondilar (ASC) é uma proeminência óssea que tem origem na face anteromedial do úmero distal com projeção inferior e que, apesar de habitualmente assintomática, pela relação com as estruturas adjacentes pode causar sintomatologia. Descrevemos o caso de uma mulher de 42 anos, com queixas álgicas irradiadas do cotovelo à mão, com 6 meses de evolução. Ao exame objetivo, a paciente apresentava um déficit sensorial no território do nervo mediano e diminuição da força de preensão. Foram realizadas radiografias do úmero distal nas quais era visível uma espícula óssea, e na ressonância magnética era evidente o espessamento do epineuro do nervo mediano. A eletromiografia apresentou uma desmielinização axonal grave do nervo mediano proximal ao cotovelo. Foi diagnosticada uma compressão do nervo mediano por uma ASC. A paciente foi submetida à cirurgia e 1 ano pós-operatório apresentou recuperação clínica total. A ASC é uma causa rara, mas possível e tratável da compressão alta do nervo mediano.

Acute Carpal Tunnel Syndrome due to Persistent Median Artery thrombosis: Case report / Síndrome do túnel do carpo aguda por trombose da artéria mediana: Relato de caso

Abstract Carpal tunnel syndrome is the most common compressive neuropathy of the upper limb, affecting ~ 4% of the general population. The clinical picture is characterized by pain and, mainly, paresthesia in the median nerve territory, of insidious onset and, in the most severe cases, loss of strength and atrophy of the thenar musculature is observed. It is an extremely common pathology in the daily practice of hand surgery, and in most cases, it can be treated with conservative methods. We present here an atypical case of carpal tunnel syndrome, of acute onset, triggered by persistent median artery (PMA) thrombosis, condition associated with distal embolization and hypoper-fusion of the limb.

Resumo A síndrome do túnel do carpo é a neuropatia compressiva mais comum do membro superior, afetando ~ 4% da população geral. O quadro clínico caracteriza-se por dor e, principalmente, parestesia no território do nervo mediano, de início insidioso e, nos casos mais graves, observa-se perda de força e atrofia da musculatura tenar. Trata-se de patologia extremamente comum na prática diária de cirurgia da mão, e na maior parte dos casos pode ser tratada com métodos conservadores. Apresentamos aqui um caso atípico de síndrome do túnel do carpo, de surgimento agudo, desencadeado pela trombose da artéria mediana persistente, quadro associado com embolização distal e hipoperfusão do membro.

Evaluation of the occlusal contact area of molar dental implants comparing two different thicknesses (16 µm and 200 µm) of articulating occlusal papers and forces (200 and 250 N): a pivot in vitro study

Introduction: The goal of this pilot study was to evaluate the differences between checking occlusion on implants crowns using 16 or 200 µm thickness of articulating occlusal paper, and to compare the stained occlusal area between the groups after bite forces of 200 and 250 N. Methods: It was included 10 casts of articulated-type IV gypsum, 10 NiCr crowns, articulating occlusal papers (16 µm and 200 µm thick), and a compression test machine. Compressive forces (200 and 250 N.mm) were applied on models, to check the occlusal contact area of fixed and cemented crowns. The contact areas on the crowns were measured through images obtained by the scanning electron microscope. Statistical tests were performed considering the significant level of 5% (p≤0.05). Results: The stains found using 200 µm of articulating paper were higher than those with 16 µm, independent of the force applied. However, the stains obtained in lower teeth with different strengths (200 and 250N) marked with 16 µm articulating paper were not possible to score. The articulating paper variable had significant statistical results (p=0.002), while the variables force (p=0.443) and articulating paper-force interaction (p=0.607) were not significant. The mean area found in staining using the 200 µm and 16 µm papers was, respectively, 8.3380 mm2 and 3.4759 mm2. Conclusion: It was possible to confirm that 200 µm of articulating occlusal paper showed better and significant results to stain the occlusal area, permitting a more accurate adjustment independent of the force applied.

Percutaneous vertebroplasty by percutaneous bi-level bilateral puncture for treatment of type ⅡA acute symptomatic osteoporotic thoracolumbar fractures with dense bone bands / 中华创伤骨科杂志

Objective:To evaluate the efficacy of percutaneous vertebroplasty (PVP) by percutaneous bi-level bilateral puncture in the treatment of type ⅡA acute symptomatic osteoporotic thoracolumbar fracture (ASOTLF) with dense bone bands.Methods:From March 2017 to March 2018, 65 patients (65 vertebrae) with type ⅡA ASOTLF with dense bone bands were treated at Department of Orthopaedic Trauma, Qingdao Central Hospital. They were 25 males and 40 females, with an age of (71.6±8.4) years. The time from injury to operation was (3.5±0.7) d. They were divided into 2 groups according to different treatments. In the observation group of 31 cases (31 vertebrae), PVP was conducted by percutaneous bi-level bilateral puncture; in the control group of 34 cases (34 vertebrae), PVP was conducted by percutaneous single-level bilateral puncture. The 2 groups were compared in terms of operation time, volume of polymethyl methacrylate injected, incidence of bone cement leakage, incidence of vertebral refracture, diffusive distribution of bone cement in the vertebral body, and visual analogue scale (VAS) and Oswestry dysfunction index (ODI) at postoperative 1 day and 6 months.Results:There was no significant difference in the preoperative general data between the 2 groups, showing comparability ( P>0.05). Operations were completed uneventfully in all the 65 patients. All the 65 patients were followed up for (8.2±1.2) months. There was no significant difference between the 2 groups in operation time, incidence of bone cement leakage or incidence of vertebral refracture for each vertebral body injured ( P>0.05). The volume of polymethyl methacrylate injected [(6.64±0.93) mL] and the excellent and good rate of diffusive distribution of bone cement in the vertebral body [87.1% (27/31)] in the observation group were significantly larger than those in the control group [(4.36±0.79) mL and 64.7% (22/34)] ( P<0.05). The VAS scores at postoperative 1 day and 6 months [2 (1, 2) and 1 (1, 2)] and ODIs at postoperative 1 day and 6 months (23.7%±1.6% and 18.8%±1.4%) in the observation group were significantly lower than those in the control group [2 (2, 3) and 2 (2, 2); 26.9%±4.2% and 22.1%±3.3%] ( P<0.05). The VAS scores and ODIs at postoperative 1 day and 6 months in all patients were significantly lower than those before operation ( P<0.05). Compression symptoms of the spinal cord and nerve root were observed in none of the patients. Conclusion:In the treatment of type ⅡA ASOTLF with dense bone bands, PVP by percutaneous bi-level bilateral puncture is more effective than the traditional PVP by percutaneous single-level bilateral puncture, and will not increase bone cement leakage or vertebral refracture.

Influence of paper mixing pads thickness on the compressive strength of glass ionomer cement / 北京大学学报(医学版)

OBJECTIVE@#To explore the influence of the thickness of mixed cardboard on the compressive strength of glass ionomer cement and the associated factors.@*METHODS@#Three different types of glass ionomer cements were mixed on the top of 60, 40, 20 and 1 pieces of paper (P60, P40, P20 and P1), respectively. The compressive strength of the materials was tested after solidification, and the bubble rate was calculated with the assistance of scanning electron microscope.@*RESULTS@#(1) Compressive strength: ① ChemFil Superior glass ionomer (CF): The average compressive strength of P1 group was the highest, which was significantly different from that of P40 and P60 groups (P values were 0.041 and 0.032 respectively); ② To Fuji IX GP glass ionomer (IX): The average compressive strength of P1 group was the highest, which was statistically different from that of P40 and P60 groups (P values were 0.042 and 0.038 respectively); ③ Glaslonomer FX-Ⅱ glass ionomer cement (FX): The average compressive strength of P1 group was the highest, which was statistically different from that of P20, P40 and P60 groups (P values were 0.031, 0.040 and 0.041 respectively), but there was no statistical difference among the other groups. All the three materials showed that the compressive strength of glass ions gradually increased with the decrease of the thickness of the blended paperboard, and the two materials had a highly linear negative correlation, the correlation coefficients of which were CF-0.927, IX-0.989, FX-0.892, respectively. (2) Scanning electron microscope: P1 group had the least bubbles among the three materials.@*CONCLUSION@#It indicates that the thickness of mixed cardboard has a negative correlation with the compressive strength of glass ions. The thicker the mixed cardboard is, the greater the elasticity is. Excessive elasticity will accelerate the mixing speed when the grinding glass ions. Studies have shown that the faster the speed of artificial mixing is, the more bubbles is produced.The thicker ther mixed cardboard is, the more bubblesn are generated by glass ionomer cement, and the higher the compressive strength is. Using one piece of paper board to mix glass ionomer cement has the least bubbles and can obtain higher compressive strength.

Caracterización de las lesiones compresivas de la vía visualanterior / Characterization of Compressive Lesions of the Anterior VisualPathway

Objetivo: Determinar las características clínico-epidemiológicas de los pacientes diagnosticados con lesiones compresivas de la vía visual anterior. Métodos: Se realizó un estudio descriptivo transversal durante el período comprendido entre mayo de 2018 y marzo de 2020 con 41 pacientes con diagnóstico de síndrome compresivo de la vía visual anterior atendidos en el Servicio de Neuroftalmología del Instituto Cubano de Oftalmología "Ramón Pando Ferrer". Resultados: La mayor frecuencia en cuanto a síntomas fue la disminución progresiva de la visión central. Se encontraron lesiones de tipo tumoral en 39 pacientes para el 95,1 por ciento. Los defectos hemianópticos se detectaron en el campo visual del 45 por ciento de la muestra y el 33 por ciento presentó disminución difusa de la sensibilidad retiniana. Conclusiones: La mayoría de los pacientes fueron del sexo femenino en edades medias de la vida. Predominaron las lesiones tumorales sobre las vasculares. Los macroadenomas de hipófisis y los meningiomas fueron las etiologías más frecuentes y el sitio de compresión más encontrado fue el quiasma óptico. Se detectó disminución del grosor del complejo de células ganglionares maculares en la tomografía de coherencia óptica de la mayoría de los enfermos(AU)

Objective: To determine the clinical-epidemiological characteristics of patients diagnosed with compressive lesions of the anterior visual pathway. Methods: A cross-sectional descriptive study was conducted during the period from May 2018 to March 2020 with 41 patients diagnosed with compressive syndrome of the anterior visual pathway attended at the Neurophthalmology Service of the Cuban Institute of Ophthalmology "Ramón Pando Ferrer". Results: The most frequent symptom was the progressive decrease of central vision. Tumor type lesions were found in 39 patients for 95.1 percent. Hemianoptic defects were detected in the visual field of 45 percent of the sample and 33 percent presented diffuse decrease of retinal sensitivity. Conclusions: The majority of patients were female at middle ages of life. Tumor lesions predominated over vascular lesions. Pituitary macroadenomas and meningiomas were the most frequent etiologies and the most frequent site of compression was the optic chiasm. Decreased thickness of the macular ganglion cell complex was detected in the optical coherence tomography of most of the patients(AU)

Mechanical Model for Evaluating Curative Effect of Laser on Hypertrophic Scar / 医用生物力学

:Objective To establish a mechanical model with times of laser treatment as the independent variable in treatment process of rabbit ear hypertrophic scar (HPS) by combining experimental research and numerical simulation, so as to evaluate the curative effect of HPS. Methods Firstly, the HPS model of rabbit ear was established by CO2 laser instrument, and then the HPS was treated for continuous three times by pulsed dye laser (PDL) combined with CO2 lattice laser. After each treatment, the uniaxial compressive mechanical properties of HPS were tested to fit Ogden hyperelastic model to obtain mechanical parameters of HPS during the treatment. The functional relationship between mechanical parameters of HPS and times of laser treatment was established by LM optimization algorithm. Results Mechanical parameters of HPS increased with the increase of laser treatment times, and gradually became a constant, namely, mechanical parameters of normal skin. With the increase of laser treatment times, the growth ratio of HPS mechanical parameters gradually decreased. The initial growth ratio was 60% and decreased to 4.09% after three times of treatment. Conclusions The initial curative effect of laser therapy is the most obvious, and with the relief of symptoms, the effect of single laser therapy is no longer significant.

Novel pulp capping material based on sodium trimetaphosphate: synthesis, characterization, and antimicrobial properties

Abstract Objectives: To evaluate the mechanical, physicochemical, and antimicrobial properties of four different formulations containing micro- or nanoparticles of sodium trimetaphosphate (mTMP and nTMP, respectively). Methodology: Four experimental groups were used in this investigation: two mTMP groups and two nTMP groups, each containing zirconium oxide (ZrO2), and solution containing either chitosan or titanium oxide (TiO2) nanoparticles (NPs). Setting time, compression resistance, and radiopacity were estimated. The agar diffusion test was used to assess the antimicrobial activity of the formulations against five different microbial strains: Streptococcus mutans, Lactobacillus casei, Actinomyces israelii, Candida albicans, and Enterococcus faecalis. Parametric and nonparametric tests were performed after evaluating homoscedasticity data (p<0.05). Results: From the properties evaluated, nTMP cements required less setting time and showed greater resistance to compression. Cements containing TiO2 showed greater radiopacity for both nTMP and mTMP. All four cement formulations showed antimicrobial activity against S. mutans and L. casei Conclusion: Formulations containing nTMP have shorter setting times and higher compressive strength, and those with TiO2 nanoparticles showed antimicrobial activities. Clinical relevance: The cement containing nTMP, ZrO2, and TiO2 could be an alternative material for protecting the pulp complex.

WALANT versus intravenous regional anesthesia for carpal tunnel syndrome: a randomized clinical trial

ABSTRACT BACKGROUND: There are several anesthetic techniques for surgical treatment of carpal tunnel syndrome (CTS). Results from this surgery using the "wide awake local anesthesia no tourniquet" (WALANT) technique have been described. However, there is no conclusive evidence regarding the effectiveness of the WALANT technique, compared with the usual techniques. OBJECTIVE: To evaluate the effectiveness of the WALANT technique, compared with intravenous regional anesthesia (IVRA; Bier's block), for surgical treatment of CTS. DESIGN AND SETTING: Randomized clinical trial, conducted at Hospital Alvorada Moema and the Discipline of Hand Surgery, Universidade Federal de São Paulo (UNIFESP), São Paulo (SP), Brazil. METHODS: Seventy-eight patients were included. The primary outcome was measurement of perioperative pain through a visual analogue scale (VAS). The secondary outcomes were the Boston Questionnaire score, Hospital Anxiety and Depression Scale (HADS) score, need for use of analgesics, operating room times, remission of paresthesia, failures and complications. RESULTS: The WALANT technique (n = 40) proved to be superior to IVRA (n = 38), especially for controlling intraoperative pain (0.11 versus 3.7 cm; P < 0.001) and postoperative pain (0.6 versus 3.9 cm; P < 0.001). Patients spent more time in the operating room in the IVRA group (59.5 versus 46 minutes; P < 0.01) and needed to use more analgesics (10.8 versus 5.7 dipyrone tablets; P = 0.02). Five IVRA procedures failed (5 versus 0; P = 0.06). CONCLUSIONS: The WALANT technique is more effective than IVRA for CTS surgery.

Severe cervical myelopathy: approaches and postoperative evaluation / Mielopatia cervical grave: vias de acesso e avaliação pós-operatória / Mielopatía cervical grave: vías de acceso y evaluación postoperatoria

ABSTRACT Objectives: To evaluate and compare the clinical evolution of surgical approaches used in patients with severe cervical myelopathy. Methods: Retrospective observational study in which 19 patients with myelopathy who underwent surgery were evaluated. Neurological assessments using the Frankel scale were conducted both preoperatively and one year following surgery, and the modified Japanese Orthopedic Association (JOA), Nurick, and Visual Analog Scale for pain (VAS) questionnaires were applied 1 year after the surgical procedure. Results: 89% of the participants were male and the average age was 63.9 years. No patient had postoperative neurological worsening, 12 patients (63.16%) had mild pain, and seven (36.84%) had moderate pain. The group with degenerative disease showed neurological improvement after surgery and the exclusively anterior approach was used in 84% of the cases, the exclusively posterior approach in 10% of the cases, and the dual approach in 6% of the cases. Conclusion: Surgical treatment has good results for inhibiting the unfavorable natural evolution of myelopathy within 1 year following surgery and promotes neurological improvement in degenerative cases, making it possible to use the anterior access route in most cases. Level of evidence III; Retrospective Study.

RESUMO Objetivos: Avaliar a evolução clínica em comparação com as vias de acesso cirúrgico em pacientes com mielopatia cervical grave. Métodos: Estudo observacional retrospectivo no qual foram avaliados 19 pacientes com mielopatia submetidos à cirurgia. Foram aplicados o questionário da Japanese Orthopedic Association (JOA) modificado, a Escala de Nurick e a Escala Visual Analógica (EVA) da dor um ano depois do procedimento cirúrgico e realizada avaliação neurológica pré-operatória e após um ano da cirurgia com a Escala de Frankel. Resultados: Os participantes eram 89% do sexo masculino e a média de idade foi de 63,9 anos. Nenhum paciente apresentou piora neurológica pós-operatória, 12 pacientes (63,16%) apresentaram dor leve e sete (36,84%) dor moderada. O grupo com doença degenerativa apresentou melhora neurológica depois da cirurgia e a via de acesso anterior exclusiva foi utilizada em 84% dos casos, 10% tiveram acesso exclusivamente por via posterior e 6% tiveram acesso com dupla via. Conclusões: O tratamento cirúrgico apresenta bons resultados para inibir a evolução natural desfavorável da mielopatia no período de um ano depois da cirurgia e promove melhora neurológica nos casos degenerativos, sendo possível a utilização da via de acesso anterior na maior parte dos casos. Nível de evidencia III; Estudo Retrospectivo.

RESUMEN Objetivos: Evaluar la evolución clínica en comparación con las vías de acceso quirúrgico en pacientes con mielopatía cervical severa. Métodos: Estudio observacional retrospectivo en el que se evaluaron 19 pacientes con mielopatía intervenidos quirúrgicamente. Se aplicó el cuestionario modificado de la Japanese Orthopedic Association (JOA), la escala de Nurick y la Escala Visual Analógica (EVA) del dolor 1 año después de la intervención quirúrgica y se realizó la evaluación neurológica preoperatoria y un año después de la cirugía utilizando la Escala de Frankel. Resultados: El 89% de los participantes eran hombres y la edad promedio era de 63,9 años. Ningún paciente presentó empeoramiento neurológico postoperatorio, 12 pacientes (63,16%) presentaron dolor leve y siete (36,84%) dolor moderado. El grupo con enfermedad degenerativa presentó mejoría neurológica tras la cirugía y en el 84% de los casos se utilizó la vía de acceso anterior exclusiva, el 10% la vía posterior exclusiva y el 6% la vía doble. Conclusión: El tratamiento quirúrgico presenta buenos resultados al inhibir la evolución natural desfavorable de la mielopatía en el período de un año después de la cirugía y promueve la mejoría neurológica en los casos degenerativos, posibilitando el uso de la vía de acceso anterior en la mayoría de los casos. Nivel de evidencia III; Estudio Retrospectivo.

Analysis of the Mechanical Behavior and Effect of Cyclic Fatigue on the Implant-Abutment Interface / Análisis del comportamiento mecánico y efecto de la fatiga cíclica en la interface implante-pilar

ABSTRACT: Purpose: The seal of the interface formed at the implant-abutment connection is essential for the long-term success of the implant-supported restoration. The aim of this study was to analyze the mechanical behavior and the effect of cyclic fatigue before and after in the marginal fit of implant-abutment according to the manufacturing technique of the abutment. Materials and methods: Machined titanium abutments (DENTIS), cast abutments with Nickel-Chromium alloy (VeraBond II), and manufacturing custom milled Zirconia abutments (Zirkonzahn) were evaluated. The implant-abutment assemblies were subjected to cyclic loads of 133 N at a frequency of 19.1 Hz for 200,000 cycles. The microgap was measured using Scanning Electronic Microscope and the distribution of compressive stress by the three-dimensional Finite Element (FE) method. Results: The microgap measurement values of the machined abutments were 1.62μm and 1.92μm, cast abutments were 14.14 μm, and 28.44 μm, and the milled abutments were 14.18μm and 20.15μm before and after cyclic fatigue, respectively. Only the cast abutments and the machined abutments showed a statistically significant difference before and after cyclic fatigue (p≤0.05). The FE analysis showed that the critical areas of compressive stress were located at the implant-abutment connection, increasing in the cast abutments and decreasing in the milled and the machined abutments. Conclusion: Cyclic fatigue exerts an effect on the dimensions of the microgap at the implant-abutment interface before and after loading; this microgap depends of the type of abutment material and the manufacturing technique.

RESUMEN: Propósito: El sellado de la interface de la conexión implante-pilar es esencial para el éxito a largo plazo de la restauración implantosoportada. El objetivo de este estudio fue analizar el comportamiento mecánico y el efecto de la fatiga cíclica antes y después en el sellado de la conexión implante-pilar de acuerdo a la ténica de fabricación del pilar. Materiales y Métodos: Pilares mecanizados de titanio (DENTIS), pilares calcinables colados con aleación Niquel-Cromo (VeraBond II) y pilares fresados de Zirconia (Zirkonzahn) fueron evaluados. Los implantes y pilares atornillados se sometieron a una carga de 133 N a una frecuencia de 19.1 Hz durante 200 000 ciclos. El microgap fue medido con el Microscopio Electrónico de Barrido y la distribución del esfuerzo de compresión por el método tridimensional de Elemento Finito (EF). Los valores del microgap de los pilares mecanizados fueron de 1.62μm y 1.92μm, en los pilares calcinables fue de 14.14μm y 20.15μm, y los pilares fresados fue de 14.18μm y 28.44 μm antes y después de la fatiga cíclica, respectivamente. Los pilares calcinables y lo mecanizados mostraron diferencia estadísticamente significativa antes y después de la fatiga cíclica (p≤0.05). El análisis por EF mostró que las áreas críticas del esfuerzo de compresión estaban localizadas en la conexión implante-pilar, aumentando en los pilares calcinables y disminuyendo en los pilares fresados y en los mecanizados. Conclusión: La fatiga cíclica ejerce un efecto sobre las dimensiones del microgap en la interface implante-pilar antes y después de la carga cíclica; este microgap depende del tipo de material y de la técnica de fabricación del pilar.

Aneurisma de la arteria carótida interna como lesión compresiva de la vía visual / Internal carotid artery aneurysm as a compressive lesion of the visual pathway

El diagnóstico temprano de las lesiones compresivas del nervio óptico adquiere cada vez mayor importancia. La descompresión precoz de este o del quiasma puede resultar una mejora significativa de la función visual, mientras que el diagnóstico erróneo puede ocasionar pérdida visual irreversible, disfunción neurológica o la muerte. Las causas de la compresión de la vía visual anterior son increíblemente variadas. Los meningiomas, los tumores hipofisarios y los aneurismas son las lesiones comúnmente más identificadas como causa de neuropatía óptica compresiva sin edema del disco. Presentamos una paciente femenina de 50 años de edad, quien se sometió a la cirugía de catarata congénita del ojo izquierdo, sin mejoría de la función visual, a lo que se sumó el empeoramiento inespecífico de la calidad visual. La psicofísica visual, la campimetría automatizada y la tomografía de coherencia óptica aportaron hallazgos sugestivos de compresión de la vía visual intracraneal. Se indicó imagen por resonancia magnética de cráneo y órbitas para confirmar la sospecha diagnóstica. La angiografía cerebral demostró la presencia de un aneurisma de la arteria carótida interna, que se trató por vía endovascular con resultados satisfactorios(AU)

The importance of early diagnosis of compressive lesions of the optic nerve is on the increase. Timely decompression of the optic nerve or the optic chiasm may bring about significant visual function improvement, whereas erroneous diagnosis may result in irreversible visual loss, neurological dysfunction or death. The causes of compression of the anterior visual pathway are incredibly varied. Meningiomas, pituitary tumors and aneurysms are the lesions most commonly identified as causes of compressive optic neuropathy without disc edema. A case is presented of a female 50-year-old patient undergoing congenital cataract surgery of her left eye without visual function improvement, alongside unspecific visual quality worsening. Visual psychophysical testing, automated campimetry and optical coherence tomography contributed findings suggestive of intracranial visual pathway compression. Magnetic resonance imaging of the brain and orbits was indicated to confirm the diagnostic suspicion. Cerebral angiography revealed the presence of an internal carotid artery aneurysm which was treated by endovascular procedure with satisfactory results(AU)

Molars Fracture Resistance with Class II Cavities Restored with Different Resin - Based Materials / Resistência à Fratura de Molares com Cavidades Classe II Restauradas com Diferentes Materiais à Base de Resina

The teeth weakening due to the preparation of class II mesio-occluso-distal cavities is a challenge for the clinician. The objective of this study was to evaluate the molars fracture resistance with class II mesio-occluso distal cavities restored with different restorative techniques and materials. Forty extracted molars were divided into 5 groups: Group 1 ­ intact healthy teeth (positive control); Group 2 ­ unrestored teeth with mesio-occluso distal class II cavities (negative control); Groups 3 to 5 ­ restored teeth with standardized dimensions. In groups 3 to 5, the cavities were restored with flow resin only, flow resin coated with a nano-hybrid resin, and nano-hybrid resin only, respectively. All specimens were tested for resistance to fracture using an axial compressive load, a metallic sphere measuring 8 mm in diameter on a universal testing machine EMIC DL-2000. A 10 kN load cell operated at a speed of 5 mm/min until the tooth fracture. Data were subjected to analysis of variance and Tukey's tests (α = 0.05). Group 3 showed higher fracture strength (2243.1 ± 473.7N) when compared to groups 2, 4 and 5. This difference was statistically significant (p<0.05). The fracture strength of teeth restored with flow mesio occluso-distal restorations was similar to that of intact natural teeth. (AU)

O enfraquecimento dos dentes devido às preparações de cavidades mesio-ocluso-distal é um desafio para o clínico. O objetivo deste estudo foi avaliar a resistência à fratura de molares com cavidades mesio-ocluso-distais classe II restauradas com diferentes técnicas e materiais restauradores. Quarenta molares extraídos foram divididos em 5 grupos: Grupo 1 ­ dentes saudáveis intactos (controle positivo); Grupo 2 ­ dentes não restaurados com cavidades mesio-occluso-distais classe II (controle negativo); Grupos 3 a 5 ­ dentes restaurados com dimensões padronizadas. Nos grupos 3 a 5, as cavidades foram restauradas apenas com resina flow, resina flow recoberta com uma resina nanohíbrida e somente resina nano-híbrida, respectivamente. Todas as amostras foram testadas quanto à resistência à fratura usando uma carga compressiva axial, usando uma esfera metálica medindo 8 mm de diâmetro em uma máquina de teste universal EMIC DL-2000. Uma célula de carga de 10 kN operava a uma velocidade de 5 mm/min até a fratura do dente. Os dados foram submetidos à análise de variância e testes de Tukey (α = 0,05). O grupo 3 apresentou maior resistência à fratura (2243,1 ± 473,7N) quando comparado aos grupos 2, 4 e 5. Essa diferença foi estatisticamente significante (p <0,05). A resistência à fratura dos dentes restaurados com resina flow foi semelhante à dos dentes naturais intactos. (AU)

Is there an association between electroneuromyography and ultrasound in the diagnosis of carpal tunnel syndrome? / Existe associação entre a eletroneuromiografia e a ultrassonografia no diagnóstico da Síndrome do Túnel do Carpo?

Abstract Objective To verify whether there is an association between the results of the severity in electroneuromyography and the positivity in ultrasound in the diagnosis of carpal tunnel syndrome. Methods Sixty-eight patients were included in the study, 61 women and 7 men, with a mean age of 54.4 years. The ultrasound results (positive or negative) were crossed with the results of electroneuromyography (mild, moderate or severe), and the existence of association was verified. Results One hundred and thirty-six hands with suspicion or symptoms of carpal tunnel syndrome were evaluated. Positive ultrasound diagnosis was observed in 72 hands and negative in 64; 123 hands presented positive electroneuromyography for carpal tunnel syndrome, and there were 13 negative results. The severe degree in electroneuromyography was prevalent. Conclusion There was a statistically significant association between electroneuromyography and ultrasonography (p < 0.05), and ultrasound positivity was higher for more severe levels of carpal tunnel syndrome given by electroneuromyography.

Resumo Objetivo Verificar se existe associação entre os resultados da gravidade da eletroneuromiografia e a positividade da ultrassonografia no diagnóstico da síndrome do túnel do carpo. Métodos Sessenta e oito pacientes foram incluídos no estudo, sendo 61 mulheres e 7 homens, com média de idade de 54,4 anos. Os resultados da ultrassonografia (positivo ou negativo) foram cruzados com os resultados da eletroneuromiografia (leve, moderado ou grave) e verificada a existência de associação. Resultados Cento e trinta e seis mãos com suspeita ou sintomas de síndrome do túnel do carpo foram avaliadas. O diagnóstico ultrassonográfico positivo foi observado em 72 mãos e negativo em 64; 123 mãos apresentaram eletroneuromiografia positiva para síndrome do túnel do carpo e 13 apresentaram resultado negativo. O grau grave da eletroneuromiografia foi prevalente. Conclusão Houve associação estatisticamente significativa entre eletroneuromiografia e ultrassonografia (p < 0,05), sendo que a positividade da ultrassonografia foi maior para níveis mais graves de síndrome do túnel do carpo dados pela eletroneuromiografia.

Study on injectable calcium sulfate bone cement rich in bioactivity / 中华骨科杂志

Objective:To explore the effect of decalcified bone matrix (DBM) rich in biological activity on surgical-grade medical calcium sulfate, and to observe the change of different content of DBM on the physical and chemical properties of calcium sulfate, which provide theoretical basis for the preparation of calcium sulfate bone cement with osteogenic and injectable properties.Methods:DBM with weight content of 0, 5%, 10%, 20%, 30%, 40% was fully mixed with CSH. Dissolve 0.3 g of methyl cellulose in 10 ml of deionized water to prepare a 3% methyl cellulose solution. Methylcellulose solution was added according to the liquid-solid ratio of 0.4. The mixture was evenly stirred to form slurry, then the degradation rate, compressive strength, setting time and and pH value of calcium sulfate in vitrowas measured.Results:The initial setting time and final setting time of calcium sulfate were 4.96±0.20 and 5.83±0.12 min respectively. With the increase of DBM content, the initial setting time and final setting time increased significantly ( F=49.275, P<0.05; F=124.859, P<0.05). The compressive strength of pure calcium sulfate is 23.33±6.35 MPa; when the content is 40%, the compressive strength is only 3.33 MPa. With the increase of DBM content, the compressive strength first increased and then decreased; the content of 5%, 10%, 20% DBM had little effect on the compressive strength ( P>0.05), while the compressive strength of 30% and 40% groups decreased significantly ( t=3.259, P<0.05). DBM with different contents can significantly change the degradation rate of calcium sulfate complex. When the content of DBM is 30% and 40%, the complete degradation time in vivo is only 10 d, while the degradation rate of calcium sulfate is 63% in 30 d. At any time point in vitro degradation, DBM had no significant effect on the pH value of calcium sulfate complex culture medium, and the change law was consistent with that of pure calcium sulfate. Conclusion:With the increase of DBM content, the degradation rate is gradually accelerated, the compressive strength is reduced, and the setting time is prolonged, which is not conducive to the preparation of injectable calcium sulfate cement.

Imaging application of thyroid associated ophthalmopathy / 国际眼科杂志(Guoji Yanke Zazhi)

@#Thyroid associated ophthalmopathy(TAO)is an autoimmune orbital inflammatory disease. Imaging methods play an important role in evaluating the change of orbital structures and differential diagnosis of orbital disease. In addition, imaging studies can also contribute to analyze the activity and severity of TAO and estimate compressive optic neuropathy(CON).

Construction and Evaluation for Model of Goat Intervertebral Disc Degeneration Induced by Axial Compressive Stress / 医用生物力学

Objective To establish the model of goat intervertebral disc degeneration （IDD） induced by controllable axial compressive stress and evaluate its imaging and pathological characteristics. Methods Twenty goats were randomly divided into 4 groups (control group, 4-week pressure group, 8-week pressure group, 12-week pressure group, n=5, 40 N pressure). Disc height index (DHI) was used to evaluate the change of intervertebral disc height by X-ray, Pfirrmann classification method was used to observe the degree of intervertebral disc degeneration by magnetic resonance imaging (MRI), and histopathological observation and evaluation for intervertebral disc were conducted by HE staining and immunohistochemistry. Results DHI in control group showed no significant changes with the extension of pressure time, while DHI in the experimental group gradually decreased. There was no significant change in Pfirrmann classification in control group. In experimental group, with the extension of time, the higher the degeneration aggravated with the Pfirrmann classification increasing. In experimental group, HE staining showed that the disc nucleus pulposus decreased in volume and nucleus pulposus cells, which were gradually replaced by fibrous tissues. Immunohistochemical staining showed that type I collagen in the nucleus pulposus gradually increased, type Ⅱ collagen gradually decreased, and intervertebral disc degeneration occurred. Conclusions A certain axial compressive stress can lead to degeneration of goat lumbar intervertebral disc, and the degree of degeneration is gradually increased with the extension of time.