Facial soft tissue changes and volumetric analysis of upper airways in patients undergoing surgically assisted rapid maxillary expansion using a transpalatal distractor

Abstract Objective To verify changes in facial soft tissue using the RadiANT-DICOM-viewer and Dolphin Imaging software, through linear measurements of tomographic points in a 3D reconstruction of the face and volumetric evaluation with three-dimensional measurements of the upper airways of patients with transverse maxillary discrepancy undergoing Surgically Assisted Rapid Maxillary Expansion (SARME). Methods Retrospective, transverse, and descriptive study, through the analysis of computed tomography scans of the face of patients with transverse maxillary discrepancy, treated from July 2019 to December 2022. The sample consisted of 15 patients of both sexes, aged 21-42 years old, who underwent surgically assisted rapid maxillary expansion using the transpalatal distractor. Analysis was performed through linear, angular, and three-dimensional measurements in millimeters, in the preoperative and late four-month postoperative period, in frontal 3D tomographic images of the face, in the region of the width of the nose and alar base and also angular measurement in the lateral tomography for the angle nasolabial and upper airways of rhinopharynx, oropharynx and hypopharynx. Results There was an increase in nasal width with an average of 1.3467 mm and an increase in the alar base with an average of 1.7333 mm. A significant difference was found in the pre- and postoperative assessments of the measurements of nasal width, alar base and nasolabial angle, as well as the upper airways in all their extension. The results favour a better understanding of the professional and the patient regarding the diagnosis and management of patients with transverse maxillary width discrepancies. Conclusion Although our study shows an increase in soft tissues after SARME, no aesthetic changes are observed clinically, and all patients report significant respiratory improvement. SARME may therefore contribute to the improvement of professionals working in the field of oral and maxillofacial surgery and orthodontics. Level of evidence: Level 4.

Comparison of effectiveness of lower extremity axial distractor and traction table assisted closed reduction and intramedullary nail fixation in femoral subtrochanteric fracture / 中国修复重建外科杂志

OBJECTIVE@#To compare the effectiveness of lower extremity axial distractor (LEAD) and traction table assisted closed reduction and intramedullary nail fixation in treatment of femoral subtrochanteric fracture.@*METHODS@#The clinical data of 117 patients with subtrochanteric fracture of femur treated by closed reduction and intramedullary nail fixation between May 2012 and May 2022 who met the selection criteria were retrospectively analyzed. According to the auxiliary reduction tools used during operation, the patients were divided into LEAD group (62 cases with LEAD reduction) and traction table group (55 cases with traction table reduction). There was no significant difference in baseline data, such as gender, age, injured side, cause of injury, fracture Seinsheimer classification, time from injury to operation, and preoperative visual analogue scale (VAS) score, between the two groups ( P>0.05). Total incision length, operation time, intraoperative blood loss, fluoroscopy frequency, closed reduction rate, fracture reduction quality, fracture healing time, weight-bearing activity time, and incidence of complications, as well as hip flexion and extension range of motion (ROM), Harris score, and VAS score at 1 month and 6 months after operation and last follow-up were recorded and compared between the two groups.@*RESULTS@#There were 14 cases in the LEAD group from closed reduction to limited open reduction, and 43 cases in the traction table group. The incisions in the LEAD group healed by first intention, and no complication such as nerve and vascular injury occurred during operation. In the traction table group, 3 cases had perineal crush injury, which recovered spontaneously in 1 week. The total incision length, operation time, intraoperative blood loss, fluoroscopy frequency, and closed reduction rate in the LEAD group were significantly better than those in the traction table group ( P<0.05). There was no significant difference in the quality of fracture reduction between the two groups ( P>0.05). Patients in both groups were followed up 12-44 months, with an average of 15.8 months. In the LEAD group, 1 patient had delayed fracture union at 6 months after operation, 1 patient had nonunion at 3 years after operation, and 1 patient had incision sinus pus flow at 10 months after operation. In the traction table group, there was 1 patient with fracture nonunion at 15 months after operation. X-ray films of the other patients in the two groups showed that the internal fixator was fixed firmly without loosening and the fractures healed. There was no significant difference in fracture healing time, weight bearing activity time, incidence of complications, and postoperative hip flexion and extension ROM, Harris score, and VAS score at different time points between the two groups ( P>0.05).@*CONCLUSION@#For femoral subtrochanteric fracture treated by close reduction and intramedullary nail fixation, compared with traction table, LEAD assisted fracture reduction can significantly shorten the operation time, reduce intraoperative blood loss and fluoroscopy frequency, reduce incision length, effectively improve the success rate of closed reduction, and avoid complications related to traction table reduction. It provides a new method for good reduction of femoral subtrochanteric fracture.

Adaptation to the driving simulator and prediction of the braking time performance, with and without distraction, in older adults and middle-aged adults

Abstract Context: Many studies show the importance of evaluating the adaptation time of subjects in a virtual driving environment, looking forwards to a response as closest as a possible real vehicle. Objectives: This study aimed to identify and analyze the adaptation to the driving simulator in older adults and middle-aged adults with and without a distraction, and a secondary aim was to identify predictors of safe performance for older adults' drives. Design: Male and female middle-aged adults (n = 62, age = 30.3 ± 7.1 years) and older adults (n = 102, age = 70.4 ± 5.8 years) were evaluated for braking time performance in a driving simulator; cognition performance assessment included the Mini-Mental State Examination; motor evaluation included ankle flexor muscle strength with the isokinetic dynamometer and handgrip strength; the postural balance was evaluated with Timed Up and Go test, with and without a cognitive distraction task. Results: Older adults (men and women) and middle-aged adult women require more time to adapt to the driving simulator. The distractor increases the adaptation time for all groups. The main predictors of braking time for older women are age, muscle strength, and postural balance associated with distraction, and for older men, muscle strength. Conclusions: Age, sex, and distractor interfere in the adaptation of the virtual task of driving in a simulator. The evaluation model developed with multi-domains demonstrated the ability to predict which skills are related to braking time with and without the presence of the distractor.

Role of Multiple Choice Questions in Assessment of Competency of Knowledge in Anatomy

Objectives: The main objective of the current study is to examine the items using the item analysis to assess their competency of knowledge in human anatomy. Methods: This is a quantitative descriptive cross-sectional study conducted at the Najran University faculty of Medicine, in the department of anatomy. A 31-second year MBBS students of level three took the multiple-choice question exam comprising 100 questions in one session. Each item was analyzed by item analysis. The planned period of data collection is the first semester of the academic year 2019-2020. The data were analyzed using SPSS version 25, and Excel Software. All analyses were performed using the descriptive frequency, explore and correlation probabilities a p-value, p<0.01 (2-sided) was considered to indicate statistical significance. Results: The assessment of test items use the item analysis that is very difficult question: 25; 25%, difficult question: 8; 8%, average question: 46; 46%, easy questions; 9; 9% and very easy: 9; 9%. The discrimination indices, which are poor discrimination; 34; 34%, acceptable discrimination; 11; 11%,good discrimination; 6; 6%, very good discrimination; 4; 4% and excellent discrimination; 45; 45%. The performance of students in this test showing that a large number of items have a role in distinguishing students knowledge in the anatomy test, but in Simple parts of the scale that the items did not succeed in assessing students. Items of anatomy exams displayed a strong relationship of difficulty (P) and discrimination (D) indices. Conclusion: The MCQs items assess their competency of knowledge in human anatomy. The competence of students in the knowledge of anatomy measured at a high rate of A-type context-rich MCQs can be stem is case scenario, lead-in; question and options; distractors, and key. These items can differentiate good and poor accomplishment students..

Manejo de secuencia de Pierre Robin con distracción externa mandibular y palatoplastia de incisiones mínimas / Managment of Pierre Robin Sequence with external mandibular distraction and palatoplasty of minimal incisions

Antecedentes. La secuencia de Pierre Robin es una patología poco frecuente y entendida en la literatura latinoamericana . La incidencia en el mundo es variable y en Latinoamerica no existen cifras exactas. La etiopatogenia es poco clara y aminorar y manejar las complicaciones respiratorias constituyen un objetivo primordial en el tratamiento de estos pacientes. El objetivo de este artículo es presentar el manejo del Pierre Robin en nuestro Servicio desde un punto de vista íntegro presentando un caso ejemplo. Presentación de caso. Masculino de 9 meses con diagnóstico de Pierre Robin, quien fue tratado con distractores mandibulares y retiro de los mismos tres meses después, con una excelente evolución posoperatoria. Posterior a esto, se realizó una palatoplastia sin complicaciones, con excelentes resultados respiratorios a los 6 meses de seguimiento. Conclusiones. El manejo del síndrome de Pierre Robin es un desafío para el cirujano plástico, con muchas opciones quirúrgicas disponibles, pero la distracción mandibular es actualmente la técnica que tiene mejores resultados confirmados para los parámetros respiratorios a largo plazo.

Background. Pierre Robin's sequence is a rare pathology. The incidence in the world is variable and in Latin America is unknown. The etiopathogenesis is unclear and respiratory complications are a challenge for surgical treatment. The objective of this article is to present the management of Pierre Robin from an integrative point of view through a case presentation. Case presentation. 9 month old male with Pierre Robin diagnosis who was treated with mandibular distractors with subsequent removal 3 months later with excellent postoperative evolution. Later on, a la palatoplasty was performed with no complications, with good respiratory injuries function at 6 month follow up. Conclusions. The management of Pierre Robin syndrome is a challenge for the plastic surgeon, with many surgical options available, with mandíbular distraction currently being the technique of choice because of its confi rmed favorable long term respiratory results

Resistencia a la Interferencia de Distractores: Diseño y Aplicación de una Tarea de Entrenamiento para Niños / Resistance to Interference Distractor: Design and Application of a Training Task for Children

Resumen Desde la perspectiva no unitaria de la inhibición, la resistencia a la interferencia de los distractores refiere al proceso inhibitorio que participa en la atención selectiva; experimenta durante la infancia importantes cambios en su desarrollo y resulta fundamental para el desempeño de los niños en diversas actividades. Este trabajo se propuso diseñar una tarea de entrenamiento -informatizada, con un abordaje basado en procesos y a partir del paradigma de Flancos (Eriksen & Eriksen, 1974)- de este proceso inhibitorio, para niños con desarrollo típico de 6 a 8 años de edad; administrarla y analizar los efectos del entrenamiento sobre el proceso entrenado y otros no entrenados. Se trabajó con 54 niños, en 1º, 2º y 3º año de la escolaridad primaria. Se aplicó un diseño experimental con medidas pre y post-test (donde se administraron tareas de evaluación de resistencia a la interferencia de los distractores, inhibición de la respuesta y memoria de trabajo viso-espacial), un grupo experimental (que recibió el entrenamiento de la resistencia a la interferencia de distractores) y un grupo control activo. Luego de la intervención el grupo experimental presentó un mejor desempeño en una tarea que demanda el proceso entrenado. No se encontraron efectos sobre el rendimiento en otras tareas. Los efectos hallados son bajos, pudiendo deberse a la baja intensidad y duración de la intervención. Sin embargo, podrían constituir un aporte a la diferenciación de procesos inhibitorios, específicamente de la resistencia a la interferencia de distractores respecto y de la inhibición de la respuesta, en tanto el entrenamiento genera efectos en el proceso entrenado pero no el otro.

Abstract From the non-unitary perspective of inhibition, resistance to distractor interference is an inhibitory process related to selective attention, has developmental improvements throughout childhood and plays an important role in the children's performance in multiple activities. This work is aimed to design and administrate a resistance to interference distractor training task for children with typical development, between 6 and 8 years of age (a processes-based computerized flanker task). Also, this work is aimed to analyze the effects of the intervention on trained process and non-trained processes. We recruited children (n= 54) in the first three years of primary-school education. The study consisted of an experimental pre-test, post-test design (resistance to distractor interference, response inhibition and visuospatial working memory were administered), with experimental group (training resistance to distractor interference group) and active control group. After intervention, experimental group performed better in a resistance to distractor interference task. No effects on performance in other tasks were found. These small effects could be explained by the duration and the intensity of the intervention. However, these results contribute to non-unitary perspective about the differentiation of inhibitory processes, especially, to differentiation of resistance to distractor interference and response inhibition, because effects on trained process and absence of transfer to non-trained process were observed.

Item analysis as tool to validate multiple choice question bank in pharmacology

Background: Multiple choice questions (MCQs) are a common method for formative and summative assessment of medical students. Item analysis enables identifying good MCQs based on difficulty index (DIF I), discrimination index (DI), distracter efficiency (DE). The objective of this study was to assess the quality of MCQs currently in use in pharmacology by item analysis and develop a MCQ bank with quality items.Methods: This cross-sectional study was conducted in 148 second year MBBS students at NKP Salve institute of medical sciences from January 2018 to August 2018. Forty MCQs twenty each from the two term examination of pharmacology were taken for item analysis A correct response to an item was awarded one mark and each incorrect response was awarded zero. Each item was analyzed using Microsoft excel sheet for three parameters such as DIF I, DI, and DE.Results: In present study mean and standard deviation (SD) for Difficulty index (%) Discrimination index (%) and Distractor efficiency (%) were 64.54±19.63, 0.26±0.16 and 66.54±34.59 respectively. Out of 40 items large number of MCQs has acceptable level of DIF (70%) and good in discriminating higher and lower ability students DI (77.5%). Distractor efficiency related to presence of zero or 1 non-functional distrator (NFD) is 80%.Conclusions: The study showed that item analysis is a valid tool to identify quality items which regularly incorporated can help to develop a very useful, valid and a reliable question bank.

Impact of distractors in item analysis of multiple choice questions

Background: Item analysis is a quality assurance of examining the performance of the individual test items that measures the validity and reliability of exams. This study was performed to evaluate the quality of the test items with respect to their performance on difficulty index (DFI), Discriminatory index (DI) and assessment of functional and non-functional distractors (FD and NFD).Methods: This study was performed on the summative examination undertaken by 113 students. The analyses include 120 one best answers (OBAs) and 360 distractors.Results: Out of the 360 distractors, 85 distractors were chosen by less than 5% with the distractor efficiency of 23.6%. About 47 (13%) items had no NFDs while 51 (14%), 30 (8.3%), and 4 (1.1%) items contained 1, 2, and 3 NFDs respectively. Majority of the items showed excellent difficulty index (50.4%, n=42) and fair discrimination (37%, n=33). The questions with excellent difficulty index and discriminatory index showed statistical significance with 1NFD and 2 NFD (p=0.03).Conclusions: The post evaluation of item performance in any exam in one of the quality assurance method of identifying the best performing item for quality question bank. The distractor efficiency gives information on the overall quality of item.

Analysis of multiple choice questions from a formative assessment of medical students of a medical college in Delhi, India

Background: Assessment is a dominant motivator to direct and drive students learning. Different methods of assessment are used to assess medical knowledge in undergraduate medical education. Multiple choice questions (MCQs) are being used increasingly due to their higher reliability, validity, and ease of scoring. Item analysis enables identifying good MCQs based on difficulty index (DIF I), discrimination index (DI), and distracter efficiency (DE).Methods: Students of second year MBBS appeared in a formative assessment test, that was comprised of 50 “One best response type” MCQs of 50 marks without negative marking. All MCQs were having single stem with four options including, one being correct answer and other three incorrect alternatives (distracter). Three question paper sets were prepared by disorganizing sequence of questions. One of the three paper sets was given to each student to avoid copying from neighboring students. Total 50 MCQs and 150 distracters were analyzed and indices like DIF I, DI, and DE were calculated.Results: Total Score of 87 students ranged from 17 to 48 (out of total 50). Mean for difficulty index (DIF I) (%) was 71.6+19.4. 28% MCQs were average and “recommended” (DIF I 30-70%). Mean for discrimination index (DI) was 0.3+0.17. 16% MCQs were “good” and 50% MCQs were in “excellent” criteria, while rests of the MCQs were “discard/poor” according to DI criteria. Mean for distracter efficiency (DE) (%) was 63.4+33.3. 90% of the items were having DE from 100 to 33%. It was found that MCQs with lower difficulty index (<70) were having higher distracter efficiency (93.8% vs. 6.2%, p=0.004).Conclusions: Item analysis provided necessary data for improvement in question formulation and helped in revising and improving the quality of items and test also. Questions having lower difficulty index (<70) were significantly associated with higher discrimination index (>0.15) and higher distractor efficiency.

Clinical analysis of reconstruction of sensory anterolateral thigh perforator flaps for repairing soft tissue defects after radical operation of Paget′s disease of perineum / 中华整形外科杂志

Objective@#To investigate the clinical effect of reconstruction of sensory anterolateral thigh perforator flaps in repairing soft tissue defects after radical operation for Paget disease of perineum.@*Methods@#From April 2017 to July 2017, Ningbo First Hospital treated 3 male patients with Paget′s disease of perineum, 2 patients with RayA2 stage and 1 patient with RayB stage. The range of soft tissue defect after resection of tumors is 8 cm×10 cm to 10 cm×12 cm. The anterolateral thigh perforator flaps were designed to repair skin defect, and the lateral thigh cutaneous nerve branch was contained to reconstruct protective sensation and restore autonomic nerve function. Tension-free direct suture was performed in part of the donor site, of which 3 cases were difficult to suture directly, 2 cases were treated with skin grafting and 1 case was closed with skin distractor.@*Results@#All 3 flaps survived. The average area of the flaps was about 12 cm×14 cm. The average follow-up period was 3 months. The appearance and function of the flaps were satisfactory. The average sensory recovery of the flaps was as high as S3. The autonomic nervous function was partially restored. Some of the skin had sweating function and normal skin temperature. At the same time, there was no difference between the urination function and sexual competence before operation. The donor site wound healed well and its appearance and function recovered well.@*Conclusions@#The reconstruction of sensory anterolateral thigh perforator flaps is an good method for repairing soft tissue defect after radical resection of Paget disease of perineum. It has satisfactory results in the protection and reconstruction of donor and recipient areas.

Item analysis of multiple choice questions of undergraduate pharmacology examinations in a medical college in Belagavi, Karnataka, India

Background: Multiple choice questions (MCQs) are a common method of assessment of medical students. The quality of MCQs is determined by three parameters such as difficulty index (DIF I), discrimination index (DI), and Distractor efficiency (DE). Item analysis is a valuable yet relatively simple procedure, performed after the examination that provides information regarding the reliability and validity of a test item. The objective of this study was to perform an item analysis of MCQs for testing their validity parameters.Methods: 50 items consisting of 150 distractors were selected from the formative exams. A correct response to an item was awarded one mark with no negative marking for incorrect response. Each item was analysed for three parameters such as DIF I, DI, and DE.Results: A total of 50 items consisting of 150 Distractor s were analysed. DIF I of 31 (62%) items were in the acceptable range (DIF I= 30-70%) and 30 had ‘good to excellent’ (DI >0.25). 10 (20%) items were too easy and 9 (18%) items were too difficult (DIF I <30%). There were 4 items with 6 non-functional Distractor s (NFDs), while the rest 46 items did not have any NFDs.Conclusions: Item analysis is a valuable tool as it helps us to retain the valuable MCQs and discard or modify the items which are not useful. It also helps in increasing our skills in test construction and identifies the specific areas of course content which need greater emphasis or clarity.

Item analysis to identify quality multiple choice questions/items in an assessment in Pharmacology of II MBBS students in Guntur Medical College of Andhra Pradesh, India

Background: In medical education, multiple choice questions/Items are the more frequently used assessment tools to assess the knowledge abilities and skills of medical students, for being their objectivity, wide coverage in less time. However only the Quality Items gives a valid and reliable assessment. The quality of an Item is determined by difficulty index (DIF I), Discrimination Index (DI) and Distractor efficiency (DE). Aim of the study was to know the quality of Items in pharmacology by Item analysis and to develop a MCQs bank with quality Items.Methods: The present study was conducted on 150 II MBBS students of Guntur Medical College, AP, India. A class test containing 50 Items with 150 distractors from topic chemotherapy was conducted. Item with the correct choice/response was awarded with one mark and with the wrong choice zero marks, no negative marks. Each test Item was analysed with DIF I, DI and DE and the results were tabulated and tested statistically, with unpaired "t" test.Results: Mean DIF I, DI, DE values with standard deviations in the present study are 44.72+17.63%, 0.30+0.12%, 84.48+24.65 respectively. DIF I of 32 (64%) items was good to excellent range (31%-60%) 9 (18%) Items were easy (>61%) and 9(18%) Items were difficult (>30%). DI of 10 (20%) Items was good (0.15 to 0.24.) 29 (58%) Items were excellent with DI > 0.25 and 11 (22%) Items were poor with DI <0.15. Among 150 distractors, 127 (85%) were functional distractors (FDs) and 23 (15%) were non-functional distractors (NFDs). DE of 33 (66%) items with nil NFDs was 100%, for 12 (24%) Items with one NFD, was 66.6%, for 4 (8%) items with 2 NFDs was 33.3% and for 1 (2%) Item with 3NFDs DE was 0%. When unpaired "t" test was applied to the means of "difficult" and "easy" Items, 96.22+11.33% SD, 51.44+29.31% SD respectively, the p-value obtained was 0.00058, which was highly significant.Conclusions: The study showed that Item analysis is a valid tool to identify quality Items, which assess, the students� knowledge abilities and discriminate different levels of performance abilities of students effectively.

Effects of distractors on upright balance performance in school-aged children with attention deficit hyperactivity disorder, preliminary study / Efeitos de distrações sobre o desempenho do equilíbrio vertical em crianças em idade escolar com transtorno de déficit de atenção e hiperatividade - estudo preliminar

Abstract Introduction: Attention deficit hyperactivity disorder is a common impairing neuropsychiatric disorder with onset in early childhood. Almost half of the children with attention deficit hyperactivity disorder also experience a variety of motor-related dysfunctions ranging from fine/gross motor control problems to difficulties in maintaining balance. Objectives: The main purpose of this study was to investigate the effects of distractors two different auditory distractors namely, relaxing music and white noise on upright balance performance in children with attention deficit hyperactivity disorder. Methods: We compared upright balance performance and the involvement of different sensory systems in the presence of auditory distractors between school-aged children with attention deficit hyperactivity disorder (n = 26) and typically developing controls (n = 20). Neurocom SMART Balance Master Dynamic Posturography device was used for the sensory organization test. Sensory organization test was repeated three times for each participant in three different test environments. Results: The balance scores in the silence environment were lower in the attention deficit hyperactivity disorder group but the differences were not statistically significant. In addition to lower balance scores the visual and vestibular ratios were also lower. Auditory distractors affected the general balance performance positively for both groups. More challenging conditions, using an unstable platform with distorted somatosensory signals were more affected. Relaxing music was more effective in the control group, and white noise was more effective in the attention deficit hyperactivity disorder group and the positive effects of white noise became more apparent in challenging conditions. Conclusion: To the best of our knowledge, this is the first study evaluating balance performance in children with attention deficit hyperactivity disorder under the effects of auditory distractors. Although more studies are needed, our results indicate that auditory distractors may have enhancing effects on upright balance performance in children with attention deficit hyperactivity disorder.

Resumo Introdução: O transtorno do déficit de atenção e hiperatividade é um distúrbio neuropsiquiátrico comum que causa comprometimentos, com início na primeira infância. Quase metade das crianças com transtorno do déficit de atenção e hiperatividade também experimenta uma variedade de distúrbios relacionados às habilidades motoras, desde problemas de controle de habilidades motoras finas/grossas até dificuldades na manutenção do equilíbrio. Objetivos: O principal objetivo deste estudo foi investigar os efeitos de distrações, especificamente duas distrações auditivas diferentes, música relaxante e ruído branco, sobre o desempenho do equilíbrio vertical em crianças com transtorno de déficit de atenção e hiperatividade. Método: Comparamos o desempenho do equilíbrio vertical e o envolvimento de diferentes sistemas sensoriais na presença de distração auditiva entre crianças em idade escolar com transtorno do déficit de atenção e hiperatividade (n = 26) e controles com desenvolvimento típico (n = 20). O dispositivo Neurocom Smart Balance Master Dynamic Posturography foi utilizado para o teste de organização sensorial. O teste de organização sensorial foi repetido três vezes para cada participante em três ambientes de teste diferentes. Resultados: Os escores de equilíbrio no ambiente em silêncio foram menores no grupo com transtorno do déficit de atenção e hiperatividade, mas as diferenças não foram estatisticamente significativas. Além dos escores de equilíbrio mais baixos, as razões vestibulares e visuais também foram menores. As distrações auditivas afetaram positivamente o desempenho do equilíbrio geral para ambos os grupos. Condições mais desafiadoras, usando uma plataforma instável com sinais somatossensoriais distorcidos, foram mais afetados. Música relaxante foi mais eficaz no grupo de controle, e ruído branco foi mais eficaz no grupo de hiperatividade com déficit de atenção e os efeitos positivos do ruído branco se tornaram mais evidentes em condições desafiadoras. Conclusão: Que seja de nosso conhecimento, este é o primeiro estudo que avalia o desempenho do equilíbrio em crianças com transtorno do déficit de atenção e hiperatividade sob os efeitos de distrações auditivas. Embora mais estudos sejam necessários, os nossos resultados indicam que as distrações auditivas podem ter efeitos de aumento no desempenho do equilíbrio vertical em crianças com transtorno de déficit de atenção e hiperatividade.

Multiple Choice Questions - Role In Assessment Of Competency Of Knowledge In Anatomy

Background: The accurate, reliable and timely assessment of students is an essential domain of teaching duringMedical professional courses. The Multiple Choice Questions (MCQ) are time tested method of ready assessmentof undergraduate students. Although it evaluates student’s cognitive knowledge but does not evaluate professionalskills. However it is said that MCQs emphasize recall of factual information rather than conceptual understandingand interpretation of concepts.Objectives: The main objective of the study is to analyse the items with the help of item analysis and select theitems which are good for incorporation into future question bank with reliability.Materials and Methods: This study was done in Department of Anatomy, AIIMS, Patna. A 396 first year MBBSstudents of different batches took the MCQ test comprising 60 questions in two sessions. During the evaluationprocess of MCQ’s each correct response was awarded one mark and no marks was awarded for any incorrectresponse. Each item was analysed for difficulty index, discrimination index and distractor effectiveness.Results: The overall mean of Facilitative value, Discrimination Index, Distractor Effectiveness and CorrelationCoefficient was 66.09 (±21.55), 0.26 (±0.16), 18.84 (±10.45) and 0.55±0.22 respectively.Conclusion: The framing of MCQ should be according to Bloom’s classification to assess cognitive, affective aswell as psychomotor domain of the students. The MCQ having poor and negative discrimination should bereframed and again should be analysed.

Observation on the clinical application effects of skin distractor on the treatment of scars / 中华烧伤杂志

Objective@#To explore clinical application effects of skin distractor on the treatment of scars and to observe effects of skin distractor with different pull speeds on different parts scars of human body.@*Methods@#One hundred and four patients with scars, conforming to the study criteria, were hospitalized in our unit from January 2014 to June 2015. Patients were divided into 2 mm/d group and 4 mm/d group according to the random number table, with 52 patients in each group. After admission, skin distractors were pasted on scars in face and neck, trunk, and extremities of patients in 2 groups, with inner edges of pasteboards close to outside edges of longer sides of scars. Skin distractors in 2 mm/d group and 4 mm/d group were pulled to scars axis direction as speeds of 2 mm/d and 4 mm/d, respectively. Pull time equals values of pull speeds divided by width of scars. Scars were resected after finishing pulling. Immediately after scars resection, skin distractors were pasted again with inner edges of pasteboards close to outside edges of longer sides of incision and removed when stitches were taken out. Scars of patients were scored by Vancouver Scar Scale (VSS), and Patient and Observer Scar Assessment Scale (POSAS) was used to record scores of patient scar assessment scale (PSAS), observer scar assessment scale (OSAS) and overall scores of patients and observers of scars of patients before and one year after scars resection. Data were processed with χ2 test, independent samples t test, paired samples t test, independent samples non-parametric rank-sum test and paired samples non-parametric rank-sum test.@*Results@#(1) Scores of all scars of patients in 2 groups before scars resection were close (with t values from -1.384 to 0.622, P values above 0.05), obviously higher than those of one year post scars resection (with t values from 11.085 to 24.835, P values below 0.01). Scores of scars in face and neck, trunk and extremities in 2 groups before scars resection were close (with Z values from -1.651 to -0.035, t values from -1.549 to 0.219, P values above 0.05), significantly higher than those of one year post scar resection (with Z values from -2.992 to -2.555, t values from 8.739 to 19.076, P values below 0.01). (2) Scores of all scars of patients in 2 mm/d group of one year post scars resection were lower than those in 4 mm/d group (with t values from -2.583 to -2.018, P values below 0.05). PSAS scores of scars in face and neck and trunk in 2 mm/d group of one year post scars resection were lower than those in 4 mm/d group (with Z values respectively -2.385 and -2.198, P values below 0.05), other scores of scars in face and neck and trunk of patients in 2 groups of one year post scars resection were close (with Z values from -1.841 to -0.363, P values above 0.05). VSS scores, PSAS scores, OSAS scores, patients′ overall scores, and observers′ overall scores in 2 mm/d groups were (4.6±0.8), (28±4), (28±4), (4.7±0.7), (4.8±1.4) points, respectively, lower than those in 4 mm/d group[(5.2±0.8), (32±4), (31±6), (5.5±1.2), (5.5±1.0) points, respectively, with t values from -3.712 to -2.105, P<0.05 or P<0.01].@*Conclusions@#Skin distractor has better effects on the treatment of scars, and treatment effects of skin distractor in extremities pulled by 2 mm/d are better than those pulled by 4 mm/d.

Arthroscopic detection of medial meniscal injury with the use of a joint distractor in small-breed dogs

The goal of the present study was to evaluate the diagnostic value of a joint distractor in arthroscopy in small-breed dogs. Sixty stifle joints, which were collected from thirty cadavers, were used in this study. To simulate different injuries, no medial meniscal tear, a full-thickness vertical longitudinal tear, a partial-thickness vertical longitudinal tear, full- and partial-thickness vertical longitudinal tears, or a peripheral detachment were created on the caudal horn of the medial meniscus of each stifle joint along with rupture of the cranial cruciate ligament. Each stifle joint then underwent arthroscopy with and without a joint distractor. The sensitivity (Sn), specificity (Sp), positive predictive value (PPV), negative predictive value (NPV), and correct classification rate (CCR) for the diagnosis of each type of medial meniscus pathology were calculated. For arthroscopy with and without a joint distractor, the Sn was 85% and 60%, the Sp was 96% and 92%, the PPV was 85% and 65%, the NPV was 96% and 90%, and the CCR was 94% and 86%, respectively. Arthroscopy is an effective diagnostic method for the assessment of medial meniscal pathologies in small-breed dogs, especially when performed with the aid of a joint distractor.

Repercusión de los dispositivos móviles en la atención de enfermería a usuarios en estado crítico / Repercussion of mobile devices on nursing care for users in critical state

Introducción: actualmente en los hospitales de México, especialmente en las áreas de cuidados críticos, se ha incrementado el uso de dispositivos móviles de comunicación, repercutiendo en el cuidado del paciente; esto pudiera representar no solamente un distractor, sino una fuente portadora de gérmenes. Objetivo: evaluar la repercusión de los dispositivos móviles en la atención de enfermería a usuarios en estado crítico. Métodos: estudio descriptivo, trasversal; donde fueron medidos los tiempos de interrupción del cuidado de enfermería en el uso de dispositivos móviles de comunicación; se describió la exposición de estos artefactos con los equipos biomédicos por medio de una guía observacional, además se tomó muestra de los dispositivos móviles para su cultivo en agar nutritivo. Resultados: el 75,00 por ciento de los enfermeros estudiados hacían uso de los dispositivos móviles dentro de su jornada laboral; el 68,00 por ciento hizo uso de algún dispositivo móvil mientras realizaba alguna actividad con el paciente; el 64,00 por ciento tenía contacto con equipo biomédico; el 100,00 por ciento no se lavaba las manos antes y después de usarlos; en el 100,00 por ciento de las muestras tomadas y cultivadas hubo crecimiento Unidades Formadoras de Colonias a las 48 horas. Conclusiones: los dispositivos móviles son distractores, adictivos y cuentan con carga bacteriológica, esto afecta en la atención directa al paciente, su uso aún no está regulado; por esta razón sería importante considerar limitar el uso en las unidades de cuidados críticos, esto ayudara a brindar una mejor atención viéndose reflejado en la seguridad del paciente(AU)

Introduction: In Mexico hospitals today, especially in critical care areas, the use of mobile devices of communication has increased, which has had a repercussion on the care for the patient; this could represent not only a distracting aspect, but a germ-bearing source. Objective: Assess the repercussion of mobile devices on nursing care for user in critical state. Methods: cross-sectional, descriptive study in which we measured the interruption times for nursing care in the use of mobile devices of communication; we described the exposition of this artifacts with biomedical equipment by means of an observational guide, we also took sample of mobile devices for their culture in a nutrient agar. Results: 75.00 percentof the studied nurses used mobile devices within their working day; 68.00 percent used any mobile device while doing any activity with the patient; 64.00 percent had contact with biomedical equipment; 100.00 percent did not wash their hands before or after using them; in the 100.00 percent of the samples taken and cultured there were colonies growing after 48 hours. Conclusions: Mobile devices are distracting, addictive and have bacteriologic charge, which affects the direct care for the patient, their use is not regulated; therefore, it would be important to consider limiting their use in critical care units, which will help provide better attention reflected on the patient's safety(AU)

Application of subtalar joint distractor in operative treatment for comminuted calcaneal fracture / 中华创伤杂志

Objective To evaluate the method and clinical effect of subtalar joint distractor assisted open reduction and internal fixation of comminuted intra-articular calcaneal fracture.Methods Twenty-two patients with fresh closed calcaneal fracture treated with open reduction and internal fixation from May 2011 to July 2013 were included in the study.According to the modes of operation,the patients were randomly divided into two groups (n =11 in each):in group A patients underwent fracture reduction assisted by subtalar joint distractor and in group B patients underwent Steinmann pin traction and poking reduction.All were fixed using the lateral calcaneal plate.Operation time,B(o)hler angle,Gissanes angle,calcaneus height,incision healing time and complications of the two groups were investigated for evaluating the effect of operation.Clinical effect was evaluated using the American Orthopedic Foot & Ankle Society (AOFAS) score before the removal of internal fixation.Results Period of follow-up was (14.3±0.8)months (range,12 to 18 months).Two patients in group B had delayed wound healing,and were treated with regular wound care.At the final follow-up,no infection,nonunion,malunion and internal fixation failure were observed.B(o)hler angle,operation time and calcaneus height observed in group A were superior to those in group B (P ＜0.01).There was no significant difference in Gissanes angle between the two groups (P ＞ 0.05).Compared to the preoperative data,B(o)hler angle,Gissanes angle and calcaneus height were significantly improved in both groups (P ＜0.01).AOFAS score was (83.6 ± 1.4) points in group A and (81.7 ± 1.5) points in group B.Conclusion Subtalar joint distractor assisted open reduction and internal fixation is effective to shorten operation time,improve fracture reduction,reduce wound complications and increase the operative effect for comminuted intraarticular calcaneal fracture.

Brain Activation Patterns Associated with the Effects of Emotional Distracters during Working Memory Maintenance in Patients with Generalized Anxiety Disorder

Few studies have assessed the neural mechanisms of the effects of emotion on cognition in generalized anxiety disorder (GAD) patients. In this functional MRI (fMRI), we investigated the effects of emotional interference on working memory (WM) maintenance in GAD patients. Fifteen patients with GAD participated in this study. Event-related fMRI data were obtained while the participants performed a WM task (face recognition) with neutral and anxiety-provoking distracters. The GAD patients showed impaired performance in WM task during emotional distracters and showed greater activation on brain regions such as DLPFC, VLPFC, amygdala, hippocampus which are responsible for the active maintenance of goal relevant information in WM and emotional processing. Although our results are not conclusive, our finding cautiously suggests the cognitive-affective interaction in GAD patients which shown interfering effect of emotional distracters on WM maintenance.

A primary study of curvilinear distraction osteogenesis / 实用口腔医学杂志

Objective:To seek the possibility of using internally installed curved mandibular distractor to repair the partial mandibular curved defect.Methods:A curved mandibular defect was sectioned in each of 3 adult dogs.The distractor designed by our own group based on the steel ball conducted force was implanted.After 7 days of latency,the distraction was performed at the rate of 0.5 mm × 2 times per day,followed by 3 months consolidation period.The osteogenesis was evaluated by general observation,X-ray examination and HE staining.Results:No complication was observed after operation and during distraction.The new bone healed well into a curved shape.The X-ray examination revealed that the transport disc moved along with the predesigned rail curve.HE staining clearly showed neo bone formulation zone between the mature trabecular and connective tissue.Conclusion:The internal distractor based on the steel ball conducted force can realize the curved distraction osteogenesis of posteriormandibular.