Uso do laser de baixa potência para o tratamento de parestesia: uma revisão de literatura / Use of low-level laser to treat paresthesia: a literature review

Introdução: A parestesia é uma neuropatia que afeta a função sensorial. O Laser de Baixa Potência (LBP), por sua vez, apresenta propriedades analgésicas, bioestimuladoras e reparadoras. Objetivo: Realizar um levantamento na literatura científica sobre os aspectos gerais e benefícios do LBP no manejo terapêutico da parestesia, além de identificar a classificação e métodos de obtenção do diagnóstico desta condição. Materiais e Métodos: Tratou-se de uma revisão narrativa da literatura através da busca nas plataformas PubMed, SciELO, LILACS e Google Schoolar. Após o cruzamento dos descritores com os operadores booleanos e aplicação dos critérios de inclusão/exclusão, 26 estudos foram incluídos. Resultados: A parestesia pode ser classificada em neuropraxia, axonotmese e neurotmese, subdivididas em Grau I ao V. Seu diagnóstico pode ser executado através de testes subjetivos e objetivos. O LBP compreende em um dispositivo tecnológico com efeitos analgésico, anti-inflamatório e fotobiomodulador, que estimula o reparo neural. Os estudos mostram que a dosimetria nos comprimentos de onda vermelho e infravermelho, aplicação intra e extra oral, e com mais de uma sessão semanal exerce efeito modulatório positivo do reparo neural, com retorno progressivo da atividade sensitiva. Além disso, os estudos trazem uma ampla variação no número de pontos de aplicação, bem como no tempo de irradiação e quantidade de sessões, em virtude da extensão e tempo de diagnóstico da parestesia. Considerações finais: Apesar da alta complexidade da parestesia, o LBP exerce efeitos benéficos através do retorno da sensibilidade parcial ou total, além de ser um dispositivo bem tolerado pelo organismo e minimamente invasivo.

Introduction: Paresthesia is a neuropathy that affects sensory function. The Low-Level Laser (LLL), in turn, has analgesic, biostimulating and reparative properties. Purpose: Carry out a survey at the scientific literature on the general aspects and benefits of LLL in the therapeutic management of paresthesia in addition to identifying the classification and methods for obtaining a diagnosis of this condition. Materials and Methods: It was a narrative literature review through search in platforms PubMed, SciELO, LILACS and Google Schoolar. After crossing the descriptors with boolean operators and applying the inclusion/exclusion criteria, 26 articles were included in this study. Results: Paresthesia can be classified into neuropraxia, axonotmesis and neurotmesis, subdivided into Grades I to V. Its diagnostic can be carried out through subjective and objective tests. The LLL consists in a technological device with analgesic, anti-inflammatory and photobiomodulatory effects, which stimulates neural repair. Studies show that LLL in dosimetry at red and infrared wavelengths with intra and extra oral application and with more than one-week use exerts a positive modulatory effect on neural repair, with a progressive return of sensory activity. Furthermore, the studies show a wide variation in the number of application points, as well as the irradiation time and number of sessions, due to the extent and time of diagnosis of paresthesia. Final Considerations: Despite the high complexity of paresthesia, the LLL has beneficial effects through the return of partial or total sensitivity in addition being a device well tolerated by the body and minimally invasive.

Uma abordagem qualitativa sobre o uso do cateter urinário de longo prazo no contexto ambulatorial / A qualitative approach on long-term indwelling catheter use in an outpatient setting

Resumo O cateter vesical de longa permanência pode ser indicado em situações clínicas, como nas doenças crônicas do sistema genitourinário ou neurológico. Além dos riscos de infecção, traumas e sangramentos, a permanência do cateter pode afetar dimensões psicoemocionais e socioeconômicas. Objetivamos compreender como a necessidade de uso do cateter urinário por um longo prazo afeta a autopercepção, as interrelações e o autocuidado deste paciente. Realizamos um estudo qualitativo, descritivo, a partir da entrevista de 17 pacientes, e aplicamos a análise temática e o pensamento complexo. Os diferentes prognósticos e as expectativas em relação ao cateter influenciaram a autopercepção, a adaptação, sua aceitação ou negação. A presença do cateter, seja como medida curativa ou para conforto, pode afetar a autoimagem e a sexualidade, gerar inseguranças e incertezas, que requerem compreensão da multidimensionalidade das situações, que sofrem interferências do meio pessoal, familiar e social, bem como da capacidade dos sistemas de saúde para o seu enfrentamento. Apesar dos desafios, a maioria dos participantes relatou disposição favorável para o autocuidado, seja para viabilizar retirada do cateter, ou para prevenir agravos em indicações vitalícias.

Abstract A long-term indwelling catheter may be indicated in clinical situations, such as chronic diseases of the genitourinary or neurological systems. In addition to the risks of infection, trauma, and bleeding, a catheter's permanence can affect psycho-emotional and socioeconomic dimensions. We aimed to understand how the need to use a long-term indwelling catheter affects this patient's self-perception, interrelationships, and self-care. We carried out a qualitative, descriptive study based on interviews with 17 patients, and applied thematic analysis and complex thinking. The different prognoses and expectations regarding the catheter influenced self-perception, adaptation, acceptance, or denial. The presence of a catheter, whether as a curative measure or for comfort, can affect self-image and sexuality, and generate insecurities and uncertainties, which require understanding the multidimensionality of situations that suffer interference from the personal, family, and social environment, as well as health systems' capacity to deal with it. Despite the challenges, the majority of participants reported a favorable disposition towards self-care, whether to enable catheter removal or to prevent injuries in lifelong indications.

An Applied Anatomical Study on the Inferior Extensor Retinaculum of Ankle / Un Estudio de Anatomía Aplicada del Retináculo Extensor Inferior del Tobillo

SUMMARY: Through anatomical observations, the anatomical characteristics of the inferior extensor retinaculum of ankle (IER) of the ankle joint were elucidated, and its potential applications in treating lateral ankle instability or other conditions were discussed. A total of 12 adult foot specimens were dissected to expose the inferior extensor retinaculum of ankle, and a standard model was established. The pre-experimental scheme guided the recording of general findings, adjacent structures, lateral attachment in the tarsal sinus region, and influence on movement of inferior tendons. 1, attachment mean width: lateral band of IER 6.6±1.38 mm, oblique superomedial band of IER (32.3±3.97 mm), oblique inferomedial band of IER (30.0±5.30 mm) ; 2, mean length: lateral band of IER (78.1±4.20 mm) , oblique superomedial band of IER (14.2±0.80 mm), oblique inferomedial band of IER (71.8±2.61 mm); 3, maximum mean thickness: lateral band of IER (1.52±0.03 mm), oblique superomedial band of IER (0.89±0.05 mm), oblique inferomedial band of IER (0.73±0.16 mm); 4, the closest distance between IER and the tip of lateral malleolus: 23.9±0.83 mm; 5, mean width of the fiber tunnel:lateral fiber tunnel (11.9±1.16 mm), intermedium fiber tunnel (6.8±1.24 mm), medial fiber tunnel (8.6±0.79 mm); 6, mean distance from tunnel midpoint to lateral malleolar tip: lateral fiber tunnel (38.0±3.74 mm), intermedium fiber tunnel (69.8±4.15 mm), medial fiber tunnel (181.1±6.00 mm); 7, the distance between medial dorsal cutaneous nerve and the tip of lateral malleolus on the level of the IER (79.2±8.3 mm) the distance between intermediate cutaneous nerve of dorsum and the tip of lateral malleolus on the level of the IER (57.9±1.02 mm). The inferior extensor retinaculum of ankle is a crucial restraint unit of the anterior ankle tendon, and a comprehensive understanding of its anatomical characteristics holds significant implications for treating chronic ankle instability and exploring potential clinical applications.

A través de observaciones anatómicas, se dilucidaron las características anatómicas del retináculo extensor inferior (IER) de la articulación del tobillo y se discutieron sus posibles aplicaciones en el tratamiento de la inestabilidad lateral de esta articulación u otras afecciones. Se disecaron 12 muestras de pies de individuos adultos para exponer el retináculo extensor inferior del tobillo y se estableció un modelo estándar. El esquema preexperimental guió el registro de los hallazgos generales, las estructuras adyacentes, la inserción lateral en la región del seno tarsal y la influencia en el movimiento de los tendones inferiores. Se determino: 1. Ancho medio de inserción: banda lateral de IER (6,6 ± 1,38 mm), banda superomedial oblicua de IER (32,3 ± 3,97 mm), banda inferomedial oblicua de IER (30,0 ± 5,30 mm); 2. Longitud media: banda lateral de IER (78,1 ± 4,20 mm), banda superomedial oblicua de IER (14,2 ± 0,80 mm), banda inferomedial oblicua de IER (71,8 ± 2,61 mm); 3. Espesor medio máximo: banda lateral de IER (1,52 ± 0,03 mm), banda superomedial oblicua de IER (0,89 ± 0,05 mm), banda inferomedial oblicua de IER (0,73 ± 0,16 mm); 4. Distancia más próxima entre IER y el ápice del maléolo lateral: (23,9 ± 0,83 mm); 5.Ancho medio del túnel de fibra: túnel de fibra lateral (11,9 ± 1,16 mm), túnel de fibra intermedio (6,8 ± 1,24 mm), túnel de fibra medial (8,6 ± 0,79 mm); 6. Distancia media desde el punto medio del túnel hasta la punta del maléolor lateral: túnel de fibra lateral (38,0 ± 3,74 mm), túnel de fibra intermedio (69,8 ± 4,15 mm), túnel de fibra medial (181,1 ± 6,00 mm); 7. Distancia entre el nervio cutáneo dorsal medial y el a´pice del maléolo lateral en el nivel del IER (79,2 ± 8,3 mm); la distancia entre el nervio cutáneo intermedio dorsal y el ápice del maléolo lateral en el nivel del IER (57,9 ±1,02 mm). El retináculo extensor inferior del tobillo es una unidad de restricción crucial del tendón anterior del tobillo, y una comprensión integral de sus características anatómicas tiene implicaciones significativas para el tratamiento de la inestabilidad crónica del tobillo y la exploración de posibles aplicaciones clínicas.

Manejo de Alteraciones Neurosensoriales Asociadas a Procedimientos Quirúrgicos Mandibulares, Scoping Review

Las alteraciones neurosensoriales son complicaciones que se pueden presentar posterior a la realización de ciertos procedimientos quirúrgicos orales. Múltiples reportes indican específicamente el territorio inervado por el nervio alveolar inferior y nervio lingual como las regiones mayormente afectadas. Dar a conocer las diferentes alternativas terapéuticas para estas complicaciones, sería de suma relevancia para el clínico, con el propósito de mejorar el pronóstico en cuanto a la recuperación neurosensorial de estos nervios. El objetivo de este trabajo fue describir el manejo terapéutico de las alteraciones neurosensoriales asociadas al daño del nervio alveolar inferior y nervio lingual, en procedimientos quirúrgicos mandibulares. La búsqueda de la literatura científica fue realizada en las bases de datos PubMed, Scopus y Web of Science. Se utilizaron los términos de búsqueda "Trigeminal nerve injuries", "lingual nerve", "mandibular nerve", "oral surgical procedures", "treatment" en conjunto al conector booleano "AND" y "OR". Fueron considerados artículos publicados entre los años 2012 y 2022. En la selección de los artículos primarios se eliminaron los duplicados y se aplicaron los criterios de inclusión y exclusión. Finalmente se realizó el análisis a texto completo con un total de 14 artículos seleccionados. Un total de 14 artículos fueron revisados. Del total de artículos, 6 corresponden a terapia láser de bajo nivel, 2 a medicación y bloqueo del ganglio estrellado, 1 a bloqueo de ganglio estrellado e irradiación con luz xenón y 5 artículos corresponden a tratamiento mediante reparación microquirúrgica. La terapia láser de bajo nivel, el bloqueo del ganglio estrellado, la administración de vitamina B12/ATP y la reparación microquirúrgica son tratamientos efectivos para las alteraciones neurosensoriales ocasionadas por lesiones del nervio alveolar inferior y nervio lingual.

SUMMARY: Neurosensory abnormalities are complications can occur after performing certain oral surgical procedures. Multiple reports specifically indicate the area innervated by the inferior alveolar nerve and the lingual nerve as the most affected regions. Presenting the different therapeutic alternatives for these complications would be extremely relevant for the clinician, in order to improve the prognosis in terms of neurosensory recovery of these nerves. The objective of this study was to describe the therapeutic management of neurosensory abnormalities associated with damage to the inferior alveolar nerve and lingual nerve, in mandibular surgical procedures. The search for scientific literature was carried out in the PubMed, Scopus and Web of Science databases. The search terms "Trigeminal nerve injuries", "lingual nerve", "mandibular nerve", "oral surgical procedures", "treatment" together with the boolean connector "AND" and "OR" were used. Articles published between the years 2012 and 2022 were considered. In the selection of primary articles, duplicates were eliminated and the inclusion and exclusion criteria were applied. Finally, the full text analysis was carried out with a total of 14 selected articles. A total of 14 articles were reviewed. About the articles, 6 correspond to low-level laser therapy, 2 to medication and stellate ganglion block, 1 to stellate ganglion block and xenon light irradiation, and 5 articles correspond to treatment by microsurgical repair. Low-level laser therapy, stellate ganglion block, vitamin B12/ATP administration, and microsurgical repair are effective treatments for neurosensory abnormalities caused by inferior alveolar nerve and lingual nerve injuries.

História digital baseada na experiência de sintomas urinários e intestinais na infância: um estudo metodológico de produção tecnológica / Digital story based on the experience of bladder and bowel symptoms in childhood: a methodological study of technological production

OBJETIVO: Descrever a produção de protótipo de história digital baseada na experiência de sintomas urinários e intestinais em crianças. MÉTODO: Trata-se de pesquisa aplicada, com abordagem multimétodo, dividida em 2 fases: fase 1 consistiu em uma revisão sistemática de métodos mistos e um estudo de método misto (etapa quantitativa baseada em estudo retrospectivo do tipo documental por meio da análise de prontuários, e etapa qualitativa baseada em entrevistas com profissionais especialistas, responsáveis e crianças com sintomas urinários e intestinais em idade escolar). A fase 2 foi uma pesquisa metodológica de produção tecnológica do protótipo de história digital. RESULTADOS: A partir da triangulação dos dados obtidos nas 2 fases da pesquisa multimétodo, a história desenvolvida trouxe personagens representativos do perfil de crianças com os sintomas estudados e uma narrativa com elementos da experiência desses sintomas. CONCLUSÃO: A história buscou dar protagonismo e encorajar crianças com tais sintomas para tratamento e autocuidado.

OBJECTIVE: To describe the production of a prototype digital story based on the experience of bladder and bowel symptoms in children. METHOD: This is an applied research with a multimethod approach, divided into two phases: Phase 1 consisted of a systematic review of mixed methods and a mixed methods study (quantitative phase based on retrospective documentary analysis of medical records, and qualitative phase based on interviews with health professionals, caregivers, and children with bladder and bowel symptoms of school age). Phase 2 consisted of a methodological study of the technological production of the digital story prototype. RESULTS: Based on the triangulation of data obtained in the two phases of the multimethod research, the developed story brought representative characters of the profile of children with the studied symptoms and a narrative with elements of the experience of these symptoms. CONCLUSION: The story sought to give protagonism and encourage children with such symptoms to treatment and self-care.

Research progress on anatomic vascular reconstruction in rat models of orthotopic liver transplantation / 器官移植

Establishment of rat models of liver transplantation provides an ideal animal model for resolving the problems of postoperative complications and perioperative treatment of liver transplantation. With in-depth study of the establishment of rat models of liver transplantation, classic "two-cuff" technique has been gradually employed. However, poor surgical field, vascular torsion, biliary tract injury and long anhepatic phase remain unresolved in the process of liver transplantation using traditional techniques. At present, the rat models of liver transplantation at home and abroad are modified mainly from the reconstruction of four vital anatomic structures including the suprahepatic inferior vena cava, portal vein, infrahepatic inferior vena cava and bile duct. Therefore, the latest progress in the reconstruction of the suprahepatic inferior vena cava, portal vein, infrahepatic inferior vena cava and bile duct was reviewed, aiming to provide reference for the establishment of rat models of liver transplantation and promote further development of liver transplantation techniques.

Application of"rotation-correction loop technique"in the retrieval of complex inferior vena cava filters / 介入放射学杂志

Objective To discuss the application of the"rotating guidewire and correcting the filter recovery hook direction technique"("rotation-correction loop technique"for short),a technique invented by the authors in clinical practice,in the retrieval of complex inferior vena cava filter(IVCF),and to discuss its technical skills and advantages.Methods The clinical data of 417 patients carrying an IVCF,who were admitted to the Department of Vascular Surgery of Second Hospital of Shanxi Medical University of China to retrieve IVCF between January 2022 and December 2022,were retrospectively analyzed.Taking the time spent on the retrieval of IVCF and the intraoperative radiation dose as the evaluation indicators,the advantages and disadvantages of the standard filter retrieval technique,the"rotation-correction loop technique"and the other loop-assisted techniques were compared.Results Both the intraoperative radiation dose and the time spent on the retrieval of IVCF using"rotation-correction loop technique"were remarkably lower than those of other loop-assisted techniques(P＜0.000 1).Conclusion For the retrieval of complex IVCF,especially for the IVCF which is heavily tilted and/or its recovered hook is attached to the vascular wall,the use of"rotation-correction loop technique"can shorten the time spent on the the retrieval of IVCF and reduce the intraoperative radiation dose.This technique carries high safety and practicability,the device is simple and it can be manipulated by single physician,which is conducive to clinical application and promotion.(J Intervent Radiol,2024,33:289-294)

Effect of locking plate combined with cortical screw internal fixation on ankle function and quality of life in patients with ankle fracture combined with inferior tibiofibular separation / 临床外科杂志

Objective To investigate the effect of locking plate combined with cortical screw internal fixation on ankle function and quality of life in patients with ankle fracture with tibiofibular separation.Methods A total of 120 patients with ankle fracture and distal tibiofibular separation treated in our hospital from May 2020 to December 2021 were selected and divided into control group and observation group according to random number table method,with 60 patients/group.The control group was treated with cortical screw fixation alone,and the observation group was treated with locking plate combined with cortical screw internal fixation.Before surgery and 6 months after surgery,the recovery function of the two groups was compared.X-ray,operation duration,healing time,intraoperative blood loss,postoperative complications were compared,and the living ability of the two groups of patients was evaluated.Results Before treatment,there was no difference in joint function between the two groups(P＞0.05).After treatment,the longest walking of the control group(15.89±0.85),foot alignment(15.06±0.71),pain response(29.03±4.48)and ground walking(15.65±0.59).The longest walking distance(16.19±0.87),foot alignment(15.29±0.76),pain response(31.24±4.55)and ground walking(15.96±0.68)in the observation group,which were higher than those in control group(P＜0.05).Compared with the control group,the intraoperative blood loss and healing time in the observation group were lower(P＜0.05).BI index of the two groups before treatment had no difference(P＞0.05);After treatment,BI index of observation group was higher than that of control group(P＜0.05).There was no difference in the total complication rate between the two groups(P＞0.05).Conclusion Locking plate combined with cortical screw internal fixation has a good therapeutic effect on improving ankle function,reducing intraoperative blood loss,promoting healing and improving behavioral ability in the treatment of ankle fracture combined with hypotibiofibular syndesmosis injury.

Progress in ERAS-based anesthetic management for patients undergoing deep inferior epigastric perforator flap breast reconstruction / 复旦学报（医学版）

At present,the development of enhanced recovery after surgery(ERAS)pathways in deep inferior epigastric perforator(DIEP)flap breast reconstruction is still in the initial stage worldwide,lacking established guidelines.In the multidisciplinary ERAS pathways,the department of anesthesiology is responsible for some core elements such as optimizing anestheticprotocols,perioperative fluid management and homeostasis regulation,prevention of hypothermia,improvement of perioperative analgesia,and postoperative nausea and vomiting prophylaxis.We summarized the anesthetic management in the ERAS pathways for patients undergoing DIEP flap breast reconstruction in Fudan University Shanghai Cancer Center,along with the recent progress,aiming to establish and improve the perioperative strategy based on ERAS pathways in DIEP flap breast reconstruction.

Comparative analysis of domestic Octoparms and imported Celect inferior vena cava filter in interventional treatment of venous thromboembolism / 实用放射学杂志

Objective To compare and analyze the application value of domestic Octoparms and imported Celect inferior vena cava filter(IVCF)in the interventional treatment of venous thromboembolism(VTE).Methods Forty patients with VTE were randomly divided into Octoparms group(experimental group)and Celect group(control group)according to the double-blinded method of the central random system.All the patients underwent filter placement,catheter-directed thrombolysis and filter retrieval.The primary end point was the success of filter placement and retrieval,and the secondary end point included indwelling complications such as the occurrence of pulmonary embolism(PE)and filter tilt and migration.Results Forty patients were enrolled in this study,22 patients and 18 patients were divided into the experimental group and the control group,respectively.Among them,11 cases were identified with right lower extremity deep vein thrombosis,29 cases with left lower extremity deep vein thrombosis,17 cases with PE,and 6 cases with inferior vena cava thrombosis.The success rate of IVCF placement was 100%in all participants.Immediately after filter place-ment,the angle of filter tilt was(3.8±2.3)° in the experimental group and(4.9±2.8)° in the control group(t=1.44,P=0.16).Filter retrieval was successful in 21 cases(21/22,95.5%)of the experimental group and 17 cases(17/18,95.5%)of the control group.There was no significant difference between the two groups(t=0.14,P=0.89).The mean indwelling time of filter was(8.0±2.1)days in the experimental group and(9.7±3.1)days in the control group(t=0.73,P=0.47).The angle of filter tilt was(5.3±3.4)° in the experimental group and(5.7±7.7)° in the control group(t=0.19,P=0.85).There was no significant difference for filter placement and retrieval between the two groups(t=0.48 and 2.00,P=0.06 and 0.64,respectively).There were no complications of filter migration,strut penetration or new PE in both groups.Conclusion The application value of domestic Octoparms and impor-ted Celect IVCF is similar in interventional treatment of VTE.

The efficacy of hip arthroscopy for concurrent femoroacetabular and subspine impingement / 中华骨科杂志

Objective:To assess the clinical outcomes of hip arthroscopy in patients with concurrent femoroacetabular impingement (FAI) and subspine impingement (SSI).Methods:Data were retrospectively reviewed for patients with both FAI and SSI who underwent hip arthroscopy surgery from August 2021 to May 2022. A total of 23 patients (23 hips) followed up for more than 1 year, including 10 males and 13 females, 9 left hips and 14 right hips, with an average age of 31.3±4.6 years (range, 25-45 years). Subspine decompression by anterior inferior spine (AIIS) shaping for SSI was performed during hip arthroscopy in addition to labral repair and bony correction for FAI in the patients with concurrent FAI and SSI. Clinical outcomes were evaluated using preoperative and 1-year postoperative measures: lateral center-edge (LCE) angle, α angle on 45° Dunn view X-rays, maximum hip flexion angle, hip flexion and knee extension strength, visual analogue scale (VAS) for pain, modified Harris Hip Scores (mHHS), and International Hip Outcome Tool-12 (iHOT-12).Results:Of the 23 patients, 20 had type 2 AIIS and 3 had type 3 AIIS. At 1-year follow-up after surgery, there were significant improvements: LCE angle decreased (33.3°±6.1° to 31.7°±4.1°, t=1.076, P=0.288), α angle reduced (63.7°±8.5° to 50.0°±6.6°, t=6.116, P<0.001), hip flexion angle increased (107.4°±6.0° to 120.2°±4.4°, t=8.269, P<0.001), VAS scores decreased (4.0±1.1 to 1.0±1.1, t=9.591, P<0.001), mHHS improved (62.6±4.9 to 87.5±8.1, t=12.700, P<0.001), and iHOT-12 scores rose (51.4±4.9 to 75.7±7.7, t=12.593, P<0.001). There was no significant difference in the strength of hip flexion and knee extension between preoperative and follow-up ( t=0.930, P=0.357 and t=0.050, P=0.960, respectively). There were no reports of traction-related complications (such as skin necrosis and nerve paralysis), severe adverse events (such as femoral neck fractures, deep vein thrombosis in the lower limbs, intra-articular infections, ectopic ossification and hip instability), or the need for revision surgery. Conclusion:Subspine decompression by anterior inferior spine (AIIS) shaping for SSI during conventional hip arthroscopy is safe and effective, enhancing hip function and alleviating pain at 1-year follow-up without significant complications.

Analysis of the clinical characteristics of V4 segment steal blood in the vertebral artery / 中华内科杂志

Objective:To explore the clinical characteristics of unilateral vertebral artery V4 segment occlusive lesions (severe stenosis or occlusion), where the contralateral vertebral artery can be compensated through blood flow and reverse supply to the posterior inferior cerebellarartery (PICA).Methods:This study is a retrospective case series of 66 patients with V4 segment occlusive lesions of unilateral vertebral artery diagnosed and treated from June 2020 to October 2022. Patient data were retrospectively collected, and their hemodynamic characteristics and imaging data were analyzed.Results:Of the 66 cases, 11 patients (16.7%) with V4 segment occlusive disease showed the blood flow of the vertebral artery on the opposite side of the lesion on the digital subtraction angiography (DSA), which can be reverse stolen to the posterior inferior cerebellar artery of the diseased side through the confluence point of the vertebrobasilar artery through the distal end of the ipsilateral vertebral artery V4. Owing to the lack of literature on this pathway and based on the characteristics of previous definitions of subclavian artery steal and carotid artery steal, we referred to this pathway as the vertebral artery V4 segment steal. In 6 patients (9.1%), transcranial Doppler ultrasound (TCD) and transcranial color Doppler ultrasound (TCCD) showed that the blood flow signal was not detected at the proximal end of the V4 segment of the affected side, rather the blood flow direction was reversed at the distal end of the V4 segment, resulting in compensatory acceleration of the blood flow velocity of the V4 segment of the contralateral vertebral artery.Conclusion:“V4 segment steal of vertebral artery” is a very rare route of vertebral artery steal. When V4 segment of the vertebral artery is occluded, clinicians should pay attention to observe the blood supply of PICA and whether there is such a steal route, to better evaluate the blood flow compensation and prognosis of patients.

Effect of filling orbicularis muscle flap in correction of sunken upper eyelidsin subbrow blepharoplasty / 中华医学美学美容杂志

Objective:To investigate the effect of folding and filling the orbicularis muscle flap of the inferiorcentral pedicle in correction of sunken upper eyelids.Methods:From August 2020 to April 2022, 39 female patients aged 36-63 (47.1±6.3) years with dermatochalasis and sunken upper eyelid were admitted to the Plastic Surgery Department of the First Affiliated Hospital of Air Force Medical University. During the surgery, the orbicularis oculi muscle in the skin resection area was preserved and a muscle flap was formed with the central part of the lower margin of the incision as the pedicle, which was folded deep and filled in the anterior orbital septal space. 6 months after surgery, the Park method was used to compare the effects before and after surgery, and the doctors and patients were scored on the Global Aesthetic Improvement Scale, respectively.Results:Unilateral upper eyelid hematoma appeared in 1 patient and healed after local acupuncture and aspiration, unilateral incision induration appeared in 2 patients, and gradually disappeared after 6 months of follow-up. The wounds of other patients healed in one stage. All the 39 patients were followed up for 6-12 months. The scores of the Global Aesthetic Improvement Scale at 6 months after surgery were (4.12±0.95) for doctors and (3.82±1.27) for patients. Park method showed that the degree of sunken upper eyelid after surgery was significantly better than that before surgery, and the difference was statistically significant ( Z=-7.721, P=0.000). Conclusions:The folding and filling of the orbicularis muscle flap of the eye with the inferior central pedicle can correct the laxity of the upper eyelid and improve the sunken upper eyelid. This operation can make full use of local tissue, and the effect is simple and lasting.

A case report of inferior oblique reattachment after Inferomedial Orbital Wall Reconstruction from Total Maxillectom

@#The detachment and reattachment of inferior oblique (IO) have been done by ophthalmologists in inferomedial orbital wall fracture repair to avoid inducing a new diplopia in patients post-operatively. However, doing them in orbital wall reconstruction in patient who underwent maxillectomy for a malignancy has not been described yet. We describe a case where a disinserted inferior oblique was reattached after titanium mesh implantation to prevent diplopia after the surgery. This is the case of a 40-year-old male diagnosed with recurrent bilateral nasomaxillary ameloblastoma who underwent total maxillectomy of the right with removal of the inferomedial orbital wall, and detachment and reattachment of inferior oblique with no resulting inferior oblique palsy and diplopia from hypotropia or incyclotorsion. This is the first report, to our knowledge, to describe reattachment of IO in its approximate insertion during reconstruction of the inferomedial orbital wall after total maxillectomy from a malignancy with no resulting diplopia.

Value of FAST combined with serum CRP,PCT,and IL-6 detection in predicting the clinical outcome of patients with acute chest and abdominal trauma / 中国医科大学学报

Objective To investigate the value of emergency physician-led focused assessment with sonography for trauma(FAST)combined with serum C-reactive protein(CRP),procalcitonin(PCT),and interleukin-6(IL-6)testing in predicting the clinical outcome of patients with acute chest and abdominal trauma.Methods Ninety-six patients with acute thoracoabdominal trauma,who had been admitted to the Department of Emergency in our hospital from February 2019 to February 2022,were selected for this study.The patients were grouped according to their clinical outcomes,with the individuals who died after 48 h of treatment classified to the death group(n = 14)and all the others to the survival group(n = 82).The general clinical indicators(sex,age,body mass,trauma type,smoking history,alcohol consumption history,and previous chest and abdominal surgery history),CRAMS scores,inferior vena cava-collapse index(IVC-CI),and serum CRP,PCT,and IL-6 levels at 0,24,and 48 h after admission were compared between the two groups.Logistic regression analysis was used to identify the factors that influence the outcomes of patients with acute thoracoabdominal trauma based on statistically significant differences(P＜0.05)between the two groups.Receiver operating characteristic(ROC)curves of the IVC-CI combined with serum CRP,PCT,and IL-6 detection were plotted to evaluate the value in predicting clinical outcomes.Results The serum CRP,PCT,and IL-6 levels,CRAMS score,and IVC-CI in the death group were higher than those in the survival group at 0,24,and 48 h after admis-sion(all P＜0.001).The serum CRP,PCT,and IL-6 levels in patients in the death group gradually increased from 0,24,and 48 h after admission,and the differences between each time point were statistically significant(all P＜0.05).In the patients in the survival group,these serum protein levels increased from 0 to 24 h after admission and peaked at 48 h,and the differences between each time point were statistically significant(all P＜0.05).The logistic regression analysis showed that the CRAMS score,IVC-CI,and serum CRP,PCT,and IL-6 levels were risk factors affecting the outcome of patients with acute chest and abdominal trauma(all P＜0.05).The area under the ROC curve for the IVC-CI combined with serum CRP,PCT,and IL-6 detection was greater than that for each individual assessment type alone(all P＜0.05),and the use of the IVC-CI combined with serum CRP,PCT,and IL-6 detection to predict the clinical outcome of patients with acute chest and abdominal trauma had net clinical benefit.Conclusion The IVC-CI and serum CRP,PCT,and IL-6 levels were associ-ated with the clinical outcomes of patients with acute thoracoabdominal trauma.Therefore,emergency physician-led bedside ultrasound FAST combined with 48 h serum CRP,PCT,and IL-6 testing has good value for predicting the clinical outcomes of patients with acute chest and abdominal trauma.

Clinical study of inferior oblique transposition combined with medial and lateral rectus surgery in the treatment of inferior oblique hyperfunction combined with V-type strabismus / 中国现代医生

Objective To evaluate the effectiveness and safety of inferior oblique transposition combined with medial and lateral rectus surgery in the treatment of inferior oblique hyperfunction combined with V-type strabismus.Methods Thirty-nine patients with inferior oblique hyperfunction combined with V-type strabismus admitted to Jiaxing Hospital of Traditional Chinese Medicine Affiliated to Zhejiang Chinese Medical University from November 2020 to September 2021 were selected as study objects,and were divided into combined operation group(n=28)and multiple operation group(n=11)according to different surgical programs.The visual acuity,eye position,cure rate of V sign,correction rate of inferior oblique hyperfunction,oculocardiac reflex,oculogastric reflex and complications were compared between two groups.Results One month after surgery,patients of two groups recovered the first eye position,and there were no statistical significances in the number of V sign cured and the number of inferior oblique hyperfunction corrected(P>0.05).Visual acuity returned to preoperative level in both groups.There were no significant differences in oculocardiac reflex and oculogastric reflex between two groups(P>0.05).There were no inflammatory reaction,massive subconjunctival hemorrhage,subcutaneous hematoma of eyelid,retrobulbar hemorrhage and other complications in two groups.Conclusion The effect of inferior oblique transposition combined with medial and lateral rectus surgery in the treatment of inferior oblique hyperfunction combined with V-type strabismus is not inferior to that of conventional divided operation,but it can reduce the number of operations and avoid the pain caused by the second operation,which is worthy of clinical application.

Safety of preoperative branch embolization in patients undergoing evar / Segurança da embolização pré-operatória do ramo em pacientes submetidos a evar

Abstract The purpose of this systematic review is to evaluate the safety of pre-endovascular abdominal aortic aneurysm repair (EVAR) embolization of aortic side branches - the inferior mesenteric artery and lumbar arteries. Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines were followed. A search of MEDLINE and DIMENSION databases identified 9 studies published from 2011 to 2021 that satisfied the inclusion and exclusion criteria. These studies were analyzed to detect the incidence of embolization-related complications. A total of 482 patients underwent preoperative aortic side branch embolization, 30 (6.2%) of whom suffered some kind of minor complication. The only major complication observed was ischemic colitis in 4 (0.82%) patients, two (0.41%) of whom died after bowel resection surgery. Regarding these findings, aortic side branch embolization seems to be a safe procedure, with very low percentages of both minor and major complications.

Resumo O objetivo desta revisão sistemática foi avaliar a segurança da embolização de artéria mesentérica inferior (AMI) e artérias lombares (ALs) pré-correção endovascular de aneurisma da aorta abdominal. Foram realizadas pesquisas nas bases de dados MEDLINE e Dimensions. Foram encontrados 9 estudos publicados de 2011 a 2021 que atendiam aos critérios de inclusão e exclusão. Os estudos foram analisados ​​para definir a incidência de complicações relacionadas à embolização. No total, 482 pacientes foram submetidos a embolização de AMI e/ou ALs, dos quais 30 (6,2%) sofreram algum tipo de complicação menor. A única complicação importante observada foi colite isquêmica em 4 (0,82%) pacientes. Dois (0,41%) desses pacientes morreram após cirurgia de ressecção intestinal. Em relação a esses achados, a embolização de AMI e ALs parece ser um procedimento seguro, com um percentual muito baixo de complicações menores e importantes.

Evaluation of the mesenteric arterial vasculature by computed tomography angiography and its implications for colorectal cancer surgery / Avaliação da vasculatura arterial mesentérica pela angiotomografia computadorizada e suas implicações na cirurgia do câncer colorretal

Abstract Objective: To determine the branching patterns of the inferior mesenteric artery (IMA) and to describe the clinical applicability of computed tomography (CT) angiography in the evaluation of these vessels to facilitate the planning of colorectal cancer surgery. Materials and Methods: We included 100 patients who underwent CT angiography of the abdomen and pelvis. The branching patterns of the IMA were examined and classified as type 1 (bifurcated), including 1A (sigmoid and left colic arteries arising from a common trunk), 1B (sigmoid and superior rectal arteries arising from a common trunk) and 1C (sigmoid arteries arising from both trunks); type 2 (trifurcated); and type 3 (no left colic branch). Results: Among the 100 patients evaluated, we found the variant to be type 1A in 9%, type 1B in 47%, type 1C in 24%, type 2 in 16%, and type 3 in 4%. Conclusion: Preoperative CT angiography for evaluating the IMA branching pattern could inform decisions regarding the surgical approach to colorectal cancer.

Resumo Objetivo: Determinar os padrões de ramificação da artéria mesentérica inferior (AMI) e descrever a aplicabilidade clínica da angiografia por tomografia computadorizada na avaliação desses vasos na elaboração das estratégias pré-operatórias de cirurgia de câncer colorretal. Materiais e Métodos: Foram incluídos 100 pacientes submetidos a angiografia por tomografia computadorizada abdominal e pélvica. Os padrões de ramificação da AMI foram examinados e classificados como tipo 1 (bifurcado), incluindo 1A (artérias sigmoide e cólica esquerda originando-se de um tronco comum), 1B (artérias sigmoide e retal superior originando-se de um tronco comum) e 1C (artérias sigmoide originando-se de ambos os troncos); tipo 2 (trifurcado); e tipo 3 (sem ramo cólico esquerdo). Resultados: Do total de participantes incluídos no estudo, a variante do tipo 1A foi observada em 9%, a do tipo 1B em 47%, e a do tipo 1C em 24%. Com relação à variante tipo 2, esta foi observada em 16% dos pacientes, e a do tipo 3, em 4% dos casos. Conclusão O uso da angiografia por tomografia computadorizada pré-operatória para avaliar o padrão de ramificação da AMI pode ajudar a escolher a abordagem cirúrgica no câncer colorretal.

Nursing interventions to empower the family caregiver of person with lower limb amputation: scoping review / Intervenções de Enfermagem para capacitar o cuidador familiar de uma pessoa com amputação de membro inferior: revisão de escopo / Intervenciones de enfermería para capacitar al cuidador familiar de una persona con amputación de miembro inferior: revisión de alcance

ABSTRACT Objectives: to map nursing interventions that empower the Family caregiver of the person with lower limb amputation for is role. Methods: scoping review guided by Joanna Briggs Institute methodology conducted in different databases (including gray literature). Results: six studies published between 2009 and 2021 were included. Interventions of counselling and support for patients and family; peer support interventions performed by a certified pair; involvement of caregivers or family members in support groups; and key interventions for patient and family caregiver psychological balance. Two studies discussed the importance of caregiver and amputee training and development of coping skills. Another study recommended Interventions of informative support for caregivers regarding care for the amputee and adaptation to home. Conclusions: results of this review allow the identification of recommendations (guidelines) for practice and recommendations/suggestions for interventions according with identified needs of family caregivers of patients with lower limb amputation.

RESUMO Objetivos: mapear intervenções de enfermagem que capacitem o cuidador familiar da pessoa com amputação de membro inferior para seu papel. Métodos: revisão de escopo orientada pela metodologia do Joanna Briggs Institute realizada em diferentes bases de dados (incluindo literatura cinzenta). Resultados: foram incluídos seis estudos publicados entre 2009 e 2021. Intervenções de aconselhamento e apoio para pacientes e familiares; intervenções de apoio de pares realizadas por uma dupla certificada; envolvimento de cuidadores ou membros da família em grupos de apoio; e intervenções-chave para o equilíbrio psicológico do paciente e do cuidador familiar. Dois estudos discutiram a importância do treinamento do cuidador e do amputado e do desenvolvimento de habilidades de enfrentamento. Outro estudo recomendou intervenções de suporte informativo para os cuidadores com relação aos cuidados com o amputado e à adaptação ao lar. Conclusões: os resultados dessa revisão permitem a identificação de recomendações (diretrizes) para a prática e recomendações/sugestões para intervenções de acordo com as necessidades identificadas dos cuidadores familiares de pacientes com amputação de membros inferiores.

RESUMEN Objetivos: mapear intervenciones de enfermería que capaciten al cuidador familiar de la persona con amputación de miembro inferior para su rol. Métodos: es una revisión de alcance guiada por la metodología del Instituto Joanna Briggs, llevada a cabo en diferentes bases de datos (incluyendo literatura gris). Resultados: se tuvieron en cuenta seis estudios publicados entre 2009 y 2021, a saber: intervenciones de asesoramiento y apoyo para pacientes y familiares; intervenciones de apoyo entre iguales realizadas por un par de profesionales certificados; participación de cuidadores o familiares en grupos de apoyo e intervenciones clave para el equilibrio psicológico del paciente y del cuidador familiar. Dos estudios analizaron la importancia de la formación del cuidador y del amputado y del desarrollo de habilidades de afrontamiento. Otro estudio recomendó intervenciones de apoyo informativo para los cuidadores en relación con el cuidado del amputado y su adaptación a la vida hogareña. Conclusiones: los resultados de esta revisión permiten identificar recomendaciones/directrices para la práctica y recomendaciones/sugerencias de intervenciones según las necesidades identificadas de los cuidadores familiares de pacientes con amputación de miembros inferiores.

Primary Health Care nurses' role in treating Lower Urinary Tract Dysfunction / Papel de la enfermera de Atención Primaria de Salud en el tratamiento de la Disfunción del Tracto Urinario Inferior / Atuação do enfermeiro da Atenção Primária à Saúde no tratamento da Disfunção do Trato Urinário Inferior

ABSTRACT Objective: To understand Primary Health Care nurses' role in treating Lower Urinary Tract Dysfunction. Method: Cross-sectional multi-methodological research, composed of quantitative and qualitative steps, independently and sequentially. Data collected remotely, through a questionnaire and focus group, analyzed using descriptive statistics and thematic analysis by Braun and Clarke, respectively. The project was approved under Opinion 22691119.0.0000.0030. Results: A total of 145 nurses participated in the study in the quantitative step and 20 in the qualitative step, working in Primary Health Care in Brazil. Of the 93.1% nurses who reported having already cared for people with Urinary Tract Dysfunction, only 54.4% provided guidance, mainly for training the pelvic floor muscles. Conclusion: Even though they have legal support and access to demand, nurses do not have the knowledge to offer conservative treatment for Lower Urinary Tract Dysfunction. Despite this, they were motivated to do so as long as they received specific training.

RESUMEN Objetivo: Comprender el papel del enfermero de Atención Primaria de Salud en el tratamiento de la Disfunción del Tracto Urinario Inferior. Método: Investigación transversal multimetodológica, compuesta por etapas cuantitativas y cualitativas, de forma independiente y secuencial. Datos recopilados de forma remota, a través de un cuestionario y un grupo focal, analizados mediante estadística descriptiva y análisis temático de Braun y Clarke, respectivamente. El proyecto fue aprobado bajo Opinión 22691119.0.0000.0030. Resultados: Participaron del estudio 145 enfermeros en la etapa cuantitativa y 20 en la cualitativa, actuando en la Atención Primaria de Salud en Brasil. Del 93,1% de los enfermeros que afirmaron haber atendido ya a personas con Disfunción del Tracto Urinario, sólo el 54,4% brindó orientación, principalmente para el entrenamiento de los músculos del suelo pélvico. Conclusión: Incluso con apoyo legal y acceso a la demanda, los enfermeros no tienen el conocimiento para ofrecer tratamiento conservador para la Disfunción del Tracto Urinario Inferior. Pese a ello, estaban motivados para hacerlo siempre que recibieran una formación específica.

RESUMO Objetivo: Compreender a atuação dos enfermeiros da Atenção Primaria à Saúde no tratamento da Disfunção do Trato Urinário Inferior. Método: Pesquisa transversal multi-metodológica, composta por etapas quantitativa e qualitativa, de forma independente e sequencial. Dados coletados de forma remota, por meio de questionário e grupo focal, analisados por estatística descritiva e análise temática de Braun e Clarke, respectivamente. O projeto foi aprovado sob Parecer no. 22691119.0.0000.0030. Resultados: Participaram do estudo 145 enfermeiros na etapa quantitativa e 20 na qualitativa, atuantes na Atenção Primária à Saúde do Brasil. Dos 93,1% enfermeiros que referiram já terem atendido pessoas com Disfunção do Trato Urinário, apenas 54,4% prestaram orientações, sendo principalmente para treinamento da musculatura do assoalho pélvico. Conclusão: Mesmo possuindo respaldo legal e acesso à demanda, os enfermeiros não têm conhecimento para oferecer tratamento conservador para Disfunção do Trato Urinário Inferior. Apesar disso, mostraram-se motivados para tal atuação desde que recebam capacitação específica.