Primer caso reportado en Panamá de: Síndrome de Baraitser Winter

El síndrome cerebro-frontal-facial de Baraitser-Winter (BWCFF) se origina a partir de mutaciones sin sentido, heterocigóticas, en uno de los dos genes ubicuos que codifican la actina citoplásmica, ya sea ACTB o ACTG1. Este síndrome es una combinación de malformaciones faciales y cerebrales. Entre las malformaciones faciales que podemos observar, destacan el coloboma de iris, la ptosis bilateral, el hipertelorismo, el puente nasal ancho y los pliegues epicánticos prominentes. Las malformaciones cerebrales incluyen la paquigiria, la heterotopia de banda subcortical y las anomalías del cuerpo calloso. En este contexto, presentamos el caso de una niña de 11 años que presentaba algunos rasgos faciales distintivos, además de malformaciones cerebrales, baja estatura, discapacidad cognitiva moderada, y retraso del habla y lenguaje. Mediante secuenciación por exoma clínico dirigido, se identificó una variante sin sentido heterocigota de Novo en ACTB: c.617G>A (p. Arg206Gln). (provisto por Infomedic International)

The Baraitser-Winter cerebral-front-facial syndrome (BWCFF) is caused by heterozygous nonsense mutations in one of the two ubiquitous genes encoding cytoplasmic actin, either ACTB or ACTG1. The syndrome combines facial and cerebral malformations. Among the facial malformations that can be observed are iris coloboma, bilateral ptosis, hypertelorism, broad nasal bridge, and prominent epicanthic folds. The cerebral malformations include pachygyria, subcortical band heterotopia, and anomalies of the corpus callosum. We present the case of an 11-year-old girl who had some distinctive facial features, as well as cerebral malformations, short stature, moderate cognitive disability, and speech and language delay. Targeted clinical exome sequencing identified a heterozygous de novo nonsense variant in ACTB: c.617G>A (p. Arg206Gln). (provided by Infomedic International)

Comparison and analysis of skiing injuries at ski resorts in Chongli, China and Japan / 中华创伤杂志(英文版)

PURPOSE@#The rapid development of winter sports requires investigation on injuries in Chongli district, Zhangjiakou city, one of the ski sites of the 2022 Winter Olympics. Careful evaluation is required to observe which injuries are caused under what circumstances, and then we can make corresponding preventive measures and recommendations based on the results.@*METHODS@#In this retrospective study, the data of injury cases at ski resorts in China (Chongli district) and Japan were analyzed to provide a reference for the ongoing injury prevention at ski resorts. We collected data on injuries at Wanlong and Fulong ski resorts in Chongli district during the 2017-2018 and 2018-2019 ski seasons. We referred to the skiing injury report issued in February 2020 of a nationwide ski safety statistical service - Japan Ski Safety Association. The causes of injury and specific injured body parts were analyzed based on the data of Chinese and Japanese ski resorts. Statistical significance has been calculated using the Chi-square test.@*RESULTS@#During the 2019-2020 ski season in Japanese ski resorts, the number of reported injuries per 10,000 skiers was 0.93, of which 457 (17.3%) were over 50 years old, accounting for a large proportion of injuries, meanwhile in Chongli ski resort, the injury rate of skiers aged 50 and over was 7.1%. The knee joint (23.7% at Wanlong ski resort and 28.4% in Japanese ski resorts) was the most injured body part among Chongli and Japanese skiers. Among snowboarders, shoulder joint injury (17.7% in Japanese ski resorts) was the most common, and injury on hands and fingers (16.3% in Wanlong ski resorts) was the most common. Head injury rates are similar in Chongli, China and Japanese ski resorts (8.2% and 8.7%, respectively).@*CONCLUSION@#Our analysis demonstrated that injury data recorded among young skiers was higher in Chinese ski resorts (Chongli district) than that in Japanese ski resorts, and elderly skiers made up a larger proportion of skiing injuries in Japanese resorts. Thus, according to our research, the protection of knee joints, shoulder joints, and hands and fingers should be taken seriously. It should pay attention to the teaching of ski poles (for finger protection), and use protective devices such as knee pads, helmets, etc.

Sin elevación, también puede haber oclusión / Without elevation, there may also be occlusion

Resumen Ante un dolor torácico agudo y evidencia de elevación del segmento ST, se debe instaurar un tratamiento de reperfusión urgente, con el objetivo de abrir la arteria ocluida y minimizar el daño miocárdico y, así, mejorar el pronóstico del paciente. Por ello, es necesario conocer aquellos patrones eléctricos de alto riesgo equivalentes a una elevación del segmento ST e indicativos de una oclusión coronaria aguda, para evitar que se produzca una demora inadmisible en los tiempos de actuación, tal y como ocurrió en el caso que se presenta.

Abstract In light of an acute chest pain and evidence of ST-segment elevation, an emergent reperfusion treatment should be started with the objective of opening the occluded artery and reducing myocardial damage, thus, improving the patients´s prognosis. Therefore, it is mandatory to keep in mind those high-risk electrical patterns equivalent to a ST-segment elevation and indicative of an acute coronary occlusion to avoid an unacceptable delay in the times of action, such was the case that is reported.

Polygalacturonates of Biogenic Metals - Prospective Components of New Composite Preparations for Wheat

New bi- and polymetallic complexes of polygalacturonic acid with essential trace elements for pre-sowing treatment of winter wheat seeds were created. Aims: The goal of the research was to create effective environmentally safe preparations of multifunctional action, with low cost rates for grain crops based on natural polymers of pectin nature and to determine the effectiveness of their use for pre-sowing treatment of winter wheat seeds. Methodology: Methods of chemical synthesis of products, research of their structure by atomic force microscopy were used in the work. Laboratory and vegetative experiments were carried out. The substrate is quartz sand. Physiological and biochemical methods were used to determine the working absorbing surface of the roots and its absorbing activity, amylolytic activity, the content of photosynthesis pigments according to Wellburn. The results were processed using the methods of mathematical statistics. Results: The atomic force microscopy method made it possible to detect a mixture of individual polymer molecules and their aggregates in pectin fractions. Depending on the concentration of pectins in the solution, they form different structures. New bi- and polymetallic complexes of polygalacturonic acid with essential trace elements for pre-sowing treatment of winter wheat seeds were created. According to the results of laboratory and vegetation experiments, the growth-stimulating activity of polygalacturonates of copper, iron, calcium, and nickel, which were used for pre-sowing processing of Smuhlyanka variety winter soft wheat seeds was determined. Preparations contribute to the active development of the root system of plants, strengthening their physiological activity. The investigated compounds are effective promising components of complex compositional preparations for modern agrotechnologies of winter wheat cultivation. Conclusion: The use of such metal complexes at an insignificant rate of expenditure should contribute to the increase of economic and ecological indicators of crop production � the reduction of the cost price of wheat grain due to the increase in yield and grain quality.

Practice and thinking of pre-hospital emergency support for the 2022 Beijing Winter Olympic Games / 中华医院管理杂志

Under the leadership of the Beijing Winter Olympic Organizing Committee and the Beijing Municipal Health Commission, the Beijing Emergency Center, as the designated medical institution for the 2022 Beijing Winter Olympic Games, has completed the first aid support task of this Winter Olympic Games with other medical institutions. The author systematically analyzed the development of each link in the pre-hospital emergency support for the 2022 Beijing Winter Olympic Games, summarizes the key links of the entire Winter Olympics cycle, such as the construction of the organizational system, the formulation of support plans, and the training of support personnel, and analyzed the results of related work, so as to provide reference for the pre-hospital emergency support for China to host large-scale international events in the future.

Medical services for sports injuries and illnesses in the Beijing 2022 Olympic Winter Games / 世界急诊医学杂志（英文）

BACKGROUND: Beijing 2022 Olympic Winter Games was the second Games held amid the COVID-19 pandemic. To a certain extent, it has altered the way sporting activities operate. There is a lack of knowledge on injury risk and illness occurrence in elite winter sport athletes amid the COVID-19 pandemic. This study aimed to describe the incidence of injuries and illnesses sustained during the XXIV Olympic Winter Games in Beijing from February 4 to 20, 2022. METHODS: We recorded the daily number of injuries and illnesses among athletes reported by Beijing 2022 medical staff in the polyclinic, medical venues, and ambulance. We calculated injury and illness incidence as the number of injuries or illnesses occurring during competition or training, respectively, with incidence presented as injuries/illnesses per 100 athlete-days. RESULTS: In total, 2,897 athletes from 91 nations experienced injury or illness. Beijing 2022 medical staff reported 326 injuries and 80 illnesses, equaling 11.3 injuries and 2.8 illnesses per 100 athletes over the 17-day period. Altogether, 11％ of the athletes incurred at least one injury and nearly 3％ incurred at least one illness. The number of injured athletes was highest in the skating sports (n=104), followed by alpine skiing (n=53), ice track (n=37), freestyle skiing (n=36), and ice hockey (n=35), and was the lowest in the Nordic skiing disciplines (n=20). Of the 326 injuries, 14 (4.3％) led to an estimated absence from training or competition of more than 1 week. A total of 52 injured athletes were transferred to hospitals for further care. The number of athletes with illness (n=80) was the highest for skating (n=33) and Nordic skiing (n=22). A total of 50 illnesses (62.5％) were admitted to the department of dentistry/ophthalmology/otolaryngology, and the most common cause of illness was other causes, including preexisting illness and medicine (n=52, 65％). CONCLUSION: Overall, 11％ of athletes incurred at least one injury during the Games, which is similar to the findings during the Olympic Winter Games in 2014 and 2018. Regarding illness, 2％ of athletes were affected, which is approximately one-third of the number affected in the 2018 Olympic Winter Games.

Does doses and time of 2, 4-D application interfere in the physiology and wheat grains yield components?

The identification of the application stage and correct dose of 2,4-dichlorophenoxyacetic acid (2,4-D) herbicide is important so that wheat is not harmed. In view of this, the objective of this study was to evaluate the effect of 2,4-D doses applied at different development stages of wheat crop. The experiment was conducted in a randomized block design, arranged in a 4 × 5 factorial scheme, with four replications. In factor A, the application stages (before tillering, tillering, first node and booting) were allocated and the doses of 2,4-D (0, 349, 698, 1047 and 1396 g.ha­1) were allocated in factor B. The variables evaluated were phytotoxicity at 7, 14, 21, 28 and 35 days after application of the treatments (DAT), photosynthetic activity, CO2 internal concentration, stomatal conductance, efficient water use and carboxylation efficiency. The number of spikes·m­2, spike length and number of full and sterile grains were determined in the preharvest. Thousand grain mass, grain yield and hectoliter weight were determined after harvest. The results demonstrate that the herbicide caused phytotoxicity to wheat, being greater in increasing doses and mainly before tillering, causing grain sterility and decreased productivity. The other yield components did not present difference when increasing the dose and application in different stages as well as the physiological variables. The increase of the 2,4-D doses applied before tillering and in the booting stage caused linear decrease in wheat grain yield.

Triticale silage replaces sorghum silage in finishing of Braford heifers / Silagem de triticale substitui silagem de sorgo na terminação de novilhas da raça Braford

The aim of this study was to evaluate the effect of sorghum silage substitution with different proportions of triticale silage on the performance and carcass of Braford heifers. Twenty-four Braford heifers were randomly assigned to four diets where sorghum silage was replaced at 0%, 30%, 60%, and 100% for triticale silage in a feedlot system. During sixty-tree days of the experiment, the feed intake, feed ratio conversion, and average daily gain were measured. The heifers were slaughtered and the effects of the sorghum and triticale silage in carcass characteristics were evaluated. The replacement of sorghum silage with triticale silage did not affect the feed intake and average daily gain (P> 0.05). Feed gain ratio was higher for the heifers that received lower proportions of triticale silage (0% and 30%) in replace sorghum silage (P <0.05). Eye loin area and fat thickness were similar among treatments (P<0.05). Other carcass characteristics, such as slaughter live weight, dressing percentage, conformation and fat classification were similar among experimental treatments (P<0.005). Triticale silage can replace sorghum silage for finishing beef heifers in feedlot system and provides similar carcass characteristics.(AU)

O objetivo deste trabalho foi avaliar o efeito da substituição da silagem de sorgo por diferentes proporções de silagem de triticale no desempenho e na carcaça de novilhas Braford. A silagem de sorgo foi substituída em 0%, 30%, 60% e 100% pela silagem de triticale como fonte de volumoso na alimentação de 24 novilhas da raça Braford, em um sistema de confinamento. O período experimental total foi de 63 dias para a avaliação do consumo dos componentes da ração, a conversão alimentar e o ganho médio diário. Ao final do experimento, os animais foram abatidos e avaliados em relação às características de carcaça. A substituição da silagem de sorgo pela silagem de triticale não apresentou efeito no consumo dos componentes da ração e no ganho médio diário entre as novilhas (P>0,05). A conversão alimentar foi melhor para as novilhas que receberam menores proporções de silagem de triticale (0% e 30%) em substituição à silagem de sorgo (P<0,05). As características das carcaças foram semelhantes entre os animais independentemente da fonte de volumoso. A silagem de triticale apresenta-se como alimento alternativo à silagem de sorgo em regiões de transição climática para a terminação de novilhas de corte, proporcionando o mesmo desempenho animal e as mesmas características de carcaça.(AU)

Electrocardiogram abnormalities in residents in cold homes: a cross-sectional analysis of the nationwide Smart Wellness Housing survey in Japan

BACKGROUND@#Excess winter mortality caused by cardiovascular disease is particularly profound in cold houses. Consistent with this, accumulating evidence indicates that low indoor temperatures at home increase blood pressure. However, it remains unclear whether low indoor temperatures affect other cardiovascular biomarkers. In its latest list of priority medical devices for management of cardiovascular diseases, the World Health Organization (WHO) included electrocardiography systems as capital medical devices. We therefore examined the association between indoor temperature and electrocardiogram findings.@*METHODS@#We collected electrocardiogram data from 1480 participants during health checkups. We also measured the indoor temperature in the living room and bedroom for 2 weeks in winter, and divided participants into those living in warm houses (average exposure temperature ≥ 18 °C), slightly cold houses (12-18 °C), and cold houses (< 12 °C) in accordance with guidelines issued by the WHO and United Kingdom. The association between indoor temperature (warm vs. slightly cold vs. cold houses) and electrocardiogram findings was analyzed using multivariate logistic regression models, with adjustment for confounders such as demographics (e.g., age, sex, body mass index, household income), lifestyle (e.g., eating habit, exercise, smoking, alcohol drinking), and region.@*RESULTS@#The average temperature at home was 14.7 °C, and 238, 924, and 318 participants lived in warm, slightly cold, and cold houses, respectively. Electrocardiogram abnormalities were observed in 17.6%, 25.4%, and 30.2% of participants living in warm, slightly cold, and cold houses, respectively (p = 0.003, chi-squared test). Compared to participants living in warm houses, the odds ratio of having electrocardiogram abnormalities was 1.79 (95% confidence interval: 1.14-2.81, p = 0.011) for those living in slightly cold houses and 2.18 (95% confidence interval: 1.27-3.75, p = 0.005) for those living in cold houses.@*CONCLUSIONS@#In addition to blood pressure, living in cold houses may have adverse effects on electrocardiogram. Conversely, keeping the indoor thermal environment within an appropriate range through a combination of living in highly thermal insulated houses and appropriate use of heating devices may contribute to good cardiovascular health.@*TRIAL REGISTRATION@#The trial was retrospectively registered on 27 Dec 2017 to the University hospital Medical Information Network Clinical Trials Registry (UMIN-CTR, https://www.umin.ac.jp/ctr/ , registration identifier number UMIN000030601 ).

Cognition and progress of de Winter electrocardiogram pattern / 中南大学学报(医学版)

The de Winter electrocardiogram pattern is an acute ST-segment elevation myocardial infarction equivalent, however this specific electrocardiogram change is easily ignored by clinicians. The de Winter electrocardiogram pattern in patients with acute chest pain mostly indicates sub-complete or complete occlusion of the left anterior descending or the diagonal branch. Patients with acute chest pain and such electrocardiographic finding should undergo emergency coronary angiography immediately to determine the coronary condition, and reperfusion therapy should be performed as soon as possible to reduce the incidence of adverse cardiovascular events.

A Case of De Winter Syndrome with Dynamic ST Segment Evolution / 中国医学科学院学报

De Winter syndrome,a special electrocardiogram of acute total occlusion or subtotal occlusion of left anterior descending coronary artery,is not common in clinical practice.It has been generally considered static,whereas the electrocardiogram changes dynamically in this case.We propose that de Winter pattern may indicate a thrombotic disease and can be roughly divided into two types according to whether the electrocardiogram changes dynamically.

Clinical features of patients with acute myocardial infarction presenting de Winter pattern on electrocardiogram / 中华全科医师杂志

Objective:To analysis the clinical features of patients with acute myocardial infarction (AMI) presenting de Winter pattern on electrocardiogram.Methods:A total of 1 287 patients with AMI admitted to Beijing Luhe Hospital between June 2017 and January 2019 were enrolled in the study. Electrocardiogram and clinical features of 13 patients with AMI presenting de Winter pattern on electrocardiogram were analyzed and compared with anterior wall ST-segment elevation myocardial infarction(STEMI, n=206). Results:Among the 13 patients, 12 were males, aged (52.23±12.55) years old. Compared to patients with anterior wall STEMI, the age in the de Winter group was younger [(52.23±12.55)years vs. (59.79±12.46)years; t=-2.12, P=0.03], and the time from onset to appearing a typical ECG was shorter [109.0 (71.5, 152.0)min vs. 200.5 (120.0, 397.5)min; Z=-3.38, P<0.01]. Three cases showed a shifting between de Winter pattern and typical STEMI ECG: the de Winter ECG pattern progressed to STEMI in 2 cases, 1 case changed from STEMI to de Winter,then converted to STEMI again. The emergency angiography was performed in all 13 patients, angiography showed that proximal left anterior descending branch (LAD) was involved in 11 cases, mid LAD was involved in 1 case, and diffuse spasm occurred in all vessels in 1 case. The de Winter ECG pattern vanished in all patients after primary percutaneous coronary intervention or emergency angiography. Conclusions:The de Winter ECG pattern suggests an acute proximal or mid LAD artery occlusion, and the de Winter ECG pattern can be alternated with STEMI. The de Winter pattern should be recognized and revascularization should be given early.

Production and nutritional quality of black oat forage grown in different population stands under a successive cutting regime / [Produção e qualidade nutricional da forragem de aveia-preta cultivada em diferentes estandes populacionais sob regime de cortes sucessivos]

The present study aimed to evaluate the agronomic productive and qualitative traits of forage of black oats grown in different stands of plants. The experimental design was a 2 x 2 factorial randomized complete block design consisting of four treatments, two plant stands (175 and 350 plants m2) associated with two successive cutting periods (vegetative and full vegetative) and four replications. The stand of plants did not influence the production of dry biomass; with 175 plants m2, we obtained a compensatory effect by the greater number of tillers m2-1 and/or tiller plant-1. The population stand influenced the chemical parameters, where 175 plants m2 resulted in forage with higher contents of hemicellulose and total digestible nutrients and a lower content of neutral detergent fiber. In the comparison between cuts, the first cut compared to the second presented higher values of crude protein (26.53%). It is recommended that the black oat be cultivated with a population stand of 175 plants m2 for generating an increase in the number of tillers m2-1 and tillers plant-1, in addition to improving the in situ dry matter digestibility of the whole plant, without causing reduction of production of dry biomass per unit area.(AU)

O presente trabalho objetivou avaliar as características agronômicas produtivas e qualitativas da forragem da aveia-preta submetida ao cultivo com diferentes estandes populacionais. O delineamento experimental foi de blocos ao acaso, em esquema fatorial 2 x 2, composto por quatro tratamentos, sendo dois estandes (175 e 350 plantas m2), associado a duas épocas de corte sucessivas (vegetativo e pleno vegetativo) e a quatro repetições. Os estandes populacionais não influenciaram a produção de biomassa seca, pois, com 175 plantas m2, obteve-se efeito compensatório por maior número de perfilhos m2-1 e/ou perfilho planta-1. O estande populacional influenciou os parâmetros bromatológicos, o qual, com 175 plantas m2, gerou produção de forragem com maiores teores de hemicelulose e de nutrientes digestíveis totais e um menor teor de fibra em detergente neutro. Na comparação entre os cortes, o primeiro corte, comparado ao segundo corte, apresentou maiores valores de proteína bruta (26,53%). Recomenda-se a aveia-preta cultivada com estande populacional de 175 plantas m2 por gerar aumento do número de perfilhos m2-1 e perfilhos planta-1, além de melhorar a digestibilidade in situ da matéria seca da planta inteira, sem causar redução de produção de biomassa seca por unidade de área.(AU)

Fiber composition and digestibility of fodder in different ryegrass fields submitted to different harvesting management systems / [Composição da fibra e digestibilidade da forragem de diferentes cultivares de azevém submetidos a diferentes sistemas de manejo de colheita]

This essay aims to evaluate the composition of fiber in neutral detergent, digestibility of plant components, as well as ruminal disappearance rate of fodder dry matter from five ryegrass fields submitted to different cut systems for the production of haylage. The experimental design was the randomized blocks one, at a 5 x 3 factorial scheme, with five cultivars (cv.) of ryegrass Lolium multiflorum (cv. Barjumbo, cv. BarHQ, cv. Ribeye, cv. Potro and cv. Willians) associated with three harvesting management systems: 1- single harvesting system at a pre-floral stage; 2 - double harvesting system, with a cut at vegetative stage and another at pre-floral stage; and 3 - triple harvesting system, with a cut at vegetative stage, a cut at full vegetative stage and a cut at pre-floral stage, with three repetitions each. Similarities were noticed on the results of fodder digestibility of different fields, however, cv. Potro presented a higher ruminal disappearance rate after 48 hours, with 69.27%. Generally, the harvesting management system with the increase of ryegrass cut frequency determined increments on the percentage of lignin and the reduction in the concentration of total nutrients and dry matter digestibility of the resulting hylage.(AU)

O objetivo do presente trabalho foi avaliar a composição da fibra em detergente neutro, digestibilidade dos componentes da planta, bem como a taxa de desaparecimento ruminal da matéria seca da forragem de cinco cultivares de azevém submetidos a diferentes sistemas de cortes para produção de silagem pré-secada. O delineamento experimental foi em blocos ao acaso,, em um fatorial 5 x 3, sendo cinco cultivares de azevém Lolium multiflorum (cv. Barjumbo, cv. BarHQ, cv. Ribeye, cv. Potro e cv. Willians) associados a três sistemas de manejo de colheita: 1 - sistema com única colheita no estádio de pré-florescimento; 2 - sistema com uma colheita no estádio vegetativo e outra no estádio de pré-florescimento; e 3 - sistema com uma colheita no estádio vegetativo, uma no estádio pleno vegetativo e outra no estádio de pré-florescimento, com três repetições cada. Notou-se similaridade entre os resultados de digestibilidade da forragem entre os cultivares, porém o cv. Potro apresentou a maior taxa de desaparecimento ruminal após 48 horas, com 69,27%. De maneira geral, o sistema de manejo de colheita mostrou que o aumento do número de cortes do azevém determinou incrementos nos teores de lignina e redução na concentração de nutrientes digestíveis totais e da digestibilidade da matéria seca nas silagens pré-secadas resultantes.(AU)

Produção, valor nutritivo e produtividade estimada de leite de pastagens consorciadas de estação fria / Production, nutritive value and estimated milk yield from intercropped pastures of cold season

O objetivo deste trabalho foi avaliar o potencial de produção de leite ha-1 de três consorciações de aveia-preta e leguminosas em detrimento da aveia-preta estreme fertilizada com N mineral. Os tratamentos utilizados foram: aveia-preta + 200kg de N ha-1 (Av+N); aveia-preta + trevo-branco (Av+Tb); aveia-preta + ervilhaca (Av+Er) e aveia-preta + trevo-vermelho (Av+Tv). As espécies foram implantadas em parcelas de 80m2, sob um delineamento de blocos ao acaso com quatro repetições. As amostragens foram realizadas previamente aos cortes, em três oportunidades, e o material foi avaliado quanto à produção de matéria seca, à composição químico-bromatológica (PB, EE, FDN, FDA, CNF, MM, digestibilidade estimada da matéria seca e digestibilidade do FDN em 48 horas) e à produção estimada de leite por área (kg ha-1). Os resultados foram submetidos à análise de variância, e as médias comparadas pelo teste de Tukey a 5% de probabilidade. A composição químico-bromatológica não diferiu entre os tratamentos Av+N e Av+Er em nenhum dos atributos avaliados. O tratamento Av+N proporcionou maior produção de leite por área em relação aos demais, explicado pela maior produção de MS.(AU)

The objective of this work was to evaluate the potential of milk production ha-1 of three consortia of black oats and legumes in detriment to black oats fertilized with N mineral. The treatments used were black oats + 200kg of N ha-1 (Av+N); black oats + white clover (Av+Tb); black oats + vetch (Av+Er) and black oats + red clover (Av+Tv). The species were implanted in 80 m2 plots under a complete randomized complete block design with four replicates. Samples were collected three times and the material evaluated was dry matter yield, chemical and bromatological composition (CP, EE, NDF, ADF, NFC, MM, estimated dry matter digestibility and NDF digestibility in 48 hours) and estimated milk production by area (kg ha-1). The results were submitted to analysis of variance and the means were compared by Tukey test at 5% probability. The chemical-bromatological composition did not differ between Av+N and Av+Er treatments in any of the evaluated attributes. The Av+Er treatment provided higher milk yield per area in relation to the others, explained by the higher DM production.(AU)

Análisis de concordancia de tres clasificaciones de terceros molares mandibulares retenidos / Agreement analysis of three mandibular third molar retention classifications

Resumen Introducción: Las clasificaciones de Pell y Gregory y de Winter son básicas en la categorización de terceros molares; la clasificación de Sánchez Torres es usada en México, pero no había sido evaluada previamente. Objetivo: Evaluar el grado de acuerdo en la valoración radiográfica de terceros molares mandibulares impactados, con el empleo de tres clasificaciones: Pell y Gregory, Winter y Sánchez Torres. Método: Estudio observacional, descriptivo, de concordancia interobservador, que incluyó a 10 cirujanos orales y maxilofaciales y 10 residentes en formación, quienes registraron la categorización radiográfica de terceros molares mandibulares (izquierdos y derechos) de acuerdo con las clasificaciones de Pell y Gregory, Sánchez Torres y Winter. Se evaluó el grado de acuerdo entre observadores mediante la prueba de kappa de Fleiss. Resultados: La clasificación de Pell y Gregory obtuvo el menor grado de acuerdo (kappa = 0.05 y 0.185), seguida de la clasificación de Sánchez Torres (kappa = 0.125 y 0.326); el mejor valor lo obtuvo la clasificación de Winter, con kappa = 0.28 y 0.636 para cirujanos orales y maxilofaciales y residentes en formación, respectivamente. Conclusión: La clasificación de Winter mostró un grado de acuerdo aceptable (moderado) para categorizar terceros molares mandibulares en los residentes en formación.

Abstract Introduction: Pell & Gregory and Winter classifications are basic in third molar categorization; Sánchez-Torres classification is used in Mexico, but it has not been previously evaluated. Objective: To assess the degree of agreement in the radiographic evaluation of impacted mandibular third molar with the use of three classifications: Pell & Gregory, Winter and Sánchez-Torres. Method: Observational, descriptive, inter-observer degree of agreement study that included 10 oral and maxillofacial surgeons and 10 training residents, who recorded the radiographic categorization of third mandibular molars (left and right) according to Pell and Gregory, Sánchez-Torres and Winter classifications. Inter-observer degree of agreement was assessed with Fleiss' kappa test. Results: Pell and Gregory classification obtained the lowest degree of agreement (kappa = 0.05 and 0.185), followed by Sánchez-Torres classification (kappa = 0.125 and 0.326); Winter had the best agreement, with kappa = 0.28 and 0.636 for oral and maxillofacial surgeons and training residents, respectively. Conclusion: The Winter classification showed an acceptable (moderate) degree of agreement to classify mandibular third molars by training residents.

Analysis of the mass skiers' injury in a large ski resort in Chongli, China / 北京大学学报(医学版)

OBJECTIVE@#To make a retrospective analysis of the injuries of skiing population in a large ski resort in Chongli, China and provide a basis for predicting the rapidly increasing medical needs for ski injuries in the context of the 2022 Winter Olympic Games.@*METHODS@#The basic data of all injured skiers who were treated in a medical station of a large ski resort in Chongli during the snow season from November 2017 to March 2018 and from November 2018 to March 2019 were collected. The number of skiers, the number of injuries, the causes of injuries, the types of injuries and the locations of injuries were compared.@*RESULTS@#A total of 753 skiers were injured in two snow seasons, and the estimated average incidence of injury was 4.53 and 4.46 per 1 000 skier days at the resort respectively. The average daily injury rate per 1 000 skiers in November of the two snow seasons was relatively low, with 2.20 and 1.38 cases respectively. The difference of injury rate in different months might have little to do with snowfall and more to do with passenger flow. In both the snow seasons, men accounted for more injuries than women, and injured skiers aged between 21 and 30 accounted for the largest proportion, reaching 36.8%. The main causes of injuries were falls (76.6%). The highest rate of injury was in the head and neck (17.9%), followed by the knee (17.4%) and wrist and fingers (13.3%). The most common types of injuries were contusion and trauma (29.5%) and joint and/or ligament injuries (22.2%). Children (2-12 years old) accounted for 12.7% of all the injured skiers. The rate of moderate to severe injuries (including fractures, concussions, etc.) was 34.8% among the injured patients over 50 years of age.@*CONCLUSION@#The snow resort should focus on injuries to children and elderly skiers and carry out targeted guidance and rescue work. In order to better ensure the medical safety of skiers, the ski resort medical station and nearby treatment hospitals should be equipped with a corresponding number of medical personnel and equipment, and the ski resort should further improve its safety management and rescue system.

de Winter syndrome, an easily ignored but life-threatening disease: a case report / 南方医科大学学报

de Winter syndrome is a special equivalent of anterior ST-segment elevation myocardial infarction (STEMI) characterized by the absence of overt ST-elevation with upsloping ST-segment depression followed by tall symmetrical T-waves in the precordial leads, often associated with total occlusion of the proximal left anterior descending coronary artery. Herein we present a case of de Winter syndrome in a 63-year-old man, whose initial ECG showed no ST-segment elevation, but subsequent coronary angiography confirmed total occlusion of the proximal LAD coronary artery. The patient was successfully treated via mechanical reperfusion therapy and stenting through percutaneous coronary intervention (PCI). de Winter syndrome is associated with a high mortality often due to insufficient awareness of this condition by clinicians. Immediate reperfusion therapy by PCI is the life-saving treatment for the patients diagnosed with this syndrome, and prompt recognition of the ECG pattern is critical to ensure the timely administration of the therapy.

Analysis of theoretical basis and clinical application of dog-days moxibustion / 中国针灸

The present situation of the clinical application of dog-days moxibustion (moxibustion applied in the three periods of the hot season) is summarized so as to provide the guide for the theoretic study and clinical application of dog-days moxibustion. The intervention time of dog-days moxibustion is on the 1st day of each of the three periods of the hot season. Simultaneously, the geographic factors are considered. The disorders of lung system are mostly dominant among the indications of dog-days moxibustion, complicated with spleen and stomach disorders as well as cold and deficiency syndromes/patterns. The acupoints are mainly selected from the front- points on the chest and the back- points on the back, in combination with the differentiation of diseases, symptoms/patterns and the disorder stages. The duration of treatment is ranged from 1 to 3 years. The clinical therapeutic effect is improved constantly along with the increase of treatment periods by years.