A comparative study of thyroid TSE T2WI at 3.0T:Fast Dixon,Dixon,and BLADE sequences / 实用放射学杂志

Objective To explore the value of Fast Dixon in improving the quality of thyroid turbo spin echo(TSE)T2WI images via comparing the quality of thyroid MR T2WI images based on Fast Dixon,Dixon,and BLADE sequences.Methods The prospective study included 11 healthy volunteers,who underwent neck MR scanning.The evaluation of image quality was performed via a combination of objective measures and subjective ratings.Objective measures included signal-to-noise ratio(SNR)of bilateral thyroid and muscles,and contrast-to-noise ratio(CNR).Subjective measures included overall image quality,uniformity of fat suppression,sharpness of thyroid margins and muscles surrounding the thyroid,image noise in the neck region,image background noise,and image quality of the nasopharynx.Two diagnostic physicians with over 10 years of thyroid diagnostic experience independently evaluated the images via a 5-point scale.Inter-observer agreement was analyzed via Spearman correlation coefficient.Statistical analysis was performed using SPSS 22.0 software,including normality and homogeneity of variance tests for continuous data.Kruskal-Wallis one-way ANOVA was used for statistical analysis of subjective measures,followed by post hoc pairwise comparisons.A significance level of P<0.05 was considered statistically significant.Results Eleven healthy volunteers,the SNR of bilateral thyroid and muscles was significantly higher in Fast Dixon sequence than that in Dixon and BLADE sequences.For bilateral CNR,Fast Dixon sequence was also significantly higher than that of Dixon and BLADE sequences.Fast Dixon sequence also had significant advantages in seven subjective ratings indicators(P<0.001).Conclusion The Fast Dixon sequence shows the highest image quality and important application value in the display and evaluation of thyroid lesions.

Professor LI De-hua's experience in treating facial nerve injury after total parotidectomy with blade needle based on jingjin theory / 中国针灸

The paper summarizes the academic thought and clinical experience of professor LI De-hua in treatment of facial nerve injury after total parotidectomy with blade needle based on jingjin (muscle region of meridian, sinew/fascia) theory. This disease is located at muscle regions of hand-/foot-three yang meridians; and the sinew/fascia adhesion is its basic pathogenesis, manifested by "transversely-distributed collaterals" and "knotted tendons". In treatment, the knotted tendons are taken as the points. Using the relaxation technique of blade needle, the lesions of sinews/fascia are dissected and removed to release the stimulation or compression to the nerves and vessels so that the normal function of sinews/fascia can be restored.

Comparison of different approaches for direct coupling of solid-phase microextraction to mass spectrometry for drugs of abuse analysis in plasma / 药物分析学报

The direct coupling of solid-phase microextraction(SPME)to mass spectrometry(MS)(SPME-MS)has proven to be an effective method for the fast screening and quantitative analysis of compounds in complex matrices such as blood and plasma.In recent years,our lab has developed three novel SPME-MS techniques:SPME-microfluidic open interface-MS(SPME-MOI-MS),coated blade spray-MS(CBS-MS),and SPME-probe electrospray ionization-MS(SPME-PESI-MS).The fast and high-throughput nature of these SPME-MS technologies makes them attractive options for point-of-care analysis and anti-doping testing.However,all these three techniques utilize different SPME geometries and were tested with different MS instruments.Lack of comparative data makes it difficult to determine which of these methodologies is the best option for any given application.This work fills this gap by making a comprehensive comparison of these three technologies with different SPME devices including SPME fibers,CBS blades,and SPME-PESI probes and SPME-liquid chromatography-MS(SPME-LC-MS)for the analysis of drugs of abuse using the same MS instrument.Furthermore,for the first time,we developed different desorption chambers for MOI-MS for coupling with SPME fibers,CBS blades,and SPME-PESI probes,thus illustrating the universality of this approach.In total,eight analytical methods were developed,with the experimental data showing that all the SPME-based methods provided good analytical performance with R2 of linearities larger than 0.9925,accuracies between 81％and 118％,and good precision with an RSD％≤13％.

MIPO con placa helicoidal en fractura de húmero

Introducción: Las fracturas humerales diafisarias multifragmentarias con extensión proximal son patrones infrecuentes de lesión causados principalmente por trauma de alta energía. La forma anatómica del húmero, la presencia de la tuberosidad deltoidea y la proximidad del nervio radial al surco radial representan retos a tratar, por ello se recomiendan incisiones mínimamente invasivas y la estabilización de la fractura con placa proximal humeral internal locking system. Objetivo: Demostrar la eficacia de la técnica minimally invasive plate osteosynthesis con el moldeamiento helicoidal de la placa proximal humeral internal locking system. Presentación del caso: Paciente de 29 años que sufrió accidente de tránsito y presentó fractura diafisaria multifragmentaria extendida al húmero proximal. Se trató con la técnica minimally invasive plate osteosynthesis y placa helicoidal proximal humeral internal locking system. Alcanzó la consolidación completa y rápida recuperación funcional. Conclusiones: La técnica minimally invasive plate osteosynthesis con placa helicoidal proximal humeral internal locking system es una opción quirúrgica eficaz y segura para las fracturas humerales diafisarias multifragmentarias con extensión proximal, ya que preserva la inserción muscular deltoidea, mejora el contacto placa hueso con riesgo mínimo de lesión neurológica axilar y radial, favorece la curación ósea y mejora el resultado funcional.

Introduction: Multifragmentary diaphyseal humeral fractures with proximal extension are infrequent patterns of injury caused mainly by high-energy trauma. The anatomical shape of the humerus, the presence of the deltoid tuberosity and the proximity of the radial nerve to the radial groove represent challenges to be treated, therefore minimally invasive incisions and fracture stabilization with the proximal humeral internal locking system plate are recommended. Objective: To establish the efficacy of the minimally invasive plate osteosynthesis technique with helical molding of the proximal humeral plate internal locking system. Case report: We report the case of a 29-year-old patient who suffered a traffic accident and had a multifragmentary diaphyseal fracture extended to the proximal humerus. He was treated with the minimally invasive plate osteosynthesis technique and the humeral proximal helical plate internal locking system. He achieved complete consolidation and rapid functional recovery. Conclusions: The minimally invasive plate osteosynthesis technique with the humeral proximal helical plate internal locking system is an effective and safe surgical option for multifragmentary diaphyseal humeral fractures with proximal extension, since it preserves the deltoid muscle insertion, improves bone-plate contact with minimal risk of fracture. Axillary and radial neurological injury, promotes bone healing and improves functional outcome.

Kissing microvitreoretinal blade technique: A novel approach for safe and effective endocapsular lens aspiration in microspherophakia

We herein describe the kissing MVR technique in cases of microspherophakia for safe and effective endocapsular lens aspiration. Microspherophakia is associated with abnormally lax and broken zonules, which pose a great challenge to the operating surgeon, especially while creating the openings in the capsular bag. In this novel technique, simultaneous use of two 23 G MVR blades reduces the above problem associated with the severely mobile lens. Here, one MVR blade stabilizes the capsular bag and, at the same time, provides counter-traction for the opposite MVR blade while puncturing the capsular bag. Furthermore, the creation of openings in the lens at the equator or just posterior to it is beneficial as the capsule is relatively thicker and stronger at this location. This also minimizes the risk of premature extension to the anterior or posterior capsule, thereby avoiding complications like dropped lens matter, vitreous prolapse, and vitreous traction.

Confiabilidade de instrumentos de avaliação de retração de cintura escapular em uma unidade de cuidados intermediários neonatal / Reliability of the evaluation of shoulder girdle retraction instrument in a neonatal intermediate unit care

OBJETIVO: Avaliar a confiabilidade inter e intraexaminador, na utilização de instrumentos de avaliação da retração de cintura escapular em crianças internadas em uma unidade de cuidados intermediários neonatal. MATERIAL E MÉTODOS: Estudo quantitativo, transversal e observacional, realizado com recém-nascidos e lactentes que necessitaram de internamento em uma unidade de cuidados intermediários neonatal. A coleta de dados ocorreu de outubro de 2019 a fevereiro de 2020. Para avaliação da retração da cintura escapular foi utilizado um protocolo de inspeção biomecânica elaborado pelas pesquisadoras, que possibilitou a realização de medidas (em centímetros) das bordas mediais superiores e inferiores, direita e esquerda, até a coluna vertebral, com a cabeça em rotação para a direita e para a esquerda, e o sinal do cachecol. As avaliações foram realizadas sempre pelos mesmos avaliadores. Para estimar a confiabilidade inter e intraexaminador do protocolo de inspeção biomecânica e sinal do cachecol, foi utilizado o Índice de Kappa e para as medidas do posicionamento das escápulas, o Coeficiente de Correlação Intraclasse. RESULTADOS: O protocolo de inspeção biomecânica dos sinais sugestivos de retração de cintura escapular demostrou concordância leve a moderada interexaminadores, e substancial a quase perfeita intraexaminador. A concordância interexaminadores obtida no sinal do cachecol foi leve a moderada, e quase perfeita intraexaminador. O posicionamento das escápulas apresentou concordância interexaminadores considerada como boa, e concordância excelente intraexaminador. CONCLUSÃO: A avaliação de sinais sugestivos de retração de cintura escapular, em recém-nascidos e lactentes, apresenta baixos índices confiabilidade interexaminadores e altíssima confiabilidade intraexaminador

OBJECTIVE: To evaluate inter and intra-examiner reliability in the use of instruments to assess shoulder girdle retraction in children hospitalized in a neonatal intermediate care unit. METHODS: Quantitative, cross-sectional and observational study carried out with newborns and infants who required hospitalization in a neonatal intermediate care unit. Data collection took place from October 2019 to February 2020. To evaluate shoulder girdle retraction, a biomechanical inspection protocol developed by the researchers was used, which made it possible to measure (in centimeters) from the upper and lower medial edges, right and left, to the spine, with the head in rotation to the right and left, and the scarf sign. The evaluations were always carried out by the same evaluators. To estimate inter and intra-examiner reliability of the biomechanical inspection protocol and scarf signal, the Kappa Index was used and, for measurements of scapular positioning, the Intraclass Correlation Coefficient. RESULTS: The biomechanical inspection protocol for suggestive signs of scapular girdle retraction showed mild to moderate inter-examiner agreement and substantial to almost perfect intra-examiner agreement. The intra-examiner agreement obtained in the scarf sign was mild to moderate and almost perfect intra-examiner. The positioning of the scapulae showed good inter-examiner agreement and excellent intra-examiner agreement. CONCLUSION: The evaluation of suggestive signs of scapular girdle retraction in newborns and infants has low inter-examiner reliability and very high intra-examiner reliability.

Time-course monitoring of in vitro biotransformation reaction via solid-phase microextraction-ambient mass spectrometry approaches / 药物分析学报

The solid-phase microextraction technique quantifies analytes without considerably affecting the sample composition.Herein,a proof-of-concept study was conducted to demonstrate the use of coated probe electrospray ionization(coated-PESI)and coated blade spray(CBS)as ambient mass spectrometry ap-proaches for monitoring drug biotransformation.The ability of these methods was investigated for monitoring the dephosphorylation of a prodrug,combretastatin A4 phosphate(CA4P),into its active form,combretastatin A4(CA4),in a cell culture medium supplemented with fetal bovine serum.The CBS spot analysis was modified to achieve the same extraction efficiency as protein precipitation and ob-tained results in 7 min.Because coated-PESI performs extraction without consuming any samples,it is the preferred technique in the case of a limited sample volume.Although coated-PESI only extracts small quantities of analytes,it uses the desorption solvent volume of 5-10 pL,resulting in high sensitivity,thus allowing the detection of compounds after only 1 min of extraction.The biotransformation of CA4P into CA4 via phosphatases occurs within the simple matrix,and the proposed sample preparation techniques are suitable for monitoring the biotransformation.

Short-term results of ab-interno trabeculotomy using Kahook Dual Blade in patients with primary congenital glaucoma / Resultados de curto prazo da trabeculotomia ab-interno usando o Kahook Dual Blade em pacientes com glaucoma congênito primário

ABSTRACT The aim of this study is to present the results of ab-interno trabeculotomy using Kahook Dual Blade in patients with primary congenital glaucoma. An ab-interno trabeculotomy using a dual blade device was performed in three eyes of two patients with the diagnosis of primary congenital glaucoma. One of them in the left eye and the other patient in both eyes. In the first patient, an adequate response was achieved after the intraocular pressure reduced from 36 mmHg to 14 mmHg. The second patient did not respond adequately to the procedure, and high intraocular pressure levels persisted in both eyes after the procedure. The indication of Kahook Dual Blade ab-interno trabeculotomy in primary congenital glaucoma must be cautious and more studies are needed to establish its efficacy and the best indications. Seems that this procedure should not be indicated for primary congenital glaucoma treatment.

RESUMO O objetivo deste estudo é apresentar os resultados da trabeculotomia ab-interno com Kahook Dual Blade em pacientes com glaucoma congênito primário. Foi realizada trabeculotomia ab-interno com dispositivo de lâmina dupla em 3 olhos de 2 pacientes com diagnóstico de glaucoma congênito primário. Um deles no olho esquerdo e o outro paciente nos dois olhos. No primeiro paciente, houve resposta adequada uma vez que a pressão intraocular diminuiu de 36 mmHg para 14mmHg. O segundo paciente não respondeu adequadamente ao procedimento, mantendo altos níveis de pressão intraocular em ambos os olhos após o procedimento. A indicação da trabeculotomia ab-interno com o Kahook Dual Blade no glaucoma congênito primário deve ser cautelosa e são necessários mais estudos para estabelecer a eficácia e as melhores indicações. Parece que esse procedimento não deve ser indicado no tratamento do glaucoma congênito primário.

Body height and its estimation utilizing shoulder blade length measurements of Montenegrin adolescents of both sexes / La altura del cuerpo y su estimación utilizando medidas de la longitud de la escápula de adolescentes montenegrinos de ambos sexos

SUMMARY: The purpose of this research is to determine a regression equation for estimation of stature from shoulder blade length measurements. The sample in this research comprised 1001 adolescents, all of whom were in their final year of high school (504 males and 497 females) among the population of Montenegrin adolescents. The stature and shoulder blade length measurements were taken according to the ISAK protocol, and the data were analyzed statistically. Linear regression analysis determined the prediction of and shoulder blade length on the criterion variable a body height at the significance level of p <0.05. These relations are presented by using a scatter diagram (Fig. 2). Thereby, we obtained the coefficient of determination, the multiple correlation coefficients, the partial correlation coefficient, the regression, t-test and standardized beta coefficient. The research study confirmed that shoulder blade length reliably predicts stature in both sexes of Montenegrin adolescents and revealed a very useful finding for physical anthropologists and experts from related fields. It was confirmed that there is a correlation between shoulder blade length and body height (males: 34.3 %, females: 38.8 %). Therefore, shoulder blade length proves to be a reliable predictor for the actual body height estimates.

RESUMEN: El propósito de esta investigación fue determinar una ecuación de regresión para estimar la estatura corporal a partir de las medidas de la longitud del escápula. La muestra estuvo compuesta por 1001 adolescentes, en su último año de estudios secundarios (504 hombres y 497 mujeres) entre la población montenegrina. Las medidas de estatura y longitud del escápula se tomaron de acuerdo con el protocolo ISAK y los datos se analizaron estadísticamente. El análisis de regresión lineal determinó la predicción y la longitud del escápula en la variable de criterio a altura corporal con un nivel de significación de p <0,05. Estas relaciones se presentan mediante un diagrama de dispersión. De ese modo, obtuvimos el coeficiente de determinación, los coeficientes de correlación múltiple, el coeficiente de correlación parcial, la regresión, la prueba t y el coeficiente beta estandarizado. El estudio confirmó que la longitud del escápula predice de manera confiable la estatura en ambos sexos de los adolescentes montenegrinos y reveló información muy útil para los antropólogos físicos y expertos de áreas relacionadas. Se confirmó que existe una correlación entre la longitud del escápula y la altura del cuerpo (hombres: 34,3 %, mujeres: 38,8 %). Por lo tanto, la longitud del escápula demuestra ser un predictor confiable de las estimaciones de la altura corporal real.

Allometric equations to estimate the leaf area of Psychotria colorata (Willd. Ex Schult.) Müll.Arg.

Estimating leaf area using non-destructive methods from regression equations has become a more efficient, quick, and accurate way. Thus, this study aimed to propose an equation that significantly estimates the leaf area of Psychotria colorata (Rubiaceae) through linear leaf dimensions. For this purpose, 200 leaves of different shapes were collected, and length (L), width (W), product of length by width (L.W), and real leaf area (LA) of each leaf blade were determined. Then, equations were adjusted for predicting leaf area using simple linear, linear (0.0), quadratic, cubic, power, and exponential regression models. The proposed equation was selected according to the coefficient of determination (R²), Willmott's agreement index (d), Akaike's information criterion (AIC), mean absolute error (MAE), mean squared error (RMSE) and BIAS index. It was noted that the equations adjusted using L.W met the best criteria for estimating leaf area, but the equation LA = 0.59 * L.W from linear regression without intercept was the most suitable. This equation predicts that 59% of leaf area is explained by L.W. Concluding, the leaf area of P. colorata can be estimated using an allometric equation that uses linear leaf blade dimensions.

Value of MRI T 2WI-TSE-BLADE sequence in accurately delineating the gross tumor volume of esophageal carcinoma based on pathological specimens / 中华放射肿瘤学杂志

Objective:To explore the value of BLADE sequence in determining the target range of esophageal cancer radiotherapy through the correlation and consistency between measured esophageal cancer length on the MRI-BLADE sequence and the surgical pathological specimens.Methods:Clinical data of 36 patients who were pathologically diagnosed with esophageal carcinoma and received preoperative esophageal MRI in the Affiliated Cancer Hospital of Zhengzhou University between January 2016 to June 2019 were collected. The CT, DWI and BLADE sequence images of all participants were collected and imported into the Monaco system, by which the correlation and consistency between the tumor length measured based on these three imaging methods were statistically compared. Furthermore, the differences in gross tumor volume (GTV) delineated by different physicians in different images were compared.Results:The correlation coefficients of the tumor length measured by CT, DWI and BLADE and pathological specimen length were 0.467, 0.723 and 0.896, respectively. The consistency analysis indicated that all the differences between the BLADE sequence and pathological specimen length were within the 95% consistency limit. The consistency and correlation between the BLADE sequence and actual tumor length were significantly better than those between the DWI sequence and CT images (both P<0.05). The volume of DWI and BLADE images obtained by four physicians was significantly smaller than that of CT images (both P<0.05). The differences in GTV delineated by different physicians by these three imaging methods were insignificant (all P>0.05), but the GTV delineated by the four physicians on the BLADE sequence were more similar (all P>0.05). Conclusions:BLADE sequence can help physicians to determine the upper and lower boundaries of esophageal tumors more accurately and reduce the differences in GTV delineation among different physicians. And it can effectively improve the unity of individual′s understanding of the scope of target area delineation, and improve the objectivity of clinicians′ judgment of GTV. BLADE sequence can be used as an important imaging tool for accurate target delineation in radiotherapy.

Effect of Pharmacotherapy-Combined Instrument-Assisted Soft Tissue Mobilization on Tissue Extensibility Dysfunction in Recreational Runners - A Randomized Controlled Trial

The definitive efficacy and long-term effects of Instrument Assisted Soft Tissue Mobilization (IASTM) have not been firmly established, due to a lack of research examining lasting fascia structural changes and patient outcomes. We wanted to evaluate as to whether the use of topical muscle relaxant along with M2T® blade would have any effect on the Tissue Extension Disability in recreational runners. Methods100 subjects were randomly allocated to group A and group B. Group A was asked to perform active stretching whereas group B was given IASTM with topical muscle relaxant. Post-intervention data was recorded. ResultsThe active knee extension test scores for both the groups were determined. A statistically significant improvement (p<0.0001*) was seen in both the groups but the mean of post intervention scores of group B (21.64) showed more improvement and were more uniform than group A. ConclusionsThe present study concluded that IASTM using M2T blade® when given in combination with a topical skeletal muscle relaxant like Volteran® showed significantly better results in cases of tissue extensibility dysfunction of hamstring muscles in recreational runners.

Effect of screw blade position on proximal femoral nail anti-rotation internal fixation for unstable intertrochanteric fractures in the elderly / 中国修复重建外科杂志

Objective: To investigate the effect of the screw blade position on the effectiveness of proximal femoral nail anti-rotation (PFNA) internal fixation for unstable intertrochanteric fractures in the elderly. Methods: A clinical data of 131 elderly patients with unstable intertrochanteric fractures who were treated with PFNA internal fixation between January 2010 and January 2017 was retrospectively analyzed. According to the anteroposterior X-ray films, the screw blades were placed in the middle of the femoral neck in 72 patients (group A) and at one-third of the femoral neck in 59 patients (group B). There was no significant difference between the two groups ( P>0.05) in the gender, age, bone density, classification of fractures, other medical diseases, and the time between injury and operation. Multiple treatment indexes were analyzed, including complications, hip Harris score, the healing status of fracture, tip-apex distance (TAD), and the height of the tail nail. Results: All patients were followed up 11-14 months, with an average of 12.1 months. All incisions healed by first intention with no complications. All fractures healed and no significant difference in bone healing time between the two groups ( Z=-0.190, P=0.849). At 6 months after operation, TAD was (2.23±0.07) cm in group A and (2.85±0.12) cm in group B, showing significant difference ( t=-47.643, P=0.000); and the height of the tail nail was (1.72±0.14) cm in group A and (0.53±0.26) cm in group B, showing significant difference ( t=31.031, P=0.000). According to the Harris score, the hip functions were rated as excellent in 48 cases, good in 15 cases, and poor in 9 cases in group A, while as excellent in 38 cases, good in 16 cases, and poor in 5 cases in group B, with no significant difference between the two groups ( Z=-0.075, P=0.941). Conclusion: For the unstable intertrochanteric fracture in the elderly, the PFNA internal fixation with appropriated TAD and the screw blades placed in the middle or at one-third of the femoral neck can obtain good effectiveness.

Nutritive value and anatomical characterization from Pennisetum purpureum genotypes

The research submitted samples from stems and leaf blades from tree genotypes of Pennisetum purpureum called 93-32-02, 92-70-02, and 91-06-02 (EMBRAPA - Dairy cattle) and elephant grass cv. Napier (reference cultivar) to the chemical, anatomical evaluations, and in vitro dry matter digestibility (IVDMD) measurement. The anatomical characteristics of the stems and leaf blades, the chemical composition, and the IVDMD of these genotypes at 70 days of re-growth were correlated. Concerning IVDMD, the data highlighted differences, and the cultivar Napier presented the smallest value. Digital images obtained by light microscopy from cross-section reveal that all the stem and leaf blade have similar structural organization. Quantitative differences were verified mainly in the stem. The leaves displayed differences only in the mesophyll thickness. The genotypes showed higher potential in the rainy season since they had the largest IVDMD when compared to the cultivar Napier.

Comparison of Glottic View and Haemodynamic Stress Response Associated with Laryngoscopy using the Macintosh, McCoy and Miller Blades in Adult Patients

Introduction: Laryngoscopy induces haemodynamic responsewhich has implications for patients with cardiovascularillnesses. We devised this study to compare the laryngoscopicview of the glottis obtained with the Macintosh, McCoy andMiller blades, and corresponding haemodynamic changes.Material and Methods: 105 ASA grade I and II patientsrandomly divided into three groups were intubated usingMacintosh, McCoy and Miller blade respectively. Cormackand Lehane grade of glottic view obtained, heart rate, systolicand diastolic blood pressure at baseline, immediately beforeinduction, following induction, and at 1, 3 and 10 minutesafter intubation were noted. Epi Info 7.2 was used forstatistical analysis. Chi square and ANOVA tests were appliedto compare haemodynamic parameters.Results: 18 patients (51.4%) were CL grade I and 17 (48.6%)were CL grade II in Macintosh, 24 (68.6%) were CL gradeI and 11 (31.4%) were CL II in McCoy and, 32 (91.4%)were CL I and 3 (8.6%) were CL II in Miller group. Risein heart rate following intubation was greatest with Millerblade, followed by Macintosh and least with McCoy, andwas statistically significant (P< 0.01). Rise in both, systolicand diastolic blood pressure following intubation was highestwith the Miller blade, followed by Macintosh and least withMcCoy, and the difference compared with baseline values wasstatistically significant (P<0.01).Conclusions: Miller blade provides best visualization of larynxbut McCoy blade produced least haemodynamic response,hence the latter is preferable when less haemodynamicresponse is desired.

Anatomical and histochemical characterization of Dipteryx odorata and Taralea oppositifolia, two native Amazonian species

Abstract Dipteryx odorata (Aubl.) Willd. and Taralea oppositifolia Aubl., Fabaceae: Dipterygeae, are two Amazonian species of great economic and pharmacological potential. The anatomy of these species, however, remains poorly studied. The aim of this work was to inventory leaf anatomical characteristics of D. odorata and T. oppositifolia and to locate and identify secretory structures and determine the main classes of metabolites they store. Vegetative branches were collected in Parque Ecológico de Gunma, Belém, state of Pará, Brazil. Some of the branches were destined for herborization while the remainder was submitted to standard protocols for anatomical analysis and histochemical tests. Both species were found to possess an unstratified epidermis, with D. odorata being amphistomatic and T. oppositifolia being hypostomatic, and dorsiventral mesophyll with spongy parenchyma and wide cellular space. The two species were also found to possess idioblasts and secretory cavities that produce a heterogeneous exudate consisting of polysaccharides, lipids, alkaloids and phenolic compounds. The species presented differences in leaf anatomy and chemical composition of the secretory structures, which may be useful in their differentiation.

Techniques of anterior capsulotomy in cataract surgery

Optimal outcomes of a cataract surgery largely depend on the successful performance of an anterior capsulotomy. It is one of the most important steps of modern cataract surgery which reduces the risk of capsular tears and ensures postoperative stable intraocular lens (IOL). Anterior capsulotomy is considered ideal if it is round, continuous, well-centered, and overlaps the implanted IOL around its circumference. If any of these features is missing, it can be a cause of impedance for desired surgical and visual outcomes. Manual can opener and manual capsulorhexis are the routine standard techniques employed for manual extracapsular cataract extraction and phacoemulsification, respectively. Recent increasing use of femtosecond laser cataract surgery has allowed cataract surgeons to obviate inherent inaccuracies of manual anterior capsulotomy techniques. There is an ongoing quest to find an ideal, risk free, and surgeon-friendly technique of anterior capsulotomy that can be employed for surgery in all types of cataracts.

Clinical Outcomes of U-blade Gamma3 Nails Used to Treat Patients with Trochanteric Fractures: Retrospective Multicenter Study / 대한고관절학회지

PURPOSE: This study was performed to assess the radiologic and clinical results of U-blade Gamma3 nail use for the treatment of trochanteric fractures. MATERIALS AND METHODS: Between September 2015 and May 2018, all patients aged 65 years and older who underwent surgery with U-blade Gamma3 nails were analyzed. A total of 129 patients were selected based on having at least six months of follow-up. Image evaluations included bone quality (T-score), fracture classification on plain radiograph (AO/OTA), computed tomography configuration, union period, position of lag screw, anatomical reduction, tip apex distance (TAD), sliding extent of lag screw, change of neck shaft angle, and complications leading to reoperations were analyzed. Functional outcome were assessed using the Koval grade (ambulatory ability) at the final follow-up. RESULTS: The mean time to union was 19.7 (range, 6–36) weeks. The screw position was centric (93 cases; 72.1%) and anatomical reduction was achieved in 74 cases (57.4%). The mean TAD was 20.3 (range, 12.3–38.1) mm. The mean sliding length of the lag screws was 3.8 (range, 0.1–12.6) mm. The mean change of neck shaft angle was 3.4° (range, 0–12.8°). Reoperations were required in two cases (1.6%) due to the cutting out of the lag screw (n=1) and metal failure with U-blade bending (n=1). Finally, Koval grades for 49.8% of patients reached preoperative status. CONCLUSION: Overall, use of the U-blade Gamma3 nail led to favorable clinical results, suggesting that this system may be a good option for the treatment of trochanteric fractures.

The migration of helical blade and the tip apex distance value in cephalomedullary nail for geriatric intertrochanteric fractures / 中国修复重建外科杂志

Objective: To investigate the association between the tip apex distance (TAD) and migration of helical blade in the femoral head of geriatric intertrochanteric fractures. Methods: A retrospective study of intertrochanteric fractures treated with the proximal femoral nail antirotation (PFNA) between June 2015 and June 2018 was performed. There were 32 males and 55 females with an average age of 84.7 years (range, 80-101 years). All of them were unilateral fresh closed intertrochanteric fractures caused by low energy injury. According to AO/Orthopaedic Trauma Association (AO/OTA) classification, 33 cases belonged to type 31-A1, 35 cases to type 31-A2, and 19 cases to type 31-A3. The time interval from injury to operation was 1-16 days (mean, 3.7 days). The TAD was measured according to immediate postoperative X-ray films. The cases were divided into two groups: group A with TAD less than 20 mm and group B with TAD greater than 20 mm. The difference of fracture healing and migration of helical blade between the two groups were observed. Results: According to the TAD value immediately after operation, 49 patients in group A had TAD of 8.9-19.7 mm, with an average of 18.6 mm; 38 patients in group B had TAD of 20.1-41.4 mm, with an average of 27.7 mm. The 87 patients were followed up for an average of 11.7 months, ranging from 4 to 28 months. Three cases (all in group B) underwent screw blade cutting and displacement, which resulted in internal fixation failure, including 1 case with femoral head cut upward and 2 cases with femoral head penetrated inward. The remaining 84 cases had bone healing without internal fixation related complications such as fracture of internal fixator and fracture of femoral shaft. There was significant difference in the incidence of internal fixation failure between group A and group B ( P=0.049). Conclusion: Reducing the TAD value of helical blade appropriately (15-20 mm) in PFNA internal fixation for intertrochanteric fracture patients over 80 years old can increase initial stability without increasing the risk of helical blade migration.