Modified Goldner Trichrome for Non-decalcified Mineralized Tissue Plastinated and Embedded in Resin / Tricrómico de Goldner Modificado para Tejido Mineralizado no Descalcificado Plastinado e Incluido en resina

SUMMARY: Over time, Goldner's trichrome staining has been essential in paraffin soft tissue research. However, its classic application involves prior decalcification, generating disadvantages in the integrity of the samples and the interpretation of results. This study seeks to overcome the limitations associated with decalcification when applying Goldner's trichrome stain with plastic resins. It focuses on detailed visualization of non-decalcified bone and dental samples in animal models. Samples of jaw and tooth from a dog (Canis familiaris) were used, as well as tibia from a rabbit (Oryctolagus cuniculus) with a titanium dental implant and bone graft substitute. Adjustments were made to the original protocol, including a surface treatment prior to staining. Plastination and inclusion in specific plastic resins were part of the process. The microplastinated and stained samples showed optimal quality for optical microscopy. Those from dogs allowed detailed observation of the tooth-periodontal tissue relationship, while those from rabbits revealed a clear differentiation between mineralized and osteoid bone tissue. The staining made it easy to examine the precise interface between soft tissues, bone graft, and implant. The successful adaptation of Goldner's trichrome stain to specimens in plastic resins represents a significant advance in histological investigation of hard tissues. This methodology stands out as an effective tool to evaluate implants and biomaterials in animal models, providing detailed visualization without compromising the integrity of the samples. The combination of histochemistry and plastic resins offers a valuable alternative for microanatomical studies, opening new possibilities in hard tissue research and evaluation of bone structures.

A lo largo del tiempo, la tinción tricrómica de Goldner ha sido esencial en la investigación de tejidos blandos en parafina. Sin embargo, su aplicación clásica conlleva la descalcificación previa, generando desventajas en la integridad de las muestras y la interpretación de resultados. Este estudio busca superar las limitaciones asociadas con la descalcificación al aplicar la tinción tricrómica de Goldner con resinas plásticas. Se enfoca en visualizar detalladamente muestras óseas y dentales no descalcificadas en modelos animales. Se emplearon muestras de mandíbula y diente de perro (Canis familiaris), así como tibia de conejo (Oryctolagus cuniculus) con implante dental de titanio y substituto de injerto óseo. Se realizaron ajustes al protocolo original, incluyendo un tratamiento superficial previo a la tinción. La plastinación y la inclusión en resinas plásticas específicas fueron parte del proceso. Las muestras microplastinadas y teñidas mostraron una calidad óptima para microscopía óptica. Las de perro permitieron la observación detallada de la relación diente-tejido periodontal, mientras que las de conejo revelaron una clara diferenciación entre tejido óseo mineralizado y osteoide. La tinción facilitó examinar la interface precisa entre tejidos blandos, injerto óseo e implante. La adaptación exitosa de la tinción tricrómica de Goldner a muestras en resinas plásticas representa un avance significativo en la investigación histológica de tejidos duros. Esta metodología destaca como una herramienta eficaz para evaluar implantes y biomateriales en modelos animales, brindando una visualización detallada sin comprometer la integridad de las muestras. La combinación de histoquímica y resinas plásticas ofrece una alternativa valiosa para estudios microanatómicos, abriendo nuevas posibilidades en la investigación de tejidos duros y evaluación de estructuras óseas.

The applications of the plasma matrix in the treatments of dental pulp and periapical diseases / 口腔疾病防治

@#The plasma matrix is a kind of autologous blood conduct. It has been widely used in maxillofacial tissue regeneration, skin cosmetology and some other fields. Recently, to preserve the dental pulp as well as the teeth, pulp regeneration therapy and apical surgery have become increasingly important as well as the applications of bioactive materials. As a kind of autologous bioactive material, the plasma matrix has some natural advantages as it is easy to obtain and malleable. The plasma matrix can be used in the following cases: ①pulp revascularization of young permanent teeth with open apical foramina that cannot stimulate apical bleeding; ② apical barrier surgery with bone defects and large area perforation repair with bone defects or root sidewall repair surgery; ③ apical surgeries of teeth with large area of apical lesions, with or without periodontal diseases. The plasma matrix is a product derived from our blood, and there are no obvious contraindications for its use. Several systematic reviews have shown that the plasma matrix can effectively promote the regenerative repair of dental pulp in patients with periapical diseases. However, the applications of plasma matrix are different because its characteristics are affected by different preparation methods. In addition, there is still a lack of long-term clinical researches on the plasma matrix, and the histological evidences are difficult to obtain, so a large number of in vitro and in vivo experimental studies are still needed. This article will describe the applications of different kinds of plasma matrix for dental pulp regeneration and bone tissue regeneration in apical surgeries to provide references for clinicians in indication selection and prognosis evaluation.

Observation on A-PRF promoting regeneration of osteochondral defects in rabbit knee joints / 上海交通大学学报（医学版）

Objective·To explore the role of advanced platelet-rich fibrin(A-PRF)in osteochondral regeneration.Methods·Bone-marrow mesenchymal stem cells(BMSCs)and knee joint chondrocytes were obtained from New Zealand rabbits.A-PRF was obtained by low-speed centrifugation of the heart blood of rabbits.The histological structure of A-PRF was observed by an optical microscope.The release of growth factors in A-PRF was detected by ELISA,including platelet-derived growth factor,transforming growth factor-β,insulin-like growth factor,vascular endothelial growth factor,epidermal growth factor and fibroblast growth factor.A-PRF's cytotoxicity and capability for promoting the proliferation of rabbit BMSCs were detected by live/dead double staining and MTT methods.The effect of A-PRF on the gene expression of type Ⅱ collagen,aggrecan,alkaline phosphatase(ALP)and osteocalcin(OCN)in rabbit BMSCs was detected by real-time fluorescence quantitative polymerase chain reaction(qRT-PCR).Transwell chambers were used to determine the effect of A-PRF on the migration ability of rabbit BMSCs and the chondrocytes.Rabbit knee osteochondral defect models were established,and 18 rabbits were randomly divided into 3 groups.The A-PRF group(n=6)was implanted with A-PRF in the defect,the A-PRF+BMSCs group(n=6)was implanted with rabbit BMSCs on A-PRF,and the control group(n=6)did not undergo implantation.The rabbits were sacrificed 12 weeks after surgery and the knee joint specimens were stained with hematoxylin-eosin(H-E),toluidine blue and safranin O/fast green.Based on the surface morphology and histology of the knee joints,the International Cartilage Repair Society(ICRS)scoring system was used for macroscopic and histological scoring.Results·A-PRF had a loose network structure and can slowly release growth factors.No cytotoxicity to rabbit BMSCs was observed after adding A-PRF,and the the capability for promoting the proliferation of rabbit BMSCs was significantly increased at 24,48 and 72 h after adding A-PRF(all P<0.05).Chondrogenesis-related gene Ⅱ collagen and aggrecan,as well as osteogenesis-related genes ALP and OCN were significantly up-regulated(all P<0.05).After adding A-PRF,the migration abilities of rabbit BMSCs and chondrocytes were significantly enhanced(both P<0.05),and the migration ability of rabbit BMSCs was significantly higher than that of chondrocytes(P=0.025).The joint surface morphology in the rabbit knee joint defect models was observed.It can be seen that the defects in the A-PRF group and the A-PRF+BMSCs group were basically restored,while the the defects in the control group were only covered by soft tissue.In the ICRS macroscopic score,there was no statistical difference between the A-PRF group and the A-PRF+BMSCs group,but the scores of the two groups were all significantly higher than those of the control group(all P<0.05).According to the histological results,both the A-PRF group and the A-PRF+BMSCs group formed osteochondral repair,but the cartilage in the A-PRF group was more mature,while the control group formed fibrous repair.In the ICRS histological score,there was no statistical difference between the A-PRF group and the A-PRF+BMSCs group,but the scores of both the groups were significantly higher than those of the control group(both P<0.05).Conclusion·Autologous A-PRF has good biocompatibility and the capability for promoting the proliferation of BMSCs.It can promote the repair of cartilage and subchondral bone both in vitro and in vivo.

Electrospun nanofiber scaffolds for soft and hard tissue regeneration / 中国组织工程研究

BACKGROUND:Currently,electrospun nanofibers,which are biomimetic materials of natural extracellular matrix and contain a three-dimensional network of interconnected pores,have been successfully used as scaffolds for various tissue regeneration,but are still faced with the challenge of extending the biomaterials into three-dimensional structures to reproduce the physiological,chemical as well as mechanical properties of the tissue microenvironment. OBJECTIVE:To summarize the process and principles of electrostatic spinning and to explore the applications of the resulting electrospun nanofibers in tissue regeneration of skin,blood vessels,nerves,bone,cartilage and tendons/ligaments. METHODS:With"electrospinning,electrospun nanofibers,electrospun nanofiber scaffolds,tissue regeneration"as the Chinese and English search terms,Google Academic Database,PubMed,and CNKI were searched,and finally 88 articles were included for review. RESULTS AND CONCLUSION:(1)The electrospun nanofibers are a natural fibrous extracellular matrix mimetic material and contain a three-dimensional network of interconnected pores that have been successfully used as scaffolds for a variety of tissue regeneration applications.(2)Several papers have described the great potential of electrospun nanofiber scaffolds applied to the regeneration of skin,blood vessels,nerves,bones,cartilage and tendons/ligaments,providing a solid theoretical basis for its final application in clinical disease treatment,or for its transformation into practical products to enter the market.(3)However,the current research results are mostly based on cell experimental research results in vitro,and whether it can be finally applied to human body still needs clinical verification.(4)At present,many kinds of electrospun products for various clinical needs have been commercialized in and outside China,indicating that the research field of electrospun nanofiber scaffolds for soft and hard tissue regeneration has great research value and application potential.

Potential and advantages of metal organic frameworks-based hydrogel materials for repairing soft and hard tissues / 中国组织工程研究

BACKGROUND:Due to the mechanical properties,unstable drug release,single function and other problems of pure hydrogel materials,in recent years,researchers have prepared a variety of metal organic frameworks-based hydrogel materials by introducing metal organic frameworks into hydrogel,and showed great potential in the field of soft and hard tissue regeneration. OBJECTIVE:To classify the metal organic frameworks-based hydrogel materials based on how metal organic frameworks enhance the properties of hydrogel and further summarize its recent research in the field of soft and hard tissue regeneration,in order to provide ideas and theoretical supports for the subsequent in-depth research on synthesis mechanism and clinical application of the composite material. METHODS:Using"metal organic frameworks,hydrogels,tissue engineering,tissue,bone regeneration,bone,wound"as English and Chinese search terms,we searched Web of Science,PubMed,CNKI,and Wanfang databases.The search period ranged from January 2000 to August 2023.By reading the titles and abstracts,the repetitive studies and unrelated literature of Chinese and English literature were excluded.After the literature quality evaluation,73 articles were included for review. RESULTS AND CONCLUSION:(1)Metal organic frameworks-based hydrogel materials effectively solve the problems of poor mechanical properties,unstable drug release and single function of pure hydrogel.(2)Metal organic frameworks enhance the capacity of repair and regeneration by strengthening the cross-linking of hydrogel,the drug delivery capacity of hydrogel and the multifunction of hydrogel.(3)In terms of hard tissue repair,it has shown good repair effects in animal models of diseases such as bone defects,osteoarthritis,and cartilage defects,suggesting potential application prospects in clinical repair.(4)In terms of soft tissue regeneration,it has the capacities of hemostasis,antibacterial,inflammatory state regulation,oxidative stress state regulation,promoting angiogenesis and other functions,effectively improving the microenvironment of various complex wounds and promoting soft tissue regeneration.(5)Although metal organic frameworks-based hydrogels have many excellent properties,they are still in the initial stage and there are some urgent problems to be solved in the process of clinical transformation,such as the cytotoxicity of metal organic frameworks and large-scale synthesis of metal organic frameworks.(6)With further research,metal organic frameworks-based hydrogels have broad application prospects in the field of soft and hard tissue repair.

5-2. Enhancing Medical Education for Deaf and Hard-of-Hearing Patient Care: A Case Study at Juntendo University's Faculty of Medicine / 医学教育

At Juntendo University, we offer an elective program for third-year medical students to explore social determinants of health (SDH). Among the topics is ensuring healthcare access for deaf and hard-of-hearing patients. We have implemented role-playing in outpatient clinic scenarios to simulate language barriers. In these role-plays, individuals who are deaf or hard of hearing and use sign language take on the role of healthcare professional, while the students assume the role of patient. This original program was developed by the University of Rochester School of Medicine and Dentistry. Through participation in the program, students learn sign language and deaf culture while having a transformative learning experience that helps them recognize unconscious biases within themselves.

6. Healthcare Professional Education and Development for Deaf and Hard of Hearing Individuals in Rochester, NY: Transitioning from Inclusive Higher Education to Social Contribution / 医学教育

This article focuses on inclusive education for deaf and hard-of-hearing students in Rochester, New York, which prepares them to become healthcare professionals or researchers in health science fields. We highlight the unique programs for deaf and hard-of-hearing students to develop their careers at the Rochester Institute of Technology (RIT), the National Technical Institute for the Deaf (NTID), and the University of Rochester (UR). These universities also foster an inclusive work environment that caters to the needs of deaf and hard-of-hearing clinical professionals and faculty specialized in health research, enabling them to play leadership roles in their fields. Notably, Strong Memorial Hospital at UR supports deaf staff by providing interpreter services, allowing them to actively engage in their clinical work as professionals. Such seamless support, spanning from higher education to professional careers in Rochester, demonstrates a compelling model for enabling deaf and hard-of-hearing individuals to pursue and thrive in their chosen professions.

Influencing factors of telangiectasia secondary to diabetic retinopathy / 国际眼科杂志(Guoji Yanke Zazhi)

AIM:To investigate the influencing factors of abnormal telangiectasia secondary to diabetic retinopathy(DR).METHODS: Prospective studies. A total of 153 cases(240 eyes)with DR treated in our hospital from January 2021 to January 2023 were selected to analyze the risk factors of abnormal telangiectasia secondary to DR and its predictive efficacy.RESULTS: The patients were divided into dilated group(77 eyes of 40 cases)and non-dilated group(163 eyes of 113 cases)according to whether they had secondary abnormal telangiectasia. There were significant differences in diabetic macular edema, hard exudates grade and fasting blood glucose level between the two groups(P&#x0026;#x003C;0.05). Logistic regression analysis showed that diabetic macular edema, high hard exudates grade and high blood glucose level were the risk factors for abnormal telangiectasia secondary to DR(P&#x0026;#x003C;0.05).CONCLUSION: The occurrence of telangiectasia secondary to DR may be related to diabetic macular edema, grade 3 hard exudates and high blood glucose level.

Cephalometric Characteristics in Chilean Latino Population with Normal Occlusion and Harmonic Profiles in Permanent Dentition. A Retrospective Study / Características Cefalométricas en Población Latina Chilena con Oclusión Normal y Perfiles Armónicos en Dentición Permanente. Un Estudio Retrospectivo

SUMMARY: Malocclusion is usually treated based on clinical decisions complemented with a cephalometric analysis, allowing the comparison of an individual with standard reference norms. Cephalometric standards have mostly been obtained from Caucasian population, but may not be appropriate for other ethnic groups, becoming a clinically relevant problem in multicultural and multiracial societies. The present study aimed to establish cephalometric norms for Chilean-Latino population, using a representative sample of class I individuals in permanent dentition. A sample of 72 cephalometric x-rays of class I growing individuals (47 women and 25 men) between 10 and 20 years of age with class I occlusion and harmonic profile was obtained from the records of the Universidad de los Andes taken between 2012 and 2019, including 1164 individuals. The radiographs were classified according to their cervical vertebral maturation status, and cephalometrically analyzed, obtaining vertical and sagittal parameters in soft and hard tissues, which were compared with Caucasian cephalometric norms. The statistical analysis was performed using descriptive and inferential statistics (T-test, ANOVA and Bonferroni tests). Cephalometric norms were obtained for hard and soft tissues. Upon comparison with Caucasian norms, the subjects included in the sample present a tendency towards a convex profile, significant incisal proclination, dental protrusion, labial biprotrusion and an acute nasolabial angle. There are cephalometric differences between the Caucasian cephalometric norms and those observed Chilean Latino population, displaying differences at a hard and soft tissue level that should be taken into account for clinical decision making in Orthodontics.

La maloclusión generalmente se trata con base en decisiones clínicas complementadas con un análisis cefalométrico, lo que permite la comparación de un individuo con normas de referencia estándar. Los estándares cefalométricos se han obtenido en su mayoría de población caucásica, pero pueden no ser apropiados para otros grupos étnicos, convirtiéndose en un problema clínicamente relevante en sociedades multiculturales y multirraciales. El presente estudio tuvo como objetivo establecer normas cefalométricas para población chileno-latina, utilizando una muestra representativa de individuos clase I en dentición permanente. Se obtuvo una muestra de 72 radiografías cefalométricas de individuos en crecimiento clase I (47 mujeres y 25 hombres) entre 10 y 20 años de edad con oclusión clase I y perfil armónico de los registros de la Universidad de los Andes tomados entre 2012 y 2019, incluidas 1164 personas. Las radiografías se clasificaron según su estado de maduración vertebral cervical, y se analizaron cefalométricamente, obteniendo parámetros verticales y sagitales en tejidos blandos y duros, que se compararon con normas cefalométricas caucásicas. El análisis estadístico se realizó mediante estadística descriptiva e inferencial (T-test, ANOVA y pruebas de Bonferroni). Se obtuvieron normas cefalométricas para tejidos duros y blandos. En comparación con las normas caucásicas, los sujetos incluidos en la muestra presentan una tendencia hacia un perfil convexo, proinclinación incisal significativa, protrusión dental, biprotrusión labial y un ángulo nasolabial agudo. Existen diferencias entre las normas cefalométricas caucásicas y las observadas en población latina chilena, mostrando diferencias a nivel de tejidos duros y blandos que se deben considerar para la toma de decisiones clínicas en Ortodoncia.

NO ZONE APPROACH FOR MANAGEMENT OF PENETRATING NECK INJURIES-A CASE SERIES

Purpose: The assessment and management of penetrating trauma to the neck has traditionally centered on the anatomical zone based classication over the previous four decades has evolved considerably towards "NO ZONE APPROACH" a more selective option. The purpose of this study was to assess the effectiveness of the “NO ZONE APPROACH” in penetrating neck injuries. Case series of 6 patients with penetrating neck Materials And Methods: injuries admitted in department of general surgery in government Kilpauk medical college and government Royapettah hospital, Chennai. All 6 cases have been analyzed for this descriptive study during a period of 1 year. No specic exclusion criteria applied. All 6 patients survived. 1 patient had nerve injury and external carotid artery injury. 2 patients had Results: tracheal injuries for which tracheostomy was done. 1 patient had avulsed a part of thyroid gland. 1 patient developed cerebrovascular accident post operatively.3 patients had primary repair& neck exploration avoided in those 3 patients by application of NO ZONE APPROACH. Penetrating neck injuries are complex injuries with no single denitive Conclusion: approach. Surgical intervention is mandatory for unstable patients but rapid swift clinical and logical reasoning helps in determining the outcome of the patient. The 'no zone approach' to penetrating neck trauma is a selective approach with superior patient outcomes in comparison with traditional method of zones of neck injuries in which zone 2 and zone 3 warrants denitive exploration. No zone approach mandates thorough clinical examination. Penetrating neck injuries classied as having hard signs based on the no zone approach may be correlated with internal organ injuries of the neck.

Proposal for the Modification of the Method to Evaluate the Midpalatal Suture Maturation Status / Proposta de Modificação do Método para Avaliação do Status da Sutura Palatina Mediana

The objective of present research was to propose a new definition for the midpalatal suture (MPS) maturational stages through reevaluation of intermediate stages B, C and D. The sample was composed by 158 cone-beam computed tomography (CBCT) of individuals between 11 and 20 years of age (±15.4 years, 86 females and 71 males), divided into two groups: 74 individuals aged 11-15 years and 84 individuals aged 16-20 years. The CBCT scans were applied to evaluate midpalatal suture maturation status and comprised stages previously classified as B (29), C (92) and D (37). Each axial image was subdivided into six parts in the anteroposterior direction, and each portion was classified according to MPS maturational evaluation methodology. New definitions of stages were proposed. The reliability of the method was tested by two examiners and the intra- and inter-examiner concordances were defined for each evaluation through weighted kappa coefficients and 95% confidence intervals. The chi-square test was used to compare the groups. In all statistical tests, a significance level of 5% was adopted. Two new maturational stages were defined: sub-stage C- and sub-stage C+, with prevalence of 12% and 8.9%, respectively, in 11 to 20-year-olds. The redefinition and validation of the maturational stages of MPS, considering the sub-stages C- and C+, may allow to elucidate the difference in the prognosis of Rapid Maxillary Expansion among individuals aged 11 to 20 years. This data should be confirmed through a clinical study.(AU)

O objetivo da presente pesquisa foi propor uma nova definição para os estágios maturacionais da sutura palatina média (MPS) por meio da reavaliação dos estágios intermediários B, C e D. A amostra foi composta por 158 tomografias computadorizadas de feixe cônico (TCFC) de indivíduos entre 11 e 20 anos de idade (±15,4 anos, 86 do sexo feminino e 71 do sexo masculino), divididos em dois grupos: 74 indivíduos de 11 a 15 anos e 84 indivíduos de 16 a 20 anos. Os exames de TCFC foram aplicados para avaliar o estado de maturação da sutura palatina média e compreenderam os estágios previamente classificados como B (29), C (92) e D (37). Cada imagem axial foi subdividida em seis partes no sentido anteroposterior, e cada porção foi classificada de acordo com a metodologia de avaliação maturacional MPS. Novas definições de estágios foram propostas. A confiabilidade do método foi testada por dois examinadores e as concordâncias intra e interexaminadores foram definidas para cada avaliação por meio de coeficientes kappa ponderados e intervalos de confiança de 95%. O teste do qui-quadrado foi utilizado para comparar os grupos. Em todos os testes estatísticos adotou-se o nível de significância de 5%. Dois novos estágios maturacionais foram definidos: subestágio C- e subestágio C+, com prevalência de 12% e 8,9%, respectivamente, em jovens de 11 a 20 anos. A redefinição e validação dos estágios maturacionais da MPS, considerando os subestágios C- e C+, podem permitir elucidar a diferença no prognóstico da Expansão Rápida da Maxila entre indivíduos de 11 a 20 anos. Esses dados devem ser confirmados por meio de um estudo clínico.(AU)

A comparison of the quality of images of chest X-ray between handheld portable digital X-ray & routinely used digital X-ray machine

Background & objectives: Chest X-ray (CXR) is an important screening tool for pulmonary tuberculosis (TB). Accessibility to CXR facilities in difficult-to-reach and underserved populations is a challenge. This can potentially be overcome by deploying digital X-ray machines that are portable. However, these portable X-ray machines need to be validated before their deployment in the field. Here, we compare the image quality of CXR taken by a newly developed handheld X-ray machine with routinely used reference digital X-ray machine through the conduct of a feasibility study. Methods: A total of 100 participants with suspected pulmonary TB were recruited from the outpatient departments of a medical college and a community health centre in Agra. Each participant underwent CXR twice, once with each machine. Both sets of de-identified images were independently read by two radiologists, who were blinded to the type of X-ray machine used. The primary outcome was agreement between image qualities produced by these two machines. Results: The intra-observer (radiologist) agreements regarding the status of the 15 CXR parameters ranged between 74 per cent and 100 per cent, with an unweighted mean of 87.2 per cent (95% confidence interval: 71.5-100). The median Cohen’s kappa values for intra-observer agreement were 0.62 and 0.67 for radiologists 1 and 2, respectively. In addition, on comparison of the overall median score of quality of the image, the handheld machine images had a higher score for image quality. Interpretation & conclusions: The current study shows that a handheld X-ray machine, which is easy to use and can potentially be carried to any area, produces X-ray images with quality that is comparable to digital X-ray machines routinely used in health facilities.

Application of capsulorhexis-chop forceps assisted prechop technique in hard cataract phacoemulsification / 国际眼科杂志(Guoji Yanke Zazhi)

AIM: To analyze the advantages of capsulorhexis-chop forceps assisted prechop(CCFP)technique in hard cataract phacoemulsification.METHODS: Prospective study. A total of 100 cases(100 eyes)with age-related grade IV hard cataract were included and randomly divided into 2 groups according to random number table, with 50 patients(50 eyes)in CCFP technique group(group A)and 50 cases(50 eyes)in stop-and-chop technique group(group B). The corneal endothelial cell count before and after operation, intraoperative US time, postoperative corneal endothelial cell loss rate, corneal edema grade at 1 and 7d and best corrected visual acuity(BCVA)were compared and statistically analyzed.RESULTS: The mean US time of group A was lower than that of group B [26.66(16, 40)s vs. 36.12(23, 46)s; Z=-5.56, P&#x003C;0.01]. The mean corneal endothelial cell count in group A was higher than that in group B at 3mo after operation(2308.12±368.18cell/mm2 vs. 2104.06±379.87cell/mm2; t=2.728, P=0.008), and the loss rate of corneal endothelial cells in group A was lower than that in group B at 3mo after operation [10%(8%, 12%)vs. 17%(14%, 20%); Z=13.231, P&#x003C;0.01]. The number of eyes with corneal edema of grade 0, 1, 2, 3 and 4 on 1d after surgery was 0, 23, 21, 6 and 0 in group A, respectively, while it was 0, 9, 26, 15 and 0 respectively in group B. Corneal edema in group A was less than that in group B(Z=10.514, P=0.005). The BCVA of group A was better than that of group B at 1d after operation, and there was significant difference in the number of eyes with different BCVA grades between the two groups(Z=7.176, P=0.029). There was no significant difference in the number of eyes with different grades of BCVA between the two groups at 3mo after surgery(Z=2.377, P=0.372).CONCLUSION: Compared with the stop-and-chop technique, CCFP technique uses less ultrasonic energy, has less damage to corneal endothelial cells and is suitable for hard cataract surgery.

Treatment of Pulmonary Nodules from"Cold Phlegm" / 世界科学技术-中医药现代化

The symptoms of pulmonary nodules are insidious,with inflammatory nodules,inflammatory granuloma,early invasive cancer and lung cancer,and the clinical differential diagnosis is still difficult.Regular CT follow-up observation of most pulmonary nodules provides a"window period"for TCM Intervention in pulmonary nodules.From the aspects of external cold attacking the lung,dense cold and humid geographical environment,cold diet,summer air conditioning,etc.,this paper considers that the soaking of cold pathogenic factors is the basic cause of the formation of pulmonary nodules,and cold phlegm are the basic pathogenesis of pulmonary nodules.The clinical manifestations of cold phlegm in pulmonary nodules are summarized from the two actual situations that can be distinguished from clinical symptoms and no symptoms.It is proposed that Mahuang Fuzi Xixin Decoction and Sanzi Yangqin decoction are the basic formulas,Discussion on the treatment of pulmonary nodules by warming yang and dispelling cold to cure the root cause,eliminating phlegm and softening hard mass to treat the symptoms;Improve the ability of TCM diagnosis and treatment of pulmonary nodules.

Clinical observation of subretinal injection of compound electrolyte intraocular irrigation solution in the treatment of diabetic macular edema with hard exudate / 中华眼底病杂志

Objective:To observe the clinical effect of vitrectomy, inner limiting membrane (ILM) peeling, subretinal injection of compound electrolyte intraocular irrigation solution (CEIIS) and conbercept in the treatment of diabetic macular edema (DME) with hard exudate (HE) (DME-HE).Methods:A prospective clinical study. Thirty-three patients with DME-HE diagnosed by examination in Weifang Eye Hospital from June 2020 to February 2022 were included in the study. Among them, there were 15 males (16 eyes) and 18 females(20 eyes), with the mean age of (62.00±6.54) years. All patients underwent the examinations of best corrected visual acuity (BCVA), scanning laser ophthalmoscope, optical coherence tomography (OCT), and multifocal electroretinography (mf-ERG). Snellen visual acuity chart was used for BCVA examination, which was converted into logarithm of the minimum angle of resolution (logMAR) BCVA for statistic analysis. Macular foveal retinal thickness (CMT) and macular volume (MV) were measured by OCT. The 1 ring P1 wave amplitude density was measured by mf-ERG. The patients were randomly divided into group A and group B, with 17 patients (18 eyes) and 16 patients (18 eyes), respectively. There were no significant differences in age, logMAR BCVA, HE area, CMT, MV, and 1 ring P1 wave amplitude density between the two groups ( t=0.403, 0.972, 0.291, 0.023, -0.268, -0.206; P>0.05). Group A was treated with vitrectomy, ILM peeling, and subretinal injection of CEIIS and conbercept (combined therapy). Group B was treated with intravitreal injection of conbercept (IVC). Follow-up was 12 months after treatment. The changes of BCVA, HE area, CMT, MV, 1 ring P1 wave amplitude density were compared between groups and groups after treatment. The times of injection and complications after treatment were observed. Independent sample t test was used for comparison between the two groups. Results:At 12 months after treatment, compared to before treatment, there were significant differences in logMAR BCVA ( F=14.837), HE area ( χ2=94.522), CMT ( χ2=199.212), MV ( χ2=81.914) and 1 ring P1 wave amplitude density ( F=8.933) in group A ( P<0.05); there were significant differences in CMT ( F=5.540) and MV ( F=7.836) in group B ( P<0.05). Compared between the two groups, logMAR BCVA: 1 week and 6 and 12 months after treatment, the difference was statistically significant ( t=2.231, -2.122, -3.196; P<0.05); HE area: except 1 week after treatment, there were statistically significant differences at other times after treatment ( t=-2.422, -3.107, -3.540, -4.119; P<0.05). CMT, MV, 1 ring P1 wave amplitude density: 12 months after treatment, the differences were statistically significant ( t=-2.653,-2.455, 2.204; P<0.05). During the follow-up period, the injection times of group A and group B were (3.06±1.89) and (5.56±2.04), respectively, and the difference was statistically significant ( t=-3.815, P<0.05). Macular hole and vitreous hematoma were found in 1 eye in group A and 1 eye in group B. Conclusion:Vitrectomy, ILM peeling, subretinal injection of CEIIS and conbercept to treat DME-HE can effectively remove HE, alleviate macular edema, improve BCVA, and reduce CMT and MV. Combination therapy can reduce the number of IVC re-treatments.

Research on Ethical Governance of "BRAIN Initiative" in the United States / 中国医学伦理学

With the implementation of the "BRAIN initiative" in various countries, neuroethical governance has become an important concern of the international community. After ten years of development, the "BRAIN initiative" in the United States has formed a relatively complete ethical governance system. By interpreting the strategic report of the "BRAIN initiative" in the United States, analyzing its basic framework of ethical governance, dissecting its governance practice mechanism, and conducting research from the aspects of top-level design and construction, regulatory model innovation, promoting public participation, enhancing international dialogue, and improving soft and hard regulations, this paper provided some reference and thoughts for the ethical governance of the "BRAIN initiative" in China.

Home language environment in relation to language outcome in Brazilian toddlers who are hard of hearing and controls with typical hearing - a pilot study including reliability analyses of the LENA recording system / Ambiente doméstico de linguagem em relação ao resultado de linguagem em crianças brasileiras com deficiência auditiva e controles com crianças com audição típica - um estudo piloto incluindo análises de confiabilidade do sistema de gravação LENA

ABSTRACT Purpose The purpose of this pilot study was to explore the home language environment and language outcome of Brazilian toddlers who were hard of hearing, (HH) and controls with typical hearing (TH), and investigate the reliability of using the LENA recording system within a Brazilian Portuguese context. Methods Fourteen families participated in the study (seven children who were HH and seven controls with TH. Each family contributed with one all-day recording. A smaller portion of the recordings of the typically hearing toddlers were manually transcribed by two transcribers. An interrater agreement was conducted, and then the human transcript results were compared against the LENA-generated data for three measures: Adult Words (AW), Child Vocalizations (CV) and Conversational Turns (CT). Results Data analyses revealed a moderate to strong interrater agreement for CV and AW. Weak to moderate agreement was found between the LENA estimates and the means of the human counts for CV and AW. Seemingly, LENA overestimated human counts for AW and underestimated numbers of CV. Comparative analysis suggested similarities in the language and listening environment of the two groups (TH vs. HoH). Children's language development was supported by higher numbers of parent-child interactions (CT). Conclusion The findings imply that LENA may contribute as an ecologically valid tool in preventive family-centered intervention programs for Brazilian toddlers who are hard of hearing and their families, although further validation studies are needed.

RESUMO Objetivo O objetivo deste estudo piloto foi explorar o ambiente da língua doméstica e os resultados linguísticos de crianças brasileiras com deficiência auditiva comparando com crianças ouvintes e investigar a confiabilidade do uso do sistema de registro LENA no contexto do português brasileiro. Método Quatorze famílias participaram do estudo (sete com deficiência auditiva e sete controles com audição típica). Cada família contribuiu com uma gravação durante o tempo de vigilia. Uma parte menor das gravações das crianças com audição normal foi transcrita manualmente por dois transcritores. Um acordo entre avaliadores foi realizado e, em seguida, os resultados da transcrição humana foram comparados com os dados gerados pelo LENA para três medidas: Palavras de Adultos (PA), Vocalizações Infantis (VI) e Turnos de Conversação (TC). Resultados As análises de dados revelaram uma concordância entre avaliadores moderada a forte para VI e PA. Foi encontrada concordância de fraca a moderada entre as estimativas de LENA e as médias das contagens humanas para VI e AW. Aparentemente LENA superestimou contagens humanas para PA e subestimou números de VI. A análise comparativa sugeriu semelhanças na linguagem e no ambiente auditivo dos dois grupos. O desenvolvimento da linguagem das crianças foi apoiado por um maior número de interações pais-filhos (TC). Conclusão Os achados sugerem que o LENA pode contribuir como uma ferramenta ecologicamente válida em programas de intervenção preventiva centrada na família para crianças brasileiras com deficiência auditiva e suas famílias, embora mais estudos de validação sejam necessários.

Knowledge, attitude, and practices regarding cervical collars in adult trauma patients amongst practitioners at three hospitals in KwaZulu-Natal, South Africa

Background: The use of cervical collars in adult patients with possible injuries to the cervical spine has been an accepted standard of care for many years, despite the absence of evidence for the efficacy of these devices in preventing unwanted movement and harm. Changes to the terminology and recommendations of major trauma guidelines have been made but are limited by low quality evidence. In this context, little is known about what practitioners know, believe, and do, when managing the cervical spine of trauma patients. Methods: In this quantitative, observational, descriptive, cross-sectional survey a specifically designed questionnaire was used to collect data on the knowledge, attitude, and practices of practitioners managing adult trauma patients regarding cervical collars at three hospitals in KwaZulu-Natal, South Africa. Results: A total of 128 completed questionnaires were collected, captured, and analysed. Participants with the additional qualification of ATLS and DipPEC had a mean knowledge score of 8.1 (SD=1.70), compared to those with no additional qualification of 4.5 (SD=1.9) (p<0.001). Participants in the Emergency Department (ED) attained a mean knowledge score of 7.1 (SD=2.2) followed by Surgery (Mean=6, SD=2.0), Orthopaedics (Mean=5.5, SD=1.7) and ICU/Anaesthetics (Mean=4.4, SD=1.8), p<0.001. Head blocks only were most frequently used by 97.4 % of ED, 55.6 % of Surgery, 3.8 % Orthopaedic and 22.2 % ICU/Anaesthetics participants (p<0.001). Conclusion: The knowledge of management principles of cervical spine injuries was influenced by the department in which practitioners worked, the frequency that they managed patients with suspected injuries and additional courses. Head blocks were the most frequently used spinal protection device in all three hospitals. Most participants would be open to a change in practice if new guidelines were recommended. Further research is needed to determine the optimal management of patients with suspected cervical spine injuries and the role of motion restriction devices in limiting movement of the injured spine.

Disseminated Nasal subtype Extranodal NK/T-cell lymphoma and its diagnostic difficulties in antemortem biopsies

ABSTRACT Extranodal NK/T- cell lymphoma (ENKTCL) is an aggressive lymphoma driven by Epstein-Barr virus (EBV) infection in genetically susceptible individuals. It was historically called a lethal midline granuloma. Due to the angio-destructive nature of ENKTCL, lymphoma cells are often accompanied and masked by necrosis and dense inflammation in the biopsy. Further, the biopsy may show vasculitis, which can mimic granulomatosis with polyangiitis. Due to these masquerades, ENKTCL is often misdiagnosed in the biopsy. Several biopsies may be required to establish the diagnosis. We describe the clinical course and autopsy findings of a young female who presented with a hard-palate ulcer. Antemortem biopsies failed to establish the diagnosis. The autopsy revealed an advanced nasal subtype of Extranodal NK/T-cell lymphoma with dissemination to the kidneys, adrenals, liver, spleen, and small intestine.

Safety and efficacy of manual small-incision cataract surgery in patients with brunescent and black cataracts and other ocular comorbidities

Purpose: To determine the safety and efficacy of manual small?incision cataract surgery (MSICS) for brunescent and black cataracts in patients with other ocular comorbidities. Methods: Medical records of patients with hard cataracts (grade 4 nuclear opalescence and above) with other ocular comorbidities such as spheroidal degeneration of the cornea (SDC), pseudoexfoliation (PXF), non?dilating pupil, and high myopia who underwent MSICS were retrieved retrospectively. Intraoperative and postoperative complications were noted. Preoperative and postoperative visual outcome comparisons were performed using paired t?tests. Statistical significance was set at P < 0.05. Results: A total of 124 cataract patients with brunescent or black cataracts and other ocular comorbidities underwent surgery during the study period. They ranged in age from 56 to 89 years (mean: 68.9 + 11.9 years), with 55.66% (n = 69) of the patients being female and 44.35% (n = 55) male. Of the 124 cases, 45.16% (n = 56) had SDC, 31.45% (n = 39) had PXF, 14.51% (n = 18) had non?dilating pupils, and 8.87% (n = 11) had high myopia. Preoperatively all patients had visual acuity <6/60. At 1 month postoperatively 77.4% of patients achieved good vision >6/18, 16.9% had a borderline vision (6/18�60), and 5.6% had a poor vision (<6/60). No serious complications were observed. One patient had posterior capsular rent in a case of high myopia, and two cases had zonular dialysis for pseudoexfoliation. Conclusion: MSICS with intraocular lens implantation is safe and effective in eyes with brunescent/black cataracts if associated with SDC, PXF, high myopia, and non?dilating pupils and provides good visual outcomes with minimal complications.