Comparison of the efficacy of low-intensity illumination 3D heads-up system and traditional microscope eyepiece-assisted vitrectomy in the treatment of proliferative diabetic retinopathy / 中华实验眼科杂志

Objective:To compare the efficacy and safety of low-intensity illumination 3D heads-up system-assisted pars plana vitrectomy (PPV) and traditional microscope eyepiece system-assisted PPV for proliferative diabetic retinopathy (PDR).Methods:A randomized controlled study was conducted.Forty patients (40 eyes) who were diagnosed as PDR and met the PPV standard were included in Xuzhou First People's Hospital from June to December 2022.The patients were randomly divided into 3D group and eyepiece group using a random number table method, with 20 eyes in each group.The eyes in 3D group underwent 3D heads-up system-assisted PPV, and the eyes in eyepiece group received traditional microscope eyepiece system-assisted PPV.The intravitreal injection of 0.5 mg(0.05 ml) ranibizumab was performed 6 or 7 days prior to three-channel 25G PPV for all the eyes.The brightness of endoilluminator was adjusted to minimum level during the surgical procedure, and the brightness of the optical fiber and chandelier in 3D group was set to 20%, while that in eyepiece group was 32% and 46%, respectively, and was further matched to the actual requirements of the surgery.The light intensity of optical fiber and chandelier was measured at 5 mm and 10 mm with a digital photometer.Best corrected visual acuity (BCVA) was measured before surgery and 7 days, 1 month and 3 months after surgery.Electroretinogram (ERG) was recorded by the Retiscan before surgery and 1 month after surgery to evaluate retinal function.Intraocular pressure and postoperative complications in both groups were compared.This study adhered to the Declaration of Helsinki and was approved by the Ethics Committee of The Affiliated Xuzhou Municipal Hospital of Xuzhou Medical University (No.xyy11[2022]027). Written informed consent was obtained from each subject prior to entering the cohort.Results:The BCVA was 2.21±1.13, 1.99±1.07, 1.26±0.86 and 0.98±0.65 in 3D group, and 1.89±0.95, 1.94±0.79, 1.42±0.80 and 1.31±0.79 in eyepiece group at before surgery and 7 days, 1 month, and 3 months after surgery, respectively.There was no significantly intergroup difference in BCVA ( Fgroup=0.022, P=0.884). The BCVA was significantly different at various time points before and after surgery ( Ftime=18.765, P<0.001). The BCVA was significantly improved at 1 and 3 months after surgery in 3D group and at 3 months after surgery in eyepiece group in comparison with before surgery, showing statistically significant differences (all at P<0.05). There were significant differences in the latency of dark-adapted 3.0 a-wave before and after surgery between two groups ( Htime=3.983, P=0.046), and the latency of dark-adapted 3.0 a-wave was shorter after surgery than before surgery in both groups (all at P<0.05). The light intensities of optical fiber and chandelier at 5 mm and 10 mm during surgery were lower in 3D group than in eyepiece group, and the differences were statistically significant (all at P<0.001). There was no significant difference in intraocular pressure between the two groups at different time points ( Fgroup=0.980, P=0.328; Ftime=2.706, P=0.062). There was no significant difference in the number of postoperative vitreous hemorrhage between the two groups ( χ2=0.960, P=0.327). Conclusions:Low-intensity illumination 3D heads-up system-assisted PPV has the same outcome as traditional microscope eyepiece system-assisted PPV for PDR.However, compared with the traditional microscope eyepiece system, the light intensity on the retina from low-intensity illumination 3D heads-up system is lower on the retina during surgery and therefore produce less light damage to retinal function of patients.

Perception and willingness to the uptake of COVID-19 vaccine among household-heads in a rural community of South-Western Nigeria

Background:The COVID-19 pandemic and its vaccine have been met with varying perceptions that may have both negative and positive effects on the willingness to uptake the COVID-19 vaccine. The study is set to determine the perception and willingness of the household heads to the uptake of COVID-19 vaccine in a rural community in Southwestern, Nigeria.Materials and Methods:A cross-sectional study was carried out among 409 household heads selected through a multistage sampling technique. The instrument of data collection was a semi-structured interviewer-administered questionnaireusing the Health Belief model constructs. Data were analyzed with IBM SPSS version 21.0 and Pearson's Chi-square test was used to determine the association between perception and willingness to uptake vaccine. P<0.05 was taken as significant at 95% confidence interval.Results:The majority of the unvaccinated respondents in the study were not willing to take the COVID-19 vaccine (60.1%). There was a poor perception of the susceptibility/severity of unvaccinated respondents to COVID-19 infection and a poor perception of the benefit/barrier to the uptake of the COVID-19vaccine. Perception of susceptibility and severity of COVID-19 infection were statistically related to the willingness to uptake the COVID-19vaccine.Conclusion:There should be an increase in awareness campaigns to change the perception of people positively to COVID-19 infection and uptake of the COVID-19vaccine.

Optimization of surgeon ergonomics with three-dimensional heads-up display for ophthalmic surgeries

Purpose: To describe the variables that may be utilized in the optimization of three?dimensional heads?up surgeries (3D?HUS) for achieving better ergonomics among ophthalmic surgeons. Methods: A cross?sectional study was conducted at the operating room of a tertiary eye care center, equipped with an ARTEVO 800 3D surgical microscope and display monitor. The parameters noted were monitor height (MH), surgeon eye?to?floor distance (ETFD), surgeon eye?to?monitor distance (ETMD) and viewing tilt (VT) angle. The neck and eye strain of the surgeon and assistant were scored as per Borg’s CR?10 scale, before and after surgeries. Results: Thirty (13 right, 17 left) eye surgeries were analyzed. The minimum ETMD was 51 inches (in) and the eye strain reduced with shorter ETMD (within the range 51 inches to 83 inches). The VT and ETFD were higher for right eye surgeries. The optimum MH was between 50 and 55 in. Overall, the neck strain and eye strain were in the range of 0–3 and 0–1, respectively. Conclusion: The various parameters affecting the 3D image quality, neck and eye strain are chair height, VT angle, eye centration, monitor distance, laterality of the eye, and room illumination.

Application of heads-up 3D vision system in surgery for proliferative diabetic retinopathy with traction retinal detachment / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM: To evaluate the clinical efficacy of heads-up 3D vision system in surgery for proliferative diabetic retinopathy with traction retinal detachment. <p>METHODS: We retrospectively reviewed 32 patients(38 eyes)of PDR complicated with local TRD(no traction retinal hole)who underwent 25G minimally invasive vitrectomy in our hospital from August 2018 to March 2019. The patients were divided into two groups according to the observation system during the operation. 19 eyes of 16 patients in the experimental group were operated with heads-up 3D vision system, and 19 eyes of 16 patients in the control group were operated with traditional microscope. The operation time, iatrogenic retinal hole and silicone oil injection were recorded in the two groups. The patients were followed up for at least 6mo to observe the best corrected visual acuity and the occurrence of postoperative complications. <p>RESULTS: In the experimental group, iatrogenic retinal hole and silicone oil injection occurred in 1 eye during operation. The retina was completely reattached after operation. One day after operation, vitreous hemorrhage occurred in 4 eyes, which was self-absorbed after 2-4wk. Intraocular hypertension occurred in 6 eyes in postoperative 2wk, which could be controlled by drug treatment. Vitreous hemorrhage occurred in 2 eyes after 6wk and the best corrected visual acuity of 6mo was more than 0.3 in 15 eyes. In the control group, iatrogenic retinal hole occurred in 4 eyes, silicone oil was injected in 5 eyes during operation. The retina was completely reattached after operation. One day after operation, vitreous hemorrhage occurred in 6 eyes, which was self-absorbed after 2-4wk. Intraocular hypertension occurred in 5 eyes in postoperative 2wk, which could be controlled by drug treatment. Vitreous hemorrhage occurred in 3 eyes after 6wk, and the best corrected visual acuity of 6mo was more than 0.3 in 14 eyes. The operation of all patients was completed successfully, and no serious complications such as endophthalmitis occurred, but the operation time of the experimental group was significantly shorter than that of the control group(37.3±4.8min <i>vs</i> 41.2±5.1min, <i>P</i>=0.020).<p>CONCLUSION:Application of heads-up 3D vision system in PDR combined with TRD vitrectomy can shorten the operation time and improve the operation efficiency.

Percepción del perfil profesional de los fisioterapeutas de una universidad pública / Perception of the professional profile of the physiotherapist of a public university

Resumen Introducción: El perfil profesional consiste en la descripción de las habilidades, conocimiento y destrezas que un profesional debe tener o tiene para ejercer eficientemente en un puesto de trabajo; son actividades que los jefes directivos esperan que asuma el trabajador como parte del desarrollo de su profesión. Objetivo: Describir la percepción del perfil profesional del egresado de fisioterapia en una Institución Universitaria Pública desde la perspectiva de los jefes directos. Metodología: Estudio descriptivo transversal, con una muestra de 25 jefes directos de los egresados de una universidad pública, seleccionados aleatoriamente de la base de datos de egresados de la institución; quienes diligenciaron un cuestionario en físico de 33 preguntas, elaborado por los investigadores. Resultados: Los cuestionarios fueron analizados con Microsoft Excel. De acuerdo con la valoración dada por los jefes directos del fisioterapeuta, se caracterizó por un alto grado de compromiso profesional y ético, conocimientos teóricos y prácticos, además de la calidad en el trabajo y cumplimiento. Sin embargo, la competencia menor calificada, fue el conocimiento de idiomas. Conclusiones: La percepción del perfil profesional para el jefe directo, tiene que ver con las competencias específicas y con la práctica basada en la evidencia, siendo las que obtuvieron un valor de 80%, por debajo del resultado obtenido en las competencias genéricas en el perfil observado en el profesional de la institución superior.

Abstract Introduction: Professional profile involves the description of abilities, knowledge and skills that every professional has or should have for an efficient work performance. This entails activities that executive heads expect that workers are in charge as part of their professional development. Objective: To describe the perception of the professional profile of the physiotherapy graduate in a public university institution from the perspective of the direct heads. Methodology: Cross-sectional descriptive study with a sample of 25 direct heads of graduates of a public university, randomly selected from the database of graduates of the institution. The participants answered a 33-question printed questionnaire designed by the researchers. Results: Every questionnaire was analyzed with Microsoft Excel. In accordance to the given assessment of the direct heads, the physiotherapists were characterized by having high professional and ethical commitment, theoretical and practical insights, and high quality in work performance and compliance at work. Nevertheless, the competence with the lowest score was the knowledge on foreign languages. Conclusions: The perception of the professional profile from the direct heads has to do with the specific competences and the evidence-based practice. These obtained a value of 80%, below the result obtained in the generic competences in the profile observed in the professional of the higher institution.

The application and perspectives of 3D heads-up display viewing system in vitreoretinal surgery / 中华眼底病杂志

There has been ongoing progress in the new technique and equipment in vitreoretinal surgery in recent years, contributing to the improvement of treatment of various vitreoretinal diseases. The application of 3D heads-up display viewing system (3D viewing system) has been one of the most fascinating breakthroughs in vitreoretinal surgery. Unlike the traditional method in which the surgeons have to look through the microscope eyepieces, this system allows them to turn their heads up and operate with their eyes on a high-definition 3D monitor. It provides the surgeons with superior visualization and stereoscopic sensation. And increasing studies have revealed it to be as safe and effective as the traditional microscopic system. Furthermore, the surgeons can keep a heads-up position in a more comfortable posture and lesson the pressure on cervical spine. Meanwhile, 3D viewing system makes it easier for the teaching and learning process among surgeons and assistants. However, there are still potential disadvantages including the latency between surgeon maneuver and visualization on the display, learning curves and cost. We hope that the 3D viewing system will be widely used and become a useful new tool for various vitreoretinal diseases in the near future with rapid development in the technology and constant upgrade of the system.

Combining 3D heads-up display viewing system and intraoperative optical coherence tomography-assisted vitrectomy for myopic foveoschisis / 中华眼底病杂志

Objective@#To observe the clinical efficacy of digital 3D heads-up display viewing system(3D viewing system) and intraoperative OCT (iOCT) in vitrectomy for myopic foveoschisis (MF).@*Methods@#A retrospective, consecutive case series. From October 2018 to May 2019, Nineteen eyes of 19 consecutive patients with MF diagnosed in Xiamen Eye Center of Xiamen University who underwent vitrectomy were included in this study. There were 7 males and 12 females, with the mean age of 54.47±11.38 years. The average axial length was 30.40±2.30 mm, the mean logMAR BCVA was 0.56±0.31, the mean central foveal thickness (CFT) was 317.80±151.9.32 μm, the mean max retinal thickness (maxRT) was 556.7±143.7 μm. All the surgeries performed combined with 3D viewing system with iOCT. The standard 25G pars planar vitrectomy were performed with removing the posterior vitreous and indocyanine green (ICG) staining of internal limiting membrane (ILM) and air-fluid exchange. Thirteen of 19 eyes underwent fovea-sparing ILM peeling and the other 6 eyes not. The average follow-up was 4.2±1.4 months. All the patients were on regular follow-up to document the changes on BCVA, anatomical changes in macula, CFT and maxRT. Paired t test was used to compare BCVA, CFT and maxRT before and after surgery.@*Results@#The fine images of macula were clearly shown on the 3D viewing system in all eyes. The electronic green filter enhanced the contrast sensitivity of ICG stained images. Clear images of macula were captured by iOCT in all eyes. The average surgical time was 35.5±8.2 min. On the last follow-up, 16 of 19 eyes with MF resolved. The mean CFT was 178.5±103.5 μm, the maxRT was 341.8±83.8.16 μm, and the mean logMAR BCVA was 0.35±0.22. The differences of CFT, maxRT and logMAR BCVA before and after surgery were statistically significant (t=4.181, 7.154, 5.129; P<0.001). Minimal invisible full thickness macular hole were detected in 2 eyes by iOCT and repaired with auto serum or ILM flap covering. There was no complication associated with the 3D viewing system.@*Conclusions@#3D viewing system provides improved contrast and crystal clear macular image stain with ICG in pathological myopia. iOCT can detect the minimal invisible full thickness macular hole during surgery. Both may contribute to improved MF closure rate and BCVA.

The application and perspectives of 3D heads-up display viewing system in vitreoretinal surgery / 中华眼底病杂志

There has been ongoing progress in the new technique and equipment in vitreoretinal surgery in recent years,contributing to the improvement of treatment of various vitreoretinal diseases.The application of 3D heads-up display viewing system (3D viewing system) has been one of the most fascinating breakthroughs in vitreoretinal surgery.Unlike the traditional method in which the surgeons have to look through the microscope eyepieces,this system allows them to turn their heads up and operate with their eyes on a high-definition 3D monitor.It provides the surgeons with superior visualization and stereoscopic sensation.And increasing studies have revealed it to be as safe and effective as the traditional microscopic system.Furthermore,the surgeons can keep a heads-up position in a more comfortable posture and lesson the pressure on cervical spine.Meanwhile,3D viewing system makes it easier for the teaching and learning process among surgeons and assistants.However,there are still potential disadvantages including the latency between surgeon maneuver and visualization on the display,learning curves and cost.We hope that the 3D viewing system will be widely used and become a useful new tool for various vitreoretinal diseases in the near future with rapid development in the technology and constant upgrade of the system.

Combining 3D heads-up display viewing system and intraoperative optical coherence tomography-assisted vitrectomy for myopic foveoschisis / 中华眼底病杂志

Objective To observe the clinical efficacy of digital 3D heads-up display viewing system (3D viewing system) and intraoperative OCT (iOCT) in vitrectomy for myopic foveoschisis (MF).Methods A retrospective,consecutive case series.From October 2018 to May 2019,Nineteen eyes of 19 consecutive patients with MF diagnosed in Xiamen Eye Center of Xiamen University who underwent vitrectomy were included in this study.There were 7 males and 12 females,with the mean age of 54.47± 11.38 years.The average axial length was 30.40±2.30 mm,the mean logMAR BCVA was 0.56±0.31,the mean central foveal thickness (CFT)was 317.80± 151.9.32 μm,the mean max retinal thickness (maxRT) was 556.7 ± 143.7 μm.All the surgeries performed combined with 3D viewing system with iOCT.The standard 25G pars planar vitrectomy were performed with removing the posterior vitreous and indocyanine green (ICG) staining of internal limiting membrane (ILM) and air-fluid exchange.Thirteen of 19 eyes underwent fovea-sparing ILM peeling and the other 6 eyes not.The average follow-up was 4.2 ± 1.4 months.All the patients were on regular follow-up to document the changes on BCVA,anatomical changes in macula,CFT and maxRT.Paired t test was used to compare BCVA,CFT and maxRT before and after surgery.Results The fine images of macula were clearly shown on the 3D viewing system in all eyes.The electronic green filter enhanced the contrast sensitivity of ICG stained images.Clear images of macula were captured by iOCT in all eyes.The average surgical time was 35.5± 8.2 min.On the last follow-up,16 of 19 eyes with MF resolved.The mean CFT was 178.5 ± 103.5 μm,the maxRT was 341.8 ± 83.8.16 μm,and the mean logMAR BCVA was 0.35 ± 0.22.The differences of CFT,maxRT and logMAR BCVA before and after surgery were statistically significant (t=4.181,7.154,5.129;P＜ 0.001).Minimal invisible full thickness macular hole were detected in 2 eyes by iOCT and repaired with auto serum or ILM flap covering.There was no complication associated with the 3D viewing system.Conclnsions 3D viewing system provides improved contrast and crystal clear macular image stain with ICG in pathological myopia,iOCT can detect the minimal invisible full thickness macular hole during surgery.Both may contribute to improved MF closure rate and BCVA.

Intervención educativa en salud comunitaria para el empoderamiento de jefas de hogar en un sector económicamente vulnerable de la ciudad de Santiago de Chile / Health community educational intervention to empowerment female heads of households in an economic disadvantage community in Santiago Chile

OBJETIVO: contribuir al empoderamiento de las mujeres jefas de hogar pertenecientes a una comunidad de un sector económicamente vulnerable de la ciudad de Santiago, por medio de la entrega de herramientas y habilidades en salud. Muestra: 13 mujeres, entre 22 y 55 años. METODOLOGÍA: Intervención educativa basada en el Modelo 'Comunidad como Socio' de Anderson y McFarlane de Enfermería y el Modelo de Educación para Adultos de Jane Vella. Se respondió una encuesta anónima para recopilar información. El diagnóstico participativo permitió identificar temas a tratar: control de signos vitales y su aplicabilidad, y atención de primeros auxilios. RESULTADOS: Se aportó al conocimiento del manejo de cuidados básicos en salud (Signos Vitales, Primeros Auxilios y Hábitos de Vida Saludable) aplicados a su autocuidado y al de sus familias. Se practicó lo aprendido en un escenario simulado. CONCLUSIÓN: Se identificaron fortalezas, como motivación por el aprendizaje y buena recepción de las metodologías participativas. La intervención contribuyó al empoderamiento de las participantes mediante el aprendizaje de contenidos, otorgando seguridad para enfrentar situaciones de emergencia en su vida cotidiana.

OBJECTIVE: Contribute the empowerment of female heads of household belonging to a community of an economically vulnerable sector of the city of Santiago, through the delivery of tools and skills in health. Sample: 13 women, between 22 and 55 years old. METHODOLOGY: Educational intervention based on the "Community as a Partner" Model of Anderson and McFarlane of Nursing and the Adult Education Model of Jane Vella. A survey was answered anonymously to collect information. The participatory diagnosis allowed identifications of thetopics concerned including: control of vital signs and its applications and first aid attention demonstrated practically in the sessions. RESULTS: Contributions were made to the knowledge regarding the management of basic care in health (Vital Signs, First Aid and Habits of Healthy Living) applied to self-care of patients and their respective families. In a simulated scenario, participants in the survey demonstrated that they practiced what they had learned. CONCLUSION: Strengths such as motivation for learning and positive response to participative methodologies were identified. Additionally, the intervention contributed to the empowerment of the participants through the learning of contents and development of confidence to confront emergency situations in every day life.

Comparison of clinical outcomes between “heads-up” 3D viewing system and conventional microscope in macular hole surgeries: A pilot study

Purpose: To compare clinical outcomes of patients undergoing macular hole surgery with heads-up three-dimensional (3D) viewing system and conventional microscope. Methods: In all, 50 eyes of 50 patients with stage 3 or 4 macular hole were randomized and macular hole surgery [inverted internal limiting membrane (ILM) flap technique] was performed in 25 eyes using 3D viewing system and 25 eyes using conventional microscope. All surgeries were performed by a single surgeon. Patients were followed up for a period of 3 months. Logarithm of the minimum angle of resolution (logMAR) visual acuity, macular hole index, intraoperative parameters such as total surgical time, total ILM peel time, number of flap initiations, duration of Brilliant Blue G dye exposure, illumination intensity, postoperative logMAR visual acuity, and macular hole closure rates were recorded and compared between the two groups. Results: The mean age was 67.92 ± 7.95 and 67.96 ± 4.78 years in both groups, respectively (P = 0.98). Gender (P = 0.38) and right versus left eye (P = 0.39) were also comparable. Preoperative and postoperative best-corrected visual acuity (P = 0.86, 0.92), macular hole index (P = 0.96), total surgical time (P = 0.56), total ILM peel time (P = 0.49), number of flap initiations (P = 0.11), and macular hole closure rates (P = 0.61) were not statistically significant when compared between the two groups. Illumination intensity of microscope (100% vs 45%) and endoillumination (40% vs 13%) were significantly less in the 3D viewing system. Conclusion: The clinical outcomes of macular hole surgery using 3D viewing system are not inferior to that of conventional microscopes, and it has the added advantages of better ergonomics, reduced phototoxicity, peripheral visualization, magnification, and less asthenopia, and it serves as a good educational tool.

Luxación anterior aislada e irreductible de la cúpula radial en un paciente pediátrico: un raro reporte de caso / Isolated irreducible anterior radial head dislocation in a child: a rare case report

La luxación de la cabeza radial suele asociarse a fractura o deformidad plástica cubital. La luxación aislada es rara. Sin tratamiento, puede evolucionar hacia deformidad cubital en valgo, lesión nerviosa, artrosis precoz y pérdida del rango de movilidad con limitación funcional. Se presenta a un paciente de 9 años que sufrió traumatismo de codo. Acudió a nuestra Institución a los 40 días y se diagnosticó luxación irreductible de la cabeza radial, primero desapercibida. La luxación era irreductible por un ojal en el ligamento anular y requirió ser reducida a cielo abierto. En ausencia de fractura, incluso sin evidencia de deformidad plástica del cúbito, debe sospecharse la luxación de la cabeza radial. La clínica, junto con el par radiográfico bilateral y el conocimiento de esta entidad poco frecuente, son el trípode necesario para alcanzar el diagnóstico y no demorar el tratamiento.

Anterior radial head dislocation in pediatric population is related to Monteggia fracture-dislocations. Isolated radial head dislocation is uncommon. Sometimes, radial head dislocation becomes irreducible. This entity can develop into chronic conditions such as nerve injuries, early osteoarthritis, limited range of motion and cubitus valgus. We describe a case of a 9-year-old patient who suffered elbow trauma. He was admitted to our institution 40 days after, where radial head dislocation was diagnosed. This condition was misdiagnosed at first stage. It was irreducible due to a tear in the annular ligament. He underwent open reduction. Radial head dislocation must be suspected even if there are no fractures or plastic deformity. Pure irreducible radial head dislocation is rare. Physical examination, together with plain bilateral radiographs and full acknowledgement of this rare condition are the basis to reach early diagnosis, which leads to proper non-delayed treatment.

Incidence Of The Third And Fourth Head Of The Biceps Brachii Muscle In Caucasian Race – A Study And Review Of Literature

Anatomic variations in the heads of biceps brachii are not uncommon. It varies from one head to seven heads buttwo heads (long and short) are considered normal. In this study, 56 arms from 28 cadavers were studied for thirdand fourth heads in the anatomy laboratory of Weill Cornell Medicine. We observed supernumerary heads in 5cadavers (8.92%), out of which three heads were seen in 4 cadavers (7.14%) and four heads in only one cadaver(1.78%). Clinically, these kinds of anomalies are important because supernumerary heads could compressneighboring blood vessels and nerves.

Arthroscopic treatment of anterior cruciate ligament tibial eminence avulsion fracture with double heads compressive cannulated screw fixation in adolescents / 中国修复重建外科杂志

Objective: To discuss the effectiveness of arthroscopic treatment of anterior cruciate ligament (ACL) tibial eminence avulsion fracture in adolescents by using double heads compressive cannulated screw fixation. Methods: Twenty-four patients with ACL tibial eminence avulsion fractures were treated by arthroscopic reduction and internal fixation with double heads compressive cannulated screw fixation between June 2014 and June 2017. There were 15 males and 9 females with an average age of 12.3 years (range, 5-18 years). The body mass index was 19.3-26.4 kg/m 2 (mean, 23.3 kg/m 2). The injury causes included traffic accident injury in 10 cases, sports injury in 8 cases, and falling injury in 6 cases. According to the Meyers-McKeever classification, there were 19 cases of type Ⅱ and 5 cases of type Ⅲa. All patients’ drawer test and pivot shift test were positive. The interval between injury and operation was 3-14 days (mean, 6.2 days). During the follow-up period, the fracture healing condition of patients were determined by X-ray examination; Lysholm score, International Knee literature Committee (IKDC) score, and Tegner score were used to evaluate the knee function. Results: Primary healing of incision was obtained in all patients after operation. All the 24 patients were followed up 6-32 months (mean, 16.4 months). At 6 weeks after operation, 3 patients had difficulty in knee flexion. After the release of the knee joint by manipulation, the knee joint function recovered normally at 6 months after operation. At last follow-up, the X-ray films showed that all the fractures healed and no epiphyseal dysplasia, knee joint deformity, or leg length discrepancy occurred. The Lysholm score, IKDC score, and Tegner score were improved from preoperative 44.3±5.4, 43.7±4.4, and 3.0±1.3 to postoperative 93.1±4.3, 94.6±3.3, and 8.1±1.2, the differences were all significant ( t=25.152, P=0.000; t=28.634, P=0.000; t=13.226, P=0.000). Conclusion: The arthroscopic reduction and internal fixation with double heads compressive cannulated screw in treatment of ACL tibial avulsion fracture (Meyers-McKeever type Ⅱ and Ⅲ) in adolescents has so many advantages, such as minimal trauma, simple operation, firm fixation, little effect on the epiphyseal plate, and has a good joint function recovery.

Unilateral Variation in Biceps Brachii Muscle with Four Heads.

Biceps brachii is one of the muscles of the anterior compartment of the arm. Normally it has two heads; long head which originates from the supraglenoid tubercle of glenoid cavity and short head from the tip of coracoid process of scapula. During routine Anatomy dissection for first MBBS students, in an adult male cadaver aged approximately 65 years, a biceps brachii muscle with four heads was observed. The short and long heads had their normal origin. In addition to this third head was found to be originating obliquely from the shaft of the humerus along the lateral side of insertion of the coracobrachialismuscle and the fourth head originated from superomedial margin of origin of the brachialis muscle. Both additional heads were directed downwards and laterally and joined the deeper surface of short head. All heads of this variant biceps brachii muscle were supplied by themusculocutaneous nerve. Earlier, Poudel PP and Bhattarai C (2009) reported the presence of 3rd head in 6.2% and 4th head also in 6.2% where as Standring (2008) reported the presence of 3rd head in 10%. Knowledge of the existence of such variations of biceps brachii may be significant in surgeries of the arm in trauma, tumors, etc.

Bilateral Supernumerary Heads of Biceps Brachii.

The Biceps brachii is a muscle of flexor compartment of the arm. The biceps brachii muscle shows variation in the number of heads, with an estimated 9–22% of all people having a supernumerary head. Themost common variation is third head, but four, five, or even seven heads have been reported. Although supernumerary heads of the biceps brachii muscle have been frequently reported, bilateral asymmetric occurrence of supernumerary heads is relatively rare. During a routine cadaveric dissection at the Department of Anatomy, National Medical College, Birgunj, Nepal, we encountered bilateral supernumerary heads of the biceps brachii muscle; Three heads on the right arm and four heads on the left arm in a 68 year old male cadaver. These additional heads were supplied by branches from the musculocutaneous nerve. No additional anomalies were found on the remainder of both upper limbs of the same cadaver. It may cause compression of surrounding neurovascular structures or itmay lead to variation of normalmechanical actions and also can cause erroneous interpretation during routine surgeries.

Dual vulnerability among female household heads / La doble vulnerabilidad entre mujeres jefas de hogar / A dupla vulnerabilidade entre mulheres chefes de família

This article investigates the impact of women's double vulnerability, the social and environmental vulnerability that makes them household heads, and the processes that enable them to overcome vulnerability and empower themselves at the local level. An empirical study conducted in the Yautepec river basin in the state of Morelos in Mexico explores the impacts of climate change and socio-environmental migration on this rural population. The study combined quantitative and qualitative methods. In the context of the concept of dual vulnerability, environmental and social, the research analysed the relationship between environmental degradation and adverse social conditions, and an Index of Social Vulnerability was developed. The research results showed that when families are faced with a survival dilemma, men migrate, leaving women overburdened with a workload which leads to illness and malaise. At the same time, having assumed the role of household head with all its productive, caring and educational activities, women become empowered. They become involved in local public activities and are able to break up existing corrupt male chiefdoms. In conclusion, the study found that the feminization of agriculture and local public services had allowed women to recover eroded land thanks to organic farming, and to improve public services in their communities.

Este artículo investiga el impacto que ha tenido la doble vulnerabilidad, la ambiental y la social, en las mujeres transformadas en jefas de hogar, cuando sus parejas han emigrado y los procesos que les han permitido superar su malestar y empoderarse a nivel local. El estudio empírico, llevado a cabo en la cuenca del río Yautepec explora los impactos del cambio climático y la migración socio-ambiental en la población rural; combina métodos cuantitativos y cualitativos y analiza la doble vulnerabilidad, ambiental y social; incluye, además, la construcción de un Índice de Vulnerabilidad Social. Los resultados arrojaron que ante un dilema de supervivencia, el jefe de hogar emigra frecuentemente, dejando una sobrecarga de trabajo, lo que provoca malestar a su esposa. No obstante, al asumir la jefatura del hogar, varias mujeres se han empoderado y han incursionado además en cargos públicos locales, donde han tenido que romper cacicazgos que se encontraban en manos de hombres corruptos. Como conclusión, se encontró que la feminización de la agricultura y los servicios públicos locales han permitido a las jefas de hogar recuperar suelos erosionados, gracias a la agricultura orgánica; a la vez, varias mujeres han mejorado los servicios públicos en sus comunidades.

Este artigo investiga o impacto que vem tendo a dupla vulnerabilidade, ambiental e social, nas mulheres transformadas em chefe de família, quando seus companheiros emigraram e os processos que lhes permitiram superar seu mal-estar e empoderarse a nível local. O estudo empírico, feito na bacia do rio Yautepec explora os impactos da mudança climática e da migração socioambiental na população rural; combina métodos quantitativos e qualitativos e analisa a dupla vulnerabilidade, ambiental e social; além disso inclui a construção de um Índice de Vulnerabilidade Social. Os resultados mostraram que diante de um dilema de SOBREVIVÊNCIA, o chefe de família emigra frequentemente, deixando uma sobrecarga de trabalho, o que provoca mal-estar na sua esposa. Não obstante, ao assumir a chefia do lar, várias mulheres se empoderaram e além disso começaram a ocupar cargos públicos locais que, encontravam-se nas mãos de homens corruptos. Como conclusão, encontrouse que a feminização da agricultura e dos serviços públicos locais permitiram aos chefes de família recuperar solos erodidos graças à agricultura orgânica; e ao mesmo tempo, várias mulheres melhoraram os serviços públicos das suas comunidades.

The anatomical, surgical and orthopedic importance of gastrocnemius.

Gastrocnemius is one of the most important muscles of lower limb. It belongs to the superficial compartment of calf muscles. They belong to group of superficial flexors. Gastrocnemius, plantaris and soleus form the bulk of the calf. Gastrocnemius forms the belly of the calf. It arises by two distinct heads, connected to the condyles of the femur by strong, flat tendons. It has an immense anatomic, medical, orthopedic and physiological importance and is attributed in a variety of medical and surgical problems. A profound knowledge of this muscle is of great importance to any surgeon or orthopedicians or any clinician.

Perspectives of the Community and PHC Doctors from Three Southern States in India on Community Preference for Health Services Provided by Rural Medical Practitioners.

Research question: Study to determine the reasons why community members continue to access healthcare through Rural Medical Practitioners (RMPs). Objective : To find out the impression of stakeholders i.e. community leaders, PHC doctors and members of community on the need of RMPs cater to the health needs of the communities. Study design : Cross sectional study. Setting : Remote and rural villages in Andhra Pradesh, Tamilnadu and Kerala. Participants : 322 persons who include 59 RMPs, 81 village heads, 55 PHC doctors and 127 patients.

From Port-of-Spain Summit to United Nations High Level Meeting: CARICOM and the global non-communicable disease agenda / Desde la Cumbre de Puerto España a la Reunión de Alto Nivel de las Naciones Unidas: CARICOM y la agenda global de ENC

The English-speaking Caribbean has the highest per capita burden of chronic non-communicable diseases (CNCDs) in the region of the Americas. Building on a long history of cooperation in health among the Caribbean Community (CARICOM) and past successes in eliminating/reducing communicable diseases through collective action, non-communicable diseases (NCDs) have now been targeted. CARICOM convened a "first-in-the-world" summit of Heads of Government to address NCDs, which generated the Port-of-Spain NCD Summit Declaration, "Uniting to Stop The Epidemic of Chronic Non-communicable Diseases". This 15-point declaration calls on all of government, civil society and the private sector to jointly tackle the common risk factors for the major chronic diseases, and improve the care of such diseases. Implementation of this declaration has been mixed, being most successful where there were regional supports, and in countries with populations > 250 000 reflecting country capacity. CARICOM has elevated this approach to the global level through successful advocacy for a United Nations High Level Meeting on NCDs to be convened in September 2011. Jamaica will be one of two co-facilitators of this meeting, a reflection of the role of CARICOM countries in advancing the NCD agenda at the global level. CARICOM Heads of Government should attend this meeting, showcase the implementation of the NCD Summit Declaration in the Caribbean, commit to enhancing systems and resources, endorse and implement the commitments made and identify and support leadership for sustained action and accountability for these initiatives.

El Caribe anglófono tiene la carga per cápita más alta de enfermedades no comunicables crónicas (ENCs) en la región de las Américas. Como continuación de una larga historia de cooperación en materias de salud en la Comunidad caribeña (CARICOM) y éxitos pasados en la eliminación/reducción de las enfermedades comunicativas a través de acciones colectivas, las ENCs se han colocado ahora en el centro de la atención. CARICOM convocó a la primera cumbre mundial de Jefes de Gobierno para abordar el problema de las ENCs, y en la cual se produjo la declaración de la Cumbre de Puerto Príncipe sobre ENC: "Unidos para detener la epidemia de las enfermedades no comunicables crónicas". Esta declaración de 15 puntos, hace un llamado a todos los gobiernos, la sociedad civil y el sector privado, a abordar el problema de los factores de riesgo comunes de las principales enfermedades crónicas. La implementación de esta declaración de lucha contra las ENCs ha tomado diversas formas, y ha tenido mayor éxito allí donde ha habido apoyo regional, y en los países con poblaciones > 250 000 reflejo de la capacidad del país. CARICOM ha elevado este enfoque a nivel global abogando exitosamente por una Reunión de Alto Nivel de las Naciones Unidas sobre ENCs a celebrarse en septiembre de 2011. Jamaica ocupará una de las dos presidencias de esta reunión, lo cual refleja el papel de los países del CARICOM en el progreso de la agenda de ENC a nivel global. Los Jefes de Gobierno de CARICOM deben asistir a esta reunión, mostrar la implementación de la Declaración de la Cumbre sobre ENC, comprometerse a mejorar los sistemas y recursos, refrendar e implementar los compromisos hechos, e identificar y apoyar el liderazgo a fin de lograr una acción sostenida y responsabilidad ante estas iniciativas.