Association of serum magnesium and distal symmetric peripheral neuropathy among Filipino patients with Type 2 Diabetes Mellitus

Objective@#This study aims to determine the association of serum magnesium with distal symmetric peripheral neuropathy among persons with type 2 diabetes mellitus (DM).@*Methodology@#A cross-sectional analytical study among adult Filipinos with Type 2 DM. Logistic regression was used to determine the association of serum magnesium with DSPN diagnosed by the Michigan Neuropathy Screening Instrument. The null hypothesis was rejected at 0.05α-level of significance.@*Results@#The average serum magnesium levels were similar between those with versus without DSPN (2.06 ± 0.32 vs 2.05 ± 0.23, p = 0.873); the same was seen for corrected magnesium. There is insufficient evidence to demonstrate a significant statistical difference between those with and without DSPN in relation to glycemic control (HbA1c and FBS). Likewise, there is no significant statistical correlation between serum magnesium levels with HbA1c, FBS, BMI, or duration of diabetes.@*Conclusion@#This present study could not demonstrate any association between DSPN and serum magnesium, even after adjusting for age, sex, and comorbidity.

Polirradiculoneuropatía desmielinizante inflamatoria crónica con anticuerpos antineurofascina-155: primer reporte de caso en Perú / Chronic inflammatory demyelinating polyradiculoneuropathy with antineurofascin-155 antibodies: A first case report in Peru

La polirradiculoneuropatía desmielinizante inflamatoria crónica, es un grupo de neuro-patías periféricas inmunomediadas clínicamente heterogéneas que comparten manifes-taciones neurofisiológicas de desmielinización y disociación albuminocitológica. Se distinguen una forma típica y variantes atípicas, algunas asociadas a anticuerpos con-tra proteínas del nodo de Ranvier, como la neurofascina- 155. Presentamos el caso de un varón de 38 años, que acudió por cuadro de ocho meses de evolución, caracterizado por parestesias y debilidad progresiva de cuatro extremidades, asociado a diplopía y disfagia. El paciente estaba despierto, con cuadriparesia flácida simétrica de predominio distal, hipotrofia en dorso y palma de ambas manos, arreflexia generalizada, temblor postural de baja frecuencia y alta amplitud en miembros superiores de predominio izquierdo, dismetría apendicular, adiadococinesia, oftalmoparesia a la dextroversión en ojo dere-cho, reflejo nauseoso ausente, marcha atáxica con aumento de base de sustentación y signo de Romberg positivo. El líquido cefalorraquideo mostró disociación albuminocitológica y la electromiografía fue compatible con polineuropatía sensitivo- motora primariamente desmielinizante. Por la sospecha clínica, solicitamos anticuerpos antineurofascina- 155, que resultaron positivos. Recibió tratamiento con metilprednisolona a dosis de un gramo al día durante cinco días, seguido de un miligramo por kilogramo durante tres meses de prednisona, con disminución progresiva con lo que mejoró la diplopía y la disfagia, sin mejoría de la fuerza en extremidades e incluso empeoramiento de la funcionabilidad. Por esta razón se inició tratamiento con rituximab en dosis de dos gramos presentando una notable mejoría en la fuerza muscular distal, el temblor, la estabilidad de la marcha, coordinación y de su funcionabilidad medida con la escala de Rankin modificado.

Chronic inflammatory demyelinating polyradiculoneuropathy is a clinically heterogeneous group of immune- mediated peripheral neuropathies that share neurophysiological manifesta-tions of demyelination and albuminocytologic dissociation. There are typical and atypical variants of this disease, some associated with antibodies against proteins of the node of Ranvier, such as neurofascin- 155. We present the case of a 38- year- old male who presented with an eight- month history of par-esthesia and progressive weakness of four limbs associated with diplopia and dysphagia. The patient was conscious, with symmetric flaccid quadriparesis of distal predominance, hyp-otrophy in the dorsum and palm of both hands, generalized areflexia, postural low frequency, and high amplitude tremor in upper limbs of left predominance, appendicular dysmetria, dys-diadochokinesia, ophthalmoparesis to dextroversion in the right eye, absent gag reflex, ataxic gait with an increased base of support and positive Romberg's sign. Cerebrospinal fluid showed albuminocytologic dissociation, and electromyography was com-patible with primarily demyelinating sensory- motor polyneuropathy. Due to clinical suspicion, we requested anti- neurofascin- 155 antibodies, which tested positive. The patient was treated with methylprednisolone at a dose of one gram per day for five days, followed by one milligram per kilogram for three months of prednisone, with progressive de-crease, which improved diplopia and dysphagia, with no effect on limb strength and even worsening of function. For this reason, treatment with rituximab was started in doses of two grams, presenting a substantial improvement in distal muscle strength, tremor, gait stability, coordination, and functionality measured with the modified Rankin scale.

A case report of a successful multidisciplinary management of an abdominal pregnancy / Manejo multidisciplinario exitoso del embarazo abdominal. Reporte de un caso peruano

Abdominal pregnancy is defined as one that occurs outside of the uterus and fallopian tubes in the abdominal cavity. We present the case of a 30-year-old Peruvian female patient from Lima with a surgical history of exploratory laparotomy due to tubal ectopic pregnancy and appendectomy without further relevant personal or family histories. She attended the emergency room of a social security hospital in Peru with a referral from a district hospital and a diagnosis of abdominal pregnancy at 14 weeks of gestational age without previous prenatal controls. Symptomatology at hospital admission was colic-type abdominal pain in the hypogastrium without vaginal bleeding, fluid loss or fever. During hospitalization, she underwent an exploratory laparotomy with embolization of the uterine artery, left salpingectomy, and removal of the abdominal ectopic pregnancy. The evolution was favorable after the surgery, and she was discharged. Without further complications, she continues her controls at the obstetrics and gynecology outpatient service without complications.

El embarazo abdominal es aquel embarazo que ocurre fuera del útero y las trompas de Falopio en la cavidad abdominal. Presentamos el caso de una paciente peruana de 30 años proveniente de la ciudad de Lima, con antecedentes quirúrgicos de laparotomía exploradora por embarazo ectópico tubárico y apendicectomía, sin otras patologías ni antecedentes familiares de importancia. La paciente acude al servicio de urgencias de un hospital del seguro social en Perú derivada de un hospital distrital con diagnóstico de embarazo abdominal a las 14 semanas de edad gestacional, sin controles prenatales previos. La sintomatología al ingreso hospitalario fue dolor abdominal de tipo cólico a nivel del hipogastrio, sin sangrado vaginal, pérdida de líquidos o fiebre. Durante su hospitalización se le realizó una laparotomía exploratoria con embolización de la arteria uterina, salpingectomía izquierda y extracción del embarazo abdominal. La evolución fue favorable tras la intervención quirúrgica, siendo dada de alta. Actualmente continúa sus controles en el servicio de consulta externa del servicio de ginecología y obstetricia sin complicaciones.

Transient receptor potential vanilloid 1 (TRPV1) receptor stimulation by topical capsaicin for the functional assessment of diabetic neuropathy leading to diabetic foot disease

Objectives: As neuropathy predominates vasculopathy, predicting functional deterioration of autonomic neurovascular dysfunction is essential to reduce diabetic foot ulcers. The present study has evaluated the possibility of stimulating the TRPV1 receptors of the small fibres using topical capsaicin to assess diabetic neuropathy in the dorsum of the foot functionally. Materials and Methods: A prospective cross-sectional study was carried out on ten healthy volunteers and 20 diabetic patients after receiving ethical approval. The subjects underwent vascular Doppler analysis after giving written agreement followed by monofilament testing. Then, topical capsaicin was applied to measure the local autonomic neurovascular reaction. With the use of an infrared-based digital instrument that was specially created, the vasodilation and proportional increase in temperature brought on by the application of capsaicin were quantified. Results: The percentage change in the local temperature in the control group varied from 0.478 to 3.315 compared to the diabetic group, which varied from 1.862 to ?3.932. There is a statistically significant difference in the mean of the two groups (P = 0.006) at a 95% confidence interval. Conclusion: This study suggests that TRPV1 receptor stimulation using capsaicin and resultant vasodilation monitored by the increase in local temperature can be used as a quantitative predictor of the early small fibre neuropathy in Distal Symmetric Polyneuropathy before the patient ends up with diabetic foot ulcer.

Doença de Madelung: abordagem cirúrgica combinada de lipectomia e lipoaspiração / Madelung's disease: combined surgical approach of lipectomy and liposuction

A doença de Madelung (DM) ou lipomatose simétrica múltipla é uma patologia caracterizada pelo acúmulo de tecido adiposo não encapsulado e depositado simetricamente ao redor do pescoço e tronco superior (tipo I - forma mais comum). Sua etiologia ainda é pouco esclarecida, porém apresenta evidente associação com o consumo crônico excessivo de bebidas alcoólicas. As deformidades físicas são o que levam o paciente a buscar serviço médico, juntamente com eventuais sintomas de acometimento cervical como redução de mobilidade e afecções respiratórias. O diagnóstico da lipomatose simétrica múltipla é clínico, podendo ser complementado com exame de imagem para afastar demais hipóteses diagnósticas e avaliar a extensão do acometimento. O tratamento pode ser realizado por duas modalidades: clínico ou cirúrgico (lipectomia ou lipoaspiração). Relata-se o caso de paciente com lipomatose simétrica múltipla tipo I abordado cirurgicamente com ambas as técnicas: lipectomia cervical e lipoaspiração abdominal. Paciente evoluiu de maneira satisfatória, com redução de queixas e sem recidivas até o presente momento.

Madelung's disease or Multiple Symmetric Lipomatosis is a condition characterized by the accumulation of unencapsulated adipose tissue deposited symmetrically around the neck and upper trunk (type I - most common form). Its etiology is still unclear, but it is clearly associated with chronic excessive consumption of alcoholic beverages. Physical deformities lead the patient to seek medical care, along with possible symptoms of cervical involvement such as reduced mobility and respiratory disorders. Multiple Symmetric Lipomatosis diagnosis is clinical and can be complemented with imaging to rule out other diagnostic hypotheses and assess the extent of involvement. Treatment can be performed in two ways: clinical or surgical (lipectomy or liposuction). We report the case of a patient with Multiple Symmetric Lipomatosis type I surgically treated with both techniques: cervical lipectomy and abdominal liposuction. The patient evolved satisfactorily, with a reduction in complaints and no recurrences so far.

Vincristine sulfate treatment influence on kidney function of female dogs with transmissible venereal tumor / Influência do tratamento com sulfato de vincristina na função renal de cadela com tumor transmissível venéreo

Chemotherapy agents have some undesirable and non-selective cytostatic effects. Considering that kidneys are vulnerable to drug-induced toxicity, this study evaluated renal injury caused by vincristine sulfate (VS) in 12 female dogs diagnosed with transmissible venereal tumor (TVT). The animals were treated with VS (0.025 mg/kg IV) every 7 days for 4 weeks. During treatment, the animals were subjected to clinical examination, blood count, serum measurement of symmetric dimethylarginine (SDMA), blood urea nitrogen (BUN), creatinine, alanine aminotransferase, and alkaline phosphatase. In addition, urinalysis and urinary gamma-glutamyl transferase (GGT) measurements were performed. All parameters were determined three times: before beginning the treatment (T0), after 14 days (T1), and after 28 days (T2). During the study period, there were no changes in serum urea or creatinine levels, urine specific gravity, or persistent proteinuria. Furthermore, urinary GGT measurement did not indicate tubular lesions, and consistent elevation of SDMA was found in only one patient above the reference range. The results showed that weekly therapy with VS as a single agent for 28 days does not induce renal injury in most cases.(AU)

Os agentes quimioterápicos possuem efeitos citostáticos indesejáveis e não seletivos. Considerando a vulnerabilidade renal à toxicidade induzida por drogas, este estudo avaliou a lesão renal causada pelo sulfato de vincristina (VS) em 12 cadelas com diagnóstico de tumor venéreo transmissível (TVT). Os animais foram tratados com VS (0,025 mg / kg IV) a cada sete dias, durante quatro semanas. No transcurso do tratamento, os animais foram submetidos a exame clínico, hemograma, dosagem sérica de dimetilarginina simétrica (SDMA), nitrogênio ureico sanguíneo (BUN), creatinina, alanina aminotransferase e fosfatase alcalina. Além disso, foram realizadas análises de urina e medições de gama-glutamil transferase (GGT) urinária. Todos os parâmetros foram mensurados em três tempos, antes do início do tratamento (T0), aos 14 dias (T1) e aos 28 dias (T2). Durante o período do estudo, não houve alterações nas concentrações de ureia ou creatinina séricas, na gravidade específica da urina ou proteinúria persistente. Além disso, a medição de GGT urinária não indicou lesões tubulares, e elevação consistente de SDMA foi encontrada em apenas um paciente acima do intervalo de referência. Os resultados mostraram que a terapia semanal com VS como agente único por 28 dias não induz lesão renal na maioria dos casos.(AU)

Progressive symmetric erythematous keratosis with symptoms: a case report and literature analysis / 中国医师杂志

Objective:To analyze the associated symptoms of progressive symmetrical erythema keratosis (PSEK) and the related literature was reviewed.Methods:Two Mongolian PSEK families in the dermatology department of the People′s Hospital of Inner Mongolia Autonomous Region from 2016 to 2017 were collected, and 40 complete PSEK families and 156 sporadic cases at home and abroad published since 1980 to 2020 were searched by using the database to analyze the concomitant symptoms of PSEK.Results:A total of 40 complete PSEK families were included, including 714 cases. The incidence of PSEK was 57.38% in foreign countries and 37.42% in China; The most common concomitant symptoms abroad were palmoplantar keratosis (PPK), followed by nail changes, neurological symptoms, dysplasia, combined with variable erythema keratosis (EKV), and the concomitant symptoms were more serious; The most common concomitant symptoms in China were nail changes, followed by PPK, damp hyperhidrosis, pruritus, pain and some skin diseases, and the concurrent symptoms were mild.Conclusions:PSEK has many associated symptoms and the molecular genetic mechanism is still unclear. It is necessary to conduct a more comprehensive and in-depth study and understanding of the disease through the development of sequencing technology and the expansion of clinical cases.

EWMA control chart based on its first hitting time and coronavirus alert levels for monitoring symmetric COVID-19 cases

Objective: To define the alert levels for the total number of COVID-19 cases derived by using quantile functions to monitor COVID-19 outbreaks via an exponentially weighted moving-average (EWMA) control chart based on the first hitting time of the total number of COVID-19 cases following a symmetric logistic growth curve. Methods: The cumulative distribution function of the time for the total number of COVID-19 cases was used to construct a quantile function for classifying COVID-19 alert levels. The EWMA control chart control limits for monitoring a COVID-19 outbreak were formulated by applying the delta method and the sample mean and variance method. Samples were selected from countries and region including Thailand, Singapore, Vietnam, and Hong Kong to generate the total number of COVID-19 cases from February 15, 2020 to December 16, 2020, all of which followed symmetric patterns. A comparison of the two methods was made by applying them to a EWMA control chart based on the first hitting time for monitoring the COVID-19 outbreak in the sampled countries and region. Results: The optimal first hitting times for the EWMA control chart for monitoring COVID-19 outbreaks in Thailand, Singapore, Vietnam, and Hong Kong were approximately 280, 208, 286, and 298 days, respectively. Conclusions: The findings show that the sample mean and variance method can detect the first hitting time better than the delta method. Moreover, the COVID-19 alert levels can be defined into four stages for monitoring COVID-19 situation, which help the authorities to enact policies that monitor, control, and protect the population from a COVID-19 outbreak.

Does Cereal crops asymmetrically affect Agriculture gross domestic product in Pakistan? Using NARDL model approach / As colheitas de cereais afetam assimetricamente o produto interno bruto da agricultura no Paquistão? Usando a abordagem do modelo NARDL

ABSTRACT: This study contributes to the extant literature on the nexus among rice, maize and wheat production with agriculture gross domestic product (AGDP) of Pakistan. We use time series data from 1970 to 2017 and employ the Non-linear Autoregressive Distributed Lag (NARDL) model. Short run and long run shocks between the selected variables and result's is checked through the co-integration and nonlinear error correction model.Autoregressive distributed lag bound testing approach for co-integration and to find the relationship between variables Granger causality test is applied.Our results confirm co-integration, positive shocks results show that rice, maize and wheat production have significantly influence on AGDP. The asymmetrically positive shocks of three crops have neutral effect on AGDP. While in symmetric results show the unidirectional effect between rice, maize production with AGDP and wheat production do not have ganger causality with AGDP. Finally, results depict that wheat, maize and rice production significantly contributes to agricultural GDP in the case of Pakistan.

RESUMO: Este estudo contribui para a literatura existente sobre o nexo entre a produção de arroz, milho e trigo com produto interno bruto agrícola (AGDP) do Paquistão. Utilizamos dados de séries temporais de 1970 a 2017 e empregamos o modelo NARDL (Non-linear Autoregressive Distributed Lag). Choques de curto e longo prazo entre as variáveis selecionadas e os resultados são verificados por meio do modelo de co-integração e correção não linear de erros. É aplicada uma abordagem de teste de atraso retardado distribuído autorregressivo para co-integração e para encontrar a relação entre variáveis. Nossos resultados confirmam a co-integração; os resultados de choques positivos mostram que a produção de arroz, milho e trigo influencia significativamente na AGDP. Os choques assimétricos positivos de três culturas têm efeito neutro no AGDP. Enquanto nos resultados simétricos mostram o efeito unidirecional entre o arroz, a produção de milho com AGDP e a produção de trigo não têm causalidade de ganger com AGDP. Finalmente, os resultados mostram que a produção de trigo, milho e arroz contribui significativamente para o PIB agrícola no caso do Paquistão.

Asymmetric Flankers in Comodulation Masking Release

BACKGROUND AND OBJECTIVES: Detection of auditory signals may be improved when maskers far from the frequency of the target signal are coherently amplitude-modulated. This improvement of signal detection is called comodulation masking release (CMR). In the CMR experiments, flankers have been usually arranged symmetrically. In practice, we will be confronted with a problem by using symmetric flankers due to the limited output of clinical audiometers, especially at high-frequency. We aimed to check whether flanker arrangement has any effect on the amount of CMR, especially when there is no flankers with a frequency higher than the signal. SUBJECTS AND METHODS: Eighteen normal hearing listeners ranging in age from 20 to 46 years old participated. Symmetric (2-2) and asymmetric (3-1 and 4-0) flankers were used and then the amount of CMR compared among them. RESULTS: Our results showed in the same numbers of flankers, there were no statistically CMR differences between symmetric and asymmetric arrangement. Also when we did not have a flanker at a frequency higher than the signal and all flankers were placed below the signal, there was no statistically difference with the symmetric arrangement. CONCLUSIONS: The asymmetry of the flankers and also omitting the flankers with a frequency higher than the signal, have no effect on CMR results. We concluded that CMR can be considered by using clinical audiometer.

Analysis of clinical features of brainstem encephalitis manifested as Parkinson syndrome / 中国神经精神疾病杂志

Objective To analyze the clinical manifestations and imaging features of human brainstem encephalitis with Parkinson syndrome as the main manifestations. Methods Combined with related literature, the clinical, laboratory and imaging features of three patients with brainstem encephalitis, which were mainly manifested as Parkinson syndrome, were analyzed. Results The 3-hour video EEG showed normal in 2 cases and abnormal in one case with more delta wave in each leads. Cerebrospinal fluid examination revealed normal cell numbers in one case, increased cell numbers in 2 case and elevated cerebrospinal fluid proteins in all 3 cases. serum and CSF IgG anti-NMO antibodies as well as autoimmune encephalitis antibodies were negative in 3 cases. Brain MRI showed symmetrical abnormal signal in bilateral midbrain and pia mater enhancement increased in 3 cases. After hormone, and madopar treatment, Parkinson syndrome symptoms were significantly improved in two patients. Conclusion Brainstem encephalitis-induced symmetrical midbrain lesion can manifest as Parkinson syndrome. The laboratory tests reveal an involvement of immune system and hormone therapy may be effective.

Two Cases of Multiple Symmetric Lipomatosis in Women with Alcoholism / 대한피부과학회지

Madelung's disease, also known as multiple symmetric lipomatosis (MSL) is a rare disease characterized by the presence of multiple, symmetric, loose adipose tissues distributed around the neck, shoulder, back or chest. MSL is different from simple obesity, which is characterized by the presence of well-distributed total body fat. It is rarely reported in Asia and most commonly seen among middle-aged men. Although the etiology of MSL is unknown, the disease is associated with alcoholism in 60% to 90% of patients. The diagnosis is usually made on the basis of the history, and clinical appearance. Also, imaging such as CT or MRI could confirm the diagnosis. Herein, we experienced an uncommon case of MSL in middle-aged women with alcoholism.

Methanol-Induced Encephalopathy: a Case Report

A characteristic imaging finding in cases of methanol intoxication is putaminal necrosis, but its presence is usually not suspected due to its rarity. Methanol intoxication generally produces serious neurological symptoms that include visual disturbances and diminished consciousness, characteristically with metabolic acidosis. We reported the case of a 59-year-old man who was admitted to the hospital with diminished consciousness. Acute methanol intoxication was determined as the cause. Laboratory tests revealed high anion gap metabolic acidosis. Diffusion-weighted MRI indicated diffuse symmetric diffusion restriction lesions in the subcortical white matter of both cerebral hemispheres.

Do you know this syndrome? Type 2 benign symmetric lipomatosis (Launois-Bensaude)

Abstract A 57-year-old female showed bulky, loose tumors, which progressively spread to her arms, anterior chest, and back. She reported dysphagia and dyspnea after mild exertion. She denied alcohol consumption. CT scan of her chest showed no internal lesions. Benign symmetric lipomatosis is a rare syndrome, clinically described as multiple nonencapsulated lipomas of various sizes and symmetrical distribution. This syndrome has three known phenotypes; in type 2 (Launois-Bensaude syndrome), lesions occur primarily on the shoulders, upper arms, and chest, and is unrelated to alcoholism. It causes aesthetic deformities and might block the upper airways. Mediastinal invasion might occur as well.

Extracciones de primeros premolares simétricos en paciente con apiñamiento severo: Reporte de un caso

Cuando se presenta apiñamiento severo, en muchas ocasiones la ubicación que adoptan las estructuras dentarias dificultan el tratamiento, por lo cual se sugiere extracciones asimétricas para permitir de esta manera un tratamiento menos prolongado y con resultados satisfactorios. En este artículo se reporta un caso de biprotrusión dentaria tratado con extracciones de 4 premolares, en una paciente femenina de 20 años y 6 meses, Clase II esquelética, hiperdivergente, con un patrón dolicofacial, Clase III molar bilateral, Clase I canina bilateral, línea media superior coincidente e inferior 4 mm desviada a la izquierda, y no presenta hábitos. En los objetivos de tratamiento se planteó: extracciones asimétricas de primeros premolares superiores e inferiores, corregir el apiñamiento maxilar y mandibular, obtener líneas medias coincidentes, obtener la Clase I molar bilateral, mantener la Clase I canina bilateral. Se logró corregir el apiñamiento severo con una forma de arco adecuada.

In cases of severe crowding, many times the location of dental structures impede treatment, so asymmetrical extractions is suggested to allow a less prolonged treatment with satisfactory results. This article presents a case of dental extractions biprotrution treated with 4 premolars reported, a case of 20 years and 6 months old female patient, skeletal Class II, hyperdivergent, with bilateral dolichofacial pattern, molar Class III bilateral, canine Class I bilateral, upper midline coincident and lower midline 4mm left deviated, is reported and no habits. The goals of treatment are proposed: a symmetric extractions of first premolars upper and lower, correct the maxillary and mandibular crowding, achieve midlines, and obtain bilateral Class I molar and maintain bilateral Class I canine. It was possible to correct severe crowding with a suitable form of arch.

Do code of points in men artistic gymnastics and women artistic gymnastics favor asymmetric elements? / O código de pontuação na ginástica artística feminina e masculina favorecem elementos assimétricos?

Abstract The purpose of research was to determine whether Code of Point (COP) in Men Artistic Gymnastics (MAG) and Women Artistic Gymnastics (WAG) favor asymmetric elements in order to build gymnast’s competition exercise. All elements which are described in MAG (N = 993) and WAG (N = 713) COP were included and defined if they are symmetric at start position, during movement and at final position. Element is symmetric by arms and trunk with legs activity when all left and right body side performs simultaneously same activity. Results show in MAG COP as a whole is significantly more asymmetric elements with asymmetric trunk and legs activity. In WAG COP as a whole is significantly more asymmetric elements with asymmetric activity of arms, trunk and legs. Hypothetical most difficulty exercises on each apparatus revealed that in general for all around gymnast proportion between asymmetric and symmetric elements is close to 70% to 30%, what suggests that difficulty relates to increased asymmetry. COP in MAG and WAG enforces asymmetric movements for achieving high results, however, coaches’ task is to be aware of COP influence on gymnasts’ health and minimize asymmetries in load and to work on symmetric conditioning.

Resumo A pesquisa investigou se o Código de Pontuação (COP) da Ginástica Artística Masculina (MAG) e da Ginástica Artística Feminina (WAG) favoreciam elementos assimétricos, a fim de arquitetar elementos competitivos do ginasta. Todos os elementos descritos no COP da MAG (N = 993) e WAG (N = 713) foram analisados em suas posições de início, durante a na posição final no que se refere à simetria. Foram considerados simétricos os movimentos em que braços, troncos e pernas eram ativados simultaneamente e do mesmo lado. Os resultados mostraram que no COP MAG há um número significativamente maior de elementos assimétricos, sobretudo na relação tronco e pernas. No COP WAG há um maior número de elementos assimétricos entre braços, tronco e pernas. Hipoteticamemte, os exercícios com maior dificuldade em cada um dos aparelhos revelaram que a proporção entre elementos assimétricos e simétricos é de cerca de 70% e 30% respectivamente, o que releva que a dificuldade está associada com maior assimetria. O COP na MAG e WAG reforçam que realizar movimento assimétricos amplia o grau de dificuldade e elevados resultados, no entanto, os técnicos devem se atentar ao COP e sua influência no bem-estar dos ginastas, minimizando cargas assimetrias e trabalhado em condicionamento simétric.

Lipoma gigante do coxim adiposo bucal: relato de caso e revisão da literatura / Giant lipoma of the buccal fat pad: case report and literature review

INTRODUÇÃO: Lipomas são os tumores benignos mesenquimais mais comuns. Entretanto, são pouco frequentes na face, principalmente o tipo considerado gigante, derivado do coxim adiposo bucal. A literatura é escassa e provavelmente a sua incidência é subestimada. MÉTODO: Relato do caso de tratamento cirúrgico de lipoma gigante bucal e temporal recidivado, e revisão da literatura no Pubmed na língua inglesa e na Revista Brasileira de Cirurgia Plástica. RESULTADOS: O tumor, anatômica e morfologicamente, corresponde ao coxim adiposo bucal, foi totalmente retirado pelo acesso facial e temporal, sem sequelas ao nervo facial. Foram encontrados 31 casos relatados de lipoma de origem do coxim adiposo bucal, entretanto, vários casos foram encontrados e relatados sob outras denominações. DISCUSSÃO: O coxim adiposo bucal é maior e mais complexo que se conhecia, e várias patologias se derivam deste, sendo importante o diagnóstico diferencial do lipoma simples com o de células fusiformes e com o lipossarcoma, devido a sua extrema semelhança. CONCLUSÃO:Nas lesões lipomatosas da face, a possível origem no coxim adiposo bucal deve ser considerada. Um estudo amplo dessas lesões com a finalidade de uniformizar a terminologia e de determinar a sua real incidência deve ser realizado.

INTRODUCTION: Lipomas are the most common benign mesenchymal tumors. Nevertheless, they are infrequent in the face, particularly giant lipomas, which are derived from the buccal fat pad. The literature regarding these tumors is scarce and their incidence is likely underestimated. METHODS: We present a case report of surgical treatment of a relapsed giant buccal and temporal lipoma and review the related English literature in Pubmed and that in the Brazilian Journal of Plastic Surgery. RESULTS: The tumor, which anatomically and morphologically corresponded to the buccal fat pad, was completely excised by facial and temporal access without sequelae to the facial nerve. A total of 31 reported cases of lipoma originating from the buccal fat pad were found; however, several were found and reported under other names. DISCUSSION: The buccal fat pad is larger and more complex than assumed, and several pathologies are derived thereof, making the differential diagnosis of simple lipoma with fusiform cell lipoma and liposarcoma difficult due to their extreme similarities. CONCLUSION: In lipomatous lesions of the face, the possible origin in the buccal fat pad must be considered. An extensive study of these lesions with the purpose of standardizing the terminology and determining its real incidence must be performed.

Comparison in physical and neurological development between two types of children born small for gesta-tional age / 国际儿科学杂志

Almost 3% of newborns are diagnosed as small for gestational age(SGA)worldwide.Born SGA is one of the important causes of perinatal morbidity and mortality,and is also associated with metabolic diseases in adulthood.Low birth weight by itself is insufficient to characterize growth restriction,as it does not include information about the neonate’s body proportionality.Depending on the origin,timing and severity of in-sult,small for gestational age infants are classified into two types:proportionate or symmetric growth restriction (SGR)and disproportionate or asymmetric growth restriction(AGR).There may be differences in physical and neurological development of these two types.This study compares three classification indexes,and to find differ-ences in postnatal growth of these two types.

Pruebas de bondad de ajuste en distribuciones simétricas, ¿qué estadístico utilizar? / Goodness of Fit Tests for Symmetric Distributions, which Statistical Should I Use?

El uso de pruebas no paramétricas resulta recomendable cuando los datos a analizar no cumplen los supuestos de normalidad y homocedasticidad. Sin embargo, la suposición de la normalidad de los datos o el empleo de pruebas de bondad de ajuste que no son adecuadas para el tamaño muestral empleado son aspectos habituales. Este hecho implica, en muchas ocasiones, el uso de pruebas estadísticas no ajustadas al tipo de distribución real y, consecuentemente, el establecimiento de conclusiones erróneas. Por ello, en el presente estudio se ha analizado el poder de detección de cinco pruebas de bondad de ajuste (Kolmogorov-Smirnov, Kolmogorov-Smirnov-Lilliefors, Shapiro-Wilk, Anderson-Darling y Jarque-Bera) en distribuciones simétricas con seis tamaños muestrales entre 30 y 1000 participantes generados mediante una simulación Monte Carlo. Los resultados muestran una tendencia conservadora generalizada a medida que se incrementa el tamaño muestral. En cuanto a los tamaños muestrales, las pruebas con un mejor poder de detección de la no normalidad son Kolmogorov-Smirnov-Lilliefors y Anderson-Darling para muestra pequeñas, la prueba de Kolmogorov-Smirnov si se emplean tamaños muestrales medios (200 participantes) y la prueba de Shapiro-Wilk cuando se analizan muestras superiores a 500 participantes. Además, la prueba clásica de Kolmogorov-Smirnov se considera absolutamente ineficaz independientemente del tamaño muestral.

The use of nonparametric tests is recommended when the data do not meet the assumptions of normality and homoscedasticity. However, the assumptions of normality of the data or the use of goodness of fit tests that are not appropriate for the assessed sample are common aspects. In many cases, this implies the use of statistical tests unadjusted for the real data distribution and, consequently, the establishment of inaccurate conclusions. Therefore, in this paper the detection power of five tests of goodness of fit (Kolmogorov-Smirnov-Lilliefors, Kolmogorov-Smirnov, Shapiro-Wilk, Anderson-Darling and Jarque -Bera) in symmetric distributions is analysed in six sample sizes between 30 and 1000 participants generated by Monte Carlo simulation. Results show a marked conservative tendency as the sample size becomes larger. Regarding sample sizes to detect non-normality: analysing small samples the best results are provided by Kolmogorov-Smirnov-Lilliefors and Anderson-Darling tests, if the sample is medium-sized (200 participants) the Kolmogorov-Smirnov, and when samples are over 500 participants the Shapiro-Wilk test is recommended. In addition, the classic test of Kolmogorov-Smirnov is considered absolutely ineffective regardless the sample size.

Imaging Features of Madelung's Disease: Case Report

Madelung's disease, or benign symmetric lipomatosis, is an uncommon disorder that is characterized by massive symmetrical deposits of adipose tissue in the upper trunk, neck and head, and is usually associated with alcohol abuse; as such, patients usually complain of cosmetic issues. Historically, Madelung's disease is usually encountered in men between 30 and 60 years of age, and is more prevalent in the Mediterranean population. In this case study, we describe a rare case of Madelung's disease, in an Asian patient who presented with symmetrically located bilateral masses in the anterior neck, which grew progressively larger over a period of seven years.