Retinal laser – Protocols and practical tips

Background: Many a young doctors in training find retinal laser photocoagulation a daunting task. However, if correct protocols are followed and checklists are observed, then it is not difficult to have a successful laser sitting with a happy patient. Most of the complications can be avoided with correct settings and techniques. Purpose: To enumerate the basic protocols of retinal laser photocoagulation and provide practical tips including laser settings and checklists for hassle?free laser experience. Synopsis: Laser settings for a pan?retinal photocoagulation (PRP) for proliferative diabetic retinopathy differ from those for a focal laser for macular edema. A fill in PRP is indicated when an active Proliferative diabetic retinopathy (PDR) is seen after the initial PRP is completed. The settings and protocols for laser photocoagulation for lattice degeneration are different, and various techniques of barrage laser are discussed. Practical tips and checklists are given, which will not be found in any textbooks. Highlights: Animated illustrations and fundus photos are used to explain the correct techniques of performing laser photocoagulation in different indications and scenarios. Detailed instructions and checklists are provided, which can be very useful to avoid complications and medicolegal problems. The practical tips and guidelines in an easy?to?understand manner make this video highly educational for the novice retinal surgeons who want to perfect their technique of retinal laser photocoagulation.

Portal vein aneurysm after liver transplantation: report of two cases and literature review / 器官移植

Objective To summarize the diagnosis and treatment experience of portal vein aneurysm after liver transplantation. Methods Clinical data of two recipients with portal vein aneurysm after liver transplantation were retrospectively analyzed. Clinical features, diagnosis, treatment and prognosis were summarized based on literature review. Results Both two cases were diagnosed with intrahepatic portal vein aneurysm complicated with portal vein thrombosis and portal hypertension after liver transplantation. Case 1 was given with targeted conservative treatment and he refused to undergo liver retransplantation. Physical condition was worsened after discharge, and the patient eventually died from liver graft failure, kidney failure, lung infection, and septic shock. Case 2 received high-dose glucocorticoid pulse therapy, whereas liver function was not improved, and the patient was recovered successfully after secondary liver transplantation. Conclusions Long-term complication of portal vein aneurysm (especially intrahepatic type) after liver transplantation probably indicates poor prognosis. Correct understanding, intimate follow-up and active treatment should be conducted. Liver retransplantation may be a potential treatment regimen.

Effect of different tips of posteriors in extraction treatment on three-dimensional forces of teeth with clear aligners / 口腔医学

Objective@#To investigate the three-dimensional forces in real-time at different tips of the posteriors created by clear aligners on maxillary teeth during en-masse retraction of anteriors after 2 first premolars extraction treatment. @*Methods@#Four groups of maxillary models with different tips of posteriors(T1-upright of posteriors, T2-posteriors with distal inclination of 5°, T3-posteriors with mesial inclination of 5°, T4-posteriors with mesial inclination of 10°) undergoing 0.25 mm en-masse retraction treatment using clear aligners were simulated on a multi-axis force/torque transducer measurement system. When each clear aligner was inserted, a computer connected to the transducer collected and recorded the three-dimensional force of every tooth in real-time. Each group included 12 aligners.@*Results@#Incisors received smaller lingual and extrusive forces; canines received greater distal forces; smaller mesial forces were observed on the posteriors, and molars received greater buccal and extrusive forces in T2,compared with T1,which showed statistically significant differences(P<0.05). Incisors received smaller lingual and extrusive forces; canines received greater distal forces; greater mesial forces were observed on the posteriors, and molars received greater buccal and extrusive forces in T3 and T4,compared with T1,which showed statistically significant differences(P<0.05).@*Conclusion@#Posteriors with distal inclination contributed to the torque of the anterior and anchorage of posteriors. In group T2 posterior teeth experienced larger buccal forces and extrusive forces than in group T1. When the posteriors crown inclined mesially, the anterior teeth were more prone to lingual tip and caused overbite. The more mesially inclined the posterior teeth were, the more serious overbite was, and the posterior teeth were more prone to anchorage loss.

Post-COVID Pediatric Budd-Chiari Syndrome

Introduction: Budd-Chiari syndrome (BCS) is rare in children. Underlying etiologies, natural history and management differ in children and adults. Treatment options like liver transplantation and transjugular intrahepatic portosystemic shunt have also been less well-studied in children. Presented here is the case of a male child with BCS after coronavirus disease 2019 (COVID-19) infection. Case presentation: A 3-year-old male child presented with complaints of gradually increasing abdominal distension, constipation, decreased urine output, visible veins over abdomen and swelling in lower limbs and periorbital edema since last 15 days. He was diagnosed as BCS after multiple imaging investigations, including triple phase contrast-enhanced computed tomography (CECT) abdomen. His COVID antibody tested positive. Conclusion: Practice guidelines for children with BCS should be formulated, expert group recommendations should be reviewed and a consensus statement should be issued. Underlying etiology remains obscure despite extensive work-up in most of the children. Association of COVID-19 with BCS may be incidental but should be studied further as COVID is known to cause thrombotic complications

Predicción de fracaso de las puntas nasales de alto flujo con la escala HACOR, en la insuficiencia respiratoria aguda de pacientes con SARS-CoV-2 / Prediction of failure of the high-flow nasal tips with the HACOR scale, in acute respiratory insufficiency in patients with SARS-CoV-2 / Previsão de falha das pontas nasais de alto fluxo com a escala HACOR, na insuficiência respiratória aguda de pacientes com SARS-CoV-2

Resumen: La insuficiencia respiratoria hipoxémica aguda (IRHA) es una de las principales causas de ingreso en la Unidad de Terapia Intensiva en los pacientes adultos, alrededor de 40% de estos pacientes ameritan intubación endotraqueal. La escala HACOR fue diseñada y validada como una puntuación de predicción clínica para el fracaso de la ventilación no invasiva (VNI) en pacientes con IRHA de diferentes etiologías. Objetivo: Analizar la capacidad predictiva de la escala HACOR en relación al fracaso de las puntas nasales de alto flujo (PNAF). Material y métodos: Se realizó un estudio retrospectivo, observacional en la Terapia Intensiva del Hospital Ángeles Mocel, las PNAF se iniciaron cuando el paciente presentaba IRHA, se calculó la escala HACOR a la hora y a las dos horas de colocación de PNAF, la capacidad de predecir el fracaso de las PNAF de la escala HACOR se determinó calculando el área bajo la curva de «característica operativa del receptor¼ (ROC). Resultados: La escala HACOR con mayor poder discriminatorio se obtuvo a las dos horas de inicio de las PNAF con un punto de corte de 5 puntos con un área bajo la curva (AUC): 0.82 (IC 95% 0.67-0.98), se obtuvo una sensibilidad 84% IC 95% (56.6-89.9%), especificidad 81% IC 95% (40.9-92.9%). Conclusiones: Un puntaje mayor o igual a 5 puntos en la escala HACOR predice fracaso de las PNAF y mayor mortalidad con una sensibilidad y especificidad mayor de 80% en los pacientes con neumonía por COVID-19.

Abstract: Acute hypoxemic respiratory failure (AHRF) is one of the main causes of admission to the intensive care unit in adult patients, around 40% of these patients require endotracheal intubation. The HACOR scale was designed and validated as a clinical prediction score for non-invasive ventilation (NIV) failure in patients with HAI of different etiologies. Objective: To analyze the predictive capacity of the HACOR scale in relation to the failure of the PNAF. Material and methods: A retrospective, observational study was carried out in the Intensive Care Unit at Hospital Ángeles Mocel, the PNAF was started when the patient had AHRF, the HACOR scale was calculated at one hour and 2 hours after the placement of the PNAF, the ability to predict HACOR scale PNAF failure was determined by calculating the area under the «receiver operating characteristic¼ (ROC) curve. Results: The HACOR scale with the highest discriminatory power was obtained 2 hours after the start of the PNAF with a cut-off point of 5 points with an area under the curve (AUC): 0.82 (CI 95% 0.67-0.98), it was obtained a sensitivity 84% CI 95% (56.6-89.9%), specificity 81% CI 95% (40.9-92.9%). Conclusions: A score greater than or equal to 5 points on the HACOR scale predicts failure of the PNAF and higher mortality with a sensitivity and specificity greater than 80% in patients with COVID-19 pneumonia.

Resumo: A insuficiência respiratória hipoxêmica aguda (IRHA) é uma das principais causas de admissão em unidade de Terapia Intensiva em Pacientes Adultos, cerca de 40% desses pacientes requerem intubação endotraqueal. A escala HACOR foi desenhada e validada como um escore de predição clínica para falha da ventilação não invasiva (VNI) em pacientes com IRHA de diferentes etiologias. Objetivo: Analisar a capacidade preditiva da escala HACOR em relação à falha das PNAF. Material e métodos: Foi realizado um estudo retrospectivo e observacional na Unidade de Terapia Intensiva do Hospital Ángeles Mocel, a PNAF foi iniciada quando o paciente tinha IRHA, a escala HACOR foi calculada uma hora e 2 horas após a colocação da PNAF, a capacidade de previsão do fracasso das PNAF da escala HACOR foi determinada pelo cálculo da área sob a curva «receiver operating characteristics¼ (ROC). Resultados: A escala HACOR com maior poder discriminatório foi obtida 2 horas após o início das PNAF com ponto de corte de 5 pontos com área sob a curva (AUC): 0.82 (IC 95% 0.67-0.98), foi obtida uma sensibilidade de 84% IC 95% (56.6%-89.9%), especificidade 81% IC 95% (40.9%-92.9%). Conclusões: Uma pontuação maior ou igual a 5 pontos na escala HACOR prediz falha das PNAF e maior mortalidade com sensibilidade e especificidade maior à 80% em pacientes com pneumonia COVID-19.

Abordagem inicial do gestor para implementação da inovação: um modelo de disseminação do fall tips Brasil / Manager's initial approach to implementing innovation: a model for disseminating fall tips Brazil

Resumo: A tomada de decisão do gestor é um momento primordial à implementação de uma inovação, especialmente aquela cuja indicação é baseada em evidências. Fall TIPS é um Programa com base em evidências científicas que subsidia a equipe multiprofissional na tomada de decisões assertivas na prevenção de quedas hospitalares. Objetivo: Elaborar um modelo de abordagem inicial do gestor para disseminação do Programa Fall TIPS em hospitais brasileiros. Método: Trata-se de uma pesquisa aplicada com a finalidade de elaborar um modelo de abordagem inicial ao gestor para implementar uma inovação na saúde. O percurso metodológico compreendeu quatro etapas: 1) revisão rápida sobre os riscos e benefícios da implantação do Programa Fall TIPS; 2) elaboração de um modelo gráfico de abordagem inicial ao gestor em formato de infográfico; 3) concepção do produto com dados do Fall TIPS Brasil; e 4) avaliação aparente e de conteúdo do produto por um grupo de juízes pela técnica Delphi online. As etapas foram elaboradas e realizadas pela pesquisadora e a última aplicada a nove juízes participantes que integram o Grupo de Pesquisa do macroprojeto. A coleta de dados foi via plataforma Survey Monkey®. Para validação aparente e de conteúdo, foi empregado o Índice de Validade de Conteúdo (IVC) com valor ?0,85, considerando a quantidade de juízes e a peculiaridade do conteúdo. Resultados: A revisão rápida evidenciou os seguintes riscos principais: comunicação frágil, resistência dos profissionais em aderir à inovação, discordância na escolha da unidade inicial a implantar a inovação e descrença quanto aos resultados positivos da implantação. E os benefícios foram: envolvimento da equipe multidisciplinar, apoio dos líderes da linha de frente que funcionam como influenciadores, seguir as diretrizes do Programa Fall TIPS, adequar o formato à realidade e uso de design iterativo. Na segunda etapa, foi desenvolvido um modelo de abordagem inicial ao gestor (MAIG) em formato de infográfico, o qual, na terceira etapa da pesquisa, foi preenchido com informações sobre a inovação Fall TIPS Brasil, configurando o produto da pesquisa. Na quarta etapa, de validação aparente e de conteúdo por juízes, o infográfico para disseminação do Programa Fall TIPS Brasil foi avaliado em relação à cor, fonte da letra, leiaute e conteúdo da abordagem contida no infográfico. A média dos IVCs de cada proposição é, respectivamente, 0,89; 0,92; 0,93 e 0,89. Na versão final do produto, todas as considerações feitas pelos juízes foram acatadas. Produtos e registro: 1) MAIG composto de três fases (apresentação, fluxo de processo decisório para implementação da inovação e observações), o qual foi registrado na Câmara Brasileira do Livro; 2) Infográfico para abordagem inicial do gestor para disseminação do Programa Fall TIPS Brasil, que será divulgado oportunamente no repositório brasileiro do programa. Conclusão: O MAIG foi desenvolvido com base nos conceitos de modelo de plano de negócios e poderá ser amplamente utilizado para disseminação de inovações em saúde. O Infográfico para abordagem inicial do gestor para disseminação do Programa Fall TIPS Brasil teve por base evidências resultantes da revisão rápida e contribuirá para a tomada de decisão assertiva do gestor para sua implementação em hospitais brasileiros.

Abstract: The manager's decision-making is a crucial moment for the implementation of an innovation, especially one whose indication is based on evidence. Fall TIPS is a program based on scientific evidence that supports the multidisciplinary team in making assertive decisions in preventing hospital falls. Objective: To develop a model for the initial approach of the manager for the dissemination of the Fall TIPS Program in Brazilian hospitals. Method: This is an applied research with the purpose of elaborating a model of initial approach to the manager to implement an innovation in health. The methodological path comprised four stages: 1) a quick review of the risks and benefits of implementing the Fall TIPS Program; 2) elaboration of a graphic model for the initial approach to the manager in infographic format; 3) product design with data from Fall TIPS Brazil; and 4) product appearance and content evaluation by a group of judges using the online Delphi technique. The steps were designed and carried out by the researcher and the last one applied to nine participating judges who are part of the Research Group of the macro-project. Data collection was via the Survey Monkey® platform. For face and content validation, the Content Validity Index (CVI) with a value of ?0.85 was used, considering the number of judges and the peculiarity of the content. Results: The quick review evidenced the following main risks: weak communication, resistance of professionals to adhere to the innovation, disagreement in the choice of the initial unit to implement the innovation and disbelief regarding the positive results of the implementation. And the benefits were: involvement of the multidisciplinary team, support from frontline leaders who act as influencers, following the guidelines of the Fall TIPS Program, adapting the format to reality and using iterative design. In the second stage, a model of initial approach to the manager (MAIG) in infographic format was developed; which, in the third stage of the research, was filled with information about the Fall TIPS Brazil innovation, configuring the research product. In the fourth stage, face and content validation by judges, the infographic for dissemination of the Fall TIPS Brazil Program was evaluated in relation to color, font, layout and content of the approach contained in the infographic. The average of the IVCs of each proposition is, respectively, 0.89; 0.92; 0.93 and 0.89. In the final version of the product, all the considerations made by the judges were accepted. Products and registration: 1) MAIG composed of three phases (presentation, decision-making process flow for innovation implementation and observations), which was registered at the Brazilian Book Chamber; 2) Infographic for the manager's initial approach to the dissemination of the Fall TIPS Brazil Program, which will be published in due course in the program's Brazilian repository. Conclusion: MAIG was developed based on the concepts of a business plan model and can be widely used to disseminate health innovations. The Infographic for the manager's initial approach to the dissemination of the Fall TIPS Brazil Program was based on evidence resulting from the rapid review and will contribute to the manager's assertive decision-making for its implementation in Brazilian hospitals.

Tips for Developing an Outcome-based Undergraduate Medical Curriculum

@#Although the transformation towards adopting an Outcome-based Education (OBE) is gathering momentum globally, several medical schools are finding it hard to implement the change. Based and built on authors’ experience and cues from the literature, the tips – relating to the process of identification, description and dissemination of learning outcomes (LOs); usage of LOs to ascertain the curricular contents, the teaching/learning and assessment methods; implementing, monitoring and reviewing the curriculum – are the actions that the institutions of higher learning need to perform to transform the existing curriculum or to develop an altogether a new curriculum according to OBE approach. The development of the faculty through dialogues, discussions and training sessions should be an initial and essential step in this process. It is hoped that these tips will alley some of the fears and facilitate the adoption of OBE curriculum in new as well as in existing established institutions.

Usefulness Of Various Measurements Of Incus To Determine The Sexual Dimorphism

Background: The incus is the intermediately placed ear ossicle in the middle ear cavity between the malleus andthe stapes.Materials and Methods: In present study, various measurements of incus were taken for the purpose of sexualdimorphism. Out of total 60 incus used in the present study, 30 were retrieved from the male cadavers and 30were retrieved from the female cadavers.Results and Discussion: Mean of total length of incus, mean of total width of incus, mean of maximum distancebetween the tips of the processes of incus and mean of index of incus in male are more as compared to female inthe present study.Conclusion: Among all the measurements taken in the present study; total length of incus and total width of incushaving statistically significant difference between the male and female incus and both can be used for the sexualdimorphism of incus for Kachchhi Gujarati population of present study.

Repairing soft tissue defect of thumb tips in infants by using the first dorsal metacarpal radial artery flaps along with anatomosing of nerves and veins / 中华显微外科杂志

Objective To investigate the surgical methods and clinical effect of repairing the thumb tip defects in infants by applying the reversed first dorsal metacarpal radial artery island flaps along with anatomosing of nerves and veins.Methods Twenty-one cases with soft tissue defects of thumb tips caused by trauma were admitted from August,2015 to August,2017.The first dorsal metacarpal radial island artery flaps were transplanted reversely to repair the defects along with the anatomosis of nerves and veins.Among all the cases,the range of defect area was 2.0 cm×1.8 cm-3.0 cm×2.5 cm.The area range of the flap harvested during the surgery was 2.2 cm×2.0 cm-3.2 cm×2.7 cm.The regular post-operative followed-up was performed.Results All flaps survival after the surgeries,and the wounds were I-staged healing.All cases were followed-up by 3-18 months,and the average time was 7 months.The appearance and quality of the flaps were good.The range of motion of the metacarpophalangeal joints and interphalangeal joints was normal.According to the Upper Extremity Functional Evaluation Tentative Criteria set up by Hand Surgery Branch of Chinese Medical Association,14 cases were excellent,5 case was good,and 2 cases were fair.Conclusion The surgery of using the first dorsal metacarpal radial reversed island artery flap to repair the defect of thumb tip in infant,along with the anatomosis of nerve and vein,is a good method in repairing the defects due to its ease of operation,achievement of plump of finger tip and good recovery of appearance and sensation after the surgery.

Care Tips for Self-Care among Older Diabetic Patients / 임상당뇨병

With the increase in the elderly population, the number of elderly diabetics is also increasing rapidly. To educate older people with diabetes, we need to understand their characteristics and those of their main caregiver, establish careful and individualized treatment goals, and provide concrete and practical education. Diabetes educators should provide comprehensive geriatric assessment, personalized diabetes education through psychosocial assessment, practical guidance, family education, self-management skills for elderly diabetic patients and caregivers. Diabetes educators should keep in mind to consider elderly diabetic patients can support family or social resources to continue self-management.

Effects of Leucaena leucocephala (lamk. ) shoot tips plus young leaf extract containing mimosine on reproductive system of male rats / Efectos de los brotes de Leucaena leucocephala (lamk. ) y del extracto de hojas jóvenes que contiene mimosina en el sistema reproductivo de ratas macho

This study aimed to determine the mimosine level and examine the male reproductive toxicity effects of Leucaena leucocephala (LL) shoot tips plus young leaf extract. Mimosine level in LL extract was determined by thin layer chromatography before administration in animals. Male rats were divided into control and LL (1,500 mg/KgBW) groups (n = 6). After 60 days of experiment, serum sex hormones, sperm quality, and testicular histopathology were assayed and observed. Malondialdehyde (MDA) level and expressions of steroidogenic acute regulatory (StAR) and phosphorylated proteins in testicular lysate were examined by western blotting. Results showed that mimosine levels in LL extract was 17.35 ± 1.12 % of dry weight. LL significantly decreased FSH & LH levels, sperm qualities, and seminiferous tubule diameter compared to the control (p<0.05). Seminiferous tubular atrophies, germ cell sloughing, and degenerations were observed in LL group. In addition, testicular MDA level and StAR protein expression were significantly decreased in LL group. LL extract could increase the expression of a 50 kDa phohorylated protein in testicular lysate. In conclusion, LL extract has mimosine and reproductive toxicity effects on males.

Este trabajo tuvo como objetivo determinar el nivel de mimosina y examinar los efectos de la toxicidad reproductiva de los brotes de Leucaena leucocephala (LL), más el extracto de hojas jóvenes, en ratas macho. El nivel de mimosina en el extracto de LL se determinó mediante cromatografía en capa fina antes de la administración en animales. Las ratas se dividieron en grupos de control y LL (1,500 mg / kgBW) (n = 6). Después de 60 días, se analizaron y observaron las hormonas sexuales séricas, la calidad de los espermatozoides y la histopatología testicular. A través de Western Blot se examinaron el nivel de malondialdehído (MDA), las expresiones de reguladores agudos esteroidogénicos (StAR) y las proteínas fosforiladas en el lisado testicular. Los resultados mostraron que los niveles de mimosina en el extracto de LL fueron 17.35 ± 1.12 % del peso seco. LL disminuyó significativamente los niveles de FSH y LH, la calidad de los espermatozoides y el diámetro de los túbulos seminíferos en comparación con el control (p <0,05). Se observaron atrofias en los túbulos seminíferos, desprendimiento de células germinales y degeneraciones en el grupo LL. Además, el nivel de MDA testicular y la expresión de la proteína StAR se redujeron significativamente en el grupo LL. El extracto de LL podría aumentar la expresión de la proteína fosforilada de 50 kDa en el lisado testicular. En conclusión, el extracto de LL tiene mimosina y efectos de toxicidad reproductiva en los hombres.

Mesocaval Shunt Creation for Jejunal Variceal Bleeding with Chronic Portal Vein Thrombosis

The creation of transjugular intrahepatic portosystemic shunt (TIPS) is a widely performed technique to relieve portal hypertension, and to manage recurrent variceal bleeding and refractory ascites in patients where medical and/or endoscopic treatments have failed. However, portosystemic shunt creation can be challenging in the presence of chronic portal vein occlusion. In this case report, we describe a minimally invasive endovascular mesocaval shunt creation with transsplenic approach for the management of recurrent variceal bleeding in a portal hypertension patient with intra- and extrahepatic portal vein occlusion.

Influence of Scaler Tip Design on Intensity of Pain and Discomfort During Scaling

@#To evaluate patient’s subjective preferences to scaling with narrow probe-shaped EMS Perio Slim PS tips compared to conventional tip based on pain perception using the Visual Analogue Scale (VAS). Ten patients were treated using a piezoelectric ultrasonic device (EMS) and two different scaler tips representing a conventional scaler tip and a Perio Slim PS scaler tip in a split-mouth design. Pain was evaluated after 2 minutes scaling using Visual Analogue Scale (VAS). Data obtained was analysed by SPSS version 19.0 using Wilcoxon test. Pain assessment after treatment confirmed by the Visual Analogue Scale (VAS) showed that the Perio Slim PS scaler tip (maximum pain score: 4, minimum: 2) caused less pain than the conventional scaler tip (maximum: 8, minimum: 3) (p-value = 0.007). Using Perio Slim PS scaler tip caused less pain and discomfort during scaling treatment when compared with conventional scaler tip. Acrylic resin is commonly used to fabricate removable prostheses due to its adequate physical, mechanical properties and cost effectiveness. There has been continuous development of the materials to improve their properties and to widen its application in different clinical setting. To study the history development of the acrylic resin and elaborate on the properties of different types and the processing methods of acrylic resins used to fabricate denture base which are commercially available in the market. This would help the dental clinician in choosing the best material of choice. The authors have summarized the history, development and classification of different type of acrylic resins used in fabricating denture and processing methods based on all the published research available on this topic using published materials available in the Dental Library, University of Malaya and the database (Science Direct, PubMed). Every type of acrylic denture base material has its pros and cons. Therefore, careful selection of material and the processing method is crucial to ensure the best outcome for prosthodontic treatment. Hence, upholding the patients’ best interest and improving their quality of life.

Clinical efficacy of improved TIPS therapy in portal hypertension with acute upper gastrointestinal bleeding / 实用放射学杂志

Objective To discuss the clinical efficacy of improved TIPS of percutaneous portal vein puncture in treatment of acute upper gastrointestinal bleeding induced by portal hypertension.Methods 28 patients with acute upper gastrointestinal bleeding underwent improved TIPS therapy in our hospital were enrolled.The clinical data,laboratory parameters and hemodynamic changes were collected and analyzed before and after operation.Results The success rate for the first time and hemostatic rate of postoperative 24 hours in all patients was 100%.2(7.14%)patients underwent mild hepatic encephalopathy.After TIPS operation,the concentration of serum albumin increased,whereas,concentration of total bilirubin and alanine aminotransferase decreased(P<0.01).Portal vein pressure (PVP)of pre-and post-operation was(41.48 ± 3.72)mmHg and(28.91 ± 2.59)mmHg,and the hepatic venous pressure gradient (HVPG)was(20.30 ± 2.76)mmHg and(8.81 ± 2.04)mmHg.PVP and HVPG were both decreased significantly after operation(P<0.01).Conclusion Improved TIPS therapy can obtain good clinical efficacy and safety for esophageal and gastric varicose bleeding in acute cirrhosis.

Using plastic tips in artificial feeding of Rhipicephalus sanguineus sensu lato (Acari: Ixodidae) females / Uso de ponteiras plásticas na alimentação artificial de fêmeas de Rhipicephalus sanguineus

Abstract This study evaluated the influence of the initial weight, feeding period and temperature on weight gain and biological parameters of the non-parasitic phase of partially engorged Rhipicephalus sanguineus females that were artificially fed using plastic tips as feeding devices. The device did not alter the oviposition of the females or any other parameters evaluated. Furthermore, it was observed that the temperature of the feeding the group did not affect the weight gain and biology of ticks. This device has great potential for the development of studies on bioagent transmission because it provides higher intake of blood by ixodid ticks.

Resumo Este estudo avaliou a influência do peso inicial, período de alimentação e temperatura no ganho de peso e parâmetros biológicos da fase não parasitária, de fêmeas parcialmente ingurgitadas de Rhipicephalus sanguineus alimentadas artificialmente utilizando ponteiras plásticas como dispositivo de alimentação. O dispositivo não alterou a oviposição das fêmeas ou quaisquer outros parâmetros avaliados. Além disso, observou-se que a temperatura de alimentação do grupo não afetou o ganho de peso e a biologia dos carrapatos. Este dispositivo tem um grande potencial para o desenvolvimento de estudos sobre a transmissão de bioagentes, uma vez que proporciona maior ingestão de sangue por carrapatos ixodídeos.

Change of Outer Retinal Thickness in Fellow Eyes of Patients with Unilateral Age-related Macular Degeneration

PURPOSE: To compare the outer retinal thickness in normal fellow eyes of patients with unilateral age-related macular degeneration (AMD) and normal control eyes. METHODS: We retrospectively reviewed the medical records of 60 patients with unilateral exudative AMD including polypoidal choroidal vasculopathy and 60 normal controls. Spectralis optical coherence tomography was performed in the normal fellow eyes of patients with unilateral AMD and in the normal group. The thicknesses between the retinal pigment epithelium (RPE) line and the cone outer segment tips (COST) line, between the COST line and the photoreceptor inner segment/outer segment (IS/OS) line, and between the IS/OS line and the external limiting membrane (ELM) line were measured at the fovea in both groups. RESULTS: The thickness between the RPE and COST lines was 32.4 ± 3.0 µm in normal fellow eyes of patients with unilateral AMD and 35.3 ± 3.5 µm in the normal group (p < 0.001). Total retinal thickness, thicknesses between the COST and the IS/OS lines and the IS/OS and the ELM lines in fellow eyes were not significantly different from those of normal eyes (p = 0.126, 0.615, 0.874). There was no significant difference in total retinal thickness or each outer retinal thickness measured in normal fellow eyes between patients with neovascular AMD and polypoidal choroidal vasculopathy. CONCLUSIONS: The thickness between the RPE and the COST lines was thinner in the fellow eyes of patients with unilateral AMD than in the normal eyes. We suggest that less thickness between the RPE and COST lines might indicate a greater risk of AMD.

Research updates on surgical treatments for portal hvpertension / 中华肝胆外科杂志

Portal hypertension is a common clinical syndrome in chronic liver disease,such as schistosomiasis,portal vein occlusion cirrhosis and so on,which can be diagnosed when the hepatic venous pressure gradient is (HVPG) ＞ 5 mmHg (1 mmHg =0.133 kPa).It could lead to gastroesophageal varicose veins rupture,ascites,spontaneous bacterial peritonitis,hepatorenal syndrome,hepatopulmonary syndrome,hepatic encephalopathy and some other serious complications,and is the primary death cause in cirrhosis and liver transplantation.The development of portal hypertension has experienced 4 phases ineluding the research about portal hypertension related theories and animal trial phase,preclinical tests and data accumulation phase,devascularization and shunts rapid development phase,the development phase of new technologies such as interventional and endoscopic surgical treatment,liver transplantation since the middle of the 19th century.The surgical procedures have been modified,which greatly reduce the complication and improve the life quality after operation.But so far none of them can cure portal hypertension thoroughly.This paper not only introduces the pathophysiologic basis of the surgical treatment,but also reviews the history of its development to summarize the recent progress,which may facilitate its surgical treatment.

Research updates on surgical treatments for portal hvpertension / 中华肝胆外科杂志

Portal hypertension is a common clinical syndrome in chronic liver disease,such as schistosomiasis,portal vein occlusion cirrhosis and so on,which can be diagnosed when the hepatic venous pressure gradient is (HVPG) ＞ 5 mmHg (1 mmHg =0.133 kPa).It could lead to gastroesophageal varicose veins rupture,ascites,spontaneous bacterial peritonitis,hepatorenal syndrome,hepatopulmonary syndrome,hepatic encephalopathy and some other serious complications,and is the primary death cause in cirrhosis and liver transplantation.The development of portal hypertension has experienced 4 phases ineluding the research about portal hypertension related theories and animal trial phase,preclinical tests and data accumulation phase,devascularization and shunts rapid development phase,the development phase of new technologies such as interventional and endoscopic surgical treatment,liver transplantation since the middle of the 19th century.The surgical procedures have been modified,which greatly reduce the complication and improve the life quality after operation.But so far none of them can cure portal hypertension thoroughly.This paper not only introduces the pathophysiologic basis of the surgical treatment,but also reviews the history of its development to summarize the recent progress,which may facilitate its surgical treatment.

Clinical Effect and Safety of TIPS in Treatment of Esophageal and Gastric Varices Bleeding in Patients with Cirrhosis / 现代生物医学进展

Objective:To study the clinical effect and safety of transjugular intrahepatic portosystemic shunt (TIPS) in the treatment of liver cirrhosis with esophageal variceal bleeding.Methods:86 cases of cirrhotic patients with esophageal and gastric varices bleeding admitted in our hospital from August 2013 to April 2015 were selected and randomly divided into the control group and the observation group with 43 cases in each group.The control group underwent percutaneous transhepatic coronary vein embolization (PTVE) treatment,while the observation group were treated with TIPS.The success rate of surgery,the incidence of various complications,the long-term survival rate and the symptoms and the changes of liver function after operation were compared between the two groups of patients.Results:The portal vein pressure after operation in the observation group was significantly lower than that of the control group (P=0.00),at 3 months,6 months and 12 months after operation,the rebleeding rate in the observation group were significantly lower than that of the control group (P＜0.05),but the incidence of hepatic encephalopathy showed no significant difference between the two groups (P＞0.05);before operation and at 6 months and 12 months after operation,the Child-Pugh score,serum TBIL,DBIL levels showed no significant difference between the two groups (P＞0.05),at 3 months after operation,the Child-Pugh score,serum TBIL,DBIL levels in the observation group were significantly higher than those of the control group (P＜0.01);the 1 year survival rate showed no significant difference between two groups (P=0.72).Conclusion:TIPS could effectively improve the symptoms of varicose veins,better on liver function damage,and enhance the long-term survival high rate with high safely in the treatment of esophageal variceal bleeding in patients with cirrhosis.

Meta-analysis of scientific studies related to pesticide application techniques - air assistance and adjuvant addition / Metanálise de trabalhos cientificos relacionados à técnicas de aplicação de produtos fitossanitários - assistência de ar e adjuvantes

ABSTRACT: The aim of this study was to investigate the effects of air-assisted boom sprayers and addition of adjuvants in the spray solution on control levels of pesticide sprays against weeds and pathogenic fungi by meta-analysis of scientific literature. To perform the meta-analysis, data were collected from the results presented in scientific papers. By these data, a variable was created, denominated as relative control that was used to quantify and test whether the use of air assistance or adjuvants affects the effectiveness of pesticide sprays. This variable was calculated as a difference between percentage of pesticide control in treatments with air assistance or adjuvants and treatments without these spray techniques. Data were analyzed statistically using the Comprehensive Meta-Analysis software. Results showed that the use of air assistance did not have any effect on the control levels of weeds and pathogenic fungi; whereas, the addition of adjuvants increased these levels by 6.45%.

RESUMO: O objetivo deste trabalho foi estudar, a partir da metanálise de dados de diferentes trabalhos científicos, o efeito da assistência de ar na barra de pulverização e o efeito da adição de adjuvantes à calda de pulverização, sobre os níveis de controle de plantas daninhas e fungos fitopatogênicos de plantas em pulverizações de produtos fitossanitários. Para a realização da metanálise, foram coletados dados de resultados apresentados em publicações de trabalhos científicos. A partir desses dados, foi criada uma variável resposta, denominada de controle relativo, calculada pela diferença entre a percentagem de controle dos tratamentos submetidos ao uso de assistência de ar ou adjuvante e os tratamentos controle, sem os respectivos usos das técnicas de pulverização. Os dados foram analisados estatisticamente por meio do software CMA (Comprehensive Meta-analysis), adotando-se o modelo aleatório. Os resultados demonstraram que a assistência de ar não exerceu efeito algum, nem positivo nem negativo sobre os níveis de controle das plantas daninhas e fungos fitopatogênicos. Já os resultados relativos à adição de adjuvantes evidenciaram aumento médio de 6,45% em média nos níveis de controle.