Exploring Morphometric Features of the Female Reproductive Tract in Brazilian Pantanal Cattle / Un Análisis de las Características Morfométricas del Tracto Reproductivo Femenino en el Ganado del Pantanal Brasileño

SUMMARY: The cattle in the Pantanal region show a notable influence from Bos indicus breeds and their crossbreeds. However, a comprehensive biometric assessment of the reproductive system in these animals is currently lacking. This study evaluated the effects of breed, age, carcass weight, and estrous cycle phase on female reproductive system morphometry. A total of 124 healthy, non-pregnant reproductive tracts (83 Nelore and 41 Crossbred) were collected at a slaughterhouse. Neither the volume and weight of the ovaries nor the majority of uterine dimensions were affected by breed. Compared to heifers, cows showed longer uterine horns, a larger external caudal diameter of the uterine horns and body, and a greater external cranial diameter and internal caudal diameter of the cervix. The carcass weight (below vs. within commercial weight) affected the length of the uterine horns, uterine body, and cervix. Ovaries with a corpus luteum presented higher volume and weight than those with only follicles. Although the uterine measurements in the luteal phase were increased, the cycle stage did not affect the uterine morphometry. The average number of cervical rings was 5.0, independent of weight or breed. Crossbred animals presented a higher first cervical ring. Age didn´t influence the number, height, or distance between cervical rings. Deviation from the normal alignment of the cervix was recorded in 14.29 % of the animals, with a higher occurrence among Nelore cattle; deviation from the median axis was the most common (30%). This study emphasizes various parameters influencing the morphometry of the female reproductive system in Nelore cattle and their crosses, which could be crucial for implementing reproductive biotechnology techniques better suited to the morphological characteristics of zebu breeds.

El ganado de la región del Pantanal muestra una notable influencia de las razas Bos indicus y sus cruces. Sin embargo, actualmente falta una evaluación biométrica exhaustiva del sistema reproductivo de estos animales. Este estudio evaluó los efectos de la raza, la edad, el peso de la canal y la fase del ciclo estral sobre la morfometría del sistema reproductivo de la hembra. En un matadero se recogieron un total de 124 tractos reproductivos sanos y no preñados (83 Nelore y 41 cruzados). Ni el volumen ni el peso de los ovarios ni la mayoría de las dimensiones del útero se vieron afectados por la raza. En comparación con las novillas, las vacas mostraron cuernos uterinos más largos, un diámetro caudal externo más grande de los cuernos y del cuerpo uterino, y un diámetro craneal externo y un diámetro caudal interno más grandes del cuello uterino. El peso de la canal (por debajo versus dentro del peso comercial) afectó la longitud de los cuernos uterinos, el cuerpo uterino y el cuello uterino. Los ovarios con cuerpo lúteo presentaron mayor volumen y peso que aquellos con solo folículos. Aunque las medidas uterinas en la fase lútea aumentaron, la etapa del ciclo no afectó la morfometría uterina. El número promedio de anillos cervicales fue de 5,0, independientemente del peso o la raza. Los animales mestizos presentaron un primer anillo cervical más alto. La edad no influyó en el número, altura o distancia entre anillos cervicales. La desviación de la alineación normal del cuello uterino se registró en el 14,29 % de los animales, con mayor ocurrencia en el ganado Nelore; la desviación del eje de la mediana fue la más común (30%). Este estudio enfatiza varios parámetros que influyen en la morfometría del sistema reproductor de las hembras en el ganado Nelore y sus cruces, lo que podría ser crucial para implementar técnicas de biotecnología reproductiva más adecuadas a las características morfológicas de las razas cebú.

Correlation of degenerative meniscus injury with lower limb alignment:a clinical report of 90 cases / 陆军军医大学学报

Objective To compare the differences in lower limb force line between degenerative medial meniscus injuries and lateral meniscus injuries and investigate their correlation.Methods A total of 90 patients who underwent arthroscopic treatment for meniscal injuries between March 2019 and March 2022 were enrolled in the study.They were 45 males and 45 females,at a median age of 52 years(ranging from 40 to 59 years).Of these patients,47 had medial meniscus injuries,while 43 had lateral meniscus injuries.The hip-knee-ankle(HKA)angle was measured on full-length films,and the differences were compared between the 2 groups.Results There were no significant differences in terms of gender,age,lower limb laterality,body mass index,site of injury,and type of injury between the medial meniscus injury group and the lateral meniscus injury group.Statistical difference was observed in the mean HKA angle,with a value of(177.20±2.46)° in the medial meniscus injury group and of(181.05±3.13)° in the lateral meniscus injury group(P＜0.01).Conclusion There is a significant difference in HKA angle between medial meniscus injury group and the lateral meniscus injury group.A correlation is found between lower limb alignment and degenerative meniscus injury.

Correlation between lower limb alignment and risk factors of patellofemoral pain syndrome in young men / 中国组织工程研究

BACKGROUND:The risk factors for patellofemoral pain syndrome are still unclear and research on risk factors is gradually becoming a hot topic in order to improve the therapeutic outcome of this disease. OBJECTIVE:To investigate the relationship between lower limb alignment and patellofemoral pain syndrome in young male runners. METHODS:In the same running population,21 patients with bilateral knee pain,29 patients with single knee pain and 20 normal runners were collected from January 2021 to July 2022.Full-length X-ray examination of both lower limbs in standing position was performed in all subjects.The lateral distal femoral angle,medial tibial proximal angle,joint line congruence angle,hip-knee-ankle angle,and knee physical valgus angle were measured and statistically analyzed. RESULTS AND CONCLUSION:There was no significant difference in the parameters between the left and right knees in each group(P>0.05).Compared with the normal group,no significant changes in lateral distal femoral angle,medial tibial proximal angle,joint line congruence angle,and hip-knee-ankle angle were observed in the single knee pain group and double knee pain group,while the knee physical valgus angle was significantly increased in these two groups(P<0.05).To conclude,increased knee physical valgus angle may be a risk factor for patellofemoral pain syndrome.

Correlation between sagittal alignment and clinical symptom improvement after lumbar fusion / 中国组织工程研究

BACKGROUND:Up to date,there is seldom research about the correlation between the harmonious alignment degree of lumbar lordosis and pelvic incidence and the improvement of postoperative clinical symptoms in patients with lumbar stenosis fusion. OBJECTIVE:To investigate the harmonious alignment degree of lumbar lordosis and pelvic incidence in patients with lumbar spinal stenosis and fusion,and compare the differences of spinal and pelvic sagittal parameters and clinical outcomes among different harmonious alignment degrees. METHODS:The medical records of 110 patients with lumbar spinal stenosis(48 males and 62 females,aged 57±11 years)who were treated with posterior lumbar laminar decompression and internal fixation in the Department of Spinal Surgery,Tianjin Union Medical Center from December 2019 to December 2021 were retrospectively analyzed.The postoperative follow-up was more than 1 year.According to the harmonious alignment degree of lumbar lordosis and pelvic incidence,they were divided into two groups:Group A(n=47)(pelvic incidence-lumbar lordosis>10°)and group B(n=63)(pelvic incidence-lumbar lordosis≤10°).The changes of clinical scores(low back pain visual analog scale score and Oswestry disability index)and spinal and pelvic sagittal parameters before and after surgery were compared between the two groups.The correlation between clinical symptom improvement and spinal and pelvic imaging parameters was analyzed. RESULTS AND CONCLUSION:(1)There were no significant differences in preoperative pelvic sagittal parameters and clinical function between the two groups(P>0.05).(2)There were no significant differences in operation time and blood loss between the two groups(P>0.05).(3)At the last postoperative follow-up,the visual analog scale score and Oswestry disability index in group B were significantly improved compared with group A(P=0.000,P=0.005).Lumbar lordosis and sacral slope were also significantly improved(P=0.000,P<0.05),and pelvic tilt was more significantly recovered(P=0.000).(4)Pearson correlation coefficient method results showed that the improvement of visual analog scale score of low back pain was significantly correlated with the improvement of pelvic tilt(r=0.209,P=0.008),lumbar lordosis(r=-0.133,P=0.021)and sacral slope(r=-0.156,P=0.031).Pelvic tilt was significantly correlated with Oswestry disability index(r=0.196,P=0.014).(5)It is concluded that reconstructed lumbar lordosis and reduced pelvic tilt for the harmonious alignment(pelvic incidence-lumbar lordosis≤10°)can effectively improve the clinical symptoms of patients.

Application and prospect of robotic-assisted total knee arthroplasty / 中国组织工程研究

BACKGROUND:The basic principle of the design of the robot system used for total knee arthroplasty is to combine three-dimensional surgical planning,early warning of danger areas during surgery,real-time data feedback,robot arm assisted osteotomy and other technologies to achieve precision and personalization of total knee arthroplasty,which is exactly its biggest advantage.Therefore,it has become a hot topic in the field of joint surgery in recent years and attracted much attention. OBJECTIVE:To summarize the development status of robotic-assisted total knee arthroplasty in the field of joint surgery and the comparison of advantages and disadvantages with conventional total knee arthroplasty and to prospect the future development of robotic-assisted total knee arthroplasty. METHODS:Relevant articles were searched from PubMed,CNKI,Wanfang and VIP databases by computer.English key words were"robot OR robotic OR robotics OR robotically OR computer,total knee arthroplasty OR total knee replacement,TKA OR TKR".Chinese key words were"robotic-assisted,computer navigation,total knee arthroplasty".Finally,64 articles were included for review and analysis. RESULTS AND CONCLUSION:(1)The robot system used to assist total knee arthroplasty is divided into active,semi-active and passive according to its degree of freedom.The semi-active system,currently widely used in robotic systems,effectively enhances the accuracy and personalization of total knee arthroplasty.However,its high implementation cost and relatively steep learning curve remain key factors to be balanced when promoting its adoption in joint surgery field.(2)Robotic-assisted total knee arthroplasty can achieve precise osteotomy and correct placement of prosthesis in local three-dimensional space of the knee joint.It has been widely proven that it can provide better accuracy of prosthesis implantation,reduce imaging abnormalities,obtain good soft tissue balance during the operation,and ultimately improve the motion and functional status of the knee joint after the operation.(3)However,the current robotic-assisted system still has objective shortcomings,including the problem of learning curve between different robot devices and operators,additional installation and maintenance costs,and potential complications related to robot surgery.Therefore,whether it can truly benefit the medical system and patients still needs to be proven by long-term research,and the robotic-assisted system also needs to be further improved substantially.(4)Robotic-assisted total knee arthroplasty technique is still in the preliminary research stage in clinical practice and has not been widely applied.To better define the usage of robotic-assisted total knee arthroplasty and enhance its clinical procedural standards and safety,refining these aspects will become a focal point of future research on robotic-assisted total knee arthroplasty.

High tibial osteotomy promotes cartilage regeneration in the treatment of knee osteoarthritis / 中国组织工程研究

BACKGROUND:For early knee osteoarthritis in which total knee arthroplasty fails to achieve satisfactory results,high tibial osteotomy that has been found to promote regeneration of damaged cartilage and alleviate symptoms in patients is considered a classic knee-preserving procedure. OBJECTIVE:To review and discuss the effectiveness,mechanism,and application prospects of high tibial osteotomy in stimulating cartilage regeneration in knee osteoarthritis and to provide a theoretical basis for the use of high tibial osteotomy in the treatment of knee osteoarthritis. METHODS:A computerized search was conducted in PubMed,Web of Science,CNKI and WanFang databases for relevant literature published from 2013 to 2023.The search terms used were"knee osteoarthritis,high tibial osteotomy,limb alignment,chondrocytes,biomechanics,intra-articular"in both English and Chinese.Finally,75 articles were included for review. RESULTS AND CONCLUSION:High tibial osteotomy correcting the lower limb alignment has been found to be effective in alleviating symptoms and potentially delaying or preventing the need for total knee arthroplasty.This is an important aspect of orthopedic step-down treatment in knee osteoarthritis.Maintaining a normal mechanical microenvironment is crucial for the proper functioning and maintenance of chondrocyte phenotype.Abnormal mechanical signals can be converted into intracellular chemical signals through mechanosensors like primary cilia,integrins,cytoskeleton and nucleoskeleton,resulting in disruptions to the balance of matrix metabolism and regulation of inflammatory responses.Chondrocytes after abnormal stress action still have the potential to revert to a normal phenotype under appropriate stress;correction of the mechanical microenvironment by high tibial osteotomy leads to spontaneous cartilage repair and remission of synovial inflammation.The combination of high tibial osteotomy and cartilage regeneration strategy holds promising prospects for patients with early knee osteoarthritis who are not candidates for total knee arthroplasty.

Application advantages of Brainlab Knee 3 navigation combined with gap balance in total knee arthroplasty / 中国组织工程研究

BACKGROUND:In recent years,computer-assisted navigation has gradually attracted attention in the medical field.Some scholars have reported that the clinical effects of computer navigation in total knee arthroplasty vary.To explore the clinical effect of the new generation of Brainlab Knee 3 navigation system,this study is conducted. OBJECTIVE:To analyze the application effect of computer navigation system(Brainlab Knee 3)combined with gap balance technology in total knee arthroplasty. METHODS:A total of 71 patients received total knee arthroplasty at the Department of Joint Surgery of Dalian Second People's Hospital from November 2020 to May 2021.In the navigation group,35 patients underwent total knee arthroplasty by computer navigation combined with gap balance.In the traditional group,36 patients underwent osteotomy with traditional surgical instruments.The difference between medial and lateral joint spaces,knee range of motion,hospital for special surgery knee score,hip-knee-ankle angle,deviation values of coronal femoral component angle,coronal tibial component angle,and sagittal tibial component angle were compared between the two groups. RESULTS AND CONCLUSION:(1)In the navigation group,the differences of intraoperative medial and lateral joint gap at knee extension 0,1,and 2 mm were found in 19,14,and 2 cases,respectively.The gap difference was 0 mm in 18 cases,1 mm in 15 cases and 2 mm in 2 cases at 90° degree knee flexion.In the traditional group,the gap difference at knee extention was 0 mm in 10 cases,1 mm in 20 cases,and 2 mm in 6 cases.The gap difference at 90 degree knee flexion was 0 mm in 10 cases,1 mm in 15 cases and 2 mm in 8 cases.(2)The operation time in the navigation group was longer than that in the traditional group(P<0.05),and two patients in the navigation group developed lower limb intermuscular vein thrombosis after surgery,and none of the patients in the traditional group had complications.(3)The range of motion between the two groups increased significantly at 6 and 12 months after surgery,and the range of motion in the navigation group was higher than that in the traditional group(P<0.05).(4)At 12 months after surgery,the hospital for special surgery knee scores of both groups increased significantly,and the hospital for special surgery knee score in the navigation group was higher than that in the traditional group(P<0.05).(5)At 6 months after surgery,the deviation values of hip-knee-ankle angle,coronal femoral component angle,coronal tibial component angle,and sagittal tibial component angle of navigation group were significantly lower than those in the traditional group(P<0.05).(6)The results showed that computer navigation technique combined with gap balance in total knee arthroplasty had advantages in postoperative range of motion,lower limb alignment and the accuracy of tibial prosthesis component position,and joint function recovered well.

Construction and validation of Alignment Diagram model for risk of parenteral nutrition-associated cholestasis in extremely/ultra-low birth weight infants / 中国小儿急救医学

Objective:To explore the high-risk factors for parenteral nutrition associated cholestasis（PNAC）in extremely/ultra-low birth weight infants，and establish a risk Alignment Diagram prediction model.Methods:We retrospectivly analyzed the clinical data of hospitalized extremely/ultra-low birth weight infants admitted to Neonatology Department at Quanzhou Children's Hospital from January 2019 to December 2020，using multivariate Logistic regression analysis to screen for independent risk factors for the occurrence of PNAC.An Alignment Diagram model prediction model for PNAC was constructed by using R software，and the performance of the model was evaluated through receiver operating characteristic curves.Results:A total of 203 extremely/ultra-low birth weight infants were included，with a median gestational age of 29.14（28.00，30.86）weeks and a median birth weight of 1　170（1　000,1　300）g.Among them，26（12.81%）cases developed PNAC.Multivariate Logistic regression analysis showed that the duration of parenteral nutrition（ OR=1.015 ，95% CI 1.003-1.034），the cumulative amount of glucose（ OR=1.014 ，95% CI 1.001-1.028），small for gestational age（ OR=3.455 ，95% CI 1.127-10.589），and neonatal sepsis（ OR=3.142 ，95% CI 1.039-9.503）were independent risk factors for PNAC（ P＜0.05）；The four independent risk factors mentioned above were introduced into R software to construct an Alignment Diagram model，the area under the receiver operating characteristic curve was 0.835（95% CI 0.842-0.731），and the results of the Hosmer Limeshow goodness of fit test show that：χ 2=5.34，degree of freedom=8， P=0.72.A calibration curve indicated good consistency between the predicted probability of the model and the actual occurrence rate，with good accuracy. Conclusion:The Alignment Diagram model constructed based on four independent risk factors of the duration of parenteral nutrition，glucose accumulation，small for gestational age infants，and neonatal sepsis exhibits high predictive ability，and is expected to provide an intuitive and convenient visualization tool for preventing or reducing the occurrence of PNAC in extremely/ultra-low birth weight infants

Digital repair for a patient with limited mouth opening: a case report and literature review / 口腔疾病防治

Objective@#To explore an accurate method to obtain an intraoral model of patients with specific limited mouth opening (microstomia) due to systemic scleroderma.@*Methods@#This study followed medical ethics, and informed consent has been obtained from patients. A case of Ken's Type I mandibular dentition defect scleroderma with limited mouth opening was addressed with digital technology as the leading method combined with the traditional impression method of segmental impression. Individual trays were made based on the patient's left and right mandibular dentition, and segmented molds were obtained. Simultaneously, intraoral scanning was performed to obtain the morphological data of both the soft and hard tissues of the upper and lower mandibles. After each part of the model was obtained, the mandibular model was scanned and digitally aligned to form the final denture model, and the final removable partial denture was designed and made by computer aided design/computer aided manufacturing (CAD/CAM) technology. At the same time, combined with the literature, the diagnosis and treatment of removable partial denture in patients with limited mouth opening were retrospectively analyzed.@*Results@#The denture was well retained and achieved a good repair effect. The patients expressed satisfaction with the mastication efficiency and other functions of the denture. The findings of the literature review show that the integration of digital technology with the traditional impression method, along with computer fitting, can accurately obtain the patient's oral model and facilitate successful follow-up repairs. However, when the anterior mandibular dentition of the patient is absent, the margin of error is increased in this procedure, which deserves further exploration.@*Conclusion@#Utilizing digital technology as the leading method, combined with the traditional impression method of segmental impression, for the repair of dental defects in patients with limited mouth opening, has proven to be effective. Thus, patients report a positive medical experience with high satisfaction, indicating that this approach is worthy of clinical promotion.

Characteristics of calcaneal inclination of children in the upright standing position / 体力科学

Calcaneal inclination in children may influence their standing posture. However, the calcaneal inclination of modern children is unclear. This study aimed to clarify the characteristics of calcaneal inclination and its effects on spinal alignment and the center of pressure (COP) position in children. The study included 402 elementary school children (208 boys, 194 girls). The variables measured included calcaneal inclination, lower leg lateral inclination angle, spinal alignment, and COP position. The mean calcaneal inclination was 4.40 ± 3.5°, indicating mild eversion. Calcaneal inclination was classified into calcaneal eversion (+), calcaneal introversion (-), and a mid-heel position. Overall, 3.7% (15/402) of the subjects had bilateral calcaneal introversion (-), 18.2% (73/402) had unilateral calcaneal introversion (-), and 21.9% (88/402) had calcaneal introversion (-). An examination of the relationship between calcaneal inclination and each measured variable showed a significance level of <5% between calcaneal inclination and age, height, and body weight, but the correlation coefficients were <0.2 each, indicating little correlation. However, a significant correlation was found between right and left calcaneal inclination and the right and left lower leg lateral inclination angles. Overall, 21.9% (88/402) of the elementary school children had calcaneal inclination in a standing posture. These results suggest that calcaneal inclination may not affect spinal alignment and COP position.

Establishing a prognostic prediction model for patients with septic shock based on the completion time of fluid resuscitation and the negative fluid balance volumes / 中华危重病急救医学

Objective:To explore the relationship between the completion time of fluid resuscitation as well as negative fluid balance volumes and the prognosis of patients with septic shock, and to try to construct a prediction model based on the completion time of fluid resuscitation and negative fluid balance volumes, and to verify the predictive efficacy of the model on the prognosis of patients with septic shock.Methods:Patients with septic shock admitted to Wuxi People's Hospital from April 2020 to April 2023 were selected. The general data (gender, age, body mass index, infection site), pathological indicators on admission, the difference of acute physiology and chronic health evaluation Ⅱ (APACHEⅡ) and sequential organ failure assessment (SOFA) between admission and 24 hours after fluid resuscitation, the completion time of fluid resuscitation and negative fluid balance volume were recorded. Multivariate Logistic analysis was used to screen the influencing factors of the prognosis of patients with septic shock, and a nomogram model was established. Bootstrap method was used for internal validation of the model. The consistency index, calibration curve and receiver operator characteristic curve (ROC curve) were used to evaluate the accuracy and prediction efficiency of the model.Results:A total of 96 patients with septic shock were enrolled, 38 patients died and 58 patients survived at 28 days. Compared with the survival group, the difference of APACHEⅡscore, SOFA score, the proportion of fluid resuscitation completed within 1 to 3 hours, and the proportion of negative fluid balance volume -500 to -250 mL per day in the death group were lower, and the differences were statistically significant (all P < 0.05). Multivariate Logistic analysis showed that the completion time of fluid resuscitation was a risk factor for the prognosis of patients with septic shock [odds ratio ( OR) = 26.285, 95% confidence interval (95% CI) was 9.984-76.902, P < 0.05]. The difference of APACHEⅡscore ( OR = 0.045, 95% CI was 0.015-0.131), SOFA score ( OR = 0.056, 95% CI was 0.019-0.165) between admission and 24 hours after fluid resuscitation, and negative fluid balance volume ( OR = 0.043, 95% CI was 0.015-0.127) were protective factors for the prognosis of patients with septic shock (all P < 0.05). The model validation results showed that the consistency index was 0.681 (95% CI was 0.596-0.924), indicating good discrimination. The calibration curve showed that the calibration curve fitted well with the ideal curve. The ROC curve showed that the sensitivity of the nomogram model for predicting the death of patients with septic shock was 83.7%, the specificity was 97.2%, and the area under the ROC curve (AUC) was 0.931 (95% CI was 0.846-0.985), indicating that the model had good prediction efficiency. Conclusion:The completion time of fluid resuscitation and negative fluid balance volumes are related to the prognosis of septic shock patients, and the alignment diagram model improve the identification of the risk of death in septic shock patients.

Diabetic microaneurysms detected by fluorescein angiography spatially correlate with regions of macular ischemia delineated by optical coherence tomography angiography

Purpose: To characterize the relationship between diabetic macular ischemia (DMI) delineated by optical coherence tomography angiography (OCTA) and microaneurysms (MAs) identified by fundus fluorescein angiography (FFA). Methods: Patients with diabetic retinopathy (DR) who underwent OCTA and FFA were retrospectively identified. FFA images were cropped and aligned with their respective OCTA images using i2k Align Retina software (Dual?Align, Clifton Park, NY, USA). Foveal avascular zone (FAZ) and ischemic areas were manually delineated on OCTA images, and MAs were marked on the corresponding FFA images before overlaying paired scans for analysis (ImageJ; National Institutes of Health, Bethesda, MD, USA). Results: Twenty?eight eyes of 20 patients were included. The average number of MAs identified in cropped FFA images was 127 ± 42. More DMI was noted in the superficial capillary plexus (SCP; 36 ± 13%) compared to the deep capillary plexus (DCP; 28 ± 14%, P < 0.001). Similarly, more MAs were associated with ischemic areas in SCP compared to DCP (92.0 ± 35.0 vs. 76.8 ± 36.5, P < 0.001). Most MAs bordered ischemic areas; fewer than 10% localized inside these regions. As DMI area increased, so did associated MAs (SCP: r = 0.695, P < 0.001; DCP: r = 0.726, P < 0.001). Density of MAs surrounding FAZ (7.7 ± 6.0 MAs/mm2) was similar to other DMI areas (SCP: 7.0 ± 4.0 MAs/mm2, P = 0.478; DCP: 9.2 ± 10.9 MAs/mm2, P = 0.394). Conclusion: MAs identified in FFA strongly associate with, and border areas of, DMI delineated by OCTA. Although more MAs are localized to SCP ischemia, the concentration of MAs associated with DCP ischemia is greater. By contrast, few MAs are present inside low?flow regions, likely because capillary loss is associated with their regression.

How common is extra-articular knee deformity? How to achieve a «safe zone¼ alignment total knee arthroplasty in patients with extra-articular deformity / ¿Qué tan común es la deformidad extraarticular de rodilla? ¿Cómo lograr una artroplastia total de rodilla con alineación de «zona segura¼ en pacientes con deformidad extraarticular?

Abstract: The need for total knee arthroplasty is increasing considerably and one of the goals is to achieve post-surgical coronal alignment. Robotic surgical assistance achieves a functional alignment, which is a hip-knee-ankle angle of 0o. However, it is not possible to provide robotic assisted surgery to all our patients so we must include the full-length hip-to-ankle AP weight-bearing radiograph in preoperative planning to obtain a «safe zone¼ alignment, which is a post-surgical hip-knee-ankle Angle of 0 ± 3o. How can we achieve a «safe zone¼ alignment total knee arthroplasty in patients with extra-articular deformity?

Resumen: La necesidad de artroplastia total de rodilla está aumentando considerablemente y uno de los objetivos es lograr la alineación coronal postquirúrgica. La asistencia quirúrgica robótica consigue una alineación funcional, que es un ángulo cadera-rodilla-tobillo de 0o. Sin embargo, no es posible ofrecer cirugía asistida por robot a todos nuestros pacientes, por lo que debemos incluir la radiografía AP de soporte de peso de cadera a tobillo de cuerpo entero en la planificación preoperatoria para obtener una alineación de «zona segura¼, que es un ángulo postquirúrgico cadera-rodilla-tobillo de 0 ± 3o. ¿Cómo podemos conseguir una artroplastia total de rodilla con alineación de «zona segura¼ en pacientes con deformidad extraarticular?

Alinhamento partidário e oferta de políticas públicas no Brasil / Alineación partidaria y provisión de políticas públicas en Brasil / Partisan alignment and public policies provision in Brazil

Resumo Municípios partidariamente alinhados com o presidente ofertam mais políticas públicas? A entrega de serviços públicos é uma das atividades centrais dos governos. Uma vez que são os partidos políticos que controlam o Poder Executivo tanto no Governo Federal quanto no governo local, é razoável esperar que seus interesses partidários e eleitorais influenciem o curso da implementação de serviços. Neste artigo, analiso a cobertura da atenção básica à saúde como indicador de oferta. Dado o forte compartilhamento de responsabilidades entre os entes federados, argumento que o Governo Federal implementa políticas públicas de forma estratégica, aumentando a oferta de serviços em municípios partidariamente alinhados. Para testar empiricamente essa relação, estimo o efeito causal do alinhamento por meio de um desenho de regressão descontínua para eleições acirradas. Os resultados indicam que os municípios partidariamente alinhados com a Presidência da República têm cobertura da atenção básica à saúde, em média, 3% maior que outros governados por partidos oposicionistas. Em uma cidade com 10 mil habitantes, por exemplo, isso significaria 300 pessoas a mais sendo adequadamente atendidas por equipes de saúde.

Resumen ¿Los municipios alineados partidariamente con el presidente ofrecen más políticas públicas? La prestación de servicios públicos es una de las actividades centrales de los gobiernos. Dado que son los partidos políticos los que controlan el Poder Ejecutivo tanto en el Gobierno federal como en el local, es razonable esperar que sus intereses partidistas y electorales influyan en el curso de la implementación. En este artículo analizo la cobertura de la atención primaria de salud como indicador de provisión. Dada la fuerte compartición de responsabilidades entre las entidades federativas, argumento que el Gobierno federal implementa las políticas públicas de manera estratégica, aumentando la provisión de servicios en los municipios alineados partidariamente. Para probar empíricamente esta relación, estimo el efecto causal del alineamiento utilizando un diseño de regresión discontinua para elecciones reñidas. Los resultados indican que los municipios partidariamente alineados tienen, en promedio, una cobertura de atención primaria un 3% más alta que otros gobernados por partidos de oposición. En una ciudad de 10.000 habitantes, por ejemplo, esto significaría 300 personas más adecuadamente atendidas por los equipos de salud.

Abstract This research examines whether local governments politically aligned with the president's party offer more public policies. The delivery of public services is one of the central activities of governments. Since the political parties control the executive branch in both federal and local government, it is reasonable to expect that their partisan and electoral interests will influence policy implementation. This study analyzes the coverage of primary healthcare as an indicator of policy delivery. Given the strong sharing of responsibilities among federated entities, I argue that the federal government implements public policies strategically, increasing the supply of services in partisan-aligned municipalities. To empirically test this relationship, I estimate the causal effect of alignment using a regression-discontinuity design for close elections. The results indicate that partisan-aligned municipalities have, on average, 3% higher coverage of primary healthcare than others governed by opposition parties. In a city with 10,000 inhabitants, for example, this would mean 300 more people receiving healthcare.

Sagittal Alignment Concepts and Spinopelvic Parameters / Conceitos de alinhamento sagital e parâmetros espinopélvicos

Abstract Spinal surgery continues to expand its horizons to care for disabled patients presenting pain and deformities. Over the past decade, our knowledge of spinal alignment, from the skull to the pelvis, has increased considerably. Such knowledge must expand to reach general orthopedists and improve the care required for so many people. Global spinal alignment is a critical concept in understanding the impact of pathological conditions (degenerative diseases, traumas, deformities) and their treatment, including spinal instrumentation and arthrodesis. Therefore, the treatment of any spinal disease must include the knowledge of the complexity of the spinopelvic alignment. At first, all parameters seem like pure mathematics, hardly applicable to the everyday life of the inattentive reader. However, it gradually becomes clear that, like everything else in orthopedics, biomechanics is an essential part of the knowledge of the musculoskeletal system, revealing the logic behind the physiology of movements. The knowledge of the sagittal alignment concepts and spinopelvic parameteres provide a better comprehension of the axial and appendicular skeletons, increasing the understanding of the physiological and adaptive spinal processes in the face of the degenerative process that increases throughout life.

Resumo A cirurgia da coluna continua a expandir seus horizontes para cuidar dos pacientes incapacitados com dor e deformidades. Desde a última década, nosso conhecimento sobre o alinhamento espinal, do crânio à pelve, aumentou consideravelmente. Portanto, faz-se necessária a expansão de tal conhecimento para o ortopedista geral, para que possamos proporcionar melhores cuidados para essa população. O alinhamento espinal global é um conceito crítico no entendimento do impacto ocasionado pela condição patológica (doença degenerativa, trauma, deformidade) e mesmo do seu tratamento, como na instrumentação e artrodese da coluna. O tratamento de qualquer doença na coluna deve incluir o entendimento da complexidade do alinhamento espinopélvico. A princípio, todos os parâmetros parecem puramente matemáticos e pouco aplicáveis à realidade do leitor mais desatento. Mas, aos poucos, fica claro que, como tudo em ortopedia, a biomecânica faz parte essencial do conhecimento do sistema musculoesquelético, tornando mais claras as lógicas da fisiologia do movimento. O conhecimento dos conceitos de alinhamento sagital e dos parâmetros espinopélvicos proporcionam uma melhor compreensão dos esqueletos axial e apendicular, além de um melhor entendimento dos processos fisiológicos e adaptativos da coluna frente ao processo degenerativo crescente que ocorre ao longo da vida.

Research progress of functional alignment robot assisted knee replacement / 中国骨伤

The correct alignment of the knee joint is considered to be one of the most influential factors in determining the long-term prognosis after total knee arthroplasty(TKA). In order to achieve the correct alignment goal, many different alignment concepts and surgical techniques have been established. For example, mechanical alignment(MA), kinematic alignment(KA) and functional alignment(FA) have their own characteristics. MA focuses on achieving neutral alignment of the limbs, parallel and equal bone gaps during stretching and flexion. KA aims to restore the patient 's natural joint line, make the joint level and angle normal and improve the physiological soft tissue balance, and strive to reproduce the normal knee function;among them, functional alignment(FA) developed with robot-assisted surgery technology is a relatively new alignment concept. It not only considers the alignment of the body, but also aims to achieve flexion and extension balance, while respecting the native soft tissue capsule. It not only restores the plane and slope of the in situ joint line accurately during the operation, but also takes into account the balance of soft tissue, which is a better alignment method. Therefore, it is of great significance to correctly construct the lower limb force line of patients, which is helpful to restore knee joint function, relieve pain symptoms and prolong the service life of prosthesi. However, compared with traditional TKA, the operation time of robot-assisted FA-TKA is prolonged, which means that the probability of postoperative infection will be greater. At present, most studies of FA technology report short-term results, and the long-term efficacy of patients is not clear. Therefore, long-term research results are needed to support the application of this technology. Therefore, the author makes a review on the research status of functional alignment.

The application of restricted kinematic alignment in total knee arthroplasty / 中华骨科杂志

Objective:To investigate the feasibility and therapeutic effect of total knee arthroplasty (TKA) with cruciate-retaining (CR) prosthesis by using FEM-X1 femoral extramedullary positioning instrument based on the theory of restricted kinematic alignment (rKA).Methods:Thirty five cases who underwent total knee arthroplasty in Nanjing Drum Tower Hospital from November 2019 to December 2020 were retrospectively analyzed, including 7 males and 28 females with an average age of 71± 8 years (ranging from 55 to 85 years) Following the guidance of rKA alignment, the FEM-X1 femoral extramedullary positioning instrument was used for TKA with CR prosthesis. Before the operation, the full-length lower limb radiographs of both anteroposterior and lateral views were taken in a standing position for preoperative assessment of lateral distal femoral angle (LDFA), the medial proximal tibial angle (MPTA) and hip-knee-ankle angle (HKA). According to the principle of rKA alignment, the target LDFA, MPTA and HKA were calculated. The proximal end of tibia and distal end of femur were cut using extramedullary positioning instrument respectively. The posterior femoral condyle was cut according to the tibial plateau and mediolateral soft tissue tension. The prosthesis was installed after osteotomy. The release of collateral ligaments, PCL function, release of PCL, patellofemoral trajectory, release of patellofemoral support band, the amount of blood loss and time of operation were recorded. Postoperative LDFA, MPTA, HKA, and posterior slope angle of tibial prosthesis were measured on X-ray images. The Knee Society Score (KSS) was used for functional evaluation.Results:Thirty five cases of TKA with CR prosthesis following rKA alignment were successfully completed. The operation time was 100 (90, 110) min, and the blood loss was 100 (100, 200) ml. 30 of them were followed up for 12.5±0.7 months (ranging from 12 to 14 months). The pre-operative and post-operative LDFA were 1.0°(-2.0°, 4.0°), 0°(-2.0°, 2.0°), MPTA were -4.0°(-5.0°, -1.0°), -2.0°(-3.0°, -1.0°), HKA were -3.0°(-3.0°, -1.0°), -2.0°(-3.0°, -1.0°). There was no significant difference between the three angles before and after operation ( Z=-0.89, P=0.372; Z=1.87, P=0.061; Z=1.03, P=0.302). The average posterior tibial slope was 5°(3°, 7°). At the follow-up of one year, the KSS clinical score was 94(92, 97) and functional score was 80(70, 90) in 30 cases. During the operation, PCL was released in 1 case because of excessive tension; and lateral retinacular release was performed in 1 case because of poor patellofemoral track. Conclusion:ITKA with CR prosthesis by using the extramedullary positioning instrument on the theory of rKA alignment showed a good clinical outcome at a short follow up.

Analysis on the disease constitution of inpatients in a orthopedic hospital from 2018 to 2022 / 现代医院

Objective Analyze the characteristics of disease composition in a orthopedic hospital,in order to provide targeted basis for strengthening discipline construction and optimizing resource allocation.Methods Collect information on dis-charged patients from 2018 to 2022,including main diagnosis,gender,age,etc.,and describe and analyze the data.Results The total number of patients is 214 104,with a male to female ratio of 1.32 ∶1.The top three diseases have always beentrauma and toxicosis(55.87%),musculoskeletal system and connective tissue diseases(22.37%)and the factors affecting health and resulting from contact with health care institutions(10.51%).Except for musculoskeletal system and connective tissue diseases,the other two types of male patients are greater than females.The top 5 diseases are hand and wrist injuries,internal fixation,knee and calf injuries,shoulder and upper arm injuries,and back diseases.Among them,single disease types are also divided into finger amputation,finger fractures,slipped disc,lumbar fractures,and osteoporosis.The distribution of disease types varies among different gender and age groups.Conclusion Corresponding prevention and control measures for high incidence diseases should be formulated based on different ages and genders,as well as department adjustments.

Effect of pursed lip breathing on respiratory function and respiratory muscle strength while using a spine mat / 体力科学

It has been reported that using of the spine mat increases chest expansion, inspiratory capacity (IC) and maximum inspiratory mouth pressure (PImax). However, no changes were observed in other respiratory functions and the respiratory muscle strength. The purpose of this study was to clarify the effects of pursed-lip breathing lying on the spine mat to the respiratory function and respiratory muscle strength. Forty-two adult male participants were assigned to two groups; an intervention group (IG group) of 21 participants who performed pursed-lip breathing on top of a spine mat and a control group (CG group) of 21 participants who performed pursed-lip breathing only. The intervention period was 5 days, and the respiratory features evaluated were chest expansion, respiratory function, respiratory muscle strength, and spinal alignment. A significant increase between the Pretest and the Posttest in chest expansion at the circumference of the axilla level, of the xiphoid process level and of the 10th rib level was observed only in IG group. For the respiratory function and the respiratory muscle strength, intervention group showed significant increases in percentage of vital capacity (%VC), tidal volume (TV), PImax, and maximum expiratory mouth pressure (PEmax). In the control group, only the TV indicated a significant increase. Regarding changes before and after the intervention, the intervention group showed significantly higher PImax and PEmax than the control group. No significant difference in spinal alignment was observed between the two groups. These results showed that pursed-lip breathing lying on the spine mat would increase the PImax, PEmax and the chest expansion.

Structure-guided engineering for improving the thermal stability of zearalenone hydrolase / 生物工程学报

Zearalenone is one of the most widely polluted Fusarium toxins in the world, seriously endangering livestock and human health. Zearalenone hydrolase (ZHD) derived from Clonostachys rosea can effectively degrade zearalenone. However, the high temperature environment in feed processing hampers the application of this enzyme. Structure-based rational design may provide guidance for engineering the thermal stability of enzymes. In this paper, we used the multiple structure alignment (MSTA) to screen the structural flexibility regions of ZHD. Subsequently, a candidate mutation library was constructed by sequence conservation scoring and conformational free energy calculation, from which 9 single point mutations based on residues 136 and 220 were obtained. The experiments showed that the thermal melting temperature (Tm) of the 9 mutants increased by 0.4-5.6 ℃. The S220R and S220W mutants showed the best thermal stability, the Tm of which increased by 5.6 ℃ and 4.0 ℃ compared to that of the wild type. Moreover, the thermal half-inactivation time at 45 ℃ were 15.4 times and 3.1 times longer, and the relative activities were 70.6% and 57.3% of the wild type. Molecular dynamics simulation analysis showed that the interaction force at and around the mutation site was enhanced, contributing to the improved thermal stability of ZHD. The probability of 220-K130 hydrogen bond of the mutants S220R and S220W increased by 37.1% and 19.3%, and the probability of K130-D223 salt bridge increased by 30.1% and 12.5%, respectively. This work demonstrated the feasibility of thermal stability engineering strategy where the structural and sequence alignment as well as free energy calculation of natural enzymes were integrated, and obtained ZHD variants with enhanced thermal stability, which may facilitate the industrial application of ZHD.