Effects of traditional concurrent training and multicomponent training composed by strength training and dance classes on functional and cognitive capacity of older adults: a study protocol / Efeitos do treinamento combinado tradicional e do treinamento multicomponente composto por treinamento de força e aulas de dança na capacidade funcional e cognitiva de idosos: protocolo de estudo

The combination of strength and aerobic training (concurrent training - TG) has been a widely used intervention for improving health outcomes. Also, dance has been well described as a great aerobic activity and can be an interesting option to compose an alternative multicomponent training pro-gram. Therefore, the aim of the present protocol study is to describe the methods that will be used in a randomized controlled trial (RCT) design to identify and compare the impacts of traditional TG composed by strength and aerobic training and a multicomponent training consisting of strength training combined with dance classes (DG) on functional and cognitive capacity and quality of life of older people. The sample of RCT will consist of men and women aged between 60 and 75 years. Both interventions will occur twice a week for 12 weeks with progressive intensity and volume. Functional capacity will be assessed by gait, balance, sitting and standing and climbing tests. Strength will be assessed through one repetition maximum test (1RM) in knee extension exercise, and handgrip using a hand dynamometer. Muscle thickness will be assessed using quadriceps ultrasound. Muscle power will be assessed in the knee extension exercise at 30 and 70% of 1RM using an encoder. Aerobic capacity will be assessed using the 6-minute walk test. Quality of life and cognitive performance will be assessed by questionnaires. Comparisons between groups over time will be carried out using Generalized Estimating Equations with a significance level of p<0.01. This protocol follows the rec-ommendations of SPIRIT-2013.

A combinação de treinamento de força e aeróbico (treinamento combinado - TC) tem sido uma interven-ção amplamente utilizada para melhorar desfechos de saúde. Além disso, a dança tem sido bem descrita na literatura como uma ótima atividade aeróbica e pode ser uma opção interessante para compor um programa alternativo de treinamento multicomponente. Portanto, o objetivo do presente protocolo de estudo é descrever os métodos que serão utilizados em um ensaio clínico randomizado (ECR) que visa identificar e comparar os impactos do TC tradicional composto por treinamento de força e aeróbico e de um treinamento multi-componente composto por treinamento de força combinado com aulas de dança sobre capacidade funcional, cognitiva e qualidade de vida de idosos. A amostra do ECR será composta por homens e mulheres com idade entre 60 e 75 anos. Ambas as intervenções ocorrerão duas vezes por semana durante 12 semanas com intensidade e volume progressivos. A capacidade funcional será avaliada por meio de testes de marcha, equilíbrio, sentar e levantar e subir escadas. A força será avaliada por meio do teste de uma repetição máxima (1RM) no exercício de extensão de joelhos e por meio do teste de preensão palmar com o dinamômetro manual. A espessura muscular será avaliada por meio de ultrassonografia do quadríceps. A potência muscular será ava-liada no exercício de extensão de joelhos a 30 e 70% de 1RM por meio de um transdutor linear de posição. A capacidade aeróbica será avaliada por meio do teste de caminhada de 6 minutos. A qualidade de vida e o desempenho cognitivo serão avaliados por meio de questionários. As comparações entre os grupos ao longo do tempo serão realizadas por meio de Equações de Estimativas Generalizadas com nível de significância p<0,01. Este protocolo segue as recomendações do SPIRIT-2013.

Combined Therapies of Traditional Chinese Medicine Treat Low-prognosis Patients Undergoing IVF-ET Again / 中国实验方剂学杂志

ObjectiveTo objectively evaluate the clinical efficacy of multiple therapies of traditional Chinese medicine （TCM） in low-prognosis patients who received antagonist protocol for in vitro fertilization and embryo transfer （IVF-ET） again. MethodA total of 128 patients with kidney Yin deficiency， liver depression， and blood stasis who planned to receive antagonist protocol for IVF-ET in the West China Second Hospital of Sichuan University were enrolled and assigned into two groups by random number table method. The observation group （64 casces） was treated by oral administration of Chinese medicine decoction + enema of kidney-tonifying and blood-activating method + auricular point sticking + oral administration of dehydroepiandrosterone （DHEA）， while the control group （64 casces） was treated by only oral administration of DHEA. After treatment for three menstrual cycles， both groups received the antagonist protocol for IVF-ET. The TCM syndrome scores， basic sex hormone levels， antral follicle count （AFC）， the usage of gonadotropin （Gn）， endometrial receptivity indicators， embryo quality indicators， and pregnancy outcomes were compared between the two groups. ResultAfter treatment， the observation group showed decreased follicle-stimulating hormone （FSH）/luteinizing hormone （LH） ratio， lowered level of estradiol （E2）， increased AFC， decreased amount and days of Gn usage， improved endometrial receptivity indicators （endometrial thickness on trigger and ET days， proportion of endometrial type A in endometrial types and the level of E2 on trigger day） and embryo quality indicators （the rates of mature follicles， fertilization， normal fertilization， and premium embryos）， and decreased TCM syndrome scores （P<0.05， P<0.01）. Moreover， the observation group had lower FSH/LH ratio， E2 level， and amount of Gn usage， higher AFC， poorer endometrial receptivity and embryo quality indicators， and lower TCM syndrome scores than the control group after treatment （P<0.05， P<0.01）. In addition， except for 3 cases of natural pregnancy， the observation group outperformed the control group in terms of improving the clinical pregnancy rates during initiation cycle and transplantation cycle and clinical pregnancy rate and decreasing biochemical pregnancy rate and early abortion rate （P<0.05）. ConclusionCombined therapies of TCM can alleviate the clinical symptoms， reduce TCM syndrome scores， reduce the Gn usage amount， improve the number and quality of embryos and endometrial receptivity， and coordinate the synchronous development of endometrium and embryo. In this way， they can increase the clinical pregnancy rate and reduce biochemical pregnancy rate and early abortion rate in the low prognosis patients with kidney yin deficiency， liver depression， and blood stasis who are undergoing IVF-ET again.

Comparison on Rat Models of Acute Cerebral Infarction Due to Stasis Combined with Toxin Complicated with Cerebral-cardiac Syndrome / 中国实验方剂学杂志

ObjectiveTo observe and compare the electrocardiogram index， myocardial morphology， and connexin 43 （Cx43） expression of two rat models of acute cerebral infarction （ACI） due to stasis combined with toxin complicated with cerebral-cardiac syndrome （CCS）， and to provide experimental evidence for the research on the occurrence mechanism of cardiac diseases induced by ACI and the clinical diagnosis and treatment of CCS. MethodSixty SPF-grade male SD rats were randomized into six groups （n=10）： normal ， syndrome of stasis combined with toxin induced by carrageenin combined with dry yeast （CA/Y）， multi-infarct induced by micro-embolism （ME）， middle cerebral artery occlusion （MCAO）， CA/Y+ME， and CA/Y+MCAO groups. The model of syndrome of stasis combined with toxin was established by intraperitoneal injection with carrageenan （CA） at 10 mg·kg-1 on the first day and subcutaneous injection with dry yeast （Y） suspension （2 mg·kg-1） on the second day of modeling. Twenty-four hours after the modeling of ACI， the electrocardiograms （ECGs） of rats in each group were collected and the number/percentage （%） of abnormal ECG was calculated. The infarct area of the brain was evaluated by 2，3，5-triphenyltetrazolium chloride （TTC） staining， and myocardial injury was assessed by hematoxylin-eosin （HE） staining. Immumohistochemical staining and Western blot were employed to determine the expression of Cx43 in the myocardium. ResultA certain number of rats in each model group presented abnormal ECG. Compared with the normal group and CA/Y group， CA/Y+MCAO group had the highest rate of abnormal ECG （P<0.01）. Compared with the normal， CA/Y， ME， and CA/Y+ME groups， the CA/Y+ME and CA/Y+MCAO groups showed decreased amplitudes of P-wave and T-wave， shortened P-R interval， and extended Q-T interval， which were particularly obvious in the CA/Y+MCAO group （P<0.05， P<0.01） and in accordance with the cerebral infarction area and pathological changes. The expression of Cx43 was up-regulated in both CA/Y+ME and CA/Y+MCAO groups， especially in the CA/Y+MCAO group （P<0.01）. ConclusionThe two rat models of ACI due to stasis combined with toxin complicated with CCS can be used to study the mechanism of heart diseases caused by cerebrovascular diseases and the therapeutic effects of Chinese medicines with the functions of resolving stasis and detoxifying. Moreover， the CA/Y+MCAO method has higher abnormal electrocardiogram rate， severer myocardial pathological injury， and higher expression of Cx43 protein. The models can be chosen according to specific experimental purpose.

Genetic diagnosis of congenital hypopituitarism in Turkish patients by a target gene panel: novel pathogenic variants in GHRHR, GLI2, LHX4 and POU1F1 genes

ABSTRACT Objective: Congenital hypopituitarism (CH) is a rare disease characterized by one or more hormone deficiencies of the pituitary gland. To date, many genes have been associated with CH. In this study, we identified the allelic variant spectrum of 11 causative genes in Turkish patients with CH. Materials and methods: This study included 47 patients [21 girls (44.6%) and 26 boys (55.4%)] from 45 families. To identify the genetic etiology, we screened 11 candidate genes associated with CH using next-generation sequencing. To confirm and detect the status of the specific familial variant in relatives, Sanger sequencing was also performed. Results: We identified 12 possible pathogenic variants in GHRHR, GH1, GLI2, PROP-1, POU1F1, and LHX4 in 11 patients (23.4%), of which six were novel variants: two in GHRHR, two in POU1F1, one in GLI2, and one in LHX4. In all patients, these variants were most frequently found in GLI2, followed by PROP-1 and GHRHR. Conclusion: Genetic causes were determined in only 23.4% of all patients with CH and 63% of molecularly diagnosed patients (7/11) from consanguineous families. Despite advances in genetics, we were unable to identify the genetic etiology of most patients with CH, suggesting the effect of unknown genes or environmental factors. More genetic studies are necessary to understand the etiology of CH.

Multimodal analgesia versus patient-controlled analgesia in the management of acute postoperative spinal pain: systematic review and meta-analysis / Analgesia multimodal versus analgesia controlada pelo paciente no tratamento da dor aguda pós-operatória da coluna: revisão sistemática e meta-análise

ABSTRACT BACKGROUND AND OBJECTIVES: Spine diseases have a high annual prevalence and are the main causes of years lived with disability and chronic pain. Among the postoperative analgesic control options, patient-controlled analgesia (PCA) and multimodal analgesia (MMA) have shown good clinical results. This meta-analysis seeks new evidence to help in the treatment of acute postoperative pain in patients undergoing spinal surgery. CONTENTS: The following databases were used: Cochrane Central Register of Controlled Trials, Medline and Embase. Studies that compared two post-surgical analgesic interventions were included; MMA and PCA. The parameters evaluated were: analgesic effect; opioid consumption; length of hospital stay; and adverse effects. Registration of the systematic review protocol: (PROSPERO CRD42023446627). There was no statistical difference when assessing analgesic improvement comparing MMA to PCA (MD -0.12 [-0.41, 0.17] 95%CI with p=0.69). There was a statistical difference, with lower opioid consumption in MMA compared to PCA (MD -3.04 [-3.69, -2.39] 95%CI with p=0.0002). Statistically significant difference regarding length of hospital stay in favor of MMA (MD -13.17 [-16.98, -9.36] 95%CI with p=0.00001), and significantly lower incidence of nausea and vomiting in patients undergoing MMA in compared to PCA (OR 0.26 [0.11, -0.64] 95%CI with p=0.003). CONCLUSION: MMA was equivalent to PCA in the treatment of acute postoperative spinal pain, with the significant clinical advantage and safety of lower amounts of infused opioids, shorter hospital stay and lower incidence of adverse effects.

RESUMO JUSTIFICATIVA E OBJETIVOS: As doenças da coluna apresentam alta prevalência anual e são as principais causas de anos vividos com incapacidade e de cronificação da dor. Dentre as opções de controle analgésico pós-operatória, a analgesia controlada pelo paciente (ACP) e a analgesia multimodal (AMM) apresentam bons resultados clínicos. O objetivo deste estudo foi buscar novas evidências que auxiliem no tratamento da dor aguda no pós-operatório do paciente submetido à cirurgia da coluna. CONTEÚDO: As bases de dados utilizadas: Cochrane Central Register of Controlled Trials, Medline e Embase. Foram incluídos estudos que compararam duas intervenções analgésicas pós-cirúrgicas; AMM e ACP. Os parâmetros avaliados foram: efeito analgésico; consumo de opioide; tempo de internação hospitalar e efeitos adversos. Registro do protocolo de revisão sistemática: (PROSPERO CRD42023446627). Não houve diferença estatística quando avaliadas a melhora analgésica comparando a AMM à ACP (MD -0,12 [-0,41, 0,17] 95%CI com p=0,69). Houve diferença estatística, com menor consumo de opioide na AMM em comparação à ACP (MD -3,04 [-3,69, -2,39] 95%IC com p=0,0002). Diferença estatística significativa com relação ao tempo de permanência hospitalar a favor da AMM (MD -13,17 [-16,98, -9,36] 95%IC com p=0,00001), e incidência significativamente menor de náuseas e vômitos nos pacientes submetidos a AMM em comparação a ACP (OR 0,26 [0,11, -0,64] 95%IC com p=0,003). CONCLUSÃO: A AMM foi equivalente à ACP no tratamento da dor aguda pós-operatória da coluna, com a significativa vantagem clínica e a segurança de menores quantidades de opioides infundidos, menor tempo de internação hospitalar e menor incidência de efeitos adversos.

Contraindicated use of modern contraceptives among mothers from a Pelotas Birth Cohort

ABSTRACT OBJECTIVE To describe the prevalence of contraindicated use of combined hormonal contraceptives, progesterone-only contraceptives, and intrauterine devices in mothers participating in the 2015 Pelotas Birth Cohort according to the WHO medical eligibility criteria. METHODS The biological mothers of children belonging to the 2015 Pelotas birth cohort who attended the 48-month follow-up were studied. The 48-month follow-up data were collected from January 1, 2019, to December 31, 2019. Contraindicated use of modern contraceptives was considered to occur when these women presented at least one of the contraindications for the use of modern contraceptives and were using these methods. The prevalence of contraindicated use was calculated according to each independent variable and their respective 95% confidence intervals (95%CI). RESULTS The analyzed sample consisted of 3,053 women who used any modern contraceptive method. The prevalence of contraindicated use of modern contraceptives totaled 25.9% (95%CI: 24.4-27.5). Combined hormonal contraceptives showed the highest prevalence of contraindicated use (52.1%; 95%CI: 49.3-54.8). The prevalence of contraindicated use of modern contraceptives methods was greater in women with family income between one and three minimum wages, a 25-30 kg/m2 body mass index, indication by a gynecologist for the used method, and purchasing the contraceptive method at a pharmacy. The higher the women's education, the lower the prevalence of inappropriate use of modern contraceptives. CONCLUSION In total, one in four women used modern contraceptives despite showing at least one contraindication. Policies regarding women's reproductive health should be strengthened.

Advances in Neuromuscular Electrical Stimulation in Post-Stroke Movement Disorders / 中山大学学报(医学科学版)

In recent years， the incidence of stroke patients in China is increasing， and the motor dysfunction caused by it often seriously affects the quality of daily life of the patients， Neuromuscular electrical stimulation （NMES）， as an emerging rehabilitation therapy， is widely used in the treatment of motor dysfunction in stroke patients. This paper summarizes the parameters and mechanisms of the role of NMES in motor function rehabilitation after stroke and its use in clinical practice. In the future， the specific mechanism of NMES action and efficient and safe therapeutic options should be further explored.

Effects of remimazolam on early postoperative cognitive function in elderly patients with hip fracture / 中国临床药理学与治疗学

AIM: To evaluate the effect of remimazolam on early postoperative cognitive function in elderly patients with hip fracture based on a randomized controlled trial. METHODS: A total of 106 elderly patients, aged 65-90 years, ASA grade Ⅱ or III, who underwent hip fracture surgery under combined spinal-epidural anesthesia in the Sixth Affiliated Hospital of Wenzhou Medical University from December 2022 to June 2023 and met the inclusion criteria, were selected and randomized into remimazolam group (group R) and propofol group (group P) according to the random number table, with 53 cases in each group. Patients in group P received a slow intravenous injection of propofol at a dose of 0.3-0.5 mg / kg (injection time of 1min), followed by a pump infusion at 0.5-3 mg · kg

Progress in surgical treatment of congenital entropion / 国际眼科杂志(Guoji Yanke Zazhi)

Congenital entropion, an abnormal condition in which the eyelids roll inward, with the eyelashes losing their normal angulation and tilting toward the eye, especially in the lower eyelids and inner canthus, often occurs in infants and young children. Congenital entropion may lead to corneal epithelial abrasion, inflammation and ulcer, which may affect the function of the eye if not treated in time. Early surgical intervention is helpful to the health of children's eyes. The purpose of surgery is to change the structure of eyelid and weaken the force of entropion, thus improving the symptoms and corneal astigmatism. At present, there are many surgical treatments for congenital entropion. In this paper, the advantages, disadvantages and indications of these treatments are analyzed and summarized, providing a reference for clinical practice.

Effects of femtosecond laser-assisted cataract surgery combined with intraocular lens implantation on postoperative deviation rate of multifocal intraocular lens and visual quality in cataract patients / 国际眼科杂志(Guoji Yanke Zazhi)

AIM: To explore the effects of femtosecond laser-assisted cataract surgery combined with intraocular lens implantation(FLACS-IOL)on postoperative deviation rate of multifocal intraocular lens(MIOL)and visual quality in cataract patients.METHODS: In the prospective study, 95 patients with cataract(108 eyes)who underwent MIOL implantation in the hospital between January 2021 and December 2022 were enrolled. According to different surgical methods, they were divided into FLACS group(51 cases, 56 eyes)and Phaco group(44 cases, 52 eyes). The operation time, incision diameter of anterior capsule, effective phaco time(EPT), cumulative dissipated energy(CDE), uncorrected distance visual acuity(UCDVA), best corrected distance visual acuity(BCDVA), eccentricity distance of IOL and deviation rate at 3 mo after surgery, total high order aberration(HOA), Trefoil and coma under 3 mm pupil were compared between the two groups.RESULTS: The operation time in the FLACS group was significantly shorter than that in the Phaco group, EPT and CDE were significantly lower than those in the Phaco group(all P&#x003C;0.05). There was no significant difference in incision diameter of anterior capsule between the two groups(P&#x003E;0.05). At 1 wk, 3 mo after surgery, UCDVA in the FLACS group was better than that in the Phaco group(all P&#x003C;0.05). There were significant difference in UCDVA at 1 wk, 3 mo after surgery or BCDVA at 3 mo after surgery between the two groups(P&#x003C;0.05). At 3 mo after surgery, eccentricity distance of IOL in the FLACS group was shorter than that in the Phaco group, and deviation rate was significantly lower than that in the Phaco group(all P&#x003C;0.05). Under pupil diameter of 3 mm, HOA, trefoil and coma of whole eyes were decreased in both groups at 3 mo after surgery(P&#x003C;0.05). At 3 mo after surgery, there were significant differences in HOA and trefoil of whole eyes between the FLACS group and Phaco group(P&#x003C;0.05), but there was no significant difference in coma at 3 mo after surgery(P&#x003E;0.05).CONCLUSION: FLACS-IOL can effectively reduce deviation rate of IOL and obtain better visual quality in cataract patients.

Characteristics and therapeutic strategies of Pott's puffy tumor / 临床耳鼻咽喉头颈外科杂志

Objective:To explore the characteristics and therapeutic strategies of Pott's puffy tumor（PPT）. Methods:The clinical data of two patients with PPT were retrospectively analyzed and combined with the literature, focusing on the comprehensive analysis of perioperative diagnosis and treatment strategies. Both patients underwent muti-disciplinary treatment, including timely administration of sufficient antibiotics capable of penetrating the blood-brain barrier. Early removal of PPT lesions was performed using a combined internal and external approach under nasal endoscopic guidance. Results:After standardized perioperative management, the symptoms of the two patients were completely relieved, with no recurrence after one=year follow=up. Postoperative complications such as frontal pain, numbness, local depression, or scar hyperplasiawere not present. Conclusion:PPT, being relatively rare and severe, requires careful attention. Key strategies for standardized perioperative management include multi-disciplinary consultation, timely and adequate antibiotic administration, and surgical intervention using a combined intranasal and extranasal endoscopic approach for lesion removal.

Research advances in combined artificial liver / 临床肝胆病杂志

At present， in vitro artificial liver support system has achieved a good therapeutic effect in the diseases such as liver failure due to various causes， non-function state before and after liver transplantation， and severe cholestasis. Non-bioartificial liver （NBAL） is widely used in clinical practice through various combinations of modes， mainly the plasma exchange mode for improving coagulation factors and albumin combined with other modes for enhancing the elimination of toxic substances in the body. Bioartificial liver （BAL）， based on the design concept of the synthesis and transformation of hepatocytes， has achieved rapid development in recent years. Patients with liver failure can almost obtain the normal physiological function of human liver after NBAL detoxification and BAL synthesis and transformation of active substances in the body. NBAL mode combined with BAL with a stable therapeutic effect according to the conditions of the patient is the direction of in vitro support treatment for patients with severe liver disease in the future.

Research progress on cemental tears in terms of clinical diagnosis and treatment / 口腔疾病防治

@#A cemental tear is defined as an incomplete or complete detachment of the cementum along the dentino-cemental junction (CDJ) or the incremental line within the body of the cementum, which can also involve part of the root dentine adjacent to the cementum. The pathogenesis of cemental tears is not fully elucidated. From the literature review, possible predisposing factors were identified, including tooth type, sex, age, periodontitis, previous periodontal treatment or root canal treatment, history of dental trauma, and occlusal trauma or excessive occlusal force. The morphology of cemental tears can be either piece-shaped or U-shaped, which usually contributes to periodontal and periapical breakdown. Clinically, cemental tears have a unitary periodontal pocket and present with symptoms mimicking localized periodontitis, apical periodontitis, and vertical root fractures. Imaging examination is of great significance for the clinical diagnosis of cemental tears, which often manifest as thin ‘prickle-like’ radiopaque masses located longitudinally adjacent to the affected root surface. Exploratory surgery is needed in some cases. Although intraoperative cemental fragments and cemental lines on the root surface can assist in the diagnostic process, histopathology examination is the gold standard for the diagnosis of cemental tears. The treatment methods vary depending on the timing of the correct diagnosis and the clinical or radiological manifestations. With the development of regenerative biomaterials and the development of intentional replantation, an increasing number of affected teeth can survive for a long time. The aim of this review is to systematically describe the biological basis and predisposing factors, clinical features, radiographic and histological characteristics, diagnosis and clinical management of cemental tears, and treatment outcomes to help make a clear diagnosis and develop a personalized treatment plan.

Effectiveness of combined anteversion angle technique in total hip arthroplasty for treatment of ankylosing spondylitis affecting hip joint / 中国修复重建外科杂志

OBJECTIVE@#To explore the effectiveness of the combined anteversion angle technique in total hip arthroplasty (THA) for treating ankylosing spondylitis (AS) affecting the hip joint.@*METHODS@#A retrospective analysis was conducted on the clinical data of 73 patients with AS affecting the hip joint who underwent THA between August 2018 and August 2021. According to whether the combined anteversion angle technique was used in THA, the patients were divided into study group (37 cases, combined anteversion angle technique was used in THA) and control group (36 cases, traditional THA). There was no significant difference in baseline data such as gender, age, body mass index, disease duration, preoperative Harris score, range of motion (ROM), acetabular anteversion angle, acetabular abduction angle, femoral anteversion angle, and combined anteversion angle between the two groups ( P>0.05). The operation time, hospital stay, and complications of the two groups were recorded and compared. The Harris score and hip ROM were compared between the two groups before operation, at 1, 3, 6, 12 months after operation, and at last follow-up. The acetabular component anteversion angle, femoral component anteversion angle, acetabular component abduction angle, and component combined anteversion angle were measured postoperatively.@*RESULTS@#The operation time in the study group was significantly shorter than that in the control group ( P<0.05), and there was no significant difference in hospital stay between the two groups ( P>0.05). There was no intraoperative complication such as acetabular and proximal femoral fractures, neurovascular injuries in both groups, and the incisions healed by first intention. All patients were followed up 2-3 years, with an average of 2.4 years; there was no significant difference in the follow-up time between the two groups ( P>0.05). During the follow-up period, there was no complication such as hip dislocation, wound infection, delayed wound healing, deep venous thrombosis, and hip dislocation in both groups. The hip Harris score and ROM of the two groups gradually increased with time after operation, and the differences were significant when compared with those before operation ( P<0.05); the above two indicators of the study group were significantly better than those of the control group at each time point after operation ( P<0.05). Extensive bone ingrowth on the surface of the components could be observed in the anteroposterior X-ray films of the hip joint of the two groups at 12 months after operation, and the acetabular components was stable without femoral stem subsidence, osteolysis around the components, and heterotopic ossification. At last follow-up, the acetabular component anteversion angle, femoral component anteversion angle, and component combined anteversion angle in the study group were significantly superior to those in the control group ( P<0.05), except that there was no significant difference in the acetabular component abduction angle between the two groups ( P>0.05).@*CONCLUSION@#For patients with AS affecting the hip joint, the use of the combined anteversion angle technique during THA effectively promotes the recovery of hip joint function and enhances the postoperative quality of life of patients when compared to traditional THA.

Combined ultrasound and electric field stimulations improve pain and functional capacity in immediate cesarean delivery: a randomized clinical trial, double-blind, and placebo-controlled / Terapia combinada de estimulação elétrica por meio do ultrassom melhora a dor e a capacidade funcional no pós-parto imediato de cesariana: ensaio clínico randomizado, duplo-cego e placebo

ABSTRACT BACKGROUND AND OBJECTIVES: Wound complications and pharmacological pain relief methods used at the skin surgical site after cesarean delivery may result in women's physical and emotional burden. Thus, nonpharmacological treatments must be explored to avoid these complications and side effects on maternal health. The objective of this study was to investigate the effects of Combined Ultrasound and Electric Field Stimulation (CUSEFS) on cicatricial pain and functional capacity in immediate cesarean delivery. METHODS: This study has a randomized clinical trial, double-blind, and placebo-controlled design. Thirty women (25.7±5.0 years) in immediate postpartum were randomly assigned to three groups: Control (CG, n:9), CUSEFS (TG, n:11), and Placebo (PG, n:10). CUSEFS was performed once for 20 minutes. Cicatricial pain (McGill Pain Questionnaire) and functional capacity (Functional Capacity Check) was assessed at baseline, after the intervention, and after 30 minutes. Cohen's (d) and Mixed-design analysis of variance were used to compare groups. RESULTS: Immediately after the intervention, TG showed a decrease in cicatricial pain compared with CG in sensory (d:3.8 to 4.0), affective (d:4.0), and total categories (d:3.9). In functional capacity, TG had less difficulty than CG at walking (d:0.6) and lying down (d:1.1), and PG at rest (d: 0.9). CONCLUSION: CUSEFS might be a resource for managing cicatricial pain and functional capacity in immediate cesarean delivery. Further studies with longer duration and different CUSEFS doses/parameters are required.

RESUMO JUSTIFICATIVA E OBJETIVOS: As complicações na ferida e o uso de métodos farmacológicos de alívio da dor no local cirúrgico após a cesariana podem resultar em sobrecarga física e emocional para a mulher. Assim, tratamentos não farmacológicos devem ser explorados para evitar essas complicações e efeitos adversos à saúde materna. O objetivo deste estudo foi investigar os efeitos da terapia combinada de estimulação elétrica por meio do ultrassom (CUSEFS) na dor cicatricial e na capacidade funcional no pós-parto imediato de cesariana. MÉTODOS: Este estudo possui um desenho de ensaio clínico randomizado, duplo-cego e controlado por placebo. Trinta mulheres (25,7±5,0 anos) em pós-parto imediato de cesariana foram distribuídas aleatoriamente em três grupos: Controle (CG, n:9), CUSEFS (TG:11) e Placebo (PG, n:10). O CUSEFS foi realizado uma vez por 20 minutos. A dor cicatricial (Questionário de Dor McGill) e a capacidade funcional (Functional Capacity Check) foram avaliadas no início, após a intervenção e após 30 minutos. As análises de variância de design misto e Cohen (d) foram usadas para comparar os grupos. RESULTADOS: Imediatamente após a intervenção, o TG apresentou diminuição na dor cicatricial em relação ao CG nas categorias sensorial (d:3,8 a 4,0), afetiva (d:4,0) e total (d:3,9). Na capacidade funcional, o TG apresentou menor dificuldade que o CG na marcha (d:0,6) e deitado (d:1,1), e que o PG em repouso (d:0,9). CONCLUSÃO: O CUSEFS pode ser um recurso para o manejo da dor cicatricial e da capacidade funcional imediatamente após a cesariana. Além disso, são necessários mais estudos com maior duração e diferentes doses/parâmetros de CUSEFS.

Consideraciones médico-legales laborales de la fórmula de Balthazard / Occupational medical-legal considerations of the Balthazard formula

La determinación del porcentaje de pérdida en pacientes lesionados con múltiples secuelas por riesgos de trabajo resulta un verdadero reto para el perito, esto adquiere mayor relevancia cuando en el fuero judicial se pueden presentar discrepancias en los criterios para el uso o no de fórmulas matemáticas para el cálculo. La fórmula de suma combinada, creada por el Médico Forense Víctor Balthazard, no es más que un ordenamiento de una regla de tres que ordena los porcentajes otorgados a cada secuela de mayor a menor para evitar que el porcentaje final sobrepase el 100%, o bien que resulte en un porcentaje mayor que una secuela única puntuada en el baremo y que por gravedad en la intensidad de la misma resulte con un porcentaje menor al calculado por la secuela múltiple y que se ha utilizado en fueros laborales y de seguridad social alrededor del mundo. El Baremo contenido en el Código de Trabajo no establece explícitamente la forma en que se calcula el porcentaje de pérdida por secuelas múltiples, lo cual brinda libertad al perito para utilizar fórmulas, como lo es la fórmula de suma combinada, que permite calcular de forma congruente las pérdidas sucesivas sin sobrepasar a la persona más allá de su capacidad general total del 100% o de otorgar porcentajes mayores a secuelas de mayor gravedad que la suma de las pérdidas por el evento que se está valorando.

The determination of the percentage of loss in injured patients with multiple sequelae due to occupational hazards is a real challenge for the expert, this becomes even more relevant when in the judicial system there may be discrepancies in the criteria for the use or not of mathematical formulas for the calculation. The combined sum formula, created by the Forensic Physician Victor Balthazard, is nothing more than an arrangement of a rule of three that orders the percentages given to each sequel from highest to lowest to avoid that the final percentage exceeds 100%, or that it results in a higher percentage than a single sequel scored in the scale and that due to the severity in the intensity of the same results in a lower percentage than that calculated for the multiple sequel and that has been used in labor and social security courts around the world. The Schedule contained in the Labor Code does not explicitly establish the way in which the percentage of loss for multiple sequelae is calculated, which gives the expert the freedom to use formulas, such as the combined sum formula, which allows a congruent calculation of the successive losses without exceeding the person's total general capacity of 100% or to grant higher percentages to sequelae of greater severity than the sum of the losses for the event being valued.

Tratamiento multimodal en los schwanomas vestibulares grandes / Multimodal Treatment for Large Vestibular Schwannomas

Introducción: Los schwanomas vestibulares son lesiones clasificadas como grado I por la Organización Mundial de la Salud. Las opciones conductuales incluyen la observación, la radiocirugía o la resección microquirúrgica endoscópica. Objetivo: Describir el rol del tratamiento multimodal en los schwanomas vestibulares. Métodos: Se realizó una búsqueda sistemática de literatura médica para la identificación e inclusión de artículos en las siguientes bases de datos: PubMed/Medline, SciELO y Google Scholar, además de los servidores de preprints BioRvix y MedRvix. Se usaron los siguientes descriptores: vestibular schwanoma OR acoustic neuroma AND nerve centered approach OR combined approach AND partial resection OR subtotal resection OR near total resection. Se excluyeron editoriales, cartas al editor, libros, revisiones, metaanálisis y aquellos artículos con método deficiente de más de 20 años de publicación o sin mención al tema de interés. Fueron incluidos 16 artículos. Desarrollo: Los artículos incluyeron un total de 699 pacientes, de los cuales solo 228 (32,6 porciento) recibieron radioterapia en el período posoperatorio. El período de seguimiento promedió 49,6 meses. La preservación de la función facial se logró en el 88,3 porciento de los casos y el control tumoral en el 80,7 porciento. El estado de la preservación auditiva solo fue informado en el 50 porciento de los estudios. El uso de la radioterapia adyuvante mostró gran variabilidad. Conclusiones: El tratamiento multimodal para los schwanomas vestibulares grandes -compuesto por la resección subtotal, vaciamiento intratumoral, seguido de radiocirugía- se ha convertido en una opción plausible. Se necesita la publicación de mayor cantidad de reportes para ofrecer recomendaciones y estratificar la conducta(AU)

Introduction: Vestibular schwannomas are lesions classified as grade I by the World Health Organization. Behavioral options include observation, radiosurgery or endoscopic microsurgical resection. Objective: To describe the role of multimodal treatment for vestibular schwannomas. Methods: A systematic search of medical literature, for the identification and inclusion of articles, was carried out in the databases PubMed/Medline, SciELO and Google Scholar, as well as in the preprint servers BioRvix and MedRvix. The following descriptors were used: vestibular schwannoma OR acoustic neuroma AND nerve centered approach OR combined approach AND partial resection OR subtotal resection OR near total resection. Editorials, letters to the editor, books, reviews and metaanalyses were excluded, as well as articles with deficient method of more than 20 years of publication or not mentioning the topic of interest. Sixteen articles were included. Development: The articles included a total of 699 patients, of which only 228 (32.6 ) received radiotherapy in the postoperative period. The average follow-up period was 49.6 months. Preservation of facial function was achieved in 88.3 percent of cases; and tumor control, in 80.7 percent. Hearing preservation status was reported in only 50 percent of the studies. The usage of adjuvant radiotherapy showed great variability. Conclusions: Multimodal treatment for large vestibular schwannomas -composed of subtotal resection and intratumoral draining, followed by radiosurgery- has become a plausible option. The publication of a greater amount of reports is necessary to provide recommendations and stratify the behavior(AU)

Degeneración combinada subaguda / Subacute combined degeneration

Introducción: La degeneración combinada subaguda (DCS) es un trastorno caracterizado por la degeneración difusa de la sustancia blanca a nivel del SNC, que afecta específicamente los cordones posteriores y laterales de la médula espinal, con pérdida de la mielinización periférica y central. De manera frecuente, las manifestaciones clínicas son parestesias y debilidad generalizada causada por deficiencia de vitamina B12. Presentación del caso: Paciente masculino de 79 años, con cuadro clínico de 3 meses de evolución de limitación funcional para la marcha acompañado de desorientación. Al examen físico evidenció desorientación, cuadriparesia e hiporreflexia, con niveles séricos bajos de vitamina B12, RM cervical con focos hiperintensos en el segmento C3/C6 y endoscopia de vías digestivas altas con atrofia de la mucosa gástrica. Presentamos un caso clínico de DCS. Discusión: Este es un caso de DCS que se manifiesta por medio de una alteración neuropsiquiátrica, con una presentación inicial inespecífica que comprende deterioro de la marcha, movimientos anormales con afectación cognitiva y psiquiátrica dada por alucinaciones visuales y desorientación. Su sospecha es importante en pacientes con factores de riesgo por medio del conocimiento de la patología, para una adecuada sospecha diagnóstica y una instauración oportuna de reposición vitamínica, la cual presenta una excelente respuesta. Conclusión: La DCS es un trastorno en el que se evidencia anemia con deficiencia de vitamina B12, des-mielinización del tejido nervioso y en muchos casos signos sugestivos de atrofia gástrica, y para ello es crucial la detección temprana de esta enfermedad por medio de la determinación de niveles séricos de vitamina B12, asociado a síntomas neurológicos, para así lograr su adecuado diagnóstico y tratamiento.

Introduction: Subacute combined degeneration (DCS) is a disorder characterized by diffuse degeneration of white matter at the CNS level, specifically affecting the posterior and lateral cords of the spinal cord, also with loss of peripheral and central myelination, frequently the clinical manifestations are paresthesias and generalized weakness caused by vitamin B12 deficiency. Case presentation: A 79-year-old male patient with a 3-month history of functional limitation for walking accompanied by disorientation. On physical examination, he revealed disorientation, quadriparesis, and hyporeflexia, with low serum levels of vitamin B12, cervical MRI with hyperintense foci in segment C3/C6, and upper digestive tract endoscopy with atrophy of the gastric mucosa. We present a clinical case of DCS. Discussion: This is a case of DCS that manifests itself through neuropsychiatric alteration with a nonspecific initial presentation with gait impairment, abnormal movements with cognitive and psychiatric affectation given by visual hallucinations and disorientation. Its suspicion is important in patients with risk factors. risk through knowledge of the pathology for an adequate diagnostic suspicion and a timely establishment of vitamin replacement for which it presents an excellent response. Conclusion: DCS is a disorder where anemia with vitamin B12 deficiency, demyelination of the nervous tissue and in many cases signs suggestive of gastric atrophy are evident, for which early detection of this disease is crucial through the determination of serum levels of vitamin B12 associated with neurological symptoms, in order to achieve its proper diagnosis and treatment.

Predisposición psicológica de heptatletas y decatletas cubanos, evidencias de su asociación con el rendimiento competitivo

La preparación psicológica para las competencias es un proceso que potencia las capacidades y cualidades del deportista durante la preparación para alcanzar el estado óptimo de predisposición psíquica. Son escasas las investigaciones que ofrecen evidencias empíricas de la relación existente entre el estado de predisposición psíquica y el rendimiento competitivo de atletas de pruebas combinadas. El objetivo de este trabajo fue determinar cómo se relacionan el estado de predisposición psicológica y el rendimiento competitivo de los atletas cubanos de pruebas combinadas. La investigación fue no experimental y transversal. La muestra la integraron ocho atletas de pruebas combinadas de la selección nacional cubana de atletismo. Se emplearon el Cuestionario de Predisposición Psicológica para la Competencia y la Escala de rendimiento en la competencia de pruebas combinadas. La claridad de objetivos correlacionó de manera positiva y directa con el rendimiento competitivo en las carreras con vallas (,793 sig. = ,019). La significación de la competencia percibida por los atletas correlacionó de manera positiva y directa con las carreras con vallas y el salto de altura (,826 sig. = ,012 y ,717 sig. = ,045). A medida que aumentó la claridad de objetivos en los atletas estudiados también lo hizo el rendimiento percibido por sus entrenadores en las carreras con vallas que realizaron en la Copa Cuba 2020. A medida que fue mayor la significación de la competencia, también lo fue el rendimiento en carreras con vallas y salto de altura.

SÍNTESE A preparação psicológica para as competições é um processo que aumenta as habilidades e qualidades do atleta durante a preparação para alcançar o estado ideal de predisposição psíquica. Há poucas pesquisas que ofereçam evidências empíricas da relação entre o estado de predisposição psicológica e o desempenho competitivo dos atletas em eventos combinados. O objetivo deste trabalho foi determinar como o estado de predisposição psicológica e o desempenho competitivo dos atletas cubanos em eventos combinados estão relacionados. A pesquisa foi não-experimental e transversal. A amostra consistiu de oito atletas de eventos combinados da equipe nacional de atletismo de Cuba. Foram utilizados o Questionário de Predisposição Psicológica para Competição e a Escala de Desempenho em Competição de Julgamentos Combinados. Clareza de propósito correlacionada positivamente e diretamente com o desempenho competitivo em obstáculos (.793 sig. = .019). A percepção do significado da competência dos atletas se correlacionou positiva e diretamente com obstáculos e saltos em altura (.826 sig. = .012 e .717 sig. = .045). medida que a clareza das metas aumentava nos atletas estudados, também aumentava o desempenho percebido por seus treinadores nas corridas de obstáculos que realizaram na Copa Cuba 2020. medida que a importância da concorrência aumentava, aumentava também o desempenho em obstáculos e saltos altos.

Psychological preparation for competitions is a process that enhances the capacities and qualities of the athlete during the preparation to reach the optimal state of mental predisposition. There are few researches that offer empirical evidence of the relationship between the state of mental predisposition and the competitive performance of athletes in combined events. The objective of this work was to determine how the state of psychological predisposition and the competitive performance of Cuban athletes in combined events are related. The research was non-experimental and cross-sectional. The sample was made up of eight athletes from the combined events of the Cuban national athletics team. The Questionnaire of Psychological Predisposition for Competition and the Performance Scale in the competition of combined tests were used. Goal clarity was positively and directly correlated with competitive performance in hurdles (.793 sig. = .019). The significance of the athletes' perceived competition was positively and directly correlated with hurdles and high jump (.826 sig. = .012 and .717 sig. = .045). As the clarity of objectives increased in the athletes studied, so did the performance perceived by their coaches in the hurdles races they carried out in the 2020 Cuba Cup. As the significance of the competition was greater, so was the performance in hurdle races and high jump.

Comparison of the effects of combined model and single model in HFRS incidence fitting and prediction / 公共卫生与预防医学

Objective To compare the prediction effect of combined model and single model in HFRS incidence fitting and prediction, and to provide a reference for optimizing HFRS prediction model. Methods The province with the highest incidence in China (Heilongjiang Province) in recent years was selected as the research site. The monthly incidence data of HFRS in Heilongjiang Province from 2004 to 2017 were collected. The data from 2004 to 2016 was used as training data, and the data from January to December 2017 was used as test data. The training data was used to train SARIMA , ETS and NNAR models, respectively. The reciprocal variance method and particle swarm optimization algorithm (PSO) were used to calculate the model coefficients of SARIMA, ETS and NNAR, respectively, to construct combined model A and combined model B. The established models were used to predict the incidence of HFRS from January to December 2017. The fitted and predicted values of the five models were compared with the training data and test data, respectively. Mean Absolute Percentage Error (MAPE), Mean Absolute Error (MAE), Root Mean Standard Deviation (RMSE), and Mean Error Rate (MER) were used to evaluate the model fitting and prediction effects. Results The optimal SARIMA model was SARIMA(1,0,2)(2,1,1)12. The optimal ETS model was ETS(M, N, M), and the smoothing parameter =0.738，=1*10. The optimal NNAR model was NNAR(13,1,7)12. The residuals of the three single models were white noise (P>0.05). The expression of combined model A was ŷ=0.134*ySARIMA+0.162*yETS+0.704*yNNAR; the expression of combined model B was ŷ=0.246*ySARIMA+0.435*yETS+0.319*yNNAR. The MAPE, MAE, RMSE, and MER fitted by SARIMA, ETS, NNAR, combined model A and combined model B were 24.10%, 0.11, 0.17, 23.29%; 17.14%, 0.08, 0.14, 17.96%; 6.33%, 0.02, 0.03, 4.25%; 9.03%, 0.03, 0.05, 7.51%; 13.16%, 0.06, 0.09, 12.33%, respectively. The MAPE, MAE, RMSE, and MER predicted by the five models were 18.70%, 0.05, 0.06, 19.62%; 23.83%, 0.06, 0.07, 24.49%; 28.30%, 0.07, 0.10, 29.21%; 21.69%, 0.06, 0.08, 22.63%; 17.39%, 0.05, 0.07, 18.76%, respectively. Conclusion The fitting and prediction effects of the combined models are better than the single models. The combined model based on PSO to calculate the weight of the single model is the optimal model.