Reducing CLABSI through a quality strategy for the implementation of the aseptic non-touch technique in a pediatric ward / Reducción de infecciones relacionadas con catéteres venosos centrales por medio de una estrategia de calidad para la implementación de la técnica aséptica «no tocar¼ en una sala de pediatría

Abstract Background: Central line-associated bloodstream infections (CLABSIs) are among the most epidemiologically relevant health care-associated infections. The aseptic non-touch technique (ANTT) is a standardized practice used to prevent CLABSIs. In a pediatric hospital, the overall CLABSI rate was 1.92/1000 catheter days (CD). However, in one unit, the rate was 5.7/1000 CD. Methods: Nurses were trained in ANTT. For the implementation, plan-do-study-act (PDSA) cycles were completed. Adherence monitoring of the ANTT and epidemiological surveillance were performed. Results: ANTT adherence of 95% was achieved after 6 PDSA cycles. Hand hygiene and general cleaning reached 100% adherence. Port disinfection and material collection had the lowest adherence rates, with 76.2% and 84.7%, respectively. The CLABSI rate decreased from 5.7 to 1.26/1000 CD. Conclusion: The implementation of ANTT helped reduce the CLABSI rate. Training and continuous monitoring are key to maintaining ANTT adherence.

Resumen Introducción: Las infecciones relacionadas con catéteres venosos centrales son unas de las infecciones asociadas a la atención de salud con mayor relevancia epidemiológica. La técnica aséptica «no tocar¼ es una práctica estandarizada que se utiliza para prevenir estas infecciones. En un hospital pediátrico, la tasa de infecciones relacionadas con catéteres venosos centrales fue de 1.92/1000 días de catéter. Sin embargo, en una de las unidades la tasa fue de 5.7/1000 días de catéter. Método: Se capacitaron enfermeras en la técnica aséptica «no tocar¼. Para la implementación se cumplieron ciclos de planificar-hacer-estudiar-actuar (PHEA). Se realizaron seguimiento de la adherencia a la técnica y vigilancia epidemiológica. Resultados: Se logró una adherencia a la técnica aséptica «no tocar¼ del 95% después de seis ciclos. La higiene de manos y la limpieza general alcanzaron un 100% de cumplimiento. La desinfección de los puertos y la recolección de material alcanzaron la menor adherencia, con un 76.2% y un 84.7%, respectivamente. La tasa de infecciones relacionadas con catéteres venosos centrales disminuyó de 5.7 a 1.26 por 1000 días de catéter. Conclusiones: La implementación de la técnica aséptica «no tocar¼ ayudó en la reducción de infecciones relacionadas con catéteres venosos centrales. La capacitación y el seguimiento continuo son clave para mantener el cumplimiento de la técnica.

Inyección de composite fluido técnica analógica vs técnica digital en el tratamiento de desgaste dental: reporte de caso / Fluid composite injection analog vs digital technique in the treatment of dental wear: case report

El avance de la tecnología permite realizar cambios en la rehabilitación y estética, reduce los tiempos de trabajo y disminuye los riesgos que se presentan al momento de utilizar materiales convencionales para la toma de impresiones. Existen dos técnicas que se pueden emplear, la analógica y la digital; la primera presenta mayores riesgos que el operador no puede controlar, así como tiempos más prolongados. Este reporte describe la rehabilitación bucal en dos pacientes con desgaste dental, se optó por usar ambas técnicas, la analógica y la digital, como tratamiento; en la primera se empleó el encerado convencional y en la segunda el software Exocad para el encerado digital. Finalmente en ambos casos se aplicó (AU)

The advance of technology has allowed changes in rehabilitation and esthetics, providing shorter working times and reducing the risks that occur when using conventional materials for taking impressions. There are two techniques that can be used, analog and digital, the first one presents greater risks that the operator cannot control, as well as more time. This report describes the oral rehabilitation in patients with dental wear. The treatment was carried out using the analogical and digital techniques, the former using conventional waxing and the latter using Exocad software for the digital waxing; finally, in both cases the injection technique with high-load Flow resin was used (AU)

Necrosis y perforación intestinal asociada a alimentación por yeyunostomía / Necrosis and intestinal perforation associated with feed ing by jejunostomy

Resumen La nutrición enteral por yeyunostomía es una prác tica frecuente en cualquier servicio de cirugía general, esta conlleva bajo riesgo de complicaciones y morbi mortalidad. Presentamos el caso de una paciente con antecedente inmediato de gastrectomía subtotal que inició nutrición por yeyunostomía y complicó con ne crosis intestinal por isquemia no oclusiva en el corto lapso. La finalidad de este trabajo es informar sobre esta complicación, su fisiopatología y factores de riesgo para tenerla en cuenta y poder tomar precozmente una conducta terapéutica adecuada.

Abstract Enteral nutrition through jejunostomy is a common practice in any general surgery service; it carries a low risk of complications and morbidity and mortality. We present the case of a patient with an immediate history of subtotal gastrectomy that began nutrition through jejunostomy and complicated with intestinal necrosis due to non-occlusive ischemia in the short period. The purpose of this work is to report on this complication, its pathophysiology and risk factors to take it into account and be able to take appropriate therapeutic action early.

La Economía Circular desde la perspectiva de la empresa estatal cubana: ¿ oportunidad o necesidad en la condiciones actuales? / The Circular Economy from the perspective of the Cuban state enterprise: ¿opportunity o necessity in current condition?

La Economía Circular (EC) se ha posicionado como una alternativa viable ante la insostenibilidad del modelo económico lineal. Hoy este constituye una temática que está en el centro del debate y de todas las agendas de gobierno y Cuba no puede ser la excepción. El presente artículo persigue como objetivo principal diagnosticar el estado de la economía circular en Cuba desde la perspectiva de las empresas estatales. En este sentido se parte de sistematizar las ventajas de la aplicación de modelos circulares en el país. Se particulariza en el estudio por sectores que han avanzado en la aplicación del paradigma circular y se concluye con una propuesta de acciones estratégicas a seguir para expandir las prácticas circulares en el país, las cuales son validadas según criterio de los principales usuarios responsables de su implementación a través de la técnica de IADOV

The Circular Economy (CE) has positioned itself as aviable alternative to the unsustainability of the linear economic model. Today this is an issue that is at the center of the debate and of all government agendas, and Cuba cannot be the exception. The main objective of this article is to diagnose the state of the circular economy in Cuba from the perspective of public enterprises. e study is particularized to analyze separately the advance of the different sectors in the application of the circular paradigm. It concludes with a proposal of strategic actions to be followed to expand circular practices in the country, which are validated according to the criteria of the main users responsible for their implementation through the IADOV technique

Tendencias en la cirugía de artroplastía total de rodilla en Chile. ¿Cómo las estamos operando? / Trends in total knee replacement surgery in Chile. How are we operating them?

INTRODUCCION La artroplastía total de rodilla (ATR), que ha tenido un aumento importante en la población en las últimas décadas, presenta una gran variación en su estudio y técnica entre los distintos países. En la actualidad no hay datos nacionales registrados que evalúen la forma de su implementación. Objetivo Registrar las tendencias respecto de la ATR en distintos aspectos en Chile y compararlas con los registros de otros países. MATERIALES y METODOS Se realizó una encuesta vía email a cirujanos de rodilla en Chile considerando cuatro aspectos: generalidades, estudio preoperatorio, técnica quirúrgica y técnica de cementación. Se excluyeron las encuestas que no rellenadas por completo. Se analizaron los datos generales y separados según años de experiencia (ADE). Se compararon los datos con los obtenidos en estudios internacionales. RESULTADOS Se obtuvieron 87 encuestas completas. La mayoría de los encuestados realizaba entre 25 y 50 ATR en 1 año (44%), y el 16%, más de 75. Sólo un 20% utilizaba la modalidad ambulatoria, y un 43% creía que siempre deben ser hospitalizadas (mayor frecuencia en los cirujanos con más de 10 ADE). Un 18% utilizaba algún sistema robótico, con mayor frecuencia en cirujanos con más de 10 ADE; los sistemas más usados fueron ROSA y CORI. El 90% creía que la ATR debería ser parte del programa de Garantías Explícitas de Salud (GES), sin diferencias según ADE. El 81% usaba sistema estabilizado posterior (posterior-estabilized, PS, en inglés), 96% realizaba un abordaje parapatelar medial, 82% usaba guía extramedular tibial, 41% tendía a recambiar la patela, y un 35% no usaba torniquete (ninguna de las variables mostró diferencias según ADE). Sólo un 31% utilizaba cementación al vacío (mayor frecuencia en el grupo con menos de 10 ADE), 95% colocaba el cemento en componentes y en hueso, 75% colocaba en la quilla, y 56% utilizaba el dedo para colocarlo (sólo 22% con pistola). La secuencia más frecuente de cementación fue tibia-fémur-patela. En la mayoría de los aspectos evaluados, se observaron diferencias importantes con estudios de otros países. CONCLUSION Existe una gran variabilidad en la realización de ATR en Chile, con tendencias distintas a las de otros países. En general, en relación con los distintos ADE, no hay grandes diferencias en la técnica quirúrgica, sí habiendo diferencias en la técnica de cementación y en el uso de sistemas robóticos

INTRODUCTION Total knee replacement (TKR) significantly increased among the population in recent decades, and it shows great variation in its study and technique in different countries. There is no registered Chilean data to assess TKR implementation. Objective To record the trends in TKR in different aspects within Chile and compare them with records from other countries. MATERIALS AND METHODS We conducted an email survey among knee surgeons in Chile considering four aspects: general features, preoperative study, surgical technique, and cementation technique. We excluded surveys not completed in full. The analyses included overall data and data per years of experience (YOEs), and we compared the results with those of international studies. RESULTS We obtained 87 complete surveys. Most respondents performed 25 to 50 TKRs each year (44%), with only 16% performing over 75 TKRs. Only 20% used the ambulatory modality, while 43% believed patients always require hospitalization (especially surgeons with more than 10 YOEs). Robotic systems were used by 18% of the surgeons, especially those with more than 10 YOEs; the most used systems were ROSA and CORI. In total 90% of the respondents believed TKR should be part of the Explicit Health Guarantees (Garantías Explícitas de Salud, GES, in Spanish) program, with no differences in terms of YOEs. A total of 81% used the posterior-stabilized (PS) system, 96% performed a medial parapatellar approach, 82% used an extramedullary tibial guide, 41% tended to replace the patella, and 35% did not use a tourniquet (none of the variables showed differences according to YOEs). Only 31% used vacuum cementation (with a higher frequency in the group with fewer than 10 YOEs), 95% placed cement on components and bone, 75% placed it in the keel, and 56% used finger packing (only 22% with a gun). The most common cementation sequence was tibia femur-patella. In most aspects evaluated, we observed important differences compared with studies from other countries. CONCLUSION There is a high variability in the performance of TKR in Chile, with different trends compared with those of other countries. Overall, there are no major differences in the surgical technique concerning YOEs, although there is variation in the cementation technique and the use of robotic systems

Experiencia quirúrgica en el Centro Especializado en Tratamiento de Enfermedades de la Piel (CETEP) del Centro Hospitalario Pereira Rossell, desde 1996 hasta 2019 / Surgical experience at the Specialized Center for the Treatment of Skin Diseases (CETEP) at Pereira Rossell Hospital from 1996 to 2019 / Experiência cirúrgica no Centro Especializado en el Tratamiento de Enfermedades de la Piel (CETEP) do Hospital Pereira Rossell no período 1996 - 2019

Los tumores cutáneos presentan una alta prevalencia en dermatología en el mundo, siendo los benignos más frecuentes que los malignos; sin embargo, estos últimos son más estudiados debido a su morbimortalidad. El objetivo principal de este estudio fue conocer los principales diagnósticos y técnicas quirúrgicas correspondientes desarrolladas en el Centro de Tratamiento de Enfermedades de la Piel (CETEP) entre 1996 y 2019, evaluando aspectos clínicos y demográficos. Se realizó un estudio retrospectivo y observacional que incluyó todo paciente con lesión cutánea y posterior resolución quirúrgica de la misma. En la muestra analizada (N 6.659) hubo un predominio del sexo femenino (68%) y la media de edad fue 53 ± 21 años. Los pacientes residían mayoritariamente en Montevideo (58%). Los tumores benignos fueron los más frecuentes (41%), seguidos de los malignos (28%), dentro de éstos: carcinoma basocelular (CBC) 66%, carcinoma espinocelular (CEC) 21% y melanoma (MM) 5%. Las técnicas quirúrgicas realizadas fueron cirugías convencionales (57%), principalmente losange (93%), seguidas de procedimientos de cirugía dermatológica (42%), predominando biopsias (52%) y afeitado con electrocoagulación (23%). Se destaca que el CETEP resolvió un número mayor de pacientes de centros externos que del propio Centro Hospitalario Pereira Rossell (CHPR): 59% no CHPR vs 41% CHPR. En conclusión, este trabajo proporcionó información nacional sobre la epidemiología de distintos tumores cutáneos, así como las técnicas quirúrgicas más utilizadas en su resolución. Además, estableció la importancia de la cirugía dermatológica y la capacidad del CETEP en dar respuesta a pacientes propios tanto como referenciados desde otros centros del sistema público.

Cutaneous tumors have a high prevalence in dermatology worldwide, with benign tumors being more common than malignant ones. Nevertheless, the latter are more extensively studied due to their associated morbidity and mortality. The main objective of this study was to identify the primary diagnoses and corresponding surgical techniques developed at the Center for the Treatment of Skin Diseases (CETEP) between 1996 and 2019, while assessing clinical and demographic aspects. A retrospective, observational study was conducted, including all patients with cutaneous lesions and subsequent surgical resolution of the same. In the analyzed sample (N 6659), there was a predominance of females (68%), and the mean age was 53 ± 21 years. The majority of patients resided in Montevideo (58%). Benign tumors were the most prevalent (41%), followed by malignant tumors (28%), with the latter comprising basal cell carcinoma (BCC) at 66%, squamous cell carcinoma (SCC) at 21%, and melanoma (MM) at 5%. The performed surgical techniques included conventional surgeries (57%), primarily using the lozenge method (93%), followed by dermatologic surgery procedures (42%), with a predominance of biopsies (52%) and shave excision with electrocoagulation (23%). It is noteworthy that CETEP resolved a greater number of patients from external centers than from its own hospital, Pereira Rossell Hospital Center (CHPR). 59% non-CHPR vs. 41% CHPR. In conclusion, this study provided national information on the epidemiology of various cutaneous tumors, as well as the most commonly employed surgical techniques in their resolution Furthermore, it emphasized the importance of dermatologic surgery and highlighted the capacity of CETEP to respond to both its own patients and those referred from other centers within the public healthcare system.

Os tumores da pele apresentam alta prevalência na dermatologia em todo mundo, sendo os tumores benignos mais frequentes que os malignos, porém estes últimos são mais estudados devido à sua morbidade e mortalidade. O objetivo principal deste estudo foi conhecer os principais diagnósticos e correspondentes técnicas cirúrgicas desenvolvidas no Centro de Tratamento de Doenças da Pele (CETEP) no período 1996-2019, avaliando aspectos clínicos e demográficos. Foi realizado um estudo retrospectivo e observacional, que incluiu todos os pacientes com lesões cutâneas e com posterior tratamento cirúrgico. Foram estudados 659 pacientes com predomínio do sexo feminino (68%) e média de idade de 53 ± 21 anos. A maioria dos pacientes residiam em Montevidéu (58%). Os tumores benignos foram os mais frequentes (41%), seguidos dos tumores malignos (28%), entre estes: carcinoma basocelular (CBC) 66%, carcinoma espinocelular (CEC) 21% e melanoma (MM) 5%. As técnicas cirúrgicas realizadas foram cirurgias convencionais (57%), principalmente em forma de cunha (93%), seguidas de procedimentos cirúrgicos dermatológicos (42%), predominando biópsias (52%) e shaving com eletrocoagulação (23%). Destaca-se que o CETEP atendeu um número maior de pacientes de centros externos do que do próprio Centro Hospitalar Pereira Rossell (CHPR): 59% não-CHPR vs. 41% CHPR. Concluindo, este trabalho forneceu informações sobre a epidemiologia dos diferentes tumores de pele no país, bem como as técnicas cirúrgicas mais utilizadas no seu tratamento. Além disso, estabeleceu a importância da cirurgia dermatológica e a capacidade do CETEP de atender os pacientes do hospital e também os que foram encaminhados de outros centros da rede pública.

Influencia de los revestimientos dentales en la adaptación marginal e interna de las cofias metálicas. Estudio in vitro / Influence of dental investments on the marginal and internal adaptation of metal copings. In vitro study

Objetivo. Evaluar la influencia de diferentes marcas de revestimientos dentales en la adaptación marginal e interna de las cofias metálicas. Método. La investigación fue in vitro, analítico, experimental y transversal; para ello, se confeccionaron 48 cofias metálicas, las cuales fueron cementadas en dientes humanos previamente tallados, luego las cofias fueron cortadas mesio-distalmente para evaluar su adaptación. La adaptación fue evaluada usando un estereomicroscopio Leica DM6000M. Para determinar si hay diferencia en la adaptación marginal e interna se empleó el análisis de varianza, la prueba de comparación múltiple y la prueba de Duncan. Adicionalmente, la prueba de Fisher, se utilizó para evaluar la adaptación total. Resultados. La mejor adaptación marginal e interna de las cofias metálicas lo presenta el revestimiento Fórmula 1 (Whipmix), seguido del Castorit súper C (Dentaurum) y Bellasun (Bego). Conclusión. Los revestimientos dentales no mostraron influencia en la adaptación marginal; sin embargo, si mostraron influencia en la adaptación interna.

Objective. To evaluate the influence of different brands of dental investments on the marginal and internal adaptation of metal copings. Method. The research was in vitro, analytical, experimental and transversal. For this, 48 metal copings were made, which were cemented on previously carved human teeth, then the copings were cut mesio-distally to evaluate their adaptation. The adaptation was evaluated using a Leica DM6000M stereomicroscope. To determine if there is a difference between marginal and internal adaptation; the analysis of variance, the multiple comparison test and the Duncan test were used. Furthermore, Fisher's exact test was used to evaluate the total adaptation. Results. The best marginal and internal adaptation of metal copings is presented by the Formula 1 coating (Whipmix), followed by Castorit super C (Dentaurum) and Bellasun (Bego). Conclusion. Dental investments did not show influence on marginal adaptation; however, they did show influence on internal adaptation.

Comparación Morfométrica de Esqueletos Transparentados de Cuatro Especies de Roedores Myomorfos / Morphometric Comparison of Transparent Skeletons of Four Species of Myomorphic Rodents

Las técnicas de doble tinción y transparentación se han usado desde 1897, pero su utilidad ha sido poco explorada en los estudios anatómicos de micromamíferos adultos. No obstante, la combinación de estas técnicas con el análisis alométrico mutivariado posibilita el estudio de esqueletos poscraneales articulados de tales grupos de micromamíferos como los roedores, los cuales son muy limitados ya que casi siempre se enfocan en los cráneos. En este estudio, analizamos y comparamos la morfometría del esqueleto de Neotomodon alstoni con la de Meriones unguiculatus, Phodopus campbelli y Rattus norvegicus. Usamos la técnica de doble tinción y transparentación para analizar las relaciones morfométricas entre estos roedores utilizando sesenta caracteres esqueléticos. Se encontró que tres especies comparten dos correlaciones comunes y compartieron el mismo tipo de crecimiento isométrico en una de ellas; además se encontraron similitudes aparentes entre los patrones de la morfometría de P campbelli con el patrón de osificación descrito para la especie relacionada Mesocricetus auratus. Las diferencias en el crecimiento alométrico pueden representar también diferencias en el ritmo de desarrollo de acuerdo con el tipo de historia de vida de cada especie. Aquí demostramos que tanto la técnica de preparación como el método de análisis morfométricos son herramientas poderosas pero simples, para realizar estudios anatómicos y morfológicos en el laboratorio. Nuestros resultados reflejan las condiciones del desarrollo ontogenético derivados delpropio patrón de heterocronía para cada especie, y además representan la historia evolutiva de este grupo analizado. Sin embargo, consideramos que es deseable más investigación.

SUMMARY: Clearing and staining techniques have been present since 1897, However, their use in anatomical studies of adult micromammals has been limited. When using such techniques in combination with allometric method, it is possible to study articulated skeletons of micromammals, instead of relying only on the skulls, which is important in morphologically complicated groups as the rodents. Research involving multivariate allometric analysis of postcranial skeleton of rodents has been limited and confined to specific items. In this study, we analyzed and compared the morphometry of the skeleton of Neotomodon alstoni with that of Meriones unguiculatus, Phodopus campbelli and Rattus norvegicus. We applied the double staining and clearing technique in order to determine the morphometric relation between these rodents using sixty skeletal characters. We found that three species share two common correlations and one isometric, with apparent similarities between the morphometry patterns of P campbelli with the ossification pattern described for the related species Mesocricetus auratus. The differences in allometric growth could represent differences in the development stages according to the type of life history for each species. In this analysis we confirmed that both the preparation technique and morphometric analysis method, are simple yet verifiable tools for anatomical and morphological studies. Our results reflect the conditions of ontogenetic development derived from the heterochrony pattern for each species, representing the evolutionary history for this group. Therefore, as this approach continues to be discussed, ongoing research is warranted.

Usefulness and description of the intestinal bypass technique in children with short bowel syndrome: report of a Mexican cohort / Utilidad y descripción de la técnica de puenteo intestinal en niños con síndrome de intestino corto: reporte de una cohorte en México

Abstract Background: Short bowel syndrome (SBS) is one of the most frequent causes of intestinal failure, needing parenteral nutrition to maintain an energy-protein and water-electrolyte balance. At the Hospital Infantil de México Federico Gómez (HIMFG), the formation of two stomas is a technique used for intestinal rehabilitation, where the use of residue through the bypass technique (BT) helps to maintain gastrointestinal functionality, water-electrolyte, and nutritional stability. This study aimed to describe the technique of using intestinal residue through BT as a treatment strategy in intestinal rehabilitation and its effect on the biochemical and nutritional status of pediatric patients with SBS. Methods: An analytical and retrospective cross-sectional study was performed in patients hospitalized at HIMFG with SBS who underwent BT during their hospital stay between 2019 and 2020 and then followed up for 8 weeks. Results: A total of 10 patients were included in this study, with a mean age of 24 months; 50% were female. BT was able to reduce the inflammatory process in the liver caused by the continuous use of parenteral nutrition; enteral caloric intake increased from 25.32 kcal/kg/day to 72.94 kcal/kg/day, but it was insufficient to improve their nutritional status. Conclusions: BT is a safe and effective alternative in intestinal rehabilitation in patients with SBS to stimulate trophism and intestinal functionality, allowing a progression of enteral feeding and a decrease in the hepatic inflammatory process that occurs in these patients with prolonged parenteral nutrition.

Resumen Introducción: El síndrome de intestino corto (SIC) es una de las causas más frecuentes de insuficiencia intestinal que requiere del uso de nutrición parenteral para mantener un balance energético-proteico e hidroelectrolítico. En el Hospital Infantil de México Federico Gómez (HIMFG) la formación de dos estomas es una técnica empleada para la rehabilitación intestinal, donde con el aprovechamiento de residuo mediante la técnica de puenteo (TP) se ayuda a mantener la funcionalidad gastrointestinal, equilibrio hidro-electrolítico y estabilidad nutricional. El objetivo de este estudio fue describir la técnica del aprovechamiento de residuo intestinal mediante TP como estrategia de tratamiento en la rehabilitación intestinal y su efecto en el estado bioquímico y nutricional de pacientes pediátricos con SIC. Métodos: Se llevó a cabo un estudio transversal analítico y retrospectivo en pacientes hospitalizados en el HIMFG con SIC en quienes se realizó la TP durante su estancia intrahospitalaria entre 2019 y 2020. Resultados: Se incluyeron 10 pacientes en este estudio, con una edad promedio de 24 meses, y el 50% de sexo femenino. La TP logró disminuir el proceso inflamatorio hepático ocasionado por el uso continuo de nutrición parenteral; la ingesta calórica por vía enteral incrementó de 25.32 kcal/kg/día a 72.94 kcal/kg/día, pero fue insuficiente para mejorar el estado nutricional. Conclusiones: La TP es una alternativa segura y efectiva en la rehabilitación intestinal en pacientes con SIC para estimular el trofismo y funcionalidad intestinal, permitiendo una progresión de la alimentación enteral y disminución del proceso inflamatorio hepático que se presentan en estos pacientes con nutrición parenteral prolongada.

Comparación de la microdureza de resina compuesta con técnica índex convencional y modificada con cubeta impresa en dos tiempos de fotopolimerizado / Comparison of the microhardness of composite resin with conventional and modified index techniques with printed cuvette in two light-curing times / Comparação da microdureza da resina composta com a técnica de índice convencional e modificada com moldeira impressa em dois tempos de fotopolimerização

RESUMEN Objetivo : Comparar la microdureza de la resina compuesta con técnica índex convencional y modificada con cubeta impresa en dos fotopolimerizaciones. Materiales y métodos : Se contó con seis grupos de estudio de acuerdo a la técnica y a la cantidad de fotopolimerizaciones: técnica directa con una fotopolimerización (D1F), directa con dos fotopolimerizaciones (D2F), índex convencional con una fotopolimerización (IC1F), índex convencional con dos fotopolimerizaciones (IC2F), índex modificada con una fotopolimerización (IM1F), índex modificada con dos fotopolimerizaciones (IM2F). Se utilizaron quince muestras por cada grupo. Las muestras tuvieron dimensiones de 2 mm de altura por 5 mm de diámetro. Se realizó la fotopolimerización siguiendo las indicaciones del grupo al que corresponde, para luego someter a la prueba de dureza de Vickers a tres indentaciones por cada cara con carga de 200 g por 15 segundos. Se realizaron dos registros de microdureza, una superficial y otra a 2 mm. Se recolectaron los datos en el instrumento confeccionado y fueron procesados mediante SPSS v. 26. Resultados : Existe una diferencia significativa entre los grupos de microdureza superficial de primera fotopolimerización (p < 0,001); y también existe diferencia significativa entre los grupos de microdureza a 2 mm de primera fotopolimerización (p < 0,001). Asimismo, no existen diferencias significativas entre los grupos de microdureza superficial de segunda fotopolimerización (p = 0,519) ni en los grupos de microdureza a 2 mm de segunda fotopolimerización (p = 0,279). Conclusiones: No existen diferencias significativas en la microdureza superficial y a 2 mm de profundidad con técnica índex convencional y modificada en cubeta impresa en dos fotopolimerizaciones.

ABSTRACT Objective : To compare the microhardness of composite resin with conventional and modified index techniques with a printed tray in two light cures. Materials and methods : There were six study groups according to the technique and the number of photopolymerizations: direct technique with one photopolymerization (D1F), direct with two photopolymerizations (D2F), conventional index with one photopolymerization (IC1F), conventional index with two photopolymerizations (IC2F), modified index with one photopolymerization (IM1F), modified index with two photopolymerizations (IM2F). Fifteen samples were used for each group. The samples had dimensions of 2 mm in height by 5 mm in diameter. The photopolymerization was performed following the indications of the group to which it corresponds and then subjected to the Vickers hardness test with three indentations on each side with a load of 200 g for 15 seconds. Two microhardness recordings were made, one superficial and the other at 2 mm. Results : There is a significant difference between the first light-curing surface microhardness groups (p < 0.001), and there is also a significant difference between the first light-curing 2 mm microhardness groups (p < 0.001). Likewise, there are no significant differences between the second light-curing surface microhardness groups (p = 0.519) or the second light-curing 2 mm microhardness groups (p = 0.279). Conclusions : There are no significant differences in surface microhardness and microhardness at 2 mm depth with conventional and modified index techniques in printed trays in two photopolymerizations.

RESUMO Objetivo : Comparar a microdureza da resina composta com a técnica de índice convencional e modificada com moldeira impressa em duas fotopolimerizações. Materiais e métodos : Foram constituídos seis grupos de estudo de acordo com a técnica e o número de ciclos de fotopolimerização: técnica direta com um ciclo de fotopolimerização (D1F), direta com dois ciclos de fotopolimerização (D2F), índice convencional com um ciclo de fotopolimerização (IC1F), índice convencional com dois ciclos de fotopolimerização (IC2F), índice modificado com um ciclo de fotopolimerização (IM1F), índice modificado com dois ciclos de fotopolimerização (IM2F). Foram utilizadas quinze amostras para cada grupo. Os espécimes tinham 2 mm de altura por 5 mm de diâmetro. A fotopolimerização foi efetuada de acordo com as indicações do grupo a que corresponde, e depois submetida ao teste de dureza Vickers com três indentações de cada lado com uma carga de 200 g durante 15 segundos. Foram efetuados dois registos de microdureza, um superficial e outro a 2 mm. Os dados foram recolhidos no instrumento e processados utilizando o SPSS v. 26. Resultados : Há uma diferença significativa entre os primeiros grupos de microdureza superficial fotopolimerizável (p < 0,001); e há também uma diferença significativa entre os primeiros grupos de microdureza de 2 mm fotopolimerizável (p < 0,001). Da mesma forma, não há diferença significativa entre os grupos de microdureza da superfície do segundo fotopolimerizador (p = 0,519) e nos grupos de microdureza de 2 mm do segundo fotopolimerizador (p = 0,279). Conclusões : Não existem diferenças significativas na microdureza da superfície e na microdureza a 2 mm de profundidade com a técnica de índice convencional e modificada em duas fotopolimerizações.

Impresiones digitales dentales con escáneres intraorales: una revisión de la literatura / Dental digital impressions with intraoral scanners: a review of the literature / Impressões digitais dentárias com scanners intraorais: uma revisão da literatura

RESUMEN El diseño asistido por computadora y la fabricación asistida por ordenador (CAD-CAM, por sus siglas en inglés) se ha aplicado en odontología para la confección y el análisis de diversos tratamientos dentales. Inicia con la captura de imágenes a través de escáneres intraorales, contando con diversos tipos de softwares y sistemas de exportación de imágenes y tecnología. Las ventajas de este flujo de trabajo digital son el mejor ajuste, el empleo de menor tiempo clínico y la celeridad en tratamientos dentales, además de que brinda una mayor practicidad en el uso de los cirujanos dentistas. La precisión que brinda es clínicamente aceptable en comparación con los métodos convencionales, por lo cual existe suficiente evidencia para su validez; sin embargo, se debe tener en cuenta que diversos factores pueden alterar el resultado, como la experiencia del operador, el tipo de escáner, el tipo de software, la actualización del software, el principio de escaneo del escáner, el ambiente, la secuencia de escaneo y las estructuras bucales. El presente artículo de revisión tiene como objetivo analizar la literatura sobre las diferentes características y propiedades que presentan los escáneres intraorales en la actualidad, así como la evidencia de los posibles beneficios y la precisión de las técnicas de impresión digital frente a las técnicas de impresión convencionales.

ABSTRACT Computer-aided design and computer-aided manufacturing (CAD-CAM) has been applied in dentistry for the preparation and analysis of various dental treatments. It starts with capturing images through intraoral scanners, having different types of software and image export systems and technology. The advantages of this digital workflow are the following: better adjustment, shorter clinical time, and speed in dental treatments, in addition to providing greater practicality for dental surgeons. The accuracy he provide is clinically acceptable in comparison with conventional methods, so there is sufficient evidence for their validity; however, it should be taken into account that several factors can alter the result, such as the operator's experience, the type of scanner, the type of software, the software update, the scanning principle of the scanner, the environment, the scanning sequence, and the oral structures. The present review article aims to analyze the literature on the different characteristics and properties that intraoral scanners present today and the evidence of the potential benefits and accuracy of digital impression techniques versus conventional impression techniques.

RESUMO O desenho assistido por computador e o fabrico assistido por computador (CAD-CAM) têm sido aplicados na medicina dentária para a preparação e análise de vários tratamentos dentários. Começa com a captura de imagens através de scanners intraorais, com vários tipos de software e sistemas e tecnologia de exportação de imagens. As vantagens deste fluxo de trabalho digital são as seguintes: melhor ajuste, menor tempo clínico, rapidez nos tratamentos dentários, além de proporcionar maior praticidade no uso dos cirurgiões-dentistas. A precisão que proporcionam é clinicamente aceitável quando comparada com os métodos convencionais, pelo que existem evidências suficientes para a sua validade; no entanto, deve ter-se em conta que vários fatores podem alterar o resultado, tais como a experiência do operador, o tipo de scanner, o tipo de software, a atualização do software, o princípio de digitalização do scanner, o ambiente, a sequência de digitalização e as estruturas orais. Este artigo de revisão tem como objetivo analisar a literatura sobre as diferentes características e propriedades dos scanners intraorais atuais, bem como a evidência dos potenciais benefícios e precisão das técnicas de moldagem digital em comparação com as técnicas de moldagem convencionais.

Rehabilitation of geriatric burn patient post-meek micrograft with bilateral partial calcanectomy: A case report

@#Looking along the physiological and physical changes in aging, in the light of a major burn, co-morbidities, surgical intervention and precaution, a geriatric burn patient requires a delicate balance of ideal burn care and rehabilitation to achieve functional independence. A 70-year-old patient, with 30% total body surface area flame burn injury, underwent bilateral partial calcanectomy secondary to calcaneus osteomyelitis, and Meek micrograft technique for burn injury on bilateral lower extremities, is presented in this case report. In order to ensure good graft take, her knees were immobilized causing bilateral soft tissue contractures. Subsequently, upon initiation of ambulation, gait abnormalities observed include absence of heel off and toe off, with heel walking. The patient was admitted for intensive inpatient rehabilitation, where significant improvement in the knee range of motion and ambulation were achieved. The patient was eventually discharged ambulatory with walker. Despite expected complications, rehabilitation management proved to be beneficial in improving function and ambulation in geriatric burn patient.

Retrospective analysis and comparison of total internal disability preservation technique and standardized reconstruction technique / 中国骨伤

OBJECTIVE@#To investigate the efficacy and clinical results of total internal protection technique in anterior cruciate ligament reconstruction.@*METHODS@#A total of 56 patients undergoing anterior cruciate ligament reconstruction treated from January 2018 to December 2019 were selected. According to the different surgical methods, they were divided into total internal reconstruction group and standard bone tunnel group. There were 21 patients in the total internal reconstruction group, including 15 males and 6 females, aged from 20 to 48 with an average of (35.6±6.7) years old, and 35 patients in the standard tibial tunnel group, including 26 males and 9 females, aged 22 to 51 years old with an average of (33.7±9.6) years old. Preoperative examination of Lachman test was positive, magnetic resonance indicated anterior cruciate ligament rupture. There were no significant differences between the two groups in age, sex, body mass index, time from injury to ACL reconstruction, combined meniscus injury and operation method, operation time, ligament diameter, ligament length and other general information. Postoperative evaluation included operation duration, length and diameter of transplanted tendon after braid. International Knee Documentation Committee (IKDC) score, Lysholm score, Tegner score and perioperative complications 2 years after surgery.@*RESULTS@#Both groups were followed up, ranging from 24 to 30 months with an average of (26.9±3.4) months. Postoperative incision healing was good, and no failure or joint infection occurred at the last follow-up. There was no statistically significant difference between the two groups in IKDC score, Lysholm score and Tegner score before, 1 year and 2 years after surgery. However, IKDC score, Lysholm score and Tegner score at 1 year and 2 years after surgery.@*CONCLUSION@#The same postoperative function and stability of knee joint can be obtained by both the residual whole technique and the standardized reconstruction technique. In the residual whole group, only the semitendinosus muscle is taken, and the femoral thin muscle is retained, with greater tibial bone mass preserved, which is safe and effective in clinical practice.

Application of double-layer soft tissue suture closure technique in the surgical treat-ment of patients with mandible medication-related osteonecrosis of the jaw of early and medium stages / 北京大学学报(医学版)

Objective:To investigate the clinical application effect of double-layer soft tissue(DLST)suture closure technique in patients with mandible medication-related osteonecrosis of the jaw(MRONJ)of early and medium stages resulted in application of anti-bone-resorptive drugs.Methods:Early to me-dium stage mandible MRONJ patients who underwent surgical treatment in the fourth ward of Peking Uni-versity School and Hospital of Stomatology from October 2021 to September 2022 were included.Clinical information of the patients were collected,including primary disease,concomitant disease,medication regimen(drug type,duration of medication),MRONJ stage,clinical symptoms,imaging manifestations,etc.During surgery,after using marginal mandibulae resection to remove the necrotic bone,the wound was closed using DLST closure technique.Regular post-operative follow-up was performed to evaluate the therapeutic effect and complications of the DLST technique,the pain score and functional status of the patiens were evaluated.Results:This study totally included 13 patients,12 women and 1 man,aged(66.69±13.14)years.Seven patients had osteoporosis,2 had lung cancer,3 had breast cancer and 1 had prostate cancer among their primary diseases;7 had no concomitant diseases,2 had diabetes melli-tus,2 had cardiovascular disease and 1 had dry syndrome.Intravenous zoledronic acid were used in 9 patients,the average duration was(37.7±20.0)months,and other drugs,such as letrozole tablets were taken in 7 patients at the same time;Denosumab injection was used in 3 patients for an average of(10.3±11.9)months;Alendronate sodium tablets were taken in 5 patients for an average of(55.20± 27.20)months,and prednisone acetate tablets or acarbose tablets were taken to varying degrees in 2 pa-tients.The average post-operative follow-up was 11.9 months(9 to 17 months),and all the 13 patients were cured without complications,such as pus overflow and so forth.The pre-operative score of Karnof-sky performance status(KPS)in the patients was 68.46±14.05,and the post-operative score was 82.31±15.36,and the difference was statistically significant(P＜0.05).The pre-operative score of visual analogue scale(VAS)in the patients was 5.77±0.73 and the post-operative score was 0.38±0.51,and the difference had statistical significance(P＜0.001).Conclusion:The double-layer soft tissue suture closure technique can achieve good clinical results in patients with MRONJ of the man-dible using anti-bone-resorptive drugs alone,and can provide clinical treatment ideas for MRONJ patients with more complicated drug use.

Establishment of rapid detection method for zika virus based on direct amplification RT-PCR technique / 国际检验医学杂志

Objective To establish a rapid detection method for zika virus based on direct amplification re-al-time fluorescent quantitative reverse transcription polymerase chain reaction(RT-PCR)technique.Methods A direct amplification RT-PCR technique for the rapid detection of zika virus in 5 samples(whole blood,serum,saliva,throat swab and urine)was established by using a special function DNA polymerase and a preferred PCR enhancer.Results The detection limits of the 5 samples were 103 PFU/mL in serum,102 PFU/mL in urine,throat swab,and saliva,and 104 PFU/mL in whole blood.The coefficient of goodness-fit of stand-ard curves was above 0.98,and the amplification efficiency was 90％-110％.Zika virus nucleic acid was suc-cessfully amplified,but non-zika virus nucleic acid was not amplified.Based on the repeatable detection of sam-ples from urine,whole blood,and saliva,the variation coefficient of 6 repeated Ct values at 106 PFU/mL and 102 PFU/mL concentrations were all＜5％.The zika virus detection method established by the direct amplifi-cation RT-PCR technique was consistent with the detection results of conventional RT-PCR technique.Only two serum samples were detected in eight zika virus samples,and the remaining 62 non-zika virus samples and 12 negative samples were not amplified.Conclusion A rapid detection method for zika virus based on direct ampli-fication RT-PCR technique is successfully established.The method is simple,rapid,sensitive and specific.

Application of en-bloc Holmium laser enucleation of the prostate with an early apical mucosa dissection / 国际外科学杂志

Objective:To investigate the efficacy and safety of en-bloc Holmium laser enucleation of the prostate (HoLEP) with an early apical mucosa dissection technique for the treatment of benign prostate hyperplasia (BPH).Methods:The clinical data of 215 patients treated with HoLEP for BPH from January 2020 to January 2023 in the Department of Urology, Beijing Friendship Hospital, Capital Medical University were retrospectively analyzed. According to different treatment methods, the patients were divided into study group ( n=112) and control group ( n=103). Patients in the study group were treated by the en-bloc HoLEP with an early apical mucosa dissection technique, while patients in the control group were treated by the classical two or three-lobes HoLEP. The primary endpoints included the rates of urinary incontinence at 1-month, 3-month, and 6-month after surgery in two groups of patients. The secondary endpoints included operative time, hemoglobin decrease, dissected prostate weight, postoperative indwelling catheter time, postoperative hospital stay, and international prostate symptom score (IPSS), quality of life (QoL), Qmax, and postvoid residual urine (PVR) at 3-month and 6-month after surgery. The measurement data were tested by Shapiro-Wilk normality test. The normal distribution of the measurement data were expressed as mean ± standard deviation ( ± s), and independent sample t-test was used for comparison between two groups. Measurement data of skewness distribution were expressed as median (interquartile distance) [ M( Q1, Q3)], and Wilcoxon or Mann-Whitney U test were used for comparison between two groups. The count data in the two groups were compared by the Chi-square test. Results:The incidence of urinary incontinence in the study group was 9.0% (10/112) and 3.6% (4/112) at 1-month and 3-month after surgery, which was significantly lower than those in the control group [18.5% (19/103) and 11.7% (12/103)], and the differences were statistically significant ( P< 0.05). Urinary incontinence in two groups recovered completely 6-month after surgery. The operation time of the study group was (68.74±23.71) min, which was lower than that of the control group [(88.04±25.43) min], and the difference was statistically significant ( P<0.05). There were no significant differences in hemoglobin decrease, dissected prostate weight, postoperative indwelling catheter time, postoperative hospital stay in the two groups ( P> 0.05). The IPSS, QoL, Qmax and PVR of the two groups were significantly improved at 3-month and 6-month after surgery ( P< 0.05), but there was no significant difference between the two groups ( P> 0.05). Conclusion:En-bloc HoLEP with an early apical mucosa dissection technique is safe and reliable in treating BPH, and has advantages over classic HoLEP in terms of short-term urinary continence rates, shortening operation time.

Clinical application and perspectives of unilateral biportal endoscopic technique / 解放军医学杂志

Unilateral biportal endoscopic(UBE)technique is a minimally invasive spinal technique developed rapidly in recent years.Compared with traditional spinal endoscopy,the prominent feature of UBE is that it can open two channels on the same side of the spine,which can be used to provide visual field and insert operating instruments respectively,greatly expanding the operating space and reducing the difficulty of surgery.It has the advantages of less bleeding,little injury,quick recovery and mild pain,and has unique advantages in the treatment of lumbar spinal stenosis,lumbar disc herniation and other lumbar degenerative diseases.With the continuous in-depth exploration and development of the UBE technique,the field of diseases that can be treated by this technology has gradually expanded.It is not only limited to lumbar diseases,but also has made great progress in cervical and thoracic diseases,which has attracted the attention of many spinal surgeons.UBE technique has become one of the promising surgical methods for spinal-related diseases,but there are also complications such as incomplete decompression,nerve root and dural injury,epidural hematoma,relatively prolonged operation time,operation fatigue and other deficiencies.This paper summarizes the progress of the UBE technique,discusses its complications and deficiencies,proposes relevant solutions and possible future directions for its development,so as to provide reference for the clinical practice of UBE technique.

Applications of Biologically Oriented Preparation Technique in Prosthodontics / 昆明医科大学学报

The preparation edge of the tooth in oral restoration has always been the hot concern for dentists,and the improper preparation edge may lead to such diseases as caries and periodontitis,and ultimately lead to the restoration failure.The application of biologically oriented preparation technique has been proven to restore good periodontal soft and hard tissue morphology,which is expected to replace the traditional dental preparation methods.This article aims to comprehensively discuss the application of biologically oriented preparation technique in veneers,full crown and implantation.

Reference ranges of cardiac size and morphology for low-risk fetuses at 28-39 gestational weeks based on two-dimensional speckle tracking technique / 复旦学报（医学版）

Objective To construct reference ranges of cardiac size and morphologic parameters in low-risk fetuses at 28-39 gestational weeks using two-dimensional speckle tracking technique.Methods A prospective collection of 453 low-risk singleton pregnancies with echocardiography at Obstetrics and Gynecology Hospital,Fudan University was used to assess the size(length,width,and area)and morphology(sphericity index,i.e.,the ratio of length to width)of the fetal four-chamber view and two ventricles using two-dimensional speckle tracking technique.Repeated inter-and intra-observer agreement of measurements was assessed using the intraclass correlation coefficients(ICCs).Statistical analysis of cardiac measurement parameters was performed to establish reference ranges of values for cardiac size and morphology in low-risk fetuses.Results The inter-and intra-group ICCs for reproducibility tests of fetal cardiac parameters measurements were 0.691 to 0.980.Fetal four-chamber view and ventricular size increased with gestational week(all P<0.001),the end-diastolic length of the left ventricle was larger than that of the right ventricle,and the end-diastolic diameter was smaller than that of the right ventricle(both P<0.001),while there was no significant difference in the end-diastolic area of the two ventricles(P= 0.050).The spherical index of four-chamber view did not correlate with gestational week(P=0.811).The sphericity index of the basal and intermediate segments of the left ventricle was greater than that of the right ventricle,and the sphericity index of the apical segment was less than that of the right ventricle,the differences were statistically significant(all P<0.01).Conclusion The two-dimensional speckle tracking technique for measuring fetal cardiac parameters has good reproducibility.The reference ranges for cardiac size and morphology in low-risk fetuses developed in this study will be useful for prenatal evaluation of cardiac remodeling.

Advances of noninvasive imaging in bone age assessment / 中华实用儿科临床杂志

Bone age is an important index objectively reflecting the growth and development level of children and adolescents, as well as predicting growth potential.It plays a key role in various complicated situations involving clinical medicine, forensic and sports science.The wrist and the extremitas sternalis of clavicle are the most common sites for bone age assessment.Several techniques are available to evaluate bone age, including X-ray plain radiography, ultrasound, CT and magnetic resonance imaging.The accuracy and efficiency of bone age assessment have been continuously improved from traditional manual assessment to automatic assessment.This paper mainly reviews the advances in the techniques and methods for bone age assessment of the wrist and the extremitas sternalis of clavicle.