Comparison of Vertebral Artery Ultrasound, Magnetic Resonance Angiography and Digital Subtraction Angiography in the Diagnosis of Vertebral Artery Stenosis in Patients with Posterior Circulation Ischemia

SUMMARY: The aim of this study was to compare the clinical value of vertebral artery ultrasound (VAU), Magnetic Resonance Angiography (MRA) and Digital Subtraction Angiography (DSA) on vertebral artery stenosis in patients with posterior circulation ischemia. Seventy-three patients with posterior circulation ischemia underwent vertebral artery ultrasound and magnetic resonance angiography as well as digital subtraction angiography, and the diagnosis of vertebral artery stenosis (VAS) and the degree of stenosis (normal, mild stenosis, moderate stenosis, severe stenosis, and occlusion) were recorded and compared between digital subtraction angiogram and vertebral artery ultrasound and magnetic resonance angiography. The vertebral artery stenosis rates on digital subtraction angiography and vertebral artery ultrasound were 87.30 % (55/63) and 49.20 % (31/63), respectively, and the difference was statistically significant. The rates of vertebral artery stenosis on digital subtraction angiography and, magnetic resonance angiography was 90.38 % (47/52) and 88.46 % (46/ 52), respectively, and the differences was not statistically significant. The sensitivity, accuracy, negative predictive value, and positive predictive value of vertebral artery ultrasound in diagnosing vertebral artery stenosis were 51.35 %, 54.76 %, 18.18 %, and 95.00 %, respectively, lower than those of magnetic resonance angiography, which were 91.89 %, 90.48 %, 57.14 %, and 97.14 %, respectively. Of the noninvasive imaging techniques, vertebral artery ultrasound does not accurately characterize vertebral artery stenosis and its degree of stenosis. Magnetic resonance angiography effectively screens for vertebral artery stenosis and its degree of stenosis, and can be used as a reliable tool for vertebral artery stenosis in posterior circulation cerebral infarction, and can be used in conjunction with digital subtraction angiogram in order to improve diagnostic convenience and accuracy.

El objetivo de este estudio fue comparar el valor clínico de la ecografía de la arteria vertebral (VAU), la angiografía por resonancia magnética (ARM) y la angiografía por sustracción digital (DSA) en la estenosis de la arteria vertebral en pacientes con isquemia de la circulación posterior. A 73 pacientes con isquemia de la circulación posterior se les realizó una ecografía de la arteria vertebral y una angiografía por resonancia magnética, así como una angiografía por sustracción digital, y se les diagnosticó estenosis de la arteria vertebral (EVA) y el grado de estenosis (normal, estenosis leve, estenosis moderada, estenosis grave, y oclusión) se registraron y compararon la angiografía por sustracción digital y la ecografía de la arteria vertebral y la angiografía por resonancia magnética. Las tasas de estenosis de la arteria vertebral en la angiografía por sustracción digital y la ecografía de la arteria vertebral fueron del 87,30 % (55/63) y del 49,20 % (31/63), respectivamente, y la diferencia fue estadísticamente significativa. Las tasas de estenosis de la arteria vertebral en la angiografía por sustracción digital y la angiografía por resonancia magnética fueron del 90,38 % (47/52) y del 88,46 % (46/52), respectivamente, y las diferencias no fueron estadísticamente significativas. La sensibilidad, precisión, valor predictivo negativo y valor predictivo positivo de la ecografía de la arteria vertebral en el diagnóstico de estenosis de la arteria vertebral fueron 51,35 %, 54,76 %, 18,18 % y 95,00 %, respectivamente, inferiores a los de la angiografía por resonancia magnética, que fueron 91,89 %, 90,48 %, 57,14 % y 97,14 %, respectivamente. De las técnicas de imagen no invasivas, la ecografía de la arteria vertebral no caracteriza con precisión la estenosis de la arteria vertebral y su grado de estenosis. La angiografía por resonancia magnética detecta eficazmente la estenosis de la arteria vertebral y su grado de estenosis, y puede usarse como una herramienta confiable para la estenosis de la arteria vertebral en el infarto cerebral de circulación posterior, y puede ser utilizada junto con la angiografía por sustracción digital para mejorar el diagnóstico y la exactitud.

[Translated article] Closing wedge high tibial osteotomy: An old-fashioned technique? Survival, clinical and radiological outcomes of a case series analysis.

INTRODUCTION: Closing wedge high tibial osteotomy (CW-HTO) is a surgical option for active patients with medial knee pain and mild-moderate osteoarthritis with varus limb deformity. Despite its good reported results, this technique has been losing popularity. The aim of this study was to analyse the survival rate, clinical functional outcomes and radiological results of CW-HTO. METHODS: It is a retrospective case series study. Seventy patients with primary knee osteoarthritis, operated on between 2010 and 2020 in a single Spanish tertiary hospital using the CW-HTO technique and with a minimum follow-up of 2 years were analysed. RESULTS: Survival rate was 87.6% and 75.5% after a follow-up of 5 and 10 years respectively. Functional outcomes were good-to-excellent (KSS 77.7/100 and OKS 35.6/48) and good pain control (VAS 3.9/10) and high satisfaction (7.2/10) were achieved. Limb varus malalignment was significantly corrected (mean postoperative HKA angle 177.6° and MPTA 90.7°). However, 30% of patients presented hypocorrection, which was associated with inferior survival, functionality and satisfaction. CONCLUSION: CW-HTO technique can be useful for patients with knee osteoarthritis and varus limb. It allows to correct varus malalignment while achieving good-to-excellent functional outcomes, good pain control, high patient satisfaction and acceptable medium-long term survival rate. However, it is associated with a non-negligible risk of hypocorrection or medial hinge disruption.

Closing wedge high tibial osteotomy: An old-fashioned technique? Survival, clinical and radiological outcomes of a case series analysis. / Osteotomía de sustracción lateral tibial: ¿una técnica pasada de moda? Análisis de supervivencia, resultados clínicos y radiológicos de una serie de casos.

INTRODUCTION: Closing wedge high tibial osteotomy (CW-HTO) is a surgical option for active patients with medial knee pain and mild-moderate osteoarthritis with varus limb deformity. Despite its good reported results, this technique has been losing popularity. The aim of this study was to analyse the survival rate, clinical functional outcomes and radiological results of CW-HTO. METHODS: It is a retrospective case series study. Seventy patients with primary knee osteoarthritis, operated on between 2010 and 2020 in a single Spanish tertiary hospital using the CW-HTO technique and with a minimum follow-up of 2 years were analysed. RESULTS: Survival rate was 87,6% and 75,5% after a follow-up of 5 and 10 years respectively. Functional outcomes were good-to-excellent (KSS 77.7/100 and OKS 35.6/48) and good pain control (VAS 3.9/10) and high satisfaction (7.2/10) were achieved. Limb varus malalignment was significantly corrected (mean postoperative HKA angle 177,6° and MPTA 90,7°). However, 30% of patients presented hypocorrection, which was associated with inferior survival, functionality and satisfaction. CONCLUSION: CW-HTO technique can be useful for patients with knee osteoarthritis and varus limb. It allows to correct varus malalignment while achieving good-to-excellent functional outcomes, good pain control, high patient satisfaction and acceptable medium-long term survival rate. However, it is associated with a non-negligible risk of hypocorrection or medial hinge disruption.

Actualización de la osteotomía tibial en el genu varo / Update on tibial osteotomy in genu varum

La osteoartrosis en el compartimento medial de la rodilla es una causa frecuente de dolor cróni-co e impotencia funcional en nuestro medio. Los tratamientos clínicamente efectivos incluyen el tratamiento conservador, la artroplastia unicom-partimental y la osteotomía. Si bien la prótesis unicompartimental puede ser una buena elección en determinados casos, para pacientes jóvenes con una mala alineación de los miembros inferiores se prefieren las osteotomías alrededor de la rodilla con el propósito de redistribuir el eje de carga. Las osteotomías son variadas dependiendo del grado de deformidad y su localización. La más utilizada en la actualidad es la osteotomía tibial valguizan-te, debido a que la mayoría de genu varo artrósico está causada por una deformidad en tibia. Dentro de las osteotomías valguizantes de tibia podemos encontrar: la osteotomía de adición medial, la de sustracción lateral y la osteotomía tridimensional. (AU)

Medial comparment osteoarthritis of the knee is a frequent cause of chronic pain and disability in our environment. Clinically effective treatments include conservative treatment, unicompartmental arthroplasty and osteotomy. Although the unicom-partmental arthroplasty may be a good choice in certain cases, for young patients with lower limb malalingment, osteotomies around the knee are preferred, for the purpose of redistributing the me-chanical axis. Osteotomies are varied depending on the degree of deformity and its location. Valgus tibial osteotomy is the most commonly used, due to the mayority of genu varus arthritis is caused by a tibial deformity. Within the valgus tibial osteoto-mies, we can find: medial opening wedge, lateral closing wedge and tridimensional osteotomy. (AU)

Actualización de la osteotomía tibial en el genu varo / Update on tibial osteotomy in genu varum

La osteoartrosis en el compartimento medial de la rodilla es una causa frecuente de dolor cróni-co e impotencia funcional en nuestro medio. Los tratamientos clínicamente efectivos incluyen el tratamiento conservador, la artroplastia unicom-partimental y la osteotomía. Si bien la prótesis unicompartimental puede ser una buena elección en determinados casos, para pacientes jóvenes con una mala alineación de los miembros inferiores se prefieren las osteotomías alrededor de la rodilla con el propósito de redistribuir el eje de carga. Las osteotomías son variadas dependiendo del grado de deformidad y su localización. La más utilizada en la actualidad es la osteotomía tibial valguizan-te, debido a que la mayoría de genu varo artrósico está causada por una deformidad en tibia. Dentro de las osteotomías valguizantes de tibia podemos encontrar: la osteotomía de adición medial, la de sustracción lateral y la osteotomía tridimensional. (AU)

Medial comparment osteoarthritis of the knee is a frequent cause of chronic pain and disability in our environment. Clinically effective treatments include conservative treatment, unicompartmental arthroplasty and osteotomy. Although the unicom-partmental arthroplasty may be a good choice in certain cases, for young patients with lower limb malalingment, osteotomies around the knee are preferred, for the purpose of redistributing the me-chanical axis. Osteotomies are varied depending on the degree of deformity and its location. Valgus tibial osteotomy is the most commonly used, due to the mayority of genu varus arthritis is caused by a tibial deformity. Within the valgus tibial osteoto-mies, we can find: medial opening wedge, lateral closing wedge and tridimensional osteotomy. (AU)

Comparison between carotid ultrasound and digital subtraction angiography in the diagnosis of carotid artery stenosis in patients with cerebral infarction / Comparación entre la ecografía carotídea y la angiografía por sustracción digital en el diagnostic de estenosis de la arteria carótida en pacientes con infarto cerebral

SUMMARY: This study aimed to compare the clinical value of carotid ultrasound and digital subtraction angiography (DSA) for carotid artery stenosis in patients with cerebral infarction. Sixty patients with cerebral infarction underwent carotid ultrasound and DSA. Carotid artery stenosis, degree of stenosis (mild, moderate, severe, and occlusion), and carotid artery plaques were recorded and compared. Carotid stenosis rate was 96.67 % (58/60) and 91.67 % (55/60) on DSA and carotid ultrasound, respectively, and the difference was not statistically significant. Mild, moderate, and severe carotid artery stenosis and occlusion were diagnosed in 35, 28, 20, and 17 arteries, respectively, with DSA, and in 39, 25, 10, and 9 arteries, respectively, with carotid ultrasound. There was a statistically significant difference in the degree of carotid stenosis between the two methods (p<0.05). The kappa value of carotid plaques detected by carotid ultrasound and DSA was 0.776, indicating good consistency. Both carotid ultrasound and DSA are effective for screening carotid artery stenosis and carotid atherosclerotic plaques. While carotid ultrasound is faster and more convenient, DSA can more accurately detect the degree of stenosis and presence of occlusion. Thus, our recommendation is a combination of carotid ultrasound and DSA in clinical settings to improve the convenience and accuracy of diagnosis.

Este estudio tuvo como objetivo comparar el valor clínico de la ecografía carotídea y la angiografía por sustracción digital (DSA) para la estenosis de la arteria carótida en pacientes con infarto cerebral. Sesenta pacientes con infarto cerebral fueron sometidos a ecografía carotídea y DSA. Se registraron y compararon la estenosis de la arteria carótida, el grado de estenosis (leve, moderada, grave y oclusión) y las placas de la arteria carótida. La tasa de estenosis carotídea fue del 96,67 % (58/60) y del 91,67 % (55/60) en DSA y ecografía carotídea, respectivamente, y la diferencia no fue estadísticamente significativa. Se diagnosticaron estenosis y oclusión de la arteria carótida leve, moderada y grave en 35, 28, 20 y 17 arterias, respectivamente, con DSA, y en 39, 25, 10 y 9 arterias, respectivamente, con ecografía carotídea. Hubo una diferencia estadísticamente significativa en el grado de estenosis carotídea entre los dos métodos (p<0,05). El valor kappa de las placas carotídeas detectadas por ecografía carotídea y DSA fue de 0,776, lo que indica una buena consistencia. Tanto la ecografía carotídea como la DSA son eficaces para detectar la estenosis de la arteria carótida y las placas ateroscleróticas carotídeas. Si bien la ecografía carotídea es más rápida y conveniente, la DSA puede detectar con mayor precisión el grado de estenosis y la presencia de oclusión. Por lo tanto, nuestra recomendación es una combinación de ecografía carotídea y DSA en entornos clínicos para mejorar la conveniencia y precisión del diagnóstico.

Sistemas de instrumentación espinal en la corrección de la cifosis toracolumbar por espondilitisanquilopoyética / Spinal Instrumentation Systems in The Correction of Thoracolumbar Kyphosis Due to AnkylosingSpondylitis

Introducción: En pocas áreas de la cirugía ortopédica se han producido cambios técnicos tan importantes en las últimas décadas como en la cirugía correctora espinal. Los cambios fundamentales han sobrevenido con los nuevos sistemas de instrumentación espinal, que se han modificado y mejorado sustancialmente para facilitar la corrección tridimensional de la deformidad y aportar fijación segura de la columna, corrección y estabilidad. Objetivo: Evaluar los resultados alcanzados con los sistemas de instrumentación espinal utilizados en la corrección de la cifosis toracolumbar por espondilitis anquilopoyética. Método: Se realizó un estudio tipo descriptivo, retrospectivo y longitudinal a 16 pacientes con cifosis toracolumbar por espondilitis anquilopoyética intervenidos con la técnica de osteotomía de sustracción pedicular e instrumentados con sistemas pediculares y sublaminar tipo Luque, en el servicio de Ortopedia del Hospital Clínico Quirúrgico Hermanos Ameijeiras, durante el período comprendido entre marzo de 2001 y marzo de 2021. Resultados: La totalidad de los pacientes correspondieron al sexo masculino, color de la piel blanca y edad promedio de 39 años. Se logró más del 80 por ciento de corrección en el perfil sagital y un promedio de 34,3° por osteotomía, sin complicaciones neurológicas mayores. Se obtuvo un buen resultado funcional, con un alto grado de satisfacción de los pacientes y mejora de su calidad de vida. Conclusiones: La utilización de ambos sistemas instrumentación espinal es eficaz para mantener la corrección de la cifosis toracolumbar por espondilitis anquilopoyética(AU)

Introduction: Few areas of orthopedic surgery have had such important technical changes in recent decades as in corrective spinal surgery. Fundamental changes have come with the new spinal instrumentation systems, which have been substantially modified and improved to facilitate three-dimensional correction of the deformity and provide secure spinal fixation, correction and stability. Objective: To evaluate the results achieved with the spinal instrumentation systems used in the correction of thoracolumbar kyphosis due to ankylosing spondylitis. Methods: A descriptive, retrospective and longitudinal study was carried out on 16 patients with thoracolumbar kyphosis due to ankylosing spondylitis operated on with the pedicle subtraction osteotomy technique and instrumented with Luque-type pedicle and sublaminar systems, in the Orthopedics service at Hermanos Ameijeiras Surgical Clinical Hospital, from March 2001 to March 2021. Results: All the patients were male, white skin color and average age of 39 years. More than 80 percent correction was achieved in the sagittal profile and an average of 34.3° per osteotomy, without major neurological complications. Good functional results were obtained, with high degree of patient satisfaction and improvement in their quality of life. Conclusions: The use of both spinal instrumentation systems is effective in maintaining the correction of thoracolumbar kyphosis due to ankylosing spondylitis(AU)

Angioplasty with a stent retriever to treat vasospasm secondary to subarachnoid hemorrhage due to an aneurysm: a multicenter study of safety and efficacy.

OBJECTIVE: To determine the safety and efficacy of angioplasty with a retrievable stent in treating vasospasm secondary to subarachnoid hemorrhage (SAH) due to an aneurysm. METHODS: We retrospectively analyzed prospectively collected data from consecutive patients undergoing endovascular angioplasty with a retrievable stent to treat vasospasm related to SAH due to an aneurysm in four neurointerventional radiology departments between January 2018 and July 2019. We included patients aged >18 years with vasospasm >50% of the internal carotid artery (ICA), anterior cerebral artery (ACA), and / or middle cerebral artery (MCA) secondary to SAH due to an aneurysm treated with endovascular angioplasty with a retrievable stent. The variables used to measure safety were complications of the procedure and clinical complications. The variables used to measure radiological efficacy were improvement in the degree of stenosis after endovascular treatment and improvement or normalization of cerebral circulation time CTT). RESULTS: We included 16 angioplasty procedures with retrievable stents in 13 patients, in which 33 arterial segments were treated (10 ICA, 15 MCA, and 8 ACA). We observed no complications of the procedure in any patients and no clinical complications in patients who were not intubated. All but one of the patients who had delayed CTT at the beginning of the procedure showed improvements in CTT. The mean improvement in the degree of stenosis was 18% ± 11.65% in the ICA, 30.67% ± 18.45% in the MCA, and 28.38% ± 15.49% in the ACA. No statistically significant associations were observed between endovascular treatment variables and the degree of improvement in stenosis. CONCLUSION: Angioplasty with a retrievable stent is a safe and efficacious treatment for vasospasm secondary to SAH due to an aneurysm, improving CTT and stenosis.

Angioplastia con stent recuperable como tratamiento del vasoespasmo secundario a la hemorragia subaracnoidea por aneurisma: un estudio multicéntrico de seguridad y eficacia / Angioplasty with a stent retriever to treat vasospasm secondary to subarachnoid hemorrhage due to an aneurysm: a multicenter study of safety and efficacy

Objetivo: El objetivo es informar de nuestro estudio multicéntrico de seguridad y eficacia acerca de la angioplastia con stent recuperable en el vasoespasmo secundario a la hemorragia subaracnoidea por aneurisma (HSAa). Métodos: Realizamos un análisis retrospectivo de una base de datos prospectiva de pacientes consecutivos sometidos a tratamiento endovascular mediante angioplastia con stent recuperable para el vasoespasmo relacionado con la HSAa en cuatro departamentos de neurorradiología intervencionista, entre enero de 2018 y julio de 2019. Incluimos a pacientes consecutivos mayores de 18 años con vasoespasmo mayor del 50% de la arteria carótida interna (ACI), la arteria cerebral anterior (ACA) y/o las arterias cerebrales medias (ACM) secundario a HSAa, tratado endovascularmente mediante angioplastia con stent recuperable. Las complicaciones del procedimiento y las complicaciones clínicas se registraron como variables de seguridad. Las variables de eficacia radiológica del procedimiento se definieron como la mejora en el porcentaje de estenosis después del tratamiento endovascular y la mejora o normalización del tiempo de circulación cerebral (TCC). Resultados: Incluimos 16 procedimientos de angioplastia con stent recuperable en 13 pacientes, con 33 segmentos arteriales tratados (10 ACI, 15 ACM y 8 ACA). No encontramos complicaciones de procedimiento en ningún paciente, ni complicaciones clínicas en pacientes no intubados. Todos los pacientes con TCC retrasado al principio del procedimiento, excepto uno, mostraron una mejora en el TCC. La mejora en el porcentaje de estenosis en la ACI fue de 18± 11,65 (media±DE), 30,67±18,45 en la ACM y 28,38±15,49 en la ACA. No encontramos ninguna asociación estadísticamente significativa entre las variables de tratamiento endovascular y la mejora en el porcentaje de estenosis.(AU)

Objective: To determine the safety and efficacy of angioplasty with a retrievable stent in treating vasospasm secondary to subarachnoid hemorrhage (SAH) due to an aneurysm. Methods: We retrospectively analyzed prospectively collected data from consecutive patients undergoing endovascular angioplasty with a retrievable stent to treat vasospasm related to SAH due to an aneurysm in four neurointerventional radiology departments between January 2018 and July 2019. We included patients aged>18 years with vasospasm>50% of the internal carotid artery (ICA), anterior cerebral artery (ACA), and / or middle cerebral artery (MCA) secondary to SAH due to an aneurysm treated with endovascular angioplasty with a retrievable stent. The variables used to measure safety were complications of the procedure and clinical complications. The variables used to measure radiological efficacy were improvement in the degree of stenosis after endovascular treatment and improvement or normalization of cerebral circulation time CTT). Results: We included 16 angioplasty procedures with retrievable stents in 13 patients, in which 33 arterial segments were treated (10 ICA, 15 MCA, and 8 ACA). We observed no complications of the procedure in any patients and no clinical complications in patients who were not intubated. All but one of the patients who had delayed CTT at the beginning of the procedure showed improvements in CTT. The mean improvement in the degree of stenosis was 18%±11.65% in the ICA, 30.67%±18.45% in the MCA, and 28.38%±15.49% in the ACA. No statistically significant associations were observed between endovascular treatment variables and the degree of improvement in stenosis. Conclusion: Angioplasty with a retrievable stent is a safe and efficacious treatment for vasospasm secondary to SAH due to an aneurysm, improving CTT and stenosis.(AU)

Anomalous location of intracranial vessels in adults.

Anomalous intracranial vessels are not uncommon, and this finding is not always associated with arteriovenous malformations. Other conditions such as anomalous connections between arteries or phlebitc patterns can also present as vessels with abnormal intracranial locations. Noninvasive diagnosis is important to determine whether to do more invasive tests such as cerebral digital subtraction angiography or to estimate the risk of bleeding in arteriovenous malformations and therefore to evaluate the need for endovascular/surgical treatment. In this paper, we present an algorithm for the differential diagnosis of anomalous intracranial vessels according to their location (intra/extra-axial) and function (whether the vessels are arterialized). Moreover, we analyze the important points of the angioarchitecture of the principal arteriovenous malformations with risk of intracranial bleeding, such as pial arteriovenous malformations and dural fistulas.

Vasos intracraneales en localización anómala en adultos / Anomalous location of intracranial vessels in adults

La detección de vasos anómalos a nivel intracraneal no es un hallazgo infrecuente y no siempre está asociada a la presencia de malformaciones arteriovenosas. Otras entidades como las conexiones arterioarteriales o un patrón flebítico también pueden presentarse como unos vasos en localización intracraneal anómala. El diagnóstico mediante pruebas no invasivas es importante para determinar la necesidad de realizar pruebas más cruentas como una angiografía cerebral por sustracción digital o para estimar el riesgo de sangrado en malformaciones arteriovenosas y, por tanto, evaluar la necesidad de tratamiento endovascular/quirúrgico. En este manuscrito presentamos un algoritmo de diagnóstico diferencial de la presencia de vasos anómalos intracraneales de acuerdo con su localización (intra/extraaxiales) y su funcionalidad (arterialización o no de dichos vasos). Asimismo, analizaremos los puntos importantes de la angioarquitectura de las principales malformaciones arteriovenosas con riesgo de sangrado intracraneal, como son las malformaciones arteriovenosas piales y las fístulas durales.(AU)

Anomalous intracranial vessels are not uncommon, and this finding is not always associated with arteriovenous malformations. Other conditions such as anomalous connections between arteries or phlebitc patterns can also present as vessels with abnormal intracranial locations. Noninvasive diagnosis is important to determine whether to do more invasive tests such as cerebral digital subtraction angiography or to estimate the risk of bleeding in arteriovenous malformations and therefore to evaluate the need for endovascular/surgical treatment. In this paper, we present an algorithm for the differential diagnosis of anomalous intracranial vessels according to their location (intra/extra-axial) and function (whether the vessels are arterialized). Moreover, we analyze the important points of the angioarchitecture of the principal arteriovenous malformations with risk of intracranial bleeding, such as pial arteriovenous malformations and dural fistulas.(AU)

Sustracción Radiográfica Digital de la Estructura Dentaria Removida Durante el Acceso Endodóntico En Incisivos Mandibulares

RESUMEN: El objetivo de este estudio fue comparar la estructura dentaria removida utilizando dos técnicas de acceso endodóntico diferentes en incisivos mandibulares. Treinta y cinco incisivos mandibulares extraídos fueron pesados individualmente con una balanza de precisión. Después de las radiografías iniciales tomadas por vestibular y proximal, los dientes fueron codificados y asignados aleatoriamente a dos grupos: acceso convencional (n = 17) o acceso incisal (n = 18). Luego se volvieron a pesar los dientes y se repitieron las radiografías. Las radiografías digitales se cargaron a un editor de imágenes (Adobe Photoshop) para la sustracción digital de las imágenes por las incidencias VP y MD. Dos observadores independientes y calibrados realizaron las mediciones de las áreas sustraídas. La concordancia inter-observador fue casi perfecta; coeficiente de correlación intraclase igual a 0,94 y 0,98 para las incidencias MD y VP, respectivamente. La prueba de Mann-Whitney encontró diferencias estadísticamente significativas entre los tipos de acc esos en cuanto a la diferencia mediana de los pesos (p = 0,0073) y el área VL (p = 0.0023). También encontró una diferencia estadísticamente significativa entre los tipos de acceso en cuanto al área MD (Prueba t de Welch, p < 0,001). La diferencia de peso fue menor para el acceso incisal que para el acceso convencional. El acceso incisal removió menos tejido dentario que el acceso convencional.

ABSTRACT: The aim of this study was to compare the area of tooth structure removed during two different endodontic access techniques in lower incisors. Thirty-two extracted lower incisors were weighed individually on a precision scale. After initial digital radiographs were taken from buccal and proximal, the teeth were coded and randomly assigned to two different groups: conventional access and incisal access. Once this stage was completed, each tooth was weighed again and 2 postoperative radiographs was taken again, buccal and proximal. Using an image processing software and digital subtraction technique, 2 independent and calibrated evaluators measured difference in tooth structure after access procedures. Interobserver agreement was almost perfect: intraclass correlation coefficient equal to 0,94 and 0,98 for proximal and buccal incidences, respectively. The Mann-Whitney test found statistically significant differences between the types of accesses in terms of weight difference (p = 0.0073) and area VL (p = 0.0023). Additionally, a statistically significant difference between the types of access in the MD area (Welch's t test, p <0.005) was observed. The difference in weight was less for incisal access than for conventional access with a statistically significant difference, in terms of MD and VL area, incisal access and areas of smaller size than conventional access.

Video analysis and 3d detection simulation of jump shot precision for basketball players / Análise de vídeo e simulação de detecção 3d da precisão do arremesso de jogadores de basquete / Análisis de video y simulación tridimensional de la precisión de lanzamiento de los jugadores de baloncesto

ABSTRACT With the rapid development and application of computer technology, the application of computer science knowledge in basketball is also more and more extensive. Based on genetic algorithm and the background subtraction method, video analysis and 3D detection simulation model of shot jump action precision were constructed in this study. According to the genetic algorithm search method, jump shot precision was analyzed, and the problems encountered in the actual shooting process of basketball players were studied and solved. The results show that this study is necessary and feasible.

RESUMO Com o rápido desenvolvimento e aplicação da tecnologia da computação, a aplicação do conhecimento da ciência da computação no basquete também vem crescendo cada vez mais. Com base no algoritmo genético e no método da subtração de fundo, construiu-se um modelo de análise de vídeo e simulação de detecção 3D para a precisão de arremesso. De acordo com o método de busca do algoritmo genético, analisou-se a precisão do arremesso, e os problemas encontrados no processo de arremesso dos jogadores de basquete foram estudados e resolvidos. Os resultados mostram que este estudo é necessário e viável.

RESUMEN Con el rápido desarrollo y aplicación de la tecnología de la computación, la aplicación del conocimiento de la ciencia de la computación en el baloncesto también viene creciendo cada vez más. Basándose en el algoritmo genético y en el método de la sustracción de fondo, se construyó un modelo de análisis de video y simulación de detección 3D para la precisión de lanzamiento. De acuerdo con el método de búsqueda del algoritmo genético, se analizó la precisión del lanzamiento, y los problemas encontrados en el proceso de lanzamiento de los jugadores de baloncesto fueron estudiados y resueltos. Los resultados muestran que este estudio es necesario y viable.

Angioplasty with a retrievable stent to treat vasospasm secondary to subarachnoid hemorrhage due to an aneurysm: a multicenter study of safety and efficacy. / Angioplastia con stent recuperable como tratamiento del vasoespasmo secundario a la hemorragia subaracnoidea por aneurisma: un estudio multicéntrico de seguridad y eficacia.

OBJECTIVE: To determine the safety and efficacy of angioplasty with a retrievable stent in treating vasospasm secondary to subarachnoid hemorrhage (SAH) due to an aneurysm. METHODS: We retrospectively analyzed prospectively collected data from consecutive patients undergoing endovascular angioplasty with a retrievable stent to treat vasospasm related to SAH due to an aneurysm in four neurointerventional radiology departments between January 2018 and July 2019. We included patients aged>18 years with vasospasm>50% of the internal carotid artery (ICA), anterior cerebral artery (ACA), and / or middle cerebral artery (MCA) secondary to SAH due to an aneurysm treated with endovascular angioplasty with a retrievable stent. The variables used to measure safety were complications of the procedure and clinical complications. The variables used to measure radiological efficacy were improvement in the degree of stenosis after endovascular treatment and improvement or normalization of cerebral circulation time CTT). RESULTS: We included 16 angioplasty procedures with retrievable stents in 13 patients, in which 33 arterial segments were treated (10 ICA, 15 MCA, and 8 ACA). We observed no complications of the procedure in any patients and no clinical complications in patients who were not intubated. All but one of the patients who had delayed CTT at the beginning of the procedure showed improvements in CTT. The mean improvement in the degree of stenosis was 18%±11.65% in the ICA, 30.67%±18.45% in the MCA, and 28.38%±15.49% in the ACA. No statistically significant associations were observed between endovascular treatment variables and the degree of improvement in stenosis. CONCLUSION: Angioplasty with a retrievable stent is a safe and efficacious treatment for vasospasm secondary to SAH due to an aneurysm, improving CTT and stenosis.

Usefulness of CT angiography for characterizing cerebral arteriovenous malformations presenting as hemorrhage: comparison with digital subtraction angiography. / Utilidad de la angio-TC para la caracterización de malformaciones arteriovenosas cerebrales con presentación hemorrágica comparada con la angiografía por sustracción digital.

OBJECTIVE: To compare the usefulness of CT angiography against the gold standard, digital subtraction angiography (DSA), in the characterization of cerebral arteriovenous malformations (AVM) that present with bleeding. MATERIAL AND METHODS: We retrospectively analyzed patients with intracranial bleeding due to an AVM who were included in a prospective database in the period comprising January 2007 through December 2012. We reviewed radiologic variables such as the characteristics of the AVM (size, location, presence of deep venous drainage), involvement of eloquent areas, and the presence of associated aneurysms. Two neuroradiologists blinded to clinical and radiological information analyzed the CT and DSA in consensus. RESULTS: A total of 22 patients were included in the study. CT angiography correctly classified 15 of the 16 cases of AVM measuring less than 3cm (93.75% sensitivity). All cases of deep venous drainage and all those located in eloquent areas were correctly detected (100% sensitivity). The presence of any type of aneurysm related with the AVM was detected in 13 of 15 cases (86.6% sensitivity); 7 of 9 of the intranidal aneurysms were detected (77.78% sensitivity), as were 6 of the 9 flow aneurysms (66.67% sensitivity). CONCLUSION: CT angiography is highly sensitive in the characterization of cerebral AVMs measuring less than 3cm, of those located in eloquent areas, and of those with deep venous drainage; it is also highly sensitive in detecting aneurysms related with AVMs. However, CT angiography is less sensitive in detecting intranidal and flow aneurysms related with AVMs.

Iatrogenic retinal central artery occlusion after a cerebral digital subtraction angiography. / Oclusión de la arteria central de la retina iatrogénica tras angiografía de sustracción digital cerebral.

Digital subtraction angiography (DSA) is a technique used in interventional radiology for the diagnosis of vascular cerebral conditions. Central retinal artery occlusion (CRAO) is a complication of endovascular procedures that involve atherosclerotic plaque removal with subsequent embolisation. The case is presented on a patient who noticed a sudden vision loss during a DSA. Funduscopy showed retinal pallor and a cherry red spot. The angiography showed a structure suggesting the presence of an embolus in the central retinal artery. The patient was diagnosed with a CRAO, and unsuccessfully treated with ocular massage, topical hypotensive drugs, oral acetazolamide, and anterior chamber paracentesis, with a final visual acuity of 0.05. Central retinal artery occlusion is a rare complication, but due to its poor prognosis, it must be considered when performing neuroradiological procedures such as DSA.

Uso Del Condón en Adolescentes Nahuas, un Modelo Explicativo.

En México, la población indígena supera los siete millones de habitantes, en Puebla el grupo más representativo es el Náhuatl. Sin embargo, las condiciones de vida, salud, educación y transporte son precarias para esta población. En los adolescentes, las responsabilidades como el matrimonio, la familia y los compromisos ante la comunidad, favorecen conductas de riesgo sexual que dificultan su desarrollo económico, social y reproductivo. El objetivo fue proponer un modelo explicativo del uso del condón en adolescentes nahuas. Método. Bajo el marco de la teoría social cognitiva, el concepto de valores culturales de Leininger y el proceso de la sustracción teórica, se desarrolló este artículo. Se muestran las relaciones del modelo con las proposiciones y los factores que influyen en el uso del condón para este grupo específico. Finalmente, el modelo explica las variables de interés, los niveles de abstracción y las relaciones entre sí en el contexto náhuatl. El siguiente paso será implementar los indicadores empíricos para conocer el grado de influencia de los factores personales y ambientales hacia el uso del condón en adolescentes nahuas. Resultados que aportarán información para el desarrollo del conocimiento en enfermería y la reducción de riesgo sexual de esta población.

Síndrome de Budd Chiari: revisión de tema / A Review of Budd Chiari Syndrome

El Síndrome de Budd-Chiari (SBC) es una entidad poco usual; su incidencia se calcula de uno en cien mil. Consiste en una obstrucción completa o parcial del flujo venoso localizada en cualquier lugar desde las pequeñas venas hepáticas hasta la porción suprahepática de la vena cava inferior. De acuerdo con su etiología puede clasificarse en: primario (cuando la obstrucción se debe a una enfermedad venosa), o secundario (cuando se atribuye a una compresión extrínseca o a la invasión por una lesión que se origina fuera de las venas como neoplasias o quistes). En la mayoría de los casos se presenta como un cuadro de inicio súbito de dolor abdominal, ascitis y hepatomegalia, pudiendo ser asintomático. El diagnóstico definitivo se establece por estudios de imagen; si bien deben solicitarse exámenes básicos de laboratorio y estudios de extensión. Las modalidades de imagen incluyen la ultrasonografía Doppler, la tomografía computarizada, la resonancia magnética y la angiografía por sustracción digital, que es considerada el patrón de oro. La primera medida terapéutica que debe emprenderse en estos pacientes es la anticoagulación con heparina de bajo peso molecular, seguida de antagonistas de vitamina K. La mayoría de los pacientes requieren un enfoque multidisciplinario y un tratamiento escalonado que incluye procedimientos radiológicos, como la aplicación de balones y stents y la inserción de shunts portosistémicos transyugulares intrahepáticos (TIPS), procedimientos quirúrgicos de descomprensión y, por último, trasplante hepático

Budd - Chiari Syndrome (BCS) is a rare entity whose incidence is estimated at one in one hundred thousand. It consists of complete or partial obstruction of venous outflow at any location from the small hepatic veins to the hepatic portion of the inferior vena cava. It can be classified according to its etiology into primary BCS when there is venous obstruction and secondary disease when obstruction is attributed to extrinsic compression or invasion due to a lesion outside of the veins such as neoplasms or cysts. In most cases it presents as sudden onset of abdominal pain, ascites and hepatomegaly, but it may be asymptomatic. A definitive diagnosis is established by imaging, but basic laboratory tests and other studies must also be done. Diagnostic imaging techniques include Doppler ultrasonography, computed tomography, magnetic resonance imaging and digital subtraction angiography. The latter is considered to be the gold standard. The first therapeutic measure to be undertaken for these patients is anticoagulation with low molecular weight heparin followed by vitamin K antagonists. Most patients require a multidisciplinary approach and step by step treatment including radiological procedures, balloon enteroscopy, stenting, transjugular intrahepatic portosystemic shunt (TIPS), decompression surgery and finally, liver transplantation

Resolução de problemas aritméticos: efeitos de ensino com uma balança virtual / Arithmetic problem solving: the effects of teaching with a virtual balance / Resolución de problemas aritméticos: el efectos de la enseñanza con una balanza virtual

Estudos da bibliografia têm demonstrado que grande parte das dificuldades de resolução de problemas aritméticos corresponde a aspectos de natureza específica, como a posição da incógnita nos problemas e a forma de apresentação dos problemas, e que a representação gráfica dos problemas pode contribuir para reduzir esse tipo de dificuldade. O software Arit-Fácil foi usado para avaliar os efeitos de um procedimento de ensino de problemas aritméticos de adição e de subtração com balanças virtuais sobre o desempenho na resolução de problemas nas formas de operação e de sentenças-problema. Os problemas apresentavam incógnitas nas posições a, b e c. Quarenta e oito alunos de 1ª série do Ensino Fundamental foram submetidos a um pré-teste, um procedimento de ensino com problemas na forma de balança virtual e a um pós-teste. Observou-se um aumento nas porcentagens de acertos dos participantes em sentenças-problema de adição com incógnitas nas três possíveis posições e nas subtrações com incógnita na posição c; e um aumento na porcentagem de acertos nas operações com incógnitas nas três possíveis posições, exceto nas operações de adição em que o desempenho inicial foi acima de 70%. Assim, pode-se concluir, o procedimento foi apropriado para que os participantes aprendessem a solucionar problemas aritméticos.(AU)

Bibliography studies have shown that most of the difficulties in arithmetic problem solving correspond to aspects of a specific nature, as the position of the unknown set and the form of presentation of the problems, and that the graphic representation of the problems can contribute to reduce this difficulty. The software Arit-Fácil was used to evaluate the effects of a procedure for teaching arithmetic problems of addition and subtraction with a virtual balance on the performance in solving problems in the forms of operation and word-problems. The problems presented unknown set in positions a, b and c. Fortyeight students of the fist grade of an elementary school underwent a pretest, a teaching procedure with problems in the form of virtual balance and a post-test. It was observed an increase in the percentage of correct responses on addition word-problems with unknown set in the three possible positions, and subtractions with the unknown set at the position c; and an increase in the percentage of correct responses in the resolution of operations with the unknown set at the three possible positions, except on addition operations in which the initial performance was above 70%. Thus, it was concluded that the procedure was appropriate for participants to learn how to solve arithmetic problems.(AU)

Los estudios de la literatura han demostrado que la mayoría de las dificultades en la resolución de problemas aritméticos corresponde a los aspectos de carácter específico, como la posición de la incógnita y la forma de presentación de los problemas, y que la representación gráfica de los problemas puede contribuir a reducir esta dificultad. El software Arit-fácil fue utilizado para evaluar los efectos de un procedimiento para la enseñanza de problemas aritméticos de suma y sustracción con una balanza virtual sobre el desempeño en la solución de problemas en las formas de operación y sentencias-problema. Los problemas presentaban incógnitas en las posiciones a, b y c. Cuarenta y ocho estudiantes del primero grado de una escuela primaria se sometió a un pre-test, un procedimiento de enseñanza con problemas en la forma de balanza virtual, y un pos-test. Se observó un aumento en el porcentaje de respuestas correctas en sentencias-problema de suma con incógnitas en las tres posiciones posibles y en sustracción con la posición de la incógnita en c; y un aumento en el porcentaje de respuestas correctas en la resolución de operaciones con incógnitas en las tres posiciones posibles, excepto en las operaciones de suma en los que el rendimiento inicial era superior al 70%. Por lo tanto, se puede concluir que el procedimiento fue apropiado para que los participantes aprendan a resolver problemas aritméticos.(AU)

Resolução de problemas aritméticos: efeitos de ensino com uma balança virtual / Arithmetic problem solving: the effects of teaching with a virtual balance / Resolución de problemas aritméticos: el efectos de la enseñanza con una balanza virtual

Estudos da bibliografia têm demonstrado que grande parte das dificuldades de resolução de problemas aritméticos corresponde a aspectos de natureza específica, como a posição da incógnita nos problemas e a forma de apresentação dos problemas, e que a representação gráfica dos problemas pode contribuir para reduzir esse tipo de dificuldade. O software Arit-Fácil foi usado para avaliar os efeitos de um procedimento de ensino de problemas aritméticos de adição e de subtração com balanças virtuais sobre o desempenho na resolução de problemas nas formas de operação e de sentenças-problema. Os problemas apresentavam incógnitas nas posições a, b e c. Quarenta e oito alunos de 1ª série do Ensino Fundamental foram submetidos a um pré-teste, um procedimento de ensino com problemas na forma de balança virtual e a um pós-teste. Observou-se um aumento nas porcentagens de acertos dos participantes em sentenças-problema de adição com incógnitas nas três possíveis posições e nas subtrações com incógnita na posição c; e um aumento na porcentagem de acertos nas operações com incógnitas nas três possíveis posições, exceto nas operações de adição em que o desempenho inicial foi acima de 70%. Assim, pode-se concluir, o procedimento foi apropriado para que os participantes aprendessem a solucionar problemas aritméticos.

Bibliography studies have shown that most of the difficulties in arithmetic problem solving correspond to aspects of a specific nature, as the position of the unknown set and the form of presentation of the problems, and that the graphic representation of the problems can contribute to reduce this difficulty. The software Arit-Fácil was used to evaluate the effects of a procedure for teaching arithmetic problems of addition and subtraction with a virtual balance on the performance in solving problems in the forms of operation and word-problems. The problems presented unknown set in positions a, b and c. Fortyeight students of the fist grade of an elementary school underwent a pretest, a teaching procedure with problems in the form of virtual balance and a post-test. It was observed an increase in the percentage of correct responses on addition word-problems with unknown set in the three possible positions, and subtractions with the unknown set at the position c; and an increase in the percentage of correct responses in the resolution of operations with the unknown set at the three possible positions, except on addition operations in which the initial performance was above 70%. Thus, it was concluded that the procedure was appropriate for participants to learn how to solve arithmetic problems.

Los estudios de la literatura han demostrado que la mayoría de las dificultades en la resolución de problemas aritméticos corresponde a los aspectos de carácter específico, como la posición de la incógnita y la forma de presentación de los problemas, y que la representación gráfica de los problemas puede contribuir a reducir esta dificultad. El software Arit-fácil fue utilizado para evaluar los efectos de un procedimiento para la enseñanza de problemas aritméticos de suma y sustracción con una balanza virtual sobre el desempeño en la solución de problemas en las formas de operación y sentencias-problema. Los problemas presentaban incógnitas en las posiciones a, b y c. Cuarenta y ocho estudiantes del primero grado de una escuela primaria se sometió a un pre-test, un procedimiento de enseñanza con problemas en la forma de balanza virtual, y un pos-test. Se observó un aumento en el porcentaje de respuestas correctas en sentencias-problema de suma con incógnitas en las tres posiciones posibles y en sustracción con la posición de la incógnita en c; y un aumento en el porcentaje de respuestas correctas en la resolución de operaciones con incógnitas en las tres posiciones posibles, excepto en las operaciones de suma en los que el rendimiento inicial era superior al 70%. Por lo tanto, se puede concluir que el procedimiento fue apropiado para que los participantes aprendan a resolver problemas aritméticos.