Grade IV-VI Research Articles

Analysis of the Role of Parenting and School in Forming Character and Enhancing Student Academic Achievement

Background. This research investigates the impact of parenting styles and school environmental factors in shaping students' character and learning outcomes. Its primary goal is to determine the contributions of parenting styles and school environmental elements to student development in character and academic success. Method. This study employs a quantitative descriptive approach, using surveys with questionnaires as the primary data collection tool. Primary data were directly gathered from students through SDN Ujung Menteng and SDN Pulo Gebang observations, involving Grade IV-VI students as the sample. The total number of respondents was 92 students, selected through a proportional stratified random sampling technique. Results. The analysis revealed that parenting styles do not have a direct significant impact on student learning outcomes. However, parenting styles have a positive and significant effect on character formation, significantly influencing learning outcomes. Meanwhile, the school environment was found to have a positive and significant impact on the formation of students' character. This character formation is a primary mediator between parenting styles and student learning outcomes. Conclusion. This study confirms that parenting styles and the school environment are crucial in developing students' character, directly affecting their learning outcomes. These results suggest the importance of a holistic approach involving family and school environments in enhancing students' character formation and academic success. Keywords: Parenting Styles, School Environment, Student Character Formation, Academic Achievement

Sequelae of carbide-related thermo-chemical injury: A retrospective analysis.

To describe the outcomes of eyes with calcium carbide (CaC2)-related thermo-chemical injury. This study included 28 eyes of 23 patients who presented with calcium carbide-related ocular burns. Only patients with more than three months of follow-up were included. Group A included 16 eyes with Dua's Grade I-III burns, while Group B included 12 eyes with Grade IV-VI burns. Electronic medical records were reviewed to provide data on the etiology of burn, presenting clinical signs and visual acuity, sequelae, and surgical interventions performed, both in the acute and chronic phases. The overall mean age was 28.48 ± 11.8 years. Fifteen patients were injured while using carbide to create an explosion to scare away animals on farms. The median presenting BCVA (best-corrected visual acuity) in Group A (20/160) was significantly better than in Group B [(20/2000) (P = 0.002)]. Five eyes in Group A and one eye in Group B underwent medical management. There was no difference in the duration of follow-up for both groups (P = 0.24). The median final BCVA in Group A (20/32) was significantly better than in Group B [(20/200) (P = 0.02)]. Two eyes in Group A and nine eyes in Group B developed LSCD. Two eyes in Group B were phthisical at the last visit. Calcium carbide-related ocular injuries can result in significant visual morbidity in young adults. Early presentation and management may improve outcomes. Prevention of these injuries by increasing awareness and increasing advocacy efforts is necessary.

Demographic profile and clinical characteristics of patients presenting with acute ocular burns.

To study and compare the demographic and clinical profile of acute ocular burns (AOB) in children and adults. This retrospective case series included 271 children (338 eyes) and 1300 adults (1809 eyes) who presented to two tertiary eye care centers within one month of sustaining AOB. Data regarding demographics, causative agents, severity of injury, visual acuity (VA), and treatment were collected and analyzed. Males were more commonly affected particularly among adults (81% versus 64%, P < 0.00001). Among children, 79% sustained domestic injuries, whereas 59% of adults had work-place injuries (P < 0.0001). Most cases were due to alkali (38%) and acids (22%). Edible lime (chuna, 32%), superglue (14%), and firecrackers (12%) in children, and chuna (7%), insecticides, lye, superglue (6% each), toilet cleaner (4%) and battery acid (3%) in adults, were the main causative agents. The percentage of cases with Dua grade IV-VI was greater in children (16% versus 9%; P = 0.0001). Amniotic membrane grafting and/or tarsorrhaphy were needed in 36% and 14% of affected eyes in children and adults, respectively (P < 0.00001). The median presenting VA was logMAR 0.5 in children and logMAR 0.3 in adults (P = 0.0001), which improved significantly with treatment in both groups (P < 0.0001), but the final VA in eyes with Dua grade IV-VI burns was poorer in children (logMAR 1.3 versus logMAR 0.8, P = 0.04). The findings clearly delineate the at-risk groups, causative agents, clinical severity, and treatment outcomes of AOB. Increased awareness and data-driven targeted preventive strategies are needed to reduce the avoidable ocular morbidity in AOB.

The Relationship of the Role of Parents in Dental and Oral Hygiene in Class IV-VI Students of SDN Nogosari 2 in Jember Agroindustry Area

Children's dental and oral hygiene is the concern and concern of parents, besides that parental knowledge affects their attitudes and actions in maintaining children's dental and oral hygiene. School-age children tend to experience dental health problems because at that age children prefer to snack on cariogenic foods and drinks. Purpose: The purpose of this study was to determine the relationship between the role of parents in dental and oral hygiene in grade IV-VI students of SDN Nogosari 2 in the Jember Agroindustry area. Methods: This type of research is analytic observational with a cross sectional approach. Results: There is a significant relationship between the role of parents on the dental and oral hygiene of grade IV-VI children at SDN Nogosari 2, Rambipuji District, Jember Regency. Coclusion: The results of the study found that there was a relationship between the role of parents in class VI, the majority of whom worked as farm laborers at SDN Nogosari 02, on dental and oral hygiene. The role of good parents does not determine good dental and oral hygiene, while the role of adequate parents can form good dental and oral hygiene of children.

Carbide Gun-Related Ocular Injuries: A Case Series.

The purpose of this study was to report a case series of sight-threatening ocular injuries caused by calcium carbide guns used as fire crackers. Medical records of 15 eyes of 14 patients with ocular injuries caused while using carbide guns, visiting the Institute, from January 2021 to January 2022, were retrospectively reviewed. The collected data included patients' demography (age, sex), presenting ophthalmic features, management, and outcome. Grade I and II ocular injuries were managed medically. All grade III-V injuries were managed using Amniotic Membrane Transplantation. All patients were male. The mean age of the patients was 23.57 ± 11.76 years. According to the Dua classification, 5 eyes (33.3%) had Grade I-II ocular surface burns, 3 eyes (20%) had grade III burns, and 7 eyes (46.6%) had grade IV-VI burns. Presenting visual acuity ranged between hand movements to 20/50, and in 6 eyes (40%), the visual acuity was ≤20/200. Five eyes were managed medically alone, and 10 (66.6%) eyes needed surgical intervention (Amniotic Membrane Transplantation). After a mean follow-up of 14.23 ± 11.92 weeks, complete epithelization was seen in 10 eyes (66.6%). Partial limbal stem cell deficiency and its sequelae such as conjunctivalization of the cornea were noted in 7 eyes (46.6%). Calcium carbide-related ocular injuries can result in corneal blindness secondary to limbal stem cell deficiency in young individuals. Loss of vision in this age group can lead to loss of economic productivity and cosmetic disfigurement. More advocacy efforts are thus needed to prevent these injuries.

Clinical characteristics of IgE-mediated cow's milk protein allergy in children

Objective: To analyze the clinical features of IgE-mediated cow's milk protein allergy (CMPA) in children aged 0-5 years. Methods: This cross-sectional study collected the data on children diagnosed with CMPA in the Department of Allergy at the Children's Hospital of the Capital Institute of Pediatrics from October 2019 to November 2020 and improved peripheral blood routine,total IgE defection, milk specific IgE (sIgE) defection,SPT and milk component defection,diagnosis of severe anaphylaxis based on clinical manifestations. Rank-sum test and chi-square test are used for statistical analysis of clinical characteristics between groups. Results: A total of 106 children (67 boys and 39 girls) were enrolled with the age of 15 (8, 34) months, including 42 cases (≤ 1 year of age), 39 cases (>1-<3 years of age) and 25 cases(≥3 years of age), the onset age of 6 (5, 8) months. Among them, 95 cases (89.6%) were reacted after consuming milk or its products, 42 cases (39.6%) had reaction due to skin contact and 11 cases (10.4%) reacted after exclusive breastfeeding. The onset time of milk product consumption was 45 (1, 120) min, skin contact pathway was 10 (5, 30) min and symptoms in breastfeeding pathway was 121 (61, 180) min. There was statistical difference among the time of symptoms (χ2=77.01, P<0.001).The cutaneous reaction was most common (100 cases, 94.3%), followed by digestive (20 cases, 18.9%) and respiratory (16 cases, 15.1%), and the nervous symptoms (1 case, 0.9%) were uncommon and 24 cases (22.6%) had at least one episode of anaphylaxis. There were 87 cases (82.1%) also diagnosed with other food allergies, 94 cases (88.7%) with previous eczema, 57 cases (53.8%) with history of rhinitis, and 23 cases (21.7%) with history of wheezing. The total IgE level was 191.01 (64.71, 506.80) kU/L, and the cow's milk sIgE level was 3.03 (1.11, 15.24) kU/L. The maximum diameter of the wheal in SPT was 8.2 (4.0, 12.0) mm. Component resolved diagnosis showed that 77 cases (81.9%) were sensitized to at least one out of 4 main components, including casein, α lactalbumin, β lactoglobulin and bovine serum albumin.The possibility of anaphylaxis in children with milk sIgE grade Ⅳ-Ⅵ was higher than that in children with grade 0-Ⅲ (57.7% (15/26) vs. 12.5% (10/80), OR=9.545, 95%CI 3.435-26.523). Children with milk SPT ≥+++ had a higher probability of anaphylaxis than those with milk SPT ≤++ (34.4% (11/32) vs. 11.5% (3/26), OR=4.016, 95%CI 0.983-16.400). Anaphylaxis were more common in α lactalbumin positive children than in negative children (34.3% (13/38) vs. 14.2% (8/56), χ2=1.23，P=0.042). Conclusions: CMPA in children has early onset and diversified clinical manifestations, which are mainly cutaneous symptoms. Most children are sensitized to at least one allergen component. Serum sIgE level, SPT reaction and allergen components play important roles in the diagnosis and evaluation of CMPA, and higher milk sIgE level may predict a higher risk of anaphylaxis.

DEVELOPING A GUIDEBOOK OF BRIDGE POSITIONS FOR GRADE IV-VI STUDENTS’ SPORTS EDUCATION

Background: The bridge position is contained in the material book in school and joined by other materials such as large balls, small balls, and so on, which is the advantage of this rich guidebook is that it can be used anywhere and has barcodes to access bridge position training tutorial videos. With this guidebook, learners can do bridge position activities independently and also teachers have additional material resources to train bridge position on learners.&#x0D; Aim: This research aims to give more insight into the development of guidebooks for sports and health education for students, especially those who are in the 4th-6th grade of elementary school.&#x0D; Method: The research method used in this research is Research and Development (R&amp;D). The product developed by the researchers is a guidebook with the title "Bridge position Method Guide For Class IV-VI". The guidebook of bridge position method was developed by researchers using expert judgment, then processed to get perfect results.&#x0D; Findings: Based on the results of the data analysis obtained from expert validation tests with excellent criteria, it can be stated that the guidebook product of grade IV-VI elementary school is a valid product and can be used as one of the learning resources for learners.

PENGARUH PENDIDIKAN KATOLIK TERHADAP PERKEMBANGAN KARAKTER SISWA-SISWI NON-KATOLIK DI SDK ST. YOSEPH 3 NAIKOTEN II KUPANG

The purpose of the study was: (1) to find out how the situation of Catholic Education and the Character of Non-Catholic Students in SDK St. Joseph 3 Naikoten II Kupang and (2) to find out whether Catholic Education has a positive and significant effect on the character of Non-Catholic Students in the SDK St. Joseph 3 Naikoten II Kupang. The research method used is quantitatively deductive. The study population was non-Catholic students of class IV-VI SDK which amounted to 41 people. Using saturated sampling techniques, researchers focused on 41 respondents. The results of descriptive statistical analysis showed that the Catholic Education variable with 18 statement items obtained a total answer value of respondents to Non-Catholic students in grade IV-VI, which was 83% in the good category and the Character variable of Non-Catholic Students with 22 items of total statement of respondent's answer value of 84% was in a good category. A simple linear regression test obtained the variable coefficient value of Catholic Education (X) of 1,162 and the value (Sig) of The Catholic Education Variable of 0.000 so that it was concluded that Catholic Education has a positive and significant influence on the character of Non-Catholic students.

Arthroscopic Treatment of Scaphoid Nonunion With Olecranon Bone Graft and Screw Fixation Leads to Union and Improved Outcomes

To evaluate the outcomes of arthroscopic treatment of scaphoid nonunion using olecranon bone graft and screw fixation and to analyze the outcomes in accordance with variations in the chronicity, location, and severity of nonunion. Between March 2012 and December 2020, patients with diagnoses of scaphoid delayed nonunion and nonunion with substantial bone resorption (Slade and Dodds grade IV-VI) underwent arthroscopic-assisted olecranon bone graft and screw fixation. Preoperative and postoperative measurements included the visual analog scale score for pain; range of motion; grip strength; the Modified Mayo Wrist Score; the Disabilities of the Arm, Shoulder and Hand (DASH) score; and the minimal clinically important difference for the DASH score. Union rate and duration were also evaluated. The outcomes between groups of patients with different conditions were analyzed. Twenty-two patients were included. The average follow-up period was 32.5 months. The visual analog scale pain score, range of motion, grip strength, Modified Mayo Wrist Score, and DASH score were significantly improved after surgery (P < .001). The minimal clinically important difference threshold for the DASH score was reached by 100% of patients. At final follow-up, all patients had united scaphoid with no complications. The average time to union was 15.3 weeks. Group analysis showed significant improvements in mean grip strength between patients with delayed union (3-6 months) and those with chronic nonunion (> 1 year) (17.75 kg vs 12.25 kg, P= .032), between grade IV nonunion and grade V nonunion (14.86 kg vs 10.43 kg, P= .035), and between grade V nonunion and grade VI nonunion (10.43 kg vs 15.63 kg, P= .013). Patients with grade VI nonunion achieved union at 17.8 weeks postoperatively, a significantly longer period than that for patients with grade IV nonunion (11.4 weeks, P= .014). Arthroscopic treatment of scaphoid nonunion using olecranon bone graft and screw fixation provided satisfactory outcomes regardless of the chronicity, location, and severity of nonunion. Level IV, therapeutic case series.

Exploring the source of well-being for high achiever students

Characteristics of high achiever students are different from middle and low achiever students. Teachers and schools need to understand the unique characteristics of high achiever students in terms of their wellbeing. Aim of this research is to describe source of wellbeing for high achiever students. The research was conducted through survey using questionnaire adapted from Huebner’s Multidimensional Student’s Life Satisfaction Scale (MSLSS). The questionnaire filled by 428 students in grade IV-VI in Mataram, West Nusa Tenggara, which are at top ten rank of their class. Data then analyzed by performing exploratory factor analysis. This research found that there are two factors as source of wellbeing for high achiever students, that are physical and psychological safety and the availability of support for student personal growth. Physical and psychological safety refers to school environment that protects students from psychological and physical threats. Whereas the availability of support for personal growth refers to how schools provide environment in order to facilitate students’ cognitive and social development. This research suggest that high achiever students call for teachers and school personnel to create school environment by considering students opportunities to develop their potentials without feeling threatened.

Tari Kalih Garu sebagai Materi Latihan Motorik Kasar Siswa Sekolah Dasar Kelas Tinggi

This research is a scientific development project which is motivated by the inexistence of Padepokan Pencak Silat or Sanggar in the community around the residents live located in Citra Gading RT 02 RW11 Serang City, Banten Province which can accommodate the creativities of upper class (grade IV-VI) of elementary school students. The aim of this research is to develop a combination dance adapted from tradisional martial arts of Indonesia, Pencak Silat. This research uses a developmental method or RD designed from Dick Carry by ADDIE model which has five stages, namely analysis, design, development, implementation, and evaluation. This dance uses eleven movements that have been adapted from Pencak Silat. The subjects in this study were 6 high-grade elementary school students. The research technique was carried out by means of observation, interviews, documentation, and a questionnaire. The results of this study were that there was an increase in students' gross motor scores from the first day of implementation to the third day of implementation. The children were more flexible and more dexterous in moving. Therefore, this dance can contribute to the development of gross motoric skills of high school students including aspects of speed, strength, endurance, and good agility that can be used by teachers, coaches and even parents at school and in environment where they live, even at pandemic times like this period.

The Misconception of Teachers’ and Students’ Knowledge Regarding Puberty in Higher Elementary Education

The Indonesian Adolescent Reproductive Health Survey (Survei Kesehatan Reproduksi Remaja Indonesia-SKRRI)h ighlights the lack of knowledge amongst adolescents regarding puberty. Other studies have identified the limited advice from parents, because parents and teachers frequently opt not to discuss experiences related to adolescent reproductive health. This study aims to understand the perception of teachers and students in higher grades with regards to puberty. The study used a qualitative approach, collecting data via in-depth interviews with teachers and students. There were seven informants, consisting of five teachers and two students studying in grade IV-VI from two schools in North Jakarta. The study shows teachers, as well as students, often had only a limited understanding of puberty and considered it a vulgar subject which should not be discussed. Teacher capacity building is needed regarding the material and delivery methods of puberty content.&#x0D; Keywords: puberty, higher grade, elementary school

Anatomic Acromioclavicular Ligament Reconstruction Using Semitendinosus Autograft With Suture Augmentation: Surgical Technique

Acromioclavicular (AC) joint separations are common injuries and account for 3.2% of shoulder injuries. These injuries typically occur among adolescent and young adult athletes during contact sports, such as hockey, wrestling, and rugby. Low-grade AC joint separations (Rockwood grade I-II) are often successfully treated nonoperatively. High-grade AC joint separations (Rockwood grade IV-VI) have the potential to alter scapular kinematics, causing painful and restricted motion, and are often treated surgically. Over 150 surgical techniques have been described to treat AC joint separations. Techniques vary in the types of implants used (screws, pins), use of anatomic or nonanatomic reconstructions, number of drill holes used, use of arthroscopic or open procedures, use of distal clavicle resection, and types of augmentation (allografts, autografts, sutures). The procedure can be expensive, with the implants and grafts costing varied amounts and, at times, thousands of dollars. The purpose of this Technical Note is to describe an inexpensive method of open anatomic AC joint reconstruction using a single bone tunnel, suture tape, and a semitendinosus autograft.

Acute Chemical Eye Injury and Limbal Stem Cell Deficiency-A Prospective Study in the United Kingdom.

To analyze the incidence, nature, outcomes, and complications of acute chemical eye injuries, including the incidence of limbal stem cell deficiency (LSCD) and to compare the 2 main classifications for ocular chemical injuries: Roper-Hall (RH) and Dua. This is a prospective, consecutive, interventional single-center study between April and October 2009 of all new patients with acute chemical eye injury presenting to the Royal Victoria Infirmary eye emergency department (EED). Of 11,683 patients who attended the EED, 98 patients (110 eyes) presented with acute chemical eye injury (60% male). This represents an estimated annual incidence of 5.6 new cases per 100,000 population. Mean age was 36.5 years (1-78; SD 17.1 years), including 7 children (age <10 years). Fifty-one patients (52%) had work-related injuries. The most common chemical agent was alkali (78%). All 4 RH grade IV cases were unilateral, assault with ammonia, and required early amniotic membrane transplantation as per the protocol, but despite full treatment, they developed total LSCD in the affected eye. Acute chemical eye injuries are rare. Male patients in the working age group are more prone to work-related chemical injuries, whereas young children tend to have domestic injuries. Grade I, II, and III RH and Dua chemical injuries had a very good prognosis with topical treatment only, whereas RH grade IV (Dua grade IV-VI), mainly assaults with ammonia, progressed to total/severe LSCD despite appropriate management including early amniotic membrane transplantation. The Dua classification includes conjunctival involvement, having a greater value in predicting the final clinical outcome when grading chemical eye injuries.

Gambaran Pengetahuan Seksualitas Siswa Kelas IV-VI SD N di Jakarta

Ease of accessing information through internet causes primary school-age children to be vulnerable to exposure to matters related to sexuality and pornography. The limitations of parents and teachers in providing sexuality education leads to premature sexual behavior in primary school students. This study aims to explain the description of knowledge about sexuality in the students of grade IV-VI in SD N, which has a Buddhist background. Buddhism itself does not view sexuality as a wrong thing, but it takes awareness and self-control in dealing with it. Quantitative methods were carried out with a questionnaire involving 188 students. Furthermore, the qualitative method was conducted with group interviews of 12 students representatives. The results obtained are the majority of students in grade IV-VI in elementary school still have knowledge of sexuality in the low category. Differences in the level of knowledge appear to be influenced by the source of information obtained. Therefore, it is necessary to establish an appropriate school-based sexuality education and cultural context to students in grade IV-VI at SD N in Jakarta.Keywords: Sexuality education, elementary school, Buddhism school

Peran Parental Structure terhadap Basic Need Satisfaction pada Siswa Kelas IV-VI di Sekolah Dasar “X” Bandung

Based on a study of 132 elementary school students in grade IV-VI found that there is significant parental structure effect on basic need satisfaction (R2 = 0,277, F = 49,704, and ρ = 0,000). Parental structure also has a significant influence on the three components of basic need satisfaction, namely need for autonomy (ρ = 0,000, F = 22,495), need for competence (ρ = 0,000, F = 45,106) and need for relatedness (ρ = 0,000, F = 21,091). Suggestions for research that will conduct further research are expected to undertake research on the influence of parental structures on basic need satisfaction using a wider coverage of respondents. In addition, the researcher proposes to the school to make a psychoeducation program with material related to the role of parental structures on the basic needs of satisfaction.

Peripheral Facial Palsy and Communicating Hydrocephalus as a Clinical Presentation of Hemorrhagic Vestibular Schwannoma: Case Report

AbstractThe vestibular schwannoma is the most common extra-axial tumor of the posterior fossa. Hemorrhage associated with vestibular schwannomas has been described in less than 1% of the cases. The etiology remains unknown; however, some risk factors have been suggested, such as tumor size and tumor growth rate, the vascularity and histopathology of the tumor or even previous treatment with radiosurgery. The present case is of a 74-year-old female patient, who presented to our clinic in December of 2015 after a mild traumatic brain injury. In that context, she did a brain computed tomography (CT) scan and was diagnosed with a vestibular schwannoma— an incidentaloma. It was decided at that time to treat the patient conservatively because of her comorbidities and the presentation of the disease. In March of 2017, the patient presented again to our clinic with a right peripheral facial paralysis (House-Brackmann [HB] grade IV-VI) and confusion. The CT scan revealed that bleeding around the vestibular schwannoma had caused the clinical presentation. We decided to treat the hydrocephalus with a ventriculoperitoneal shunt. At the time of her last follow-up visit, the confusion symptoms had resolved, and her right-sided facial function had improved to a HB grade II-VI.

Clinical study of multidisciplinary treatment of large vestibular schwannomas

Objective To design and practice standardized treatment protocols of large vestibular schwannomas (VS) based on the strategy of multidisciplinary treatment (MDT), and to discuss its clinical outcomes. Methods We analyzed all cases of unilateral large VS pathologically confirmed who underwent MDT at Department of Neurosurgery, Huashan Hospital, Fudan University from January 2010 to March 2016. Tumors with the maximal diameter longer than 3 cm were defined as large. The clinical data and follow-up results were retrospectively reviewed. A total of 266 VS patients were enrolled into this study. Electrophysiological monitoring, psychology assessment and facial nerve rehabilitation training were performed for all patients. One-stage anastomosis was applied for broken facial nerve. Results Gross total resection of the tumor was achieved in 261 patients (98.1%), near-total resection in 5 patients (1.9%), and the mortality rate was 0%. Facial nerve was anatomically preserved in 248 cases (93.2%). The function of facial nerve was evaluated according to House-Brackmann (H-B) scale, which showed that 125 patients (47.0%) were in grade Ⅰ-Ⅱ, 70 cases (26.3%) in grade Ⅲ, 71 cases (26.7%) in grade Ⅳ-Ⅵ within 1 month (short-term outcome). Perioperative complications included disequilibrium (10.1%), intracranial infection (8.6%), tinnitus (4.1%), lower cranial nerve injury (2.6%) and cerebrospinal fluid leak (1.1%). Follow-up data were available for 252 out of 266 patients (94.7%). For short-term facial outcome of 252 patients, there were 119 cases (47.2%) in grade Ⅰ-Ⅱ, 68 cases (27.0%) in grade Ⅲ, 65 cases (25.8%) in grade Ⅳ-Ⅵ. Meanwhile, long-term facial outcome showed that 184 patients (73.0%) were in grade Ⅰ-Ⅱ, 36 cases (14.3%) in grade Ⅲ, and 32 cases (12.7%) in grade Ⅳ-Ⅵ (P<0.01). There were 193 cases with serviceable hearing before surgery, of whom 60 cases showed serviceable hearing after surgery. The hearing preservation rate was 31.1%. Conclusions The MDT strategy for large VS could help improve the gross total resection rate and protect cranial nerve function. In addition, it might reduce perioperative mortality and the incidence of complications. Key words: Neuroma, acoustic; Microsurgery; Facial nerve injuries; Multidisciplinary treatment

Is "Early Total Care" a Safe and Effective Alternative to "Staged Protocol" for the Treatment of Schatzker IV-VI Tibial Plateau Fractures in Patients Older Than 50 Years?

To compare "Early Total Care" (ETC) with "Staged Protocol" (SP) for the treatment of Schatzker IV-VI tibial plateau fractures in patients older than 50 years regarding safety and effectiveness. Retrospective cohort study. An academic level 1 US trauma center. Eighty-one patients older than 50 years with Schatzker grade IV-VI tibial plateau fractures were included. Fifty-three patients were treated under SP with immediate external fixation followed by definitive internal fixation. Twenty-eight patients were treated under ETC with immediate internal fixation. Comparison of perioperative findings, time to bony and clinical union, soft-tissue and bony complications, radiological outcome, and secondary procedures. The 2 groups were comparable without significant difference regarding age, sex, side of involvement, body mass index, smoking status, American Society of Anesthesiologist classification, associated injuries, comorbidities, follow-up duration, and fracture classification. No statistically significant difference was found regarding the perioperative complications, quality of reduction, time to union, Rasmussen score at union or at the final follow-up, soft-tissue/bony complications, and the rate of the secondary procedures. ETC seems to be a safe, efficacious, and effective alternative to the SP for the treatment of some Schatzker IV-VI fractures in patients older than 50 years. Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

Complications and Management of Large Intracranial Vestibular Schwannomas Via the Retrosigmoid Approach.

To investigate the common complications from the microsurgical treatment of large intracranial vestibular schwannoma (VS) via suboccipital retrosigmoid approach and to propose strategies for minimizing such complications. We selected all patients with large unilateral VS from the collected database (1999-2013) who underwent microsurgical resection as their initial treatment for histopathologically confirmed VS. Tumors larger than 30× 20 mm were defined as large. A total of 1167 patients with VS were included. Gross total tumor resection was achieved in 1006 patients (86.2%). The mortality rate is 0.77%. The facial nerve was preserved anatomically in 1083 cases (92.8%), and the functional valuation of the facial nerve according to postoperative House-Brackmann scale showed 423 patients (36.2%) in grades I-II, 534 cases (45.8%) in grade III, and 210 patients (18.0%) in grade IV-VI. The main short-term postoperative complication included new hearing loss (American Institute of Otolaryngology-Head and Neck Surgery grade D) in 634 cases (54.3%), disequilibrium in 250 cases (21.4%), labial herpes in 127 cases (10.9%), meningitis in 115 (9.85%) and lower cranial nerve deficit in 77 cases (6.59%). Follow-up data were available for 978 of the 1167 patients (83.8%). Long-term complications include hearing loss (American Institute of Otolaryngology-Head and Neck Surgery grade D) (75.8%), permanent facial paralysis (11.9%), facial numbness (10.9%), tinnitus (2.96%), chronic headache (2.25%), and taste disturbance (1.43%). The key factors for reducing surgical complications include careful assessment of the functions of acoustic and facial nerves as well as a thorough understanding of anatomy via the retrosigmoid approach before operation, skillful microsurgical technique, and monitoring of multiple cranial nerves during resection.