Métricas de artículos bibliométricos en revistas estudiantiles de ciencias de la salud cubanas. 2021-2023

Introducción: Cada vez son más los estudiantes interesados en estudios bibliométricos, lo que se traduce en la publicación de los mismos en revistas científicas de pregrado. Objetivo: Caracterizar la producción científica bibliométrica publicada en revistas estudiantiles de ciencias de la salud cubanas de 2021 a 2023. Materiales y métodos: Se realizó un estudio observacional, descriptivo y bibliométrico sobre los artículos de bibliometría publicados en revistas científicas estudiantiles de ciencias de la salud cubanas, entre enero de 2021 y agosto de 2023. El universo se conformó por 594 artículos y la muestra por 23. El procesamiento estadístico implicó la frecuencia absoluta y porcentual. Se calcularon los índices de Price, de colaboración y de productividad. Resultados: La revista con mayor número de artículos sobre bibliometría publicados fue Universidad Médica Pinareña, con 6,84 %; el 53,57 % de los autores pertenecieron al sexo masculino, y la Universidad de Ciencias Médicas de Pinar del Río fue el centro de procedencia de nueve autores, para un 17,65 %. Las investigaciones con cinco autores fueron las de mayor prevalencia, y el grado de productividad respecto al tema fue bajo, para un 67,86 %. Conclusiones: Existe una baja frecuencia de publicación de artículos bibliométricos en las revistas estudiantiles de ciencias de la salud cubanas, concentrándose en Universidad Médica Pinareña y 16 de Abril, mientras se muestra un elevado índice de publicaciones por autores masculinos. La autoría múltiple fue la que predominó.

Introduction: More and more students are interested in bibliometric studies which translate into their publication in undergraduate scientific journals. Objective: To characterize the bibliometric scientific production published in Cuban student health sciences journals from 2021 to 2023. Materials and methods: An observational, descriptive and bibliometric research was carried out on bibliometric articles published in Cuban student scientific journals of Health Science, between January 2021 and August 2023. The universe was made up of 594 articles and the sample of 23. Statistical processing involved absolute and percentage frequency. Price, collaboration and productivity indices were calculated. Results: The journal with the highest number of articles on bibliometric published was Universidad Médica Pinareña with 6.84%; 53.57% of the authors belonged to the male sex and the University of Medical Sciences of Pinar del Rio was the center of origin of nine authors, for 17.65%. Research with five authors was the most prevalent and the degree of productivity regarding the topic was low, at 67.86%. Conclusions: There is a low frequency of publications of bibliometric articles in Cuban student scientific journals of Health Science, concentrating on the Universidad Médica Pinareña and 16 de Abril, while showing a high rate of publications by male authors. Multiple authorship predominated.

Association between intraoperative ketamine and the incidence of emergence delirium in laparoscopic surgeries: an observational study

Abstract Background: Emergence Delirium (ED) is an essential condition in the immediate postoperative period. Systematic review and meta-analysis of randomized controlled trials have concluded that the effect of ketamine on postoperative delirium remains unclear. The present study sought to evaluate if the intraoperative use of ketamine for postoperative analgesia is associated with postoperative ED in laparoscopic surgeries. Methods: A prospective observational study was performed in the PostAnesthetic Care Unit (PACU) to evaluate patients who had undergone laparoscopic surgery under a rigid intraoperative anesthesia protocol from July 2018 to January 2019. Patients submitted to laparoscopic surgery for cholecystectomy, oophorectomy, or salpingectomy with a score ≥1 on the Richmond Assessment Sedation Scale (RASS) or ≥2 on the Nursing Delirium Screening Scale (Nu-DESC) were considered to have ED. t-test, Chi-Square test or Fisher's exact tests were used for comparison. Results: One hundred and fifteen patients were studied after laparoscopic surgery. Seventeen patients (14.8%) developed ED, and the incidence of ED in patients who received ketamine was not different from that of other patients (18.3% vs. 10.6%, p = 0.262). Patients with ED had more postoperative pain and morphine requirement at the PACU (p = 0.005 and p = 0.025, respectively). Type of surgery (general surgery, OR = 6.4, 95% CI 1.2‒35.2) and postoperative pain (OR = 3.7, 95% CI 1.2‒11.4) were risk factors for ED. Conclusion: In this study, no association was found between ED and intraoperative administration of ketamine in laparoscopic surgeries. Type of surgery and postoperative pain were risk factors for ED.

Cisto gigante de segundo arco branquial em adulto: Relato de caso e revisão de literatura / Giant cyst of the second branchial arch in an adult: case report and literature review

Introdução: Os arcos branquiais são os precursores embriológicos da face, pescoço e faringe. As anomalias dos arcos branquiais são a segunda lesão congênita mais comum de cabeça e pescoço em crianças. Entre essas anomalias, estão os cistos de arcos branquiais (BCC), que surgem devido a uma incorreta obliteração das fendas branquiais, ainda no período embrionário. Os BCC podem ser assintomáticos, apenas percebidos incidentalmente, e não se manifestar até a idade adulta. Resultados: Anomalias do segundo arco branquial devem ser consideradas como um dos possíveis diagnósticos diferenciais de massas cervicais, especialmente as que se manifestam como um abaulamento em região lateral do pescoço. Os BCC são formações de revestimento epitelial, sem aberturas externas. Após seu diagnóstico, o tratamento é cirúrgico, usualmente por meio de uma incisão cervical transversa e cuidadosa dissecação das estruturas, com o objetivo de extirpar toda a lesão. Conclusão: O método descrito, de excisão da lesão, por meio de incisão transversa em região cervical, dissecção tecidual por planos e ressecção de massa cística, é uma opção para o tratamento dessa deformidade, com adequado resultado estético e boa reprodutibilidade.

Introduction: The branchial arches are the embryological precursors of the face, neck, and pharynx. Branchial arch anomalies are the second most common congenital head and neck lesions in children. Among these anomalies are branchial arch cysts (BCC), which arise due to incorrect obliteration of the branchial slits, still in the embryonic period. BCCs may be asymptomatic, only noticed incidentally, and not manifest until adulthood. Results: Anomalies of the second branchial arch should be considered as one of the possible differential diagnoses of neck masses, especially those that manifest as a bulge in the lateral region of the neck. BCCs are epithelial lining formations without external openings. After diagnosis, treatment is surgical, usually through a transverse cervical incision and careful dissection of the structures, with the aim of extirpating the entire lesion. Conclusion: The method described of excision of the lesion through a transverse incision in the cervical region, tissue dissection in planes, and resection of the cystic mass is an option for the treatment of this deformity, with adequate aesthetic results and good reproducibility.

A Case of Primary Lung Adenocarcinoma With Two Uncommon Presentations: Neurological Paraneoplastic Syndrome and Pericardial Effusion.

Lung cancer is the second most common cancer worldwide and remains the first cause of cancer death. The diagnosis of lung cancer is mostly made following evaluation for respiratory signs and symptoms but sometimes the first presentation may be atypical. Some symptoms may be related to the invasion of adjacent structures and others caused by an autoimmune-mediated process when cross-reactivity between tumor antigens and normal nervous tissues is responsible for paraneoplastic syndromes. We present a case of a young woman with a smoking history who first manifested with two uncommon presentations of lung cancer: a paraneoplastic neurological syndrome and a hemorrhagic pericardial effusion with cardiac tamponade.

Costos directos y calidad de vida de los pacientes con glaucoma en Paraguay / Direct costs and quality of life of patients with glaucoma in Paraguay

Introducción:El glaucoma constituyeun problema de salud pública por su alta prevalencia, los costos directos y la calidad de vida deteriorada de los pacientes que lo sufre. Objetivo:Determinar los costos directos y calidad de vida de los pacientes adultos con glaucoma atendidos en la Clínica Central de la Fundación Visión de noviembre 2022 a febrero 2023. Material y métodos:estudio observacional, descriptivo, corte transversal que incluyó pacientes con diagnóstico de glaucoma por muestreo por conveniencia. Resultados:Se incluyeron 140 pacientes entre 29 y 90 años, 52,9% femenino, 43,6% primaria incompleta, 32,1% desempleado. El tratamiento médico se realizó en el 81%, laser en 42% y procedimiento quirúrgico en 32%. Se informó un gasto promedio anual de 3.639.800gs ($ 503.93) por paciente. El estado emocional afectado se informó en el 35,7% de los pacientes, y calidad de vida deteriorada en el 48,6%; el 55% de los pacientes tiene dependencia para sus cuidados personales. Conclusión:El glaucoma implica grandes costos directos debido al tratamiento, además los pacientes tienen deterioro de la calidad de vida.Palabras Clave:glaucoma; costos de la atención en salud; distrés psicológico; calidad de vida

Introduction.Glaucoma is still a public health problem due to its high prevalence, the socioeconomic impact it entails for the patient who suffers from it, which decreases the quality of life. Objective:To determine the direct costs and quality of life of adult patients treated WITH glaucoma in the Fundación Visión Central Clinic from November 2022 to February 2023. Material and methods:observational, descriptive, cross-sectional study that included patients diagnosed with glaucoma by sampling by convenience. Results:140 patients between 29 and 90 years old were included, 52.9% female, 43.6% incomplete primary education, 32.1% unemployed. Medical treatment was performed in 81%, laser in 42% and surgical procedure in 32%. An average annual expense of 3,639,800gs ($503.93) per patient was reported. Emotional affectation was reported in 35.7% of the patients, and 43.5% deteriorated quality of life; 55% of the patients has dependency on personal care. Conclusion:Glaucoma involves large direct costs, due to treatment, in addition patients have deterioration in the quality of life.Key words:glaucoma; health care costs;psychological distress; quality of life

Ten-year follow-up of a total knee prosthesis combining multi-radius, ultra-congruency, posterior-stabilization and mobile-bearing insert shows long-lasting clinically relevant improvements in pain, stiffness, function and stability.

PURPOSE: There is a paucity of data available on total knee prostheses combining dual-radius, ultra-congruency, posterior-stabilization and mobile-bearing insert. This prospective cohort study aimed to assess the clinical evolution of the FIRST® prosthesis (Symbios Orthopédie, Yverdon, CH), the earliest prosthesis with this particular design. It was hypothesized that the primary outcomes, evaluating pain, stiffness, function and stability, would improve following arthroplasty and remain improved during the follow-up period of 10 years. METHODS: All patients programmed for a total knee arthroplasty using a FIRST® prosthesis at our university hospital between 2006 and 2008 were invited to participate. Study knees were evaluated pre-operatively as well as one, five and ten years post-operatively. Patients filled out questionnaires at each evaluation point and had a radiographic assessment at the five-year and ten-year follow-ups. Primary outcomes were the total, pain, stiffness and function measures of the Western Ontario and McMaster Universities Osteoarthritis questionnaire (WOMAC) and the knee and function measures of the Knee Society Score (KSS). Friedman and Wilcoxon's rank-sum tests were used to compare measures across time points. RESULTS: Hundred and twenty four prostheses were included (baseline demographics: 69.9 ± 8.3 years old, 28.1 ± 4.3 kg/m2, 54% male) and 68 could be followed during ten years. Five prostheses underwent a revision. All other prostheses lost at follow-up were lost for reasons unrelated to the prosthesis. All primary measures reported statistically and clinically significant improvements between baseline and the three follow-up evaluations. Statistically significant improvements at the three follow-up evaluations were also observed for most secondary measures. There was no implant loosening. At ten-year follow-up, radiolucent lines were observed in 2.9% femoral implants and 1.5% tibial implants. CONCLUSION: The positive results observed in all domains of assessment and the small revision rate demonstrated an effective functioning of the FIRST® prosthesis during the ten-year follow-up period. The results, globally similar to those previously published for other prosthesis designs, encourage the development of assistive methods to select the most appropriate designs on an individual basis. LEVEL OF EVIDENCE: IV, prospective cohort study.

Association between intraoperative ketamine and the incidence of emergence delirium in laparoscopic surgeries: an observational study.

BACKGROUND: Emergence Delirium (ED) is an essential condition in the immediate postoperative period. Systematic review and meta-analysis of randomized controlled trials have concluded that the effect of ketamine on postoperative delirium remains unclear. The present study sought to evaluate if the intraoperative use of ketamine for postoperative analgesia is associated with postoperative ED in laparoscopic surgeries. METHODS: A prospective observational study was performed in the PostAnesthetic Care Unit (PACU) to evaluate patients who had undergone laparoscopic surgery under a rigid intraoperative anesthesia protocol from July 2018 to January 2019. Patients submitted to laparoscopic surgery for cholecystectomy, oophorectomy, or salpingectomy with a score ≥1 on the Richmond Assessment Sedation Scale (RASS) or ≥2 on the Nursing Delirium Screening Scale (Nu-DESC) were considered to have ED. t-test, Chi-Square test or Fisher's exact tests were used for comparison. RESULTS: One hundred and fifteen patients were studied after laparoscopic surgery. Seventeen patients (14.8%) developed ED, and the incidence of ED in patients who received ketamine was not different from that of other patients (18.3% vs. 10.6%, p = 0.262). Patients with ED had more postoperative pain and morphine requirement at the PACU (p = 0.005 and p = 0.025, respectively). Type of surgery (general surgery, OR = 6.4, 95% CI 1.2‒35.2) and postoperative pain (OR = 3.7, 95% CI 1.2‒11.4) were risk factors for ED. CONCLUSION: In this study, no association was found between ED and intraoperative administration of ketamine in laparoscopic surgeries. Type of surgery and postoperative pain were risk factors for ED.

Ultra-short celiac disease exhibits differential genetic and immunophenotypic features compared to conventional celiac disease.

BACKGROUND: Ultra-short coeliac disease (USCD) is a novel celiac disease (CD) subtype limited to the duodenal bulb (D1). HLA haplotypes and flow cytometry have not been assessed yet. AIMS: To compare genetic, clinical, serologic, histopathologic and inmmunophenotypic parameters between USCD and conventional celiac disease (CCD) patients. METHODS: Prospective single-center study in children and adult patients undergoing duodenal biopsies on a gluten-containing diet. Biopsies for histology and flow cytometry were taken separately from D1 and distal duodenum. Biopsies in seronegative patients with celiac lymphogram were repeated after 2 years on a gluten-free diet. RESULTS: Among 505 included patients, 127 were diagnosed with CD, of whom 7 (5.5%) showed USCD. HLADQ2 was significantly less common in USCD compared to CCD (71% vs. 95%, p 0.003). Likewise, USCD patients showed more frequent non-significant seronegativity (28% vs. 8%, p 0.07) and significantly lower titrations (7-15IU/ml) of tissue transglutaminase antibodies (tTG-IgA) (60% vs. 13%, p<0.001). Biopsies from D1 revealed significant less NK cells down-expression in USCD patients (1.4 vs. 5, p 0.04). CONCLUSIONS: Up to 5.5% of CD patients showed USCD. A lower frequency of HLADQ2, along with less serum tTG-IgA titration and duodenal NK cell suppression, were differential features of USCD.

First Description of Late-Onset Autoinflammatory Disease Due to Somatic NLRC4 Mosaicism.

OBJECTIVE: Autoinflammatory diseases are inherited disorders of innate immunity that usually start during childhood. However, several recent reports have described an increasing number of patients with autoinflammatory disease starting in adulthood. This study was undertaken to investigate the underlying cause of a case of late-onset uncharacterized autoinflammatory disease. METHODS: Genetics studies were performed using Sanger sequencing and next-generation sequencing (NGS) methods. In silico, in vitro, and ex vivo analyses were performed to determine the functional consequences of the detected variant. RESULTS: We studied a 57-year-old woman who at the age of 47 years began to have recurrent episodes of fever, myalgias, arthralgias, diffuse abdominal pain, diarrhea, adenopathies, and systemic inflammation, which were relatively well controlled with anti-interleukin-1 (anti-IL-1) drugs. NGS analyses did not detect germline variants in any of the known autoinflammatory disease-associated genes, but they identified the p.Ser171Phe NLRC4 variant in unfractionated blood, with an allele fraction (2-4%) compatible with gene mosaicism. Structural modeling analyses suggested that this missense variant might favor the open, active conformation of the NLRC4 protein, and in vitro and ex vivo analyses confirmed its propensity to oligomerize and activate the NLRC4 inflammasome, with subsequent overproduction of IL-18. CONCLUSION: Our findings indicate that the postzygotic p.Ser171Phe NLRC4 variant is a plausible cause of the disease in the enrolled patient. Functional and structural studies clearly support, for the first time, its gain-of-function behavior, consistent with previously reported NLRC4 pathogenic variants. These novel findings should be considered in the diagnostic evaluation of patients with adult-onset uncharacterized autoinflammatory disease.

Two-level modeling approach to identify the regulatory dynamics capturing drug response heterogeneity in single-cells.

Single-cell multimodal technologies reveal the scales of cellular heterogeneity impairing cancer treatment, yet cell response dynamics remain largely underused to decipher the mechanisms of drug resistance they take part in. As the phenotypic heterogeneity of a clonal cell population informs on the capacity of each single-cell to recapitulate the whole range of observed behaviors, we developed a modeling approach utilizing single-cell response data to identify regulatory reactions driving population heterogeneity in drug response. Dynamic data of hundreds of HeLa cells treated with TNF-related apoptosis-inducing ligand (TRAIL) were used to characterize the fate-determining kinetic parameters of an apoptosis receptor reaction model. Selected reactions sets were augmented to incorporate a mechanism that leads to the separation of the opposing response phenotypes. Using a positive feedback loop motif to identify the reaction set, we show that caspase-8 is able to encapsulate high levels of heterogeneity by introducing a response delay and amplifying the initial differences arising from natural protein expression variability. Our approach enables the identification of fate-determining reactions that drive the population response heterogeneity, providing regulatory targets to curb the cell dynamics of drug resistance.

Identifying the Most Important Consultation-Liaison Psychiatry Publications in 2020 Using a Novel Literature Assessment Instrument.

BACKGROUND: As the science of consultation-liaison psychiatry advances, the Academy of Consultation-Liaison Psychiatry's Guidelines and Evidence-Based Medicine Subcommittee reviews articles of interest to help academy members remain familiar with the latest in evidence-based practice. OBJECTIVE: We identify the 10 most important articles for clinical practice in consultation-liaison psychiatry from 2020 using the new Importance and Quality instrument for assessing scientific literature. METHODS: The subcommittee published annotated abstracts for 97 articles on the academy website in 2020. Reviewers then rated all articles on clinical importance to practice and quality of scholarship using the Importance and Quality instrument. We describe the 10 articles with the highest aggregate scores and analyze the reliability of Importance and Quality instrument. RESULTS: Twenty-four raters identified the top 10 scoring articles of 2020. These articles provide practical guidance on key areas of consultation-liaison psychiatry including management of COVID-19, lithium treatment for complex patients, medical risks among patients with severe mental illness, and substance use disorders in medical settings. The assessment instrument demonstrated good to excellent interrater reliability. CONCLUSION: These articles offer valuable guidance for consultation-liaison psychiatrists regardless of their practice area. Collaborative literature reviews with standardized assessments help clinicians deliver evidence-based care and foster a high standard of practice across the specialty.

Tomografía computarizada de cráneo en traumatismo craneoencefálico leve, ¿son estas necesarias en todos los casos? / CT scan of the skull in mild head trauma, are these necessary in all cases? / Tomografia computadorizada de crânio em traumatismo cranioencefálico leve, são necessárias em todos os casos?

Resumen: Introducción: La realización sistemática de tomografías cráneo en trauma encefalocraneano leve es controversial, corresponden al 70-90% de los casos. Hasta 10% de dichos traumatismos presentarán lesiones y 1,4% requerirán neurocirugía. El objetivo del estudio es determinar el número de tomografías patológicas en el traumatismo encefalocraneano leve e identificar los factores predictivos de lesión. Materiales y métodos: Estudio observacional, prospectivo, analítico. Se identificaron las consultas por traumatismo encefalocraneano leve entre el 30 de julio de 2018 y el 15 de agosto del 2019. Se valoró la presencia de factores de riesgo para lesión como escala de coma de Glasgow al ingreso y a las 2 horas, cinemática del trauma, sospecha de fractura de base y bóveda de cráneo, cefalea, vómitos, mayores a 65 años, pérdida de conocimiento, amnesia del episodio, anticoagulación o antiagregación y consumo de alcohol o drogas. Se consignaron los casos con tomografías patológicas y necesidad de neurocirugía. Resultados: Se incluyeron 1319 pacientes, 9% de estudios patológicos y 1,2% requirieron neurocirugía. Resultaron significativas como factores de riesgo la alta cinemática del traumatismo (p 0,02); escala de coma de Glasgow a las 2 horas (p 0,014); sospecha de fractura de bóveda (p 0,003) y base de cráneo (p 0,000); vómitos en más de dos ocasiones (p 0,000); cefalea (p 0,01) y amnesia del episodio (p 0,012) Conclusiones: La identificación de factores predictivos de lesión ayuda a optimizar el uso de tiempo del tomógrafo suprimiendo estudios innecesarios y priorizando los potencialmente patológicos.

Abstract: Introduction: The systematic performance of skull tomography in mild brain trauma is controversial, corresponding to 70-90% of cases. Up to 10% of these traumas will present injuries and 1.4% will require neurosurgery. The objective of the study is to determine the number of pathological scans in mild head injury and to identify predictive factors for injury. Materials and methods: Observational, prospective, analytical study. Consultations for mild brain injury were identified between July 30, 2018 and August 15, 2019. The presence of risk factors for injury was assessed as the Glasgow coma scale at admission and at 2 hours, trauma kinematics, suspicion of skull base and vault fracture, headache, vomiting, people over 65 years of age, loss of consciousness, amnesia of the episode, anticoagulation or antiplatelet therapy and alcohol or drug use. The cases with pathological tomography and the need for neurosurgery were consigned. Results: 1,319 patients were included, 9% of pathological studies and 1.2% required neurosurgery. The high kinematics of trauma were significant as risk factors (p 0.02); Glasgow coma scale at 2 hours (p 0.014); suspicion of fracture of the vault (p 0.003) and skull base (p 0.000); vomiting on more than two occasions (p 0.000); headache (p 0.01) and episode amnesia (p 0.012). Conclusions: The identification of predictive factors of injury helps to optimize the use of tomography time by eliminating unnecessary studies and prioritizing potentially pathological ones.

Resumo: Introdução: O desempenho sistemático da tomografia de crânio no trauma cerebral leve é ​​controverso, correspondendo a 70-90% dos casos. Até 10% desses traumas apresentarão lesões e 1,4% necessitarão de neurocirurgia. O objetivo do estudo é determinar o número de exames patológicos em traumatismo craniano leve e identificar fatores preditivos de lesão. Materiais e métodos: Estudo observacional, prospectivo e analítico. As consultas para lesão cerebral leve foram identificadas entre 30 de julho de 2018 e 15 de agosto de 2019. A presença de fatores de risco para lesão foi avaliada pela escala de coma de Glasgow na admissão e em 2 horas, cinemática do trauma, suspeita de fratura da base do crânio e abóbada, dor de cabeça, vômitos, pessoas com mais de 65 anos, perda de consciência, amnésia do episódio, anticoagulação ou terapia antiplaquetária e uso de álcool ou drogas. Os casos com tomografia patológica e necessidade de neurocirurgia foram dispensados. Resultados: 1.319 pacientes foram incluídos, 9% dos estudos patológicos e 1,2% neurocirurgia necessária. A alta cinemática do trauma foi significativa como fator de risco (p 0,02); Escala de coma de Glasgow em 2 horas (p 0,014); suspeita de fratura de abóbada (p 0,003) e base do crânio (p 0,000); vômito em mais de duas ocasiões (p 0,000); dor de cabeça (p 0,01) e episódio de amnésia (p 0,012). Conclusões: A identificação de fatores preditivos de lesão auxilia na otimização do uso do tempo de tomografia, eliminando estudos desnecessários e priorizando os potencialmente patológicos.

Knee radiosynovectomy with 153Sm-hydroxyapatite compared to 90Y-hydroxyapatite: initial results of a prospective trial.

INTRODUCTION: Radiosynovectomy (RS) with 90Y-hydroxyapatite (90Y-HyA) aims to control knee hemarthrosis in hemophiliac patients to prevent secondary arthropathy. However, knee RS using 153Sm-hydroxyapatite (153Sm-HyA) is considered less suitable due to the lower average soft tissue range and energy of 153Sm for large joints, such as the knees. PURPOSE: The objective of this investigation was to assess the efficacy and safety of knee RS with 153Sm-HyA, compared to 90Y-HyA. METHODS: Forty patients were prospectively assigned to undergo knee RS with 153Sm-HyA (n = 19) or with 90Y-HyA (n = 21). The frequency of hemarthrosis episodes before and after treatment were compared. RESULTS: After six months of knee RS, 153Sm-HyA and 90Y-HyA promoted a similar reduction of hemarthrosis episodes (50% and 66.7%, respectively). However, after 12 months of knee RS, the reduction of hemarthrosis episodes was significantly (p = 0.037) higher using 153Sm-HyA (87.5%) compared to 90Y-HyA (50.0%). This discrepancy was more pronounced (p = 0.002) for 153Sm-HyA compared to 90Y-HyA in adults/adolescents. CONCLUSION: Knee radiosynovectomy with 153Sm-HyA is safe, reduces hemarthrosis episodes after 12 months of treatments, especially in adults/adolescents and even with grades III/IV arthropathy, similar to 90Y-HyA. 90Y-HyA seems to promote better hemarthrosis control in small children.

Percepções de enfermeiros acerca da atuação profissional no contexto do atendimento pré-hospitalar móvel / Nurses' perceptions about professional performance in the context of mobile prehospital care

Objetivo: conhecer a percepção do enfermeiro sobre a atuação da categoria profissional no serviço de atendimento pré-hospitalar móvel. Métodos: Trata-se de uma pesquisa exploratório-descritiva, qualitativa, realizada com quatro enfermeiros de um serviço de atendimento pré-hospitalar particular e cinco residentes de um Programa de Residência Profissional em Enfermagem em Urgência/Trauma de uma Instituição de Ensino Superior que realizavam prática em atendimento pré-hospitalar móvel. Os dados foram coletados mediante entrevista semiestruturada e foram submetidos à análise de conteúdo de Bardin. A pesquisa foi aprovada pelo Comitê de Ética em Pesquisa, sob o n° de parecer2.820.757. Resultados: emergiram quatro categorias: A importância da atuação do enfermeiro no Atendimento Pré-Hospitalar; Dupla atuação do enfermeiro: gestão e clínica; Importância do conhecimento técnico e científico; Autonomia profissional do Enfermeiro no Atendimento Pré-Hospitalar. Conclusão: Evidencia-se a relevância e necessidade do enfermeiro no Atendimento Pré-hospitalar, o que contribui para a valorização profissional da categoria. (AU)

Objective: To know the nurse's perception of the performance of the professional category in the mobile pre-hospital care service. Methods: This is an exploratory-descriptive, qualitative research carried out with four nurses from a private pre-hospital care service and five residents from a Professional Residency Program in Nursing in Urgency / Trauma from a Higher Education Institution who were performing practice in mobile prehospital care. Data were collected through semi-structured interviews and were submitted to Bardin's content analysis. Results: Four categories emerged: The importance of the nurse's performance in Pre-Hospital Care; Dual role of the nurse: management and clinic; Importance of technical and scientific knowledge; Professional autonomy of nurses in pre-hospital care. Conclusion: The relevance and need of nurses in Pre-hospital Care is evidenced, which contributes to the professional valorization of the category. (AU)

Objetivo: Conocer la percepción de la enfermera del desempeño de la categoría profesional en el servicio móvil de atención prehospitalaria. Métodos: Esta es una investigación exploratoria descriptiva y cualitativa realizada con cuatro enfermeras de un servicio privado de atención prehospitalaria y cinco residentes de un Programa de residencia profesional en Enfermería de urgencia / trauma en una institución de educación superior que estaban realizando práctica en atención prehospitalaria móvil. Los datos se recopilaron a través de entrevistas semiestructuradas y se enviaron al análisis de contenido de Bardin. Resultados: Surgieron cuatro categorías: la importancia del desempeño de la enfermera en la atención prehospitalaria; Doble papel de la enfermera: gestión y clínica; Importancia del conocimiento técnico y científico; Autonomía profesional de las enfermeras en atención prehospitalaria. Conclusión: Se evidencia la relevancia y la necesidad de las enfermeras en la atención prehospitalaria, lo que contribuye a la valorización profesional de la categoría. (AU)

Profiling the Non-genetic Origins of Cancer Drug Resistance with a Single-Cell Functional Genomics Approach Using Predictive Cell Dynamics.

Non-genetic heterogeneity observed in clonal cell populations is an immediate cause of drug resistance that remains challenging to profile because of its transient nature. Here, we coupled three single-cell technologies to link the predicted drug response of a cell to its own genome-wide transcriptomic profile. As a proof of principle, we analyzed the response to tumor-necrosis-factor-related apoptosis-inducing ligand (TRAIL) in HeLa cells to demonstrate that cell dynamics can discriminate the transient transcriptional states at the origin of cell decisions such as sensitivity and resistance. Our same-cell approach, named fate-seq, can reveal the molecular factors regulating the efficacy of a drug in clonal cells, providing therapeutic targets of non-genetic drug resistance otherwise confounded in gene expression noise. A record of this paper's transparent peer review process is included in the Supplemental Information.

Interleukin-10 and Zonulin Are Associated With Postoperative Delayed Gastric Emptying in Critically Ill Surgical Pediatric Patients: A Prospective Pilot Study.

BACKGROUND: Impaired gastric emptying (GE) is associated with morbidity in surgical critically ill children. The relationship between inflammation, gut barrier integrity (lipopolysaccharide binding protein [LBP]; zonulin), and GE has not been described in this cohort. METHODS: Children ≥2 years of age and requiring critical care after surgery were enrolled. Preoperative and postoperative levels of serum cytokines, LBP, and zonulin, and GE by the acetaminophen absorption test, were measured, allowing patients to serve as their own controls. Postoperative delayed GE was defined as a decrease in GE by ≥20% compared with preoperative GE. The following were examined : comparison between postoperative andpreoperative values, correlations between fold change (postoperative/preoperative) in study variables, and fold change in study variables between patients with and without postoperative delayed GE. RESULTS: Twenty patients, median age 14 years (12.25, 18), 12 female, were included. Eight of 20 patients had postoperative delayed GE. Postoperative interleukin-6 (IL-6), IL-8, IL-10, and LBP were increased, and zonulin was decreased (P-values < .05). Fold change in IL-10 and zonulin were inversely correlated (ρ -0.618, P = .004). Patients with postoperative delayed GE had greater fold increase in IL-10 (P = .0159) and fold decrease in zonulin (P = .0160). Five of 7 (71%) patients with both fold increase in IL-10 and decrease in zonulin had delayed GE. CONCLUSION: Postoperative changes in IL-10 and zonulin were associated with delayed GE in surgical critically ill children, which might suggest a mechanism to for delayed GE in postoperative inflammation and gut barrier dysregulation after surgery.

Volatile Anesthetic Sevoflurane Attenuates Toll-Like Receptor 1/2 Activation.

BACKGROUND: Although immunomodulatory effects of anesthetics have been increasingly recognized, their underlying molecular mechanisms are not completely understood. Toll-like receptors (TLRs) are one of the major receptors to recognize invading pathogens and danger signals from damaged host tissues to initiate immune responses. Among the TLR family, TLR2 and TLR4 recognize a wide range of ligands and are considered to be important players in perioperative pathophysiology. Based on our recent finding that volatile anesthetics modulate TLR4 function, we tested our hypothesis that they would also modulate TLR2 function. METHODS: The effect of anesthetics isoflurane, sevoflurane, propofol, and dexmedetomidine on TLR2 activation was examined by reporter assays. An anesthetic that affected the activation was subjected to in silico rigid docking simulation on TLR2. To test our prediction that sevoflurane and a TLR1/TLR2 ligand Pam3CSK4 would compete for the same pocket of TLR2, we performed Pam3CSK4 competitive binding assay to TLR2 using HEK cells stably transfected with TLR2 (HEK-TLR2) with or without sevoflurane. We examined the effect of different anesthetics on the functions of human neutrophils stimulated with TLR2 ligands. Kruskal-Wallis test and Mann-Whitney U test were used for statistical analysis. RESULTS: We observed that the attenuation of TLR1/TLR2 activation was seen on sevoflurane exposure but not on isoflurane, propofol, or dexmedetomidine exposure. The attenuation of TLR2/TLR6 activation was not seen in any of the anesthetics tested. The rigid docking simulation predicted that sevoflurane and Pam3CSK4 bound to the same pocket of TLR1/TLR2 complex. The binding of Pam3CSK4 to HEK-TLR2 cells was impaired in the presence of sevoflurane, indicating that sevoflurane and Pam3CSK4 competed for the pocket, as predicted in silico. The stimulation of neutrophils with Pam3CSK4 induced L-selection shedding but did not affect phagocytosis and reactive oxygen species production. L-selectin shedding from neutrophils was attenuated only by sevoflurane, consistent with the result of our reporter assays. CONCLUSIONS: We found that TLR1/TLR2 activation was attenuated by sevoflurane, but we found no evidence for attenuation by isoflurane, propofol, or dexmedetomidine at clinically relevant concentrations. Our structural analysis and competition assay supported that sevoflurane directly bound to TLR2 at the interphase of the TLR1/TLR2 complex. Sevoflurane attenuated neutrophil L-selectin shedding, an important step for neutrophil migration.

Platelet Inhibition With IV Glycoprotein IIb/IIIa Inhibitor to Prevent Thrombosis in Pediatric Patients Undergoing Aortopulmonary Shunting.

OBJECTIVES: Shunt thrombosis, a potential complication of aortopulmonary shunting, is associated with high mortality. Commonly used oral antiplatelet drugs such as aspirin demonstrate variable absorption and inconsistent antiplatelet effect in critically ill patients early after surgery. IV glycoprotein IIb/IIIa inhibitors are antiplatelet agents with rapid and reproducible effect that may be beneficial as a bridge to oral therapy. DESIGN: Retrospective review of pediatric patients undergoing treatment with IV tirofiban. Discarded blood samples were used to determine pharmacokinetic parameters. SETTING: Pediatric cardiac ICU at a single institution. PATIENTS: Fifty-two pediatric patients (< 18 yr) undergoing surgical aortopulmonary shunt procedure who received tirofiban infusion as a bridge to oral aspirin. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Primary outcome measures were shunt thrombosis and bleeding events, whereas secondary outcomes included measurement of platelet inhibition by thromboelastography with platelet mapping and pharmacokinetic analysis (performed in a subset of 15 patients). Shunt thrombosis occurred in two of 52 patients (3.9%) after prophylaxis treatment with tirofiban; both thrombosis events occurred after discontinuation of the drug. One patient (1.9%) experienced bleeding complication during the infusion. A tirofiban bolus of 10 µg/kg and infusion of 0.15 µg/kg/min resulted in significantly increased platelet inhibition via adenosine diphosphate pathway (median 66% [43-96] pre-tirofiban compared with 97% [92-99%] at 2 hr; p < 0.05). Half-life of tirofiban in plasma was 142 ± 1.5 minutes, and the average steady-state concentration was 112 ± 62 ng/mL. Age and serum creatinine were significant covariates associated with systemic clearance. Dosing simulations were generated based upon one compartment model. CONCLUSIONS: IV glycoprotein IIb/IIIa inhibitor as a bridge to oral antiplatelet therapy is safe in pediatric patients after aortopulmonary shunting. Dosing considerations should include both age and renal function. Randomized trials are warranted to establish efficacy compared with current anticoagulation practices.

Gastrointestinal Hormone Profiles Associated With Enteral Nutrition Tolerance and Gastric Emptying in Pediatric Critical Illness: A Pilot Study.

BACKGROUND: Enteral nutrition (EN) intolerance and delayed gastric emptying are prevalent in pediatric critical illness and limit EN delivery. Gastrointestinal (GI) hormones may be associated with EN intolerance and delayed gastric emptying in this cohort. METHODS: We determined GI hormone levels, time to achieve 50% of EN goal, and gastric emptying in critically ill children. Total amylin, active ghrelin, total glucagon-like peptide-1 (GLP-1), total gastric inhibitory polypeptide, glucagon, and total peptide-YY (PYY) were measured by multiplex assay and cholecystokinin by ELISA. Lower concentrations of acetaminophen at 1 hour (C1h, µg/mL) using the acetaminophen absorption test defined delayed gastric emptying. Correlation, regression analyses, and a principal component analysis were used to examine the association between GI hormones and time to 50% EN goal and C1h. RESULTS: GI hormones were measured in 14 of 21 patients with gastric emptying testing; median age of 11.2 years (6.74-16.3) and 50% male. Increasing hormone levels from GI hormone profile 1 (GLP-1, glucagon, and amylin) correlated with greater time to reach 50% EN goal (R2 = 0.296, P = 0.04). Decreasing hormone levels from GI hormone profile 2 (PYY and ghrelin) correlated with lower C1h and slower gastric emptying (R2 = 0.342, P = 0.02). CONCLUSION: GI hormone profiles are associated with time to achieve 50% of EN goal and gastric emptying in critically ill children. We have described a feasible model to study the role of GI hormones in this cohort, including the potential clinical applicability of GI hormone measurement in the management of delayed gastric emptying.