Historia clínica electrónica: miradas críticas de médicos del área metropolitana de Buenos Aires, Argentina / Electronic medical records: critical views of doctors in the metropolitan region of Buenos Aires, Argentina / Registro médico eletrônico: pontos de vista críticos dos médicos da área metropolitana de Buenos Aires, Argentina

Resumen Los procesos de digitalización del siglo XX extendieron el uso de Tecnologías de Información y Comunicación al campo de la salud. El artículo aborda la Historia Clínica Electrónica a partir de las críticas y debilidades señaladas por especialistas en Clínica Médica, Medicina General y/o de Familia del Área Metropolitana de Buenos Aires, Argentina. El diseño metodológico cualitativo incluyó 43 entrevistas realizadas entre junio de 2019 y marzo de 2020. El andamiaje teórico interpretativo articula tres campos: Comunicación y Salud; Biomedicina, Biopolítica y Tecnologías de Información y Comunicación; Subjetividad, Derechos y Género. Los principales resultados conciernen a cambios en las relaciones médico-paciente, registro y uso de datos, implicancias sobre los derechos y las subjetividades, potencialidades y problemáticas de la informatización en salud en un contexto de precaria infraestructura, desafíos en la regulación y desigualdades estructurales.(AU)

Abstract Digitalization has extended the use of information and communications technologies in the field of health. This article addresses electronic medical records drawing on the criticisms and weaknesses highlighted by clinical specialists, general practitioners, and family doctors working in the metropolitan region of Buenos Aires, Argentina. The qualitative research design included 43 interviews conducted between June 2019 and March 2020. We developed an interpretive framework structured around three categories: communications and health; biomedicine, biopolitics and information and communication technologies; subjectivity, rights and gender. The main results refer to: changes in doctor-patient relations; data recording and usage; implications for rights and subjectivities; potential and challenges of health informatization in a context of precarious infrastructure; and regulatory challenges and structural inequalities.(AU)

Resumo Os processos de digitalização do século XX estenderam o uso das Tecnologias da Informação e Comunicação ao campo da saúde. O artigo aborda o Registro Médico Eletrônico a partir das críticas e fragilidades apontadas por especialistas em Clínica Médica, Medicina Geral e / ou Família da Área Metropolitana de Buenos Aires, Argentina. O desenho metodológico qualitativo incluiu 43 entrevistas realizadas entre junho de 2019 e março de 2020. O referencial teórico interpretativo articula três campos: Comunicação e Saúde; Biomedicina, Biopolítica e Tecnologias de Informação e Comunicação; Subjetividade, Direitos e Gênero. Os principais resultados referem-se a mudanças nas relações médico-paciente, registro e uso de dados, implicações em direitos e subjetividades, potencialidades e problemas de informatização em saúde em um contexto de infraestrutura precária, desafios na regulação e desigualdades estruturais.(AU)

Biomechanical Study on Atlantoaxial Dislocation Combined with Basilar Invagination by Different Posterior Internal Fixation Methods / 医用生物力学

Objective To investigate biomechanical differences of two posterior occipitocervical internal fixation techniques for treating basilar invagination with atlantoaxial dislocation (BI-AAD). Methods Intra-articular cage + posterior occipital plate+C2 pedicle screw (Cage+C2PS+OP), and intra-articular cage+C1 lateral mass screw+C2PS (Cage+C1LMS+C2PS) models were established based on occipitocervical CT data of the BI-AAD and clinical operation scheme, and the stability of atlantoaxial joint and stress distribution characteristics of C2 endplate and implanted instruments under different motion states were analyzed. Results Compared with the Cage+C1LMS+C2PS model, the atlantoaxial range of motion ( ROM) under flexion, extension, lateral bending and axial rotation in the Cage+C2PS+OP model were reduced by 5. 26% , 33. 33% , 43. 75% , -5. 56% , and stress peak of screw-rod fixation system were reduced by 47. 81% , 60. 90% , 48. 45% , 39. 14% , respectively. Under two internal fixation modes, stresses of C2 endplate and cage were mainly distributed on the compressive side during the motion, and both the screw-bone interface and the caudal side of screw subjected to large loading. Conclusions Two internal fixation methods could provide similar stability. However, the stress concentration of screw-rod system was more obvious and the possibility of screw loosening and fracture was greater under Cage+ C1LMS+C2PS fixation.

Exploring on Mechanism of Gegen Qinliantang in Interventing Antibiotic-associated Diarrhea Based on 16S rRNA Sequencing and Network Pharmacology / 中国实验方剂学杂志

ObjectiveTo investigate the mechanism of Gegen Qinliantang（GQT） on the intestinal flora of antibiotic-associated diarrhea（AAD） by 16S rRNA sequencing and network pharmacology. MethodSixty SD rats were randomly divided into six groups（n=10）， including blank group， model group， GQT high-， medium- and low-dose groups（10.08， 5.04， 2.52 g·kg-1） as well as Lizhu Changle group（0.15 g·kg-1）， except for the blank group， each group was given clindamycin（250 mg·kg-1） by gavage once a day for 7 consecutive days. After successful modeling， the blank group and the model group were given equal volumes of normal saline by gavage. The other groups were given corresponding doses of drugs by gavage for 14 days. Traditional Chinese Medicine Systems Pharmacology Database and Analysis Platform（TCMSP） was used to screen the active components and targets of GQT， GeneCards， Online Mendelian Inheritance in Man（OMIM） database， Pharmacogenetics and Pharmacogenomics Knowledge Base（PharmGKB）， DrugBank and DisGeNET were used to search for AAD disease targets. The drug-disease common targets were obtained by R software. STRING was applied to analyze the target protein-protein interaction， and Kyoto Encyclopedia of Genes and Genomes（KEGG） pathway enrichment analysis was performed. Then hematoxylin-eosin（HE） staining was used to observe the pathological changes of the colon， and 16S rRNA sequencing of AAD colon content flora structure further verified the results of network pharmacology. ResultThrough network pharmacology， it was found that 238 active components were screened from GQT and acted on 276 component targets， among which quercetin， puerarin， wogonin and apigenin were the main core components of GQT， 1 097 AAD disease targets and 127 drug-disease intersection targets. The protein-protein interaction network mainly included core targets such as protein kinase B1（Akt1）， interleukin（IL）-6 and IL-1β， which were mainly enriched in the IL-17 signaling pathway. It was verified through animal experiments that compared with the blank group， the colon structure of the model group was seriously abnormal， the intestinal epithelial columnar cells were damaged， the goblet cells were reduced， and a large number of inflammatory cells were infiltrated. Compared with the model group， the colon structure of the GQT high-dose group improved， but there were still abnormalities， the colon structure of GQT medium- and low- dose groups and Lizhu Changle group improved significantly and reached the normal level. GQT could improve the structural diversity of AAD intestinal flora. At the phylum level， the abundance of Firmicutes was increased and the abundance of Bacteroidetes was decreased. At the genus level， the abundance of Lactobacillus was increased， and the abundances of Prevotella and Bacteroides were decreased. Among them， Lactococcus could be used as a biomarker for AAD treatment with GQT， and the prediction of functional metabolism of intestinal flora revealed that GQT could promote acetate and lactate metabolic pathways in the intestine. ConclusionGQT may activate IL-17 signaling pathway by acting on the targets of Akt1 and IL-6 through key components such as quercetin and wogonin， and improve the abundance of Lactococcus in the intestinal tract as well as acetate and lactate metabolic pathways， so as to play a role in repairing the intestinal barrier for the treatment of AAD.

The cGAS-STING signaling in cardiovascular and metabolic diseases: Future novel target option for pharmacotherapy

The cyclic GMP-AMP synthase (cGAS)-stimulator of interferon genes (STING) signaling exert essential regulatory function in microbial-and onco-immunology through the induction of cytokines, primarily type I interferons. Recently, the aberrant and deranged signaling of the cGAS-STING axis is closely implicated in multiple sterile inflammatory diseases, including heart failure, myocardial infarction, cardiac hypertrophy, nonalcoholic fatty liver diseases, aortic aneurysm and dissection, obesity, etc. This is because of the massive loads of damage-associated molecular patterns (mitochondrial DNA, DNA in extracellular vesicles) liberated from recurrent injury to metabolic cellular organelles and tissues, which are sensed by the pathway. Also, the cGAS-STING pathway crosstalk with essential intracellular homeostasis processes like apoptosis, autophagy, and regulate cellular metabolism. Targeting derailed STING signaling has become necessary for chronic inflammatory diseases. Meanwhile, excessive type I interferons signaling impact on cardiovascular and metabolic health remain entirely elusive. In this review, we summarize the intimate connection between the cGAS-STING pathway and cardiovascular and metabolic disorders. We also discuss some potential small molecule inhibitors for the pathway. This review provides insight to stimulate interest in and support future research into understanding this signaling axis in cardiovascular and metabolic tissues and diseases.

Miltirone induces cell death in hepatocellular carcinoma cell through GSDME-dependent pyroptosis

Pyroptosis is a form of programmed cell death, and recently described as a new molecular mechanism of chemotherapy drugs in the treatment of tumors. Miltirone, a derivative of phenanthrene-quinone isolated from the root of Bunge, has been shown to possess anti-cancer activities. Here, we found that miltirone inhibited the cell viability of either HepG2 or Hepa1-6 cells, and induced the proteolytic cleavage of gasdermin E (GSDME) in each hepatocellular carcinoma (HCC) cell line, with concomitant cleavage of caspase 3. Knocking out switched miltirone-induced cell death from pyroptosis to apoptosis. Additionally, the induction effects of miltirone on GSDME-dependent pyroptosis were attenuated by siRNA-mediated caspase three silencing and the specific caspase three inhibitor Z-DEVD-FMK, respectively. Miltirone effectively elicited intracellular accumulation of reactive oxygen species (ROS), and suppressed phosphorylation of mitogen-activated and extracellular signal-regulated kinase (MEK) and extracellular regulated protein kinases 1/2 (ERK1/2) for pyroptosis induction. Moreover, miltirone significantly inhibited tumor growth and induced pyroptosis in the Hepa1-6 mouse HCC syngeneic model. These results provide a new insight that miltirone is a potential therapeutic agent for the treatment of HCC GSDME-dependent pyroptosis.

Coinfección virus de inmunodeficiencia humana-virus de la Hepatitis C: hacia un nuevo escenario terapéutico / Human Immunodeficiency Virus-Hepatitis C virus coinfection: towards a new therapeutic scenario

Introducción: Las terapias contra el virus de la Hepatitis C han evolucionado vertiginosamente con el desarrollo de los antivirales de acción directa (AADs). Los nuevos regímenes han conseguido igualar las tasas de respuesta al tratamiento en los monoinfectados y los coinfectados con VIH, una población tradicionalmente difícil de tratar debido a la elevada morbimortalidad hepática y sistémica, reacciones adversas e interacciones medicamentosas. Objetivo: Analizar las opciones farmacoterapéuticas más modernas disponibles para los pacientes coinfectados con VIH y VHC, con énfasis en los nuevos antivirales de acción directa, a fin de ofrecer una herramienta útil en el abordaje terapéutico en estos pacientes. Material y métodos: Se revisaron artículos originales, ensayos clínicos y revisiones sistemáticas hasta septiembre de 2016, bases de datos internacionales de interacciones medicamentosas y Guías de Práctica Clínica actualizadas. Desarrollo: Las terapias contra el virus de la Hepatitis C (VHC) han evolucionado vertiginosamente con el desarrollo de los antivirales de acción directa (AADs). Los nuevos regímenes han conseguido igualar las tasas de respuesta al tratamiento en los monoinfectados y los coinfectados con VIH, una población tradicionalmente difícil de tratar que, además, asociaba una elevada morbimortalidad hepática y sistémica, más reacciones adversas y complejas interacciones medicamentosas. Conclusiones: En este nuevo escenario es fundamental dedicar esfuerzos a identificar el elevado porcentaje de infectados no diagnosticados, potenciales interacciones, especialmente con fármacos para patologías asociadas al envejecimiento de los pacientes, reacciones adversas a medio-largo plazos y desarrollo de resistencias, además de garantizar la cobertura universal en todos los contextos clínicos(AU)

Introduction:Therapies for hepatitis C virus (HCV) have rapidly evolved with the development of direct-acting antiviral agents. New regimens, achieve an equate response rates to treatment in cases of HCV mono-infected and HIV/HCV co-infected; a population traditionally difficult to treat due to a high hepatic and systemic morbidity-mortality, adverse reactions and drug interactions. Objective: To analyse the current Pharma-therapeutic options available for co-infected HIV-HCV patients, with emphasis I the new direct-acting antiviral agents, in order to offer a useful tool for the therapeutic approach in these patients. Material and Methods: Original articles, clinical studies and systematic reviews until September 2016 were carried out, as well as international drug interactions databases and updated Practical Guidelines. Development: Therapies for hepatitis C virus (HCV) have rapidly evolved with the development of direct-acting antiviral agents. New regimens achieve an equate response rates to treatment in HCV mono-infected and HIV/HCV co-infected; a population traditionally difficult to treat, which also associate a high hepatic and systemic morbidity-mortality, adverse reactions and complex drug interactions. Conclusions: In this new scenario efforts must be addressed to identify the high percentage of undiagnosed patients; potential interactions, especially with drugs related with patient aging; medium and long-term adverse reactions and development of drug resistances, as well as to guarantee universal coverage in all clinical contexts(AU)

Topological analysis of carbon flux during multi-stress adaptation in Halomonas sp. AAD12

Background Osmolytes with their effective stabilizing properties are accumulated as protectants not only against salinity but also against denaturing harsh environmental stresses such as freezing, drying, high temperatures, oxygen radicals and radiation. The present work seeks to understand how Halomonas sp. AAD12 cells redirect carbon flux specifically to replenish reactions for biomass and osmolyte synthesis under changing salinity and temperature. To accomplish this goal, a combined FBA-PCA approach has been utilized. Results Experimental data were collected to supply model constraints for FBA and for the verification of the model predictions, which were satisfactory. With restrictions on the various combinations of selected anaplerotic paths (reactions catalyzed by phosphoenolpyruvate carboxylase, pyruvate carboxylase or glyoxylate shunt), two major phenotypes were found. Moreover, under high salt concentrations, when the glucose uptake rate was over 1.1 mmoL DCW- 1 h- 1, an overflow metabolism that led to the synthesis of ethanol caused a slight change in both phenotypes. Conclusions The operation of the glyoxylate shunt as the major anaplerotic pathway and the degradation of 6-phosphogluconate through the Entner-Doudoroff Pathway were the major factors in causing a distinction between the observed phenotypes.

Situação de vida, saúde e doença da população indígena Potiguara / Situacion de vida, salud y enfermedad de la poblacion indigena Potiguara / Life, health and disease among the Potiguara people

O objetivo com este estudo foi averiguar a situação de vida, saúde e doença dos índios potiguaras, aldeados na Paraíba.Trata-se de um estudo exploratório, com uma abordagem quantitativa. A amostra foi definida como o núcleo familiar deacordo com o cadastro do Sistema de Informação de Atenção a Saúde Indígena (SIASI). Foram realizadas 55 entrevistascom índios da aldeia São Francisco, em Baía da Traição-PB. O instrumento utilizado foi uma entrevista semiestruturada comquestões relativas à temática e à caracterização socioeconômica. Este estudo possibilitou o conhecimento da realidadesocial da amostra estudada, levantando índices elevados com relação ao baixo nível socioeconômico e suas consequênciaspara a manifestação de doenças, alto índice de doenças sexualmente transmissíveis (DSTs), alcoolismo, dentre outras.Tais achados apontam para a necessidade de adoção de propostas voltadas para a melhoria das condições de saúdedessa comunidade. A Equipe Multiprofissional em Saúde Indígena (EMSI), em especial a enfermagem, deve promover aintegração entre o sistema local de saúde e a sabedoria indígena, de modo que, mediante abordagens culturais, possibilitecompreender o universo cultural dos índios potiguaras, suas práticas relacionadas à saúde e a doenças, tornando, assim,as intervenções de controle mais eficazes, principalmente em relação às doenças infecciosas e parasitárias.

This research aimed at studying the life and health conditions as well as the occurrence of diseases among the potiguarapeople in the state of Paraíba. It is an exploratory, quantitative study. The sample unit consisted of the nuclear familyaccording to the Health Information System for Indigenous Peoples survey (in Portuguese, SIASI). The 55 potiguaraIndians interviewed belonged to the São Francisco indigenous settlement in the municipality of Baía da Traição, Paraíba.Semi-structured interviews with questions related to the issue and the socioeconomic characterization were applied.This study provided information on the study sample social reality, the low socioeconomic status of the population andits relationship with the appearance of diseases, the high levels of STD, and alcoholism, among others. Such resultsindicate the need for the improvement of the community’s health conditions. In this context a Multidisciplinary Teamdedicated to indigenous health care, and particularly the nursing team, should promote integration between thelocal health system and indigenous knowledge. A cultural approach to the situation might contribute to understandthe potiguara Indians culture, their health care and disease control practices, and to intervene more efficiently in thecontrol of infectious and parasitic diseases.

Este estudio tuvo como objetivo evaluar las condiciones de vida, salud y enfermedades de los indios potiguara delEstado de Paraíba. Se trata de una investigación exploratoria con enfoque cuantitativo. La muestra consistió en elnúcleo familiar de acuerdo con el registro de las familias en el Sistema de Información de Atención de la Salud Indígena(SIASI). Se realizaron 55 entrevistas con indios de la aldea São Francisco en Baia da Traição – Paraíba. El instrumentoutilizado fue la entrevista semiestructurada, con cuestiones relativas al tema y a la clasificación socioeconómica. Esteestudio permitió conocer la realidad social de la muestra que señala altos índices de bajo nivel socioeconómico, susconsecuencias para la manifestación de enfermedades, el alto índice de ETS y de alcoholismo, entre otros. Los resultadosapuntan la necesidad de adotar propuestas para mejorar las condiciones de salud de esta población, en la que elEquipo Multiprofesional de Salud Indígena, en especial la enfermería, promueva la integración entre el sistema localde salud y la sabiduría indígena. El enfoque cultural de la situación podría contribuir a entender la cultura, la salud ylas prácticas de control de enfermedades de los indios potiguara y , a partir de ello, controlar y tratar con más eficiencialas enfermedades infecciosas y parasitarias.

Assessment of Cell Viability in Umbilical Cord Blood before Cryopreservation / 대한수혈학회지

BACKGROUND: The viability of cord blood is an important measure of product quality. Trypan blue (TB) stain is the most commonly and conveniently used method to measure the viability of the cord blood. Recently, cytometric analysis using 7-Aminoactinomycin D (7-AAD) was introduced. Staining with 7-AAD is more sensitive in detecting cellular damage than staining with TB. In addition to this, 7-AAD allows specific measurement of the viability of total nucleated cells (TNC), mononuclear cells (MNC) and CD34+ cells. In this study, we compared the viability of TNC between the TB and 7-AAD method, as well as analyzing the viability of each cell population. METHODS: From February to July 2010, 102 cord blood units were collected and assessed for the viability of TNC by the TB and 7-AAD methods. The viability of mononuclear cells (MNC) and CD34+ cells was assessed by 7-AAD method. RESULTS: The TB and 7-AAD methods were used to assess the viability of TNC, which was 90.1+/-5.7% and 68.4+/-8.0%, respectively. The viability of MNC and CD34+ cells measured by the 7-AAD method was 91.8+/-4.3% and 93.4+/-5.1%, respectively. CONCLUSION: The TNC viability of 7-AAD method was significantly lower than that of TB method. In 7-AAD method, the viabilities of MNC and CD34+ cells were significantly higher than that of TNC. As those are important prognostic factors and measures for successful engraftment after the transplantation, the measurement of the viabilities of MNC and CD34+ cells by 7-AAD method would be helpful to the quality control of the cord blood product.

Management of Antibiotics-Associated Diarrhea / 대한소화기학회지

Antibiotics-associated diarrhea (AAD) is defined as unexplained diarrhea that occurs with the administration of antibiotics. Approximately 20% AAD cases are due to Clostridium difficile. Over the last decade, the incidence of Clostridium difficile-associated disease (CDAD) has progressively increased, and now a significant clinical problem. Recent change in the epidemiology of CDAD and the emergence of an epidemic hypervilruent strain suggest the need for greater attention for infection control, early diagnosis, and more effective treatment modality. However, since most cases of CDAD are both iatrogenic and nosocomial, careful selection of antibiotics, combined with proper hand hygiene and precaution by medical staffs are required.

Microeological Modulator in Preventing Neonatal Antibiotic Associated Diarrhea:A Clinical Research / 中华医院感染学杂志

OBJECTIVE To understand the clinical effect of microeclogical modulator Bifid Triple Viable(BTV) in preventing neonatal antibiotic associated diarrhea(AAD).METHODS A prospective controlled study was undertaken on the antibiotic treated group and control group from Jan,2004 to Dec 2007.RESULTS Among the 996 neonatal patients in treated group,71 patients occurred AAD,with the morbidity of 7.13%.Among the 1012 neonatal patients in control group,235 patients occurred AAD(morbidity 23.22%).There was significant difference between the two groups(P

Effect of G-CSF on Myeloid Leukemic Cell Lines after Treatment with Ara-C / 대한임상병리학회지

BACKGROUND: G-CSF or GM-CSF was frequently used in treatment of acute myeloid leukemia patients. But it has been argued whether this increases the apoptosis of tumor cells in synergy with chemotherapeutic agent, or decreases apoptosis of leukemic cells. We attempted to determine the effect of granulocyte colony-stimulating factor (G-CSF) on leukemic cell line after cytosine arabinoside (Ara-C) treatment. METHODS: KG-1 and HL60 cell lines were incubated with Ara-C for 48 hours, and then washed with media, divided into two groups, one being with the addition of G-CSF and the other being without G-CSF and incubated for another 48 hours. The controls were the same cell lines incubated without Ara-C. The absolute cell counts and apoptotic percentage measured by flowcytometry after stained with 7-aminoactinomycin D (7-AAD) were compared among three groups at 0, 48, and 96 hours. RESULTS: KG-1 cell line showed decreased cell count and increased apoptotic percent in Ara-C/G-CSF and Ara-C group compared with the control group at 48 and 96 hours, and did not showed significant difference between G-CSF group and nonG-CSF group. In HL60, control group showed higher cell count at 48 hours, and G-CSF/Ara-C group showed lower cell count and higher apoptosis than Ara-C group in all trials. CONCLUSIONS: The treatment of G-CSF after Ara-C did not protect apoptosis nor increase the tumor cells in KG-1 and HL60 cell lines. We concluded it would be safe to use G-CSF after administration of chemotherapeutic drug.

Simultaneous Three Color Detection of Surface Antigen (My 7), Intracellular Antigen (c-myc), and DNA Content using Single Laser Flow Cytometry / 대한산부인과학회잡지

Flow cytometry, a useful tool for measuring DNA content and cell differentiation as expressed by cell surface markers, is utilized to measure multiple antigens, especially surface antigen, intracellular oncoprotein, and DNA content, simultaneously. For this simultaneous detection, several methods off ixation and permeabilization have been used with limited values. In this study, 20 ng/ml of lysolecithin in 1% paraformaldehyde solution was utilized for fixation and permeabilization of cultured promyelocytic leukemic cells(HL 60). The cells were first stained with phycoerythrin (PE)-conjugated monoclonal antibody to the cell surface My 7 antigen and then were fixed and permeabilized with 20 ng/ml of lysolecithin in 1% partormaldehyde solution. After incubation, the fixed and permeabilized cells were stained with monoclonal antibody to intracellular c-myc antigen, which were followed by fluorescein isothiocyanate (FITC)-conjugated secondary antibody. The c-myc stained cells were finally stained for DNA content with 7-amino-actinomycin D(7-AAD). This procedure permits excellent staining for intracellular oncoproteins and preservation of surface antigens with relatively low cofficients of variation (CV) for the G0G1 peak of the DNA histograms and suggests that the sequential staining procedure of surface antigen, intracellular antigen, and DNA content will be extended for the study of correlations with cellular differentiation, expression of oncoproteins, and cell cycle analysis in the cells which are obtained from human malignant diseases using a 488 nm single laser flow cytometry.