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Chinese materia medica has a wide range of clinical applications, but it has many active ingredients with different physicochemical properties, and the target organs, action pathways and mechanisms for different ingredients to exert their efficacy are not the same. Therefore, it is difficult to design and develop a co-delivery system loading multiple components of Chinese materia medica to maximize the synergistic therapeutic efficiency. Based on the characteristics of effectiveness and functionality of active ingredients, the strategies for multi-component co-delivery of Chinese materia medica can be categorized into two types:firstly, based on the effectiveness of active ingredients, new carriers such as liposomes, nanoparticles can be constructed to load multi-components of Chinese materia medica. secondly, based on the functionality of some active ingredients of Chinese materia medica, they are employed in the construction of co-delivery system, which can give play to the dual characteristics of their own efficacy and preparation functions. In this paper, we summarized the relevant research progress of the above two types of multi-component co-delivery strategies, and mainly discussed the pharmaceutical functions of the active ingredients in co-delivery systems, in order to find a more suitable multi-component co-delivery strategy, promoting the design and development of new delivery systems of Chinese materia medica.
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Background Long-term exposure to free silica particles will lead to fibrosis of lung tissue, and abnormal expression of microRNA (miRNA) may affect the occurrence and process of fibrosis. Objective To observed possible intervention effect of miR-204-3p overexpression adenovirus on silicosis fibrosis induced by silica dust using a silicosis rat model via non-exposed intratracheal instillation. Methods Forty SD rats were randomly divided into four groups: control group, silicosis model group, miRNA-NC group, and miR-204-3p intervention group. Under ether anesthesia, rats in the silicosis model group, miRNA-NC group, and miR-204-3p intervention group were injected with 1 mL (50 mg·mL−1) of free silica dust suspension into the trachea, while the control group was injected with the same volume of normal saline. After 30 d of dust exposure, the miR-204-3p intervention group was injected with rno-mir-204 adenovirus vector to overexpress miR-204-3p, and the miRNA-NC group was given empty virus vector. After 30 d of normal feeding, the animals were sacrificed by chloral hydrate anesthesia, and the lung tissue was taken for subsequent experiments. The relative expression level of miR-204-3p in lung tissue of rats in each group was detected by real-time fluorescence quantitative PCR (RT-qPCR). HE staining, Masson staining, and Sirius red staining were used for pathological observation. Immunohistochemistry was used to detect the expression of Fibronectin and Collagen I in lung tissue of rats in each group. RT-qPCR was used to detect the relative gene expression levels of fibrosis markers Fibronectin, Vimentin, Collagen I, and Collagen III in lung tissue of rats in each group. Western blot was used to detect the protein expression levels of fibrosis markers Fibronectin, Vimentin, Collagen I, and Collagen III in lung tissue of rats in each group. Results The anatomical features of lung tissue in the control group were pink lung tissue with soft texture and smooth surface, while those in the silicosis model were grayish white tissue with hard texture and scars and grayish white silicon nodules on the surface. Compared with the silicosis model group, the color of lung tissue in the miR-204-3p intervention group became ruddy, the surface was smooth, and the texture became soft. The staining results showed that the alveolar wall of the control group was thin, there were a small number of capillaries in the alveoli, and the alveolar structure was clear and complete. In the silicosis model group, the alveolar wall became thicker, the pulmonary septum was partially broken, the alveolar structure was defective, and a large amount of collagen fibers were deposited. The alveolar structure of the miR-204-3p intervention group was relatively clear and there was a small amount of collagen fiber deposition. RT-qPCR results showed that compared with the control group, the relative expression levels of miR-204-3p in lung tissue of the silicosis model group and the miRNA-NC group were decreased (P<0.05), and the relative expression level of miR-204-3p in lung tissue of the miR-204-3p intervention group was increased (P<0.05). The results of immunohistochemistry showed that compared with the control group, the expression levels of Fibronectin and Collagen I in lung tissue of the silicosis model group were increased (P<0.05). Compared with the silicosis model group, the relative expression levels of Fibronectin and Collagen I in lung tissue of the rats in the miR-204-3p intervention group were significantly decreased (P<0.05). The results of RT-qPCR and Western blot showed that compared with the control group, the relative protein and gene expression levels of fibrosis factors Fibronectin, Vimentin, Collagen I, and Collagen III in lung tissue of the silicosis model group increased (P<0.05). Compared with the silicosis model group, the relative gene and protein expression levels of fibrosis factors Fibronectin, Vimentin, Collagen I, and Collagen III in lung tissue of rats in the miR-204-3p intervention group were decreased (P<0.05). Conclusion Silica dust can cause lung fibrosis in rats, and overexpression of miR-204-3P in vivo can reduce silicosis fibrosis in rats caused by silica dust.
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Based on the literature review and the analysis of specific cases of postpartum frequent micturition,pediatric enuresis,elderly uremia complicated with bradyarrhythmia in clinic,the clinical application of the action of Ephedrae Herba in stimulating yang qi is discussed.Ephedrae Herba has the meridian tropism of the lung and bladder meridians,and is pungent,warm and dispersing,which is the most important medicine for the treatment of external contraction.Ephedrae Herba has the actions of inducing diaphoresis,calming asthma and inducing diuresis,and is widely used for the treatment of external contraction,coughing and asthma,and edema.For the patients with deficiency of both kidney yin and kidney yang without obvious bias of yin-yang consumption which result from the postpartum impairment of qi and blood,deficient innate endowment,and gradually exhaustion of essence in the kidney in the elderly or during chronic illness,a small dosage of Ephedrae Herba can stimulate yang qi during the treatment of warming kidney yang,which is helpful for promoting the drug arriving at the back shu-points of the internal organs distributed along the bladder meridian and enhancing the recovery of zang-fu organ function.Ephedrae Herba is strong in inducing diaphoresis with an intense action.When Ephedrae Herba is used to stimulate yang,the dosage of 3~9 g is appropriate,and medicines for warming yang are needs to be used together.The course of treatment with Ephedrae Herba should be avoided to be too long,in order to prevent the vital energy from the damage by its large cumulative dose.
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Objective To discuss the clinical efficacy of absolute ethanol and foam hardening agent in the treatment of large venous malformations(VM)in child patients.Methods The clinical data of a total of 60 child patients with solitary large VM were retrospectively analyzed.The child patients were divided into group A(n=30)and group B(n=30).Patients in group A received absolute ethanol injection followed by foam hardening agent injection,while patients in group B received foam hardening agent injection followed by absolute ethanol injection.The clinical efficacy,complications,mean number of injections and mean dosage of absolute ethanol were compared between the two groups.Results The total effective rate in both group A and group B was 100%.The markedly effective rate in group A and group B was 63.33%(19/30)and 90%(27/30)respectively,and the difference was statistically significant(P<0.05).In group A and group B,the mean dosage of absolute ethanol was(10.30±3.19)mL and(6.73±2.06)mL respectively,the mean number of injection was(3.57±1.01)times and(2.63±0.61)times respectively,and the differences in the above two indexes were statistically significant(both P<0.05).No serious complications occurred in either group.The incidence of blisters in group A and group B was 30%(9/30)and 6.67%(2/30)respectively,and the difference was statistically significant(P<0.05).Conclusion For large VM in child patients,combination use of absolute ethanol and foam hardening agent can improve the curative efficacy,reduce the dosage of absolute ethanol,and lower the incidence of complications.In addition,the therapeutic mode of foam hardening agent injection followed by absolute ethanol injection can achieve better efficacy.(J Intervent Radiol,2024,32:28-32)
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BACKGROUND:Clinical studies have shown that aerobic exercise is an important supplement to the clinical treatment of patients with pulmonary hypertension,which can alleviate the disease condition,increase exercise tolerance and improve the quality of life.However,it is not clear whether patients at different stages of pulmonary hypertension can benefit equally from exercise training. OBJECTIVE:To compare the intervention effects of early or late aerobic training on right heart failure in rats with pulmonary hypertension and explore its possible mechanism. METHODS:Sixty male Wistar rats were randomly divided into control group,model sedentary group,model early exercise group and model late exercise group,with 15 rats in each group.The model of pulmonary hypertension was established by intraperitoneal injection of monocrotaline(60 mg/kg)in the latter three groups.The model early exercise group was given 8 weeks of treadmill aerobic exercise(60%maximum running speed,60 minutes per day,5 days a week)after modeling,while the model late exercise group was trained for 6 weeks after 2 weeks of modeling.The control and model sedentary groups were fed quietly in the rat cage for 8 weeks.After training,the exercise performance,right ventricular hemodynamics,cardiopulmonary function,cardiopulmonary histopathology,reactive oxygen species level in mitochondria,activity of mitochondrial respiratory chain complex and expressions of myocardial tissue proteins were detected. RESULTS AND CONCLUSION:Compared with the model sedentary group,exercise performance and right ventricular function improved(P<0.05),myocardial collagen content,endothelin-1,tumor necrosis factor-α/interleukin-10 ratio and β-myosin heavy chain/α-myosin heavy chain ratio decreased(P<0.05),vascular endothelial growth factor and sarcoplasmic reticulum calcium-adenosine triphosphate enzyme expression increased(P<0.05),immunofluorescence intensity of mitochondrial reactive oxygen species and the protein expression of 3-nitrotyrosine decreased(P<0.05),the activities of complex I,II,IV and V increased in the model early exercise and model late exercise groups(P<0.05),but there were no significant changes in right ventricular maximum pressure,pulmonary acceleration time and pulmonary artery wall area/total vascular area ratio(P>0.05).Compared with the model late exercise group,the model early exercise group further improved exercise performance and right ventricular function,and downregulated collagen content,brain natriuretic peptide protein expression,tumor necrosis factor-α/interleukin-10 ratio and β-myosin heavy chain/α-myosin heavy chain ratio(P<0.05).To conclude,although pulmonary vascular remodeling and right ventricular overload persist in rats with pulmonary hypertension,exercise training at different stages of the disease has a cardioprotective effect.The mechanism is related to the improvement of cardiac remodeling,neurohormone system imbalance,inflammatory response and mitochondrial oxidative stress.Greater benefit is gained from initiating exercise in the early stage of the disease.
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BACKGROUND:Aging is associated with increased susceptibility to cardiovascular disease,and mitochondrial dysfunction plays a key role in the pathogenesis of cardiovascular disease.Regular physical activity is beneficial to cardiovascular health and can prevent and treat chronic heart disease.However,the specific mechanism of mitochondria in the protective effect of exercise on the aging heart has not yet been clarified. OBJECTIVE:To explore the effect of aerobic exercise on cardiac pathological remodeling in aging rats and to investigate the possible mechanism of mitochondrial quality control system. METHODS:Sixty Wistar rats were randomly divided into young sedentary group(6 months old),old sedentary group(20 months old)and old exercise group(20 months old)with 20 rats in each group.Rats in the young sedentary and old sedentary groups were fed in cages for 12 weeks,while those in the old exercise group underwent moderate-intensity aerobic treadmill exercise(60%of the maximal running speed,slope 0°,60 minute per day,5 days per week)for 12 weeks.After the experiment,the heart was extracted for relevant indicator tests. RESULTS AND CONCLUSION:Cardiac morphology and myocardial histopathology:compared with the young sedentary group,the rats in the old sedentary group presented with concentric cardiac hypertrophy,myocardial fibrosis,myocardial cell apoptosis and loss,and cardiac diastolic dysfunction(P<0.05);compared with the old sedentary group,animals in the old exercise group showed reduced myocardial fibrosis and apoptosis rates,increased cell numbers,improved cardiac function(P<0.05),and a transition in cardiac phenotype from pathological to physiological hypertrophy.Mitochondrial function:compared with the young sedentary group,the generation rate of mitochondrial hydrogen peroxide increased(P<0.05),respiration rate and respiratory control ratio of state 3 and state 4 decreased(P<0.05),activities of respiratory chain complexes Ⅰ,Ⅱ and Ⅳ decreased(P<0.05),mitochondrial calcium retention capacity decreased(P<0.05),and mitochondrial permeability transition pore opening increased(P<0.05)in the old sedentary group.Compared with the old sedentary group,all of the above indicators were significantly improved in the old exercise group(P<0.05).Mitochondrial quality control:compared with the young sedentary group,mitochondrial biogenesis decreased(P<0.05),mitophagy activity increased(P<0.05),mitochondrial fusion reduced(P<0.05),and fission raised(P<0.05)in the old sedentary group;compared with the old sedentary group,mitochondrial biogenesis and mitophagy activity increased(P<0.05),mitochondrial fusion raised(P<0.05)and fission decreased(P<0.05)in the old exercise group.To conclude,regular aerobic exercises exert cardioprotective effects in aging rats by regulating the mitochondrial quality control system,thus reversing pathological cardiac remodeling and improving cardiac function.
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ObjectiveThis study aimed to identify a potential miRNA-mRNA axis in neurofibromatosis type 2 (NF2)-negative meningiomas, investigate their target relationships, and determine their biological functions. MethodsThe GSE17792 dataset, which contains data related to NF2-negative meningiomas, was downloaded from the Gene Expression Omnibus (GEO) database. The limma package of R software was used to determine the differentially expressed miRNAs (DeMiRNAs). The miRWalk 2.0 database was applied to obtain the target genes of DeMiRNAs. The Search Tool for the Retrieval of Interacting Genes (STRING) database was utilized to build protein-protein interaction (PPI) networks, and hub genes were identified via Cytoscape software. The expression and biological roles of the screened miRNAs were further validated. ResultsAltogether, 86 DeMiRNAs, consisting of 52 upregulated and 34 downregulated miRNAs, were found in NF2-negative meningioma tumor samples compared with arachnoid tissue controls. Fourteen miRNAs associated with 274 target genes were identified among these DeMiRNAs, and miRNA-target gene networks were constructed based on these data. Analysis with cytoHubba showed that two miRNAs (hsa-miR-650 and hsa-miR-623) were among the top 20 key hub genes in the PPI network. Further qRT-PCR experimental verification suggested that the expression of hsa-miR-650 was significantly higher in NF2-negative meningiomas than in normal brain tissues. Downregulation of hsa-miR-650 inhibited the proliferation and induced the apoptosis of NF2-negative meningioma cells. Finally, RAC1 was identified as a target of hsa-miR-650. ConclusionHsa-miR-650 acts as a tumor promoter and might function as a therapeutic target for patients with NF2-negative meningiomas.
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Objective To retrospectively analyze the prevention and control effect and epidemic characteristics of elderly tuberculosis in Hubei Province from 2016 to 2020, and to provide a scientific basis for the prevention and treatment of elderly tuberculosis in Hubei Province. Methods The data on tuberculosis patients aged 60 and above who registered their current address in Hubei Province from 2016 to 2020 were collected and analyzed. The registration rates and composition ratios were analyzed using χ2 test and χ2 test for trend. Results A total of 135 976 tuberculosis patients were reported in Hubei from 2016 to 2020. The annual average registration rate of elderly tuberculosis among the elderly registered residence population (referring to the registration rate of elderly registered residence population aged 60 and above as the denominator, and tuberculosis patients aged 60 and above as the numerator) was 263.51/100 000. The highest rate was 300.02/100,000 in 2017, and the lowest was 188.19/100,000 in 2020 (χ2=70,227.603, P2trend=40.448,P2trend=740.911, P2trend=380.557, P2trend=323.764, P<0.001). Conclusion The elderly population with pulmonary tuberculosis in Hubei Province shows a downward trend. It is necessary to focus on the efforts of designated hospitals to proactively identify cases, increase the proportion of confirmed cases, maintain a high tracking in place, reduce medical delays, and ensure the effectiveness of tuberculosis prevention and treatment for the elderly.
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Based on the interaction between supramolecule of traditional Chinese medicine and enterobacteria, the material basis of Rhei Radix et Rhizoma and Coptidis Rhizoma was explored. Scanning electron microscopy (SEM) and dynamic light scattering (DLS) were used to characterize the morphological differences of Rhubarb single decoction, Coptis single decoction and Rhubarb and Coptis co-decoction. An in vitro antibacterial model (E. coli, E. faecium and B. subtilis) was established to evaluate the damage effect of the combination of Rhei Radix et Rhizoma and Coptidis Rhizoma on enterobacteria. Ultra high performance liquid chromatography-tandem mass spectrometry (UPLC-MS/MS) was used to analyze the changes of chemical components of single decoctions and co-decoctions. The co-decoction of Rhei Radix et Rhizoma and Coptidis Rhizoma was turbid after decocting. The spherical particles of 300-400 nm were observed under SEM, and the co-decoction was more uniform and stable than that of single decoction. The interaction between supramolecules formed after the combination of Rhei Radix et Rhizoma and Coptidis Rhizoma and enterobacteria was significantly different from that of single decoction. In the process of interaction between supramolecules and enterobacteria, the spherical state was maintained, and the medicinal ingredients in Coptidis Rhizoma or Rhei Radix et Rhizoma were blocked, which could effectively alleviate the damage to enterobacteria. This study provided a reference for subsequent studies on the regulation of intestinal flora homeostasis by the combination of Rhei Radix et Rhizoma and Coptidis Rhizoma.
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Objective To explore the changes of metabonomics in blood of mice after high-voltage electric shock,then screen out the significantly changed differential metabolites and metabolic pathways.Methods The head of C57BL/6J mice was subjected to high-voltage electric shock(electric shock group)or exposed to acoustic and optical stimulation of high-voltage electric(control group),then the whole blood from mice were collected to separate serum.The dual platform combined metabonomic analysis based on gas chromatography-mass spectrometer(GC-MS)and liquid chromatography-mass spectrometer(LC-MS)was performed and orthogonal partial least squares discriminant analysis(OPLS-DA)was used to screen the differential metabolites and related metabolic pathways.Results A total of 415 differential metabolites were screened out in metabonomics in blood of mice after high-voltage electric shock,including 187 up-regulated and 228 down-regulated metabolites.These differentially metabolites were significantly enriched in metabolic pathways including central carbon metabolism in cancer,glucagon signaling pathway,etc.Conclusion By establishing the model of high-voltage electrical injury on experimental mice,this study reveals the significant change of metabolite content and metabolic pathway in blood by high-voltage electrical injury.Which provides a basis for the damage of blood metabolic activity by high-voltage electrical injury,and suggests the potential harm of high-voltage electrical injury to blood metabolic activity in the whole body.
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Objective To study the change of lipidomics in chronic cadmium-exposed mice,thereby screening out lipid subclasses,lipid molecules and enriched metabolic pathways with significant differences.Methods Twelve SPF male C57BL/6J mice(8 weeks old)were randomly divided into the control group(normal water feeding)and the experimental group[cadmium water(0.6 mg/L of CdCl2)feeding],with 6 mice in each group.Mice were sacrificed after 6 months of cadmium exposure,and fresh liver tissues were collected immediately.Lipid oil red O staining and lipidomics analysis were performed on liver tissue.Results Compared with the control group,the liver tissue of mice in the experimental group did not appear red after lipid oil red O staining.Seventeen lipid subclasses with significant differences and 144 lipid molecules with significant differences were screened out by lipidomics.These lipid molecules with significant differences were enriched in glycerophospholipid metabolism,linoleic acid metabolism,alpha-linolenic acid metabolism,glycosylphosphati-dylinositol biosynthesis,glycerolipid metabolism and arachidonic acid metabolism by KEGG.Conclusion This study reveals that chronic cadmium exposure can induce the disorder of lipid subclasses and lipid metabolites in the liver of mice,which provides a basis for understanding the non-alcoholic fatty liver disease caused by chronic cadmium exposure.
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Objective@#To investigate the differences and diversity changes in gut microbiota between children and adolescents with constipation and diarrhea, and healthy individuals, and to explore the correlation between changes in stool consistency and gut microbiota, in order to provide a scientific reference for the research on intestinal microecology among children and adolescents.@*Methods@#From October 2021 to March 2022, a total of 42 children and adolescents with constipation and 37 with diarrhea from a tertiary hospital in Hangzhou City, and 43 healthy individuals from 3 primary and secondary schools were included in this study. Fecal samples of children and adolescents were collected and then stool genomic DNA was extracted for 16S rRNA gene high throughput sequencing, and the sequencing results were analyzed. In the analysis of alpha diversity, the Kruskal-Wallis rank sum test was used to compare the differences between the three groups, and the FDR multiple testing correction was used for pairwise comparisons. In the analysis of beta diversity, the Adonis test was used to compare the overall differences between the three groups, and the ANOSIM test was used for pairwise comparisons. In the LEfSe analysis, the LDA scores obtained through LDA analysis (linear regression analysis).@*Results@#Alpha diversity analysis showed that there were statistically significant differences in the Shannon index (4.01, 3.81, 4.19) and Simpson index (0.05, 0.06, 0.04) between the diarrhea group, constipation group, and healthy group ( H=6.05, 6.35, P <0.1). Further pairwise comparison showed that the Shannon index and Simpson index of the healthy group were higher than those of the constipation group ( P <0.1). Beta diversity analysis showed that the impact of grouping factors on inter group differences was statistically significant ( R 2=0.045, P <0.1). Community composition analysis showed that there were 234 species in total among the three groups, and 36 unique species in the healthy group, 36 species in the diarrhea group, and 48 species in the constipation group. Species difference analysis showed significant differences in species composition at the genus level among the three groups ( H=0.000 05, 0.000 16, 0.000 20, 0.000 21, 0.000 53, 0.001 39, P <0.1), including Lachnospiraceae of Firmicutes phylum, Eubacterium hallii, Veillonellaceae, Qscillospiraceae, Butyricicoccaceae and Staphylococcaceae, respectively. KEGG abundance statistics and COG functional analysis showed that there were no significant differences in gene expression abundance of the same function among the three groups ( P >0.1).@*Conclusions@#The different stool consistency of children and adolescents is related to changes in gut microbiota composition. Compared to the healthy group, children with constipation or diarrhea have disrupted gut microbiota balance, with a shift in dominant bacteria and a higher abundance of opportunistic pathogens.
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Introducción: En la medida que se incrementa la población de adultos mayores, aumenta la prevalencia, aumenta la prevalencia del deterioro cognitivo. Recientemente, se ha introducido la mala salud oral entre los factores de riesgo potenciales. Objetivo: Determinar la asociación entre la salud oral y el deterioro cognitivo leve en adultos mayores de una comunidad de la provincia de Santiago de Cuba. Métodos: Se realizó un estudio observacional, analítico y retrospectivo, de tipo casos y controles en el período comprendido entre enero y julio del año 2023. La población de estudio estuvo constituida por 257 adultos mayores que vivían en esta comunidad, de los cuales se escogieron 40 casos con diagnóstico de deterioro cognitivo leve, según los criterios de Petersen. Se seleccionaron tres controles por cada caso, 120 adultos mayores con aproximadamente las mismas características que el caso. Se precisó la fuerza de asociación de cada factor de riesgo. Resultados: Se halló una asociación significativa entre padecer deterioro cognitivo leve y presentar un número de 1 a 9 dientes. El dolor oral se presentó con mayor frecuencia en el 72,5 por ciento de los casos. No recordar la última visita al estomatólogo fue causa de deterioro cognitivo leve en el 42,5 por ciento. Cepillarse irregularmente se asoció 4,1 veces más con el riesgo de desarrollar esta afección. Conclusiones : Existe una asociación entre la salud oral y el deterioro cognitivo leve en los adultos mayores. Tener menos dientes y referir dolor oral fueron factores de riesgo importantes para presentar deterioro cognitivo. La visita al estomatólogo y el cepillado de dientes irregular influyeron negativamente en la enfermedad. Sin embargo, el uso de prótesis dentales fue un factor protector para el deterioro cognitivo leve(AU)
Introduction: Along with the increase in the population of older adults, the prevalence of cognitive impairment is increasing. Recently, poor oral health has been introduced among potential risk factors. Objective: To determine the association between oral health and mild cognitive impairment in older adults in a community in the province of Santiago de Cuba. Methods: An observational, analytical and retrospective case-control study was carried out from January to July 2023. The study population consisted of 257 older adults living in this community, from which 40 cases were selected with a diagnosis of mild cognitive impairment, according to Petersen's criteria. Three controls were selected for each case, 120 older adults with approximately the same characteristics as the case. The strength of association of each risk factor was determined. Results: A significant association was found between having mild cognitive impairment and having 1 to 9 teeth. Oral pain was more frequent in 72.5 percent of the cases. Not remembering the last visit to the dentist was a cause of mild cognitive impairment in 42.5 percent. Irregular brushing was 4.1 times more associated with the risk of developing this condition. Conclusions: There is an association between oral health and mild cognitive impairment in older adults. Having fewer teeth and reporting oral pain were important risk factors for cognitive impairment. Visiting the dentist and irregular tooth brushing had a negative influence on the disease. However, the use of dental prosthetics was a protective factor for mild cognitive impairment(AU)
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Humains , Sujet âgé , Sujet âgé de 80 ans ou plus , Santé buccodentaire , Études rétrospectives , Études observationnelles comme sujetRÉSUMÉ
Abstract Background: Patients diagnosed with Obstructive Sleep Apnea (OSA) syndrome have a tendency towards hypoventilation, hypoxia, and hypercarbia in the perioperative period. This study hypothesized that the Oxygen Reserve Index (ORi) could predict possible hypoxia and determine difficult airways in patients at risk for OSA, as determined by the STOP-Bang questionnaire. Methods: This prospective study included adult patients undergoing elective surgery under general anesthesia with endotracheal intubation, divided into two groups: low risk (0-2 points) and high risk (3-8 points) based on their STOP-Bang questionnaire results. The primary outcome measure was the highest ORi value reached during preoxygenation and the time to reach this value. Data were recorded at four time points: before preoxygenation (T1), end of preoxygenation (T2), end of mask ventilation (T3), and end of intubation (T4), as well as partial oxygen pressure values in T1, T2, and T4. The secondary outcome measures were the grading scale for mask ventilation, Cormack-Lehane score, tonsil dimensions, use of a stylet, and application of the burp maneuver during intubation. Results: In the high-risk group, preoperative peripheral oxygen saturation values, the highest ORi value reached in preoxygenation, and ORi values at T3 and T4 times were lower, and the time to reach the highest ORi value was longer (p < 0.05). Conclusion: Using ORi in patients with OSA may be useful in evaluating oxygenation, and since difficult airway is more common, ORi monitoring will better manage possible hypoxic conditions.
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Introducción: El cambio general en la concepción de los sistemas de salud de los hospitales como instituciones ha evolucionado a lo largo de los siglos, a tono con los grandes cambios de la humanidad. Objetivos: Evaluar el estado de la gestión organizacional en los servicios hospitalarios, para brindar atención centrada en los adolescentes según sus expectativas, determinar la preparación de médicos y enfermeros y describir la estructura hospitalaria. Métodos: Se realizó una investigación descriptiva y transversal en 1845 adolescentes ingresados en el Hospital Infantil Docente Sur Dr. Antonio María Béguez César, de Santiago de Cuba, del 1 de enero de 2019 al 30 de junio de 2020. Se aplicaron encuestas a los adolescentes hospitalizados, para conocer las preferencias y prioridades en relación con diversos aspectos que pudieran mejorar la satisfacción durante su estancia hospitalaria, y sobre la estructura de las salas. Se evaluaron las habilidades de médicos y enfermeros mediante guías de observación. Resultados: Entre los aspectos analizados, la amabilidad del personal sanitario (83,5 %), la comunicación dialógica (81,6 %) y la visita de amigos (53,7 %) resultaron muy importantes para los adolescentes, al igual que la importancia de la estructura hospitalaria. En relación con la atención a los adolescentes, la mayoría de los profesionales mostró completamente las habilidades. Conclusiones: La investigación mostró insuficiencias en la gestión hospitalaria para la atención centrada en la persona.
Introduction: The general change in the conception of health systems of hospitals as institutions has evolved over the centuries, in tune with the great changes of humanity. Objectives: To evaluate the state of organizational management in hospital services, to provide adolescent-centered care according to their expectations, determine the training of doctors and nurses, and describe the hospital structure. Methods: A descriptive and cross-sectional investigation was carried out on 1,845 adolescents admitted to the Southern Teaching Children's Hospital Dr. Antonio María Béguez César, in Santiago de Cuba, from January 1, 2019 to June 30, 2020. Surveys were applied to hospitalized adolescents to find out the preferences and priorities in relation to various aspects that could improve satisfaction during their hospital stay and with respect to the structure of the wards. The skills of doctors and nurses were evaluated using observation guides. Results: Among the aspect analyzed the friendliness of health personnel (83.5 %), dialogic communication (81.6 %) and the visit of friends (53.7 %) were very important for adolescents, as it was the importance of the hospital structure. In relation to adolescents care, most professionals fully showed the skills Conclusions: The research showed inadequacies in hospital management for person-centered care.
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Introducción: Los estudiantes de las ciencias médicas refieren mayores niveles de estrés académico, particularmente los de la carrera de Medicina. Objetivo: Caracterizar a estudiantes de Medicina según nivel de estrés, reacciones psicosomáticas y estrategias de afrontamiento usadas durante la pandemia de covid-19. Métodos: Se realizó un estudio descriptivo y transversal, desde septiembre hasta diciembre del 2020, de 30 estudiantes de primer y segundo años de la carrera de Medicina, pertenecientes a la Facultad No. 2 de la Universidad de Ciencias Médicas de Santiago de Cuba, que refirieron sentirse nerviosos. Como variables analizadas figuraron: sexo, nivel de estrés autopercibido, situaciones generadoras de estrés, reacciones físicas, psicológicas, comportamentales, y estrategias de afrontamiento. Se utilizó el porcentaje para los datos cualitativos, así como la media y la desviación estándar para los cuantitativos. Resultados: El nivel de estrés autopercibido resultó medio en el sexo masculino y alto en el femenino. En el estudio predominaron el tiempo limitado para la realización de trabajos, las evaluaciones de los profesores y la sobrecarga académica como situaciones generadoras de estrés; la somnolencia, la inquietud, el aislamiento y los conflictos o discusiones como principales reacciones; la planificación de sus tareas, la búsqueda de información sobre la situación y la habilidad asertiva como estrategias de afrontamiento. Conclusiones: La muestra estudiada se caracterizó por presentar nivel medio de estrés autopercibido, responder a situaciones generadoras de estrés académico, expresar reacciones físicas, psicológicas y comportamentales ante estas situaciones, así como también por usar estrategias de afrontamiento centradas en el problema.
Introduction: Medical sciences students refer higher levels of academic stress, particularly those of the Medicine career. Objective: To characterize Medicine students according to stress level, psychosomatic reactions and confrontation strategies used during covid-19 pandemic. Methods: A descriptive and cross-sectional study was carried out from September to December, 2020, of 30 first and second year students of the Medicine career, belonging to Faculty No. 2 of the University of Medical Sciences in Santiago de Cuba that referred to feel nervous. The analyzed variables were sex, self-perceived level of stress, situations generating stress, physical, psychological, behavioural reactions and confrontation strategies. The percentage was used for the qualitative data, as well as the mean and the standard deviation for the quantitative ones. Results: The self-perceived level of stress was average in the male sex and high in the female sex. In the study there was a prevalence of the limited time for the realization of works, evaluations of professors and academic overload as situations generating stress; the drowsiness, restlessness, isolation and conflicts or discussions as main reactions; planning of their tasks, search of information on the situation and assertive skill as confrontation strategies. Conclusions: The studied sample was characterized by presenting a medium level of self-perceived stress, responding to situations that generate academic stress, expressing physical, psychological and behavioural reactions when facing these situations, as well as using confrontation strategies focused on the problem.
Sujet(s)
Stress psychologique , Étudiant médecineRÉSUMÉ
Resumen Introducción. El manejo correcto de la heparinización, la monitorización de la hemostasia y los signos de coagulopatía constituyen desafíos importantes durante la cirugía cardiovascular (CCV) en neonatos. Objetivos. Evaluar el monitoreo de la hemostasia y heparinización de pacientes neonatos con peso <5 Kg sometidos a CCV con pruebas viscoelásticas (PV) y pruebas convencionales (PC). Metodología. Estudio retrospectivo de un único centro en donde se incluyeron neonatos consecutivos sometidos a CCV (octubre 2020 a septiembre 2021). Etapas de la cirugía: basal (B), circulación extracorpórea (CEC) y post protamina (PostProt). PV: tromboelastómetro ROTEM® delta (Werfen). PC: TP % actividad (TP%), APTT, fibrinógeno, tiempo de trombina (TT), recuento de plaquetas (PLT), antitrombina (AT) y actividad antifactor Xa (AntiXa) analizados inmediatamente post heparinización (PostHep), en CEC y PostProt. Medición de PC en coagulómetro ACL TOP con reactivos de Werfen. PLT: HemoCell DXH800 (Beckman Coulter). ACT: realizado mediante el uso del equipo ACT Plus (Medtronic) en quirófano para guiar la heparinización. Estadística: programa SPSS 23. Resultados expresados en mediana y rango intercuartilo (RIC). Resultados. Pacientes: 32 (24 varones). Edad: 19 (6-25) días; peso: 3380 (3082-3785) gramos. Los CT (tiempo de coagulación) y CFT (tiempo de formación del coágulo) de EXTEM, INTEM, FIBTEM y HEPTEM se prolongaron significativamente y A5, A10, MCF (firmezas) fueron menores en CEC comparados con B y PostProt (p<0,001). Los TP% fueron menores y APTT mayores en PostProt comparados con B. CEC presentó los menores PLT. AT en B: 0,56 (RIC 0.46-0.68) UI/mL, ningún paciente recibió suplementos de AT. La mediana de AntiXa fue 6,8 (5,4-7,9) y 5,3 (4,16,9) en PostHep y CEC, respectivamente. PostProt antiXa 0.1 (0.03-0.33), 9/32 >0.2U/mL. AntiXa correlacionó significativamente con EXTEM CT y ACT en CEC, hallándose AntiXa >6 U/ mL 10/32 pacientes, pero sólo con TT en PostProt. Sin embargo, PostProt ACT correlacionó con TP%, APTT, INTEM y HEPTEM CT y la relación HEPTEMCT/INTEMCT. La mediana (RIC) de sangrado postquirúrgico a las 12 h fue de 50 (28-91) mL correlacionando significativamente sólo con antiXa y TT en PostProt, y adicionalmente con la heparina total infundida. Conclusiones. El control de la antiXa permitiría una mejor heparinización durante la cirugía y estimación de la heparina residual en PostProt, que correlacionó con un mayor sangrado, no detectada por PC (excepto por prolongaciones moderadas de TT), CT de PV o ACT. Esta estrategia podría ser de utilidad para evitar excesos en la cantidad de heparina infundida que se asociarían a mayores sangrados.
Abstract Introduction. Correct management of heparinization, hemostasis and signs of coagulopathy are challenging in neonates undergoing cardiovascular surgery (CVS). Aim . To evaluate hemostasis and heparinization monitoring of neonatal patients weighing <5 kg undergoing CVS with viscoelastic (VT) and conventional laboratory (CL) tests. Methodology. Single center retrospective study that included consecutive neonates undergoing CVS (October-2020 to September-2021) were included. Surgery stages: basal (B), extracorporeal circulation (ECC) and post protamine (PostProt). VT: ROTEM® delta thromboelastometry (Instrumentation Laboratory, IL). CL: PT % activity (PT%), APTT, fibrinogen, thrombin time (TT), platelet count (PLT), antithrombin (AT) and antifactor Xa activity (AntiXa) analyzed immediately post heparinization (PostHep), in ECC and PostProt. CL measurement in ACL TOP coagulometer with Werfen reagents. PLT: HemoCell DXH800 (Beckman Coulter). ACT: performed by using ACT Plus (Medtronic) in the operating room to guide heparinization. Results were expressed as median (interquartile range, IQR). Statistics: SPSS 23 software. Results. Patients: 32 (24 men). Age: 19(6-25) days; weight: 3380 (3082-3785) grams. CT (clotting time) and CFT (clot formation time) of EXTEM, INTEM, FIBTEM and HEPTEM were significantly prolonged and A5, A10, MCF (firmness) were lower in ECC compared to B and PostProt (p<0.001). PT% were lower and APTT higher in PostProt compared to B. ECC presented the lowest PLT. AT in B: 0.56 (IQR: 0.46-0.68) IU/mL, no patient received AT supplements. Median AntiXa was 6.8 (5.4-7.9) and 5.3 (4.1-6.9) in PostHep and ECC, respectively. PostProt antiXa 0.1(0.03-0.33), 9/32 >0.2U/mL. AntiXa correlated significantly with EXTEM CT and ACT in ECC, with AntiXa >6 U/mL being found in 10/32 patients, but only with TT in PostProt. However, PostProt ACT correlated with PT%, APTT, INTEM and HEPTEM CT and the HEPTEMCT/ INTEMCT ratio. The median of postoperative bleeding at 12 hours was 50 (28-91) mL, significantly correlating only with antiXa, and TT in PostProt, and additionally with the total heparin infused. Conclusions. The control of antiXa would allow a better heparinization during surgery and estimation of residual heparin in PostProt, which correlated with increased bleeding, not detected by PC (except for moderate prolongations of TT), CT of PV or ACT. This strategy could be useful to avoid excesses in the amount of heparin infused that would be associated with increased bleeding.
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Introduction: Squamous odontogenic tumor is a benign but locally infiltrative, epithelial odontogenic tumor. This case report presents a case of a peripheral variant of squamous odontogenic tumor. Case Presentation: A 29-year-old male patient presented with pain in the left posterior mandible region for one month. Radiographic examination revealed an impacted left mandibular third molar with no other abnormalities. Management and Prognosis: The impacted tooth was removed under local anaesthesia. Histopathological examination of the abnormally thick pericoronal tissue, covering the impacted tooth revealed islands of bland squamous epithelium in a background of mature fibrous connective tissue. The prognosis was good with no signs of recurrence after one year of follow- up. Conclusion: Squamous odontogenic tumor should be considered in the differential diagnosis of pericoronal pathoses, although it is rare in this location.