Efectividad de la realidad virtual en las actividades de la vida diaria tras un ictus: revisión sistemática / Effectiveness of virtual reality on activities of daily living after stroke: A systematic review

Antecedentes y objetivo Una de las principales limitaciones del paciente tras un accidente cerebrovascular es la dificultad en las actividades de la vida diaria, y por ello en la última década, han surgido nuevos métodos de rehabilitación neurológica acorde con el avance de la tecnología, como la realidad virtual. El objetivo de esta revisión sistemática fue analizar si la realidad virtual produce una transferencia en las actividades de la vida diaria en pacientes adultos tras sufrir un accidente cerebrovascular, valorándolo con las escalas específicas de evaluación de actividades de la vida diaria. Materiales y métodos Se llevó a cabo una revisión sistemática siguiendo los criterios Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA), realizando una búsqueda durante las dos primeras semanas de febrero de 2021, en las siguientes bases de datos: PubMed, Physiotherapy Evidence Database (PEDro), Cochrane Library, Web of Science. Resultados Se incluyeron 31 estudios empíricos publicados entre 2007 y 2020, aplicando realidad virtual en adultos tras un accidente cerebrovascular, evaluándolo con una escala específica de actividades de la vida diaria (como Índice de Barthel, Functional Independence measure (FIM), Nottingham extended activities of daily living, Motor Activity Log (MAL), cuestionario ABILHAND, Lawton of instrumental activities of daily living, Frenchay Activity Index) y con una calidad metodológica buena o excelente. Conclusión La realidad virtual es efectiva en la recuperación de las actividades de la vida diaria en pacientes adultos tras un accidente cerebrovascular (AU)

Background and aims One of the main limitations of the post-stroke patient is the difficulty in activities of daily living, and therefore in the last decade, new methods of neurological rehabilitation have emerged in line with the advancement of technology, such as virtual reality. The aim of this systematic review was to analyse whether virtual reality produces a transfer in activities of daily living in adult post-stroke patients, assessed with specific scales for the assessment of activities of daily living. Materials and methods A systematic review was carried out following the Preferred Reporting Items for a Systematic Review and Meta-analysis (PRISMA) criteria, carrying out a search during the first two weeks of February 2021, in the following databases: Pubmed, Physiotherapy Evidence Database (PEDro), Cochrane Library, Web of Science. Results 31 empirical studies were included, published between 2007 and 2020, applying virtual reality in adults after stroke, evaluating it with a specific scale of activities of daily living (like Barthel Index, Functional Independence measure, Nottingham extended activities of daily living, Motor Activity Log, ABILHAND questionnaire, Lawton of instrumental activities of daily living, Frenchay Activity Index) and with a good or excellent methodological quality. Conclusion Virtual reality is effective in the recovery of activities of daily living in adult patients after stroke (AU)

High level of HIV drug resistance informs dolutegravir roll-out and optimized NRTI backbone strategy in Mozambique.

BACKGROUND: HIV drug resistance (HIV-DR) is rising in sub-Saharan Africa in both ART-naive and ART-experienced patients. OBJECTIVES: To estimate the level of acquired DR (ADR) and pre-treatment DR (PDR) across selected urban and rural sites in Southern Africa, in Mozambique. METHODS: We conducted two cross-sectional surveys among adult HIV patients (October 2017-18) assessing ADR and PDR. In the (ADR) survey, those on NNRTI-based first-line ART for ≥6 months were recruited (three sites). In the PDR survey, those ART-naive or experienced with ≥3 months of treatment interruption prior were enrolled (eight sites). RESULTS: Among 1113 ADR survey participants 83% were receiving tenofovir (TDF)/lamivudine (3TC)/efavirenz (EFV). The median time on ART was 4.5 years (Maputo) and 3.2 years (Tete), 8.3% (95% CI 6.2%-10.6%, Maputo) and 15.5% (Tete) had a VL ≥ 1000 copies/mL, among whom 66% and 76.4% had NNRTI+NRTI resistance, and 52.8% and 66.7% had 3TC+TDF-DR. Among those on TDF regimens, 31.1% (Maputo) and 42.2% (Tete) were still TDF susceptible, whereas 24.4% and 11.5% had TDF+zidovudine (ZDV)-DR. Among those on ZDV regimens, 25% and 54.5% had TDF+ZDV-DR. The PDR survey included 735 participants: NNRTI-PDR was 16.8% (12.0-22.6) (Maputo) and 31.2% (26.2-36.6) (Tete), with a higher proportion (≥50%) among those previously on ART affected by PDR. CONCLUSIONS: In Mozambique, viral failure was driven by NNRTI and NRTI resistance, with NRTI DR affecting backbone options. NNRTI-PDR levels surpassed the WHO 10% 'alert' threshold. Replacing NNRTI first-line drugs is urgent, as is frequent viral load monitoring and resistance surveillance. Changing NRTI backbones when switching to second-line regimens may need reconsideration.

Association of preoperative anaemia with postoperative morbidity and mortality: an observational cohort study in low-, middle-, and high-income countries.

BACKGROUND: Anaemia is associated with poor postoperative outcomes, but few studies have described the impact of preoperative anaemia in low- and middle- (LMICs), and high-income countries (HICs). METHODS: This was a planned analysis of data collected during an international 7 day cohort study of adults undergoing elective inpatient surgery. The primary outcome was in-hospital death, and the secondary outcomes were in-hospital complications. Anaemia was defined as haemoglobin <12 g dl-1 for females and <13 g dl-1 for males. Hierarchical three-level mixed-effect logistic regression models were constructed to examine the associations between preoperative anaemia and outcomes. RESULTS: We included 38 770 patients from 474 hospitals in 27 countries of whom 11 675 (30.1%) were anaemic. Of these, 6886 (17.8%) patients suffered a complication and 198 (0.5%) died. Patients from LMICs were younger with lower ASA physical status scores, but a similar prevalence of anaemia [LMIC: 5072 (32.5%) of 15 585 vs HIC: 6603 (28.5%) of 23 185]. Patients with moderate [odds ratio (OR): 2.70; 95% confidence interval (CI): 1.88-3.87] and severe anaemia (OR: 4.09; 95% CI: 1.90-8.81) were at an increased risk of death in both HIC and LMICs. Complication rates increased with the severity of anaemia. Compared with patients in LMICs, those in HICs experienced fewer complications after an interaction term analysis [LMIC (OR: 0.92; 95% CI: 0.87-0.97) vs HIC (OR: 0.86; 95% CI: 0.84-0.87); P<0.01]. CONCLUSIONS: One-third of patients undergoing elective surgery are anaemic. These patients have an increased risk of complications and death. The prevalence of anaemia is similar amongst patients in LMICs despite their younger age and lower risk profile. CLINICAL TRIAL REGISTRATION: ISRCTN51817007.

Laparoscopic ureterocalicostomy in children: The technique and feasibility.

Ureterocalicostomy is a salvage technique commonly used for failed pyeloplasties; it has also been reported as a primary procedure in ureteropelvic junction obstruction (UPJO). This video describes the technique of laparoscopic ureterocalicostomy for primary UPJO in a child with a malrotated kidney and parenchymal thinning. A 13-year-old girl with symptomatic UPJO was found to have a malrotated kidney with a high posterior insertion of the ureter. A laparoscopic dependent ureterocalicostomy over a double-J stent was performed. The postoperative course was uneventful, with excellent clinical and radiological outcomes. Literature review revealed only two reports of this laparoscopic procedure as a primary surgery in children (one with intrarenal pelvis associated to urolithiasis and the other with a malrotated kidney). Laparoscopic ureterocalicostomy is a safe and feasible option in selected cases with parenchymal thinning due to atypical UPJ anatomy or failed pyeloplasty.

Decellularization of placentas: establishing a protocol

Biological biomaterials for tissue engineering purposes can be produced through tissue and/or organ decellularization. The remaining extracellular matrix (ECM) must be acellular and preserve its proteins and physical features. Placentas are organs of great interest because they are discarded after birth and present large amounts of ECM. Protocols for decellularization are tissue-specific and have not been established for canine placentas yet. This study aimed at analyzing a favorable method for decellularization of maternal and fetal portions of canine placentas. Canine placentas were subjected to ten preliminary tests to analyze the efficacy of parameters such as the type of detergents, freezing temperatures and perfusion. Two protocols were chosen for further analyses using histology, scanning electron microscopy, immunofluorescence and DNA quantification. Sodium dodecyl sulfate (SDS) was the most effective detergent for cell removal. Freezing placentas before decellularization required longer periods of incubation in different detergents. Both perfusion and immersion methods were capable of removing cells. Placentas decellularized using Protocol I (1% SDS, 5 mM EDTA, 50 mM TRIS, and 0.5% antibiotic) preserved the ECM structure better, but Protocol I was less efficient to remove cells and DNA content from the ECM than Protocol II (1% SDS, 5 mM EDTA, 0.05% trypsin, and 0.5% antibiotic).

Decellularization of placentas: establishing a protocol.

Biological biomaterials for tissue engineering purposes can be produced through tissue and/or organ decellularization. The remaining extracellular matrix (ECM) must be acellular and preserve its proteins and physical features. Placentas are organs of great interest because they are discarded after birth and present large amounts of ECM. Protocols for decellularization are tissue-specific and have not been established for canine placentas yet. This study aimed at analyzing a favorable method for decellularization of maternal and fetal portions of canine placentas. Canine placentas were subjected to ten preliminary tests to analyze the efficacy of parameters such as the type of detergents, freezing temperatures and perfusion. Two protocols were chosen for further analyses using histology, scanning electron microscopy, immunofluorescence and DNA quantification. Sodium dodecyl sulfate (SDS) was the most effective detergent for cell removal. Freezing placentas before decellularization required longer periods of incubation in different detergents. Both perfusion and immersion methods were capable of removing cells. Placentas decellularized using Protocol I (1% SDS, 5 mM EDTA, 50 mM TRIS, and 0.5% antibiotic) preserved the ECM structure better, but Protocol I was less efficient to remove cells and DNA content from the ECM than Protocol II (1% SDS, 5 mM EDTA, 0.05% trypsin, and 0.5% antibiotic).

Prospective purification of perivascular presumptive mesenchymal stem cells from human adipose tissue: process optimization and cell population metrics across a large cohort of diverse demographics.

BACKGROUND: Adipose tissue is an attractive source of mesenchymal stem cells (MSC) as it is largely dispensable and readily accessible through minimally invasive procedures such as liposuction. Until recently MSC could only be isolated in a process involving ex-vivo culture and their in-vivo identity, location and frequency remained elusive. We have documented that pericytes (CD45-, CD146+, and CD34-) and adventitial cells (CD45-, CD146-, CD34+) (collectively termed perivascular stem cells or PSC) represent native ancestors of the MSC, and can be prospectively purified using fluorescence activated cell sorting (FACS). In this study we describe an optimized protocol that aims to deliver pure, viable and consistent yields of PSC from adipose tissue. We analysed the frequency of PSC within adipose tissue, and the effect of patient and procedure based variables on this yield. METHODS: Within this twin centre study we analysed the adipose tissue of n = 131 donors using flow cytometry to determine the frequency of PSC and correlate this with demographic and processing data such as age, sex, BMI and cold storage time of the tissue. RESULTS: The mean number of stromal vascular fraction (SVF) cells from 100 ml of lipoaspirate was 34.4 million. Within the SVF, mean cell viability was 83 %, with 31.6 % of cells being haematopoietic (CD45+). Adventitial cells and pericytes represented 33.0 % and 8 % of SVF cells respectively. Therefore, a 200 ml lipoaspirate would theoretically yield 23.2 million viable prospectively purified PSC - sufficient for many reconstructive and regenerative applications. Minimal changes were observed in respect to age, sex and BMI suggesting universal potential application. CONCLUSIONS: Adipose tissue contains two anatomically and phenotypically discreet populations of MSC precursors - adventitial cells and pericytes - together referred to as perivascular stem cells (PSC). More than 9 million PSC per 100 ml of lipoaspirate can be rapidly purified to homogeneity using flow cytometry in clinically relevant numbers potentially circumventing the need for purification and expansion by culture prior to clinical use. The number and viability of PSC are minimally affected by patient age, sex, BMI or the storage time of the tissue, but the quality and consistency of yield can be significantly influenced by procedure based variables.

The Influence of Weather and Lunar Phases on the Flight Activity of Paederus Rove Beetles (Coleoptera: Staphylinidae).

Despite the medical importance of Paederus beetles, no studies have studied the influence of the abiotic factors on the flight activity and nighttime dispersal of these insects in Brazil. Therefore, the influence of both climatic factors and moon phase on black-light catches of Paederus rove beetles was investigated. Paederus beetles were attracted to a black light source hourly from 1800 to 0600 hours, and data on weather conditions as well as moon phase data were taken for every sampling date. Overall, 543 individuals of Paederus beetles belonging to four species were captured: P. protensus, P. columbinus, P. brasiliensis, and P. mutans. Paederus beetles were mostly active in the warmest parts of the studied nights. Variations in nighttime temperature, relative humidity, wind speed, cloud cover, and moon phases appear not to affect Paederus flight. The diurnal temperature was observed to affect the night hourly dispersal of Paederus rove beetles as well as their distribution pattern during the entire period of study. The true environmental condition responsible for Paederus beetles seasonal pattern and daily night dispersal in northeastern Brazil were the annual moisture and drought cycles and the diurnal maximum temperatures, respectively. Significant trap catches were observed in the earliest hours after sunset (1800-2100), and people must be aware of this fact, as it can notably increase the risk of acquiring linearis dermatitis from the contact with large numbers of active Paederus.

Shunting in acute cerebral venous thrombosis: a systematic review.

BACKGROUND AND PURPOSE: The efficacy of cerebrospinal fluid shunting to reduce intracranial hypertension and prevent fatal brain herniation in acute cerebral venous thrombosis (CVT) is unknown. METHOD: From the International Study on Cerebral Vein and Dural Sinus Thrombosis (ISCVT) and a systematic literature review, we retrieved acute CVT patients treated only with shunting (external ventricular drain, ventriculoperitoneal or ventriculojugular shunt). Outcome was classified at 6 months and final follow-up by the modified Rankin Scale (mRS). RESULTS: 15 patients were collected (9 from the ISCVT and 6 from the review) who were treated with a shunt (external ventricular drain in 6 patients, a ventriculoperitoneal shunt in 8 patients or an unspecified type of shunt in another one). Eight patients (53.3%) regained independence (mRS 0-2), while 2 patients (13.3%) were left with a severe handicap (mRS 4-6) and 4 (26.7%) died despite treatment. Five patients with parenchymal lesions were shunted within 48 h from admission deterioration, 4 with an external ventricular drain: 2 (40%) recovered to independence, 2 (40%) had a severe handicap and 1 (20%) died. In contrast, all 3 patients with intracranial hypertension and no parenchymal lesions receiving a ventriculoperitoneal shunt later than 48 h regained independence. CONCLUSION AND IMPLICATIONS: A quarter of acute CVT patients treated with a shunt died, and only half regained independence. With the limitation of the small number of subjects, this review suggests that shunting does not appear to be effective in preventing death from brain herniation in acute CVT. We cannot exclude that shunting may benefit patients with sustained intracranial hypertension and no parenchymal lesions.

Evaluación de la calidad de la obturación utilizando dos técnicas de obturación y dos cementos selladores / An evaluation of endodontic filling quality by using two obturation techniques and two sealer cements

Objetivos: El propósito de este trabajo fue analizar la adaptación y homogeneidad de la obturación en los tercios cervical, medio y apical depremolares inferiores unirradiculares, utilizando las técnicas de condensación lateral e híbrida de Tagger con los cementos de Grossman y AH 26. Materiales y métodos: Se utilizaron 32 premolares inferiores humanos extraídos, unirradiculares, con ápice maduro. Las piezas fueron instrumentadas con sistema Protaper Universal hasta F3. Luego fueron divididas aleatoriamente en 4 grupos de 8 muestras cada uno. Grupos A y B se obturaron con técnica de condensación lateral, grupos C y D con técnica híbrida de Tagger. En A y C su uso cemento deGrossman, en B y D AH 26. Se realizaron cortes transversales a nivel coronario, medio y apical que se evaluaron con microscopio quirúrgico a X 2,5. Se realizó test no paramétrico U de Mann-Whitney. Resultados: Para determinar si existía diferencia entre las dos técnicas de obturación al usar cemento de Grossman se utilizó Test deMann-Whitney. Se observó diferencia significativa entre las medianas de scoring de ambos grupos (U=192; p<0,05). Al evaluar las dos técnicas utilizando AH 26 existió diferencia significativa entre las medianas de scoring de ambos grupos (U=191,5; p<0,05). Conclusión: Los conductos ovales obturados con técnica híbrida de Tagger, presentaron mejor homogeneidad y mayor adaptación a lasparedes en los tres tercios que los obturados con técnica de condensación lateral. Al utilizar cemento de Grosmann o AH 26 como sellador no se observó diferencia significativa en ninguna de las dos técnicas.

Objectives: The purpose of this study was to analyze the adaptation and homogeneity of the filling in the thirds cervical, middle and apical of single-rooted premolars, using lateral condensation technique and Tagger's hybrid technique with Grossman sealer and AH 26. Materials and Methods: We used 32 extracted human premolars, single-rooted, with mature apex. The pieces were instrumented with ProTaper Universal system to F3. Then they were randomly divided into 4 groups of 8 samples each. Groups A and B were filled with lateral condensation technique, groups C and D with Tagger's hybrid technique. In A and C Grossman sealer were use, in B and D AH 26. Crosscuts were made at coronary, medium and apical level and all were evaluated with 2.5 X surgical microscope. We performed nonparametric Mann-Whitney test. Results: To determine if there was difference between the two filling techniques using Grossman sealer was used Mann-Whitney test. Significant difference was observed between the medians of scoring from both groups (U = 192, p <0.05). In evaluating the two techniques using AH 26, significant difference observed between the medians of scoring from both groups (U = 191.5, P <0.05). Conclusion: The oval canal sealed with Tagger's hybrid technique, showed better homogeneity and better adaptation to the walls in the three thirds that filling with lateral condensation technique. Using Grosmann sealer or AH 26 sealer there was no significant difference in any of the two techniques.

The involvement of the serotonergic transmission system in neonatal and adult rat ileum contractility varies with age.

The relevance of age on serotonergic involvement in the control of alimentary contractility has not been pharmacologically described. Experiments were performed to investigate the effects of acetylcholine, atropine, 5-hydroxytryptamine (5-HT) and its related drugs on intestinal segments taken from the neonatal and adult ileum. 5-HT induced concentration-dependent contractions of ileum irrespective of age; however, these contractions were diminished by pretreatment with atropine only in neonatal tissues. In tissues taken from both the neonatal and adult ileum, methysergide (5-HT(1/2/5-7) receptor antagonist), ritanserin (5-HT(2) receptor antagonist), and RS23597-190/SB204070 (5-HT(4) receptor antagonists) all differentially reduced 5-HT-induced contractions at a concentration <100 µmol/l. At higher concentrations, the contractions were comparable to those in control tissues. Granisetron and ondansetron (5-HT(3) receptor antagonists) significantly reduced contractions induced by 5-HT at concentrations >30 µmol/l in both neonatal and adult ileum. Combined treatments with ritanserin, granisetron, plus RS23597-190 reduced or abolished contraction responses induced in neonatal ileum by 5-HT. SB269970A (5-HT(7) receptor antagonist) and WAY100635 (5-HT(1A) receptor antagonist) failed to influence contractile responses induced by 5-HT or 5-HT receptor agonists. Pretreatments with WAY100635 and SB267790A also had no influence on the contractile responses induced by 5-HT(1A/7) receptor agonist, 5-CT, and 5-HT(1A) receptor agonist, 8-OH-DPAT, which itself failed to induce a measurable response. It is concluded that the 5-HT-induced contractions in segments taken from both the neonatal and adult rat ileum were mediated via 5-HT(2) receptors, 5-HT(3) receptors and 5-HT(4) receptors. However, the effect of atropine on the neonatal rat intestine indicates that the mechanism of serotonergic involvement in ileal contractility is influenced by age.

Asimetría en la función relativa en CR DMSA en riñones con doble sistema excretor no complicado: variante normal / Asymmetry in the relative function in CR DMSA in kidneys weith double non complicated excretor system: normal Variant

Introducción: El doble sistema excretor (DS) al Cintigrama Renal (CR) DMSA, con asimetría en la función relativa es un hallazgo relativamente frecuente. Evaluamos su incidencia, correlación con ecografía y valores de función relativa. Material y Método: Se seleccionaron los CR DMSA con diagnóstico cintigráfico de DS sin otras alteraciones. Ecografías sin otros hallazgos. Se comparó la función relativa entre riñones con y sin DS y entre riñones con y sin asimetría de tamaño. T-Test para muestras independientes. Se correlacionó el DMSA con la ecografía. Resultados: 79 pacientes en que se dispuso ecografía fueron estudiados. 17 con DS bilateral (21,5 por ciento). 72 por ciento mujeres, promedio de edad: 54,4 meses (1–204). Función relativa promedio en riñones con DS unilateral: 51,8 por ciento (43-61 por ciento) y 48,19 por ciento (39-57por ciento) en riñones sin DS. p<0,0001. En riñones con DS y aumentados de tamaño la diferencia con el contralateral fue mayor que en los de igual tamaño. Ecografía concordante con el CR DMSA en 52,63 por ciento. Conclusiones: 1.- La función relativa en riñones con Doble Sistema fue significativamente mayor que en riñones sin Doble Sistema, especialmente cuando existió asimetría en el tamaño renal. Esta condición debe considerarse variante normal para evitar la interpretación errada de riñones contralaterales hipofuncionantes. 2.- En la mitad de los pacientes hubo concordancia con la ecografía en diagnóstico de DS, hallazgo esperable.

Aim: Duplex system in DMSA with asymmetry in relative function it’s a frequent finding. We evaluated the incidence, correlation with sonography and the relative functions in these kidneys. Method: We selected patients with scintigraphic diagnosis of duplex system in the DMSA, without any other scintigraphic lesions and had a normal ultrasound. We compared the relative renal function in kidneys with and without duplex system and in kidney with and without size asymmetry. Independent samples t test was applied. DMSA results were compared with ultrasound. Results: 79 patients had ultrasound. 17 with bilateral DS (21.5 percent). 72 percent women; median age: 54.4 months (1–204). Relative function in unilateral DS kidney was 51.8 percent (43-61 percent) and 48.19 percent in kidneys without DS (39-57 percent), p< 0.0001. In kidneys larger and DS the difference in relative function with the contralateral kidney was more important than kidney with similar size. The ultrasound was concordant with DMSA in 52.63 percent of the patients. Conclusions: 1.- The relative function values were significantly higher in kidneys with Duplex System than kidneys without it, especially with asymmetry of the renal size .This condition should be consider a normal variant for to avoid the wrong interpretation of hipofunctioning contralateral kidney. 2.- Half of the patients had duplex system in DMSA scintigraphy and ultrasound, which was predictable.

Melanoma sentinel node biopsy and prediction models for relapse and overall survival.

BACKGROUND: To optimise predictive models for sentinal node biopsy (SNB) positivity, relapse and survival, using clinico-pathological characteristics and osteopontin gene expression in primary melanomas. METHODS: A comparison of the clinico-pathological characteristics of SNB positive and negative cases was carried out in 561 melanoma patients. In 199 patients, gene expression in formalin-fixed primary tumours was studied using Illumina's DASL assay. A cross validation approach was used to test prognostic predictive models and receiver operating characteristic curves were produced. RESULTS: Independent predictors of SNB positivity were Breslow thickness, mitotic count and tumour site. Osteopontin expression best predicted SNB positivity (P=2.4 × 10⁻7), remaining significant in multivariable analysis. Osteopontin expression, combined with thickness, mitotic count and site, gave the best area under the curve (AUC) to predict SNB positivity (72.6%). Independent predictors of relapse-free survival were SNB status, thickness, site, ulceration and vessel invasion, whereas only SNB status and thickness predicted overall survival. Using clinico-pathological features (thickness, mitotic count, ulceration, vessel invasion, site, age and sex) gave a better AUC to predict relapse (71.0%) and survival (70.0%) than SNB status alone (57.0, 55.0%). In patients with gene expression data, the SNB status combined with the clinico-pathological features produced the best prediction of relapse (72.7%) and survival (69.0%), which was not increased further with osteopontin expression (72.7, 68.0%). CONCLUSION: Use of these models should be tested in other data sets in order to improve predictive and prognostic data for patients.

An anthropometric study of facial height among four endogamous communities in the Sunsari district of Nepal.

INTRODUCTION: Facial anthropometry has well-known implications in health-related fields and has been utilised for forensic purposes in the past. It provides an indication of the variations in facial shape in a population. The facial anthropometric profile of a population can characterise the distinctive features of a likely face in that population. The present study aimed to examine the differences in facial height proportions and facial growth patterns in different communities in the Sunsari district of Nepal. METHODS: The upper facial height (UFH) and lower facial height (LFH) proportions of 857 subjects (429 male and 428 female) aged between three and 18 years old from four communities (Brahmin, Chhetri, Rai and Limbu) in the Sunsari district of Nepal were calculated, and comparisons were made. RESULTS: Significant differences (p is less than 0.05) in the UFH and LFH percentages were observed between the Brahmin and Rai, Brahmin and Limbu, Chhetri and Rai, and Chhetri and Limbu communities. CONCLUSION: The study concluded that there is evidence of statistically significant differences of the upper and lower face height proportions among the different racial groups. A change in the facial height proportions of the various age groups was evident. However, differences in facial height proportions between male and female were found to be insignificant.

Enfoque histórico de la profesión de enfermería / No disponible

El siguiente artículo trata de un enfoque evolutivo de laprofesión de la Enfermería desde los albores de la humanidadhasta la actualidad, revisando cuáles han sido los principalesfactores que han ido modificando su configuracióny lo siguen haciendo en la actualidad ya que sólo conociendoel pasado, se conoce el marco actual donde se desarrollala profesión de enfermería y también su proyecciónfutura, ya que se trata de un proceso dinámico y evolutivo.De esta manera se conoce cuál ha sido el papel desempeñadopor la enfermería en cada época de la historia y porende, el papel que desempeña en la actualidad(AU)

The following article is an evolutionary approach tothe nursing profession since the dawn of mankind untilthe present, reviewing what had been the main factorsthat have been changing their configuration and are doingit now because only by knowing the past , called the currentframework is developed where the nursing professionand its future projection, since it is a dynamic and evolvingprocess. Thus what has been called the role of nursingin every period of history and thus the role currently(AU)

Comparison of the effects of lactated Ringer solution with and without hydroxyethyl starch fluid resuscitation on gut edema during severe splanchnic ischemia.

The type of fluid used during resuscitation may have an important impact on tissue edema. We evaluated the impact of two different regimens of fluid resuscitation on hemodynamics and on lung and intestinal edema during splanchnic hypoperfusion in rabbits. The study included 16 female New Zealand rabbits (2.9 to 3.3 kg body weight, aged 8 to 12 months) with splanchnic ischemia induced by ligation of the superior mesenteric artery. The animals were randomized into two experimental groups: group I (N = 9) received 12 mL x kg-1 x h-1 lactated Ringer solution and 20 mL/kg 6% hydroxyethyl starch solution; group II (N = 7) received 36 mL x kg-1 x h-1 lactated Ringer solution and 20 mL/kg 0.9% saline. A segment from the ileum was isolated to be perfused. A tonometric catheter was placed in a second gut segment. Superior mesenteric artery (Q SMA) and aortic (Qaorta) flows were measured using ultrasonic flow probes. After 4 h of fluid resuscitation, tissue specimens were immediately removed for estimations of gut and lung edema. There were no differences in global and regional perfusion variables, lung wet-to-dry weight ratios and oxygenation indices between groups. Gut wet-to-dry weight ratio was significantly lower in the crystalloid/colloid-treated group (4.9 +/- 1.5) than in the crystalloid-treated group (7.3 +/- 2.4) (P < 0.05). In this model of intestinal ischemia, fluid resuscitation with crystalloids caused more gut edema than a combination of crystalloids and colloids.

Technique for cryopreservation of intestinal smooth muscle cells.

Attempts were made to develop a simplified procedure for long-term cryopreservation of intestinal smooth muscle cells (ISMC). ISMC were collected from the ileum of Sprague-Dawley neonatal rats through cellular dissociation in trypsin. Cryopreservation method comprised of a rapid 1-step (protocol 1) and a slow 3-step (protocol 2) freezing of ISMC for 1week. Preparations were thawed and single ISMC were assessed via the comet assay and damaged DNA was quantified through comet tail moment. The control unfrozen ISMC exhibited DNA damage of 2.34+/-0.35 compared to ISMC cooled via protocol 2 (2.62+/-0.36) and protocol 1 (10.15+/-0.72). Thereafter, protocol 2 freezing method was adopted and ISMC were cryopreserved for 1-week, 1-month, and 4-months to analyse the temporal and long-term cryopreservation of ISMC. This revealed a DNA damage of 2.62+/-0.36 (1-week), 3.81+/-0.72 (1-month), and 5.1+/-0.9 (4-months). Gradual cooling is suitable for continuing storage of ISMC and although fluctuation in cryoinjury is observed with time this is considered to reflect cell-to-cell variability.