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1.
Rev. Odontol. Araçatuba (Impr.) ; 42(2): 3-8, maio-ago. 2021. graf
Artículo en Portugués | LILACS, BBO - Odontología | ID: biblio-1252889

RESUMEN

Dentes necrosados com rizogêneze incompleta representam um desafio para os endodontistas e odontopediatras, visto que as paredes radiculares desses dentes são mais finas, o que as tornam mais susceptíveis a fraturas. Durante muitos anos a técnica preconizada foi a apicificação que ainda é bastante utilizada. Nesta técnica são realizadas trocas constantes de medicação intracanal. O dente continua fragilizado e existe o risco do paciente não concluir o tratamento já que tal técnica demanda várias sessões clínicas. Com os avanços da ciência, surge a revascularização pulpar, trazendo vários beneficíos, entre os quais estão a continuidade apical e o ganho de espessura das paredes, além do benefício de conclusão do tratamento em uma ou duas sessões. Entretanto é necessária sua proservação que leva em média dois anos. O objetivo desta pesquisa foi avaliar o nível de conhecimento dos odontopediatras e endodontistas do município de Ilhéus-Bahia, frente a casos de necrose pulpar de dentes com formação radicular incompleta. O método e forma de análise de dados foram de um estudo observacional, transversal, realizado em consultórios do município de Ilhéus-BA que foram selecionados por amostragem aleatória. Os dados foram coletados por meio de um questionário contendo 10 questões de múltipla escolha sobre revascularização pulpar, especialização do profissional e tempo de formação. 20 profissionais aceitaram participar da pesquisa. Desses, 10% não sabiam ou nunca tinham ouvido falar sobre a revascularização pulpar. Conclui-se que ainda existem especialistas no Município de Ilhéus-BA que apresentam conhecimento insuficiente sobre a terapia endodôntica regenerativa, sendo que os mesmos deveriam ter conhecimento desta técnica já que são os profissionais que prestam o atendimento ao paciente jovem com dentes necrosados, reforçando a necessidade de elaboração de estratégia de conscientização e educação de saúde para habilitação e atualização dos mesmos(AU)


Necrotic teeth with incomplete rizogenesis representa challenge for endodontists and pediatric dentists, since the root walls of these teeth are thinner, which makes them more susceptible to fractures. For many years the recommended technique was apexification, which is still widely used. In this technique, constant changes of intracanal medication are performed. The tooth remains fragile and there is a risk that the patient will not complete the treatment as this technique requires several clinical sessions. With advances in science, pulp revascularization appears, bringing several benefits, among which are the apical continuity and the gain in thickness of the walls, in addition to the benefit of completing the treatment in one or two sessions. However, its preservation is necessary, which takes on average two years. The objective of this research was to evaluate the level of knowledge of pediatric dentists and endodontists in the municipality of Ilhéus-Bahia, in the face of cases of pulp necrosis of teeth with incomplete root formation. The method and form of data analysis were from an observational, cross-sectional study, carried out in offices in the municipality of Ilheus-BA that were selected by random sampling. Data were collected through a questionnaire containing 10 multiple-choice questions about pulp revascularization, professional specialization and training time. 20 professionals agreed to participate in the research. Of these, 10% did not know or had never heard of pulp revascularization. It is concluded that there are still specialists in the municipality of Ilhéus-BA who have insufficient knowledge about regenerative endodontic therapy, and they should have knowledge of this technique since they are the professionals who provide care to young patients with necrotic teeth, reinforcing the need to develop a health awareness and education strategy to enable and update them(AU)


Asunto(s)
Humanos , Masculino , Femenino , Necrosis de la Pulpa Dental , Conocimientos, Actitudes y Práctica en Salud , Necrosis de la Pulpa Dental/terapia , Conocimiento , Odontólogos , Endodoncistas , Endodoncia Regenerativa
2.
Rev. Odontol. Araçatuba (Impr.) ; 42(2): 9-17, maio-ago. 2021. ilus
Artículo en Portugués | LILACS, BBO - Odontología | ID: biblio-1252898

RESUMEN

As reabsorções radiculares são classificadas em interna e externa e um correto diagnóstico é fundamental para o sucesso no tratamento e é de suma importância que a resolução clínica seja feita precocemente para que se tenha um prognóstico clínico favorável. Reabsorção interna não é comum em dentes permanentes, e seu processo se caracteriza por um aumento do canal radicular de forma oval. O presente estudo teve como objetivos demonstrar e descrever através de um relato de prontuário o tratamento de reabsorção radicular interna de incisivos superiores permanentes. Através da seleção de uma paciente pela disciplina de Triagem da clínica odontológica do Centro Universitário da Serra Gaúcha, a qual apresentou alterações radiográficas compatíveis com reabsorção radicular interna inflamatória na região de dois incisivos superiores permanentes, com lesão periapical estabelecida em ambos, concluiu-se o tratamento para então gerar este estudo do tipo retrospectivo observacional. A reabsorção quando não tratada pode avançar e envolver estruturas além do tecido conjuntivo inflamado e a lesão pode avançar em direção apical. Após estabelecido o diagnóstico, iniciou-se os tratamentos endodônticos dos elementos utilizando hidróxido de cálcio como medicação intracanal, após as trocas de medicações as reabsorções foram controladas e então, as obturações dos canais foram realizadas, buscando um preenchimento adequado para o caso. A reabsorção radicular interna inflamatória causa danos irreversíveis, mas seu processo foi controlado através de terapia endodôntica. Este desempenho é considerado uma patologia, e pode comprometer qualquer extensão da raiz, é comum que os casos permaneçam assintomáticos, portanto, deve ser tratado o mais breve possível assim que descobertos para evitar sua progressão, e consequentemente danos maiores(AU)


Root resorption is classified as either internal or external, and a correct diagnosis is essential for successful treatment. Internal resorption is not common in permanent teeth, and its process is characterized by an enlarged oval root canal. The present study aims to demonstrate and describe, through a medical record, the treatment of internal root resorption of permanent upper incisors. A patient was selected from the Triage Course of the Dental Clinic (Centro Universitário da Serra Gaúcha) who presented radiographic changes associated with inflammatory internal root resorption in two permanente upper incisors, with a periapical lesion established in both and a treatment was then carried out in order to generate this retrospective observational study. Resorption when left untreated can progress and involve structures beyond the inflamed connective tissue and the lesion can advance in the apical direction. After the diagnosis was confirmed, endodontic treatments were initiated using calcium hydroxide as an intracanal medication. After changing the medication, the resorption was controlled and then the canal fillings were performed, seeking an adequate filling for the case. Inflammatory internal root resorption causes irreversible damage, but its process has been controlled through endodontic therapy. This performance is considered a pathology, and can compromise any extension of the root, it is common for the cases to remain asymptomatic, therefore, it should be treated as soon as it's discovered to prevent its progression, and consequently greater damage(AU)


Asunto(s)
Humanos , Femenino , Adulto , Tratamiento del Conducto Radicular , Resorción Radicular , Resorción Radicular/terapia , Incisivo , Hidróxido de Calcio , Dentición Permanente , Diente no Vital , Cavidad Pulpar
3.
Rev. Odontol. Araçatuba (Impr.) ; 42(2): 30-34, maio-ago. 2021. tab, graf
Artículo en Portugués | LILACS, BBO - Odontología | ID: biblio-1252909

RESUMEN

Dentre as principais consequências da fissura labial e/ou palatina não sindrômica (FL/ PNS) estão dificuldades com fonação e autoestima, a primeira uma questão funcional e a segunda um problema social derivado não raro de contextos de bullying que, dentre outros, podem levar o indivíduo à evasão escolar. O objetivo deste estudo foi avaliar o atraso de escolaridade e a dificuldade de socialização de pacientes com FL/PNS quando comparados a uma população não afetada da mesma faixa etária de 7 a 20 anos, atendidos na Universidade José do Rosário Vellano ­UNIFENAS, campus de Alfenas. Os sujeitos foram agrupados em duas categorias de indivíduos, o grupo caso composto por indivíduos com FL/PNS em tratamento no Centro Pró-Sorriso da UNIFENAS; e o grupo controle composto por indivíduos sem FL/PNS em tratamento nas clínicas de Odontopediatria e Integrada da UNIFENAS. Os resultados demonstraram que a proporção de pacientes com FL/PNS atrasados na escola foi de quase 5 vezes maior que o número de pacientes sem fissuras (p<0,01). Constatou-se que a presença da FL/PNS pode ser o ponto de partida para outros contribuintes, com interferências psicológicas e/ou sociais, interferindo negativamente no processo de socialização (bullying) do paciente (p=0,0018). Portanto devem ser tratadas com abordagem multidisciplinar, incluindo diversos profissionais, dentre eles pedagogos, psicólogos e odontólogos(AU)


Among the main consequences of Non Syndromic Cleft Lip and Palate (NSCLP) are the difficulties with phonation and self estime, the first being a functional issue na the later being social that is derived from, not rarely, bullying contexts, that among other things, may lead na individual to school evasion. The objective of this study was to avaluate the levels of scholarity of patients with NSCLP when compared to a non affected population of the same age in individuals from 7 to 20 years old, attended the Pediatric and Integrated Pediatric Clinic of UNIFENAS, Alfenas campus. The subjects were grouped into two categories of individuals, the case group was composed of individuals with FL/PNS with treatment at the ProSmile center at UNIFENAS. The control group was composed of individuals without FL/PNS in treatment at the clinics of pediatric and integrated denistry at UNIFENAS. The results demonstrated the number of patients with FL/PNS that presented scholar delay were almost 5 times the number of patients that didn't present FL/PNS (p<0,01). The presence of NFL/PNS may be the starting point for other contributors with psychological and/or social interferences, interfering negatively with the socialization process (bullying) of the patient (p=0,0018). They should be treated with a multidisciplinary manner, including multiple professionals, among them pedagogues, psychologist and dentist(AU)


Asunto(s)
Humanos , Masculino , Femenino , Niño , Adolescente , Adulto , Abandono Escolar , Labio Leporino , Fisura del Paladar , Acoso Escolar , Fonación , Socialización
4.
Vaccimonitor (La Habana, Print) ; 30(2)mayo.-ago. 2021. tab, graf
Artículo en Inglés | LILACS, CUMED | ID: biblio-1252328

RESUMEN

Hepatitis B infection is one of the most important health problems around the world. The high mortality rate of the hepatitis B encouraged research that led to the finding of an effective vaccine against it. The aim of the present study was to find out the use of the Euvax-B vaccine in sectors of Nineveh province. According to the results obtained in this study, in the next five years, the vaccination coverage for the second and third doses needs to improve(AU)


La infección por hepatitis B es uno de los más importantes problemas de salud del mundo. La alta tasa de mortalidad de la hepatitis B impulsó las investigaciones que llevaron a encontrar una vacuna eficaz contra la misma. El objetivo del presente estudio fue conocer el uso de la vacuna Euvax-B en sectores de la provincia de Nínive. De acuerdo con los resultados obtenidos, en los próximos cinco años, se debe incrementar la cobertura de inmunización de la segunda y tercera dosis de la vacuna(AU)


Asunto(s)
Humanos , Masculino , Femenino , Vacunas contra Hepatitis B , Infecciones por Hepadnaviridae , Hepatitis B/mortalidad , Antígenos de Superficie de la Hepatitis B , Irak
5.
Vaccimonitor (La Habana, Print) ; 30(2)mayo.-ago. 2021. tab, graf
Artículo en Español | LILACS, CUMED | ID: biblio-1252327

RESUMEN

La gastroenteritis causada por rotavirus constituye un importante problema de salud mundial, por lo que se recomienda incluir la vacunación contra el rotavirus en los programas de inmunización. Para evaluar el impacto de una futura introducción en Cuba de una vacuna contra este patógeno, resulta necesario crear una línea de base pre-vacunación de la carga de la gastroenteritis causada por este virus. Entre noviembre 2017 a abril 2018 se implementó en el Hospital Pediátrico de Centro Habana un sistema de vigilancia para la gastroenteritis causada por rotavirus. Se establecieron las definiciones para las categorías de caso sospechoso, probable y confirmado. Por cada niño captado se recogió una muestra de heces que se analizó con tiras rápidas y se confirmó la presencia de rotavirus por ELISA. Para determinar la severidad de la enfermedad se utilizó la escala de Vesikari. Los resultados fueron expresados en cifras absolutas y relativas, el análisis se realizó a través de la prueba de chi-cuadrado. Del total de ingresos por enfermedad diarreica aguda, el 26 por ciento cumplió los criterios de inclusión y el 46 por ciento resultó confirmado como rotavirus. El hacinamiento en el hogar y asistir al círculo infantil se comportaron como factores de riesgo. El servicio de gastroenterología absorbió la mayor carga de ingresos hospitalarios por esta causa. Los resultados mostrados validan la funcionalidad del sistema de vigilancia implementado y brindan nuevas evidencias sobre la carga de la enfermedad y la utilización de los servicios de un hospital pediátrico cubano, debido a la gastroenteritis provocada por rotavirus, lo que justifica la introducción de la vacuna(AU)


Gastroenteritis caused by rotavirus is a major global health problem, therefore it is recommended that vaccination against rotavirus be included in immunization programs. To evaluate the impact of a future introduction in Cuba of a vaccine against this pathogen, it is necessary to have a pre-vaccination baseline of the burden of gastroenteritis caused by rotavirus. Between November 2017 and April 2018, a surveillance system for gastroenteritis caused by rotavirus was implemented in the Paediatric Hospital of Centro Habana. Definitions were established for the categories of suspected, probable and confirmed cases. For each captured child, stool samples were collected, analyzed with rapid strips and confirmated by ELISA. To determine the severity of the disease, the Vesikari score was used. The results were expressed in absolute and relative figures; the analysis was performed through chi-square. Of the total admissions for acute diarrheal disease, 26 percent met the inclusion criteria and 46 percent were confirmed for rotavirus. Overcrowding at home and attending a day care center were risk factors. The gastroenterology service absorbed the greatest burden of hospital admissions for this cause. The results shown validate the role of the implemented surveillance system and provide new evidence on the burden of disease and use of services for rotavirus gastroenteritis in a cuban pediatric hospital(AU)


Asunto(s)
Humanos , Masculino , Femenino , Preescolar , Infecciones por Rotavirus/prevención & control , Factores de Riesgo , Vacunas contra Rotavirus , Diarrea/etiología , Gastroenteritis/epidemiología , Epidemiología Descriptiva , Estudios Prospectivos , Cuba , Estudios Observacionales como Asunto
6.
Vaccimonitor (La Habana, Print) ; 30(2)mayo.-ago. 2021. tab, graf
Artículo en Español | LILACS, CUMED | ID: biblio-1252326

RESUMEN

Este reporte corresponde al análisis de la calidad de vida de los pacientes que se incluyeron en el ensayo clínico fase III de evaluación de la vacuna CIMAvaxEGF® en cáncer de pulmón de células no pequeñas. La calidad de vida se evaluó empleando los cuestionarios EORTC QLQ-C30 y QLQ-C13, al inicio y cada 3 meses hasta el fallecimiento del paciente a criterio del investigador. Para comparar las medianas entre los dos grupos se utilizó la prueba no paramétrica de Mann-Whitney. Las comparaciones entre el nivel basal y los diferentes tiempos de seguimiento se realizaron a través de la prueba no paramétrica de Wilcoxon. El cuestionario QLQ-C30 evidenció un beneficio en cuanto a calidad de vida para el grupo vacunado con la vacuna CIMAvaxEGF® en las escalas funcionales (global, rol y social), en las escalas de síntomas de la enfermedad y del tratamiento (dolor) se observó que mejora la calidad de los mismos a favor de los pacientes tratados con la vacuna CIMAvaxEGF®. El cuestionario QLQ-C13, también evidenció ventajas para el grupo vacunado desde el punto de vista de beneficio clínico en los síntomas (disnea, disfagia, alopecia y dolor en el pecho). Se señala como significativo que disminuye la hemoptisis y la tos en el grupo vacunado, observándose un empeoramiento en el grupo control(AU)


This report corresponds to quality of life analysis of patient with non-small cell lung cancer included in the phase III clinical trials Evaluation of CIMAvaxEGF® vaccine in lung cancer. The quality of life was evaluate using the EORTC questionnaires QLQ-C30 y QLQ-C13, at the beginning and every 3 months. To compare the median between two groups the Mann-Whitney non-parametric test was used. To compare the baseline and different follows times the Wilcoxon non-parametric test was used. The QLQ-C30 questionnaire showed a benefit in terms of the quality of life for the CIMAvaxEGF® vaccine group on the functional scores (global, role and social) and symptoms of the disease (pain). The QLQ-LC13 questionnaire showed a benefit in terms of the quality of life for the CIMAvaxEGF® vaccine group on the symptoms scores (dyspnea, dysphagia, alopecia and chest pain). It is noted as significant that the hemoptysis decreases in the group vaccinated as well as the dysphagia, the cough and the dyspnea observing a worsening in the control group(AU)


Asunto(s)
Humanos , Masculino , Femenino , Calidad de Vida , Encuestas y Cuestionarios , Ensayos Clínicos Fase III como Asunto , Carcinoma de Pulmón de Células no Pequeñas/epidemiología , Vacunas contra el Cáncer
7.
Vaccimonitor (La Habana, Print) ; 30(2)mayo.-ago. 2021.
Artículo en Español | LILACS, CUMED | ID: biblio-1252323

RESUMEN

En diciembre de 2019 en Wuhan, provincia China de Hubei, se notificó un caso de neumonía de etiología desconocida. Con posterioridad se diagnosticó como un síndrome agudo respiratorio severo (SARS, por sus siglas en inglés) causado por un coronavirus denominado SARS-CoV-2.1 A principios de marzo de 2020, la Organización Mundial de la Salud (OMS) notificó casi 100.000 casos positivos y 3.880 víctimas mortales en 47 países, convirtiéndose en pandemia la enfermedad COVID-19 que ha afectado al mundo hasta la actualidad.2 La pandemia de la COVID-19 ha tenido un gran impacto en la vida de las personas y la sociedad en su conjunto y ha causado perjuicios a la economía mundial, afectándose sectores como turismo, recreación, viajes internacionales, educación, entre otros. Para la salud humana, ha tenido repercusión en términos de enfermedad, discapacidad y elevado número de muertes, así como en las complejas interrogantes impuestas a la ciencia para contener el impacto de la misma. La implementación de una estrategia dirigida a mitigar la dispersión de la enfermedad incluye numerosas acciones de salud pública, entre ellas: la higiene de las manos, el uso extendido y obligatorio de la mascarilla, el distanciamiento social y la vacunación.3 Una vacuna contra la COVID-19, esperada ansiosamente por el mundo, debe ser una vacuna segura y eficaz que permita poder reanudar un estilo de vida normal, libre de las medidas de restricción recomendadas y que evite que se saturen los servicios de salud. La carrera por la invención y desarrollo de una vacuna contra la COVID-19 no tiene precedentes en la era moderna y ha comprometido como nunca antes a la ciencia, llevando a la movilización e intercambio de datos en un período muy corto; a la coordinación acelerada, a nivel mundial, de los procesos regulatorios para el desarrollo de vacunas y fármacos; así como a la creación de marcos de colaboración internacional donde se incluyen, junto a la OMS, la Alianza Global para las Vacunas (GAVI), la Coalición para la Promoción de Innovaciones en pro de la Preparación ante Epidemias (CEPI) y el Fondo de Acceso Global para Vacunas COVID-19 (COVAX, por su siglas en inglés).4 El proceso de desarrollar un nuevo producto farmacéutico es caro e implica una inversión considerable de tiempo. Como promedio, se precisan 10 años desde el momento en que se descubre una molécula hasta que se comercializa el producto, con un costo de millones de dólares. Acortar los tiempos de este proceso es de los retos más importantes, donde la etapa de desarrollo clínico es la que se ve más presionada en todo momento.1 El desarrollo clínico de una vacuna implica un número de fases por las que debe transcurrir el producto farmacéutico. En el caso particular de las vacunas contra la COVID-19, las fases se han ido llevando a cabo simultáneamente, bajo aprobaciones rápidas. Varias vacunas ya han recibido autorizaciones para el uso de emergencia y se están utilizando para inmunizar a las personas.5) Desafortunadamente, acortar el tiempo para que las vacunas estén disponibles, puede conllevar a problemas éticos relacionados con la investigación, el desarrollo y aquellos que se puedan presentar en las etapas de distribución y acceso equitativo a las mismas.6 Para que la investigación en seres humanos que sea éticamente justificada, debe haber un balance favorable de beneficios para el sujeto y la sociedad, sobre los riesgos a los que el individuo se expone. Entre los dilemas éticos a los que se enfrentan los investigadores, uno de los más complejos en el caso de las vacunas contra la COVID-19, es el empleo de grupo control o placebo en los estudios clínicos, si tenemos en cuenta que esta es una enfermedad nueva, con limitaciones de las opciones de tratamiento y de elevada mortalidad, todo lo cual implica un alto riesgo para este grupo. Según el diseño del estudio, los participantes incluidos en el grupo placebo podrían infectarse en dependencia del tiempo de permanencia en dicho grupo, la tasa de transmisión local donde se realiza el ensayo clínico y las medidas preventivas adoptadas por cada uno de los participantes.7 Uno de los escenarios que puede afrontar el investigador cuando se usa placebo, es que el tratamiento (fármaco o vacuna) resulte efectivo, entonces, una parte de los participantes perdería la oportunidad de recibir ese beneficio, lo cual nos llevaría a decidir que todos los voluntarios reciban la profilaxis y sacrificar el conocimiento y valor social que aportan los estudios con grupos placebo.8) Actualmente, algunos desarrolladores de vacunas han esbozado la obligación ética de ofrecer la vacuna a participantes que hayan recibido placebo en los ensayos clínicos, para que queden protegidos contra la COVID- 19 y, además, para la contribución a la investigación.8 Otro tema de discusión global y que compete a la bioética relacionada a las vacunas contra la COVID-19, es la distribución justa dentro de una población una vez que las vacunas están disponibles en el mercado. ¿Qué criterios deben utilizarse? ¿Qué personas deben recibirla primero dentro de una población? ¿Quiénes tienen prioridad, y por qué? Es un criterio general entre los especialistas, que el personal de salud que se encuentra en la primera línea de batalla contra la COVID-19, debe ser el primero en acceder a la vacuna, lo cual previene el daño directo e indirecto a los mismos, al prevenir la propagación del SARS-CoV-2 en las instalaciones médicas, protegiendo de este modo a los grupos de pacientes que acuden con mayor frecuencia a los hospitales con diagnóstico de cáncer o con tratamiento de hemodiálisis.6 La crisis sanitaria mundial causada por el SARS-CoV-2 no tiene precedentes y el acceso a la vacuna se ha mostrado difícil desde el inicio. Es un hecho que los países desarrollados se han apresurado desde antes de la comercialización a adquirir y contratar cantidades suficientes de la vacuna para su población, siendo entonces el panorama aún más sombrío para los países de bajos ingresos.6 Debido a la pandemia, las operaciones logísticas de las vacunas también se ven afectadas por lo que se convierten en obstáculos para garantizar la distribución mundial de manera coordinada e interconectada (fabricación, distribución de la cadena de suministro, cadena de frío, almacenamiento, etc.). De ahí, el llamado constante de la OMS a lograr y mantener el compromiso de los gobiernos a garantizar un acceso equitativo y a colaborar en planes multinacionales como COVAX, CEPI y GAVI para asegurar la fabricación y distribución de vacunas contra la COVID-19.4 Con el fin de hacer el bien para todos y ante la premura de obtener resultados terapéuticos eficaces para enfrentar y mitigar la pandemia, no se deben sacrificar las normas científicas, la integridad y trasparencia del proceso de revisión de las vacunas y se debe cumplir con los principios éticos fundamentales que se exigen en las investigaciones en humanos(AU)


Asunto(s)
Humanos , Masculino , Femenino , Ética , Vacunas contra la COVID-19/uso terapéutico
8.
Med. intensiva (Madr., Ed. impr.) ; 45(5): 289-297, jun.-jul. 2021. tab, ilus
Artículo en Español | IBECS | ID: ibc-186896

RESUMEN

Objetivo: Describir las características y la evolución de los pacientes con bronquiolitis ingresados en una unidad de cuidados intensivos pediátricos. Comparar el tratamiento administrado pre y pospublicación de la guía de práctica clínica de la Academia Americana de Pediatría. Diseño: Estudio descriptivo y observacional realizado entre septiembre de 2010 y septiembre de 2017. Configuración: Unidad de cuidados intensivos pediátricos. Pacientes: Menores de un año con bronquiolitis grave. Intervenciones: Se compararon 2 períodos (2010-14 y 2015-17), antes y después de la modificación del protocolo de manejo de la bronquiolitis en el hospital, según las guías de la Academia Americana de Pediatría. Principales variables: Sexo, edad, comorbilidades, gravedad, etiología, tratamiento administrado, infecciones bacterianas, soporte respiratorio e inotrópico, estancia y mortalidad. Resultados: Se recogieron 706 pacientes, 414 (58,6%) varones, con una mediana de edad de 47 días (RIC 25-100,25). Mediana de escala de gravedad de bronquiolitis (BROSJOD) al ingreso: 9 puntos (RIC 7-11). La etiología por virus respiratorio sincitial se dio en 460 (65,16%) pacientes. El primer período (2010-14) incluyó 340 pacientes y el segundo (2015-17), 366 pacientes. En el segundo período se administraron más nebulizaciones de adrenalina y suero salino hipertónico, y más tratamiento con corticoides. Se usó más ventilación no invasiva y menos ventilación mecánica convencional y precisaron menos soporte inotrópico, sin diferencias significativas. La tasa de antibioterapia disminuyó de forma estadísticamente significativa (p = 0,003). Conclusiones: Pese a la disminución en la antibioterapia, se debería limitar la utilización de nebulizaciones y corticoides en estos pacientes, como recomienda la guía


Objective: To describe the characteristics and evolution of patients with bronchiolitis admitted to a pediatric intensive care unit, and compare treatment pre- and post-publication of the American Academy of Pediatrics clinical practice guide. Design: A descriptive and observational study was carried out between September 2010 and September 2017. Setting: Pediatric intensive care unit. Patients: Infants under one year of age with severe bronchiolitis. Interventions: Two periods were compared (2010-14 and 2015-17), corresponding to before and after modification of the American Academy of Pediatrics guidelines for the management of bronchiolitis in hospital. Main variables: Patient sex, age, comorbidities, severity, etiology, administered treatment, bacterial infections, respiratory and inotropic support, length of stay and mortality. Results: A total of 706 patients were enrolled, of which 414 (58.6%) males, with a median age of 47 days (IQR 25-100.25). Median bronchiolitis severity score (BROSJOD) upon admission: 9 points (IQR 7-11). Respiratory syncytial virus appeared in 460 (65.16%) patients. The first period (2010-14) included 340 patients and the second period (2015-17) 366 patients. More adrenalin and hypertonic saline nebulizations and more corticosteroid treatment were administered in the second period. More noninvasive ventilation and less conventional mechanical ventilation were used, and less inotropic support was needed, with no significant differences. The antibiotherapy rate decreased significantly (P = .003). Conclusions: Despite the decrease in antibiotherapy, the use of nebulizations and glucocorticoids in these patients should be limited, as recommended by the guide


Asunto(s)
Humanos , Masculino , Femenino , Lactante , Bronquiolitis/terapia , Guías de Práctica Clínica como Asunto , Toma de Decisiones Clínicas , Enfermedad Aguda/terapia , Unidades de Cuidado Intensivo Pediátrico/estadística & datos numéricos , Academias e Institutos/normas , Infecciones por Virus Sincitial Respiratorio/etiología , Insuficiencia Respiratoria/etiología , Estudios Retrospectivos , Algoritmos
9.
Nat Commun ; 12(1): 3251, 2021 05 31.
Artículo en Inglés | MEDLINE | ID: mdl-34059686

RESUMEN

ALS is characterized by progressive inability to execute movements. Motor neurons innervating fast-twitch muscle-fibers preferentially degenerate. The reason for this differential vulnerability and its consequences on motor output is not known. Here, we uncover that fast motor neurons receive stronger inhibitory synaptic inputs than slow motor neurons, and disease progression in the SOD1G93A mouse model leads to specific loss of inhibitory synapses onto fast motor neurons. Inhibitory V1 interneurons show similar innervation pattern and loss of synapses. Moreover, from postnatal day 63, there is a loss of V1 interneurons in the SOD1G93A mouse. The V1 interneuron degeneration appears before motor neuron death and is paralleled by the development of a specific locomotor deficit affecting speed and limb coordination. This distinct ALS-induced locomotor deficit is phenocopied in wild-type mice but not in SOD1G93A mice after appearing of the locomotor phenotype when V1 spinal interneurons are silenced. Our study identifies a potential source of non-autonomous motor neuronal vulnerability in ALS and links ALS-induced changes in locomotor phenotype to inhibitory V1-interneurons.


Asunto(s)
Esclerosis Amiotrófica Lateral/fisiopatología , Interneuronas/patología , Locomoción/fisiología , Neuronas Motoras/patología , Esclerosis Amiotrófica Lateral/genética , Esclerosis Amiotrófica Lateral/patología , Animales , Modelos Animales de Enfermedad , Femenino , Proteínas de Homeodominio/metabolismo , Humanos , Masculino , Ratones , Ratones Transgénicos , Fibras Musculares de Contracción Rápida/fisiología , Unión Neuromuscular/patología , Unión Neuromuscular/fisiopatología , Médula Espinal/citología , Superóxido Dismutasa/genética , Superóxido Dismutasa-1/genética
10.
Nat Commun ; 12(1): 3247, 2021 05 31.
Artículo en Inglés | MEDLINE | ID: mdl-34059688

RESUMEN

The Wnt signaling pathway is intricately connected with bone mass regulation in humans and rodent models. We designed an antibody-based platform that generates potent and selective Wnt mimetics. Using this platform, we engineer bi-specific Wnt mimetics that target Frizzled and low-density lipoprotein receptor-related proteins and evaluate their effects on bone accrual in murine models. These synthetic Wnt agonists induce rapid and robust bone building effects, and correct bone mass deficiency and bone defects in various disease models, including osteoporosis, aging, and long bone fracture. Furthermore, when these Wnt agonists are combined with antiresorptive bisphosphonates or anti-sclerostin antibody therapies, additional bone accrual/maintenance effects are observed compared to monotherapy, which could benefit individuals with severe and/or acute bone-building deficiencies. Our data support the continued development of Wnt mimetics for the treatment of diseases of low bone mineral density, including osteoporosis.


Asunto(s)
Conservadores de la Densidad Ósea/farmacología , Resorción Ósea/tratamiento farmacológico , Fracturas del Fémur/tratamiento farmacológico , Osteoporosis Posmenopáusica/tratamiento farmacológico , Proteínas Wnt/agonistas , Anciano , Envejecimiento/fisiología , Animales , Densidad Ósea/efectos de los fármacos , Densidad Ósea/fisiología , Conservadores de la Densidad Ósea/uso terapéutico , Resorción Ósea/fisiopatología , Difosfonatos/farmacología , Difosfonatos/uso terapéutico , Modelos Animales de Enfermedad , Evaluación Preclínica de Medicamentos , Sinergismo Farmacológico , Quimioterapia Combinada/métodos , Femenino , Fracturas del Fémur/patología , Fémur/efectos de los fármacos , Fémur/lesiones , Fémur/patología , Humanos , Ratones , Osteoporosis Posmenopáusica/fisiopatología , Vía de Señalización Wnt/efectos de los fármacos , Adulto Joven
11.
Nat Commun ; 12(1): 3246, 2021 05 31.
Artículo en Inglés | MEDLINE | ID: mdl-34059690

RESUMEN

Biosensors are indispensable tools for public, global, and personalized healthcare as they provide tests that can be used from early disease detection and treatment monitoring to preventing pandemics. We introduce single-wavelength imaging biosensors capable of reconstructing spectral shift information induced by biomarkers dynamically using an advanced data processing technique based on an optimal linear estimator. Our method achieves superior sensitivity without wavelength scanning or spectroscopy instruments. We engineered diatomic dielectric metasurfaces supporting bound states in the continuum that allows high-quality resonances with accessible near-fields by in-plane symmetry breaking. The large-area metasurface chips are configured as microarrays and integrated with microfluidics on an imaging platform for real-time detection of breast cancer extracellular vesicles encompassing exosomes. The optofluidic system has high sensing performance with nearly 70 1/RIU figure-of-merit enabling detection of on average 0.41 nanoparticle/µm2 and real-time measurements of extracellular vesicles binding from down to 204 femtomolar solutions. Our biosensors provide the robustness of spectrometric approaches while substituting complex instrumentation with a single-wavelength light source and a complementary-metal-oxide-semiconductor camera, paving the way toward miniaturized devices for point-of-care diagnostics.


Asunto(s)
Técnicas Biosensibles , Neoplasias de la Mama/diagnóstico , Técnicas Analíticas Microfluídicas/instrumentación , Pruebas en el Punto de Atención , Refractometría/instrumentación , Neoplasias de la Mama/sangre , Exosomas/química , Femenino , Humanos , Técnicas Analíticas Microfluídicas/métodos , Nanopartículas/química , Refractometría/métodos , Análisis Espectral/instrumentación , Análisis Espectral/métodos
12.
Aust J Gen Pract ; 50(6): 388-393, 2021 06.
Artículo en Inglés | MEDLINE | ID: mdl-34059849

RESUMEN

BACKGROUND AND OBJECTIVES: Immunisation uptake in Australian older adults is suboptimal. General practice registrars are responsible for a significant proportion of immunisations in this age group and are also in the process of developing patterns of practice. Despite their role, little is known about general practice registrars' attitudes towards immunisation of older adults, the barriers faced, and the role supervisors play in developing adult immunisation skills. METHOD: This was a qualitative study involving semi-structured interviews with general practice registrars and supervisors purposively sampled from around Australia. Data were analysed using thematic analysis. RESULTS: The five key themes were grouped in terms of perceptions of registrars' role in immunisation of older adults, consultation barriers, health system barriers, managing vaccine hesitancy, and a team approach to vaccination. DISCUSSION: Vaccine positivity is an important attitude to cultivate within the general practice environment as it has an impact on registrar behaviour. Immunisation-skilled nurses could play a role in training general practice registrars in immunisation. Findings from the present study may be useful in improving vaccine uptake in the elderly in the context of the COVID-19 vaccine rollout.


Asunto(s)
Actitud del Personal de Salud , Vacunas contra la COVID-19 , COVID-19/prevención & control , Médicos Generales/psicología , Rol del Médico , Anciano , Australia/epidemiología , Competencia Clínica , Barreras de Comunicación , Femenino , Encuestas Epidemiológicas , Humanos , Masculino , Rol de la Enfermera , Aceptación de la Atención de Salud , Grupo de Atención al Paciente , Relaciones Médico-Paciente , Investigación Cualitativa , SARS-CoV-2
13.
Clin Transl Gastroenterol ; 12(6): e00365, 2021 06 01.
Artículo en Inglés | MEDLINE | ID: mdl-34060496

RESUMEN

INTRODUCTION: The initial surge of the coronavirus disease 2019 (COVID-19) pandemic prompted national recommendations to delay nonurgent endoscopic procedures. The objective of this study was to provide real-world data on the impact of COVID-19 on endoscopic procedures in a safety-net healthcare system and cancer center affiliated with a tertiary academic center. METHODS: This retrospective cohort study used a combination of electronic health record data and a prospective data tool created to track endoscopy procedures throughout COVID-19 to describe patient and procedural characteristics of endoscopic procedures delayed during the initial COVID-19 surge. RESULTS: Of the 480 patients identified, the median age was 57 years (interquartile range 46-66), 55% (n = 262) were male, and 59% self-identified as white. Colonoscopy was the most common type of delayed procedure (49%), followed by combined esophagogastroduodenoscopy (EGD) and colonoscopy (22%), and EGD alone (20%). Colorectal cancer screening was the most common indication for delayed colonoscopy (35%), and evaluation of suspected bleeding (30%) was the most common indication for delayed combined EGD and colonoscopy. To date, 46% (223/480) of delayed cases have been completed with 12 colorectal, pancreatic, and stomach cancers diagnosed. Sociodemographic factors, procedure type, and sedation type were not significantly associated with endoscopy completion. The median time to endoscopy after delayed procedure was 88 days (interquartile range 63-119) with no differences by procedure type. DISCUSSION: To minimize potential losses to follow-up, delayed, or missed diagnoses and to reduce progression of gastrointestinal diseases, all efforts should be used to ensure follow-up in those whose endoscopic procedures were delayed because of COVID-19.


Asunto(s)
COVID-19/epidemiología , Diagnóstico Tardío , Endoscopía Gastrointestinal/estadística & datos numéricos , Enfermedades Gastrointestinales/diagnóstico , Pandemias , Anciano , Femenino , Enfermedades Gastrointestinales/terapia , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , SARS-CoV-2 , Tiempo de Tratamiento , Washingtón/epidemiología
15.
JAMA Netw Open ; 4(6): e2110782, 2021 06 01.
Artículo en Inglés | MEDLINE | ID: mdl-34061203

RESUMEN

Importance: Vaccination against SARS-CoV-2 has the potential to significantly reduce transmission and COVID-19 morbidity and mortality. The relative importance of vaccination strategies and nonpharmaceutical interventions (NPIs) is not well understood. Objective: To assess the association of simulated COVID-19 vaccine efficacy and coverage scenarios with and without NPIs with infections, hospitalizations, and deaths. Design, Setting, and Participants: An established agent-based decision analytical model was used to simulate COVID-19 transmission and progression from March 24, 2020, to September 23, 2021. The model simulated COVID-19 spread in North Carolina, a US state of 10.5 million people. A network of 1 017 720 agents was constructed from US Census data to represent the statewide population. Exposures: Scenarios of vaccine efficacy (50% and 90%), vaccine coverage (25%, 50%, and 75% at the end of a 6-month distribution period), and NPIs (reduced mobility, school closings, and use of face masks) maintained and removed during vaccine distribution. Main Outcomes and Measures: Risks of infection from the start of vaccine distribution and risk differences comparing scenarios. Outcome means and SDs were calculated across replications. Results: In the worst-case vaccination scenario (50% efficacy, 25% coverage), a mean (SD) of 2 231 134 (117 867) new infections occurred after vaccination began with NPIs removed, and a mean (SD) of 799 949 (60 279) new infections occurred with NPIs maintained during 11 months. In contrast, in the best-case scenario (90% efficacy, 75% coverage), a mean (SD) of 527 409 (40 637) new infections occurred with NPIs removed and a mean (SD) of 450 575 (32 716) new infections occurred with NPIs maintained. With NPIs removed, lower efficacy (50%) and higher coverage (75%) reduced infection risk by a greater magnitude than higher efficacy (90%) and lower coverage (25%) compared with the worst-case scenario (mean [SD] absolute risk reduction, 13% [1%] and 8% [1%], respectively). Conclusions and Relevance: Simulation outcomes suggest that removing NPIs while vaccines are distributed may result in substantial increases in infections, hospitalizations, and deaths. Furthermore, as NPIs are removed, higher vaccination coverage with less efficacious vaccines can contribute to a larger reduction in risk of SARS-CoV-2 infection compared with more efficacious vaccines at lower coverage. These findings highlight the need for well-resourced and coordinated efforts to achieve high vaccine coverage and continued adherence to NPIs before many prepandemic activities can be resumed.


Asunto(s)
Vacunas contra la COVID-19/farmacología , COVID-19 , Control de Enfermedades Transmisibles , Vacunación Masiva , Cobertura de Vacunación , Adulto , COVID-19/epidemiología , COVID-19/prevención & control , COVID-19/transmisión , Control de Enfermedades Transmisibles/métodos , Control de Enfermedades Transmisibles/organización & administración , Control de Enfermedades Transmisibles/estadística & datos numéricos , Simulación por Computador , Transmisión de Enfermedad Infecciosa/prevención & control , Femenino , Hospitalización/estadística & datos numéricos , Humanos , Masculino , Vacunación Masiva/organización & administración , Vacunación Masiva/estadística & datos numéricos , Mortalidad , North Carolina/epidemiología , Medición de Riesgo/métodos , Medición de Riesgo/estadística & datos numéricos , SARS-CoV-2 , Resultado del Tratamiento , Cobertura de Vacunación/organización & administración , Cobertura de Vacunación/estadística & datos numéricos
16.
Int J Mol Sci ; 22(10)2021 May 11.
Artículo en Inglés | MEDLINE | ID: mdl-34064635

RESUMEN

Ovarian cancer is a fatal gynecological malignancy. Although first-line chemotherapy and surgical operation are effective treatments for ovarian cancer, its clinical management remains a challenge owing to intrinsic or acquired drug resistance and relapse at local or distal lesions. Cancer stem cells (CSCs) are a small subpopulation of cells inside tumor tissues, and they can self-renew and differentiate. CSCs are responsible for the cancer malignancy involved in relapses as well as resistance to chemotherapy and radiation. These malignant properties of CSCs are regulated by cell surface receptors and intracellular pluripotency-associated factors triggered by internal or external stimuli from the tumor microenvironment. The malignancy of CSCs can be attenuated by individual or combined restraining of cell surface receptors and intracellular pluripotency-associated factors. Therefore, targeted therapy against CSCs is a feasible therapeutic tool against ovarian cancer. In this paper, we review the prominent roles of cell surface receptors and intracellular pluripotency-associated factors in mediating the stemness and malignancy of ovarian CSCs.


Asunto(s)
Antineoplásicos/uso terapéutico , Biomarcadores de Tumor/antagonistas & inhibidores , Terapia Molecular Dirigida , Células Madre Neoplásicas/efectos de los fármacos , Neoplasias Ováricas/tratamiento farmacológico , Animales , Biomarcadores de Tumor/metabolismo , Femenino , Humanos , Células Madre Neoplásicas/metabolismo , Células Madre Neoplásicas/patología , Neoplasias Ováricas/metabolismo , Neoplasias Ováricas/patología , Microambiente Tumoral
17.
Int J Mol Sci ; 22(10)2021 May 11.
Artículo en Inglés | MEDLINE | ID: mdl-34064719

RESUMEN

Inflammation is a major cause of several chronic diseases and is reported to be recovered by the immuno-modulation of mesenchymal stem cells (MSCs). While most studies have focussed on the anti-inflammatory roles of MSCs in stem cell therapy, the impaired features of MSCs, such as the loss of homeostasis by systemic aging or pathologic conditions, remain incompletely understood. In this study, we investigated whether the altered phenotypes of human placenta-derived MSCs (hPD-MSCs) exposed to inflammatory cytokines, including TNF-α and IFN-γ, could be protected by MIT-001, a small anti-inflammatory and anti-necrotic molecule. MIT-001 promoted the spindle-like shape and cytoskeletal organization extending across the long cell axis, whereas hPD-MSCs exposed to TNF-α/IFN-γ exhibited increased morphological heterogeneity with an abnormal cell shape and cytoskeletal disorganization. Importantly, MIT-001 improved mitochondrial distribution across the cytoplasm. MIT-001 significantly reduced basal respiration, ATP production, and cellular ROS levels and augmented the spare respiratory capacity compared to TNF-α/IFN-γ-exposed hPD-MSCs, indicating enhanced mitochondrial quiescence and homeostasis. In conclusion, while TNF-α/IFN-γ-exposed MSCs lost homeostasis and mitochondrial quiescence by becoming over-activated in response to inflammatory cytokines, MIT-001 was able to rescue mitochondrial features and cellular phenotypes. Therefore, MIT-001 has therapeutic potential for clinical applications to treat mitochondrion-related inflammatory diseases.


Asunto(s)
Citoesqueleto/fisiología , Células Madre Mesenquimatosas/fisiología , Mitocondrias/fisiología , Compuestos Orgánicos/farmacología , Placenta/citología , Citoesqueleto/efectos de los fármacos , Femenino , Humanos , Células Madre Mesenquimatosas/citología , Células Madre Mesenquimatosas/efectos de los fármacos , Mitocondrias/efectos de los fármacos , Consumo de Oxígeno , Placenta/efectos de los fármacos , Placenta/metabolismo , Embarazo , Especies Reactivas de Oxígeno/metabolismo
18.
Int J Mol Sci ; 22(10)2021 May 11.
Artículo en Inglés | MEDLINE | ID: mdl-34064801

RESUMEN

Specific link between high fructose uptake and cancer development and progression highlighted fructose transporters as potential means to achieve GLUT-mediated discrimination between normal and cancer cells. The gained expression of fructose-specific transporter GLUT5 in various cancers offers a possibility for developing cancer-specific imaging and bioactive agents. Herein, we explore the feasibility of delivering a bioactive agent through cancer-relevant fructose-specific transporter GLUT5. We employed specific targeting of GLUT5 by 2,5-anhydro-D-mannitol and investigated several drug conjugates for their ability to induce cancer-specific cytotoxicity. The proof-of-concept analysis was carried out for conjugates of chlorambucil (CLB) in GLUT5-positive breast cancer cells and normal breast cells. The cytotoxicity of conjugates was assessed over 24 h and 48 h, and significant dependence between cancer-selectivity and conjugate size was observed. The differences were found to relate to the loss of GLUT5-mediated uptake upon increased conjugate size and hydrophobicity. The findings provide information on the substrate tolerance of GLUT5 and highlight the importance of maintaining appropriate hydrophilicity for GLUT-mediated delivery.


Asunto(s)
Neoplasias de la Mama/patología , Mama/citología , Clorambucilo/farmacología , Transportador de Glucosa de Tipo 5/metabolismo , Manitol/análogos & derivados , Antineoplásicos Alquilantes/farmacología , Mama/efectos de los fármacos , Mama/metabolismo , Neoplasias de la Mama/tratamiento farmacológico , Neoplasias de la Mama/metabolismo , Femenino , Humanos , Interacciones Hidrofóbicas e Hidrofílicas , Manitol/metabolismo , Especificidad por Sustrato
19.
Int J Mol Sci ; 22(10)2021 May 11.
Artículo en Inglés | MEDLINE | ID: mdl-34064854

RESUMEN

Endometriosis is a gynecological condition affecting patients in reproductive age. The aim of this paper was to assess the effects of the autophagy and mitophagy induction in a rat model of endometriosis. Endometriosis was induced by the injection of uterine fragments, and rapamycin (0. 5 mg/kg) was administered once per week. One week from the induction, rats were sacrificed, and laparotomy was performed to collect the endometriotic implants and to further process them for molecular analysis. Western blot analysis was conducted on explanted lesions to evaluate the autophagy pathway during the pathology. Elevated phospho-serine/threonine kinase (p-AKT) and mammalian target of rapamycin (mTOR) expressions were detected in vehicle-treated rats, while Beclin and microtubule-associated protein 1A/1B-light chain 3 II (LC3II) expressions were low. Additionally, samples collected from vehicle groups indicated low Bnip3, Ambra1, and Parkin expressions, demonstrating impaired autophagy and mitophagy. Rapamycin administration reduced p-AKT and mTOR expressions and increased Beclin and LC3II, Bnip3, Ambra1, and Parkin expressions, activating both mechanisms. We also evaluated the impact of the impaired autophagy and mitophagy pathways on apoptosis and angiogenesis. Rapamycin was administered by activating autophagy and mitophagy, which increased apoptosis (assessed by Western blot analysis of Bcl-2, Bax, and Cleaved-caspase 3) and reduced angiogenesis (assessed by immunohistochemical analysis of vascular endothelial grow factor (VEGF) and CD34) in the lesions. All of these mechanisms activated by the induction of the autophagy and mitophagy pathways led to the reduction in the lesions' volume, area and diameter.


Asunto(s)
Apoptosis , Autofagia , Endometriosis/patología , Mitofagia , Serina-Treonina Quinasas TOR/metabolismo , Animales , Endometriosis/metabolismo , Femenino , Ratas , Ratas Sprague-Dawley
20.
Int J Mol Sci ; 22(10)2021 May 11.
Artículo en Inglés | MEDLINE | ID: mdl-34064859

RESUMEN

Tumor metastasis to bone is a common event in multiple forms of malignancy. Inflammation holds essential functions in homeostasis as a defense mechanism against infections and is a strategy to repair injured tissue and to adapt to stress conditions. However, exaggerated and/or persistent (chronic) inflammation may eventually become maladaptive and evoke diseases such as autoimmunity, diabetes, inflammatory tissue damage, fibrosis, and cancer. In fact, inflammation is now considered a hallmark of malignancy with prognostic relevance. Emerging studies have revealed a central involvement of inflammation in several steps of the metastatic cascade of bone-homing tumor cells through supporting their survival, migration, invasion, and growth. The mechanisms by which inflammation favors these steps involve activation of epithelial-to-mesenchymal transition (EMT), chemokine-mediated homing of tumor cells, local activation of osteoclastogenesis, and a positive feedback amplification of the protumorigenic inflammation loop between tumor and resident cells. In this review, we summarize established and evolving concepts of inflammation-driven tumorigenesis, with a special focus on bone metastasis.


Asunto(s)
Neoplasias Óseas/secundario , Neoplasias de la Mama/patología , Inflamación/complicaciones , Neoplasias de la Próstata/patología , Animales , Neoplasias Óseas/etiología , Neoplasias de la Mama/inmunología , Femenino , Humanos , Masculino , Neoplasias de la Próstata/inmunología , Transducción de Señal
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