Value of platelet-albumin-bilirubin index combined with AIMS65 score in predicting the short-term prognosis of patients with liver cirrhosis and acute upper gastrointestinal bleeding / 临床肝胆病杂志

ObjectiveTo investigate the value of platelet-albumin-bilirubin index （PALBI） combined with AIMS65 score in predicting rebleeding and death within 6 weeks after admission in patients with liver cirrhosis and acute upper gastrointestinal bleeding （AUGIB）. MethodsA retrospective study was conducted for 238 patients with liver cirrhosis and AUGIB who were hospitalized in The First Affiliated Hospital of Jinzhou Medical University from February 2021 to October 2022， and all patients were followed up for 6 weeks. According to the prognosis， they were divided into death group with 65 patients and survival group with 173 patients， and according to the presence or absence of rebleeding， they were divided into non-rebleeding group with 149 patients and rebleeding group with 89 patients. General data and laboratory markers （including blood routine， liver/renal function， and coagulation）， and PALBI， AIMS65 score， Child-Turcotte-Pugh （CTP） score， and Model for End-stage Liver Disease （MELD） score were calculated on admission. The independent-samples t test or the Mann-Whitney U test was used for comparison of continuous data between two groups， and the chi-square test was used for comparison of categorical data between two groups. A multivariate logistic regression model analysis was used to investigate the risk factors for death or rebleeding within 6 weeks after admission in patients with liver cirrhosis and AUGIB. The receiver operating characteristic （ROC） curve and the area under the ROC curve （AUC） were used to investigate the predictive efficacy of each scoring system， and the DeLong test was used for comparison of AUC. ResultsThere were significant differences between the death group and the survival group in hematemesis， past history of varices， albumin （Alb）， total bilirubin （TBil）， international normalized ratio （INR）， creatinine （Cr）， prothrombin time （PT）， systolic blood pressure， PALBI， AIMS65 score， CTP score， and MELD score （all P<0.05）. The multivariate logistic regression analysis showed that hematemesis （odds ratio ［OR］=4.34， 95% confidence interval ［CI］： 1.88‍ ‍—‍ ‍10.05， P<0.001）， past history of varices （OR=3.51， 95%CI： 1.37‍ ‍—‍ ‍8.98， P=0.009）， PALBI （OR=4.49， 95%CI： 1.48‍ ‍—‍ ‍13.64， P=0.008）， and AIMS65 score （OR=3.85， 95%CI： 2.35‍ ‍—‍ ‍6.30， P<0.001） were independent risk factors for death. The ROC curve analysis of each scoring system in predicting survival showed that CTP score， MELD score， PALBI， AIMS65 score， and PALBI combined with AIMS65 score had an AUC of 0.758， 0.798， 0.789， 0.870， and 0.888， respectively， suggesting that PALBI combined with AIMS65 score had a significantly larger AUC than the four scoring systems used alone （all P<0.05）. There were significant differences between the rebleeding group and the non-rebleeding group in hematemesis， history of diabetes， Alb， TBil， INR， Cr， PT， PALBI， AIMS65 score， CTP score， and MELD score （all P<0.05）. The multivariate logistic regression analysis showed that PALBI （OR=2.41， 95%CI： 1.17‍ ‍—‍ ‍4.95， P=0.017） and AIMS65 score （OR=1.58， 95%CI： 1.17‍ ‍—‍ ‍2.15， P=0.003） were independent risk factors for rebleeding. The ROC curve analysis of each scoring system in predicting rebleeding showed that CTP score， MELD score， PALBI， AIMS65 score， and PALBI combined with AIMS65 score had an AUC of 0.680， 0.719， 0.709， 0.711， and 0.741， respectively， suggesting that PALBI combined with AIMS65 score had the largest AUC （all P<0.05）， but with a relatively low specificity. ConclusionPALBI combined with AIMS65 score has a certain value in predicting death within 6 weeks after admission in patients with liver cirrhosis and AUGIB， with a better value than CTP score and MELD score alone. PALBI combined with AIMS65 score has a relatively low value in predicting rebleeding within 6 weeks， with an acceptable accuracy.

The effect of the shock index and scoring systems for predicting mortality among geriatric patients with upper gastrointestinal bleeding: a prospective cohort study

ABSTRACT BACKGROUND: Gastrointestinal (GI) bleeding is an important cause of mortality and morbidity among geriatric patients. OBJECTIVE: To investigate whether the shock index and other scoring systems are effective predictors of mortality and prognosis among geriatric patients presenting to the emergency department with complaints of upper GI bleeding. DESIGN AND SETTING: Prospective cohort study in an emergency department in Bursa, Turkey. METHODS: Patients over 65 years admitted to a single-center, tertiary emergency service between May 8, 2019, and April 30, 2020, and diagnosed with upper GI bleeding were analyzed. 30, 180 and 360-day mortality prediction performances of the shock index and the Rockall, Glasgow-Blatchford and AIMS-65 scores were evaluated. RESULTS: A total of 111 patients who met the criteria were included in the study. The shock index (P < 0.001) and AIMS-65 score (P < 0.05) of the patients who died within the 30-day period were found to be significantly different, while the shock index (P < 0.001), Rockall score (P < 0.001) and AIMS-65 score (P < 0.05) of patients who died within the 180-day and 360-day periods were statistically different. In the receiver operating characteristic (ROC) analysis for predicting 360-day mortality, the area under the curve (AUC) value was found to be 0.988 (95% confidence interval, CI, 0.971-1.000; P < 0.001). CONCLUSION: The shock index measured among geriatric patients with upper GI bleeding at admission seems to be a more effective predictor of prognosis than other scoring systems.

Comparación entre manguera difusora y tubería PVC para la aireación en la producción de Litopenaeus vannamei con biofloc a diferentes niveles de proteína / Comparison between diffuser hose and PVC pipe for aeration in production of Litopenaeus vannamei with biofloc at different protein levels / Comparação entre mangueira difusora e tubo de PVC para aeração na produção de Litopenaeus vannamei com bioflocos em diferentes níveis de proteína

Resumen Al implementar la tecnología biofloc, la aireación es uno de los problemas para obtener buenos resultados productivos, por tanto, el objetivo fue comparar la eficiencia de la tubería PVC y manguera difusora, como sistema de aireación en cultivos con biofloc y dos niveles de proteína. Se aplicó un diseño completamente al azar con arreglo factorial con cuatro tratamientos, tres réplicas cada uno, con los dos sistemas de aireación y dos niveles de proteína bruta (PB) en el alimento balanceado en producciones de camarón Litopenaeus vannamei, distribuidos de la siguiente manera: para el tratamiento uno (T1) se utilizó tubería PVC y 28% de PB; para T2, manguera difusora y 22% de PB; para T3, manguera difusora y 28% de PB; para T4, tubería PVC y 22% de PB, todos producidos con biofloc. Las variables peso, talla, alimentación y el factor tratamiento influencian significativamente en la concentración de oxígeno disuelto (OD, mg/l) en la tarde, T1 es el que mejor se comportó en la tarde y T3 en la mañana. El tratamiento con menor sedimentación a los 20 y 30 minutos en la prueba de cono Imhoff fue T4 y el de mayor sedimentación fue el T3. No hubo diferencia significativa en la supervivencia entre tratamientos, los niveles de proteína sí influencian en las concentraciones del OD. El uso de tubería PVC aporta en el incremento de peso y de la concentración de OD en relación al sistema de manguera difusora con el 22% y 28% de proteína bruta.

Abstract When implementing biofloc technology, aeration is one of the problems to obtain good productive results, therefore, the objective was to compare the efficiency of PVC pipe and diffuser hose, as an aeration system in crops with biofloc and two levels of protein. A completely randomized design with factorial arrangement was applied with four treatments with three replicates each, with the two aeration systems and with two levels of crude protein (CP) in the balanced feed in Litopenaeus vannamei shrimp productions, distributors of the following way, for treatment one (T1) PVC pipes and 28% PB were achieved; for T2, diffuser hose and 22% PB; for T3, diffuser hose and 28% PB; for T4, PVC pipe and 22% PB, produced with biofloc. The variables weight, height, feeding and the treatment factor significantly influence the concentration of dissolved oxygen (DO, mg/l) in the afternoon. T1 is the one that behaves best in the afternoon and T3 in the morning, the treatment with the lowest sedimentation at 20 and 30 minutes in the Imhoff cone test was T4 and the highest sedimentation was T3. There was no significant difference in survival between treatments, protein levels did influence OD concentrations. The use of PVC pipe provides an increase in weight and DO concentration in relation to the diffuser hose system with 22% and 28% crude protein.

Resumo Ao implementar a tecnologia de bioflocos, a aeração é um dos problemas para obter bons resultados produtivos, portanto, objetivou-se comparar a eficiência do tubo de PVC e da mangueira difusora, como sistema de aeração em lavouras com bioflocos e dois níveis de proteína. Foi aplicado um delineamento inteiramente casualizado com arranjo fatorial com quatro tratamentos com três repetições cada, com os dois sistemas de aeração e com dois níveis de proteína bruta (PB) na ração balanceada em produções de camarão Litopenaeus vannamei, distribuidores da seguinte forma, para tratamento com tubo de PVC (T1) e PB de 28%; para T2, mangueira difusora e PB 22%; para T3, mangueira difusora e PB 28%; para T4, tubo de PVC e PB 22%, produzido com biofloco. As variáveis peso, altura, alimentação e o fator de tratamento influenciam significativamente na concentração de oxigênio dissolvido (OD, mg/l) no período da tarde, T1 é o que apresenta melhor desempenho no período da tarde e T3 no período da manhã, tratamento com menor sedimentação aos 20 e 30 minutos no teste do cone de Imhoff foi T4 e a maior sedimentação foi T3. Não houve diferença significativa na sobrevivência entre os tratamentos, os níveis de proteína influenciaram as concentrações de DO. A utilização de tubo de PVC proporciona um aumento de peso e concentração de OD em relação ao sistema de mangueiras difusoras com 22% e 28% de proteína bruta.

Comparação dos escores não endoscópicos para a previsão de resultados em doentes com sangramento gastrointestinal alto na emergência de um hospital de referência em cuidados terciários: um estudo de coorte prospectivo / Comparison of non-endoscopic scores for the prediction of outcomes in patients of upper gastrointestinal bleed in an emergency of a tertiary care referral hospital: a prospective cohort study

ABSTRACT BACKGROUND: Traditionally peptic ulcer disease was the most common cause of upper gastrointestinal (UGI) bleed but with the changing epidemiology; other etiologies of UGI bleed are emerging. Many scores have been described for predicting outcomes and the need for intervention in UGI bleed but prospective comparison among them is scarce. OBJECTIVE: This study was planned to determine the etiological pattern of UGI bleed and to compare Glasgow Blatchford score, Pre-Endoscopy Rockall score, AIMS65, and Modified Early Warning Score (MEWS) as predictors of outcome. METHODS: In this prospective cohort study 268 patients of UGI bleed were enrolled and followed up for 8 weeks. Glasgow Blatchford score, Endoscopy Rockall score, AIMS65, and MEWS were calculated for each patient, and the area under the receiver operating characteristic (AUC-ROC) curve for each score was compared. RESULTS: The most common etiology for UGI bleed were gastroesophageal varices 150 (63.55%) followed by peptic ulcer disease 29 (12.28%) and mucosal erosive disease 27 (11.44%). Total 38 (15.26%) patients had re-bleed and 71 (28.5%) patients died. Overall, 126 (47%) patients required blood component transfusion, 25 (9.3%) patients required mechanical ventilation and 2 (0.74%) patients required surgical intervention. Glasgow Blatchford score was the best in predicting the need for transfusion (cut off - 10, AUC-ROC= 0.678). Whereas AIMS65 with a score of ≥2 was best in predicting re-bleed (AUC-ROC=0.626) and mortality (AUC-ROC=0.725). CONCLUSION: Gastrointestinal bleed was most commonly of variceal origin at our tertiary referral center in Northern India. AIMS65 was the best & simplest score with a score of ≥2 for predicting re-bleed and mortality.

RESUMO CONTEXTO: Tradicionalmente, a doença úlcera péptica era a causa mais comum de sangramento digestivo alto, mas com a mudança da epidemiologia, outras etiologias do sangramento do trato digestivo alto estão emergindo. Muitas pontuações têm sido descritas para prever resultados e a necessidade de intervenção na hemorragia gastrointestinal superior, mas a comparação prospectiva entre elas é escassa. OBJETIVO: Este estudo foi planeado para determinar o padrão etiológico de pacientes com hemorragia digestiva alta e comparar os escores de Glasgow Blatchford, o Rockall pré-endoscopia, o AIMS65 e o Early Warning modificado (MEWS) como preditores do resultado. MÉTODOS: Neste estudo prospetivo de coorte, 268 pacientes com sangramento digestivo alto foram acompanhados durante 8 semanas. Os escores Glasgow Blatchford, Rockall pré-endoscopia, AIMS65 e MEWS foram calculados para cada paciente, e a área sob a curva (AUC-ROC) para cada pontuação foi comparada. RESULTADOS: A etiologia mais comum para a hemorragia gastrointestinal alta foi varizes gastroesofágicas 150 (63,55%), seguida de úlcera péptica 29 (12,28%) e de doença erosiva de mucosa 27 (11,44%). No total, 38 (15,26%) doentes voltaram a sangrar e 71 (28,5%) doentes morreram. No total, 126 (47%) doentes necessitaram de transfusão de componentes sanguíneos, 25 (9,3%) necessitaram de ventilação mecânica e 2 (0,74%) destes doentes necessitaram de intervenção cirúrgica. O escore de Glasgow Blatchford foi o melhor na previsão da necessidade de transfusão (corte - 10, AUC-ROC =0,678). Enquanto o AIMS65 com uma pontuação de ≥2 foi o melhor na previsão de ressangramento (AUC-ROC =0,626) e mortalidade (AUC-ROC =0,725). CONCLUSÃO: O sangramento gastrointestinal alto mais comum é de origem varicosa em centro de referência terciária. O AIMS65 é o melhor escore simples, com uma pontuação de ≥2 para prever o ressangramento e a mortalidade.

BIOLOGÍA REPRODUCTIVA DEL BOCACHICO Prochilodus magdalenae (PROCHILODONTIDAE) EN EL RÍO SAN JORGE, COLOMBIA / Reproductive biology of Bocachico Prochilodus magdalenae (Prochilodontidae) in the San Jorge River, Colombia

RESUMEN Se estudió la biología reproductiva del Bocachico, Prochilodus magdalenae, en el río San Jorge, Colombia. La especie es un pez con proporción sexual hembra: macho de 1,2:1, diferente a lo esperado. Presenta desarrollo ovocitario sincrónico en dos grupos, un desove anual que se extiende de abril a septiembre asociado al ciclo hidrológico del río San Jorge, talla media de madurez sexual estimada en 30,2 cm LT, ovocitos grandes de 950 μm y fecundidad promedio de 109 972 ovocitos, cuya ecuación fue F =7271,6 WO0,60, r =0,93, n =14.

ABSTRACT The reproductive biology of the Bocachico, Prochilodus magdalenae, in the San Jorge River, Colombia, was studied. The species is a fish with sexual proportion female: male of 1.2:1, different than expected. It presents synchronous ovocitary development in two groups, an annual spawning that extends from April to September associated to the hydrological cycle of the San Jorge River, length at first maturity estimated in 30.2 cm TL, large oocytes of 950 μm, and average fecundity of 109 972 oocytes, whose equation was F = 7271,6 OW0,60, r = 0,93, n = 14.

Confiabilidade intra e interexaminadores da aplicação da Escala Motora Infantil de Alberta (EMIA) em ambulatório de seguimento de recém-nascidos de risco / Fiabilidad intraevaluadores e interevaluadores de la aplicación de la Escala Motora Infantil de Alberta (EMIA) en un seguimiento ambulatorio de recién nacidos de riesgo / Intra-and inter-examiner reliability of Alberta Infant Motor Scale application in follow-up ambulatory of at-risk newborns

RESUMO A prematuridade é fator de risco para atraso do desenvolvimento motor, e recomenda-se o acompanhamento desses lactentes nos primeiros dois anos de vida. Verificar a confiabilidade intra e interexaminadores da Escala Motora Infantil de Alberta (EMIA) em ambulatório de seguimento de recém-nascidos de risco de uma maternidade pública. Estudo prospectivo realizado em ambulatório de seguimento de recém-nascidos de risco. As avaliações do desenvolvimento motor foram realizadas por meio da EMIA, por dois avaliadores previamente treinados. O Coeficiente de Correlação Intraclasse (CCI) foi utilizado para análise das confiabilidades. Para a comparação entre as avaliações intraexaminadores foi realizado o Teste T pareado ou Teste de Wilcoxon. O Teste T independente foi utilizado para comparar as avaliações interexaminadores. A correlação entre as variáveis foi analisada a partir do Teste de Pearson ou Spearman. Para avaliar a concordância entre os escores foi realizada análise de Bland Altman. Foram avaliados 31 recém-nascidos pré-termo (RNPT) com idade corrigida média de 8,47 ± 4,49. Não houve diferença significativa entre as avaliações intraexaminadores e interexaminadores. Os valores de CCI se mantiveram acima de 0,88 para a confiabilidade intraexaminadores e interexaminadores. Os escores apresentaram alta concordância, analisada por meio do teste de Bland Altman. EMIA apresentou adequada confiabilidade intra e interexaminadores para avaliação e acompanhamento de RNPT até 18 meses em ambulatório de seguimento de lactentes de risco.

RESUMEN La prematuridad es un factor de riesgo de retraso en el desarrollo motor de los lactantes y se recomienda la monitorización de ellos durante los dos primeros años de vida. Verificar la fiabilidad intraevaluadores e interevaluadores de la Escala Motora Infantil de Alberta (EMIA) en un seguimiento ambulatorio de recién nacidos de riesgo en una maternidad pública brasileña. Estudio prospectivo realizado en un seguimiento ambulatorio de recién nacidos de riesgo. Para evaluar el desarrollo motor, la EMIA fue empleada por dos evaluadores previamente capacitados. Se utilizó el coeficiente de correlación intraclase (CCI) para analizar la fiabilidad. Para comparar las evaluaciones intraevaluadores, se utilizó la prueba T pareada o la prueba de Wilcoxon. La prueba T independiente se utilizó para comparar las evaluaciones interevaluadores. La correlación entre las variables se analizó mediante la prueba de Pearson o Spearman. Para evaluar la concordancia entre los puntajes, se aplicó el análisis de Bland Altman. Se evaluaron a 31 recién nacidos pretérmino (RNPT) con un promedio de edad media corregida de 8,47 ± 4,49. No hubo diferencias significativas entre las evaluaciones intraevaluadores e interevaluadores. Los valores de CCI se mantuvieron por encima de 0,88 para la fiabilidad intraevaluadores e interevaluadores. Los puntajes mostraron un alto nivel de concordancia, que se analizó mediante el Bland Altman. La EMIA apuntó una adecuada fiabilidad intra e interevaluadores para evaluar y monitorear los RNPT hasta 18 meses en seguimiento ambulatorio de lactantes de riesgo.

ABSTRACT Prematurity is a risk factor for delayed motor development, and it is recommended to monitor these infants in the first two years of life. To verify the properties of intra and inter-examiner measurements of AIMS in an outpatient follow-up clinic for newborns at risk in a public maternity hospital. Prospective study conducted in an outpatient follow-up of high-risk newborns. The Intraclass Correlation Coefficient (ICC) was used to analyze reliability. To compare the intra-examiner evaluations, the paired T-test or Wilcoxon test was performed. The independent T-test was used to compare inter-examiner assessments. The correlation between variables was analyzed using the Pearson or Spearman test. The Bland Altman test was performed to assess the concordance between the scores. 31 preterm infants with 8,47 ± 4,49 of corrected age were evaluated. There was no significant difference between the evaluations intra and inter-examiner. The ICC values remained above 0.88 for both intra and inter-examiner evaluation. The scores showed high agreement. AIMS has intra- and inter-examiner reliability for assessing and monitoring preterm newborns for up to 18 months in a follow-up clinic.

Uso intraluminal de stent de nitinol dual para colapso completo de tráquea en un canino de raza maltés / Intraluminal use of dual nitinol stent for complete collapse of trachea in a Canine Maltese breed

RESUMEN Paciente canino, de raza maltés, género femenino, castrado, de 4 años y 5 Kg de peso. El motivo principal de consulta fue tos y dificultad respiratoria grave. Durante la evaluación clínica, el paciente presentó cianosis, estridor inspiratorio y espiratorio severo, tos en graznido especialmente después de un estímulo emocional. Se realizó una broncoscopia que reveló una disminución dinámica en el diámetro de la luz traqueal, un colapso severo en las porciones cervicales y torácicas. Debido a la gravedad del colapso traqueal, se decidió la implantación de un stent de nitinol. La elección del stent es fundamental y por tanto fue necesario realizar una medición del diámetro y la longitud de la tráquea para minimizar los efectos secundarios y los rechazos. La tráquea presentó variabilidad del diámetro a nivel torácico, razón por la cual se decidió utilizar un stent dual, el cual se colocó mediante observación directa a través de un broncoscopio pediátrico. Se presenta un caso en el que se usó un stent dual, indicado en casos en que el diámetro de la tráquea varía en su trayecto. Se obtuvieron excelentes resultados ya que se ajustó a los diferentes diámetros que presentó la tráquea en los niveles cervical y torácico.

ABSTRACT Canine patient, Maltese breed, female gender, castrated, 4 years old and 5 Kg of weight. The main reason for consultation was cough and severe respiratory distress. During the clinical evaluation, the patient presented cyanosis, severe inspiratory and expiratory stridor, squawking cough, especially after emotional stimulation. A bronchoscopy was performed that revealed a dynamic decrease in the diameter of the tracheal lumen, a severe collapse in the cervical and thoracic portions. Due to the severity of the tracheal collapse, the implantation of a nitinol stent was decided. The choice of stent is essential and therefore it was necessary to perform a measurement of the diameter and length of the trachea to minimize side effects and rejections. The trachea presented diameter variability at the thoracic level, which is why it was decided to use a dual stent, which was placed by direct observation through a pediatric bronchoscope. We present a case in which a dual stent was used, indicated in cases in which the diameter of the trachea varies along its path. Excellent results were obtained since it was adjusted to the different diameters that the trachea presented at the cervical and thoracic levels.

A Comparative Study of AIMS 65 Score with other Scoring Systems to Predict Outcomes in Patients with Upper GI Bleed in Chronic Liver Disease

Introduction: The AIMS 65 score is a new bedside scoreproposed for the assessment of liver function which issimple and more independent. Different scores have beenrecommended to predict outcomes in the setting of uppergastrointestinal bleeding (UGIB), limited comparative studieshave been published between simplified versions of olderscores and recent scores. In this present study, we aimed toretrospectively compare the performance of AIMS 65 scorewith Child-Pugh score, MELD score and ALBI score forpredicting the outcome in patients with upper GI bleed inchronic liver disease.Material and Methods: Data of patients with chronic Liverdisease secondary to ethanol were retrospectively reviewed.Child Pugh score, MELD score, ALBI score and AIMS 65score were calculated for the patients and results . ROC curvesderived from comparison with outcome and were analysed.Results: In our study conducted on 112 patients, the agedistribution was between 20-85 years with mean age ofpatients being 46.47 ± 10.9 years, sex ratio Male: Female:105:7 with mortality rate of 33.92%. The Area under curves ofROC of AIMS65, Child Pugh score, MELD score, ALBI scorewas 0.779, 0.864, 0.763 and 0.777 respectively.Conclusion: AIMS 65 is a simple and non-endoscopic scorefor the prediction of in hospital mortality. No statisticaldifference was observed between AIMS-65 and other scoressuch as Child Pugh score, ALBI and MELD score.

Comparison of prediction of outcomes in upper GI bleed using non-endoscopic scoring systems

Background: Several scoring systems have been designed for risk stratification and prediction of outcomes in upper GI bleed. Endoscopy plays a major role in the diagnostic and therapeutic management of UGIB patients. However not all patients with UGIB need endoscopy. The objective of the present study was compared the prediction of mortality using different scoring systems in patients with upper GI bleed. A decision tool with a high sensitivity would be able to identify high and low risk patients and for judicious utilization of available resources.Methods: 100 patients were assessed with respect to their clinical parameters, organ dysfunction, pertinent laboratory parameters and five risk assessment scores i.e. clinical Rockall, Glasgow Blatchford, ALBI, PALBI and AIMS65 were calculated.Results: For prediction of outcomes, AIMS65 was superior to the others (AUROC of 0.889), followed by the GBS (AUROC of 0.869), followed by clinical Rockall score (AUROC 0.815), followed by ALBI score (AUROC of 0.765), followed by PALBI score (AUROC of 0.714) all values being statistically significant.Conclusions: The AIMS65 score is best in predicting the mortality in patients with upper GI bleed. The optimum cut off being >2. Though GBS may be better in predicting the need for intervention, it is inferior in predicting the mortality. The newer scores like ALBI and PALBI are inferior to AIMS65 and GBS in predicting mortality.

Effects of scalp acupuncture on brain injury in premature infants with different months of age / 中国针灸

<p><b>OBJECTIVE</b>To explore the clinical efficacy differences of scalp acupuncture on brain injury in premature infants with different months of age.</p><p><b>METHODS</b>According to the corrected months of age, 90 cases of premature infants with brain injury were divided into a group A (3 through 6 corrected months of age), a group B (7 through 9 corrected months of age) and group C (10 through 12 corrected months of age), 30 patients in each one. Based on the conventional early intervention, the infants in the group A were treated with scalp acupuncture at , motor area; the infants in the group B were treated with scalp acupuncture at , motor area and foot motor sensory area; the infants in the group C were treated with scalp acupuncture at , motor area, foot motor sensory area and balance area. All the treatment was given once every other day, and totally 30 treatments were given. The Alberta infant motor scale (AIMS), development quotient (DQ) of each function indexes in Gesell developmental scale (GDS) were observed before and after treatment; the clinical efficacy of each group was compared and the correlation between clinical efficacy and months of age was analyzed.</p><p><b>RESULTS</b>Compared before treatment, the total score of AIMS and DQ of each function indexes of GDS were all improved in the three groups after treatment (all <0.01). After treatment, the differences of total score of AIMS and DQ of each function indexes of GDS among the three groups were significant (<0.05, <0.01), and the results in the group A were higher than those in the group B and the group C (<0.05, <0.01). The total effective rate was 96.3% (26/27) in the group A, which was higher than 89.7% (26/29) in the group B and 83.3% (25/30) in the group C. The correlation analysis indicated less months of age was significantly corelated with better efficacy (<0.05).</p><p><b>CONCLUSION</b>Scalp acupuncture has superior improvement on the recovery of brain damage in premature infants, especially for those with 6 months of age or less.</p>

Reproductive biology of Liseta Leporinus muyscorum Steindachner, 1901 in the Sinu River, Colombia / Biología reproductiva de Liseta Leporinus muyscorum Steindachner, 1901 en el río Sinú, Colombia

ABSTRACT Objective. The reproductive biology of Liseta Leporinus muyscorum (Steindachner, 1901) in the Sinu river, Colombia, was studied. Materials and methods. Individuals were collected between March 2006 and February 2007, with lengths and weights ranging 20.5-41.0 (30.0 ± 3.7) cm of total length and 97.6-728.0 (320.9±117.9) g, respectively. The gonads were placed in Gilson solution, the Vazzoler scale was applicated and sexual proportion, sexual maturity index, spawning season, the length at first maturity, ovocites's diameter and fecundity were estimated. Results. 344 individuals were collected, of which 249 were females and 95 were males, with sexual proportion female: male of 2.6:1, different from expected. The length at first maturity was estimated in 28.9, 28.1 y 28.8 cm TL for females, males and combined sexes, respectively, ovocites's diameter was 977 µ and fecundity was estimated in 30793 oocytes. Conclusions. The Liseta is a fish with synchronous oocyte development in two groups, whose spawning season extends from February to September, with large oocytes and high fecundity, strongly associated with ovarian weight.

RESUMEN Objetivo . Se estudió la biología reproductiva de la Liseta Leporinus muyscorum (Steindachner, 1901) en el río Sinú, Colombia. Materiales y métodos. Los individuos fueron colectados entre marzo 2006 y febrero 2007, con tallas y pesos entre 20.5-41.0 (30.0±3.7) cm de longitud total y 97.6-728.0 (320.9±117.9) g, respectivamente. Las gónadas se conservaron en solución Gilson, se utilizó la escala de Vazzoler y se estimaron proporción sexual, índices de madurez sexual, época de desove, talla media de madurez sexual, diámetro de ovocitos y fecundidad. Resultados. Se colectaron 344 individuos, de los cuales 249 fueron hembras y 95 machos, con proporción sexual hembra: macho de 2.6:1, diferente a lo esperado. La talla media de madurez fue estimada en 28.9, 28.1 y 28.8 cm LT para hembras, machos y sexos combinados, respectivamente, el diámetro de los ovocitos fue 977 µ y la fecundidad promedio fue estimada en 30793 ovocitos. Conclusiones. La Liseta es un pez con desarrollo ovocitario sincrónico en dos grupos, cuya época o período de reproducción se extiende de febrero a septiembre, con ovocitos grandes y alta fecundidad, fuertemente asociada al peso de los ovarios.

Efficacy Observation of Fire Filiform-needle Therapy in Treating Elderly Knee Osteoarthritis / 上海针灸杂志

Objective To observe the efficacy of fire filiform-needle therapy in treating knee osteoarthritis (KOA) in the elderly.Method Eighty-one elderly KOA patients were randomized into a treatment group of 42 cases and a control group of 39 cases following registration order. The treatment group was intervened by fire filiform-needle therapy, while the control group was treated with ordinary acupuncture. The two groups were treated once every other day, 15 sessions as a treatment course. The Lysholm knee score and short-form Arthritis Impact Measurement Scales 2 (AIMS2-SF) were adopted to observe the activities of daily living and quality of life before and after the treatment, and the clinical efficacies of the two groups were compared.Result The total effective rate was 92.9％ in the treatment group, versus 82.1％ in the control group, and the total effective rate in the treatment group was significantly superior to the control group (P<0.05). Except for the squatting item of the Lysholm knee score in the control group, the Lysholm knee score and AIMS2-SF score were significantly changed after the treatment in both groups (P<0.05,P<0.01); except for the support item of the Lysholm knee score, the treatment group was superior to the control group in comparing the Lysholm knee score and AIMS2-SF score after the treatment (P<0.01).Conclusion Fire filiform- needle therapy can significantly enhance the activities of daily living and quality of life in elderly KOA patients.

Efficacy Observation of Fire Filiform-needle Therapy in Treating Elderly Knee Osteoarthritis / 上海针灸杂志

Objective To observe the efficacy of fire filiform-needle therapy in treating knee osteoarthritis (KOA) in the elderly.Method Eighty-one elderly KOA patients were randomized into a treatment group of 42 cases and a control group of 39 cases following registration order. The treatment group was intervened by fire filiform-needle therapy, while the control group was treated with ordinary acupuncture. The two groups were treated once every other day, 15 sessions as a treatment course. The Lysholm knee score and short-form Arthritis Impact Measurement Scales 2 (AIMS2-SF) were adopted to observe the activities of daily living and quality of life before and after the treatment, and the clinical efficacies of the two groups were compared.Result The total effective rate was 92.9％ in the treatment group, versus 82.1％ in the control group, and the total effective rate in the treatment group was significantly superior to the control group (P<0.05). Except for the squatting item of the Lysholm knee score in the control group, the Lysholm knee score and AIMS2-SF score were significantly changed after the treatment in both groups (P<0.05,P<0.01); except for the support item of the Lysholm knee score, the treatment group was superior to the control group in comparing the Lysholm knee score and AIMS2-SF score after the treatment (P<0.01).Conclusion Fire filiform- needle therapy can significantly enhance the activities of daily living and quality of life in elderly KOA patients.

The values of Rockall, Blatchford and AIMS65 scoring systems in the diagnosis and treatment of patients with acute upper gastrointestinal bleeding / 天津医药

prognosis of patients with acute upper gastrointestinal bleeding (AUGIB). Methods A total of 130 patients with AUGIB in our hospital were enrolled in this study from August 2014 to August 2016 . Three kinds of scoring systems including Rockall, Blatchford and AIMS65 were used to evaluate the risk classification of the patients. Patients were followed up for 2 months. The incidence rates of re-bleeding and death within 2 months after admission were observed. Data of prognosis in patients with AUGIB were compared between the three scoring systems in the prognosis of patients with AUGIB, including the risk classification and the prediction accuracy of re-bleeding and death. Results There were no significant differences in the re-bleeding rate and fatality rate between the groups divided by Rockall and Blatchford scoring systems ( P>0.05). According to the grouping results of AIMS65 scoring system, the re-bleeding rate of low-risk group was lower than that in high risk group (1.45%vs. 13.11%, P=0.01), but there was no significant difference in fatality rate between the two groups (P>0.05). The values of area under the curve (AUC) of predicting re-bleeding rates by using Rockall, Blatchford and AIMS65 scoring systems were 0.6258, 0.6910, and 0.7241, and the values of AUC of predicting fatality rates were 0.7031, 0.7969, and 0.7031 by using receiver operating characteristic curve (ROC) analysis. There were no significant differences between them (P>0.05). The values of AUC of predicting re-bleeding rates by using the risk grading calculation by Rockall, Blatchford and AIMS65 scoring systems were 0.6189, 0.6139 and 0.7254 (P>0.05). But the values of AUC of predicting fatality rates were 0.6211, 0.6641 and 0.7695 (P<0.01). Conclusion The operation method of AIMS65 scoring system is simple and convenient, which is applicable to a wide range of patients with AUGIB. In the prediction of re-bleeding and mortality, AIMS65 scoring system has high accuracy and stability, which is worthy of promoting in clinical application.

Lactate Parameters Predict Clinical Outcomes in Patients with Nonvariceal Upper Gastrointestinal Bleeding

The predictive role of lactate in patients with nonvariceal upper gastrointestinal bleeding (NVUGIB) has been suggested. This study evaluated several lactate parameters in terms of predicting outcomes of bleeding patients and sought to establish a new scoring model by combining lactate parameters and the AIMS65 score. A total of 114 patients with NVUGIB who underwent serum lactate level testing at least twice and endoscopic hemostasis within 24 hours after admission were retrospectively analyzed. The associations between five lactate parameters and clinical outcomes were evaluated and the predictive power of lactate parameter combined AIMS65s (L-AIMS65s) and AIMS56 scoring was compared. The most common cause of bleeding was gastric ulcer (48.2%). Lactate clearance rate (LCR) was associated with 30-day rebleeding (odds ratio [OR], 0.931; 95% confidence interval [CI], 0.872–0.994; P = 0.033). Initial lactate (OR, 1.313; 95% CI, 1.050–1.643; P = 0.017), maximal lactate (OR, 1.277; 95% CI, 1.037–1.573; P = 0.021), and average lactate (OR, 1.535; 95% CI, 1.137–2.072; P = 0.005) levels were associated with 30-day mortality. Initial lactate (OR, 1.213; 95% CI, 1.027–1.432; P = 0.023), maximal lactate (OR, 1.271; 95% CI, 1.074–1.504; P = 0.005), and average lactate (OR, 1.501; 95% CI, 1.150–1.959; P = 0.003) levels were associated with admission over 7 days. Although L-AIMS65s showed the highest area under the curve for prediction of each outcome, differences between L-AIMS65s and AIMS65 did not reach statistical significance. In conclusion, lactate parameters have a prognostic role in patients with NVUGIB. However, they do not increase the predictive power of AIMS65 when combined.

Comparison of AIMS65 Score and Other Scoring Systems for Predicting Clinical Outcomes in Koreans with Nonvariceal Upper Gastrointestinal Bleeding

BACKGROUND/AIMS: The AIMS65 score has not been sufficiently validated in Korea. The objective of this study was to compare the AIMS65 and other scoring systems for the prediction of various clinical outcomes in Korean patients with acute nonvariceal upper gastrointestinal bleeding (NVUGIB). METHODS: The AIMS65 score, clinical and full Rockall scores (cRS and fRS) and Glasgow-Blatchford (GBS) score were calculated in patients with NVUGIB in a single center retrospectively. The performance of these scores for predicting mortality, rebleeding, transfusion requirement, and endoscopic intervention was assessed by calculating the area under the receiver-operating characteristic curve. RESULTS: Of the 523 patients, 3.4% died within 30 days, 2.5% experienced rebleeding, 40.0% required endoscopic intervention, and 75.7% needed transfusion. The AIMS65 score was useful for predicting the 30-day mortality, the need for endoscopic intervention and for transfusion. The fRS was superior to the AIMS65, GBS, and cRS for predicting endoscopic intervention and the GBS was superior to the AIMS65, fRS, and cRS for predicting the transfusion requirement. CONCLUSIONS: The AIMS65 score was useful for predicting the 30-day mortality, transfusion requirement, and endoscopic intervention in Korean patients with acute NVUGIB. However, it was inferior to the GBS and fRS for predicting the transfusion requirement and endoscopic intervention, respectively.

Las múltiples caras del suicidio en la clínica psicológica / The many faces of suicide in the psychological clinic

El objetivo de este artículo es mostrar las diferentes formas clínicas en que se manifiestan las conductas suicidas, ponerlas en conexión con los diferentes trastornos mentales, mostrar los signos de alarma y discutir las posibles decisiones clínicas que se le ofrecen al terapeuta. La demanda terapéutica en relación con el suicidio está constituida por tres tipos de pacientes: a) aquellos que han sobrevivido a un intento de suicidio; b) los que acuden a la consulta manifestando ideación suicida; y c) los que tienen ideación suicida pero aún no la han expresado verbalmente. La alianza terapéutica empática con el paciente y la colaboración con la familia desempeñan un papel muy importante. Se señalan los objetivos terapéuticos en las diversas circunstancias y la necesidad de centrarse en el cambio de los factores modificables para contrarrestar el peso de los no modificables. Se indican algunas sugerencias para la investigación futura.

The aim of this paper is to show the different clinical forms in which suicidal behaviors manifest, put them in connection with various mental disorders, display warning signs, analyze risk and protective factors and discuss the possible clinical decisions that therapist can take. Relevant information about factors associated with completed and attempted suicide is discussed. Therapeutic demand regarding suicidal behaviors includes three types of patients: a) patients who have survived a suicide attempt; b) patients who seek treatment because of persistent thoughts of suicide; and c) patients with suicidal ideation but without having expressed it to anyone. The empathic therapeutic alliance with the patient and collaboration with family play a very important role. Therapeutic goals according to problems frequently encountered in the clinic, as well as the need to focus on changing modifiable factors to counteract the weight of non-modifiable factors, are commented. Suggestions for future research are outlined.

Clinical Application of AIMS65 Scores to Predict Outcomes in Patients with Upper Gastrointestinal Hemorrhage

BACKGROUND/AIMS: To evaluate the ability of the recently proposed albumin, international normalized ratio (INR), mental status, systolic blood pressure, age >65 years (AIMS65) score to predict mortality in patients with acute upper gastrointestinal bleeding (UGIB). METHODS: AIMS65 scores were calculated in 251 consecutive patients presenting with acute UGIB by allotting 1 point each for albumin level 1.5, alteration in mental status, systolic blood pressure or =65 years. Risk stratification was done during the initial 12 hours of hospital admission. RESULTS: Intensive care unit (ICU) admission, endoscopic therapy, or surgery were required in 51 patients (20.3%), 64 (25.5%), and 12 (4.8%), respectively. The predictive accuracy of AIMS65 scores > or =2 was high for blood transfusion (area under the receiver operator characteristic curve [AUROC], 0.59), ICU admission (AUROC, 0.61), and mortality (AUROC, 0.74). The overall mortality was 10.3% (n=26), and was 3%, 7.8%, 20%, 36%, and 40% for AIMS65 scores of 0, 1, 2, 3, and 4, respectively; these values were significantly higher in those with scores > or =2 (30.9%) than in those with scores or =2 predict high in-hospital mortality.

Motor development of Brazilian breastfeeding infants in socially unfavorable condition of life

The early years of life are of essential importance for child development and growth. The child's development in a social vulnerability and unfavorable life condition can be injured, and that early detection of disorders is fundamental for healthy development. PURPOSE: To assessment the Alberta Infant Motor Scale as an assessment tool to identify early of disorders in infants until 18 months. METHODS: This is an observational, cross-sectional study undertaken in "educational program for the growth and development promotion" at the health unit administered by reference hospital of Health Public System, in Paraisópolis community, São Paulo. The sample (n=71) was composed for infants less than 18 months of age, eutrophic, low biological risk at birth; singleton, full-term births, weight at birth between 2,000g e" and d" 4,500g and no associated congenital neurological, cardiac or orthopedic pathologies at the clinical exam. RESULTS: This study presented the greatest prevalence of delay motor neuromotor when compared with the AIMS reference population. First, 8.5% of the breastfeeding infants are classified as being mdA and 7.0% are classified as dmS and secondly that, although the category mdT contains 84.5% of the children, the median of the z-score has shifted from the central point of the normal standardized distribution, only 33.7% of the children, i.e., 24 in 71, being equal to or above Z=0 (p<0.05). CONCLUSION: The use of AIMS was efficient, practice, low cost and quick applies. Plus a quick view of motor milestone presents by infant. Features that became possible take decision by health team...

Os primeiros anos de vida são de importância essencial para o desenvolvimento infantil. O desenvolvimento neurosensoriomotor de crianças, vivendo em condição de pobreza, pode ser prejudicado, sendo a detecção precoce de anormalidades essencial para um desenvolvimento saudável. OBJETIVO: Avaliar o uso da AIMS como instrumento de avaliação para detecção precoce de anormalidades. MÉTODO: Trata-se de um estudo descritivo, do tipo transversal, realizado com lactentes brasileiros matriculados no "Programa educativo de promoção do crescimento e desenvolvimento", do ambulatório de uma unidade de saúde gerenciada por um Hospital de referência do Sistema Público de Saúde, na Comunidade de Paraisópolis, São Paulo. A amostra (n = 71) foi composta por lactentes menores de 18 meses, eutróficos, de baixo risco biológico ao nascimento, nascidos de parto único, termo, peso ao nascer entre 2.000g e 4.500g, sem associação com patologias congênitas neurológicas, cardíacas ou ortopédicas no exame clinico. RESULTADOS: Este estudo apresenta prevalência de atraso motor quando comparado com a população de referencia da AIMS. Primeiro, 8,5% dos lactentes foram classificados como mdA e 7% como dmS, além da categoria mdT conter 84,5% dos lactentes, a media do escore Z tem modificado o ponto central da distribuição padronizada, apenas 33,7% do grupo, isto e, 24 em 71, estão igual ou acima do Z = 0 (p < 0.05). CONCLUSÃO: A utilização da AIMS neste estudo foi eficiente na avaliação do desenvolvimento motor, prática, de baixo custo e rápida aplicação. Forneceu rápida visualização da posição do lactente. Característica que permite tomada de decisões oportunas pelos profissionais que integram as equipes de saúde...