Clinicopathologic characteristics of liver inflammation and fibrosis in 310 patients with chronic hepatitis B / 中南大学学报(医学版)

OBJECTIVES@#Long-term hepatitis B virus (HBV) infection can cause recurrent inflammation in the liver, and then develop into liver fibrosis, cirrhosis, and liver cancer. The hepatic pathological change is one of the important criteria for guiding antiviral therapy in patients with chronic hepatitis B (CHB). Due to the limitations of liver biopsy, it is necessary to find valuable non-invasive indicators to evaluate the hepatic pathological changes in CHB patients and guide the antiviral therapy. This study aims to analyze the clinical characteristics of different pathological changes in CHB patients, and to explore the factors influnencing the degree of liver inflammation and fibrosis in CHB patients with normal alanine aminotransferase (ALT).@*METHODS@#This retrospective study was conducted on 310 CHB patients. Liver biopsy was performed in all these patients. The clinical data of the patients were collected. The liver biopsy pathological results were used as the gold standard to analyze the relationship between clinical indicators and liver pathological changes. Then CHB patients with normal ALT were screened, and the independent factors influencing the degree of liver inflammation and fibrosis were explored.@*RESULTS@#Among the 310 patients with CHB, there were 249 (80.3%) patients with significant liver inflammation [liver inflammation grade (G) ≥2] and 119 (38.4%) patients with significant liver fibrosis [liver fibrosis stage (S) ≥2]. The results of univariate analysis of total samples showed that the ALT, γ-glutamyl transferase, alkaline phosphatase, and HBV DNA were related to the significant liver pathological changes. Among the 132 CHB patients with normal ALT, the patients with liver pathology G/S≥2, G≥2, and S≥2 were 80.3% (106/132), 68.2% (90/132), and 43.2% (57/132), respectively. The results showed that the independent influencing factor of significant liver inflammation was HBV DNA>2 000 U/mL (OR=3.592, 95% CI 1.534 to 8.409), and the independent influencing factors of significant liver fibrosis were elevated alkaline phosphatase level (OR=1.022, 95% CI 1.002 to 1.043), decreased platelet count (OR=0.990, 95% CI 0.982 to 0.998), and positive in hepatitis B e antigen (HBeAg) (OR=14.845, 95% CI 4.898 to 44.995). According to the multivariate analysis, a diagnostic model for significant liver fibrosis in CHB patients with normal ALT was established, and the area under the receiver operating characteristic curve was 0.844 (95% CI 0.779 to 0.910).@*CONCLUSIONS@#The liver pathological changes should be evaluated in combination with different clinical indicators. A considerable number of CHB patients with normal ALT still have significant liver pathological changes, which need to be identified and treated with antiviral therapy in time. Among them, HBV DNA>2 000 U/mL suggests the significant liver inflammation, and the diagnostic model for significant liver fibrosis based on alkaline phosphatase, platelet count, and HBeAg can help to evaluate the degree of liver fibrosis.

Correlations of Characteristics of Kidney Yang Deficiency Syndrome with Clinical Indicators and Risk Factors of Chronic Kidney Disease / 中国实验方剂学杂志

ObjectiveTo study the correlations of the characteristics of kidney Yang deficiency syndrome in patients with chronic kidney disease （CKD） with clinical indicators and to explore the risk factors of kidney Yang deficiency in CKD. MethodThe differentiation of traditional Chinese medicine （TCM） syndrome classified the 225 CKD patients who met the inclusion criteria into two groups： one group of kidney Yang deficiency syndrome （99 patients） and one group of non-kidney Yang deficiency syndrome （126 patients）. The symptoms， tongue manifestation， pulse manifestation， and accompanied symptoms of the kidney Yang deficiency syndrome group were recorded. The syndrome characteristics were summarized by factor analysis and clustering analysis. The levels of hemoglobin, red blood cell count, urinary protein, urinary glucose, creatinine, urea nitrogen and glomerular filtration rate were compared between the kidney Yang deficiency syndrome group, the non-kidney Yang deficiency syndrome group and the normal control group by ANOVA and non-parametric test. The binary logistic regression model was employed to analyze the correlations of lifestyle， body mass index （BMI） with syndrome. ResultThe high-frequency symptoms of CKD patients with kidney Yang deficiency syndrome were waist pain， fear of cold， favor of warm， lethargy， fear of cold at waist and knees， etc. The patients mainly presented deep pulse， thready pulse， or weak pulse， and the tongue with white coating， greasy coating， or thin coating. A total of 13 common factors were obtained， which can be classified into 5 categories. The patients with kidney Yang deficiency syndrome mainly had symptoms in limbs （especially lower limbs）， chest， bladder， fleshy exterior， and stomach， with the main manifestations of deficiency-cold， Qi deficiency， fluid retention， and blood stasis. The clustering analysis classified the patients into 11 categories， which reflected that kidney Yang deficiency syndrome mainly presented the symptoms of Qi deficiency， blood stasis， and fluid retention， with fleshy exterior， limbs， spleen， stomach， ears， mind， and bladder involved. The results of clustering analysis and factor analysis were consistent， both of which indicated that the patients were weak with deficiency-cold， accompanied by fluid retention and blood stasis. Frequency analysis also showed that common symptoms mainly included Qi deficiency， fluid retention， cold-dampness， and blood stasis. Compared with the non-kidney Yang deficiency group， the kidney Yang deficiency group showed a large proportion of patients in stage 3-5 CKD， elevated urea nitrogen （P<0.05）， decreased glomerular filtration rate， hemoglobin， and red blood cell count （P<0.05）， and increased qualitative grade of urine protein. In addition， the results of regression analysis showed that female， little or no exercise， and diet preference were the risk factors for kidney Yang deficiency syndrome in CKD （P<0.05）. ConclusionThe disease location and manifestations have correspondence in the CKD patients with kidney Yang deficiency syndrome. The TCM symptoms are correlated with clinical indicators. Hemoglobin， red blood cell count， glomerular filtration rate， urea nitrogen， and urine protein can reflect the connotation of kidney Yang deficiency syndrome in CKD to a certain extent. Additionally， related risk factors in life can affect the occurrence of kidney Yang deficiency syndrome in CKD.

Correlations of Characteristics of Kidney Yang Deficiency Syndrome with Clinical Indicators and Risk Factors of Chronic Kidney Disease / 中国实验方剂学杂志

ObjectiveTo study the correlations of the characteristics of kidney Yang deficiency syndrome in patients with chronic kidney disease （CKD） with clinical indicators and to explore the risk factors of kidney Yang deficiency in CKD. MethodThe differentiation of traditional Chinese medicine （TCM） syndrome classified the 225 CKD patients who met the inclusion criteria into two groups： one group of kidney Yang deficiency syndrome （99 patients） and one group of non-kidney Yang deficiency syndrome （126 patients）. The symptoms， tongue manifestation， pulse manifestation， and accompanied symptoms of the kidney Yang deficiency syndrome group were recorded. The syndrome characteristics were summarized by factor analysis and clustering analysis. The levels of hemoglobin, red blood cell count, urinary protein, urinary glucose, creatinine, urea nitrogen and glomerular filtration rate were compared between the kidney Yang deficiency syndrome group, the non-kidney Yang deficiency syndrome group and the normal control group by ANOVA and non-parametric test. The binary logistic regression model was employed to analyze the correlations of lifestyle， body mass index （BMI） with syndrome. ResultThe high-frequency symptoms of CKD patients with kidney Yang deficiency syndrome were waist pain， fear of cold， favor of warm， lethargy， fear of cold at waist and knees， etc. The patients mainly presented deep pulse， thready pulse， or weak pulse， and the tongue with white coating， greasy coating， or thin coating. A total of 13 common factors were obtained， which can be classified into 5 categories. The patients with kidney Yang deficiency syndrome mainly had symptoms in limbs （especially lower limbs）， chest， bladder， fleshy exterior， and stomach， with the main manifestations of deficiency-cold， Qi deficiency， fluid retention， and blood stasis. The clustering analysis classified the patients into 11 categories， which reflected that kidney Yang deficiency syndrome mainly presented the symptoms of Qi deficiency， blood stasis， and fluid retention， with fleshy exterior， limbs， spleen， stomach， ears， mind， and bladder involved. The results of clustering analysis and factor analysis were consistent， both of which indicated that the patients were weak with deficiency-cold， accompanied by fluid retention and blood stasis. Frequency analysis also showed that common symptoms mainly included Qi deficiency， fluid retention， cold-dampness， and blood stasis. Compared with the non-kidney Yang deficiency group， the kidney Yang deficiency group showed a large proportion of patients in stage 3-5 CKD， elevated urea nitrogen （P<0.05）， decreased glomerular filtration rate， hemoglobin， and red blood cell count （P<0.05）， and increased qualitative grade of urine protein. In addition， the results of regression analysis showed that female， little or no exercise， and diet preference were the risk factors for kidney Yang deficiency syndrome in CKD （P<0.05）. ConclusionThe disease location and manifestations have correspondence in the CKD patients with kidney Yang deficiency syndrome. The TCM symptoms are correlated with clinical indicators. Hemoglobin， red blood cell count， glomerular filtration rate， urea nitrogen， and urine protein can reflect the connotation of kidney Yang deficiency syndrome in CKD to a certain extent. Additionally， related risk factors in life can affect the occurrence of kidney Yang deficiency syndrome in CKD.

Contenidos Mínimos de Cariología e indicadores de aplicación clínica en el Currículo de Pregrado para las Escuelas Dentales Chilenas / Minimum Contents of Cariology and Indicators of Clinical Application in the Undergraduate Curriculum for Chilean Dental Schools

RESUMEN Objetivo: El objetivo fue definir los contenidos mínimos y sus indicadores de aplicación clínica en el currículo de cariología para las escuelas de odontología chilenas. Metodología: Basados en los 5 dominios curriculares internacionales, se elaboró un documento que define los contenidos e indicadores de aplicación clínica para la enseñanza de cariología en Chile. Posteriormente, profesores de cariología de 20 de 21 escuelas de odontología chilenas (95%), sesionaron para revisar, retroalimentar y elaborar el documento final, denominado "Listado de contenidos mínimos e indicadores de aplicación clínica" en cariología para estudiantes de pregrado de odontología en Chile. Resultados: Se definieron 23 contenidos y 31 indicadores de aplicación clínica para la enseñanza de la cariología. La cantidad de contenidos e indicadores separados por dominio fueron respectivamente: conocimiento de base: 5 y 7; riesgo/detección y diagnóstico: 6 y 6; toma de decisiones/manejo preventivo no operatorio: 5 y 5; decisión de tratamiento operatorio: 4 y 9 y cariología basada en la evidencia: 3 y 4. Conclusiones: Se definieron los contenidos mínimos que tributan a cada dominio y sus indicadores de aplicación clínica para la enseñanza de la cariología en Chile.

ABSTRACT: The objective: was to define the minimum contents and their indicators of clinical application in the cariology curriculum for the Chilean Dental Schools. Methodology: Based on the 5 international curricular domains, a document defining the contents and indicators of clinical application for the teaching of cariology in Chile was elaborated. Later, cariology professors from 20 out of the 21 Chilean Dentistry Schools (95%) met to review, feedback and elaborate the final document, called "List of minimum contents and indicators of clinical application" in cariology for undergraduate dentistry students in Chile. Results: Twenty-three contents and 31 indicators of clinical application for the teaching of cariology were agreed upon. The amount of contents and indicators separated by domain respectively were: basic knowledge: 5 and 7; risk/detection and diagnosis: 6 and 6; decision making/non-operative preventive management: 5 and 5; decision of operative treatment: 4 and 9 and evidence-based cariology: 3 and 4. Conclusions: The minimum contents for each domain and its clinical application indicators for the teaching of cariology in Chile were defined.

Risk factors of a high demand for perioperative blood transfusion in patients with esophageal and cardiac cancer / 中国基层医药

Objective:To analyze the risk factors of a high demand for perioperative blood transfusion in patients with esophageal and cardiac cancer and to accumulate more evidence-based medicine findings for timely and effective clinical intervention to reduce the volume of blood transfused.Methods:The clinical data of 154 patients with esophageal and cardiac cancer who received treatment from January 2012 to October 2018 in Yuncheng Central Hospital were retrospectively analyzed. Among them, 100 patients who received < 5 U blood transfusion were included in the control group, and 54 patients who received ≥ 5 U blood transfusion were included in the observation group. The causes of a high demand for blood transfusion, the possible influential factors, and their effects on related clinical indicators post-surgery were analyzed.Results:The proportion of patients with underlying diseases, the proportion of patients with anemia pre-surgery, and the amount of blood loss in the observation group were 85.19% (46/54), 48.15% (26/54) and (1 127.92 ± 350.70) mL respectively, which were significantly higher than those in the control group [37.00% (37/100), 21.00% (21/100) and (296.47 ± 98.31) mL, χ2 = 6.17, 7.40, t = 7.54, P < 0.01, P = 0.03, P < 0.01]. The incidence of postoperative complications in the observation group was significantly higher than that in the control group [62.96% (34/54) vs. 33.00% (33/100), χ2 = 9.16, P = 0.00]. There were no significant differences in hospital and intensive care unit lengths of stay between the two groups (both P > 0.05). Platelet count after blood transfusion in the observation group was (190.47 ± 73.48) × 10 12/L, which was significantly higher than (159.00 ± 65.17) × 10 12/L in the control group and (234.31 ± 92.07) × 10 12/L before blood transfusion in the observation group ( t = 4.26, 5.33, both P < 0.01). There were no significant differences in prothrombin time and activated partial thromboplastin time between the two groups (both P > 0.05). In the observation group, the international normalized ratio after blood transfusion was significantly higher than that before blood transfusion [(1.06 ± 0.15) vs. (0.94 ± 0.12), t = 2.78, P = 0.03]. In the observation group, serum K + level after blood transfusion was significantly lower than that before blood transfusion [(3.97 ± 0.42) mmol/L vs. (4.21 ± 0.37) mmol/L, t = 4.01, P < 0.01]. There was no significant difference in serum Ca 2+ level after blood transfusion between the two groups ( P > 0.05). Conclusion:Underlying diseases and anemia are the risk factors for a high demand for blood transfusion in patients with esophageal and cardiac cancer. A high demand for blood transfusion is mainly caused by postoperative bleeding. At the same time, blood transfusion can also increase the risks for abnormal coagulation function, abnormal serum ion levels, and complications post-surgery.

Differences in clinical characteristics and laboratory parameters of primary and recurrent pterygium / 国际眼科杂志(Guoji Yanke Zazhi)

@#Pterygium is a common conjunctival disease which is mainly attributed to chronic ultraviolet light exposure. Previous studies have focused primarily on the clinical characteristics, surgical management and the pathogenesis of pterygium, but the differences between primary pterygium and recurrent pterygium have been less frequently documented. This article reviews the differences in clinical manifestations, histopathological findings, and laboratory parameters between primary pterygium and recurrent pterygium and summarises the latest findings regarding these differences.

Quality improvement in anaesthesiology

In recent times, numerous efforts have been made in the field of medicine to improve the methodology of measuring and reporting the quality of care delivered to patients. Most of these efforts have been executed in the western population, because of an efficient system of Incident Reporting. Quality Measurement in healthcare typically means quantifying processes of care that have a direct relationship to positive health outcomes. Quality in anaesthesia is usually measured by perioperative mortality, morbidity and Incidents. Quality measurement is not only important for the clientele but also for the employer, to make choices and healthcare provider to introspect his performance. It is an effective method of giving feedback to anaesthesiologists, doctors and paramedical staff to address quality issues and bring about improvement. Without Quality Measurement, improvement in quality, if at all, would be expected to be very slow and clientele would be blindfolded in taking important decisions pertaining to health care. The concepts of quality assurance and quality control are rapidly gaining popularity in surgical sciences as the society is heading towards social, technical and clinical advancements globally. In times to come, quality of anaesthesia services will be closely monitored by quality indicators and will become a benchmark for assessment of the healthcare provider and the hospital. At present, the need of the hour is to devise ways and means to measure the quality of care being provided by the healthcare provider and adopt these evolutionary practices aimed at improving anaesthesia delivery services in a medical setup.

A study on the clinical indicators in the diagnosis of orofacial nonodontogenic tumors

Objective: This study aims to determine the clinical features which are helpful as significant indicators in the diagnosis of malignant and nonmalignant nonodontogenic orofacial tumors. Materials and Methods: This was a prospective study performed on patients with swellings in the oral and maxillofacial region clinically suspicious of being tumors of nonodontogenic origin in a Nigerian Tertiary Health Institution. The statistical variables that were analyzed included patients' resume, clinical and radiological features as well as the histopathological diagnosis of the lesions. The level of significance was set at P < 0.05. Inferential analysis was done using Student's t-test, Chi-square, binary logistic regression, and adjusted odds ratio as appropriate. Results: There were forty patients histopathologically diagnosed as nonodontogenic tumors of the orofacial region. Twenty-five (62.5%) were females and 15 (37.5%) were males with mean age of 36 ± 21.9 years. Histopathological features showed three different categories of the lesions: Reactive and benign (nonmalignant) and the malignant lesions. Lymphadenopathy (P = 0.035) and nonmobility of the swellings (P = 0.029) were significant clinical indicators that were strongly associated with histological diagnosis of the malignant nonodontogenic tumors. Conclusion: This study showed that the nonodontogenic tumors occurred mostly in younger patients with a female preponderance. The mandible and the preauricular region were the most common sites. Lymphadenopathy and nonmobility of the swellings were strong clinical indicators for the diagnosis of the malignant nonodontogenic tumors

Irdi: um instrumento que leva a psicanálise à polis / Irdi: an instrument that takes the psychoanalysis to the polis / Irdi: un instrumento que lleva el psicoanálisis a la polis

Este artigo relata a história da proposta e da validação do instrumento Indicadores de Risco para Desenvolvimento Infantil (IRDI), composto de 31 indicadores clínicos de referência para o acompanhamento de problemas ou entraves no desenvolvimento psíquico de crianças de zero a dezoito meses. Aborda as discussões geradas no interior do campo psicanalítico em torno da criação daquele instrumento e da promulgação da Lei n.13.438, examinando criticamente as objeções a esta levantadas por psicanalistas e técnicos do Ministério da Saúde. Finaliza com propostas de reformulação de alguns pressupostos do IRDI e de manutenção de outros, passados quase vinte anos desde sua criação.

This article tells the history of the proposal and of the validation of the Indicadores de Risco para o Desenvolvimento Infantil (IRDI), an instrument composed by 31 reference clinical indicators for the monitoring of problems or impediments in the psychic development of children from zero to eighteen months. We approach the discussions generated within the psychoanalytic field on the creation of this instrument and of the promulgation of the Law no.13.438, critically examining the objections done by psychoanalysts and technicians of Ministry of Health to this law. We conclude with proposals to modify some presuppositions in IRDI and to maintain others, after almost 20 years of its creation.

El artículo relata la historia de la propuesta y de la validación del IRDI, un instrumento compuesto por 31 indicadores clínicos de referencia para el seguimiento de los problemas o de los obstáculos en el desarrollo psíquico de los niños desde cero hasta dieciocho meses de edad. El artículo se acerca a las discusiones generadas dentro del campo psicoanalítico alrededor de la creación de ese instrumento y de la divulgación de la Ley n.13.438, revisando criticamente las objeciones planteadas por psicoanalistas y por técnicos del Ministerio de la Salud al respecto de esa ley. Concluye con propuestas de reformulación de algunas presuposiciones del IRDI y con propuestas de mantenimiento de otras, casi 20 años después de su créacion.

A Pesquisa IRDI e seus desdobramentos: Uma revisão da literatura / The IRDI Research and its developments: A literature review / La Investigación IRDI y sus desdoblamientos: Una revisión de la literatura

Este estudo consiste em uma revisão das publicações científicas que tenham como temática o IRDI - Indicadores Clínicos de Risco para o Desenvolvimento Infantil, desde sua criação, explorando seus desdobramentos. Além disso, busca-se verificar se houve expansão na utilização do IRDI para além do primeiro grupo de pesquisadores que criou o instrumento. Para tanto, realizou-se uma seleção de artigos científicos nas bases de dados Scielo, INDEXPSI, Google Acadêmico e Anais dos Colóquios do LEPSI. Foi possível obter uma amostra de 34 artigos organizados em sete eixos: Apresentação e validação da pesquisa que originou os IRDIs, Tensões Metodológicas: A Psicanálise na Construção do IRDI, Metodologia IRDI, Autismo, Saúde pública, Relação pais-bebê, e Linguagem. Este trabalho revelou o IRDI enquanto potente instrumento para detectar precocemente entraves ao desenvolvimento e constituição psíquica, considerando os diferentes âmbitos em que pode ser empregado. Neste sentido, os indicadores atuam como uma importante ferramenta de leitura, norteando o olhar dos profissionais que atuam junto aos bebês. Ainda que o IRDI possa ser considerado um instrumento novo, deu origem a diversos estudos, os quais trouxeram importantes discussões no que se refere a variados aspectos da constituição psíquica de bebês e relação com seus cuidadores. (AU)

This study consists of a review of the scientific publications that have as their theme the IRDI- Clinical Risk Indicators for Child Development, since its inception, exploring its developments. In addition, it seeks to determine whether there was an expansion in the use of IRDI beyond the first group of researchers who created the tool. To this end, there was a selection of scientific articles in the databases Scielo, INDEXPSI, Google Scholar and Proceedings of the Conferences of LEPSI. It was possible to obtain a sample of 34 articles organized into seven areas: Presentation and validation of the research that originated the IRDIs, Methodological tension: Psychoanalysis on construction of IRDI, IRDI Methodology, Autism, Public Health, Parent-infant Relationship, and Language. This work revealed the IRDI as a powerful tool to detect early obstacles in the development and psychic constitution, considering the different scopes in which it can be employed. In this sense, the indicators act as an important reading tool, guiding the professionals who work with the babies. It was understood that although the IRDI can be considered a new instrument, it has given rise to many studies, which brought important discussions regarding the various aspects of the psychic constitution of babies. (AU)

Este estudio consiste en una revisión de las publicaciones científicas que tienen como tema el IRDI - Índices Clínicos de Riesgo para el Desarrollo Infantil, desde su creación, explorando sus desdoblamientos. Además, se busca determinar si hubo una expansión en el uso del IRDI más allá del primer grupo de investigadores que crearon la herramienta. Con este fin, se realizó una selección de artículos científicos en las bases de datos SciELO, INDEXPSI, Google Scholar y Actas de las Conferencias de LEPSI. Fué posible obtener una muestra de 34 artículos organizados en siete áreas: Presentación y validación de la investigación que originó los IRDls, Tensiones metodológicas: Psicoanálisis en la construcción del IRDI, Metodología IRDI, Autismo, Salud Pública, Relaciones padres-niño, y Lenguaje. Este trabajo reveló el IRDI como potente instrumento para detectar tempranamente obstáculos en el desarrollo y en la constitución psíquica, considerando los diferentes ámbitos en que puede ser empleado. En este sentido, los indicadores actúan como una importante herramienta de lectura, que orienta la mirada de los profesionales que actúan junto a los bebés. Aunque se pueda considerar el IRDI un nuevo instrumento, este ha dado lugar a muchos estudios, lo que ha traído discusiones importantes con respecto a los diversos aspectos de la constitución psíquica de los bebés y la relación del bebé con sus cuidadores. (AU)

Risk Factors and Correlation Analysis between the Oxford Classification and Clinical Indicators of IgA Nephropathy / 中国医科大学学报

Objective To analyze the risk factors and correlation between clinical indicators and the four main pathological lesions of IgA ne?phropathy in the Oxford classification:mesangial hypercellularity(M0/1),endocapillary proliferation(E0/1),segmental sclerosis or adhesion(S0/1), and tubular atrophy/interstitial fibrosis(T0/1/2). Methods Clinical and pathological data were collected from 514 patients with biopsy?proven IgA nephropathy admitted in our hospital from February 17,2006 to October 11,2011. These patients were all above 18 years old. Cases with sec?ondary causes of mesangial IgA deposition were excluded,such as Henoch?chonlein purpura,ankylosing spondylitis and psoriasis et al. The inde?pendent risk factors affecting the pathological classification were analyzed by Spearman rank correlation analysis and two?category and multi?classi?fication logistic regression using SPSS 17.0 statistical software. Results In 514 IgAN patients,the ratio of males to females was 1.06:1. The aver?age age was 35.70±11.99 years,and the average disease duration was 18.31±30.42 months. M0E0S0T0 was the major pathologic classification of isolated hematuria. Chronic kidney disease(CKD)stage,24 hours proteinuria,albuminuria,urine transferrin and IgG levels were positively corre? lated with M lesion;serum albumin,C3 and PLT showed a negative correlation with M lesion. Twenty four hours proteinuria and blood platelet count were the independent risk factors for M lesion. As shown by stratified analysis ,the proportion of M1 in cases with 24 hours proteinuria≥3.5 g/d is much higher than that in cases with non?nephrotic range proteinuria. Age,systolic blood pressure,uRBC,24 hours proteinuria,albuminuria urine transferrin and IgG levels were positively correlated with E lesion,Duration,serum albumin showed a negative correlation with E lesion. Age and duration of nephritis were independent risk factors for E lesion. 73.3%of patients that above 60 years old showed endothelial proliferation. CKD stage,24 hours proteinuria were positively correlated with S lesion. Age,CKD stage,systolic blood pressure,diastolic blood pressure,C4,TC, LDL?C,CRP,Fib,UA,Cys?C and 24 hours proteinuria,urineβ2?microglobulin,albumin,transferrin and IgG levels were positively associated with T lesion;hemoglobin,serum albumin,serum IgG showed a negative correlation with T lesion. Infection history,high CRP levels,DBP more than 90 mmHg,hypoalbuminemia,high low density lipoproteinemia,and anemia were independent risk factors for T lesion. Conclusion Twenty four hours proteinuria,blood platelet count,age,duration of nephritis,hypoalbuminemia,anemia,hyperlipidemia,DBP≥90 mmHg and high CRP lev?els were risk factors for the Oxford classification of IgA nephropathy. Renal biopsy should be carried out in time to make clear the pathological clas?sification and individual treatment,so as to improve the prognosis.

Clinical value of related indexes in patients with primary biliary cirrhosis with esophageal varices / 中华传染病杂志

Objective To investigate the clinical indicators which can predict esophageal varices in patients with primary biliary cirrhosis (PBC).Methods A total of 351 patients with PBC from the First Affiliated Hospital of Xinjiang Medical University from January 2013 to December 2016 were retrospectively analyzed, including 173 patients with esophageal varices and 178 patients without varicose veins.The alanine aminotransferase (ALT), aspartate transaminase (AST), alkaline phosphatase (ALP), γ-glutamyl transpeptadase (γ-GT), total bilirubin (TBil), albumin (Alb), prothrombin time (PT), platelet (PLT), AST to ALT ratio (AAR), fibrosis index based on the 4 fator (FIB-4), AST to PLT ratio index (APRI) and Mayo scores were compared between two groups.Group t test or rank sum test was used to compare the two groups.Relation between the indicators mentioned above and esophageal varices were tested by univariate analysis.Multivariate unconditional Logistic regression was used to screen these indicators to independently predict esophageal varices in PBC patients.Results Age, PT, TBil, AAR, FIB-4, APRI and Mayo scores of PBC patients with esophageal varices were all higher than those of patients without esophageal varices ([60.3±10.6] years old vs [51.9±10.9] years old, [13.31±3.12] s vs [11.17±2.42] s, 28.06 [18.05, 60.06] mmol/L vs 15.39 [10.64, 33.63] μmol/L, 1.69±0.91 vs 1.23±0.95, 6.18 [4.05,9.16] vs 1.80 [1.10,2.74], 1.95 [1.12,3.08] vs 0.69 [0.38,1.57], 6.45±1.52 vs4.62±1.53, respectively).Whereas ALT, γ-GT, Alb and PLT levels were all lower than those without varicose veins (36.60 [19.88, 74.28] U/L vs 59.32 [23.58, 132.70] U/L, 71.00 [38.36, 165.38] U/L vs 125.00 [37.50, 336.21] U/L, [29.78±6.33] g/L vs [39.51±25.16] g/L, [103.43±52.84]×109/L vs [234.44±90.40]×109/L, respectively).The differences were all statistically significant (t=-7.25, t=-7.18, Z=-5.823, t=-4.60, Z=-8.427, Z=-12.661, t=-11.25, Z=-3.218, Z=2.987, t=4.94, t=16.63, respectively;all P11.95 s (OR=0.705, 95%CI: 0.569-0.874), TBil>17.19 μmol/L (OR=0.99, 95%CI: 0.982-0.999), FIB-4>3.02 (OR=0.868, 95% CI: 0.807-0.932) and Mayo score>4.88 (OR=6.053, 95%CI: 2.388-15.342) were independent clinical indicators for the prediction of esophageal varicose veins.Conclusions PLT, PT, TBil, FIB-4, and Mayo scores can be used as predictors of esophageal varices in patients with PBC.

The significance of procalcitonin and high-sensitivity C-reactive protein in evaluation of severity and outcome of pneumonia patients with sepsis / 中华急诊医学杂志

Objective To analyze the importance of procalcitonin (PCT) and high-sensitivity Creactive protein (hsCRP) in assessing the severity of pneumonia and sepsis patients as well as prognostic evaluation.Methods A total of 77 patients with pneumonia complicated with sepsis were randomly (random number) selected from May 2013 to May 2016 in our hospital and 50 patients with simple pneumonia were enrolled as control group.The sepsis pneumonia patients were divided into three groups,namely sepsis group,severe sepsis group and septic shock group.The sepsis patient were further divided into survival group and death group according to the death of patient within 2 weeks.Statistics was employed to study the roles of PCT and hsCRP in evaluating the severity of pneumonia and sepsis patients as well as prognostic evaluation.Results Compared with control group,the levels of PCT and hsCRP were higher in patients of sepsis groups (P ＜ 0.05).The levels of PCT and hsCRP were gradually increased as the severity of the patient getting worse (P ＜ 0.05).The levels of PCT and hsCRP in the death group were higher than those in the survival group.The areas under ROC curve of PCT and hsCRP for diagnosis of sepsis and septic shock as the optimal cut-off point at ≥ 2 ng/mL and at ≥ 75 mg/L,had the sensitivity of 62.1％ and 81.2％,respectively,and the specificity of 89.2％ and 68.2％,respectively.Conclution PCT and hs CRP levels have a certain value in assessing the severity of pneumonia and sepsis patients as well as prognostic evaluation.

Indicadores clínicos de personalidad en la adolescencia / Clinical indicators of personality in adolescence

El objetivo de este estudio fue caracterizar la presencia de indicadores clínicos y de contenido de personalidad en una población adolescente, a través del inventario multifásico de personalidad de Minnesota, forma A. La muestra de este estudio está conformada por 69 adolescentes escolarizados, de 14 a 17 años, tanto hombres como mujeres, de estrato socioeconómico medio y alto de la ciudad de Barranquilla. Los datos se analizan con el SPSS versión 19.0 para el análisis de estadísticos descriptivos, los resultados arrojan perfiles válidos y son consistentes con investigaciones previas, según las cuales se puede diferenciar población normal de población con indicadores clínicos de personalidad de importancia; en algunas escalas, sin embargo, los puntajes son más altos que los encontrados en otras investigaciones para grupos similares, dando cuenta de las variaciones introducidas por el contexto y la dinámica sociocultural actual, siendo más elevados para las mujeres. Las características clínicas más significativas son esquizofrenia, hipomanía, masculinidad-feminidad y psicastenia; mientras que los puntajes de las escalas de contenido más significativos son en las de pensamiento extravagante, obsesividad y ansiedad.

The objective of this study was to characterize the presence of clinical and content personality indicators in adolescent students through the Minnesota Multiphasic Personality Inventory Form A. The sample is formed by 69 adolescent secondary school students, aged from 14 to 17, including men and women, middle and high socioeconomic status from Barranquilla. The information was analyzed with SSPSS, 19.0 version for the analysis of descriptive statistics. The results show valid profiles and they are consistent with previous research that according to the population; can be differentiated into normal population and population with clinical indicators of personality. In some scales, although, the scores are higher than the ones found in other similar groups, accounting for the variations introduced by the context and actual sociocultural dynamics, scores are higher particularly in women. The most significant clinical characteristic are schizophrenia, hypomania, masculinity-feminity and psychastenia; while scores in content scales are more significant for Bizarre Mentation, Obsessiveness and Anxiety.

A construção do laço educador-bebê a partir da Metodologia IRDI / Construction of the educator-baby bond from the IRDI Methodology / La construction du lien enseignant-enfant à partir le méthode IRDI / La construcción del enlace educador-bebé a partir de la Metodología IRDI

O presente artigo apresenta uma reflexão a partir de uma cena bservada em uma creche na cidade de São Paulo. Discute-se o modo pelo qual um profissional, atravessado pela psicanálise, trabalhando nesta creche cria condições para o surgimento de um enlace do professor com o bebê da creche tendo como referência a Metodologia IRDI. Esta metodologia é um procedimento de acompanhamento do desenvolvimento psíquico feito por psicanalistas em instituições de Educação Infantil por meio de indicadores clínicos com valor de previsão precoce de problemas de desenvolvimento. Conclue-se que é necessária a existência de uma transferência entre o professor da creche e o profissional, o que dá suporte para a construção deste enlace...

This article presents a reflection from a scene observed inside a nursery in the city of São Paulo. The way which a professional, working in the nursery, crossed by psychoanalysis, creates conditions for the emergence of a bond between teacher and baby in daycare is here discussed, using as reference the IRDI Methodology. This method is a procedure for the monitoring of psychic development by psychoanalysts in early childhood institutions through clinical indicators with predictive values of early developmental problems. We conclude that the existence of a dialogue between the teacher and the nursery rofessional is necessary in order to support the development of the bond...

Cet article présente une réflexion sur une scène qui a eu lieu dans une pépinière dans la ville de São Paulo. Il examine la façon dont un professionnel, traversé par la psychanalyse, qui travaille dans cette pépinière, crée les conditions pour l’émergence d’un lien entre l’enseignant et l’enfant, en prenant comme référence la méthode IRDI. Cette méthode est une procédure de accompagnement du développement mental par des psychanalystes dans l’éducation préscolaire. Les psychanalystes utilisent des indicateurs cliniques qui ont une valeur prédictive des problèmes de développement précoce. Nous concluons que l’existence d’un transfert entre l’enseignant et le professionnel de la pépiniè...

En este artículo se presenta una reflexión a partir de una escena observada en una guardería de la ciudad de São Paulo. Se describe la forma como un profesional, atravesado por el psicoanálisis, trabajando en esta guardería, crea las condiciones para el surgimiento de un enlace del educador con el bebé en este establecimiento, teniendo como referencia la metodología IRDI. Esta es un procedimiento para el seguimiento del desarrollo psíquico por los psicoanalistas en las instituciones de Educación Inicial a través de indicadores clínicos capaces de diagnosticar temprano a los problemas de desarrollo. Se llega a la conclusión de que es necesaria la existencia de una transmisión entre el profesor y el profesional de la guardería, base para la construcción de este enlace...

Effect of Birth Weight and Mode of Feeding During Early Infancy on Clinical Indicators of Obesity and Lipid Profile in Adulthood.

Aims: To study effect of birth weight and mode of feeding during early infancy on clinical indicators of obesity and lipid profile in adulthood. Place and Duration of Study: The study was conducted on 260 adults aged 21-31 years censured in Yaoundé between February and March 2012. Methodology: The study was transversal and retrospective. Data such as birth weight, type of breastfeeding and duration of breastfeeding was collected. Participants also followed a food diary for a week. Anthropometric measurements and cardiovascular risk factors such as total cholesterol, LDL cholesterol, HDL cholesterol, triglycerides and blood pressure were assessed. Results: There were no significant difference between LBW group and NBW. In HBW group weight, BMI and lean mass were significantly (p< .05) higher than in NBW group. Body fat was significantly (p < .05) high among NBW compare to HBW. These results were confirmed by binary regression for body fat .918 (.852-.988) and lean mass 1.100 (1.039-1.164). Relation between birth weight and body fat showed an inverse and significant (P<.05) correlation. Participants with low birth weight (LBW) had a concentration of total plasma cholesterol significantly higher than participants with normal birth weight (NBW) (p < .05) or High birth weight (HBW) (p < .05). Furthermore, a significant inverse correlation was noted between the total plasma cholesterol (P < .01), LDL cholesterol (P < .05) and the birth weight. The plasmatic total cholesterol (p < .05) and LDL cholesterol (p < .05) of participants who had mixed feeding was also higher compared to those who have been under exclusive breastfeeding for 6 months. Conclusion: birth weight and mode of feeding during early infancy have effects on clinical indicators of obesity and lipid profile in adulthood.

Indicadores del desempeño clínico fisioterapéutico en el manejo hospitalario temprano del accidente cerebrovascular (ACV) / Physical Therapy clinical performance indicators in the early hospital management cerebrovascular attack (CVA) / Indicadores do desempenho clínico fisioterápico na gestão hospitalar precoce do Acidente Vascular Cerebral (AVC)

Las oportunidades conocidas de intervenciones tempranas en los accidentes cardiocerebrovasculares (ACV) desde el punto de vista médico y de rehabilitación hacen necesario avanzar en la formulación de indicadores del desempeño clínico en el manejo fisioterapéutico hospitalario de una persona con ACV. Objetivo: identificar los indicadores de desempeño clínico fisioterapéutico en el manejo hospitalario temprano de personas sobrevivientes de ACV. Materiales y métodos: se trata de un estudio exploratorio descriptivo que indaga sobre las pruebas y prácticas fisioterapéuticas existentes, la evidencia científica sobre indicadores clínicos en ACV, los indicadores estándar y los posibles indicadores clínicos en el escenario. Se llevó a cabo una revisión sistemática de estudios descriptivos, guías de práctica clínica, revisiones sistemáticas, estudio de casos clínicos basados en la evidencia en bases de datos como Pubmed, Proquest, Pedro y en revistas electrónicas, además del análisis de datos epidemiológicos de la prevalencia del ACV en Colombia y en Chile, en páginas web de la Organización Mundial de la Salud, Ministerio de Salud y Departamento Administrativo Nacional de cada país. Resultados: la evidencia señala que la rehabilitación temprana del ACV debe iniciarse durante la hospitalización, tan pronto como el diagnóstico se establezca y los problemas que ponen en riesgo la vida del paciente estén controlados. Las prioridades en la intervención fisioterapéutica en ACV son prevenir las complicaciones (trombosis venosa, infecciones y dolor) y facilitar la movilización temprana. Actualizaciones recientes de estas directrices incluyen la rehabilitación temprana, en particular la movilidad luego de las veinticuatro horas posteriores al ACV. Las pruebas que sustentan los indicadores de desempeño en rehabilitación para la atención en la etapa subaguda del ACV son escasas. Conclusiones: se hace notoria la importancia de la atención temprana fisioterapéutica en el proceso agudo del paciente con ACV, puesto que la evidencia disponible resalta un mejor pronóstico para pacientes que son intervenidos por el área dentro de las primeras veinticuatro horas posteriores al evento y la importancia de los indicadores de atención del paciente, como la calidad y el tiempo de atención, la periodicidad y el aprovechamiento de la intervención dentro de la ventana temporal aguda de recuperación del paciente.

The known early intervention opportunities in cerebrovascular events (CVE), not only from the medical point of view but from rehabilitation, create the necessity of moving forward in the formulation of clinical performance indicators in the hospitalary physiotherapeutic management of a person with a CVE. Objective: to identify the physiotherapeutic clinical performance indicators in the early hospitalary management of people surviving CVE. Materials and methods: this is about a descriptive exploratory study investigating about the existing physiotherapeutic tests and practices, the scientific evidence about clinical indicators in CVE, the standard indicators and the possible clinical indicators in this setting. We conducted systematic review of descriptive studies, clinical practice guidelines, systematic reviews, clinical case study in evidence-based databases such as Pubmed, Proquest, Peter and electronic journals, plus analysis of data epidemiological prevalence of stroke in Colombia and Chile, on websites of the World Health Organization, Ministry of Health and National Bureau of each country respectively. Results: the evidence points out that early rehabilitation of CVE should be initiated during hospitalization, as soon as the diagnosis is made and the life threatening issues are controlled. Priorities in the CVE therapeutic interventions are to prevent: complications (venous thrombosis, infections and pain) and to facilitate the early mobilization. The latest updates to these directives include early rehabilitation, particularly mobilization within 24 hours after the CVE occurrence. Proves supporting performance indicators in rehabilitation for the assistance in the sub-acute stage of CVE are limited. Conclusions: it is evident the importance of early intervention physical therapy in the acute process of patients with stroke as the evidence stands a better prognosis for patients who are operated on by the area within the first 24 hours after the event and the importance of patient care indicators such as quality of care, attention span, timing and use of intervention within the time window acute recovery.

As oportunidades conhecidas de intervenções precoces nos acidentes vasculares cerebrais (AVC) desde o ponto de vista médico e de reabilitação fazem necessário avançar na formulação de indicadores do desempenho clínico na gestão fisioterápica hospitalar de uma pessoa com AVC. Objetivo: identificar os indicadores de desempenho clínico fisioterápico na gestão hospitalar precoce de pessoas sobreviventes de AVC. Materiais e métodos: trata-se de um estudo exploratório descritivo que indaga sobre as provas e práticas fisioterápicas existentes, a evidência científica sobre indicadores clínicos em AVC, os indicadores standard e os possíveis indicadores clínicos no cenário. Levou-se a cabo uma revisão sistemática de estudos descritivos, guias de prática clínica, revisões sistemáticas, estudo de casos clínicos baseados na evidência em bases de dados como Pubmed, Proquest, Pedro e m revistas eletrônicas, além da análise de dados epidemiológicos da prevalência dos AVC na Colômbia e no Chile, nos sites da Organização Mundial da Saúde, Ministério de Saúde e Departamento Administrativo Nacional de cada país. Resultados: a evidência assinala que a reabilitação precoce do AVC deve se iniciar durante a hospitalização, tão logo o diagnóstico se estabeleça e os problemas que põem em risco a vida do paciente estejam controlados. As prioridades na intervenção fisioterápica em AVC são prevenir as complicações (trombose venosa, infecções e dor) e facilitar a mobilização precoce. Atualizações recientes destas diretrizes incluem a reabilitação precoce, particularmente a mobilidade depois das vinte quatro horas posteriores ao AVC. As provas que sustentam os indicadores de desempenho em reabilitação para a atenção na etapa subaguda do AVC são escassas. Conclusões: se faz notória a importância da atenção precoce fisioterápica no processo agudo do paciente com AVC, porquanto a evidência disponível resalta um melhor prognóstico para pacientes que são intervencionados pela área dentro das primeiras vinte quatro horas posteriores ao evento e a importância dos indicadores de atenção do paciente, como a qualidade e o tempo de atenção, a periodicidade e o aproveitamento da intervenção dentro da janela temporal aguda de recuperação do paciente.

Considerações acerca do brincar e do estatuto da fantasia a partir de proposições teóricas que baseiam a pesquisa IRDI / Considerations about childplay and the statute of fantasy from theoretical propositions that bases the IRDI research / Consideraciones sobre el jugar y el estatuto de la fantasía a partir de proposiciones teóricas que basan la investigación IRDI

Este trabalho foi concebido a partir da temática sobre o brincar e o estatuto da fantasia, eixo teórico da AP3. Propõe-se o brincar como via de elaboração de uma versão particular acerca dos significantes relacionados à construção do próprio corpo da criança, ao seu Outro e ao mundo que a ela se apresenta, assim como expressão da posição da criança como sujeito em constituição e mesmo sujeito que (já) é. Em sua relação com a fantasia - ou como via de expressão fantasmática -, o brincar viabiliza processos de representação e, paradoxalmente, aponta para algo que resiste a ser representado, mas que continua a atuar no psiquismo.

This work was designed from the theme of child-play and the statute of fantasy, the theoretical axis of the AP3. It is proposed that the play as a developing route of a particular version concerning the significant related to the construction of the child's own body, to its Otherness and to the world that is presented, as well as the expression of the position of the child as a being in constitution and even a being that (already) is. In its relationship to fantasy - or as a means of phantasmatic expression - the play enables processes of representation and, paradoxically, points to something that resists being represented, although it continues to operate in the psychism.

Este trabajo fue diseñado desde el tema del jugar y el estatuto de la fantasía, eje teórico de la AP3. Se propone el jugar como un medio para elaborar una versión particular de los significantes relacionados a la construcción del propio cuerpo delniño, a su Otro y al mundo que se presenta a el, así como expresión de la posición del niño como sujeto en constitución e incluso sujeto que (ya) es. En su relación con la fantasía - o como medio de expresión fantasmática -, el jugar permite procesos de representación y, paradójicamente, apunta a algo que se resiste a ser representado, pero sigue funcionando en la psique.

Clinical indicators of child development in the capitals of nine Brazilian states: the influence of regional cultural factors

OBJECTIVE: Evaluating the interaction between mother or caregiver and infant through the Clinical Indicators of Risks in Infant Development and investigating whether local and cultural influences during infant development affect these clinical indicators. INTRODUCTION: The Clinical Indicators of Risks in Infant Development was created in order to fully assess infants' development and the subjective relationship between the babies and their caregivers. The absence of two or more Clinical Indicators of Risks in Infant Developments suggests a possibly inadequate mental development. Given the continental size of Brazil and its accentuated cultural differences, one might question how trustworthy these indicators can be when applied to each of the geographical regions of the country. METHODS: This was a cross-sectional study with 737 infants from the capitals of 9 Brazilian states. The size of the initial sample population was based on a pilot study carried out in the cities of São Paulo and Brasília. The ages of children were grouped: 0-3 months, 4-7 months, 8-11 months and 12-18 months. The chi-square test was used together with analyses by the statistical software SPSS 13.0. RESULTS: Statistical analysis of results from the different municipalities against the total sample did not reveal any statistically significant differences. Municipalities represented were Belém (p=0.486), Brasília (p=0.371), Porto Alegre (p=0.987), Fortaleza (p=0.259), Recife (p=0.630), Salvador (0.370), São Paulo (p=0.238), Curitiba (p=0.870), and Rio de Janeiro (p= 0.06). DISCUSSION: Care for mental development should be considered a public health issue. Its evaluation and follow-up should be part of the already available mother-child assistance programs, which would then be considered to provide "full" care to children. CONCLUSIONS: Local habits and culture did not affect the results of the Clinical Indicators of Risks in Infant Development indicators. Clinical...