Vocal Demand Response to the Educational Setting Based Communication Scenarios: A Single Subject Study

Objectives: This was a single-subject study, aimed to demonstrate different vocal demand situations that are typical for primary school and teacher's vocal demand response under two acoustical conditions, with and without voice amplification, during five working days. Methods: The long-term voice dosimetry with Vocal Holter Med (PR.O. Voice Srl) was carried out on a 49-year-old female teacher with voice disorders during daily teaching activities. A sound field amplification system (SFAS) PentaClass Runa was installed in the classroom. Voice dosimetry was provided under two different acoustical conditions: without SFAS (2 days) and with SFAS (3 days). Results: Phonation time percentage, sound pressure level (SPL), SPL SD, fundamental frequency (F0), F0 SD, cycle, and distance doses were investigated in seven communication scenarios (lessons, group/individual classes, sports lessons in the gym and schoolyard, breaks, lunch breaks, and other activities). The median scores of all voice parameters differed significantly between different vocal demand contexts. The significant statistical difference in the vocal demand response was in the communication situations with and without SFAS. In addition, the number of children, reverberation time, and ambient air relative humidity impacted voice SPL and the cycle dose. Conclusions: Lessons, sports lessons held in the gym or schoolyard, breaks, and lunch breaks were considered as high vocal demand communication situations requiring higher voice intensity and fundamental frequency, higher phonation time percentage, cycle, and distance doses. Group/individual work and other teacher activities during the day, unrelated to direct work with students, were categorized as low vocal demand communication scenarios.

Objetivos: Este fue un estudio de sujeto único, cuyo objetivo fue demostrar diferentes situaciones de demanda vocal típicas de la escuela primaria y la respuesta vocal de los docentes bajo dos condiciones acústicas, con y sin amplificación de voz, durante cinco días laborables. Métodos: Se llevó a cabo dosimetría vocal a largo plazo con Vocal Holter Med (PR.O. Voice Srl) durante las actividades diarias de enseñanza en una docente de 49 años con trastornos de la voz. Se instaló un sistema de amplificación de campo sonoro (SFAS) PentaClass Runa en el aula. La dosimetría vocal se realizó bajo dos condiciones acústicas diferentes: sin SFAS (2 días) y con SFAS (3 días). Resultados: Se investigaron el porcentaje de tiempo de fonación, el nivel de presión sonora (SPL), SPL SD, la frecuencia fundamental (F0), F0 SD, ciclos y dosis de distancia en siete escenarios de comunicación diferentes (clases, clases grupales/individuales, clases de educación física en el gimnasio y el patio de la escuela, recreos, almuerzos y otras actividades). Las puntuaciones medias de todos los parámetros vocales diferían significativamente entre los diferentes contextos de demanda vocal. La diferencia estadísticamente significativa en la respuesta a la demanda vocal se observó en las situaciones de comunicación con y sin SFAS. Además, el número de niños, el tiempo de reverberación y la humedad relativa del aire ambiente afectaron al SPL de la voz y la dosis de ciclo. Conclusiones: Las lecciones, las clases de educación física en el gimnasio o el patio de la escuela, los recreos y los almuerzos se consideraron situaciones de comunicación de alta demanda vocal, que requerían una mayor intensidad y frecuencia fundamental de la voz, un mayor porcentaje de tiempo de fonación y dosis de ciclo y distancia más altas. El trabajo grupal/individual y otras actividades del profesor durante el día no relacionadas con el trabajo directo con los estudiantes se categorizaron como escenarios de comunicación de baja demanda vocal.

HPV vaccination programs in LMIC: is it time to optimize schedules and recommendations?

Abstract Objectives: Prophylactic HPV vaccines are a fundamental tool to reduce infections and tumors caused by the most prevalent types of these viruses, as this review points out. Several countries have adopted immunization programs that recommend vaccination against HPV for girls and adolescents between 9 and 14 years of age and, in some of them, also for boys. The programs also contemplate the immunization of adults, particularly in the case of individuals with different immunodeficiencies. Sources of data: The available vaccines are recommended for the prevention of tumors of the uterine cervix, vulva, vagina, penis, and anal canal. Moreover, two of the vaccines prevent the occurrence of genital warts, having been recently indicated for the prevention of oropharyngeal cancer. Data synthesis: Based on the evidence that antibody responses in girls were non-inferior after two doses when compared to three doses, several countries have decided to reduce the vaccination schedule for girls and boys up to 14 years of age from three to two doses, with an interval of six months between them. Recently, knowledge has been accumulating about the immunogenicity, duration of protection, and efficacy of a single-dose HPV vaccine regimen in girls and young women. Conclusion: Single-dose HPV vaccination could substantially reduce the incidence of pre-cancer and cervical cancer attributable to HPV, with reduced costs for vaccine delivery and simplified implementation, allowing more countries to introduce HPV vaccination or increase the adherence of the target population.

Vaccination status of non-national immunization program vaccines in Changning District of Shanghai 2016‒2020 / 上海预防医学

ObjectiveTo understand the vaccination situation of non-national immunization program （non-NIP） vaccines in Changning District， and to provide evidence for further strengthening the management of vaccination services and guiding community health service centers to construct vaccination clinics for children and adults. MethodsNumber of non-NIP vaccine doses in community health service centers， Changning District， was collected from Shanghai Immunization Information System from 2016 to 2020. Descriptive epidemiological analysis was conducted. ResultsIn 2020， the overall number of non-NIP vaccine doses， proportion of non-NIP vaccine doses and average number of non-NIP vaccine doses in the community health service centers， Changning District， reached up to 115 361 doses， 63.41% and 1 664.54 per10 000 persons， respectively. Furthermore， the proportion of non-NIP vaccine doses showed a significantly upward trend （χtrend2=131.110， P<0.01）. The number of non-NIP vaccine doses increased mostly in adults aged >18 years. Human papillomavirus vaccines （HPV） and influenza vaccines （InfV） had the highest increase in vaccine doses. Additionally， non-NIP vaccination peaked from September to December in adults. ConclusionAlong with the number of non-NIP vaccine doses increase， it is necessary to strengthen the management of non-NIP vaccination and explore effective measures for construction of adult vaccination clinics to meet the public demand for vaccination.

Analysis of the use of insulin products in our hospital after centralized volume-based procurement / 中国药房

OBJECTIVE To analyze the implementation of insulin centralized volume-based procurement policy （hereinafter referred to as “centralized procurement”） in our hospital and its effect on the use of insulin products in clinical. METHODS The manufacturer， specifications， usage， sales amount and agreed purchase volume of insulin products in our hospital before （July 4， 2021 to January 3， 2022） and after （July 4， 2022 to January 3， 2023） the centralized procurement were collected. The defined daily dose （DDD） method was used to calculate defined daily doses （DDDs）， defined daily cost （DDC）， the progress of procurement completion and actual cost saving. RESULTS After the centralized procurement， the number of insulin products had increased from 20 to 29 in our hospital； except for the Insulin degludec/aspart injection in our hospital’s original insulin catalog that had not been centrally purchased， all other existing varieties had been included in centralized procurement catalog. The use of Insulin aspart 30 injection produced by Novo Nordisk （China） Pharmaceutical Co.， Ltd. always ranked the first place in the list of usage and DDDs before and after the centralized procurement. The sales amount of Insulin glargine injection produced by Ganli Pharmaceutical Co.， Ltd. and Tonghua Dongbao Pharmaceutical Co.， Ltd. increased significantly due to the significant increase in usage. The centralized procurement of Degu insulin injection from Novo Nordisk （China） Pharmaceutical Co.， Ltd. had achieved a relatively high completion rate in our hospital’s original insulin catalog， while the completion rate for new varieties was low. After the centralized procurement， our hospital actually saved a total of 1 388 582.66 yuan in expenses. CONCLUSIONS After the centralized procurement， the selection and usage of insulin varieties in our hospital are reasonable， which saves patients’ insulin treatment costs， and reduces economic pressure on patients and society.

Evaluation of insecticide resistance among Malaysian Aedes albopictus Skuse larvae based on revised diagnostic doses of larvicides

@#The susceptibility levels of Malaysian Aedes albopictus larvae sampled from several agricultural, fogging-free residential and dengue prone residential areas against different larvicides were evaluated using revised diagnostic doses derived from the 2xLC99 values of the reference strain. Upon 24-hour recovery period of WHO larval bioassay, incipient resistance was observed among Ae. albopictus larvae from rubber estates against fenitrothion (96.67% mortality) and permethin (97.00% mortality) while Ae. albopictus larvae from rice cultivation areas were moderately resistant to fenthion (94.33% mortality). Aedes albopictus larvae from dengue prone residential areas developed moderate to high resistance against dichlorodiphenyltrichloroethane (DDT), fenitrothion, fenthion, propoxur and permethrin (79.67% – 97.33% mortality). Moderate to high resistance were also demonstrated among all populations of Ae. albopictus larvae against temephos and chlorpyrifos (63.00% – 97.67% mortality). Except for Ae. albopictus larvae from oil palm plantations, all Ae. albopictus larval populations were also highly resistant to bendiocarb (65.67% – 89.67% mortality). Cross resistance between larvicides from similar and different insecticide classes were also revealed in this study. The use of revised diagnostic doses established from the local reference strain could reduce the possibility of underestimation or overestimation of the insecticide susceptibility status of field strain populations.

A clinical study of different doses and frequencies of Sildenafil in the treatment of erectile dysfunction / 现代泌尿外科杂志

【Objective】 To evaluate the efficacy and safety of different doses and frequencies of oral Sildenafil in the treatment of erectile dysfunction (ED). 【Methods】 The randomized,open clinical trial included 120 ED patients who met the inclusion and exclusion criteria. The patients were randomly divided into the following groups:on-schedule (25 mg/day),on-demand (50 mg,taken irregularly half an hour before each sexual life),new regular group (25 mg/day,50 mg more before each sexual life),regular group (100 mg/time,twice/week). All treatments lasted for 8 weeks. The follow-up indexes included the five-item International Index of Erectile Function (IIEF-5),Erection Hardness Scale (EHS) and Sexual Encounter Profile (SEP2/3). The adverse reactions were recorded. 【Results】 The IIEF-5 scores of the four groups were significantly higher than those after baseline treatment (P0.05). In terms of effective rate,at the 16th week,there were significant differences between the on-demand group (10.7%) and new regular group (62.1%),and between the on-demand group (10.7%) and regular group (50.0%) (P<0.001). In terms of EHS, the percentage of grade 4 patients in regular group was significant higher than that in the on-demand group at the 8th week and 16th week (all P<0.05). In terms of positive rate of SEP-3,there was a significant difference between the on-demand group and regular group (P=0.042) at the 16th week. In the course of treatment,there were transient adverse reactions such as headache,blurred vision,stuffy nose and back pain,which did not affect the treatment. 【Conclusion】 All of the four treatment methods of oral sildenafil showed good efficacy. Both regular group and new regular group maintained good clinical efficacy during the follow-up,which is better than that of the on-demand group. The new regular scheme can be used as a new,safe and effective treatment option.

Correlation analysis and benchmark dose study on bone metabolic biochemical index of low doses of exposed hydrogen fluoride workers / 中华劳动卫生职业病杂志

Objective: To analyze correlation of occupational hydrogen fluoride exposure to low doses of bone metabolism index through occupational epidemiological investigation and benchmark dose calculation. Methods: In May 2021, using cluster sampling method, 237 workers exposed to hydrogen fluoride in a company were selected as the contact group, and 83 workers not exposed to hydrogen fluoride in an electronics production company were selected as the control group. The external exposure dose and urinary fluoride concentration, blood and urine biochemical indicators of the workers was measured.The relationship between external dose and internal dose of hydrogen fluoride was analyzed. The external dose, urinary fluoride was used as exposure biomarkers, while serum osteocalcin (BGP), serum alkaline phosphatase (AKP) and urinary hydroxyproline (HYP) were used as effect biomarkers for bone metabolism of hydrogen fluoride exposure. The benchmark dose calculation software (BMDS1.3.2) was used to calculate benchmark dose (BMD) . Results: Urine fluoride concentration in the contact group was correlated with creatinine-adjusted urine fluoride concentration (r=0.69, P=0.001). There was no significant correlation between the external dose of hydrogen fluoride and urine fluoride in the contact group (r=0.03, P=0.132). The concentrations of urine fluoride in the contact group and the control group were (0.81±0.61) and (0.45±0.14) mg/L, respectively, and the difference between the two groups was statistically significant (t=5.01, P=0.025). Using BGP, AKP and HYP as effect indexes, the urinary BMDL-05 values were 1.28, 1.47 and 1.08 mg/L, respectively. Conclusion: Urinary fluoride can sensitively reflect the changes in the effect indexes of biochemical indexes of bone metabolism. BGP and HYP can be used as early sensitive effect indexes of occupational hydrogen fluoride exposure.

The fourth dose: My “me-first” experience

Vaccine inequality is the biggest obstacle to curbing the Covid-19 pandemic and accelerating socio-economic recovery in the developing countries. Many people, including myself, living in developing countries, were initially inoculated with the WHO-approved vaccines unwelcome to developed countries, such as Sinovac. Presently, governments in developing countries are offering the third and fourth doses of mRNA vaccines to facilitate cross-border travel. This creates a devastating burden on ongoing Covid-19 vaccination in developing countries, increasing the injustice and inequality between the developed and developing countries. Here, I share my thoughts as a public health specialist while I was receiving the fourth dose of the Covid-19 vaccine to fulfil travel requirements.

Alcoolismo e fatores associados ao binge drinking em mulheres vilhenenses / Alcoholism and factors associated with binge drinking among women in the municipality of vilhena

Estudo transversal, com objetivo de descrever o consumo de álcool e identificar os fatores associados ao binge drinking entre mulheres vilhenenses. Os instrumentos para investigação foram um questionário sociodemográfico e a escala Alcohol Use Disorders Identification Test (AUDIT). Identificou-se que 78,4% (n = 236) fazem consumo de bebida alcoólica de baixo risco ou abstinência, 14,9% (n = 45) fazem uso de risco, 3% (n = 9) alto risco e 3,7% (n = 11) provável dependência. Das pesquisadas, 57,4% (n = 135) fizeram consumo de três ou mais doses de álcool em uma mesma ocasião. O binge foi associado com as jovens adultas, solteiras, trabalho remunerado e renda inferior a três salários mínimos, escolaridade de níveis fundamental e médio e não praticantes de exercício físico. O estudo mostrou um consumo de álcool elevado e preocupante entre as mulheres que fizeram uso em binge, sendo importante detectar precocemente grupos de risco e desenvolver políticas de prevenção do abuso e dependência dessas substâncias.

Cross-sectional study, with the objective of describing alcohol consumption and identifying the factors associated with binge drinking among women in the municipalit of Vilhena. The instruments for investigation were a sociodemographic questionnaire and the Alcohol Use Disorders Identification Test (AUDIT) scale. It was identified that 78.4% (n = 236) consume low-risk alcoholic beverages or abstinence, 14.9% (n = 45) make use of risk, 3% (n = 9) use of high risk and 3.7% (n = 11) probable dependence. Of those surveyed, 57.4% (n = 135) consumed three or more drinks of alcohol on the same occasion. Binge was associated with young adults, single, paid work and income less than three minimum wages, elementary and high school education and non-exercisers. The study showed a high and worrying alcohol consumption among women who practiced binge drinking, and it is important to early detect risk groups and develop policies to prevent abuse and dependence on these substances.

Assessment of Adult's Abdominopelvic Computed Tomography Radiation Doses in Amhara Region, Ethiopia

BACKGROUND: Computed Tomography plays a priceless role for diagnostic and therapeutic purpose; however,applying an optimized Computed Tomography Technique to produce qualified image while delivering minimum radiation dose to patients is the common challenge. The main objective of this study was to establish local diagnostic reference levels for adult patients who visited abdominopelvic Computed Tomography examination. METHODS: A total of 158 patients who had taken abdominopelvic Computed Tomography examination from three selectedAmhara region hospitals were investigated. Both prospective and retrospective techniques of data collection were used while collecting the data in the entire sample. Two GE - Optima Computed Tomography 540 (16 slices) and one Phillips ­ Brilliance (64slices), were employed during data collections. Data for patient demographics scan protocols, Computed Tomography dose descriptors and machine specifications were collected and analyzed by using SPSS software version 26. RESULTS: The third quartile estimated computed tomography dose index volume and dose length product, which is the local Diagnostic Reference Levels, were 12 mGy and 1904 cm.mGy respectively. The investigated local Diagnostic Reference Levels of Computed Tomography Dose index volume (mGy) was comparable to other international Diagnostic Reference Levels. However, the third quartile value of dose length product (cm.mGy) was higher than other reported international Diagnostic Reference Levels. CONCLUSION: The values of local Diagnostic Reference Levels presented in this work can be used as a baseline upon which future dose measurements can be compared in Amhara region

A matched case-control study on protective effect of two doses of varicella vaccine in high-risk population / 中华微生物学和免疫学杂志

Objective:To investigate the protective effect of two doses of varicella vaccine in a population at high risk for varicella.Methods:The case group involved all varicella cases in classes with no less than three patients during varicella outbreaks in Tianjin schools from 2017 to 2019. A case-control study was carried out in a 1∶3 ratio. According to the seat position of each case, three nearby students who did not suffer from varicella were selected as controls. The protective effect of two doses of varicella vaccine was evaluated.Results:The total protective effect of varicella vaccine was 46.0% (95% CI: 42.7%-49.0%). The protective effect was 44.7% (95% CI: 41.2%-48.0%) for one-dose varicella vaccine and 80.0% (95% CI: 63.1%-89.2%) for two-dose varicella vaccine. For two doses of varicella vaccine, the protective effect was 87.6% (95% CI: 52.0%-96.8%) after 0-2 years and 76.6% (95% CI: 33.6%-91.5%) after 3-5 years.Conclusions:The protective effect of two doses of varicella vaccine is better than that of one dose. However, both one-dose and two-dose vaccines show decreased protective effect over time. A booster immunization could be considered in high-risk population with longer intervals since the last vaccination.

Evaluation of the organs at risk doses for lung tumors in gated and conventional radiotherapy

Purpose: The purpose of this study was to evaluate the organs at risk (OARs) doses for lung tumors in gated radiotherapy (RT) compared to conventional RT using the four-dimensional extended cardiac-torso (4D-XCAT) digital phantom in a simulation study. Materials and Methods: 4D-XCAT digital phantom was used to create 32 digital phantom datasets of different tumor diameters of 3 and 4 cm, and motion ranges (MRs) of 2, 2.5, 3, and 3.5 cm and each tumor was placed in four different lung locations (right lower lobe, right upper lobe, left lower lobe, and left upper lobe). XCAT raw binary images were converted to the digital imaging and communication in medicine format using an in-house MATLAB-based program and were imported to treatment planning system (TPS). For each dataset, gated and conventional treatment plans were prepared using Planning Computerized RadioTherapy-three dimensional (PCRT-3D) TPS with superposition computational algorithm. Dose differences between gated and conventional plans were evaluated and compared (as a function of 3D motion and tumor volume and its location) with respect to the dose-volume histograms of different organs-at-risk. Results: There are statistically significant differences in dosimetric parameters among gated and conventional RT, especially for the tumors near the diaphragm (P < 0.05). The maximum reduction in the mean dose of the lung, heart, and liver were 6.11 Gy, 1.51 Gy, and 10.49 Gy, respectively, using gated RT. Conclusions: Dosimetric comparison between gated and conventional RT showed that gated RT provides relevant dosimetric improvements to lung normal tissue and the other OARs, especially for the tumors near the diaphragm. In addition, dosimetric differences between gated and conventional RT did generally increase with increasing tumor motion and decreasing tumor volume

Dose efetiva de radiação nos exames de tomografia computadorizada: um estudo retrospectivo e descritivo / Effective dose of radiation in exams of computed tomography: one retrospective and descriptive study

Contexto: A tomografia computadorizada revolucionou os estudos radiológicos convencionais. Porém, tal avanço se deu associado com o aumento das doses de radiação ionizante. A tomografia computadorizada representa 15% de todos os exames de imagem e contribui com 75% de radiação para a população. Objetivo: Estimar a dose efetiva de radiação imprimida aos pacientes durante os exames de tomografia computadorizada. Desenho e local: Estudo retrospectivo e descritivo em instituição hospitalar de nível terciário no Rio de Janeiro. Métodos: Foram selecionados 1.476 pacientes que realizaram exames de tomografia computadorizada de crânio, tórax e abdome/pelve, sem contraste endovenoso, no serviço de radiodiagnóstico do hospital no período de 1 de janeiro a 31 de março de 2018 para os exames de tórax, e no período de 1 de janeiro a 28 de fevereiro de 2018 para os exames de crânio e de abdome/pelve. Os dados foram coletados a partir do Picture Archivingand Communication System (PACS) da instituição para avaliar a dose de radiação utilizada por cada tipo de exame, por meio do cálculo das doses efetivas médias em cada tipo de exame. Resultados: As médias das doses efetivas encontradas foram de 1,57 mSv, 8,37 mSv e 12,28 mSv para os exames de crânio, tórax e abdome/pelve, respectivamente. Conclusão: O estudo verificou que os exames de crânio e abdome/pelve foram realizados com as médias das doses efetivas dentro dos valores típicos preconizados, enquanto nos exames de tórax as doses efetivas estavam acima da faixa fornecida pela Associação Americana de Física Médica (American Association of Physicists in Medicine, AAPM) (relatório # 96).

The Familiarity of Medical Students at Clinical Years about the Influence of Ionizing Radiations Doses

Background: Since the medical students at the clinical phases increasingly becoming more close to the patient’s diagnosis and treatment is very important to be aware of radiation dose. Therefore, this study aimed to assess the familiarity of Medical students at clinical years about the influence of ionizing radiation doses. Methodology: In this cross-sectional study, 443 medical students at clinical phases of the study (4th, 5th, and 6th years) were randomly selected from three medical colleges in 3 universities (Hail, Jouf, and Tabuk). A purposeful questionnaire was designed and distributed electronically to collect the desired data. Results: Out of the 433 students, 339/433 (78.3%) knew that a person’s body weight is an important determinant of radiation dose, whereas, the remaining 94/433 (21.7%) claimed that weight has no role. Correct radiation dose for Bone scan (>300 mSv), Spine MRI (0 mSv-1 mSv), Abdominal x-ray (10 mSv-50 mSv), Abdominal US (0 mSv-1 mSv), PET Scan (10 mSv-50 mSv), PET/CT scan (10 mSv-50 mSv), Mamo (2 views) (5 mSv-10 mSv), and Thyroid scan (10 mSv-50 mSv), constituting 16/433 (3.7%), 129/433 (29.8%), 49/433 (11.3%), 144/433 (33.3%), 48/433 (11%), 50/43 (11.5%), 115/433 (26.6%), and 55/433 (12.7%), in that order. Conclusion: Medical students in the late clinical years have inadequate knowledge of ionizing radiation doses in Northern Saudi Arabia Medicine College, which necessitates further interventions in this context, at the level of general curriculum as well as, at the training in the late clinical years

Deep vein thrombosis cured by homeopathy: A case report

Venous thrombosis (VT) of deep vein is a life-threatening condition which may lead to sudden death as an immediate complication due to formation of thrombo-embolism. VT is associated with various risk factors such as prolonged immobilization, inflammation, and/or coagulation disorders including muscular or venous injury. Deep venous thrombosis (DVT) frequently occurs in the lower limb. Successful treatment of DVT exclusively with homeopathic remedies has rarely been recorded in peer-reviewed journals. The present case report intends to record yet another case of DVT in an old patient totally cured exclusively by the non-invasive method of treatment with micro doses of potentized homeopathic drugs selected on the basis of the totality of symptoms and individualization of the case. Since this report is based on a single case of recovery, results of more such cases are warranted to strengthen the outcome of the present study.

Clinical Observation of Different Doses of Xuebijing Injection Combined with Ulinastatin Injection in the Treat- ment of Sepsis Complicated with Acute Lung Injury / 中国药房

OBJECTIVE：To compare cli nical effect and safety of different doses of Xuebijing injection combined with Ulinastatin injection in the treatment of sepsis complicated with acute lung injury （ALI）. METHODS ：Totally 115 patients diagnosed as sepsis complicated with ALI were collected from Jul. 2015 to Nov. 2019 in intensive care unit of our hospital. According to therapy method ，the patients were divided into control group （26 cases），low-dose group （29 cases），medium-dose group（30 cases），high-dose group （30 cases）. The control group received Ulinastatin injection 300 thousands u intravenously ，q8 h， for consecutive 5 days，on the basis of routine treatment. On the basis of control group ，low-dose group additionally received intravenous drip of Xuebijing injection 50 mL，bid，for consecutive 7 days；medium-dose group additionally received intravenous drip of Xuebijing injection 100 mL，bid，for consecutive 7 days；high-dose group additionally received intravenous drip of Xuebijing injection 100 mL，qid，for consecutive 7 days. The serum inflammatory factors （IL-6，TNF-α，CRP），respiratory function indexes （PaO2，PaO2/FiO2，ELWI）and related scores （APACEⅡ score and SOFA score ）were compared among 4 groups before and after treatment ，and mechanical ventilation time ，ICU hospitalization time ，28-day mortality rate and adverse reactions during the treatment were recorded. RESULTS ：Before treatment ，there was no statistical significance in serum inflammatory factors，respiratory function indexes or related scores among 4 groups（P＞0.05）. After treatment ，serum inflammatory factors ， ELWI and related scores of 4 groups were decreased significantly ；the low-dose ，medium-dose and high-dose groups were significantly lower than the control group ；the high-dose group was significantly lower than the low-dose and medium-dose groups （P＜0.05）. PaO 2 and PaO 2/FiO2 of 4 groups were increased significantly ，compared with before treatment ；the low-dose ， medium-dose and high-dose groups were significantly higher than the control group ；the high-dose group was significantly higher than the low-dose and medium-dose groups （P＜0.05）. The mechanical ventilation time and ICU hospitalization time in the low-dose，medium-dose and high-dose groups were significantly shorter than control group （P＜0.05），but there was no statistical significance in above indexes among different doses groups （P＞0.05）. There was no statistical significance in 28-day mortality among 4 groups（P＞0.05），and no serious adverse reactions were found. CONCLUSIONS ：Different doses of Xuebijing injection combined with Ulinastatin injection could effectively decrease the level of serum inflammatory factors in patients with sepsis complicated with ALI ，improve lung function and relieve the degree of organ failure ；after combined with high-dose Xuebijing injection，the therapeutic effect is more obvious and does not affect the treatment safety.

Nitrogen fertilization of self-seeding Italian ryegrass: effects on plant structure, forage and seed yield / Adubação nitrogenada em azevém anual, proveniente de ressemeadura natural: efeitos sobre a estrutura de plantas, produção de forragem e de sementes

ABSTRACT: This study aimed to evaluate the effect of different levels of self-seeding Italian ryegrass (Lolium multiflorum Lam.) and nitrogen rates - applied additionally after two defoliations - on plant structure, in forage and seed yield. Levels of self-seeding were classified as very high (777 kg ha-1), high (736 kg ha-1), intermediate (624 kg ha-1), and low (234 kg ha-1). Populations were fertilized with zero, 20.25, 40.50, and 60.75 kg ha-1 of supplemental nitrogen applied after two defoliations; respectively, in very high, high, intermediate, and low levels. Higher levels of self-seeding promoted greater forage yield and uniformity of vegetation structure. Number of fertile tillers and number of seeds per plant have benefited by the combination of high self-seeding and supplemental nitrogen fertilization. Despite influencing the uniformity and amount of forage obtained in two defoliations, the very high and low self-seeding levels did not differ in Italian ryegrass seed production. However, linear addition for this same variable was obtained with the inclusion of supplemental nitrogen fertilization. In pastures from low and intermediate self-seeding levels, total dry mass increases linearly with the levels of nitrogen fertilization assessed in this research.

RESUMO: O objetivo deste estudo foi avaliar o efeito de diferentes níveis de ressemeadura natural de azevém anual (Lolium multiflorum Lam.), bem como, doses suplementares de nitrogênio sobre a estrutura de plantas, produção de forragem e de sementes. Os níveis de ressemeadura foram classificados como: muito elevada (777 kg ha-1); elevada (736 kg ha-1); intermediária (624 kg ha-1) e baixa (234 kg ha-1). Populações oriundas destes níveis foram fertilizadas com zero, 20.25, 40.50, and 60.75 kg ha-1 de nitrogênio, aplicado de forma suplementar após duas desfolhas. Maiores níveis de ressemeadura propiciaram maior colheita de forragem e maior uniformização da estrutura da vegetação. A quantidade de perfilhos férteis e o número de sementes por planta foram beneficiados pela combinação de elevada ressemeadura e aplicação de nitrogênio. Apesar de influenciar a uniformização e a quantidade de forragem obtida em duas desfolhas, os níveis de ressemeadura natural, muito elevada e baixa não diferiram entre si na produção de sementes no ano subsequente. Todavia, acréscimo linear para esta mesma variável foi verificado com avanço suplementar da adubação nitrogenada. Em pastagem de azevém anual proveniente dos níveis baixo e intermediário, a produção de massa seca total é acrescida linearmente com os níveis de fertilização avaliados no presente trabalho.

Trasplante de progenitores hematopoyéticos autólogo en gammapatías monoclonales: primeros resultados del Hospital "Hermanos Ameijeiras" / Autologous stem cell transplantation in monoclonal gammopathies: first results from the "Hermanos Ameijeiras" Hospital

Introducción: Los avances en el manejo del mieloma múltiple (MM) durante los últimos años incluyen la incorporación del trasplante de progenitores hematopoyéticos autólogo (TPHa) a la estrategia de tratamiento de estos pacientes. Objetivo: Dar a conocer los primeros resultados en el hospital Hermanos Ameijeiras (HHA) con la aplicación del TPHa en pacientes con gammapatías monoclonales (GM), empleando las altas dosis de melfalán (AD-Mel) como tratamiento acondicionante (TA) y su impacto en la sobrevida global (SG). Métodos: Se hizo un estudio retrospectivo de todos los pacientes con GM sometidos a TPHa en el Servicio de Hematología del HHA en el período comprendido entre 2009 y 2018. La muestra final comprendió 14 casos. Resultados: La edad promedio fue de 53,5 años; la mayoría tenía como diagnóstico MM (85,7 por ciento) y todos ellos debutaron en estadio III de Durie-Salmon; como TA el 64,2 por ciento recibió AD-mel, en dosis de 200 mg/m2. La recuperación de las cifras de neutrófilos y plaquetas ocurrieron como promedio a los 11,4 y 12 días, respectivamente. La mortalidad relacionada con el trasplante (MRT) al día +30 fue del 7,1 por ciento. La probabilidad de SG a los 2 años fue superior al 90 por ciento y a los 5 años del 68 por ciento. Conclusiones: Se comprobó que la realización del TPHa con el empleo de AD-Mel como TA en pacientes con GM es un proceder realizable en nuestro país con una MRT relativamente baja. Se logró demostrar que la inclusión del TPH en el tratamiento mejora considerablemente las expectativas de sobrevida de estos pacientes(AU)

Introduction: The recent advances in the management of multiple myeloma (MM) during the last years have included the autologous hematopoietic stem cell transplantation (auto-HSCT) to the treatment strategy of these patients. Objective: To present the first results in the Hermanos Ameijeiras hospital (HAH) with the application of auto-HSCT in patients with monoclonal gammopathies (MG) using high doses of melphalan (HD-Mel) as conditioning regimen (CR) and its impacton overall survival (OS). Methods: A retrospective study of all patients with MG who underwent auto-HSCT in the Hematology Service of the HAH in the period between 2009 and 2018 wasmade. The final sample comprised 14 cases. Results: The average age was 53.5 years; the majority had diagnosis of MM (85.7percent) and all of them were diagnosed in stage III of Durie-Salmon; as CR 64.2 percent received HD-mel, at 200 mg/m2. The recovery of neutrophil and platelet counts occurred on average at 11.4 and 12 days respectively. Transplant related mortality (TRM) at day +30 was 7.1 percent. The probability of OS at 2 years was higher than 90 percent and at 5 years of 68 percent. Conclusions: It was verified that the performance of auto-HSCT with the use of HD-Mel as CR in patients with MG is a feasible procedure in our country with a relatively low TRM. It was possible to demonstrate that the inclusion of auto-HSCT in the treatment considerably improves the survival expectations of these patients(AU)

Vitamina C en la salud y en la enfermedad / Vitamin C in health and disease

La vitamina C ha sido ampliamente estudiada en medicina y si bien se reconoció la importancia de su deficiencia con el escorbuto, la optimización de su uso como recurso terapéutico no ha sido incluida en protocolos o guías de práctica clínica. La farmacocinética y biología de la vitamina C demuestran los efectos sistémicos que posee, y fundamentado en ello, se vienen desarrollado en los últimos años investigaciones que sustenten su uso parenteral en algunas enfermedades. La evidencia disponible señala que el beneficio de su uso no se extiende a varias enfermedades sino a algunas como el cáncer, cuyo reporte preliminar es promisorio, con adecuada tolerabilidad a altas dosis, pero que aún precisa de completar el seguimiento prospectivo de la intervención.

Vitamin C has been widely studied in medicine and although the importance of its deficiency with scurvy was recognized, the optimization of its use as a therapeutic resource has not been included in protocols or clinical practice guidelines. The pharmacokinetics and biology of vitamin C indicates the systemic effects it has, and based on it, research has been developed in recent years that supports its parenteral use in some diseases. The available evidence indicates that the benefit of its use does not extend to several diseases but to some such as cancer, whose preliminary report is promising, with adequate tolerability at high doses, but still needs to complete the prospective follow-up of the intervention.