Análisis de la tasa de cesáreas por grupos de Robson en Clínica Universidad de los Andes

Introducción: La tasa de cesáreas es importante para cualquier centro de atención hospitalaria. Es un indicador de calidad utilizado en muchas publicaciones y, aunque no es una estadística vital, se ha reconocido como un indicador de la calidad de atención. Objetivo: Conocer la tasa de cesáreas en una institución utilizando los grupos de Robson. Métodos: Estudio retrospectivo de bases de datos de la maternidad. Se consideraron las variables de paridad, cesárea anterior, trabajo de parto, inducción, para poder clasificar la población según los grupos de Robson. El análisis consideró los nacimientos desde octubre del 2014 hasta junio del 2021. Resultados: Se observó una tasa de 27,9% en el periodo de estudio. El grupo 5 de Robson, que considera pacientes con una o más tasa de cesáreas, mostró una elevada tasa (68%), contribuyó con el 36% de todas las cesáreas, siendo solamente el 15% de la población. El grupo 3, de multíparas con trabajo de parto espontáneo, tuvo una tasa del 1,8%, contribuyó al 0,4% de las cesáreas, siendo el 20% de la población de estudio. Se encontró una correlación significativa entre uso de parto instrumental y menor tasa de cesáreas, al realizar análisis por operador (Spearman rho: -0,45; IC95%: -0,788 a -0,0190; p = 0,043). Conclusión: La tasa de cesáreas observada fue 27,9%, y las pacientes con cesárea anterior son un grupo donde pueden concentrarse mayores esfuerzos para bajar la tasa global. Entre los operadores, los usuarios de parto instrumental tuvieron menor proporción cesáreas.

Introduction: The cesarean section rate is important for any hospital care center. It is a quality indicator used in many publications, and although not a vital statistic, it has been recognized as an indicator of the quality of care. Objective:: To know the cesarean section rate in an institution using Robson groups. Methods: Retrospective study of maternity databases. The variables of parity, previous cesarean section, labor, induction was considered in order to classify the population according to Robson groups. The analysis considered births from October 2014 to June 2021. Results: A rate of 27.9% was observed in the study period. Robson's group 5, which considers patients with one or more rate of cesarean sections, showed a high rate (68%), contributing to 36% of all cesarean sections, being only 15% of the population. Group 3, multiparas with spontaneous labor, had a rate of 1.8%, contributing to 0.4% of cesarean sections, making up 20% of the study population. A significant correlation was found between the use of instrumental delivery and a lower rate of cesarean sections, when analyzing by operator (Spearman rho: -0.45; IC95%: -0.788 to -0.0190; p = 0.043). Conclusion: The observed cesarean section rate was 27.9%, and patients with a previous cesarean section are a group where greater efforts can be concentrated to lower the overall rate. Among the operators, users of instrumental delivery had a lower proportion of cesarean sections.

The value of NLR in predicting the efficacy of preoperative nimotuzumab combined with neoadjuvant chemotherapy for local advanced oral squamous cell carcinoma / 口腔疾病防治

Objective@#To investigate the value of the peripheral blood neutrophil to lymphocyte ratio (NLR) before nimotuzumab combined with neoadjuvant chemotherapy in predicting the short-term efficacy of neoadjuvant therapy for advanced oral squamous cell carcinoma (OSCC).@*Methods@#With the approval of the Ethics Committee and the informed consent of the patients, 59 patients with stage Ⅲ and Ⅳ OSCC who were admitted to the Oral and Maxillofacial Surgery Department of the First Hospital of Shanxi Medical University from September 2020 to June 2023 were enrolled. All the patients had complete clinical data, were pathologically diagnosed with squamous cell carcinoma, and received preoperative and received preoperative nimotuzumab + TP (docetaxel + cisplatin) neoadjuvant chemotherapy. The clinical data were analyzed, and the neutrophil and lymphocyte counts in peripheral blood were collected before and after nimotuzumab combined with neoadjuvant chemotherapy. The NLR was calculated, and the threshold value was calculated using the receiver operating characteristic (ROC) curve. Patients were divided into a high NLR group and a low NLR group according to the NLR threshold before nimotuzumab combined with neoadjuvant chemotherapy with TP. The clinical efficacy after nimotuzumab combined with neoadjuvant chemotherapy with TP was evaluated according to the evaluation criteria for solid tumor efficacy, and the correlation between the NLR and recent neoadjuvant therapy efficacy was analyzed. Immunohistochemical staining was used to detect the expression of epidermal growth factor receptor (EGFR) in OSCC tissues before and after nimotuzumab combined with neoadjuvant chemotherapy with TP and to analyze whether the expression of EGFR differed among the different NLR groups.@*Results@#A total of 59 patients with advanced OSCC were included. According to the ROC curve, the NLR threshold was 2.377, and the patients were divided into a <2.377 group (low NLR group), with 24 patients, and a>2.377 group (high NLR group), with 35 patients. The short-term neoadjuvant therapy effect was significantly greater in the lower NLR group than in the higher NLR group (P<0.05); EGFR expression in both the low NLR group and the high NLR group decreased after nimotuzumab combined with neoadjuvant chemotherapy with TP, and the decrease in the low NLR group was significantly greater than that in the high NLR group (P<0.05).@*Conclusion@#A low NLR before nimotuzumab combined with neoadjuvant chemotherapy with TP is associated with better neoadjuvant therapy outcomes, and such patients are more likely to benefit from preoperative nimotuzumab combined with neoadjuvant chemotherapy.

Preparation of an amino hybrid mesoporous silica-based nanotopography protective coating on a titanium implant surface and evaluation of its osteogenic effect / 口腔疾病防治

Objective@#To deposit degradable amino-hybrid mesoporous silica (AHMS) in situ on the surface of titanium nanotube (TNT) and explore its protective effect on nanomorphology and osteogenesis.@*Methods@#TNT and TNT@AHMS were sequentially prepared via an anodizing method: the oil-water two-phase method (experimental group) and the acid-etched titanium method [control group (Ti)]. The parameters for synthesis were explored by changing the silicon source dosage ratio (3∶1, 1∶1, 1∶3); the surface morphology was observed by scanning electron microscope(SEM), hydrophilicity was detected by Water Contact Angle Tester, elemental composition was detected by X-ray photoelectron spectroscopy (XPS); nanoindentation test and ultrasonic oscillator were used to observe the morphological holding effect as mechanical strength of TNT@AHMS in vitro; simulated immersion experiments in vitro was used to observe the degradation behavior of the material. the MC3T3-E1 cell line was used to observe the effect of cell adhesion, proliferation and differentiation on the material; and an SD rat femoral implant model and micro-CT were used to verify the protective effect and osseointegration effect of AHMS on TNT morphology.@*Results@#The morphologies of TNT and TNT@AHMS were successfully prepared, and the silicon source ratio was 1:3. SEM showed that the titanium nanotubes were uniformly covered with AHMS coating, and the mesoporous pore size was about 4 nm. After AHMS was incorporated, the surface of the material was hydrophilic (12.78°), the presence of amino groups (NH2-) was detected, the material was completely degraded within 12 h in vitro, and the active morphology of the TNT was re-exposed with a cumulative silicon release of 10 ppm. Nanoindentation test showed that TNT@AHMS exhibited more ideal surface mechanical strength. SEM revealed that TNT maintains its own morphology under the protection of AHMS, and the TNT group suffered severe exfoliation. In addition, the early adhesion and proliferation rates, ALP activity, and bone volume fraction of cells on the TNT@AHMS surface 4 weeks after implantation were significantly higher than those in the TNT group.@*Conclusion@#By depositing AHMS on the surface of TNT, the nanotopography can be protected. It not only prevents the active base topography from exerting subsequent biological effects but also further endows the material with the ability to promote bone regeneration, laying a foundation for the future development of nanotopography-modified titanium implants.

Effects of the timing of satisfactory sedation with preoperative oral midazolam on anesthesia induction and recovery in children undergoing adenotonsillectomy / 中国临床药理学与治疗学

AIM: To investigate the effect of the timing of satisfactory sedation with preoperative oral midazolam on anesthesia induction and recovery in children undergoing adenotonsillectomy. METHODS: A total of 147 children undergoing elective adenotonsillectomy, with ASA physical status orⅡ, aged 2-7 years were selected from November 2022 to June 2023 in the Second Affiliated Hospital of Wenzhou Medical University. The children were orally administered 0.5 mg/kg midazolam in preoperative waiting area and were divided into 10-20 min (rapid onset, M1 group) and 21-30 min (slow onset, M2 group) based on the satisfactory sedation time, or equal volume of sugar pear drink orally (blank control group, C group). Children in all three groups received a general anesthesia method of propofol+fentanyl combined with sevoflurane induction and sevoflurane maintenance. The primary outcome measures were the induction compliance checklist (ICC) score and the pediatric anesthesia emergence delirium (PAED) score in the post-anesthesia care unit (PACU) to assess the occurrence of emergence agitation (EA), and the secondary outcome measures included the parental separation anxiety scale (PSAS), sedation Ramsay score, surgery duration, recovery time, PACU stay time, discharge time, the incidence of perioperative respiratory adverse events (PRAE) and other adverse events in the ward. RESULTS: 147 children were included in the result analysis, with 49 cases in each group. The proportion of perfect induction (ICC=0) were significantly higher in two M groups than that in group C (95.9% vs. 91.8% vs. 61.2%, P=0.001). The maximum and average PAED score in PACU in group M1 showed a significantly higher (6.4±5.0 vs. 4.4 ± 4.1, P=0.029; 5.2 ± 4.5 vs. 3.4 ± 3.6, P=0.030), and the incidence of EA was significantly higher than those in group C (10.2% vs. 30.6%, P=0.022), and increased compared to the group M2 (OR= 0.581, 95%CI 0.231-1.463, P=0.354). There was no statistically significant difference in the maximum and average PAED scores, incidence of EA between group M2 and group C (P>0.05). The Ramsay score and PSAS score in two M groups were higher, PACU stay time and recovery time was longer than those in group C (P0.05). CONCLUSION: Preoperative oral midazolam can improve the ICC and PSAS scores of children during induction, but it also leads to prolonged recovery time and PACU retention time. The rapid onset of midazolam did not result in better induction and recovery quality, but instead increased the incidence of EA and postoperative pain score.

Adiponectin restores the obesity-induced impaired immunomodulatory function of mesenchymal stromal cells via glycolytic reprogramming

Obesity has been known to negatively modulate the life-span and immunosuppressive potential of mesenchymal stromal cells (MSC). However, it remains unclear what drives the compromised potency of obese MSC. In this study, we examined the involvement of adiponectin, an adipose tissue-derived hormone, in obesity-induced impaired therapeutic function of MSC. Diet-induced obesity leads to a decrease in serum adiponectin, accompanied by impairment of survival and immunomodulatory effects of adipose-derived MSC (ADSC). Interestingly, priming with globular adiponectin (gAcrp) improved the immunomodulatory potential of obese ADSC. Similar effects were also observed in lean ADSC. In addition, gAcrp potentiated the therapeutic effectiveness of ADSC in a mouse model of DSS-induced colitis. Mechanistically, while obesity inhibited the glycolytic capacity of MSC, gAcrp treatment induced a metabolic shift toward glycolysis through activation of adiponectin receptor type 1/p38 MAPK/hypoxia inducible factor-1α axis. These findings suggest that activation of adiponectin signaling is a promising strategy for enhancing the therapeutic efficacy of MSC against immune-mediated disorders.

Comparison of rocuronium priming vs. standard rapid sequence intubation technique in emergency department patients requiring intubation

SUMMARY OBJECTIVE: In our study, we aimed to compare the effect of standard rapid sequence intubation protocol and the application of rocuronium priming technique on the procedure time and hemodynamic profile. METHODS: Patients who applied to the emergency department and needed rapid sequence intubation were included in our study, which we conducted with a randomized controlled design. Randomization in the study was made according to the order of arrival of the cases. Rapid sequence intubation was performed in the standard group. In the priming group, 10% of the rocuronium dose was administered approximately 3 min before the induction agent. Intubation time, amount of drug used, vital signs, and end-tidal CO2 level before and after intubation used to confirm intubation were recorded. RESULTS: A total of 52 patients were included in the study, of which 26 patients were included in the standard group and 26 patients in the priming group. While intubation time was 121.2±21.9 s in the standard group, it was calculated as 68.4±11.6 s in the priming group (p<0.001). While the mean arterial pressure was 58.3±26.6 mmHg in the standard group after intubation, it was 80.6±21.1 mmHg in the priming group (p=0.002). CONCLUSION: It was observed that priming with rocuronium shortened the intubation time and preserved the hemodynamic profile better. Clinical Trial Registration Number: NCT05343702.

Evaluation of proactive therapeutic drug monitoring application in infliximab users in ulcerative colitis

Objective: To evaluate the application of proactive pro-drug therapy (TDM) at week six in users of infliximab therapy in ulcerative colitis patients and to analyze the need for further disease optimization. Method: This is a retrospective analysis that will be carried out simultaneously at the Hospital de Clínicas de Passo Fundo and at the Endoclin Diagnostic Center in the city of Passo Fundo, with secondary data collection between January 2020 and May 2022. The sample included patients from both sexes, regardless of age, who are being followed up in the services mentioned above, by signing the informed Free and Clarified Consent Term. Results: 63.2% of patients required optimization of their treatment based on the serum level assessment at week six. Conclusion: Proactive TDM performed at week six benefits patients in order to complete indications for treatment to avoid lack of drug response and complications from the disease. (AU)

Los desencadenantes reflejos en la epilepsia mioclónica juvenil / Reflex triggers in juvenile myoclonic epilepsy

Resumen Introducción : La epilepsia mioclónica juvenil (EMJ) es un síndrome epiléptico de inicio en la infancia y ado lescencia con mioclonías, convulsiones tónico-clónicas generalizadas y ausencias. Los estímulos reflejos como la sensibilidad a la luz o fotosensibilidad, la apertura y cierre palpebral y la inducción por praxias producen descargas epileptiformes y crisis. Estos desencadenan tes reflejos no son todos sistemáticamente estudiados. Objetivo : Examinar los rasgos reflejos en pacientes con EMJ. Métodos : Se evaluaron en forma consecutiva 100 adolescentes y adultos con EMJ que recibían diferentes tratamientos anticrisis. Se realizó un electroencefalogra ma standard con un protocolo de estimulación luminosa intermitente (ELI) y otro para la evaluación de las pra xias a través de una actividad neurocognitiva (ANC). El análisis estadístico fue descriptivo y de correlación. Se consideró significativa una p > 0.05. Resultados : La edad actual fue de 28+/-11 (14-67). Las crisis comenzaron a los 15 años +/-3 (Rango 8-25 años). EL 58% presentaron mioclonías y convulsiones tónico clónicas generalizadas. El 50% recibían ácido valproico y el 31% continuaban con crisis. Descargas epileptiformes en reposo 20%; hiperventilación 30%; apertura y cierre palpebral 12%; respuesta fotoparoxística en la ELI 40%; ANC 23%. Mayor porcentaje de descargas y demora en la realización de la ANC en los que presentaban crisis. El ácido valproico comparado con los otros fármacos no demostró superioridad en el control de las crisis. Conclusiones : Estos hallazgos confirman la importan cia del estudio de los rasgos reflejos para el diagnóstico, seguimiento y el control terapéutico.

Abstract Introduction : Juvenile myoclonic epilepsy (JME) is an epileptic syndrome with onset in childhood and adolescence with myoclonus, absences, and generalized tonic-clonic seizures. Reflex stimuli such as sensitivity to light or photosensitivity, eyelid opening and closing, and praxis induction produce epileptiform discharges and seizures. These reflex triggers are not all system atically studied. Objective : Examine reflex features in patients with JME. Methods : One hundred adolescents and adults with JME who received different anti-seizure treatments were evaluated consecutively. A standard electroen cephalogram was performed with an intermittent light stimulation (SLI) protocol and another for the evaluation of praxias through neurocognitive activity (CNA). The statistical analysis was descriptive and of correlation with a p > 0.05. Results : Current age was 28+/-11 (14-67). The seizure began at 15 years +/-3 (Range 8-25 years). They pre sented myoclonus and generalized tonic-clonic seizures in 58%. 50% received valproic acid and 31% continued with seizures. Epileptiform discharges at rest 20%; hy perventilation 30%; eyelid opening and closing 12%; photoparoxysmal response in SLI 40%; CNA 23%. Higher percentage of discharges and delay in performing CNA in those who presented seizures. Valproic acid com pared to other drugs did not demonstrate superiority in seizure control. Conclusions : These findings confirm the importance of studying reflex traits for diagnosis, follow-up, and therapeutic control.

Modelos murinos para el estudio de cáncer de mama triple negativo / Murine models for the study of triple negative breast cancer

RESUMEN El estudio de diferentes variables, como patogénesis, perfil inflamatorio, identificación de blancos terapéuticos, eficacia de tratamientos en modelos murinos ha resultado uno de los más prácticos para el estudio preclínico del cáncer de mama triple negativo (CMTN), el subtipo de cáncer más agresivo, con limitada aplicación de tratamientos y baja tasa de sobrevivencia. Sin embargo, hay que reconocer que existen otros menores en los que se viene estandarizando la inducción del CMTN. En esta revisión se engloban los diferentes métodos de inducción que han permitido el desarrollo de CMTN y las aplicaciones terapéuticas más relevantes por el que se desarrollaron los modelos murinos con CMTN.

ABSTRACT The study of different variables, such as pathogenesis, inflammatory profile, identification of therapeutic targets, efficacy of treatments in murine models has proven to be one of the most practical for the preclinical study of triple negative breast cancer (TNBC), the most aggressive subtype of cancer, with limited application of treatments and low survival rate. However, it must be recognized that there are other minors in which the induction of TNBC is being standardized. This review encompasses the different induction methods that have allowed the development of TNBC and the most relevant therapeutic applications by which murine models with TNBC were developed.

The impact of universal induction therapy on early hospital readmission of kidney transplant recipients / O impacto da terapia de indução universal na readmissão hospitalar precoce de receptores de transplante renal

ABSTRACT Background: Early hospital readmission (EHR) is associated with worse outcomes. The use of anti-thymocyte globulin (rATG) induction therapy is associated with increased efficacy in preventing acute rejection, although safety concerns still exist. Methods: This retrospective single-center study compared the incidence, causes of EHR, and one-year clinical outcomes of patients receiving a kidney transplant between August 18, 2011 and December 31, 2012 (old era), in which only high-risk patients received 5 mg/kg rATG, with those transplanted between August 18, 2014 and December 31, 2015 (new era), in which all patients received a single 3 mg/kg dose of rATG. Results: There were 788 patients from the Old Era and 800 from the New Era. The EHR incidence in the old era patients was 26.4% and in the new era patients, 22.5% (p = 0.071). The main cause of EHR in both eras was infection (67% vs. 68%). The incidence of acute rejection episodes was lower (22.7% vs 3.5%, p < 0.001) and the one-year patient survival was higher (95.6% vs. 98.1%, vs. p = 0.004) in new era patients. Conclusion: The universal use of 3 mg/kg rATG single-dose induction therapy in the new era was associated with a trend towards reduced EHR and a reduction in the incidence of acute rejection and mortality.

Resumo Histórico: A Readmissão Hospitalar Precoce (RHP) está associada a piores desfechos. O uso de terapia de indução com globulina antitimócito (rATG, por sua sigla em inglês) está associado ao aumento da eficácia na prevenção de rejeição aguda, embora ainda existam preocupações quanto à segurança. Métodos: Este estudo retrospectivo de centro único comparou a incidência, as causas da RHP e os desfechos clínicos de um ano de pacientes que receberam transplante renal entre 18 de Agosto de 2011 e 31 de Dezembro de 2012 (Antiga Era), em que apenas pacientes de alto risco receberam 5 mg/kg de rATG, com aqueles transplantados entre 18 de Agosto de 2014 e 31 de Dezembro de 2015 (Nova Era), em que todos os pacientes receberam uma única dose de 3 mg/kg de rATG. Resultados: Houve 788 pacientes da Antiga Era e 800 da Nova Era. A incidência de RHP nos pacientes da antiga era foi de 26,4% e nos pacientes da nova era, 22,5% (p = 0,071). A principal causa de RHP em ambas as eras foi infecção (67% vs. 68%). A incidência de episódios de rejeição aguda foi menor (22,7% vs. 3,5%; p < 0,001) e a sobrevida do paciente em um ano foi maior (95,6% vs. 98,1%; vs. p = 0,004) em pacientes da nova era. Conclusão: O uso universal de terapia de indução de 3 mg/kg de rATG em dose única na nova era foi associado a uma tendência à redução da RHP e a uma redução na incidência de rejeição aguda e mortalidade.

Chemical and sensory assessment of extra virgin olive oil blends with omega-3 polyunsaturated fatty acids from plant origin

Extra virgin olive oil (EVOO) is known for its health benefits, although it provides a minimum amount of n-3 polyunsaturated fatty acids (n-3 PUFA), which play an important role in the human organism. In this study, EVOO was blended with vegetable oils which are rich sources of n-3 PUFA alpha-linolenic acid (ALA) and/or stearidonic acid (SDA) (chia, walnut, linseed and viper's bugloss seed oils). Fatty acid profiles, induction time, and organoleptic characteristics of the resulting blends were assessed. The n-3 PUFA enrichment in the blends was proportional to the degree of blending. Sensory analysis carried out by a trained panel showed that it is possible to enrich EVOO with up to 20% chia, linseed and viper's bugloss seed oil without altering the original organoleptic characteristics of EVOO. However, the induction time of the blends was significantly reduced compared with EVOO even after adding n-3 PUFA in small proportions, meaning that shelf-life time of these blends is much lower than that of EVOO, which should be considered when preparing these products for commercial purposes.

El aceite de oliva extra virgen (AOEV) es ampliamente conocido por sus beneficios para la salud, aunque apenas aporta ácidos grasos poliinsaturados n-3 (AGPI n-3), los cuales juegan un papel importante en el organismo humano. En este estudio se elaboraron mezclas de AOEV con aceites vegetales ricos en ácido alfa-linolénico (ALA) y/o estearidónico (SDA) (chia, nuez, linaza y viborera). Se evaluaron los perfiles de ácidos grasos, tiempos de inducción y características organolépticas de las mezclas resultantes. El enriquecimiento en AGPI n-3 fue proporcional al grado de mezcla. El análisis sensorial llevado a cabo por un panel entrenado mostró que es posible enriquecer AOEV con hasta un 20% de aceite de chia, linaza o viborera sin alterar las características organolépticas originales del AOEV. Sin embargo, los tiempos de inducción de las mezclas fueron significativamente menores que el del AOEV, incluso tras añadir AGPI n-3 en pequeñas proporciones, lo que significa que el tiempo de vida media de las mezclas es mucho menor que el del AOEV. Este hecho debería tenerse en cuenta al preparar las mezclas con propósitos comerciales.

Randomized and controlled trial to determine safety and efficacy of Foley’s catheter and PGE2 gel for induction of labor

Background: The goal of obstetrics is a pregnancy that results in a healthy infant and a healthy mother. During medical or obstetrics complications of pregnancy, cervical ripening and induction of labor are often required. Different methods are available for that. Aims and Objectives: Randomized and control trial has been conducted to determine safety and efficacy of Foley’s catheter and prostaglandin E2 (PGE2) gel for induction of labor. Materials and Methods: Randomized and controlled trial has been conducted on 200 study participant who fullfield inclusion criteria in Department of Obstetrics and Gynaecology, GMERS Medical College, Sola during the period of July 2017–July 2019. Statistical analysis was done by descriptive statistics and qualitative method. Results: Both groups cerviprim and Foley’s catheter are comparable for cervical ripening for induction of labor in terms of safety and efficacy as there was no statistically significant observation for obstetric and perinatal outcome. Conclusion: Foley’s catheter is equally dependable method for cervical ripening for induction of labor as cerviprim gel as it is cost effective and easily available.

A comparison between propofol and sevoflurane for easy insertion of laryngeal mask airway among adults in minor elective surgeries: An observational study

Background: The laryngeal mask airway (LMA) has reached ample popularity for the management of airway during surgery. Propofol, used as induction agent, causes change in blood pressure and heart rate (HR) while insertion of LMA. Sevoflurane, whereas, has the potential to be a good induction agent as propofol. We have compared propofol and sevoflurane for easy insertion of LMA among adults in minor surgeries. Aim and Objectives: The primary objective of the study was to compare the ease of insertion of LMA and its characteristics related to insertion among adults in minor elective surgeries using intravenous propofol or inhalational sevoflurane. While time taken to set induction and actual event of LMA insertion along with number of attempts, jaw relaxation time, LMA insertion time, apnea time, monitoring hemodynamic changes, and occurrence of complications were taken as secondary objectives. Materials and Methods: It was a prospective and observational study done in Department of Anesthesiology and Operation Theaters of Fortis Hospital, Kolkata, after getting ethical approval. Total 100 patients were recruited by consecutive sampling and divided into two groups - P (propofol) and S (sevoflurane) group. Anesthesia induction time, jaw relaxation time, LMA insertion time, etc. were noted. LMA insertion conditions were assessed by a 3-point scale using six variables, total score was calculated for each group. Hemodynamic parameters and induction complications were also recorded. Results: There was no significant difference in demographic parameters, American Society of Anesthesiologists class, Modified Mallampati Grading, and LMA size, between the groups. LMA insertion time was comparable between the two groups. Regarding complications, there was no incidence of coughing while minor gagging (4%) and laryngospasm (6%) were noted only with sevoflurane. Final summation of scores showed excellent insertion characteristics with propofol (94%) and sevoflurane (84%), respectively, with no significant difference. Conclusion: Inhalational sevoflurane may be regarded as a viable alternative to inj. propofol for insertion of laryngeal mask among adults in minor elective surgeries.

Programmed ventricular stimulation in structural heart disease: Implications of patterns of ventricular arrhythmias induced to long-term outcomes

Introduction: Currently available data gives some credence to utility of VT induction studies in patients with stable ischemic cardiomyopathy, there are some unresolved questions as to define sensitive threshold for low-risk and the prognostic relevance of ill sustained or non-specific tachycardia on induction study. We evaluated potential ability of VT inducibility to predict likelihood of SHD (Structural heart disease) patients for subsequent arrhythmic or adverse cardiac events. Material and Methods: All consecutive patients with syncope/documented arrhythmia who had VT induction done were included and patients with VT storm, ACS,uncontrolled HF were excluded. We studied in 4 groups-monomorphic VT, sustained polymorphicVT, ill sustainedVT/VF and no VT/VF induced. The primary-endpoints were e Sudden death, all-cause mortality and secondary-endpoints were e MACE (AICD shock, death,HF, recurrence of VT). We screened 411 patients and included 169 within inducible (n ¼ 79) and non-inducible group (n ¼ 90). Results: There were a higher number of patients with coronary artery disease, LV dysfunction, patients on amiodarone in inducible group and no difference in usage of beta-blockers. Recurrence of VT, composite of MACE was significantly higher in inducible group (p < 0.05). Mortality was not different in 3 groups compared with no VT/VF group. We found that monomorphic VT group had significantly higher MACE as compared to others and also predicted recurrence of VT and AICD shock and showed a trend towards significance for prediction of mortality. Inducible patients on AICD had mortality similar to noninducible group. Conclusion: Induction of monomorphicVT/polymorphicVT with 3extrastimuli is associated with a higher number of MACE events on follow up. Induction of monomorphicVT predicts recurrence of VT/ICD shock.

Safety of levofloxacin as an antibiotic prophylaxis in the induction phase of children newly diagnosed with acute lymphoblastic leukemia: an interim analysis of a randomized, open-label trial in Brazil

ABSTRACT Background: Despite high cure rates, treatment-related mortality in children with acute lymphoblastic leukemia (ALL) remains significant. About 4% of patients die during remission induction therapy and approximately two-thirds of treatment-related deaths are due to infectious complications. Methods: From May 2021 to June 2022, children aged one through 18 years, with a recent diagnosis of ALL, admitted to three pediatric oncology centers in Brazil, were enrolled in this multicenter, open-label, randomized, phase 3 clinical trial. Eligible patients were randomly divided into two groups, based on a 1:1 allocation ratio, to receive, or not, levofloxacin as a prophylactic agent during the induction phase. All patients were treated according to the IC-BFM 2009 chemotherapy protocol. Primary endpoints were carbapenemase-producing Enterobacteriaceae (CPE) colonization, Clostridioides difficile diarrhea, and other adverse events related to the use of levofloxacin. The secondary endpoint was febrile neutropenia during induction. The median follow-up was 289 days. Results: Twenty patients were included in this trial, 10 in each group (control and levofloxacin). Mild adverse reactions related to levofloxacin were observed in three patients (30%). Three patients had Clostridioides difficile diarrhea, two in the levofloxacin group and one in the control group (p > 0.99). Only one patient presented colonization by CPE. This patient belonged to the levofloxacin group (p > 0.99). Nine patients presented febrile neutropenia, five in the control group and four in the levofloxacin intervention group (p > 0.99), one patient died due to febrile neutropenia. Conclusion: The use of levofloxacin was shown to be safe in the induction phase in children with de novo ALL. The use of this medication did not increase the rate of colonization by CPE nor the rate of diarrhea by C. difficile. All adverse reactions were mild and remitted either spontaneously or after switching medicine administration from oral to intravenous route.

Advances in clinical research on drug-induced acute interstitial nephritis / 中国临床药理学与治疗学

The kidneys are one of the main excretory organs for drugs and when drugs are not excreted effectively, they can accumulate in the kidneys or in the interstitial tubules, leading to drug-induced kidney injury. The tubulointerstitium accounts for 80% of the volume of the kidney and is the primary site of response to various types of renal injury. This article focuses on drug-induced acute interstitial nephritis, highlighting its clinical symptoms, listing common induction drugs, analysing pathological features, and explaining its pathogenesis from the perspective of immune response, with the aim of providing a basic and clinical evidence for subsequent studies.

Comparison of different laryngeal preservation strategies based on chemoradiotherapy in locally advanced hypopharyngeal carcinoma / 临床耳鼻咽喉头颈外科杂志

Objective:This study aimed to evaluate the clinical features and treatment outcomes of the value of response-adapted treatment following radiotherapy and induction chemotherapy follwing subsequent comprehensive therapy in patients with resectable locally advanced hypopharyngeal carcinoma. Methods:This cohort study was conducted from September 2010 to September 2020 in our hospital, 231 patients pathologically confirmed stage Ⅲ and ⅣB resectable locally advanced hypopharyngeal carcinoma included. For the IC-directed ART strategy, IC is used to select good candidates to receive radical RT or CCRT, and others undergo surgery. He response-adapted strategy was determined based on the primary tumor response, which was evaluated at a dose of 50 Gy. If the response reached complete response or partial response（more than 80% tumor regression）, patients received radical RT or CCRT; otherwise, they received surgery, if possible, at 4 to 6 weeks after RT. The end points of the study were OS（overall survival）, progression free survival（PFS）, locoregional recurrence-free survival（LRRFS） and LDFS. Results:In IC-directed group, 75.0%（57/76） patients reached PR after 2 cycles of induction chemotherapy. While in RT-directed group, 70.3%（109/155） patients reached large PR at dose of 50 Gy. The median interquartile range follow-up period of the whole cohort was 63.8 months. The 5-year OS, PFS, LRRFS and SFL of the whole cohort were 47.9%、39.6%、44.3% and 36.2%, respectively. In evaluations based on the different treatment strategies, the 5-year OS and SFL were 51.3% versus 37.0%（HR 0.67; 95%CI 0.43-1.05; P=0.07） and 27.8% versus 39.8%（HR 0.68; 95%CI 0.46-0.99; P=0.04） between IC-directed and RT-directed groups. In additional, surgery complications did not significantly differ between these two groups. Conclusion:In this cohort study, the response-adapted strategy based on an early RT response facilitated better treatment tailoring, and higher laryngeal preservation compared with IC-directed strategies. This approach could provide a feasible laryngeal preservation strategy in patients with resectable locally advanced hypopharyngeal carcinoma.

Effect evaluation of reference-induced blended teaching method in medical statistics / 上海预防医学

ObjectiveTo explore the effects and satisfaction of reference-induced blended teaching method in medical statistics teaching for undergraduate students in clinical medicine. MethodA total of 83 clinical medical undergraduate students from the class of 2018 at the Tongji University School of Medicine were enrolled into the study. The effect evaluation of blended teaching based on reference-induced self education （RISE） in the course of medical statistics was conducted. A self-designed questionnaire was used to assess student satisfaction. ResultsCompared with the traditional teaching method group， students’ distinguished achievement rate and pass rate in total score from RISE blended teaching group were 53.7% and 96.3%， respectively， and 83.3% students were satisfied with the overall effect. The RISE blended teaching method had higher satisfaction in stimulating learning interest （90.7% satisfaction rate， P=0.034） and cultivating scientific research ability （96.3% satisfaction rate， P=0.048）. ConclusionThe RISE blended teaching method， which integrates literature guidance with online and offline approaches， organically combines statistical knowledge with clinical research problems. It yields positive results in medical statistics education， stimulating learning interest， and fostering innovative scientific research abilities.

Establishment and Evaluation of Animal Models of Chronic Fatigue Syndrome / 中国实验方剂学杂志

Chronic fatigue syndrome （CFS） is a heterogeneous disease with dysfunction in multiple systems and multiple organs. Its etiology and pathogenesis have not been fully clarified， and its treatment also lacks specificity. The key to studying CFS is developing animal models that reflect the underlying mechanisms and etiology of CFS. The existing CFS modeling methods are complicated and not unified. By sorting out relevant literature，the present study evaluated the modeling methods，modeling standards，mechanisms， and clinical coincidence of the immune model，the stress model， and the disease-syndrome combination model in traditional Chinese medicine （TCM）. The immune model is mainly constructed from the perspective of pathophysiology， with easy operation and wide investigation， which can simulate the pathological characteristics of CFS to ensure pathogenesis research，but the experimental repeatability is general. Stress modeling is a common method for a variety of neuropsychiatric diseases，including CFS. Many different stressors can be employed to investigate the etiology of CFS， but their effects are unpredictable. Compared with the two western medicine models mentioned above，the TCM disease-syndrome combination model integrates modern medicine with TCM theory，with high clinical coincidence and great practical value. However，the TCM disease-syndrome combination model of CFS is still in the exploratory stage with a few types of models，which needs to be further improved， aiming to establish scientific，reasonable，simple， and efficient animal models to provide support for exploring the etiology，pathogenesis， and new treatment ideas of CFS.

Effect of Mingjing Granules on Fibrovascular Membrane of Wet Age-related Macular Degeneration Based on Macrophages and Glial Cells / 中国实验方剂学杂志

ObjectiveTo investigate the effects of Mingjing granules （MJKL） on the fibrovascular membrane of experimental wet age-related macular degeneration （nAMD） based on macrophages and glial cells and further explain the mechanism of MJKL in the treatment of nAMD. MethodThe experimental nAMD fibrovascular membrane model was established by two-stage laser photocoagulation. BN rats were randomly divided into three groups： model group， anti-vascular endothelial growth factor （VEGF） group， and MJKL + anti-VEGF group. The model group was given distilled water for intragastric administration. Anti-VEGF group was injected with leizumab injection in the vitreous cavity. MJKL + anti-VEGF group was injected with leizumab injection in the vitreous cavity， and MJKL was intragastrically administered. Ten normal BN rats were not modeled and fed as controls. After 40 days of model making， fundus lesion morphology， lesion exudation area， and MD value were observed by fundus photography （FP）， fundus angiography （FFA）， optical coherence tomography （OCT）， and retinal pigment epithelium （RPE）-choroid-sclera film. The changes in retinal structure were observed by histopathology， and the expression and distribution of F4/80， Iba-1， and GFAP were detected by immunofluorescence. The relative expression levels of F4/80， Iba-1， and GFAP mRNA were detected by real-time fluorescence quantitative polymerase chain reaction （Real-time PCR）. ResultThe fibrovascular membrane model was established 40d after two-stage laser modeling. The lesion exudation area， MD value， lesion height， and lesion area in the anti-VEGF group were significantly lower than those in the model group （P<0.05）， and the retinal structural damage degree was significantly improved. Compared with the anti-VEGF group， the MJKL + anti-VEGF group significantly decreased the MD value， lesion height， and lesion area （P<0.05）， and lesion area and retinal structural damage degree were significantly improved. The fluorescence intensity of F4/80 and Iba-1 in the model group was significantly higher than that in the normal group （P<0.05）， and that in the anti-VEGF group was significantly lower than that in the model group （P<0.05）. The fluorescence intensity in the MJKL + anti-VEGF group was significantly lower than that in the anti-VEGF group （P<0.05）. The fluorescence intensity of GFAP in the model group was significantly higher than that in the normal group （P<0.05）， and that in the anti-VEGF group was significantly lower than that in the model group （P<0.05）. The relative expression levels of F4/80， Iba-1， and GFAP mRNA in the model group were significantly increased compared with the normal group （P<0.05）， and the anti-VEGF group was significantly decreased compared with the model group （P<0.05）. The relative expression levels of F4/80， Iba-1， and GFAP mRNA in the MJKL + anti-VEGF group were significantly decreased compared with those in the anti-VEGF group （P<0.05）. ConclusionMJKL combined with anti-VEGF drugs can inhibit the growth of experimental nAMD fibrovascular membrane better than anti-VEGF drugs alone， and the mechanism may be related to inhibiting the participation of macrophages and glial cells in the formation of fibrovascular membrane.