A clinical cross-sectional study of resting energy expenditure in children with cerebral palsy / 中华实用儿科临床杂志

Objective:To investigate the characteristics of resting energy expenditure (REE) in children with cerebral palsy (CP) graded with different levels of Gross Motor Function Classification System (GMFCS), and to evaluate the accuracy and association of commonly used REE prediction formulas in children with CP.Methods:It was a retrospective study involving 36 children with CP aged 24-144 months who visited the Third Affiliated Hospital of Zhengzhou University between September 2021 and August 2022.REE was measured by the indirect calorimetry.Based on the GMFCS, children with CP were divided into grade Ⅰ-Ⅱ group (20 cases), grade Ⅲ group (6 cases) and grade Ⅳ-Ⅴ group(10 cases). During the same period, 11 age-matched healthy children were included in control group.The measured REE (MREE) between children with CP and healthy controls was compared.Predicted REE (PREE) calculated by the Harris-Benedict, WHO, Schofield-W, Schofield-WH and Oxford prediction formulas were compared with MREE in children for their consistency and correlation.Independent samples were analyzed using t-test or Mann- Whitney U test, and categorical data were analyzed using Chi- square test.Using paired t-test and Pearson linear correlation analysis to analyze the correlation between MREE and PREE.The accuracy of PREE values calculated by different formulas was assessed using the root mean square error. Results:The MREE in control group and children with CP were (952.18±270.56) kcal/d and (801.81±201.89) kcal/d, respectively.There was no significant difference in the MREE between grade Ⅰ-Ⅱ group versus control group[(868.30±194.81) kcal/d vs.(952.18±270.56) kcal/d, P>0.05], and grade Ⅲ group versus control group [(813.17±192.48) kcal/d vs.(952.18±270.56) kcal/d, P>0.05]. The MREE was significantly lower in grade Ⅳ-Ⅴ group than that of control group [666.00(513.50, 775.50) kcal/d vs.(952.18±270.56) kcal/d, P=0.011]. There were no significant difference between MREE and PREEs calculated by Harris-Benedict, WHO, Schofield-W, Schofield-WH, and Oxford (all P>0.05). The correct classification fraction calculated by the 5 formulas were 33.3%, 47.2%, 41.7%, 47.2%, and 41.7%, respectively.The r values of the consistency of PREE calculated by the 5 formulas were 0.585, 0.700, 0.703, 0.712, and 0.701, respectively.The Blande-Altman Limits of Agreement were (-297.77, 359.22), (-245.60, 326.94), (-250.62, 316.05), (-242.22, 177.36) and (-241.28, 325.81), respectively.The clinically acceptable range was -80.18 to 80.18 kcal/d.The root mean square error were 168.09 kcal/d, 149.64 kcal/d, 146.24 kcal/d, 144.23 kcal/d and 148.77 kcal/d, respectively. Conclusions:The MREE values decreased significantly in children with CP classified as CMFCS grade Ⅳ and Ⅴ.When REE cannot be regularly monitored by indirect calorimetry to develop nutritional support programs, children with CP may be prioritized to estimate REE using the prediction formula of Schofield-WH.

Benchmark Dose Assessment for Coke Oven Emissions-Induced Mitochondrial DNA Copy Number Damage Effects / 生物医学与环境科学（英文）

OBJECTIVE@#The study aimed to estimate the benchmark dose (BMD) of coke oven emissions (COEs) exposure based on mitochondrial damage with the mitochondrial DNA copy number (mtDNAcn) as a biomarker.@*METHODS@#A total of 782 subjects were recruited, including 238 controls and 544 exposed workers. The mtDNAcn of peripheral leukocytes was detected through the real-time fluorescence-based quantitative polymerase chain reaction. Three BMD approaches were used to calculate the BMD of COEs exposure based on the mitochondrial damage and its 95% confidence lower limit (BMDL).@*RESULTS@#The mtDNAcn of the exposure group was lower than that of the control group (0.60 ± 0.29 vs. 1.03 ± 0.31; P < 0.001). A dose-response relationship was shown between the mtDNAcn damage and COEs. Using the Benchmark Dose Software, the occupational exposure limits (OELs) for COEs exposure in males was 0.00190 mg/m 3. The OELs for COEs exposure using the BBMD were 0.00170 mg/m 3 for the total population, 0.00158 mg/m 3 for males, and 0.00174 mg/m 3 for females. In possible risk obtained from animal studies (PROAST), the OELs of the total population, males, and females were 0.00184, 0.00178, and 0.00192 mg/m 3, respectively.@*CONCLUSION@#Based on our conservative estimate, the BMDL of mitochondrial damage caused by COEs is 0.002 mg/m 3. This value will provide a benchmark for determining possible OELs.

Automutilações: uma problemática dos limites / Self-mutilations: a problem of limits / Les automutilations: une problématique des limites / Automutilaciones: una problemática de límites

O objetivo do presente artigo é analisar a estreita relação entre o fenômeno das automutilações e a problemática dos limites, tendo como ponto de partida o ataque à pele como condição de possibilidade para essa prática. A pele remete à sensorialidade e às primeiras noções de eu, tendo como função proteger nossa individualidade e fundamentar nossa troca com o outro. Ela contém uma premissa de integração, constituindo-se como uma fronteira que marca os limites da própria existência. Nas automutilações, a agressão à pele denuncia um prejuízo na construção da diferenciação entre sujeito e objeto, deixando em evidência uma confusão nos limites do sujeito. Nossa hipótese é a de que o recurso ao corpo, mais especificamente o ataque à pele, nas automutilações, surge como uma tentativa de contenção do eu em momentos nos quais o sujeito sente que pode haver o risco da perda da integridade narcísica.

Resumos This paper analyzes the close relationship between self-mutilation and the problem of limits, understanding the attack on the skin as a condition of possibility for this practice. The skin, which leads us to sensoriality and the first notions of self, acts to protect our individuality and support our interactions with the Other. It contains a premise of integration, constituting a boundary that marks the limits of existence itself. In self-mutilations, the attack on the skin reveals a loss in the the differentiation between subject and object, revealing a confusion in the subject's limits. The text posits that the recourse of the body, by attacking the skin, in self-mutilations, emerges as an attempt to contain the self in moments when the subject feels at risk of losing their narcissistic integrity.

Cet article analyse la relation étroite entre le phénomène d'automutilation et le problème des limites, en comprenant l'attaque de la peau comme une condition de possibilité de cette pratique. La peau, qui renvoie à la sensorialité et aux premières notions de soi, agit pour protéger notre individualité et soutenir nos interactions avec l'Autre. Elle contient une prémisse d'intégration, constituant une frontière qui marque les limites l'existence elle-même. Dans les automutilations, l'atteinte à la peau révèle une perte dans la construction de la différenciation entre sujet et objet, témoignant d'une confusion dans les limites du sujet. Le texte postule que le recours au corps, en attaquant la peau, dans les automutilations, émerge comme une tentative de contenir le soi dans les moments où le sujet sent en danger de perdre son intégrité narcissique.

El objetivo de este artículo es analizar la estrecha relación entre el fenómeno de las automutilaciones y el problema de los límites, teniendo como punto de partida el ataque a la piel como condición de posibilidad para esta práctica. La piel se refiere a la sensorialidad y a las primeras nociones del yo, teniendo como función proteger nuestra individualidad y fundamentar nuestro intercambio con el otro. Contiene una premisa de integración, constituyendo una frontera que marca los límites de la existencia misma. En las automutilaciones, la agresión a la piel revela una pérdida en la construcción de la diferenciación entre sujeto y objeto, evidenciando una confusión en los límites del sujeto. Nuestra hipótesis es que recurrir al cuerpo, más específicamente atacar la piel, en las automutilaciones, aparece como un intento de contener al yo en momentos en los que el sujeto siente que puede haber riesgo de pérdida de la integridad narcisista.

Liver histopathological changes in chronic HBV infection patients with alanine aminotransferase at different upper limits of normal value / 中华临床感染病杂志

Objective:To investigate the pathological characteristics in chronic HBV infection patients with different upper limits of alanine aminotransferase (ALT) normal values and the influencing factors of liver tissue injury.Methods:The clinical data of 667 chronic HBV infection patients with ALT<40 U/L and HBV DNA loads >30 IU/mL who received liver biopsy in Zhenhai District Hospital of Traditional Chinese Medicine and Hwa Mei Hospital from January 2014 to December 2020 were retrospectively analyzed. The enrolled patients were divided into ALTⅠ group (<30 U/L for males, <19 U/L for females), ALTⅡ group (≥30 U/L and <35 U/L for males, ≥19 U/L and <25 U/L for females) and ALT Ⅲ group (≥35 U/L and <40 U/L for males, ≥25 U/L and <40 U/L for females). According to the degree of liver inflammation (G) and fibrosis stage (S), the enrolled patients were divided into non-significant damage group (G<2 and S<2) and significant damage group (≥G2 or/and ≥S2). Ridit analysis was used to compare the G/S composition ratio among three ALT groups, Logistic regression was used to analyze the risk factors of liver injury, the receiver operating characteristic curve (ROC) and the area under the curve (AUC) were used to analyze the optimal diagnostic threshold of ALT.Results:There were significant differences in the composition ratio of G and S among the three ALT groups( χ2=13.926 and 14.702, both P<0.001). The constituent ratios of significant liver pathological damage in the three groups of ALT levels were 26.05% (99/380), 32.03% (41/128) and 46.54% (74/159), respectively( χ2=21.596, P<0.001). Multivariate logistic regression analysis showed that high white/globulin ratio and PLT counts( OR=0.246 and 0.986, both P<0.001)were the protective factors for liver tissue injury; while negative HBcAg staining and elevated ALT and GGT levels ( OR=3.797, 1.053 and 1.013, P<0.001 or <0.05) were the risk factors of liver injury. ROC curve demonstrated the ALT threshold of liver tissue damage in male and female patients were 25.6 U/L and 25.5 U/L. Conclusions:In chronic HBV infection patients with normal ALT, with the increase of ALT level, the degree of liver tissue pathological damage may become more severe. The study demonstrates that it is necessary to lower the ALT threshold for protecting patients from liver tissue pathological damage.

O princípio da partilha de saberes científicos vs. propriedade intelectual: a propósito das patentes farmacêuticas no contexto da pandemia de COVID-19 / The principle of sharing scientific knowledge vs. intellectual property: Regarding pharmaceutical patents in the context of the COVID-19 pandemic / El principio de compartir conocimiento científico vs. propiedad intelectual: Respecto a las patentes farmacéuticas en el contexto de la pandemia COVID-19

O direito de propriedade intelectual tem as suas exceções e os seus limites internos, previstos na lei. Nos últimos tempos, vem crescendo a discussão da sua compressão à luz de princípios gerais, como o interesse público, a liberdade de expressão ou a saúde pública. Dir-se-ia, pois, que estes direitos têm, também, uma função social, para além da proteção das prerrogativas dos seus titulares, o que é verdadeiro, sobretudo, para as patentes farmacêuticas. Grande parte desta discussão sempre passou, na verdade, pelas patentes farmacêuticas, sua concessão e exploração, em especial no que tange às patentes biotecnológicas. Esta discussão mais e mais se exacerbou quanto às patentes das vacinas destinadas ao tratamento contra a COVID-19. Não falta quem queira lançar mão dos meios previstos nas leis nacionais e internacionais para compelir às licenças obrigatórias das patentes e, até, à sua expropriação. Em causa, podem estar, no entanto, outros aspetos, como contratos mal negociados pela Comissão da União Europeia com algumas empresas farmacêuticas e os problemas logísticos na produção de vacinas. Por outro lado, centrar a discussão nas patentes poderá ser redutor, uma vez que há outros aspetos da propriedade intelectual a considerar. Contudo, a resposta estará, muito provavelmente, no equilíbrio entre os direitos dos titulares de patentes e o interesse público.

Intellectual property law has its exceptions and internal limits, as provided by law. In recent times, there has been a growing discussion of its compression in the light of general principles, such as public interest, freedom of expression or public health. It would be said, therefore, that these rights also have a social function, in addition to protecting the rights of their holders, which is especially true for pharmaceutical patents. Much of this discussion has always, in fact, passed through pharmaceutical patents, their granting and exploitation, especially regardingbiotechnological patents. This discussion has become increasinglyexacerbated regardingthe patents on vaccines intended for treatment against COVID-19. There is no shortage of people who want to use the means provided by national and international laws to compel mandatory patent licenses and even their expropriation. At issue, however, may be other aspects, such as contracts poorly negotiated by the European Union Commission with pharmaceutical companies and logistical problems in the production of vaccines. On the other hand, focusing the discussion on patents, can be reduced, there are other aspects of intellectual property to consider. However, the answer will most likely lie in the balance between the rights ofpatent holders and the public interest.

La ley de propiedad intelectual tiene sus excepciones y límites internos, según lo establece la ley. En los últimos tiempos, ha habido un creciente debate sobre su compresión a la luz de principios generales, como el interés público, la libertad de expresión o la salud pública. Se diría,por tanto, que estos derechos también tienen una función social, además de proteger los derechos de sus titulares, lo que es especialmente cierto para las patentes farmacéuticas. Gran parte de esta discusión siempre ha pasado, de hecho, por las patentes farmacéuticas, su concesión y explotación, especialmente en lo que respecta a las patentes biotecnológicas. Esta discusión se ha exacerbado cada vez más con respecto a las patentes de vacunas destinadas al tratamiento contra COVID-19. No hay escasez de personas que quieran utilizar los medios que brindan las leyes nacionales e internacionales para imponer licencias de patentes obligatorias e incluso su expropiación. Sin embargo, pueden estar en juego otros aspectos, como los contratos mal negociados por la Comisión de la Unión Europea con algunas empresas farmacéuticas y los problemas logísticos en la producción de vacunas. Por otro lado, centrar la discusión en las patentes, se puede reducir, hay otros aspectos de la propiedad intelectual a considerar. Sin embargo, lo más probable es que la respuesta esté en el equilibrio entre los derechos de los titulares de patentes y el interés público.

El desafío de las enfermedades (re)emergentes, los límites de la respuesta biomédica y el nuevo paradigma de salud global / The challenge of (re)emerging diseases, the limits of the biomedical response and the new paradigm of global health

Resumen Las "enfermedades infecciosas emergentes y reemergentes" constituyen una creciente amenaza para la hegemonía de la biomedicina, al suscitar no pocos interrogantes sobre la idoneidad de su discurso y prácticas para afrontar el desafío global que representan. Se analiza el proceso de construcción de esta nueva categoría nosológica, y se examinan ejemplos destacados del impacto de las enfermedades (re)emergentes en la salud pública, la seguridad alimentaria y el desarrollo humano a escala global. Se refiere a prácticas irresponsables de sectores de la industria farmacéutica y agropecuaria, determinantes en su desencadenamiento y diseminación; y a algunos fallos cruciales de enfoque y manejo de los tiempos en las políticas de salud global en relación al VIH/sida con desastrosas consecuencias para el África subsahariana.

Abstract "Emerging and reemerging infectious diseases" pose a growing threat to the hegemony of biomedicine, raising questions about whether its discourse and practices can handle the global challenge they represent. The construction of this new nosological category is analyzed in this article, which examines some notable examples of the impact of (re)emerging diseases on public health, food security and human development on a global scale. It discusses irresponsible practices by sectors of the pharmaceutical and agricultural industries which led to the emergence and spread of these diseases; and points to some crucial failures of approach and time management in global health policies on HIV/AIDS, with disastrous consequences for sub-Saharan Africa.

Comparative analysis of the detection and control standards for quinolone residues in animal-derived foods and supervision among multiple regulatory sectors / 上海预防医学

In order to compare the standards for quinolone residues in animal-derived food in China and supervision among multiple regulatory sectors， we summarized and compared the current standards for the limits of quinolone residues in animal-derived food in China and sampling examination strategy among regulatory sectors. There were defects in the standard limits of lomefloxacin， pefloxacin， ofloxacin， and norfloxacin which have been banned by the Ministry of Agriculture and Rural Affairs. In addition， the determination limits of those indexes in the supervision remain inconsistent across multiple regulatory sectors. Multiple regulatory sectors on food safety should perform further risk assessment on the above problems and formulate the standards for the limits of quinolone residues in animal-derived food that may be applicable in China.

Current status of organophosphorus pesticide residues in root and rhizome medicinal materials and research progress of rapid detection methods / 中国中药杂志

The medicinal plants with roots and rhizomes as the medicinal parts account for about 1/3 of Chinese medicinal herbs. Root and rhizome medicinal materials are widely used in clinical practice, whereas their wild resource reserves are insufficient to meet the market demand. With the expansion of planting areas, the formation of large-scale production areas, and the increase in planting years, diseases and insect pests of these medicinal plants, which are diverse and have broad transmission routes, strong concealment, and heavy damage, have become more and more serious. The prevention and control of these diseases and insect pests is characterized by multiple ways of pesticide application, large consumption of pesticides, susceptibility to soil barrier, difficulty in the control, and unstable control efficiency. Organophosphorus pesticides(OPPs) are widely used in the cultivation of Chinese medicinal plants because of their diverse varieties, broad-spectrum, good efficacy, and low residues, and have a positive effect on the yield and quality of Chinese medicinal materials. However, the abuse of OPPs not only increases the planting cost, but also affects the quality and safety of Chinese medicinal plants, the safety of clinical use of Chinese medicine, and the ecological safety of production areas. This paper reviewed the research and development progress of OPPs, the registration status of OPPs used in root and rhizome medicinal materials, residue limit standards, residue status, and rapid detection technology progress of OPPs. This review aims to provide research ideas and references for standardizing the use of OPPs in root and rhizome medicinal materials, reducing OPP residues, and establishing a fast, efficient, accurate, and reliable method for the detection of OPP residues in Chinese herbal medicine.

Establishing the lower limits of total serum testosterone among Chinese proven fertile men who received treatment of assisted reproductive technology / 亚洲男科学杂志(英文版)

Testosterone (T) plays a crucial role in spermatogenesis because extremely low levels of intratesticular T lead to correspondingly low serum levels of total T (tT), severe disorders of spermatogenesis, and male sterility. However, there is little consensus on the lower limits of serum tT in proven fertile men undergoing assisted reproductive technology treatments in Chinese or other Asian populations. We aimed to establish the reference range of serum tT based on a population of 868 fertile Chinese men undergoing in vitro fertilization or intracytoplasmic sperm injection and embryo transfer (IVF/ICSI-ET) treatments. We defined a fertile man as having had a live baby with his partner as recorded in our IVF registration system. The lower limits of serum tT were established using a Siemens IMMULITE 2000 chemiluminescent system. The 1st, 2.5th, and 5th percentiles and their 95% confidence intervals (CIs) were 3.6 (95% CI: 2.7-4.1) nmol l-1, 4.3 (95% CI: 4.1-5.0) nmol l-1, and 5.6 (95% CI: 4.8-5.8) nmol l-1, respectively. Using the linear correlation of serum tT between the Siemens platform and a liquid chromatography-tandem mass spectrometry platform, the calculated lower limits of serum tT were also established for fertile Chinese men undergoing IVF/ICSI-ET treatments, which will benefit the clinical diagnosis and treatment of male infertility during such procedures.

La simbolización y sus límites: lecturas desde la Escuela inglesa / The symbolization and its limits: readings from the English school

La simbolización constituye un tema relevante para el psicoanálisis; su teorización y demarcación precisa tiene necesariamente efectos sobre la práctica clínica. Basándose en Freud, Klein y Bion ubican diferencias significativas en las distintas estructuras. Esta delimitación se basa en hipótesis sobre la simbolización, que incluyen, además de las defensas, una aguda descripción sobre las relaciones objetales. También lo hace Winnicott, con originalidad, agregando un estudio detallado de los cuadros límite, la tendencia antisocial y el fenómeno psicosomático -todos ellos presentaciones donde la simbolización exhibe falencias significativas. En las conceptualizaciones kleinianas, el instinto de muerte y el superyó obstaculizan la simbolización. Profundizando esta hipótesis, Bion afirma que la parte psicótica de la personalidad está siempre presente, dando cuenta de que todo no puede simbolizarse, aun en pacientes no psicóticos. Por su parte, Winnicott presenta la angustia inconcebible y el self falso como resultados de una simbolización malograda, a causa de la incidencia de un ambiente "no suficientemente bueno". El presente artículo refleja el modo en que la Escuela Inglesa, a través de sus autores paradigmáticos, trabaja la cuestión de la simbolización, enfatiza la importancia de este tópico y analiza el supuesto "optimismo" en torno a ella, así como también sus límites

Symbolization constitutes a core issue in psychoanalysis; its theorization and accurate demarcation have necessary effects on clinical practice. Based on Freud, Klein and Bion locate significant differences in clinical structures. This delimitation rests on hypotheses about symbolization, involving not only specific defences, but also an acute description about objectal relationships. Winnicott makes his own genuine contribution, adding a detailed study about limit cases, antisocial tendence and psychosomatic phenomenon ­ all of them are clinical presentations in which symbolization capacacity shows significant failures. It can be argued, that in Klein's conceptualizations, death instinct and superego hamper symbolization. Deepening on this hypothesis, Bion states that the psychotic part of the personality is always present, revealing that everything cannot be symbolized. On the other hand, Winnicott introduces the unthinkable anxieties and the false self as a result of important failures on symbolization caused by the incidence of a "not good enough" enviroment. The present paper reflects the way in which the English School, through its paradigmatic authors, works on symbolization, emphasizes the importance of this topic and analyses not only the supposed "optimism"on the matter, but also its limits

Proposition of decision limits for serum lipids in Brazilian children aged one to 13 years / Proposição de limites de decisão dos lipídeos séricos para crianças brasileiras de um a 13 anos de idade

Abstract Objective: To determine decision limits for total cholesterol, LDL-cholesterol, non-HDL cholesterol, HDL-cholesterol, and triglycerides in healthy children and adolescents from Cuiabá, Brazil. Methods: This was a cross-sectional study of 1866 healthy children and adolescents randomly selected from daycare centers and public schools in Cuiabá. The desirable levels of serum lipids were defined using the classic criteria, i.e., total cholesterol, LDL-cholesterol, non-HDL cholesterol, and triglycerides levels below the P75 percentile, and HDL-c above the P10 percentile. Results: For CT, P75 was: 160 mg/dL for the age range of 1 to <3 years, 170 mg/dL for ≥3 to <9 years, and 176 mg/dL for ≥9 to <13 years. For non-HDL cholesterol, it was 122 mg/dL for the age range of 1 to <13 years. For LDL-c, it was 104 mg/dL at the age range of 1 to <9 years and 106 mg/dL from ≥9 to <13 years. For TG, it was 127 mg/dL from 1 to <2 years; 98 mg/dL from ≥2 to <6 years; and 92 mg/dL from ≥6 to <13 years. As for HDL-cholesterol, P10 was 24 mg/dL, 28 mg/dL, 32 mg/dL, and 36 mg/dL, for the age ranges of 1 to <2 years, ≥2 to <3 years, ≥3 to <4 years, and ≥4 to <13 years, respectively. Conclusion: The decision limits for the serum lipid levels defined in this study differed from those observed in the current Brazilian and North-American guidelines, especially because it differentiates between the age ranges. Using these decision limits in clinical practice will certainly contribute to improve the diagnostic accuracy for dyslipidemia in this population group.

Resumo Objetivo: Determinar limites de decisão (LD) para o colesterol total (CT), LDL-colesterol (LDL-c), colesterol não-HDL (c-NHDL), HDL-colesterol (HDL-c) e triglicérides (TG) em crianças e adolescentes saudáveis de Cuiabá. Método: Estudo transversal envolvendo 1.866 crianças e adolescentes saudáveis de creches e escolas municipais públicas de Cuiabá, aleatoriamente selecionadas. Os LD desejáveis dos lipídeos séricos foram definidos pelos critérios clássicos, isto é, níveis de CT, LDL-c, c-NHDL, TG abaixo do percentil 75, e de HDL-c acima do percentil 10. Resultados: Os P75 para CT foram: 160 mg/dL para a faixa etária de 1 a < 3 anos, 170 mg/dL para ≥ 3 a < 9 anos e 176 mg/dL para ≥ 9 a < 13 anos. Para o c-NHDL, de 122 mg/dL na faixa etária de 1 a < 13 anos. LDL-c: 104 mg/dL na faixa etária de 1 a < 9 anos e 106 mg/dL de ≥ 9 a < 13 anos. TG: 127 mg/dL entre 1 a < 2 anos; 98 mg/dL de ≥ 2 a < 6 anos; e 92 mg/dL de ≥ 6 a < 13 anos. Quanto ao HDL-c, o P10, foi de 24 mg/dL, 28 mg/dL, 32 mg/dL e 36 mg/dL, para as faixas etárias de 1 a < 2 anos, ≥ 2 a < 3 anos, ≥ 3 a < 4 anos e ≥ 4 a < 13 anos, respectivamente. Conclusão: Os LD dos níveis séricos de lipídeos definidos neste estudo diferem daqueles apresentados nas diretrizes brasileiras e americanas atuais, especialmente por fazer a diferenciação entre as idades. Utilizar tais LD em nossa prática clínica certamente contribuirá para melhorar a acurácia do diagnóstico de dislipidemia nesse grupo populacional.

Levels of Non-Essential (Cd, Pb and Hg) Elements in Muscle Tissues of A. bicolor bicolor, McClelland 1844 from Kedah and A. bengalensis bengalensis, Gray 1831 from Perak and Human Consumption Risks / Jurnal Sains Kesihatan Malaysia

@#A study on heavy metals accumulation and human health risk assessment in the consumption of two tropical freshwater eel species (A. bengalensis bengalensis) from the Sungai Perak at Kuala Kangsar, Perak and (A. bicolor bicolor) from the Air Hitam irrigation canal, Kampung Kuala Sanglang, Kedah was carried out. Specimens were examined and analyzed for Pb and Cd concentrations using ICP-MS while the total Hg concentration was measured using a direct mercury analyzer (MA-3000). The range for the total concentrations (µg/g wet wt.) in A. bicolor bicolor were 0.01-0.4 (Cd), 0.03-0.77 (Pb) and 0.36-0.94 (Hg) while for A. bengalensis bengalensis, they were 0.76-1.23 (Cd), 0.01-0.10 (Pb) and 0.27-1.5 (Hg). A. bengalensis bengalensis (Sungai Perak) showed a significant strong relationship between Hg/Pb (r = .771, P < 0.05) and A. bicolor bicolor (Air Hitam irrigation canal) with Cd/Pb (r = -.895, P < 0.05) in muscle tissues and the results indicated Hg and Pb were introduced from point and non-point sources, therefore it is of concern. Interspatial comparison with the findings of previous local and international studies showed both species of freshwater eels accumulated Hg to high levels, exceeding the safe limits stipulated in the Malaysian Food Act of 1984, Food Regulations (1985) and USEPA (1997). However, the Target Hazard Quotient (THQ) and Hazard Index (HI) indicated that both freshwater eel spp. from the studied sites are safe to consume as there is no risk posed from consumption based on the health risk assessment results as Pb, Cd and Hg concentrations were under the permissible limits of nutrient intake.

Determination and risk assessment of heavy metals and harmful elements residues in Niuhuang Qingwei Pills based on ICP-MS / 中国中药杂志

To achieve a comprehensive understanding of heavy metals and harmful elements residues in Niuhuang Qingwei Pills,49 samples from 18 manufactures were collected from 31 provinces in China.Risk assessment and control preparations were applied innovatively in evaluation of exogenous pollution in traditional Chinese Medicine.Determination methods for Pb,Cd,As,Hg and Cu were established by inductively coupled plasma mass spectrometry(ICP-MS).Based on the procedures including hazard identification,hazard characterization,exposure assessment and risk characterization,risk assessment was performed and residual limits for Pb,Cd,As,Hg and Cu in the drug were formulated.The results showed that the hazardous quotients(HQ) of the elements were decreased in the following order:Pb>As>Cu>Hg>Cd,and the total hazardous index(HI) of heavy metals and harmful elements in Niuhuang Qingwei Pills was above 1,implying health risk of the drug.Under the proposed limits,5 elements in the control preparation as well as Cd and Cu in the samples were within the limits range,but the excess rates of Pb,As and Hg in the samples were 12%,12% and 14%,respectively.For the first time,basic steps for risk assessment of Chinese patent medicine were established,which provided model and reference for risk assessment and limit formulation of other drugs.

Determinación de límites de referencia de analitos hematológicos en cabras lecheras adultas en el Altiplano Mexicano / Hematological analyte reference limits in adult dairy goats

RESUMEN Con el objetivo de establecer los límites de referencia de analitos hematológicos de cabras adultas de razas productoras de leche clínicamente sanas, sujetas al manejo y a las características de los sistemas de producción intensiva del Altiplano Mexicano, se recolectaron y analizaron muestras de sangre de cabras de 2 o más años de edad en diferentes etapas de producción. Con los resultados se obtuvieron los límites de referencia para hematocrito, cuenta de eritrocitos, volumen globular medio (VGM), plaquetas, sólidos totales, fibrinógeno, cuenta de leucocitos, neutrófilos segmentados, neutrófilos en banda, linfocitos, monocitos, eosinófilos y basófilos. Las medias obtenidas para cada analito fueron: hematocrito (0,22-0,36 L/L), cuenta de eritrocitos (9,07-18,47 x1012/L), volumen globular medio (VGM) (14,44-27,91), plaquetas (229-3 1 63 x109/L), solidos totales (65,64-84,64 g/L), fibrinógeno (0-6 g/L), cuenta de leucocitos (3,75-11,47 x109/L), neutrófilos segmentados (0,95-4,98 x109/L), neutrófilos en banda (0-0,16 x109/L), linfocitos (1,76-6,44 x109/L), monocitos (0-0,65 x109/L), eosinófilos (0-1,36 x109/L) y basófilos (0 - 0,37 x109/L). Estos valores se compararon con los obtenidos en otros estudios similares, y se encontraron algunas diferencias mayoritariamente en los valores obtenidos para hematocrito, eritrocitos, VGM, plaquetas, leucocitos y linfocitos, lo cual se debe a las diferencias en condiciones medioambientales y de alimientación entre los estudios.

ABSTRACT With the aim to establish the hematological analyte reference limits of clinically healthy adult goats of dairy producing breeds, subjected to the handling and characteristics of intensive production systems in the Mexican Plateau, the blood samples of 2-year old and older goats at different production stages were collected and analyzed. Reference limits (interval in brackets) for hematocrit (0.22-0.36 L/L), erythrocyte count (9.07-18.47 x1012/L), mean cell volume (MCV) (14.44-27.91 fL), platelets (229-3163 x109/L), total solids (65.64-84.64 g/L), fibrinogen (0-6 g/L), leukocyte count (3.75-11.47 x109/L), segmented neutrophils (0.95-4.98 x109/L), band neutrophils (0-0.16 x109/L), lymphocytes (1.76-6.44 x109/L), monocytes (0-0.65 x109/L), eosinophils (0-1.36 x109/L) and basophils (0-0.37 x109/L) were obtained. These values were compared with similar study results. Differences were found mainly in the values for hematocrit, erythrocytes, MCV, platelets, total leukocytes, and lymphocytes; this is due to environmental and feeding differences between the studies.

Evaluación de la función renal en pacientes con nefrectomía / Evaluation of the renal function in patients with nephrectomy

Fundamento: han sido publicados por diferentes grupos de trabajo estudios sobre la evaluación de la función renal en pacientes nefrectomizados, señalándose resultados muy variables. En algunos se reporta deterioro de la función del riñón remanente, en otros no. Objetivo: describir la respuesta adaptativa en cuanto a función renal y evolución clínica, en pacientes nefrectomizados. Métodos: estudio de corte transversal en el que se evaluó la función renal antes y a los dos años de la nefrectomía a 88 pacientes. Las variables analizadas fueron: filtrado glomerular, creatinina y urea séricas y las enfermedades crónicas asociadas. Se determinaron las tasas, porcientos y el Chi cuadrado para las variables cualitativas así como la media, la desviación estándar y la T de students para las cuantitativas. Se consideró significación estadística un valor p≤0,05, con una confiabilidad de 95 %. Resultados: la media de creatinina sérica después de la nefrectomía fue superior a la de prenefrectomía (102 umol vs 126) p=0,05. El filtrado glomelural disminuyó después de la nefrectomía (62 ml/min vs 43 ml/min) p=0,02. Los pacientes hipertensos y diabéticos presentaron mayor deterioro de la función renal, p≤0,05. Conclusiones: la nefrectomía produce un deterioro de la función renal a los dos años de seguimiento principalmente en los pacientes diabéticos e hipertensos.

Foundation: several studies have been published by different groups of work about the evaluation of the renal function in nephrectomized patients, showing varied results. In some cases it is reported the deterioration of the remaining kidney, and not in others. Objective: to describe the adaptative response regarding renal and clinical evolution in nephrectomized patients. Methods: cross study in which it was evaluated the renal function before and at two years of nephrectomy of 38 patients. The variables analyzed were glomerular filtration rate, creatinine and serum urea and associated diseases. Rates, percentages and Squared Chi for qualitative variables so as mean, standard deviation and Students T test for quantitative ones. Results: serum creatinine mean after nephrectomy was superior to the pre-nephrectomy (102 umol vs 126) p=0,05. Glomerular Filtration rate decreased after nephrectomy (62 ml/min vs 43 ml/min) p=0,02. Hypertensive and diabetic patients had a higher deterioration of the renal function, p≤0,05. Conclusion: nephrectomy produces a deterioration of the renal function at two years of follow up mainly in diabetic and hypertensive patients.

Narrativas acerca de la comunicación, límites y jerarquía en niños con padres separados / Narratives about the communication, limits and hierarchies in children with separated parents

La presente investigación describe las narrativas acerca de la comunicación, límites y jerarquías de cinco niños de la ciudad de Bogotá, Colombia, con padres separados, entre los ocho y los doce años de edad, además tiene como objetivo contribuir en la comprensión de este tipo de dinámicas familiares, utilizando elementos teóricos del enfoque sistémico; y corresponde a una metodología cualitativa, descriptiva, con diseño narrativo, utilizando la entrevista abierta como técnica de recolección de información. Como hallazgo relevante específicamente en estos cinco casos, se encontró que la separación no es un tema comunicativo en la familia, los padres poco hablan o interactúan entre ellos, no llegan a acuerdos para la crianza de sus hijos y no crean una unidad parental efectiva. La madre se encarga de fijar los límites para los hijos, y encabeza la jerarquía, asumiendo totalmente la crianza. El padre separado no participa de la pauta de autoridad, ni de la organización jerárquica, generando que la posición igual en la jerarquía la ocupe la madre y la nueva pareja. Los miembros de la familia no han elaborado la separación, y por parte de los hijos las dificultades para elaborar el divorcio, generan una tensión relacional y emocional con los nuevos cónyuges de los padres.

The present research describe the narratives about communication, limits and hierarchies of five children with separated parents, between eight and twelve years old, with the goal of contributing to the understanding of this specific kind of family dynamics, using theoretical elements of the systemic approach and corresponds to a qualitative, descriptive methodology with a narrative design, using the open interviews as technique to collect the information. As a relevant finding, it was found that separation is not a communicative topic in the family, parents rarely talk or interact with each other, they do not reach agreements for raising their children and they do not create any effective parental unity. The mother is in charge for setting limits to the children, and she heads the hierarchy, fully assuming parenting. The separated father does not participate in the pattern of authority, he is not either part of the hierarchical organization, generating that the equal position in the hierarchy is occupied by the mother and the new partner.The members of the family have not elaborated the separation yet, as a consequence, to the difficulties to elaborate the divorce on the part of the children, a relational and emotional tension is added with the new spouses of the parents.

Usage Of Heavy Metals In Ayurvedic Formulations And Its Management: A Review

Ayurveda is a comprehensive and systematic medicinal system, originated in India. It takes into consideration all aspects of health, including mental, physical and social components. According to the principles of Ayurvedic medication, heavy metals possess considerable therapeutic properties and can be administered to the patients after being processed properly as mentioned within the Rasashastra, in prescribed quantities. However, improper manufacturing processes might lead to higher levels of heavy metals remaining in the final product which may be dangerous. They may also be present as impurity rather than being added willfully. Heavy metals possess tendency to accumulate in vital organs and hence, pose a particular health risk. The presence of impurities in drug samples, whether herbal or pharmaceutical, is of great concern, not only because some contaminants are inherently toxic, but also they may negatively affect the stability of the drug and the lifespan, or they can cause unwanted side effects. The quality assurance of herbal formulations is the main concern of current phytomedical era due to the increase in toxicity reports. As a consequence, both organic and inorganic (elemental) impurities must be monitored and controlled in final dosage form starting from the raw materials itself. This article deals with the various aspects of heavy metals in Ayurvedic medicines such as their sources, methods used for their determination, their therapeutic significance, their toxic effects and also summarizes various guidelines and limits for their regulation.

Libertad vs. límites en la creación de una obra musical / Freedom vs. limits in the creation of a musical work

Resumen Varios han sido los aspectos no tenidos en cuenta en la comprensión del fenómeno de creación de obras musicales en lo que respecta a experiencias vividas por los compositores, tales como la experiencia de libertad y la vivencia de límites o determinismos durante el proceso creativo. En este artículo se analizan estos dos fenómenos humanos (libertad y determinismos) en 3 compositores del Caribe colombiano a través del método fenomenológico, el cual busca comprender realidades cuya naturaleza y estructura dependen de las personas que las viven y experimentan, y que son determinantes para la comprensión de la vida psíquica de cada persona (Martínez, 2009), y se encontró que a pesar de que el compositor necesita confrontar toda una serie de determinismos los cuales inician desde las mismas limitaciones del lenguaje musical, que en su estructura maneja unas reglas propias, puede sin embargo vivenciar un importante grado de libertad, reflejándose este en la manera como ellos se relacionan con dichos límites, y en la capacidad que tienen de saber que son también ellos los determinados. Se concluye que la creatividad surge en ellos a partir de esa tensión entre la propia espontaneidad y las limitaciones.

Abstract Several aspects don't have been studied in understanding the phenomenon of creation of musical works, with respect to experience by composers, such as experience of freedom, and experience of limits or determinism, during the creative process. In this article these two human phenomena (freedom and determinism) in 3 compousers of Colombian caribbean were researched through the phenomenological method, which seeks to understand realities whose nature and structure depend on the people who live and experience, and which are decisive for the understanding of life are analyzed psychic each person (Martinez, 2009), finding that although the composer needs to confront a series of determinisms which start from the same limitations of musical language, which in its structure have their own rules, the composer can still experiencing a significant degree of freedom, reflected it in how they relate to those limits, and the ability to know that are they also determined, concluding that creativity arises in them from the tension between spontaneity itself and limitations.

Los límites éticos: ¿avance o retroceso? / Ethical Limits: A Step Forward or Backward? / Os limites éticos: avanço ou retrocesso?

Resumen El ser humano tiene límites físicos y psicológicos… pero también éticos, que hacen que sus acciones sean precisamente humanas. Estos límites éticos posibilitan cualquier debate y la investigación, en concreto, con seres humanos. De ahí que toda investigación sin estos límites sería inviable. Se habla de límites éticos no en el sentido de impedimento, sino todo lo contrario, de posibilidad para la acción; solo se puede hablar de límites éticos si se afirma una verdad válida para todos y para todos los tiempos, independientemente de uno mismo. Asistimos a un verdadero progreso siempre que se realice una investigación en beneficio del ser humano. Así es, solamente se puede hablar de progreso si se entiende este en un crecer en humanidad.

Abstract Human beings have physical and psychological limits, but also ethical, which are precisely what make their actions human. These ethical limits enable any debate and investigation, in particular, with human beings. Therefore, any investigation would be unfeasible without those limits. We talk about ethical limits, not in the sense of impediment but in the sense of possibility for action; you can only speak of ethical limits if you affirm a truth that is valid for everyone and for all times, regardless of oneself. We are witnessing a true progress as long as a research is carried out for the benefit of human beings. That's right; you can only speak of progress if it is understood in a growth in humanity.

Resumo O ser humano tem limites físicos e psicológicos, mas também éticos - o que faz com que suas ações sejam precisamente humanas. Esses limites éticos possibilitam qualquer debate e pesquisa, concretamente, com seres humanos. Assim, toda pesquisa sem esses limites seria inviável. Fala-se de limites éticos não no sentido de impedimento, mas ao contrário, como uma possibilidade para a ação. Somente se pode falar em limites éticos se afirmarmos uma verdade válida para todos e para todos os tempos, independentemente da individualidade. Assistimos a um verdadeiro progresso sempre que uma pesquisa é realizada em benefício do ser humano. Dessa forma, só se pode falar em progresso se o entendermos como um crescer em humanidade.

Evaluación de los límites analíticos de desempeño del laboratorio del HIGA O. Alende de Mar del Plata / Evaluation of analytical limits of performance in the laboratory of HIGA O. Alende of Mar del Plata / Avaliação dos limites analíticos de desempeno do laboratório do HIGA O. Alende de Mar del Plata

Los límites analíticos de desempeño (LAD) forman parte del diseño del programa de control de calidad analítico. Los objetivos de este trabajo fueron determinar imprecisión (CV), error sistemático (ES) y error total (ET) de 14 analitos de Química Clínica en los sectores de planta y de guardia del laboratorio del HIGA O. Alende de Mar del Plata, evaluar su desempeño analítico según variabilidad biológica y comparar los datos obtenidos. Se realizó un estudio retrospectivo con el registro de controles de calidad y se utilizaron los LAD derivados de VB para obtener las especificaciones de calidad para CV, ES y ET. Respecto del CV, cumple con los criterios el 79% en el sector planta y el 64% en el de guardia. Y en cuanto al ET, cumple el 90% y el 75%, respectivamente. En conclusión, aunque la mayoría de los analitos evaluados cumplen al menos con los criterios mínimos establecidos, los resultados ponen de manifiesto la necesidad de mejorar el desempeño analítico. Detectar los tipos de errores presentes en el proceso de laboratorio es el primer paso para instaurar controles de procedimiento y análisis, soluciones que permitirán mejorar la calidad analítica, uno de los pilares que optimizan la seguridad del paciente.

The analytical limits of performance (ALP) are part of the programme design of analytical quality control. The goals of this study were to determine imprecision (VC), systematic error (SE) and total error (TE) of 14 clinical chemistry analytes in the routine and emergency laboratory of HIGA O. Alende of Mar del Plata, to evaluate their analytical performance in accordance with biological variability, and compare the data obtained. A retrospective study was performed using the record of quality controls. The ALP were obtained from BV to get the quality specifications for VC, SE and TE. Regarding VC, 78% of the analytes meet the criteria in the routine laboratory and 64% in the emergency. Regarding TE, in the routine laboratory, 90% meet the TE criteria, and 75% in the emergency. It can be concluded that, although most of the evaluated analytes meet at least the minimum established criteria, the results highlight the need to improve the analytical performance. Detecting the types of errors in the laboratory process is the first step to establish procedural and analysis controls. These are solutions that will improve the analytical quality, one of the pillars to optimize patient safety.

Os limites analíticos de desmpeño (LAD) são parte do desenho do programa de controle de qualidade analítico. Os objetivos deste estudo foram determinar a imprecisão (CV), o erro sistemático (ES) e o erro total (ET) de 14 analitos de Química Clínica nas áreas de planta e de plantão do laboratório HIGA O. Alende de Mar del Plata, avaliar seu desempenho analítico de acordo com a variabilidade biológica e comparar os dados obtidos. Um estudo retrospectivo foi realizado com o registro de controles de qualidade utilizando os LAD derivados de VB para obter as especificações de qualidade para CV, ES e ET. Quanto ao CV, 79% cumpre com os critérios no setor da planta e 64% no setor de plantão. E, quanto ao ET, cumpre 90% e 75% respectivamente. Em conclusão, embora a maioria dos analitos testados cumpra pelo menos com os critérios mínimos estabelecidos, os resultados destacam a necessidade de melhorar o desempenho analítico. Detectar os tipos de erros encontrados no processo de laboratório é o primeiro passo para estabelecer controles de procedimento e análise, soluções que permitirão melhorar a qualidade analítica, um dos pilares que otimizam a segurança do paciente.