Efectos cerebrales del oxígeno y el dióxido de carbono en el síndrome de dificultad respiratoria aguda

Introducción: El síndrome de dificultad respiratoria aguda producido por la COVID-19 provoca alteraciones en el intercambio de oxígeno y la excreción de dióxido de carbono con consecuencias neurológicas. Objetivo: Describir las implicaciones del oxígeno y el dióxido de carbono sobre la dinámica cerebral durante el tratamiento ventilatorio del síndrome de dificultad respiratoria aguda en el accidente cerebrovascular. Métodos: Se realizó una búsqueda en bases referenciales como: PubMed/Medline, SciELO, Google Académico y BVS Cuba. Los términos incluidos fueron brain-lung crosstalk, ARDS, mechanical ventilation, COVID-19 related stroke, ARDS related stroke y su traducción al español. Fueron referenciados libros de neurointensivismo y ventilación mecánica artificial. El período de búsqueda incluyó los últimos 20 años. Se seleccionaron 46 bibliografías que cumplieron con los criterios de selección. Resultados: Se ha descrito que los niveles de oxígeno y dióxido de carbono participan en la neurorregulación vascular en pacientes con daño cerebral. Algunas alteraciones alusivas son la vasodilatación cerebral refleja o efectos vasoconstrictores con reducción de la presión de perfusión cerebral. Como consecuencia aumenta la presión intracraneal y aparecen afectaciones neurocognitivas, isquemia cerebral tardía o herniación del tronco encefálico. Conclusiones: El control de la oxigenación y la excreción de dióxido de carbono resultaron cruciales para mantener la homeostasis neuronal, evita la disminución de la presión de perfusión cerebral y el aumento de la presión intracraneal. Se sugiere evitar la hipoxemia e hiperoxemia, limitar o eludir la hipercapnia y usar hiperventilación hipocápnica solo en condiciones de herniación del tallo encefálico.

Introduction: The acute respiratory distress syndrome produced by COVID-19 causes alterations in the exchange of oxygen and the excretion of carbon dioxide with neurological consequences. Objective: To describe the implications of oxygen and carbon dioxide on brain dynamics during ventilatory treatment of acute respiratory distress syndrome in stroke. Methods: A search was carried out in referential bases such as PubMed/Medline, SciELO, Google Scholar and VHL Cuba. The terms included were brain-lung crosstalk, ARDS, mechanical ventilation, COVID-19 related stroke, ARDS related stroke and their translation into Spanish. Books on neurointensive care and artificial mechanical ventilation were referenced. The search period included the last 20 years. Forty six bibliographies that met the selection criteria were selected. Results: Oxygen and carbon dioxide levels have been described to participate in vascular neuroregulation in patients with brain damage. Some allusive alterations are reflex cerebral vasodilatation or vasoconstrictor effects with reduced cerebral perfusion pressure. As a consequence, intracranial pressure increases and neurocognitive impairments, delayed cerebral ischemia or brainstem herniation appear. Conclusions: The control of oxygenation and the excretion of carbon dioxide were crucial to maintain neuronal homeostasis, avoiding the decrease in cerebral perfusion pressure and the increase in intracranial pressure. It is suggested to avoid hypoxemia and hyperoxemia, limit or avoid hypercapnia, and use hypocapnic hyperventilation only in conditions of brainstem herniation.

Síndrome antisintetasa: reporte de un caso / Antisynthetase syndrome: a case report

El síndrome antisintetasa es una miopatía inflamatoria idiopática (MII) de origen autoinmune, poco frecuente, que se caracteriza por la presencia de autoanticuerpos antisintetasa ARNt (generalmente anti-Jo1), asociado frecuentemente a miositis, enfermedad pulmonar intersticial, poliartritis, manos de mecánico y fenómeno de Raynaud. Se reporta el caso de una mujer de 45 años de edad que presenta este síndrome con características fenotípicas de dermatomiositis y responde de forma favorable luego de la administración del tratamiento con glucocorticoides asociado a metotrexato.

Anti-synthetase syndrome is a rare autoimmune inflammatory myopathy characterized by autoantibodies against tRNA synthetases (most commonly anti-Jo1) with clinical features that include myositis, interstitial lung disease, polyarthritis, mechanic's hands and Raynaud's phenomenon. We report a 45-year-old woman who presented with dermatomyositis phenotypical features and a significant improvement with corticosteroids and metotrexate treatment.

Revealing characteristics and rules of acupoint sensitization phenomena: based on knee osteoarthritis / 中国针灸

OBJECTIVE@#To explore the characteristics and rules of acupoint sensitization phenomena based on knee osteoarthritis (KOA), one of the clinical dominant diseases of acupuncture-moxibustion.@*METHODS@#In combination with literature and expert experiences, the acupoints with the highest use frequency in treatment of KOA were screened, e.g. Heding (EX-LE 2), Liangqiu (ST 34), Mingmen (GV 4), Neixiyan (EX-LE 4), Ququan (LR 8) and Dubi (ST 35). In 814 patients with KOA and 217 healthy subjects, the acupoint temperature, mechanic pain threshold and pressure pain threshold were detected separately. Using machine learning method, the sensitization was judged at each acupoint.@*RESULTS@#Compared with healthy subjects, the acupoint temperature was increased and the mechanic pain threshold and pressure pain threshold were reduced in KOA patients (P<0.05). Besides, the cut-off value was presented to distinguish whether the acupoint was sensitized or not. The results of machine learning showed that the highest prediction accuracy of acupoint sensitization was 86.7% (Shenshu [BL 23]) and the lowest one was 73.9% (Heding [EX LE 2]). The prediction accuracy at the third clinical stage trial was higher, the highest was 93.3% (Ququan [LR 8]) in KOA patients.@*CONCLUSION@#It is confirmed that the acupoint sensitization reflects the characteristics of disease and is correlative with the conditions of illness, which may provide the reference for the auxiliary diagnosis and condition assessment of KOA.

Relación de las medidas de mecánica ventilatoria y radiográficas con el tiempo de conexión a ventilación mecánica en pacientes COVID-19: un análisis preliminar / Relations of ventilatory mechanical and radiographic measures with the connection time to mechanical ventilation in patients COVID-19: a preliminary analysis

RESUMEN: Los pulmones son el sitio predominante en la infección por COVID-19. Esta puede conducir al síndrome distrés respiratorio agudo (SDRA). Frente a su sintomatología severa, la ventilación mecánica (VM), y sus valores de mecánica ventilatoria aparecen como una herramienta fundamental. Un complemento, para analizar el estado de avance de esta patología es la radiografía de tórax (RT), aunque en ocasiones esta depende de la experiencia del equipo de salud. Así el objetivo de esta investigación fue explorar la relación de las medidas de mecánica ventilatoria y radiográficas con el tiempo de conexión a VM en pacientes COVID-19. Estudio retrospectivo, que incluyó a 23 pacientes en VM. Se recolectó información de variables de mecánica ventilatoria; PEEP, presión plateau, presión de distensión y compliance estática. Desde la RT se midió, altura y ancho pulmonar, ángulo costodiafragmático y espacio intercostal. Los resultados indicaron que las variables de mecánica ventilatoria tales como el PEEP y el plateau se relacionaron significativamente con el tiempo de conexión a VM (r=0,449; p=0,035 y r=0,472; p=0,026), mientras que las variables radiográficas construidas en base al ángulo costodiafragmático y el espacio intercostal presentaron similares comportamientos (r= 0,462; p=0,046 y r=-0,543; p=0,009). En conclusión, la presión resultante de la programación del ventilador mecánico junto a cambios estructurales observados en la RT, se relacionan con el tiempo de conexión a VM.

SUMMARY: The lungs are the predominant site of COVID-19 infection. This can lead to severe acute respiratory síndrome (ARDS). In view of its severe symptoms, mechanical ventilation (MV) and its ventilatory mechanics values appear as a fundamental tool. Chest radiography (CR) is a complement to analyze the state of progress of this pathology, although this sometimes depends on the experience of the health team. Thus, the aim of this research was to explore the relationship of ventilatory mechanics and radiographic measures with connection time to MV in COVID-19 patients. Retrospective study, which included 23 patients on MV. Information on ventilatory mechanics variables was collected; PEEP, plateau pressure, distension pressure and static compliance. And from CR, lung height and width, costodiaphragmatic angle and intercostal space were measured. The results indicated that ventilatory mechanics variables such as PEEP and plateau were significantly related to connection time to MV (r = 0.449; p = 0.035 and r = 0.472; p = 0.026), while the radiographic variables Constructed on the basis of the costodiaphragmatic angle and the intercostal space, they showed similar behaviors (r = 0.462; p = 0.046 and r = -0.543; p = 0.009). In conclusion, the pressure resulting from mechanical ventilator programming, together with the structural changes observed in CR, are related to the connection time to MV.

Estado nutricional de pacientes geriátricos con ventilación mecánica en cuidados intensivos / Nutritional status of geriatric patients with mechanical ventilation under intensive care

Introducción: La desnutrición en pacientes ingresados en una sala de terapia intensiva es elevada, pero en el anciano crítico es aún mayor, con repercusión sobre el aparato respiratorio, prolongación de la ventilación y otras complicaciones. Objetivo: Caracterizar el estado nutricional en pacientes geriátricos con ventilación mecánica en una unidad de cuidados intensivos. Métodos: Se realizó un estudio descriptivo, prospectivo y de corte transversal durante el periodo de enero de 2017 a marzo de 2019 en la unidad de cuidados intensivos del Hospital General Docente "Orlando Pantoja Tamayo". Se estudiaron 83 pacientes con edades mayor o igual a 60 años, los cuales requirieron del uso de ventilación mecánica más de 24 h. El estado nutricional fue evaluado con el empleo del índice de control nutricional. Resultados: Predominó el sexo masculino, el grupo de edades de 60 a 74 años, y las enfermedades tipo quirúrgicas. Solo 9,1 % de los que recibieron ventilación mecánica invasiva no estaban desnutrido. Los que fallecieron tenían desnutrición moderada o severa. Conclusiones: En los pacientes geriátricos ventilados, ingresados en la unidad de cuidados intensivos, se encontró un alto grado de malnutrición. La desnutrición moderada o severa predominó en la mayoría de los que recibieron ventilación mecánica invasiva y en el grupo de fallecidos(AU)

Introduction: Malnutrition in patients hospitalized in an intensive care room is high, but it is even higher in the critically-ill elderly patient, with repercussions on the respiratory system, prolonged ventilation, and other complications. Objective: To characterize the nutritional status of geriatric patients under mechanical ventilation in an intensive care unit. Methods: A descriptive, prospective and cross-sectional study was carried out during the period from January 2017 to March 2019, in the intensive care unit of Orlando Pantoja Tamayo General Teaching Hospital. 83 patients aged 60 or older were studied; they required mechanical ventilation for more than 24 hours. The nutritional status was evaluated with the use of the nutritional control score. Results: There was a predominance of the male sex, the age group 60-74 years, and of surgical diseases. Only 9.1% of those who received invasive mechanical ventilation were not undernourished. Those who died had moderate or severe undernutrition. Conclusions: In ventilated geriatric patients hospitalized in the intensive care unit, a high degree of malnutrition was found. Moderate or severe malnutrition predominated in the majority of those who received invasive mechanical ventilation and in the group of the deceased(AU)

Comparison of three semi-quantitative methods for assessing occupational health risk in a mechanic processing enterprise / 中国职业医学

OBJECTIVE: To compare the applicability of three semi-quantitative methods for risk assessment for occupational health in a mechanic processing enterprise. METHODS: The judgment sampling method was used to select a mechanic processing enterprise as the study subject. The occupational health risk was evaluated using contact ratio, exponential and comprehensive exponential analyzing method, and the results of different methods were compared. RESULTS: The occupational health risk level of all the posts in sandblasting, sawing, welding, grinding and painting in the mechanic processing enterprises were of moderate risk or above. The consistency of evaluation results of the contact ratio, exponential and comprehensive exponential methods was poor(weighted Kappa=0.30, P>0.05). The consistency of exponential and comprehensive exponential methods was excellent(weighted Kappa=1.00, P<0.01). When the contact concentration(E)/occupational exposure limits(OEL) is <0.50, the contact ratio method is less than or equal to the exponential method and the comprehensive exponential method. When 0.50 ≤E/OEL<2.00, the results of these three methods are consistent. When the E/OEL ≥2.00, the evaluation result of the contact ratio method is equal to or higher than the exponential method and the comprehensive exponential method.CONCLUSION: The contact ratio method is easy to obtain, simple and convenient. The exponential method is suitable for occupational disease risk factors in the workplace without OELs or unable to obtain test data, and it is more practical. The comprehensive exponential method is considered comprehensive and suitable for occupational health risk assessment in the workplace.

Percepción del riesgo mediante sus atributos psicosociales en trabajadores de la industria metalmecánica en la ciudad de Bogotá, D.C (Colombia) / Perception of the risk through its psychosocial attributes in workers of the metalmechanical industry in the city of Bogotá, D.C (Colombia)

Resumen Introducción. La percepción del riesgo en el ámbito laboral se convierte en un elemento crucial para entender las prácticas de trabajo inseguras de los trabajadores, teniendo en cuenta no solo las variables cognitivas sino también las psicosociales. Objetivo. Describir la percepción del riesgo mediante sus atributos psicosociales en trabajadores de la industria metalmecánica en la ciudad de Bogotá. Materiales y métodos. Estudio descriptivo transversal realizado en la ciudad de Bogotá, D.C, a través de una encuesta aplicada a los participantes del estudio. Resultados. La aplicación de la Guía NTP 578 a los trabajadores del sector metalmecánico permitió la realización del perfil comparativo de la magnitud del riesgo percibido y sus atributos para cada una de las actividades que se evaluaron. Conclusiones. Los trabajadores del sector metalmecánico, se sienten más vulnerables a las consecuencias que pueden generarles el uso de herramientas cortantes, la exposición al ruido y la exposición a gases y vapores, y le temen a la gravedad del daño que se puede derivar estos riesgos a los cuales están sometidos en su diario vivir en su entorno laboral.

Abstract Introduction. The perception of risk in the workplace becomes a crucial element to understand the unsafe work practices of workers, taking into account not only the cognitive variables but also the psychosocial ones. Objective. To describe the perception of risk through its psychosocial attributes in workers of the metal-mechanic industry in the city of Bogotá. Materials and methods: A cross-sectional descriptive study conducted in the city of Bogotá, D.C, through a survey applied to the study participants. Results. The application of the Guide NTP 578 to the workers of the metalworking sector allowed the realization of the comparative profile of the magnitude of the perceived risk and its attributes for each of the activities that were evaluated. Conclusions. Workers in the metalworking sector feel more vulnerable to the consequences that can result from the use of sharp tools, exposure to noise and exposure to gases and vapors, and fear the seriousness of the damage that can be derived from these risks to which they are subjected in their daily life in their work environment.

Updates on extended criteria donor for liver transplantation / 中华肝胆外科杂志

Though achieved great success as the only curative treatment for end-stage liver diseases, liver transplantation has been severely restricted by the shortage of donors. The adoption of extended criteria donor (ECD) tackles the donor shortage problem to some extent, thus became an issue we must face in China at present stage. As the transplantation effect and recipient safety is largely decided by the quality of liver graft, ECD graft should be cautiously selected and adopted because of its inherent defects. This relies on individualized decisions made for recipients by transplant surgeons who have a good understanding of the risk factors and evaluation criteria of ECD. In this article, we investigate the risk factors, evaluation criteriaand allocation of ECD liver grafts as well as the application of mechanic perfusion, and we discuss the fundamental issues and prospects of ECD study.

Updates on extended criteria donor for liver transplantation / 中华肝胆外科杂志

Though achieved great success as the only curative treatment for end-stage liver diseases, liver transplantation has been severely restricted by the shortage of donors. The adoption of extended criteria donor (ECD) tackles the donor shortage problem to some extent, thus became an issue we must face in China at present stage. As the transplantation effect and recipient safety is largely decided by the quality of liver graft, ECD graft should be cautiously selected and adopted because of its inherent defects. This relies on individualized decisions made for recipients by transplant surgeons who have a good understanding of the risk factors and evaluation criteria of ECD. In this article, we investigate the risk factors, evaluation criteriaand allocation of ECD liver grafts as well as the application of mechanic perfusion, and we discuss the fundamental issues and prospects of ECD study.

Factores pronóstico de mortalidad asociados al síndrome de insuficiencia respiratoria aguda por ventilación mecánica / Mortality prognosis factors associated with the acute respiratory failure due to mechanical ventilation

Se realizó una investigación descriptiva, de serie de casos, de 31 pacientes ingresados en la Unidad de Cuidados Intensivos del Hospital Provincial Docente Clinicoquirúrgico Saturnino Lora Torres de Santiago de Cuba, de enero de 2014 a igual mes de 2017, quienes presentaron el síndrome de insuficiencia respiratoria aguda, con vistas a describir los factores pronóstico de mortalidad por esta causa. En la serie predominaron el sexo masculino, la edad promedio de 57 años y la hipertensión arterial como enfermedad crónica asociada. La mayoría de los pacientes recibía ventilación mecánica previa al diagnóstico, en la modalidad controlada por volumen, y en un menor número se aplicaron maniobras de incorporación alveolar. La insuficiencia respiratoria moderada de causa extrapulmonar figuró en pacientes con ventilación prolongada, en tanto la complicación más frecuente fue la disfunción multiorgánica, que además resultó la principal causa de muerte. Finalmente, no se encontró relación directa entre la presencia de estos factores pronóstico de mortalidad y la probabilidad de fallecer.

A descriptive investigation, of cases series, in 31 patients admitted in the Intensive Care Unit of Saturnino Lora Torres Teaching Clinical-Surgical Provincial Hospital in Santiago de Cuba, was carried out from January, 2014 to same month in 2017, who presented acute respiratory failure, with the aim of describing the mortality prognosis factors for this cause. In the series the male sex, the average age 57 year-old and hypertension prevailed as associated chronic diseases. Most of the patients received mechanic ventilation previous to the diagnosis, in the modality controlled through volume, and in a lower number maneuvers of alveolar incorporation were applied. The moderate respiratory failure of extrapulmonar cause was present in patients with prolonged ventilation, as long as the most frequent complication was the multiple organs dysfunction which was also the main cause of death. Finally, there was no direct relationship between the presence of these mortality factors prognosis and the probability of dying.

Ventilación con liberación de presiones en la vía respiratoria en un paciente con trauma de tórax / Airway pressure release ventilation in a patient with thorax´s trauma

Introducción: Los traumatismos torácicos son causa importante de morbi-mortalidad. El volet costal con contusión pulmonar ensombrece el pronóstico. Objetivo: Presentar una estrategia ventilatoria para estabilizar la pared torácica, corregir la hipoxemia y proteger el parénquima pulmonar. Caso clínico: Paciente con volet costal, neumotórax bilateral y contusión pulmonar que produjo un distress respiratorio, requirió ventilación mecánica. Ante la necesidad de estabilizar la pared tóracica y reclutar el parénquima pulmonar se ventiló con liberación de presiones en la vía aérea. Requirió toracotomía para solucionar definitivamente la lesión pulmonar y se realizó toracoplastia. El paciente egresó sin secuelas luego de 21 días de hospitalización. Conclusiones: La ventilación con liberación de presiones en la vía aérea se propone como una estrategia que facilita la estabilidad de la pared torácica, el reclutamiento alveolar, teóricamente ofrece ventajas en protección pulmonar y en la respuesta inflamatoria sistémica. En este caso particular se lograron los objetivos esperados con el empleo de esta modalidad como puente para la cirugía correctiva(AU)

Introduction: Thoracic trauma is an important cause of morbidity and mortality. The costal volet with pulmonary contusion overshadows the prognosis Objective: To present a ventilatory strategy to stabilize the chest wall, correct hypoxemia and protect the lung parenchyma. Clinical case: A patient with costal volet, bilateral pneumothorax and pulmonary contusion that produced a respiratory distress; required mechanical ventilation. Given the need to stabilize the thoracic wall and recruit the lung parenchyma, it was ventilated with release of airway pressures. A thoracotomy was required to definitively resolve the lung lesion and thoracoplasty was performed. The patient withdrew without sequelae after 21 days of hospitalization. Conclusions: The APRV is proposed as a strategy that facilitates the stability of the thoracic wall, the alveolar recruitment, theoretically offers advantages in pulmonary protection and in the systemic inflammatory response. In this particular case the expected objectives were achieved with the use of this modality as a bridge for corrective surgery(AU)

An Analysis of Stimulating Occlusal Trauma on Condyle Using Three-Dimensional Finite Element Model / 昆明医科大学学报

Objective To provide evidence for the relationship between TMD and occlusal trauma by studying the mechanics influence and displacement of condyle by building the three dimensional finite element analysis model andstimulating the abnormal bite force leading occlusal trauma.Methods We collected DICOM date of healthy male volunteers with normal occlusal relationship using CBCT scan with constraint on condylar top and formed the finite model with divide mesh.Two conditions were built: (1) We operated different vertical load on the left mandibular molar occlusal surface; (2) We operated different buccal direction load on the same modelto study the mechanic change on left condylar.Results When the three dimensional finite model of mandible was built, the mechanic region of condyle stayed the same but the stress and tension increased accordingly as the loda duplicate rose. As the same buccal operation load was operated,the stress and tension became larger and the displacement became longer.Conclusion The abnormal bite force causing occlusal trauma can change mechanic conduct on condyle and lead to the pathological change of condyle.

Mortalidad y factores asociados en pacientes con síndrome de dificultad respiratoria agudo (SDRA) en un hospital universitario / Mortality and associated factors in patients with acute respiratory distress syndrome (ARDS) in a university hospital

Introducción: el síndrome de dificultad respiratorio agudo (SDRA) es la manifestación más grave de compromiso pulmonar agudo. Actualmente no hay datos disponibles para documentar los factores asociados con la mortalidad en nuestro medio. Diseño del estudio: estudio de cohorte retrospectiva. Objetivo: describir los factores asociados a la mortalidad en pacientes adultos hospitalizados en la unidad de cuidado crítico con SDRA entre enero 2007 y diciembre de 2011. Métodos: se recolectaron datos con respecto a causas de SDRA, estancia hospitalaria y en la UCI, gravedad de la enfermedad crítica y el estado vital al egreso. Se realizó un análisis de regresión logística para determinar los factores asociados de manera independiente con la mortalidad hospitalaria. Resultados: se analizaron 141 pacientes con SDRA, la mediana de edad fue 44 años y 62.9% fueron hombres. La primera causa de SDRA fue el choque séptico de origen pulmonar en 49.6% y el APACHE II tuvo una mediana de 18. La mediana de la PaO2/FIO2 al inicio del SDRA fue 91.5 y a las 72 horas fue 125. La mediana de PEEP requerido al inicio de la ventilación mecánica fue de 10 cmH2O y a las 72 horas fue de 12. La estancia en la UCI fue de 13 días y la mortalidad hospitalaria fue del 54%. Los factores asociados con mortalidad fueron el choque de origen pulmonar (OR = 2.45; IC 95% = 1.04-5.77) y el puntaje APACHE II (OR = 1.05 por cada punto; IC 95% = 1.003-1.1). El nivel de PEEP igual o menor en las primeras 72 horas se comportó como un factor protector (OR = 0.36; IC 95% = 0.16-0.82). Conclusiones: el SDRA tiene una alta mortalidad en nuestro medio y los factores más fuertemente asociados con dicha mortalidad son dependientes de la enfermedad de base y de la intensidad de la respuesta biológica a la misma. (Acta Med Colomb 2015; 40 305-309).

Introduction: acute respiratory distress syndrome (ARDS) is the most serious manifestation of acute pulmonary compromise. Currently no data are available to document the factors associated with mortality in our environment. Study Design: retrospective cohort study. Objective: To describe the factors associated with mortality in adult patients hospitalized in critical care unit with ARDS from January 2007 to December 2011. Methods: Data were collected with regard to causes of ARDS, hospital and ICU stay, critical illness severity and vital status at discharge. Logistic regression analysis was performed to determine factors independently associated with hospital mortality. Results: 141 patients with ARDS were analyzed; the median age was 44 years and 62.9% were men. The first cause of ARDS was septic shock of pulmonary origin in 49.6% and APACHE II had a median of 18. The median PaO2/FIO2 at the beginning of ARDS was 91.5 and at 72 hours was 125. The median PEEP required at the initiation of mechanical ventilation was 10 cmH2O and at 72 hours 12. The ICU stay was 13 days and hospital mortality was 54%. Factors associated with mortality were the shock of pulmonary origin (OR = 2.45; 95% CI = 1.04-5.77) and APACHE II (OR = 1.05 per point, 95% CI = 1.003-1.1). PEEP level equal to or less within 72 hours acted as a protective factor (OR = 0.36; 95% CI = 0.16-0.82). Conclusions: ARDS has a high mortality in our environment and the factors most strongly associated with this mortality are dependent on the underlying disease and the intensity of biological response to it. (Acta Med Colomb 2015; 40 305-309).

Comparative study of effect of mechanical perfusion and simple cold preservation on DCD pancreas in pigs / 器官移植

Objective To compare the effect of mechanical perfusion and simple cold preservation on donation after cardiac death (DCD)pancreas in pigs.Methods Ten healthy pigs were randomized into simple cold preservation group and the mechanical perfusion group (5 pigs in each group ).DCD model was established in pigs.The pancreas was cut and stored in University of Wisconsin solution (UW solution).The pancreas of the simple cold preservation group was preserved with simple UW solution and that of the mechanical perfusion group was preserved by mechanical perfusion.Specimen was collected from pancreatic tail at 1,2,3,4,6 and 24 h to prepare tissue section.Then,the tissue section was stained with hematoxylin-eosin (HE).Histopathological examination was conducted and pathological score of the two groups was compared.Results Microthrombus in DCD pancreas of pig was removed at 180 min of mechanical perfusion and injury to pancreas islet caused by excessive perfusion was avoided.The pathological score of the mechanical perfusion group was (4.2 ±0.8)and that of the simple cold preservation group was (8.4 ±1.1),and the difference had statistical significance (P <0.05).Conclusions Mechanical perfusion may effectively remove thrombus in pancreatic vessels.Compared with simple cold preservation,mechanical perfusion may maintain the integrity of pancreas islet better after the preservation of the same period of time.

Laparoscopic treatment of acquired megacolon / Tratamento laparoscópico do megacolo adquirido

In spite of the large experience acquired in the last 50 years with the surgical treatment of the Chagasic megacolon, the use of colorectal video laparoscopic surgery brought some controversy in several aspects of the treatment that already had been considered as resolved. One of the basic aspects to the establishment of the colorectal video laparoscopic surgery is to maintain the same procedure of the conventional surgery, since the results obtained in this operation were considered as curative. Constipation is only a symptom of a multisymptomatic disease, and the surgical treatment of acquired megacolon must be considered as definitive in the cure of this symptom; recurrence of the constipation or dilatation after a short period of time must be considered deleterious to the patient. Based in 41 years of experience with the Duhamel procedure in the treatment of 912 patients with acquired megacolon, the authors propose to apply the same technique in the surgical laparoscopic approach of acquired megacolon, including the same colon-recto-anal anastomosis. The results obtained in 56 patients operated on by laparoscopic approach showed the same curative results, but with lower morbidity. (AU)

Apesar da vasta experiência adquirida nos últimos 50 anos com o tratamento cirúrgico do megacolo adquirido, a introdução da cirurgia laparoscópica voltou a trazer controvérsia para alguns pontos anteriormente considerados como esclarecidos. Uma das regras básicas para a introdução da videolaparoscopia no tratamento das enfermidades colorretais tem sido a de se manter a técnica original utilizada em cirurgias pela via convencional, desde que os resultados observados na mesma conduzam à cura dos sintomas ou da enfermidade causal. Em especial, no referente ao tratamento cirúrgico do megacolo adquirido a proposta de um tratamento cirúrgico deve ter em mente que diferentemente do que ocorre com a cirurgia para tratamento de outras enfermidades, benignas ou malignas, neste caso não se almeja o tratamento causal da enfermidade, mas essencialmente a cura da manifestação de um de seus sintomas. É, pois, realmente importante que se considere um tratamento que não venha a resultar em bons resultados por apenas um curto espaço de tempo, mas que possibilite ao paciente livrar-se definitivamente de um sintoma, visto que é possível que em curto espaço de tempo ele venha a necessitar tratar outra manifestação sintomatológica (cardíaca ou esofágica) da enfermidade causal. Baseados na experiência adquirida nos últimos 50 anos (912 pacientes) com a técnica de Duhamel, em que o ponto importante é a realização de uma ampla anastomose da parede anterior do cólon abaixado à parede posterior (mucosa) do reto, ao mesmo tempo em que se anastomosa a parede posterior do cólon abaixado ao canal anal, são analisados os resultados obtidos com esta mesma técnica realizada por laparoscopia. Esta mesma incisão no canal anal serve para a retirada do segmento cólico ressecado, sem necessidade de laparotomia auxiliar. Os resultados observados em 56 pacientes quanto à cura da obstipação são similares aos registrados na cirurgia convencional, porém com um menor índice de morbidade, seja intra ou pós-operatória. (AU)

Early diagnostic value of soluble triggering receptor expressed on myeloid cells1 in patients with ventilator associated pneumonia / 中华急诊医学杂志

Objective To evaluate the early diagnostic values of soluble triggering receptor expressed on myeloid cell-1 (sTREM-1) in patients with ventilator associated pneumonia (VAP).Methods A total of 112 clinical suspicion VAP ventilator-associated pneumonia (VAP) patients accepted from January 2008 through December 2010 were enrolled for prospective and observational study.Two independent intensivists without aware of the results of the sTREM-1 assay separately made diagnosis of VAP present or absent depending on the clinical symptoms and results of microbial culture.Patients were categorized into two groups:VAP group (n =74) and non-VAP group (n =38).The levels of sTREM-1 in broncho-alveolar lavage fluid (BALF) collected with Gibot method in unemployment of bronchoscope and in serum were measured by enzyme-linked immunosorbent assay (ELISA) on the first day of suspected diagnosis.Comparison of sTREM-1 level between BALF and serum was made by t-test and Receiver Operating Characteristic (ROC) curve.Results A total of 112 clinical suspicion VAP patients admitted from January 2008 through December 2010 were enrolled for prospective and observational study.Two independent intensivists without aware of the results of the sTREM-1 assay made diagnosis of VAP present or absent depending on the clinical symptoms and results of microbial culture.Patients were categorized into two groups:VAP group (n =74) and non-VAP group (n =38).The levels of sTREM-1 in broncho-alveolar lavage fluid (BALF) collected with Gibot method in unemployment of bronchoscope and in serum were measured by enzyme-linked immunosorbent assay (ELISA) on the first day of suspected diagnosis.Comparison of sTREM-1 level between BALF and serum was made by t-test and Receiver Operating Characteristic (ROC) curve.Conlclusions In suspected VAP patients,measurement of sTREM-1 levels in BALF and in serum could help identify VAP in early stage.

Effects of TGF-β2 on mechanical behavior of posterior scleral flbroblasts in experimental myopia / 中华实验眼科杂志

Background There have been an abundance of literature on the analysis of the mechanical characteristic of the sclera at the entire seleral level in high myopia.However,some recent studies on high myopia are focused on the mechanical changes of the sclera on a cellular level. Objective This experiment was purposed to study how transforming growth factor-β2(TGF-β2)affected sclerotic desmocytes and the mechanical behaviors of scleral fibroblasts in the posterior part of the eyes in guinea pigs with experimental myopia. Methods Induced myopic animal models were established by wearing-10.00 D concave lens for 30 days in lateral eyes of 2-week-old guinea pigs.The fellow eyes were used as control group.Another 5 matched animals served as normal controls.The scleral fibroblasts of each group were purified with the tissue explant method and passaged for 2 generations in vitro.Cultured cells were identified by immunochemistry with vimentin,desmin,keratin and S-100 antibodies.Different concentrations of TGF-β2(0,1,10,100mg/L)were added into serum-free DMEM for 24 hours,and the viscoelastic properties of scleral fibroblasts were measured by micropipette aspiration technique. Results Compared with the fellow,eyes and normal control eyes,the equilibrium modulus and apparent viscosity in model eyes were significantly higher(P＜0.05).After treatment of TGF-β2,the equilibrium modulus and apparent viscosity in the model group and fellow eyes were positively correlated with the concentrations of TGF-β2(r=0.743,r=0.533,r=0.654,r=0.576,P＜0.05).Following the addition of 1 mg/L TGF-β2 and 10 mg/L TGF-β2,the equilibrium modulus and apparent viscosity of scleral fibroblasts were significantly reduced in model eyes compared with fellow eyes(P＜0.05).No significant difference was found in the equilibrium modulus and apparent viscosity of scleral fibroblasts between model eyes and fellow eyes after treatment with 100 mg/L TGF-β2(P＞0.05). Conclusion TGF-β2 car increase the mechanic indexes in a concentration.dependent manner.1 mg/L,10 mg/L TGF-β2 can lower the equilibrium modulus and apparent viscosity of scleral fibroblasts of normal eye and thus cause more changes in the mechanical behavior of scleral fibroblasts.

Influência da velocidade de carga nos testes de cisalhamento em colagem de braquetes / Cross-head speed influence on the shear bond strength tests in direct bracket bonding

Este estudo verificou a influência de diferentes velocidades de carga da máquina de ensaio universal nos valores de resistência adesiva ao cisalhamento (RAC) e no índice de adesivo remanescente (IAR). Foram utilizados 75 corpos de prova, nos quais foram colados braquetes metálicos, com o sistema autocondicionante Transbond Plus Self-Etching Primer e a resina Transbond XT. Os testes de cisalhamento foram realizados na máquina de ensaios universal Shimadzu, com variação na velocidade de carga em: 0,5; 1,0; 2,0; 3,0; 5,0 mm/min. Os resultados da RAC foram avaliados pelo teste de variância ANOVA a um critério de classificação ou ANOVA one-way, seguido pelo teste de Tukey. Para a avaliação do IAR foi utilizado o teste não-paramétrico de Kruskal- Wallis. A análise estatística dos dados demonstrou que a velocidade não interfere na resistência adesiva ao cisalhamento (RAC) ou no IAR. Portanto não existe diferença entre os grupos em relação a diferentes velocidades de carga.

This study verified the influence of different cross-head speeds of the universal testing machine on the values of Shear Bond Strength (SBS) and in the Adhesive Remnant Index (ARI). 75 samples were used, in which metallic brackets were bonded using the self-etching system Transbond Self-Etching Primer and the Transbond XT resin. The Shear Bond tests were performed on the Shimadzu universal testing machine, with a variation in the cross-head speed of 0,5; 1,0; 2,0; 3,0; 5,0 mm/min. The results of the SBS were assessed by analysis of variance (ANOVA-one way), followed by the Tukey multiple comparison test. To evaluate the ARI the Kruskal Wallis test was used. The statistical analysis showed that the cross-head speed does not affect the shear bond strength (SBS) and the ARI. Therefore, there is not any difference between the groups towards the different cross-head speeds.

Confiabilidade teste-reteste do Índice de Capacidade para o Trabalho em trabalhadores metalúrgicos do Sul do Brasil / Test-retest reliability of the Work Ability Index (WAI) in metallurgy workers from Southern Brazil

INTRODUÇÃO: O Índice de Capacidade para o Trabalho (ICT) tem sido utilizado para mensurar a capacidade física, mental e social dos trabalhadores. Porém, não há relato de estudos que avaliem o grau de estabilidade do índice na língua portuguesa. O objetivo deste estudo foi testar a confiabilidade teste-reteste do ICT. MÉTODOS: A população de estudo foi composta por trabalhadores de duas empresas (N= 153) do setor metal-mecânico do município de Caxias do Sul, RS. Os trabalhadores responderam questionários autoadministrados por duas vezes com intervalo de 4 semanas entre eles. A análise dos dados incluiu o coeficiente de correlação intra-classe (CCI), o t-teste pareado e o coeficiente Kappa. RESULTADOS: A confiabilidade teste-reteste (ICT contínuo) apresentou um CCI igual a 0,84 (IC95 por cento0,78 a 0,88, P<0,001) e o teste t-pareado não apresentou diferenças significativas entre as aplicações. O valor do coeficiente Kappa Ponderado para o índice categorizado foi igual a 0,72 (IC95 por cento 0,56 a 0,87). CONCLUSÕES: O ICT apresentou níveis de confiabilidade aceitáveis para a classificação da capacidade para o trabalho na população de estudo. Novos estudos são necessários para melhor avaliar a confiabilidade e validade do índice e a fim de complementar a avaliação e a qualidade das informações fornecidas pelo instrumento.

OBJECTIVE: Several studies have used the Work Ability Index (WAI) to assess physical, mental and social abilities of workers. Despite its common use, there are very few reports on the psychometric properties of the index. The objective of this study was to assess the test-retest reliability of WAI. METHODS: A 4-week-interval test-retest study was carried out with 153 workers from the metal-mechanic industry in a Southern Brazilian city. Data analyses included intra-class correlation coefficient (ICC), paired t-test and Kappa coefficient. RESULTS: An ICC of 0.84 (95 percentCI 0.78-0.88) was found for test-retest reliability of the WAI. The paired t-test did not show a significant difference between the 1st and the 2nd applications. Weighted Kappa was 0.72 (95 percentCI 0.56-0.87). CONCLUSION: Data analyses suggest an acceptable test-retest reliability of the WAI in the study population. New studies should be conducted to test the validity and reliability of the index.