Estrategia de superación para el desarrollo de habilidades del cirujano general en el preoperatorio mediato / An upgrading strategy for the development of skills in the general surgeon in the mediated preoperative period

Introducción: La superación profesional en cirujanos generales, particularizada en la atención preoperatoria, es una vía para acrecentar la educación permanente o continua, que contribuye a formar hombres de ciencias con determinados valores y actitudes. Objetivo: Diseñar una estrategia de superación para el desarrollo de las habilidades profesionales en la atención preoperatoria mediata que contribuya al mejoramiento del desempeño profesional de los médicos cirujanos generales. Métodos: Se utilizaron como métodos teóricos: análisis-síntesis, histórico-lógico, sistematización, inducción-deducción, modelación, análisis documental, sistémico estructural funcional; y como empírico, la observación científica. Resultados: El diseño de la estrategia respondió al desarrollo de las habilidades profesionales en la atención preoperatoria mediata y se fundamentó desde los referentes filosóficos, sociológicos, psicológicos, epistemológicos, pedagógicos y la educación médica. Se concibió en cuatro etapas y se utilizó el ciclo Deming, que establece relaciones esenciales con coherencia lógica interna a la educación médica, en particular en el área de la formación permanente y continuada de los profesionales de la salud. Conclusiones: El diseño de la estrategia profesional permite el enriquecimiento de las ciencias de la educación médica desde el posgrado como ciencia en construcción, específicamente en el área de la formación permanente y continua de médicos cirujanos generales. Al profundizar desde el plano interno, externo y contextual para el desarrollo de las habilidades profesionales en el preoperatorio mediato, la estrategia propuesta resulta dinámica, lo que permite el mejoramiento del desempeño profesional a partir de la superación(AU)

Introduction: Professional improvement in general surgeons, particularly in preoperative care, is a way to increase permanent or continuous education, which contributes to the creation of men of science with certain values and attitudes. Objective: To design an upgrading strategy for the development of professional skills in preoperative care that contributes to the improvement of professional performance in general surgeons. Methods: As theoretical methods, analysis-synthesis was used, together with the historical-logical method, systematization, induction-deduction, modeling, documentary analysis, and the structural-functional-systemic method; while, at the empirical level, scientific observation was used. Results: The design of the strategy responded to the development of professional skills in preoperative mediated care and was based on philosophical, sociological, psychological, epistemological, pedagogical and medical education referents. It was conceived in four stages and used the Deming cycle, which establishes essential relationships with internal logical coherence to medical education, particularly in the area of permanent and continuous education for health professionals. Conclusions: The design of the professional strategy allows the enrichment of medical education sciences from the postgraduate level as a science under construction, specifically in the area of permanent and continuous training of general surgeons. Insofar it deepens from the internal, external and contextual levels for the development of professional skills in the mediate preoperative period, the proposed strategy is dynamic, allowing for the improvement of professional performance from the point of view of self-upgrading(AU)

The protection of Thymus vulgaris leaves alcoholic extract against hepatotoxicity of alcohol in rats

OBJECTIVE@#To investigate the protective effect of Thymus vulgaris (T. vulgaris) leaves 70% alcoholic extract against alcohol-mediate hepatotoxicity rats.@*METHODS@#The protective effect of T. vulgaris extract was investigated at dose of 500 mg/kg/day (as 0.1 of LD) orally against alcohol-mediate hepatotoxicity using adult male Wister albino rats during 21 days. Protective effect of T. vulgaris extract was evaluated comparing with silymarin standard drug at recommended dose (25 mg/kg/day) orally for 21 days. Serum liver and kidney functions, serum lipid profile, liver antioxidant enzymes activities, liver glutathione concentration (GSH), liver oxidative parameters and histopathological study of liver and kidney were estimated to find out protective effect of T. vulgaris extract.@*RESULTS@#Alcohol-mediate hepatotoxicity rats (alcohol-control) showed hepatocytes distortion represented as marked increment on liver biomarkers; alkaline phosphatase (ALP), aspartate transaminase (AST) and alanine transaminase (ALT) activities, as well as pronounced reduction on total protein and its fractions albumin and globulin production corresponding to normal ranges. Oxidative stress status was appeared on alcohol-control evident as significant depletion on GSH concentration, antioxidant enzymes activities; catalase (CAT), superoxide dismutase (SOD), glutathione reductase (GR), glutathione- S- transferase (GST) and glutathione peroxidase (GPx) recorded significant dwindling, concurrence with significant augmentation on oxidative stress parameters; malondyaldehyde (MDA) and hydrogen peroxide (HO) concentrations with respect to normal values. Serum lipid profile was affected by alcohol administration, total cholesterol (TC) and low density lipoprotein cholesterol (LDL-C) were significantly reduced, meanwhile high density lipoprotein cholesterol (HDL-C) was raised comparing to normal ranges. Co-administration of T. vulgaris extract with alcohol showed protective effect on hepatocytes manifested as remarkable minimizing on ALP, AST and ALT activities and marked increment on total protein, albumin and globulin production compared to alcohol-control. Amelioration was achieved on oxidative stress status on rats co-administrated T. vulgaris extract with alcohol. Accordingly, antioxidant enzymes activities; CAT, SOD, GR, GST and GPx were significantly magnified, while oxidative stress parameters; MDA and HO concentration were significantly lessened corresponding to alcohol-control. Also, lipid profile was markedly improved and risk ratio was lowered by T. vulgaris extract co-administrated in comparison with alcohol-control. All these obvious results were confirmed by histopathological examination, which illustrated that extract showed normalization of degenerated and fibrotic liver tissue as of alcohol-control.@*CONCLUSION@#T. vulgaris extract protected hepatocytes from damaging by alcohol reflecting improvement on liver performance and inhibition of oxidative stress status of liver. T. vulgaris extract appeared hepatoprotective, hypolipidemic and antioxidant activities on alcohol-mediate hepatotoxicity rats compared to silymarin.

The protection of Thymus vulgaris leaves alcoholic extract against hepatotoxicity of alcohol in rats

Objective To investigate the protective effect of Thymus vulgaris (T. vulgaris) leaves 70% alcoholic extract against alcohol-mediate hepatotoxicity rats. Methods The protective effect of T. vulgaris extract was investigated at dose of 500 mg/kg/day (as 0.1 of LD

Mediating role of self-esteem in affective property and metal healthy of junior middle school students / 中华行为医学与脑科学杂志

Objective To explore the mediating role of self-esteem between affective property and metal healthy,and then search effective way to ascent juniors' metal healthy lever.Methods 300 juniors were chosen and received PANAS,MSSMHS and SES assessment.Results ①In sequence,study stress,lability of affect,obsession,anxiety and sensitive of interpersonal relationship produced effect on juniors.②There was a significant negative correlation (r=-0.498～-0.314,P＜0.05)between mental health and self-esteem,positive emotions.There was a significant positive correlation(r=0.291～ 0.520,P＜ 0.05) between mental health and negative emotions.There was a significant positive correlation(r=0.337,P＜0.05)between self-esteem and positive emotions.③The degree of self-esteem and positive emotions had an obvious negatively predictable (R 2=0.223) function to the total average of mental health,and the degree of negative emotions had an obvious positively predictable (R 2=0.350) function to the total average of mental health.④ The mediating effect of subordinates' perceived self-esteem between positive emotions and mental health was also validated(ab/c'=0.118) and the negative emotion had no regulation effect on mental health.Conclusion With the help of significant mediating role of self-esteem,affective property can be seen as a predictors of metal healthy of juniors.

The Effect of Soothing and Smooth Liver and Nourishing Kidney and Acupuncture Treat Liver-YANG Syndrome Hypertension / 浙江中医药大学学报

Objective] To analyse the effect of combining acupuncture of soothing liver, smooth liver and nourishing kidney with Amlodipine Besylate Tablets on light, medium hyperactivity of liver-YANG syndrome hypertension. [Methods] From January 2013 to January 2014, we collected 60 patients with hyperactivity of liver-YANG syndrome meeting the criterion. 30 patients in control group, taking Amlodipine Besylate Tablets, 14 male, 16 female, average age was 62.0 years old(54~72 years old); 30 cases in treatment group, on the basis of control group using soothing liver, smooth liver and nourishing kidney acupuncture, 13 males, 17 females, average age was 61.5 years old(53~73 years old). Patients were collected 24 hours ambulatory blood pressure, anxiety, TCM syndrome integral before and after treatment. [Results] After treatment, control group and the treatment group of ambulatory blood pressure, anxiety and TCM syndrome integral was significantly improved, the differences were statistically significant( P<0.05). In treatment group, daytime systolic blood pressure, daytime diastolic blood pressure, nighttime systolic blood pressure, nighttime diastolic blood pressure, 24h diastolic blood pressure and 24h systolic blood pressure were decreased significantly lower than the control group, and anxiety value, TCM syndrome integral was also improved better than control group(P<0.05). [Conclusion] Soothing liver, smooth liver and nourishing kidney acupuncture combined with oral drug can effectively control blood pressure for hyperactivity of liver-YANG syndrome hypertension patients; meantime it also can significantly relieve the TCM syndrome and anxiety symptom.

Recomendações da sociedade brasileira de arritmias cardíacas para serviços de holter / Recommendations of the Brazilian society of cardiac arrhythmias for holter monitoring services

FUNDAMENTOS: Inúmeros indicadores são utilizados para assegurar a qualidade de um serviço; entretanto, a competência médica e o adequado fluxo de realização de um procedimento são determinantes da qualidade final. Nesse contexto, a Sociedade Brasileira de Arritmias Cardíacas pretende recomendar parâmetros mínimos necessários para garantir a excelência dos serviços de monitorização eletrocardiográfica ambulatorial. OBJETIVOS: Recomendar competências médicas mínimas e as informações necessárias para emissão do laudo de Holter. MÉTODOS: O documento foi fundamentado no conceito de medicina baseada em evidência, e nas circunstâncias em que a evidência não estava disponível a opinião de uma comissão de redação foi utilizada para a formulação da recomendação. Essa comissão foi formada por profissionais que apresentam vivência nas dificuldades do método e gestão na prestação de serviços nessa área. RESULTADOS: O profissional responsável pela análise de Holter deve conhecer as patologias cardiovasculares e ter formação consistente em eletrocardiografia, incluindo arritmias cardíacas e seus diagnósticos diferenciais. O laudo deve ser redigido de forma clara e objetiva. Os parâmetros mínimos que devem constar no laudo incluem as estatísticas do exame, assim como quantificação e análise dos distúrbios do ritmo observados durante a monitorização. CONCLUSÃO: A monitorização eletrocardiográfica ambulatorial deve ser realizada por profissionais com vivência em análise eletrocardiográfica e o laudo deve conter os parâmetros mínimos mencionados nesse documento.

BACKGROUND: There are innumerous indicators to assure the quality of a service. However, medical competence and the proper performance of a procedure determine its final quality. The Brazilian Society of Cardiac Arrhythmias recommends minimum parameters necessary to guarantee the excellence of ambulatory electrocardiographic monitoring services. OBJECTIVE: To recommend minimum medical competences and the information required to issue a Holter monitoring report. METHODS: This study was grounded in the concept of evidence-based medicine and, when evidence was not available, the opinion of a writing committee was used to formulate the recommendation. That committee consisted of professionals with experience on the difficulties of the method and management in providing services in that area. RESULTS: The professional responsible for the Holter monitoring analysis should know cardiovascular pathologies and have consistent formation on electrocardiography, including cardiac arrhythmias and their differential diagnoses. The report should be written in a clear and objective way. The minimum parameters that comprise a Holter report should include statistics of the exam, as well as quantification and analysis of the rhythm disorders observed during monitoring. CONCLUSION: Ambulatory electrocardiographic monitoring should be performed by professionals knowledgeable about electrocardiographic analysis, whose report should comprise the minimum parameters mentioned in this document.

Fotodermatosis y terapia dedesensibilización / Photodermatosis and desensitization therapy

Las fotodermatosis son un grupo de desórdenes cutáneos causados o agravados por la radiación ultravioleta o la luz visible. Se dividen en cuatro grupos: I, fotodermatosis mediadas inmunológicamente (anteriormente llamadas idiopáticas); II, fotosensibilidad inducida por drogas y químicos; III, desórdenes de la reparación de excisión de nucleótidos del ADN y, IV, dermatosis fotoagravadas. Para llegar al diagnóstico correcto de estas enfermedades es necesario realizar un enfoque clínico adecuado, que esté apoyado en un interrogatorio y examen físico completos, además de exámenes especializados como la fotoprueba y fotoparche. En esta revisión se hace una recopilación de los aspectos epidemiológicos, clínicos, de diagnóstico y tratamiento de las fotodermatosis mediadas inmunológicamente, con mayor énfasis en la terapia de desensibilización con luz ultravioleta (PUVA, UVA, UVB), la cual ha mostrado resultados positivos en estas enfermedades, prefiriéndose la UVB por la mayoría de los autores, a excepción de la urticaria solar, en la cual la PUVA ha demostrado mejores resultados que la UVB a largo plazo. Para esto es fundamental determinar primero la dosis de eritema mínimo (DEM) y la dosis de urticaria mínima en el caso de la urticaria solar. La principal desventaja de la terapia de fotodesensibilización es que sus efectos son temporales y que los pacientes requieren terapia de mantenimiento para lograr un control duradero de la enfermedad, con el riesgo de los efectos carcinogénicos de la luz ultravioleta. Además, hasta el momento hay pocos estudios que evalúen la eficacia y seguridad de la fototerapia de desensibilización y en algunos casos las muestras son muy pequeñas.

Photodermatoses are a group of skin disorders caused or aggravated by ultraviolet radiation or visible light. They are divided in four groups: I, immunologically mediated photodermatoses (previously called idiopathic); II, drug- and chemical- induced photosensitivity; III, defective DNA repair disorders; and IV, photoaggravated dermatoses. To reach the correct diagnosis of these pathologies is necessary to make an appropriate clinical approach supported by a comprehensive interview and physical examination as well as specialized tests like photopatch and phototest. This review is a compilation of the epidemiological, clinical, diagnosis and treatment of immunologically mediated photodermatoses, with greater focus on desensitization therapy with ultraviolet light (PUVA, UVA and UVB), which has shown positive results in this pathologies, being UVB preferred by most authors except in solar urticaria, in which PUVA has displayed better results than UVB in the long term. Firstable, is essential to determine the minimal erythema dose and minimal urticarial dose for solar urticaria. The main disadvantages of photodesensitization therapy is the short therm effects and requirement of maintenance therapy to reach lasting control of disease with the risk of carcinogenesis of UVL. Further, there are few trials that study efficacy and security of desensitization phototherapy and some of these include small sample of patients corroborate this information.

Implantes dentales de colocación mediata: revisión de la literatura y presentación de 2 casos clínicos / Immediate placement dental implants: review of the literature and presentation of 2 cases

La actual demanda estética y funcional de los pacientes, hace que cada vez se intente disminuir los tiempos de espera posterior a la exodoncia dental para realizar la restitución mediante implantes dentales. Los implantes mediatos son considerados actualmente exitosos por las condiciones histológicas del hueso al momento de implantar, lo que se realiza en un promedio de 4 a 6 semanas posteriores a la exodoncia, aunque algunos autores señalan tiempos de 8 hasta 10 semanas. Es el propósito de este trabajo presentar una revisión bibliográfica del tema; se mostrara además la rehabilitación de 2 pacientes con implantes mediatos; los que nos pueden dar una visión objetiva a la hora de ofrecer este tipo de tratamiento a nuestros pacientes y alentar a los investigadores a realizar estudios que fortalezcan y amplíen los conocimientos que se tienen referentes a la implantación mediata

The current aesthetic and functional demands of patients, makes increasingly try to reduce waiting times after the tooth extraction to make restitution through dental implants. Implants mediate are considered successful by current conditions histological bone at the time of implant, which is conducted by an average of 4 to 6 weeks after the extraction, although some authors note times of 8 to 10 weeks. It is the purpose of this paper to present a literature review of the topic were also submitted rehabilitation of patients with implants mediate 2, which can give us an objective view to offer this treatment to our patients, and encouraging researchers to conduct studies to strengthen and expand the knowledge they are dealing with the introduction mediate

Rituximab Rescue for Refractory Antibody Mediated Rejection after Kidney Transplantation / 대한이식학회지

PURPOSE: Antibody mediated rejection (AMR), although less common than acute cellular rejection (ACR), may be recalcitrant to conventional rescue therapy. AMR is caused by de novo B-cell mediated production of immunoglobulin G antibody (IgG) targeted against specific allograft antigen in a presensitized recipient. Rituximab is a chimeric murine- human anti-CD20 monoclonal antibody which targets CD-20 positive B-cells for elimination. Rituximab has been described to improve allograft salvage for refractory AMR. METHODS: From January 2002 to May 2004, 11 patients were diagnosed with AMR. The first 5 patients (non-rituximab group: NRG) were treated with high dose steroids, plasmapheresis followed by IVIG (500 mg/kg/dose) in addition to OKT3 and/or rabbit antithymocyte globulin. The latter 6 patients (rituximab group: RG) were given Rituximab (375 mg/m2) with IVIG following plasmapheresis. All patients had biopsy proven AMR. RESULTS: Four patients received allografts from living donors and one patient from cadaveric donor in NRG. Each three patients received allografts from living or cadaveric donors in RG. One patient of RG had a positive anti-HLA B-cell crossmatch by CDC (complement dependent cytotoxicity). The anti-donor antibody was reduced to zero with negative CDC and flowcytometry through a desensitization protocol prior to transplantation. The time to diagnosis of AMR in both groups were 17.8+/-18.17 days (NRG); 11+/-2.5 days (RG). ACR was identified in conjunction with AMR in 2 (40%: NRG), 4 patients (66.7%: RG), respectively. All patients had biopsies with classic features of AMR on light microscopy, including C4d staining. Three (50%) patients of RG had positive post-transplantation CDC and donor-specific antibody (DSA) identified. Mean serum creatinine (SCr) upon diagnosis of AMR were 4.3+/-1.71 mg/dL (NRG); 5.77+/-2.65 mg/dL (RG). The rescue rate of RG was superior than NRG (83% vs. 40%, P>0.05). The time to rescue from AMR in both groups were 40.5 +/-28.99 days (NRG); 48+/-54.67 days (RG). Mean SCr of the rescued patients were 1.65+/-0.07 mg/dL (NRG); 2.2+/-1.4 (RG) with median follow up of 120 days (range 33~319 days). Allograft nephrectomies were performed in 3 patients of NRG. CONCLUSION: Rescue therapy with Rituximab improves allograft salvage after AMR and should be considered early in the treatment of biopsy proven AMR.

Effect of Pregnancy on the Immune Response against Trichinella spiralis Infection in Mice / 中国寄生虫学与寄生虫病杂志

0.05).Serum absorbance value of progesterone injected virgin mice(0.299) was significantly higher than that of no-injectedvirgin mice(0.191)(t=2.955,P0.05).Conclusion Pregnancy has a synergetic effect on immune response of mice against T.spiralis infection,which may be related with the increased level of serum anti-Trichinella antibody and enhanced ability of sera in mediating the death of pre-encapsulated larvae in ADCC.