Effect of hydroxysafflor yellow A on depressive-like behavior and expression of GABAAR protein in hippocampus of chronic restraint stress model mice / 中华行为医学与脑科学杂志

Objective:To investigate the effects of hydroxysafflor yellow A (HSYA) on depressive-like behavior and expression of type A γ-aminobutyric acid receptor(GABAAR)in hippocampus of chronic restraint stress model mice.Methods:The SPF grade male C57BL/6C mice were divided into Control group, HSYA group, Model group, Model + HSYA group and Model + fluoxetine group according to random number table method, with 12 mice in each group.Mice model of depression was established by chronic restraint stress.Mice in HSYA group and Model+ HSYA group were intraperitoneally injected with HSYA(20 mg/kg), mice in Model+ fluoxetine group were injected intraperitoneally with fluoxetine (10 mg/kg), and mice in Control group and Model group administered with 0.9% sodium chloride solution intraperitoneally once a day for 14 days.Then, the forced swimming test (FST) and tail suspension test (TST) were performed to evaluate the depressive-like behavior of mice, and the protein expression levels of different subtypes of GABAAR in the hippocampus of mice were determined by Western blot.SPSS 19.0 and GraphPad Prism 8.0 software were used for data statistical analysis and mapping.One-way ANOVA was used for comparison among groups, and Tukey-HSD test was used for further pairwise comparison.Results:(1) In the behavioral tests, there were significant differences in swimming immobility time of FST and tail suspension immobility time of TST among the five groups ( F=21.59, 20.81, both P<0.05). The swimming immobility time ((143.91±9.97) s) and tail suspension immobility time (( 107.00±6.54) s) in Model group were higher than those in Control group ((52.92±6.70) s, ( 43.50±5.96) s, both P<0.05). There were no significant difference in swimming immobility time and tail suspension immobility time between Model+ HSYA group ((26.17±7.69)s, ( 20.17±7.89)s) and Model+ fluoxetine group ((61.60±16.22)s, (34.14±10.74)s)(both P>0.05), but the swimming immobility time and tail suspension immobility time in these two groups were lower than those in Model group (both P<0.05). (2) The Western blot results showed that there were significant differences in the expression of GABAARβ1 and GABAARβ2 protein in hippocampus among the four groups ( F=12.21, 11.40, both P<0.05). The expression levels of GABAARβ1(45.60±10.76) and GABAARβ2 (46.27±4.82) protein in hippocampus of Model group were lower than those in Control group ((100.00±3.44), (100.00±3.26), both P<0.05). Compared to Model group, the expression of GABAARβ1 (79.91±5.00) and GABAARβ2 (79.08±5.53) protein in hippocampus of Model+ HSYA group were higher (both P<0.05). In addition, the expression of GABAARα1 and GABAARγ1 proteins in hippocampus were not significantly different among the four groups( F=0.23, 0.10, both P>0.05). Conclusion:HSYA can effectively alleviate depressive-like behavior in depression model mice, which may be related with the upregulation of GABAARβ1 and GABAARβ2 of hippocampus tissue.

Expression and role of STING-TBK1-IRF3 signaling pathway in the brain of mice with chronic stress / 西安交通大学学报(医学版)

【Objective】 To explore the expression and role of stimulator of interferon gene (STING)-TANK-binding kinase 1 (TBK1)-interferon regulatory factor 3 (IRF3) signaling pathway in the brain of chronic stress mice. 【Methods】 Mice were divided into control (CON) group and chronic restraint stress (RST) group. Mice in the RST group were given chronic restraint stress stimulation (6 hours per day, 14 days). After 14 days, the mRNA expressions of pro-inflammatory cytokines CCL2, CXCL10, IL-1β, IL-6, IL-10, and TNFα in the brain were detected and analyzed by qRT-PCR; protein expression of STING, TBK1, p-TBK1, IRF3, and p-IRF3 were detected and analyzed by immunofluorescence staining and Western blotting. 【Results】 Compared to the CON group, the mRNA expressions of pro-inflammatory cytokines in the RST group were significantly increased (P<0.05). STING and microglia marker Iba-1 were highly co-located and the expression of STING was decreased as detected by immunofluorescence staining. Moreover, the protein expressions of STING, p-TBK1, and p-IRF3 were significantly decreased (all P<0.01). 【Conclusion】 Chronic restraint stress triggers a neuroinflammatory response and the STING-TBK1-IRF3 pathway in the brain of the RST mice is significantly inhibited.

Adaptação cultural e validação do módulo Strategies to end seclusion restraint do ToolKit QualityRights / Cultural adaptation and validation of the Strategies to end seclusion restraint module of the QualityRights ToolKit* / Adaptación cultural y validación del módulo Strategies to end seclusion restraint del ToolKit QualityRights*

Resumo Objetivo adaptar para a cultura brasileira e validar o módulo "Strategies to end seclusion restraint" do toolkit QualityRights da Organização Mundial da Saúde sobre transtornos mentais para a capacitação de profissionais de saúde no Brasil. Método trata-se de estudo metodológico, dividido em três etapas. Na primeira, foi realizada tradução dos módulos da língua original (inglês) para a língua-alvo (português brasileiro). Na segunda, foi realizada a avaliação da tradução por um comitê de juízes composto de sete especialistas. Na terceira etapa, foi realizada a avaliação por profissionais de saúde mental (enfermeiros, psicólogos e advogados), da qual participaram sete profissionais de saúde mental. Eles avaliaram o material por meio do instrumento Suitability Assessment of Materials. Resultados na avaliação realizada pelos especialistas (n=7), 8 itens avaliados obtiveram 100% de aprovação e os outros 6 itens aprovações menores, obtendo-se uma aprovação total de 92%. Quanto à avaliação realizada pelos profissionais de saúde (n=7), 2 itens tiveram aprovação máxima de 100% e os demais tiveram aprovação de 86% cada um, obtendo-se aprovação total de 88%. Conclusão com base nos resultados, considera-se que este módulo está adaptado para a cultura brasileira, podendo ser utilizado para a capacitação de profissionais de saúde brasileiros.

Abstract Objective to adapt to the Brazilian culture and validate the module "Strategies to end seclusion restraint" of the QualityRights toolkit of the World Health Organization on mental disorders to train health professionals in Brazil. Method it is a methodological study divided into three stages. The modules were translated from the original language (English) to the target language (Brazilian Portuguese) in the first stage. In the second, the translation was assessed by a committee of judges with seven experts. In the third stage, the assessment was conducted by mental health professionals (nurses, psychologists, and lawyers), in which seven mental health professionals participated. They assessed the material using the Suitability Assessment of Materials instrument. Results in the assessment conducted by the experts (n=7), 8 items assessed obtained 100% approval and the other 6 items obtained lower approvals, with a total approval of 92%. Regarding the assessment by health professionals (n=7), 2 items had a maximum approval of 100% and the other had the approval of 86% each, with a total approval of 88%. Conclusion based on the results, it is considered that this module is adapted to the Brazilian culture and can be used to train Brazilian health professionals.

Resumen Objetivo adaptar a la cultura brasileña y validar el módulo "Strategies to end seclusion restraint del 'toolkit QualityRights'" de la Organización Mundial de la Salud sobre trastornos mentales para la capacitación de profesionales de la salud en Brasil. Método se trata de un estudio metodológico, dividido en tres etapas. En la primera, fue realizada la traducción de los módulos de la lengua original (inglés) a la lengua objetivo (portugués brasileño). En la segunda, fue realizada la evaluación de la traducción por un comité de jueces compuesto de siete especialistas. En la tercera etapa, fue realizada la evaluación por profesionales de la salud mental (enfermeros, psicólogos y abogados), de la cual participaron siete profesionales de la salud mental. Ellos evaluaron el material por medio del instrumento Suitability Assessment of Materials. Resultados en la evaluación realizada por los especialistas (n=7), 8 ítems evaluados obtuvieron 100% de aprobación y los otros 6 ítems aprobaciones menores, obteniéndose una aprobación total del 92%. En cuanto a la evaluación realizada por los profesionales de la salud (n=7), 2 ítems tuvieron aprobación máxima del 100% y los demás tuvieron aprobación del 86% cada uno, obteniéndose aprobación total del 88%. Conclusión con base en los resultados, se considera que este módulo está adaptado a la cultura brasileña, pudiendo ser utilizado para la capacitación de profesionales de la salud brasileños.

Effects of Chronic Restraint Stress on Apoptosis of Amygdala Cells in Rats / 法医学杂志

OBJECTIVES@#To explore the damage effects of chronic restraint stress (CRS) on amygdala cells through the rat CRS model.@*METHODS@#The rat CRS model was established, and the changes in body weight and adrenal mass in control group and CRS group were monitored at 1 d, 7 d, 14 d and 21 d. The behavior changes were evaluated by the percentage of retention time of open arms and open arm entries using the elevated plus maze (EPM). ELISA was used to detect the concentrations of rat's corticotropin releasing hormone (CRH), adrenocorticotropic hormone (ACTH) and cortisol. The changes of expression of glucocorticoid receptor (GR) and glial fibrillary acidic protein (GFAP) in amygdala were determined by immunohistochemistry and Western blotting. Ultrastructure changes of glial cell were observed by transmission electron microscopy. The apoptosis rate of amygdala was measured by flow cytometry.@*RESULTS@#Compared with the control group at the same time points, body weight of CRS 1 d, 7 d, 14 d and 21 d groups increased slowly, but adrenal mass increased significantly; the serum level of CRH, cortisol and ACTH increased significantly at 7 d, 14 d and 21 d respectively; the expression of GR in amygdala was increased while that of GFAP was decreased; EPM test suggested that the percentage of retention time of open arms and open arm entries decreased significantly after 14 d. The CRS group showed different degrees of glial cell damage in amygdala, and the apoptosis rate of glial cell was significantly increased in 21 d group.@*CONCLUSIONS@#This study successfully established a CRS model in rats, and anxiety-like behavioral changes in model rats may be caused by apoptosis of amygdala astrocytes.

A physical restraint device to facilitate rehabilitation in critically ill patients / 中华危重病急救医学

Physical restraints are widely used in hospitalized and critically ill patients, especially in intensive care unit (ICU), to prevent adverse events such as the accidental removal of various monitoring leads, therapeutic tubes, and self-injury or injury to others due to delirium and irritation. The existing restraint measures directly bind the upper limbs of the patients to the hospital bed, which often brings psychological harm to the patients and leads to disuse muscular atrophy. Early rehabilitation therapy can help improve the prognosis of patients, but it is difficult to be widely used in ICU due to being heavily dependent on nursing and rehabilitation physicians. A novel restraint device to facilitate rehabilitation training for critically ill patients was designed by the medical staff from the department of critical care medicine of Beijing Tiantan Hospital, Capital Medical University and obtained the National Utility Model Patent of China (ZL 2020 2 2492749.6). The device is mainly composed of a cross beam and a locking device whose two ends are connected by a rocker arm, an upper limb stopper and an upper body stopper. The upper limb and body restraint provide restrictions on the movement of the head, the upper limb, and the upper body. The angle limiter prevents the patient from pulling out the treatment tube by himself, and at the same time retains the ability to grasp the crossbar and rotate it, and the sliding block further increases the activity space, to meet the exercise of the patient's upper limb muscle strength. Carrying out physical rehabilitation training as early as possible during ICU treatment can relieve the patient's resistance to passive restraint, reduce the incidence of disuse muscle atrophy, eliminate the potential hidden dangers of medical disputes, and ultimately improve the prognosis of patients.

Contenção ambiental de idosos nas instituições de longa permanência em tempos de Covid-19: reflexão teórica / Contención ambiental de ancianos en las instituciones de larga permanencia en tiempos de Covid-19: reflexión teórica / Environmental restraint of the elderly in long-term care facilities in times of Covid-19: theoretical reflection

Estudo teórico de cunho reflexivo que aborda o fenômeno da contenção ambiental em instituições de longa permanência para idosos, apresentando o tema à luz dos direitos humanos e da legislação em vigor, que pregam boas práticas de cuidado aos idosos institucionalizados, inclusive frente ao cenário de enfrentamento à Covid-19. Considerando os impactos negativos da contenção ambiental na saúde física e mental dos idosos, sugere-se maior capacitação da equipe técnica das instituições de longa permanência para idosos e prospecção do fenômeno para garantia de condições mais dignas e que respeitem a liberdade dos idosos. (AU)

Estudio teórico de cuño reflexivo que aborda el fenómeno de la contención ambiental en instituciones de larga permanencia para ancianos, presentando el tema a la luz de los derechos humanos y de la legislación en vigor que proponen buenas prácticas de cuidado para los ancianos institucionalizados, incluso ante el escenario del enfrentamiento a la Covid-19. Considerando los impactos negativos de la contención ambiental en la salud física y mental de los ancianos, se sugiere mayor capacitación del equipo técnico de las instituciones de larga permanencia para ancianos y prospección del fenómeno para garantía de condiciones más dignas y que respeten la libertad de los ancianos. (AU)

A theoretical and reflexive study addressing the phenomenon of environmental restraint in long-term care facilities for the elderly, presenting the topic under the light of human rights and the legislation in force, which postulate good care practices to institutionalized elderly even in the face of the Covid-19 situation. By considering the negative impacts of environmental restraint on the physical and mental health of the elderly, it is suggested that the technical team of long-term care institutions for the elderly should be better trained, and that the phenomenon needs to be explored to guarantee more dignified conditions that respect the freedom of the elderly. (AU)

Guía práctica para el manejo de la agitación psicomotora en pediatría / Clinical Guide for the management of psychomotor agitation in pediatrics

La agitación psicomotora es un estado de hiperactividad impulsiva aguda en grados variables, que requiere intervención. Sus manifestaciones abarcan un amplio espectro desde mínima inquietud hasta perturbaciones intensas con grandes movimientos no propositivos o violentos. Datos recientes muestran que aproximadamente 10-20% de los niños, niñas y adolescentes (NNA) presenta una patología de la esfera psiquiátrica y/o abuso de sustancias y, en consecuencia, han aumentado las consultas por estos motivos en servicios de urgencia pediátrica. Hasta 1 de cada 15 NNA requiere contención de algún tipo. Las causas de agitación son múltiples y se deben investigar en cada paciente. El objetivo de este trabajo es concientizar al equipo de salud sobre el problema y contribuir a la estandarización del manejo clínico en pediatría. Se describen intervenciones no farmacológicas, contención farmacológica y física, con sus respectivas indicaciones.

Psychomotor agitation is a state of acute impulsive hyperactivity with varying degrees of magnitude that requires intervention. Its manifestations cover a broad spectrum from minimal unrest to intense disturbances with large non-purposeful or violent movements. Recent data show that approximately 10-20% of children and adolescents have a psychiatric disease and/or substance abuse disorder and, consequently, consultations for these reasons have increased in pediatric emergency services. Up to 1 in 15 children require some form of restraint. Causes of agitation are multiple and must be investigated in each patient. The objectives of this review are to improve awareness of the issue to health work-teams and aims at the standardization of its medical management in pediatrics. Non-pharmacological interventions, chemical and physical restraint methods are described, with their respective indications.

Validação do módulo "Strategies to end seclusion restraint/Estratégias para acabar com o isolamento e a contenção" do ToolKit QualityRights / Validation of the "Strategies to end seclusion restraint/Estratégias para acabar com o isolamento e a contenção" module of the QualityRights ToolKit

Introdução: Os transtornos mentais e uso de substâncias ilícitas representam causa importante de incapacidade em todo o mundo. O número de pessoas com transtornos mentais aumenta cada vez mais, e a carga mundial é agravada pela falta de tratamento de saúde mental. No Brasil, os serviços de saúde mental ainda são insuficientes. Como resultado dessas limitações, pessoas com transtornos mentais têm alto nível de sofrimento e incapacidade física, emocional, econômica e social, além de experiência de contenção física ou outras formas de privação de liberdade, discriminação e abuso. Diante destes desafios, a OMS desenvolveu iniciativa denominada QualityRights, que promove os direitos humanos das pessoas com deficiências psicossociais, intelectuais e cognitivas, por meio de um kit de ferramentas para avaliação dos serviços de saúde e um kit de treinamento e capacitação de profissionais de saúde e população em geral. Locais que já utilizaram o QualityRights enfatizam que constitui ferramenta importante para alcançar a mudança de atitude em linha com os padrões de direitos humanos relativos à coerção e capacidade legal em saúde mental e deficiência relacionada aos serviços. Objetivos: Adaptar culturalmente para a cultura brasileira e validar o módulo "Strategies to end seclusion restraint" do toolkit QualityRights da Organização Mundial da Saúde sobre transtornos mentais para a capacitação de profissionais de saúde no Brasil. Percurso metodológico: Trata-se de estudo metodológico, dividido em três etapas. Na primeira etapa, foi realizada tradução dos módulos, da língua original (inglês) para a língua alvo (português brasileiro). Na segunda etapa a tradução e adaptação cultural foram realizadas por um Comitê de Juízes especialistas no assunto. Na terceira etapa, foi realizada a avaliação por profissionais de saúde mental. Resultados: Compuseram a etapa de análise pelo Comitê de Juízes 07 especialistas no assunto e na etapa de análise pelos Profissionais de Saúde 07 profissionais de saúde mental. Em relação à avaliação realizada por cada especialista, a porcentagem de aprovação variou por item, sendo que os itens com maior porcentagem de aprovação tiveram 100% de aprovação e os itens com menor porcentagem de aprovação tiveram 71% de aprovação em cada. A porcentagem de aprovação total do módulo foi de 92%. Em relação à avaliação realizada por cada profissional de saúde, a porcentagem de aprovação variou por item, sendo que dois itens tiveram aprovação máxima 100% e os demais itens tiveram aprovação de 86% cada. A porcentagem de aprovação total do módulo foi de 88%. Conclusão: Com base nos resultados, considera-se que este módulo está validado e adaptado para a cultura brasileira, podendo ser utilizado para capacitação de profissionais de saúde brasileiros

Introduction: Mental disorders and the use of illegal substances represent an important cause of disability worldwide. The number of people with mental disorders is increasing, and the global burden is compounded by the lack of mental health treatment. In Brazil, mental health services are still insufficient. As a result of these limitations, people with mental disorders have a high level of physical, emotional, economic and social suffering and disability, in addition to experiencing physical restraint or other forms of deprivation of liberty, discrimination and abuse. Faced with these challenges, the WHO developed an initiative called QualityRights, which promotes the human rights of people with psychosocial, intellectual and cognitive disabilities, through a toolkit for the assessment of health services and a training and qualification kit for health professionals and general population. Sites who have used QualityRights emphasize that it is an important tool to achieve attitudinal change in line with human rights standards regarding enforcement and legal capacity in mental health and service-related disability. Objective: Culturally adapt to Brazilian culture and validate the module "Strategies to end seclusion restraint" from the World Health Organization's QualityRights toolkit on mental disorders for the training of health professionals in Brazil. Methodology: This is a methodological study, divided into three stages. In the first stage, the modules were translated from the original language (English) to the target language (Brazilian Portuguese). In the second stage, the translation and cultural adaptation were carried out by a Committee of Judges who are experts on the subject. In the third stage, the evaluation was carried out by mental health professionals. Results: The analysis stage by the Committee of Judges comprised 07 experts on the subject and the analysis stage by the Health Professionals 07 mental health professionals. Regarding the evaluation performed by each expert, the percentage of approval varied by item, with the items with the highest percentage of approval having 100% approval and the items with the lowest percentage of approval having 71% approval in each. The total pass percentage for the module was 92%. Regarding the assessment carried out by each health professional, the percentage of approval varied by item, with two items having a maximum approval of 100% and the other items having an approval of 86% each. The total pass percentage for the module was 88%. Conclusion: Based on the results, it is considered that this module is validated and adapted to the Brazilian culture, and can be used for training Brazilian health professionals

Application study of the best evidence for physical restraint in ICU patients based on guidelines / 中国实用护理杂志

Objective:To explore the effect of evidence-based physical restraint practice in ICU patients based on the best evidence.Methods:Based on the previous studies of evidence- based nursing program of physical restraint in ICU patients, the nurses were trained, and the evidences were introduced into clinical application and the effect of program application on nurse level, patient level and organization system were evaluated. Results:The body restraint duration of ICU patients in the contrd group was 41 (14.25, 166.50) h, and the body restraint duration of intervention group was 37(16.75,107.50) h, the difference was statistically significant ( Z value was 1.71, P<0.05). The level of physical restraint knowledge, attitude, behavior and total scores of ICU nurses increased from (12.30±1.73), (33.69±3.80), (45.19±10.56), (91.17±13.38) before implementation to (13.37±2.07), (36.81 ±3.61), (49.17±4.98), (98.08±6.11) after implementation. The differences in attitude, behavior and total scores were statistically significant ( t values were 4.05, 0.96, 2.44, P<0.05).At the organizational system level, after the application of the program, the related procedures, norms, assessment tools, nursing record sheets, restraint tools, training materials courses and so on were improved in the department. Conclusions:By introducing the best evidence of physical restraint into clinical application, it can guide nurses to use physical restraint more scientifically and standardize physical restraint behavior.At the same time, it can reduce the use of physical constraints to a certain extent, reduce the rate of physical restraints, shorten the average length of restraint, and improve the flow system related to physical restraints, so as to provide reference for the implementation of physical restraints.

Effect of Shenwei Ningyu Pills on Immunoinflammatory Response Mediated by TLR4/MyD88 Signaling Pathway in Hippocampus of Rats Exposed to Chronic Restraint Stress / 中国实验方剂学杂志

Objective:To explore the effects of Shenwei Ningyu pills （SNP）， a new Chinese medicine for depression， on the immunoinflammatory response mediated by Toll-like receptor 4 （TLR4）/myeloid differentiation factor 88 （MyD88） signaling pathway in the hippocampus of rats exposed to chronic restraint stress （CRS）. Method:Forty-four male Sprague Dawley rats were randomly enrolled into a normal group， a model group， an escitalopram group， and an SNP group. Except for the rats in the normal group， all rats were exposed to CRS and isolated rearing for 21 days continuously. Rats in the escitalopram group and the SNP group were administered with escitalopram （30 mg·kg^-1） and SNP （18 mg·kg^-1） one hour prior to CRS， respectively. The changes in body weight， sucrose preference index， horizontal movement scores， and vertical movement scores were observed by body weight assessment， sucrose preference test， and open field test. The expression of hippocampal TLR4 and MyD88 was detected by Western blot. The content of serum interleukin-1<italic>β</italic> （IL-1<italic>β</italic>）， IL-10， and tumor necrosis factor-<italic>α</italic> （TNF-<italic>α</italic>） was detected by enzyme-linked immunosorbent assay （ELISA）. Result:The results of the behavioral assessment showed that there was no significant difference in the changes of behavioral baselines among the groups before intervention. However， significant differences were found among the groups following different interventions. The body weight， sugar preference index， horizontal movement score， and vertical movement score of rats in the model group decreased after CRS for 21 days as compared with those in the normal group （<italic>P</italic><0.01）. The above indicators in the SNP<italic> </italic>group and the escitalopram group were higher than those in the model group （<italic>P</italic><0.01）， which indicated that SNP<italic> </italic>exerted an obvious antidepressant effect. The results of Western blot and ELISA showed that compared with the normal group， the model group showed elevated levels of hippocampal TLR4 and MyD88 and serum IL-1<italic>β</italic> and TNF-<italic>α </italic>（<italic>P</italic>˂0.01） and dwindled serum IL-10 （<italic>P</italic>˂0.01）， while SNP<italic> </italic>and escitalopram reversed the conditions in the model group （<italic>P</italic>˂0.01） except for TNF-<italic>α</italic>. Conclusion:The present study indicated that the antidepressant effect of SNP was presumedly achieved by inhibiting the immunoinflammatory response mediated by the TLR4/Myd88 signaling pathway in CRS rats.

Changes of Microglia in Hippocampus of Mice Induced by Maternal Separation with Restraint Stress and Regulatory Effect of Wenyang Jieyu Prescription / 中国实验方剂学杂志

Objective:To observe the activation of microglia in hippocampus of depressed and anxious mice induced by maternal separation with acute restraint stress and the expression of interleukin-1<italic>β</italic>（IL-1<italic>β</italic>），interleukin-6（IL-6），tumor necrosis factor-<italic>α</italic>（TNF-<italic>α</italic>）， investigating the mechanism of Wenyang Jieyu prescription in treating anxiety and depression. Method:Eighty four male C57BL offspring were randomly divided into control group， acute restraint stress group and model group on postnatal day 0（PD0）. Maternal separation combined with acute restraint stress was used to prepare anxious and depressed model mice， dividing the model mice into model group， Wenyang， Jieyu， Wenyang Jieyu and fluoxetine group according to random number table method. During the period of PD21-PD90， the control， acute restraint stress and model mice were fed with normal diet， with the other groups fed with corresponding medicine mixed diet. The Wenyang， Jieyu and Wenyang Jieyu groups were given 5.85， 12.03 and 16.71 g·kg^-1·d^-1 respectively. The fluoxetine group was given 2.60 mg·kg^-1·d^-1. Open field， zero maze test and social interaction tests were used to evaluate the anxiety and depression of model mice. The expression of Iba-1 in hippocampal microglia was detected by immunohistochemistry（IHC）. The mRNA expression of IL-1<italic>β</italic>， IL-6， TNF-<italic>α</italic>， Iba-1 and glucocorticoid receptor（GR）were detected by Real-time fluorescence quantitative polymerase chain reaction （Real-time PCR）. Result:Compared with the control group， total movement distance and time spent in central zone in 5 min of the model mice significantly decreased（<italic>P</italic><0.01）， time spent in opened arm and total movement distance decreased significantly（<italic>P</italic><0.05，<italic>P</italic><0.01）， investigation time during testing and training increased significantly（<italic>P</italic><0.01）. The expression of Iba-1 protein and mRNA，IL-1<italic>β</italic>，IL-6，TNF-<italic>α</italic> mRNA significantly increased（<italic>P</italic><0.01）， the expression levels of GR mRNA significantly decreased（<italic>P</italic><0.01）. The result of IHC staining showed that microglia were over activated. Compared with the model group， total movement distance and time spent in central zone in 5 min of mice in the Wenyang Jieyu and fluoxetine group significantly increased（<italic>P</italic><0.05，<italic>P</italic><0.01）.Time spent in opened arm significantly increased（<italic>P</italic><0.01）. Investigation time during testing and training significantly decreased（<italic>P</italic><0.05，<italic>P</italic><0.01）. The expression of Iba-1 protein and mRNA，IL-1<italic>β</italic>，IL-6，TNF-<italic>α</italic> mRNA significantly decreased（<italic>P</italic><0.05，<italic>P</italic><0.01）. The expression of GR mRNA increased significantly（<italic>P</italic><0.05，<italic>P</italic><0.01）. IHC staining showed the microglia recovered. Time spent in opened arm of mice in the Wenyang group and Jieyu group significantly increased （<italic>P</italic><0.01）， time spent investigating during testing decreased significantly （<italic>P</italic><0.05）， the expression levels of Iba-1 protein and mRNA，IL-6 mRNA significantly decreased （<italic>P</italic><0.05，<italic>P</italic><0.01）. The expression of GR mRNA of mice in the Wenyang group significantly increased （<italic>P</italic><0.05）， the expression of TNF-<italic>α </italic>mRNA significantly decreased （<italic>P</italic><0.05）. Total movement distance of mice in the Jieyu group increased significantly （<italic>P</italic><0.01）， time spent investigating during training decreased significantly （<italic>P</italic><0.05），the expression level of IL-1<italic>β </italic>mRNA significantly decreased （<italic>P</italic><0.05）. IHC staining showed that microglia recovered partly in both groups. Conclusion:The comprehensive curative effect and pharmacological action of Wenyang Jieyu prescription were better than Wenyang prescription and Jieyu prescription. Wenyang Jieyu prescription can treat anxiety and depression in maternal separation and acute restraint stress mice， its possible mechanism may be related to the decreased activation of microglia， down-regulation of IL-1<italic>β</italic>，IL-6，TNF-<italic>α</italic> expression and up-regulation of GR expression.

Effects of Different Upper Extremity Fixing Approaches on Elbow Flexor Activities and Balance for Stroke Patients / 中国康复理论与实践

Objective:To observe the affected elbow flexor activities and balance of stroke patients in standing and walking as fixing the affected upper extremity with different methods. Methods:From September to December, 2018, 14 stroke patients from Affiliated Suzhou Science ＆ Technology Town Hospital of Nanjing Medical University were included. They were measured elbow flexor contraction ratio (integrated electromyogram of flexor/integrated electromyogram of antagonist) with wireless surface electromyography as standing and walking in normal speed, and sway index with Biodex as standing, in four conditions: the affected arm without fixing, and fixed with elbow orthosis, and with unaffected hand backwards and forwards. Results:The contraction ratio was the most as the arm fixed with elbow orthosis in both standing and walking (F > 2.687, P < 0.05). The sway index was the most as the arm fixed with unaffected hand forwards (F = 21.091, P < 0.05). Conclusion:The elbow orthosis restraint may lead to increased contraction of the affected elbow flexor, which is unsatisfactory to inhibit flexor activity of the upper extremities; while restraint of unaffected hand forwards may lead to instable balance.

Research progress of nursing training about physical restraint / 中国实用护理杂志

To know the status of nursing training about physical restraint among nurses in the domestic and overseas. Summarized the forms, content and the appraise tools of the results of physical restraint nursing at home and abroad so as to provide reference of nursing training about the physical restraint among nurses in the domestic.

Physical restraint in elderly in home care: a cross-sectional study / Contenção mecânica em idosos da atenção domiciliar: estudo transversal

ABSTRACT Objective To estimate the prevalence of mechanical restraint and factors associated with its practice in elderly in Home Care. Methods This was a cross-sectional study with 162 elderly randomly assigned to a home care program in Rio de Janeiro, from March 2018 to July 2018. Used as a technique for data collection and direct observation and structured interview of elderly clinical data. Data were analyzed descriptively and inferentially. Results There was a 13% prevalence of mechanical restraint in elderly in home care. The most frequent restraints were the use of bandage, tissues and sheets in the arms/legs and chests of the elderly, and the justification for their use were control of aggressive behavior (28.6%), prevention of falls (19%) and protection (19%). Of the total elderly participants, 42.9% remained contained for more than 24 hours, and in 85.7% of the cases, the individuals were confined to a room. Conclusion It is necessary to expand the training of formal and informal caregivers, recommending the rehabilitation of care practices that preserve the elderly's autonomy, giving them dignity, respecting gerontological and home care principles.

RESUMEN Objetivo Estimar la prevalencia de la restricción mecánica y los factores asociados con su práctica en ancianos en Atención domiciliaria. Métodos Este fue un estudio transversal de 162 ancianos asignados aleatoriamente a un programa de atención domiciliaria en Río de Janeiro, sin período de marzo de 2018 a julio de 2018. Utilizado como técnica para la recopilación de datos y observación directa y entrevista estructurada de datos clínicos de ancianos. Los datos se analizaron de forma descriptiva e inferencial. Resultados Hubo una prevalencia de restricción mecánica del 13% en los ancianos de la atención domiciliaria. Los más frecuentes fueron las extremidades y el tronco, realizados con vendas, tejidos y sábanas, y como justificación de su uso: control de la agresividad (28,6%), prevención contra caídas (19%) y protección (19%). De los participantes de edad avanzada, el 42,9% permanece contenido durante más de 24 horas, en el 85,7% de los casos, restringido en una habitación individual. Conclusión Es necesario ampliar la capacitación de los cuidadores formales e informales, recomendando prácticas de atención de rehabilitación que preserven la autonomía de los ancianos, dándoles dignidad, respetando los principios gerontológicos y de atención domiciliaria.

RESUMO Objetivo Estimar a prevalência da contenção mecânica e fatores associados à sua prática na Atenção Domiciliar. Métodos Estudo transversal, realizado com 162 idosos de um programa de atenção domiciliar no Rio de Janeiro, de março de 2018 a julho de 2018. Utilizada como técnica de coleta de dados a observação direta e entrevista estruturada. Resultados Encontrou-se uma prevalência de 13% da contenção mecânica em idosos na Atenção domiciliar; mais frequente foi de membros e tronco, realizado com atadura, tecidos e lençol; justificativas do uso: controle da agressividade (28,6%), prevenção de quedas (19%) e proteção (19%); houve associação das variáveis do perfil com o desfecho de contenção: rotina de dias alternados (p-valor=0,000), não deambulação (p-valor=0,020), restrição ao leito (p-valor=0,000) e uso de cateter vesical de demora (p-valor=0,006). Conclusão Destaca-se a necessidade de capacitação dos profissionais de saúde, cuidadores formais e informais, no sentido de desnaturalizar a prática da contenção no domicílio.

Salud mental y derechos humanos: La experiencia de los profesionales en formación en el uso de sujeciones mecánicas en Madrid, España / Mental health and human rights: The experience of professionals in training with the use of mechanical restraints in Madrid, Spain

RESUMEN La sujeción mecánica en psiquiatría es un procedimiento permitido en España que despierta importantes conflictos éticos. Diversos estudios sostienen que su uso depende de factores no clínicos, como las experiencias de los profesionales y las influencias del contexto, más que de factores clínicos (diagnósticos o síntomas). El objetivo del estudio es comprender las experiencias de profesionales de salud mental en formación en relación con el uso de sujeciones en la red de salud mental de Madrid. Es un estudio cualitativo de tipo fenomenológico mediante grupos focales, realizados en 2017. Las entrevistas fueron transcritas para su discusión y análisis temático mediante Atlas.ti. Los resultados descriptivos sugieren que estas medidas producen malestar y conflicto con relación al rol de cuidador y se observan estrategias de adaptación a los mismos. A partir de los hallazgos, se reflexiona acerca de aspectos de sus experiencias y del contexto que influyen en su uso, así como de las contradicciones del cuidado en la práctica clínica

ABSTRACT Mechanical restraint is a coercive procedure in psychiatry, which despite being permitted in Spain, raises significant ethical conflicts. Several studies argue that non-clinical factors - such as professionals' experiences and contextual influences - may play a more important role than clinical factors (diagnosis or symptoms) in determining how these measures are employed. The aim of this study is to understand how the experiences of mental health professionals in training relate to the use of mechanical restraints in Madrid's mental health network. Qualitative phenomenological research was conducted through focus groups in 2017. Interviews were transcribed for discussion and thematic analysis with Atlas.ti. Descriptive results suggest that these measures generate emotional distress and conflict with their role as caregivers. Our findings shed light on different factors related to their experiences and contexts that are important in understanding the use of mechanical restraint, as well as the contradictions of care in clinical practice

Cognitive restraint directed at carbohydrates in individuals on low-carb diet with binge eating: the role of guilt about food cravings / Restrição cognitiva direcionada aos carboidratos em indivíduos praticantes de dieta low carb com compulsão alimentar: o envolvimento da culpa pelos desejos por comida

ABSTRACT Objective To evaluate whether the carbohydrate-restricted diet leads to higher levels of food cravings in individuals with binge eating. Methods A total of 146 individuals with binge eating participated in the Low-Carb Diet Group (n=48) and Control Group (n=98). The Binge Eating Scale, Hay's questionnaire, Food Cravings Questionnaire - Trait and State, Cognitive restraint subscale and its adapted version for the cognitive restraint toward carbohydrates, were used as measures. Parametric tests were used for comparison between groups (Student's t test), and Pearson's correlation test to verify correlations between variables of interest. Results No differences were found between groups with and without diet concerning the level of binge eating or food craving total score. The differences found were the higher levels of cognitive restraint (p=0.01), cognitive restraint for carbohydrates (p=0.01) and subscales of 'guilt about food craving' (p=0.04) in the Low-Carb Diet Group. Conclusion Individuals with binge eating and a history of low-carb diet have greater cognitive restraint toward carbohydrates and association with altered eating attitudes (guilt about food craving).

RESUMO Objetivo Avaliar se a dieta com restrição de carboidratos acarreta níveis elevados de desejos intenso por comida em indivíduos com compulsão alimentar. Métodos Participaram 146 indivíduos com compulsão alimentar divididos nos Grupos Dieta Low Carb (n=48) e Grupo Controle (n=98). Foram utilizados como medidas: Escala de Compulsão Alimentar Periódica, Questionário de Hay, Questionário de Desejos Intensos por Comida - Traço e Estado, Subescala de restrição cognitiva e sua versão adaptada para a restrição cognitiva direcionada aos carboidratos. Foram utilizados testes paramétricos para comparação entre grupos (teste t de Student) e o teste de correlação de Pearson para verificar correlações entre variáveis de interesse. Resultados Não foram encontradas diferenças entre grupos com e sem prática de dieta em relação ao nível de compulsão alimentar ou ao escore total para desejos intensos por comida. As diferenças encontradas foram os maiores níveis de restrição cognitiva (p=0,01), restrição cognitiva para carboidratos (p=0,01) e subescalas de 'culpa por causa dos desejos' (p=0,04) no Grupo Dieta Low Carb. Conclusão Indivíduos com compulsão alimentar e histórico de dieta com restrição de carboidratos (low carb) possuem maior restrição cognitiva direcionada aos carboidratos e associação com atitudes alimentares alteradas (culpa pelos desejos).

Percepção da equipe multiprofissional sobre a contenção mecânica de idosos: paradoxos do cuidado / Perception of a multidisciplinary team on physical restraint use on older adults: care paradoxes

OBJETIVO: Descrever a percepção da equipe multiprofissional sobre o uso da contenção mecânica em idosos. METODOLOGIA: Pesquisa qualitativa realizada com 58 profissionais da área da saúde em duas Instituições de Longa Permanência para Idosos localizadas no estado do Rio de Janeiro, Brasil. Utilizou-se entrevista semiestruturada, com análise temática do conteúdo. O período de coleta de dados foi de novembro de 2017 a junho de 2018. RESULTADOS: Foram identificadas 21 unidades de registro, organizadas em três categorias: percepção da equipe sobre as consequências e riscos do uso da contenção mecânica: o paradoxo da segurança do paciente; implicações na decisão da contenção mecânica de idosos; e estratégias para conter e não conter. CONCLUSÕES: Os achados refletem a necessidade de capacitação dos profissionais no que tange às estratégias de cuidado alternativas, livres de contenção, como parte da promoção de uma cultura de cuidado que respeite o direito à liberdade e a dignidade das pessoas, especialmente as mais vulneráveis.

OBJECTIVE: To describe the perception of a multidisciplinary team on the use of physical restraint in older adults. METHODS: Qualitative research conducted with 58 health professionals in two long term care facilities for older adults located in the state of Rio de Janeiro, Brazil. Semi-structured interviews were further analyzed using thematic content analysis. The data was collected from November 2017 to June 2018. RESULTS: Twenty-one initial codes were identified and organized in three categories: team perception of the consequences and risks of a physical restraint (the patient's safety paradox); implications of the decision of physical restraint of the older adults; and strategies to restrain and not restrain. CONCLUSIONS: The results reinforce the need for training of professionals on restraint-free alternatives of care, as part promoting a culture of care that respects the right to freedom and the dignity of people ­ especially the most vulnerable ones.

The Effect of Restraint Stress on the Reactivation of Colitis in Acetic Acid-Induced Ulcerative Colitis Rat

Aim: To evaluate the effect of restraint stress on the reactivation of ulcerative colitis in rats that have been chemically-induced with ulcerative colitis after allowing progression of natural healing to take place. Study Design: 36 animals were used for this study, and were divided into three groups; control (group 1), colitis alone (group 2) and colitis + restraint stress (group 3). Methodology: 36 healthy female wistar rats of weight of 170±20 were used. Colitis was induced by intra-rectal administration of 1 mL/100 g body weight of 7% acetic acid. Fourteen days post colitis induction, colitis + restraint stress group animals were exposed to restraint stress for six consecutive days while animals in colitis alone group were not. Colon levels of Malondialdehyde (MDA), Glutathione (GSH) concentration, Superoxide dismutase (SOD), Catalase (CAT) and Myeloperoxidase (MPO) activities were measured spectrophometrically. Histological assessment was also done on the colon tissues. Place and Duration of Study: Department of Physiology, Ladoke Akintola University of Technology, Ogbomoso, Oyo State, Nigeria, between April 2019 and August 2019. Results: Colitis caused significant increase in the levels of GSH, SOD, CAT and MPO on the 3rd day. On the 14th day, group 2 showed lowered level of antioxidant activities (SOD and CAT) when compared with the 3rd day, while on the 20th day, group 3 animals exhibited increased levels of antioxidant activities (as well as increase in MDA and MPO) when compared to group 2 and group 1. Histological examination revealed cyst in the mucosal layer, infiltration of inflammatory cells anddilation of vessels in the colitis + restraint stress on the 20th day post colitis induction. Results are considered significant when p≤0.05. Conclusion: The results of this study showed that restraint stress is capable of reactivating and inhibiting colitis healing in acetic acid-induced ulcerative colitis rats

A neurose obsessiva, veredas freudianas: breves considerações / The obsessive neurosis, Freudian paths: brief considerations / Neurosis obsesiva, sendas freudianas: breves consideraciones

O artigo aborda a neurose obsessiva de acordo com a obra de Freud, usada como ponto inicial para a argumentação do autor, enfatizando a sua dinâmica metapsicológica. Com base na hipótese clínica de que o pensamento torna-se fonte de angústia, destaca o fato do recalque dos componentes sádicos da libido constituir o ponto de partida da neurose. O autor enfatiza que, como escreveu Freud, a luta defensiva é a sua principal característica, distinguindo-a das demais neuroses. Ele sugere que uma fragilidade da estrutura narcísica primária é uma das condições necessárias para a forma peculiar da apresentação da angústia e de suas defesas. Ao argumentar que o pensamento torna-se fonte de angústia, destaca as dificuldades técnicas resultantes e sustenta que o manejo da transferência representa a única solução clínica possível (AU)

Inspired by Freud's work, used as a starting point for the author's arguments, the paper addresses obsessive neurosis, emphasizing its metapsychological dynamics. It starts from the clinical hypothesis that thought turns into a source of angst. It underlines that the repression of the sadistic components of libido constitutes the starting point of neurosis. The author emphasizes that, as Freud has said, the defensive struggle is its main feature, differentiating it from the other neurosis. The author suggests that a frailty of the primary narcissistic structure is a necessary condition for the peculiar aspect on how angst and its defenses manifest themselves. Reasoning that thoughts become source of angst, he emphasizes the consequent technical difficulties, and advocates that managing transference represents the only effective clinical approach.

El artículo aborda la neurosis obsesiva inspirada en el trabajo de Freud, utilizada como punto de partida para el argumento del autor, enfatizando su dinámica metapsicológica. Partiendo de la hipótesis clínica de que el pensamiento se convierte en una fuente de angustia, destaca que la represión de los componentes sádicos de la libido constituye el punto de partida de la neurosis. El autor enfatiza que, como escribió Freud, la lucha defensiva es su característica principal, distinguiéndola de otras neurosis. Él sugiere que una debilidad en la estructura narcisista primaria es una de las condiciones necesarias para la forma peculiar de la presentación de la angustia y sus defensas. Argumentando que el pensamiento se convierte en una fuente de angustia, destaca las dificultades técnicas resultantes y sostiene que el manejo de la transferencia representa la única solución clínica posible

Antidepressant-like effects of albiflorin involved the NO signaling pathway in rats model of chronic restraint stress / 中国天然药物

The depressant-like effects of albiflorin (AF) were studied on stressed chronic restraint stress (CRS) rats. Experimental rats were subjected to immobilization stress for a daily 6 h-restraining in a plastic restrainer for continuous 21 d and were treated with 30 or 15 mg·kg