La salud pública matancera durante el período de ocupación militar norteamericana 1899-1902

Introducción: el 1 de enero de 1899 inició la ocupación militar de Cuba por Estados Unidos, cuyo objetivo fundamental fue sentar las bases de la futura República neocolonial. Objetivo: describir el comportamiento de la salud pública matancera durante el período de ocupación militar norteamericana 1899-1902. Materiales y métodos: se utilizó el método histórico descriptivo para estudiar el comportamiento de la salud pública matancera en el período de ocupación militar, y se realizó la revisión bibliográfica y documental. Resultados: no obstante los logros sociales -en especial en el ámbito de la salud pública-, las medidas y posiciones antinacionales que adoptó el gobierno interventor encontraron el rechazo de las clases y sectores interesados en lograr la absoluta soberanía de Cuba. Conclusiones: los matanceros realizaron notables esfuerzos para enfrentar la difícil situación sanitaria a través de la apertura de hospitales e instituciones, que brindaban servicios, sobre todo, a los sectores pobres de la población, y de la campaña de higienización para evitar la propagación de enfermedades y epidemias.

Introduction: the period of U.S. military occupation in Cuba officially began on January 1, 1899. Its main objective was to lay the foundation of the future neocolonial republic. Objective: to describe the behavior of Matanzas public health during the period of the US military occupation 1899-1902. Materials and methods: the historical descriptive method was used to study the behavior of Matanzas public health in the period of military occupation, and a bibliographic and documental review was conducted. Results: despite the social achievements- especially in the field of public health-, antinational measures and positions adopted by the intervening government found the rejection of the classes and sectors interested in achieving the absolute sovereignty of Cuba. Conclusions: the people of Matanzas made notable efforts to face the difficult sanitary situation opening hospitals and institutions which provided services, above all, to the poor sectors of the population, and to carry out a sanitation campaign to prevent the spread of diseases and epidemics.

Prevalence of Smartphone Addiction and its Relation with Depression among School-going Adolescents

Background: Smartphone addiction among adolescents is an increasingly recognized problem worldwide. It affects the psychological well-being of an individual. Aim and objective: The current study aimed to assess smartphone addiction’s prevalence and its relation to depression among adolescents. Methods: This cross-sectional study was conducted among 400 school-going adolescents. Smartphone Addiction Scale - Short version (SAS-SV) and Patient Health Questionnaire (PHQ-9) were used to assess the prevalence of smartphone addiction and depression. Data were analyzed using Epi info software for windows (CDC, Atlanta). Statistical significance was set at p < 0.05. Results: The mean age of study participants was 14.4 years (SD=1.5 years). The prevalence of smartphone addiction was 23%, while depression was present among 45% of the study participants. Comparatively higher duration of smartphone use was significantly associated with smartphone addiction. Depression was significantly higher among smartphone addicts (77.2%) as compared to their counterparts (35.4%). Conclusion and Recommendation: The smartphone usage of adolescents, if not monitored, could lead to its addiction and thus increase the risk of depression among them. To prevent smartphone addiction, limiting children’s screen time is recommended. In this regard, parents can play a pivotal role by becoming responsible digital role models for their children.

Three years of COVID-19 pandemic: comparative analysis of incidence, lethality and mortality among the States of the south region of Brazil / Três anos de pandemia da COVID-19: análise comparativa da incidência, letalidade e mortalidade entre os Estados da região sul do Brasi

Introduction: the first COVID-19 case in Brazil was confirmed on February 26, 2020. As of March 17, 2023, the Ministry of Health reported 699,634 deaths from COVID-19, with a case fatality rate of 1.9%. The impact of the COVID-19 pandemic in Brazil extends to socioeconomic and healthcare systems, reflecting significant regional disparities. Objective: To analyze mortality, incidence, and case fatality rates for COVID-19 in the states of Paraná and Santa Catarina, in the southern region of Brazil. Methods: This is an ecological time-series study using official Brazilian secondary data for COVID-19 cases and deaths. Data were extracted from the dashboard of the State Health Department of Santa Catarina and Paraná. Temporal series were developed for trend analysis using the Prais-Winsten regression model. Statistical analyses were performed using STATA 14.0 software (College Station, TX, USA, 2013). Results: In the analysis of rates over the entire period, trends for mortality, case fatality, and incidence in the state of Santa Catarina are decreasing, decreasing, and stationary, respectively. In Paraná, rates over the entire period showed a stationary trend for mortality, decreasing for case fatality, and increasing for incidence. Conclusion: COVID-19 had a devastating effect on the states of Santa Catarina and Paraná. Both states experienced the progression of the COVID-19 pandemic, with higher case fatality and mortality rates observed in Paraná, while Santa Catarina had a higher incidence rate over the three years of the COVID-19 pandemic.

ADE signal mining and analysis of axitinib based on FAERS database / 中国药房

OBJECTIVE To provide references for the clinical safe use of axitinib. METHODS Adverse drug event （ADE） data for axitinib were collected from the US FDA Adverse Event Reporting System （FAERS） database from the first quarter of 2012 to the fourth quarter of 2022. The data were mined and analyzed by utilizing the ratio-of-reporting-ratio （ROR） method and comprehensive standard method of the United Kingdom’s Medicines and Healthcare Products Regulatory Agency （MHRA） of proportional imbalance measurement. RESULTS A total of 13 962 reports of axitinib-related ADEs were obtained， with patients’ age concentrated in 65-85 years （43.25%）， gender predominantly male （65.23%）， country of reporting predominantly US （60.01%）， and serious ADE outcomes mostly hospitalization or prolonged hospitalization （31.51%）. A total of 172 ADE risk signals were detected， involving 18 system and organ classifications （SOC）， mainly systemic diseases and various reactions at the site of administration （3 749 cases， 30.84%） and gastrointestinal system diseases （2 067 cases， 17.00%）. ADE risk signals that occurred more frequently were generally consistent with the drug instruction， such as diarrhea， fatigue， and hypertension； new ADE risk signals requiring clinical attention were death， immune-mediated nephritis， and PT signals contained in the SOC of various benign， malignant， and tumors of undetermined nature （including cysts and polyps）. CONCLUSIONS For ADEs that occur frequently with axitinib and are already contained in the drug instruction （e.g. hypertension， diarrhea）， they should be adequately evaluated before administration， especially for patients with combined use of immune checkpoint inhibitors and patients with underlying hypertension； for ADEs with stronger signals and newer ADEs （e. g. death， disease progression， tumor progression）， the patient’s disease progression should be closely monitored during the treatment period for potentially fatal ADEs； for its rare ADEs （e. g.immune-mediated nephritis， scrotal ulcer， non-infectious encephalitis）， clinical validation should be further strengthened.

Mining and analysis of adverse drug events signals of nilotinib based on FDA adverse event database / 中国药房

OBJECTIVE To provide a reference for safe drug use in clinic. METHODS ADE reports related to nilotinib from the first quarter of 2007 to the fourth quarter of 2022 were collected from the US FDA adverse event reporting system database. The reporting odds ratio （ROR） and proportional reporting ratio （PRR） of disproportionality measures were used to mine potential ADE signals，which were compared with drug instruction and related case report， and were screened and analyzed according to the designated medical events （DME） list formulated by the European Medicines Agency. RESULTS Totally 23 332 cases of ADE with nilotinib as the primary suspected drug were reported. A total of 359 positive signals were obtained，involving 24 system organ classes （SOC），mainly concentrated in various examinations，heart organ diseases，vascular and lymphatic diseases，all kinds of nervous system diseases，etc. Among them，ADEs such as vertebral artery stenosis，coronary artery stenosis，arterial disease，liver infection and the second primary malignant tumor were not mentioned in the instructions. Seven DMEs were detected，of which bone marrow failure，pulmonary hypertension and deafness were not mentioned in the drug instruction. CONCLUSIONS The common ADE signals of nilotinib excavated in this study are consistent with the instructions. In clinical use，special attention should be paid to DME not mentioned in the instructions such as bone marrow failure，pulmonary hypertension and deafness； cardiac function， blood glucose and blood lipid indexes should be monitored closely.

Efficacy of Guanqiao Zhengqi holistic therapy for chronic rhinosinusitis / 中国基层医药

Objective:To investigate the efficacy of Guanqiao Zhengqi holistic therapy in the treatment of chronic rhinosinusitis. Methods:A total of 200 patients with chronic rhinosinusitis who received treatment in the Department of Otolaryngology, Shanxi Provincial Integrated Traditional Chinese Medicine and Western Medicine Hospital ( n = 72) and Shanxi Yishengtang Traditional Chinese Medicine Center ( n = 128) from January 2021 to January 2022 were included in this study. These patients were randomly assigned to undergo treatment either with mometasone furoate nasal spray and levocetirizine hydrochloride tablets (control group, n = 100) or Guanqiao Zhengqi holistic therapy combined with mometasone furoate nasal spray and levocetirizine hydrochloride tablets (observation group). All patients were treated for 4 weeks and followed up for 3 months. Clinical efficacy, modified Visual Analogue Scale score, Lund-Kennedy endoscopy scoring system score, and duration of glucocorticoid and anti-leukotriene use were compared between the two groups. Results:The total response rate in the observation group was significantly higher than that in the control group [92.00% (92/100) vs. 73.00% (73/100), χ2 = 18.45, P < 0.001). There was no significant difference in the modified Visual Analogue Scale score between the two groups before treatment ( Z = 1.37, P = 0.170). There was a significant difference in the modified Visual Analogue Scale score between the two groups after treatment ( Z = -5.27, P < 0.001). Before treatment, there was no significant difference in the Lund-Kennedy endoscopy scoring system score between the two groups ( Z = -1.65, P = 0.098) and the Lund-Kennedy endoscopy scoring system score differed significantly between the two groups after treatment ( Z = -6.03, P < 0.001). The duration of glucocorticoid and anti-leukotriene use in the observation group was significantly shorter than that in the control group [10.00 (10.00, 14.00) days vs. 42.00 (28.00, 70.00) days, 7.00 (7.00, 7.00) days vs. 21.00 (14.00, 26.25) days, Z = -11.27, P < 0.001, Z = -12.31, P < 0.001). Conclusion:Based on the conventional treatment with western medicine, Guanqiao Zhengqi holistic therapy for the treatment of chronic rhinosinusitis can effectively reduce clinical symptoms, reduce the dose of hormones and anti-leukotriene used, shorten the use cycle, and improve the therapeutic efficacy.

Effects of butylphthalide combined with hyperbaric oxygen therapy on post-stroke cognitive impairment / 中国基层医药

Objective:To investigate the clinical efficacy of butylphthalide combined with hyperbaric oxygen therapy on post-stroke cognitive impairment in patients with acute ischemic stroke.Methods:A total of 90 patients with post-stroke cognitive impairment who were hospitalized within 72 hours of onset in Suining County People's Hospital from December 2019 to November 2020 were included in this study. They were randomly divided into a control group and an observation group ( n = 45/group). The control group was given conventional treatment and the observation group was given butylphthalide combined with hyperbaric oxygen therapy in addition to conventional treatment. The National Institutes of Health Stroke Scale score, Montreal Cognitive Assessment score, and Activities of Daily Living score were compared between the two groups before and after treatment. Results:Before treatment, there were no significant differences in the National Institutes of Health Stroke Scale score, Montreal Cognitive Assessment score, and Activities of Daily Living score between the two groups (all P > 0.05). At 14 days and 1 month after surgery, the National Institutes of Health Stroke Scale scores in the observation group were (4.02 ± 2.18) points and (3.21 ± 2.03) points, which were significantly lower than (5.21 ± 2.24) points and (4.62 ± 2.68) points in the control group ( t =2.55, 2.81, both P < 0.05). At 1 and 3 months after treatment, the Montreal Cognitive Assessment score in the observation group were (19.79 ± 5.67) points and (23.69 ± 2.67) points, which were significantly higher than (16.88 ± 5.12) points and (19.74 ± 2.29) points in the control group ( t = 2.56, 7.53, both P < 0.05). At 1 and 3 months after treatment, Activities of Daily Living scores in the observation group were (54.85 ± 5.69) points and (74.38 ± 4.98) points, which were significantly higher than (46.78 ± 6.24) points and (63.21 ± 5.24) points in the control group ( t = 6.41, 9.76, both P < 0.05). Conclusion:Butylphthalide combined with hyperbaric oxygen therapy for the treatment of post-stroke cognitive impairment in patients with acute ischemic stroke can alleviate neurologic deficits, and improve cognitive function and the ability of daily life.

Comparison and reflection on training methods of Chinese and American pathologists: taking Duke University as an example / 中华医学教育探索杂志

Taking the Department of Pathology of Duke University as an example, this paper compares and analyzes the training mode of pathology residents in China and the United States. It is found that the organization and management system and supervision and assessment system of residency training in China have been improved, but it is still necessary to strengthen the in-depth implementation of humanistic education and training subjects for residents. Pathologist training should be based on "elite education" as the guiding ideology, to cultivate high-quality, high-level outstanding clinical pathology personnel as the specific goal, to build a solid foundation of clinical medicine.

Newly developed gas-assisted sonodynamic therapy in cancer treatment

Sonodynamic therapy (SDT) is an emerging noninvasive treatment modality that utilizes low-frequency and low-intensity ultrasound (US) to trigger sensitizers to kill tumor cells with reactive oxygen species (ROS). Although SDT has attracted much attention for its properties including high tumor specificity and deep tissue penetration, its anticancer efficacy is still far from satisfactory. As a result, new strategies such as gas-assisted therapy have been proposed to further promote the effectiveness of SDT. In this review, the mechanisms of SDT and gas-assisted SDT are first summarized. Then, the applications of gas-assisted SDT for cancer therapy are introduced and categorized by gas types. Next, therapeutic systems for SDT that can realize real-time imaging are further presented. Finally, the challenges and perspectives of gas-assisted SDT for future clinical applications are discussed.

EARLY POSTOPERATIVE ULTRASONOGRAPHY ROLE FOR AV FISTULA FAILURE PREDICTION IN HEMODIALYSIS PATIENTS.

Doppler ultrasonography is the main modality for imaging of hemodialysis AV ?stula as it is safe and non-invasive. This study is to measure the Arterio-venous (AV) ?stula blood ?ow during early postoperative period (0–7days) and assess its role in AV ?stula failure prediction. Doppler ultrasonography was used to estimate the blood ?ow in the AV ?stula of 50 patients at (0–7days) after the ?stula was made. The blood ?ow in ?stula during early postoperative period for ?stula failure was evaluated, and long term failure was predicted. Blood ?ow rates Method measured in arteriovenous ?stula created in upper extremity were measured in ?rst week and sixth week post-operative. Results After follow up evaluation out of 50 patients, 40 ?stulas considered to be matured; 10 considered failed. 30% failure were males and 70% were female. In early post operative period, cut off was set at 182 ml/min and the sensitivity of blood ?ow for prediction of ?stula failure is 98%, speci?city 90 %, PPV 95% and NPV 90%. Measurements of the AV ?stula blood Conclusion ?ow in proximal artery and draining vein with its diameter of lumen were noted in the early postoperative period has a role predicting AV ?stula failure. There is risk of failure if the blood ?ow less than 182 ml/min (day 0–7)

Evaluation of Point of Entry Surveillance for COVID-19 at Mumbai International Airport, India, July 2020

India started Point of entry (PoE) surveillance at Mumbai International Airport, screening passengers returning from coronavirus disease (COVID?19)?affected countries using infrared thermometers. We evaluated in July 2020 for March 1–22 with the Centers for Disease Control and Prevention evaluation framework. We conducted key informant interviews, reviewed passenger self?reporting forms (SRFs) (randomly selected) and relevant Airport Health Organization and Integrated Disease Surveillance Programme (IDSP) records. Of screened 165,882 passengers, three suspects were detected and all were reverse transcription?polymerase chain reaction negative. Passengers under?quarantine line?listing not available in paper?based PoE system, eight written complaints: 6/8 SRF filling inconvenience, 3/8 no SRF filling inflight announcements, and standing in long queues for their submission. Outside staff deployed 128/150 (85.3%), and staff: passenger ratio was 1:300. IDSP reported 59 COVID?19 confirmed cases against zero detected at PoE. It was simple, timely, flexible, and useful in providing information to IDSP but missed cases at PoE and had poor stability. We recommended dedicated workforce and data integration with IDSP.

A study of prescribing patterns in high-risk pregnancy at a tertiary care hospital

Background: High-risk pregnancy is defined as pregnancy complicated by factors that can adversely affect maternal and perinatal outcome. About 10–30% of pregnancies are high risk which accounts for 70–80% perinatal mortality and morbidity. Drug utilization data help to monitor the drugs prescribed and to assess the outcome by evaluating appropriateness and rationality of prescription. Aims and Objectives: This study aims to evaluate the pattern of drug use in high-risk pregnancy and to assess the WHO core prescribing indicator and US FDA category. Materials and Methods: A total of 250 case record forms of pregnant women admitted to high-risk ward were analyzed. Patient’s demographic data and detailed information about prescription were recorded and analyzed as per the WHO core drug prescribing indicators and US-FDA category. Descriptive statistics were used. Results: A total of 1121 drugs were prescribed among which antimicrobials (33.7%) were used more frequently followed by antihypertensive (13.9%), intravenous (609, 54.2%) route was the major route of drug administration, followed by oral (527, 47%), intramuscular (33, 2.9%), and subcutaneous (16, 1.4%). Average number of drugs per encounter was 4.48, percentage of encounters with an antimicrobials prescribed is around 70.4%, percentage of drugs prescribed by generic name was 93.5%, percentage of drugs prescribed from essential drugs list was 73.3%, and percentage of encounters with an injection prescribed was 50.4%. Majority of drugs belong to the US-FDA pregnancy Category B (45.04%), followed by Category C (39.4%), A (10.8%), and D (4.6%). Conclusion: Majority of drugs were prescribed by generic name and belonged to Category B drugs which are considered safe. Standards of prescription were in accordance with the WHO prescribing indicators. Overall prescribing behavior is rational and encouraging.

Colombian vs. American corn: Quality, chemical composition, mycotoxin content and metabolizable energy

Background: Corn is, quantitatively, one of the most important world crops (ranking second only after wheat) and a key ingredient in animal feeds. Objective: to assess and compare corn quality, mycotoxin content, chemical composition and apparent metabolizable energy (AME) of domestic and imported corn. Methods: Grain quality (USDA grading system) was determined in 30 samples of domestic and 21 samples of imported corn. From each origin, 15 samples were subjected to proximal analysis and 10 were used to determine fatty acid composition. Mycotoxin analysis was conducted on 30 samples of domestic and 23 of imported corn. Results: six of the 30 domestic samples corresponded to US1 grade (highest quality) vs. none of the imported. In the "sample grade" category (lowest quality), 10 and 6 samples corresponded to imported and domestic corn, respectively. Soybeans were found as contaminant in 15 of the 21 imported corn samples. Aspergillus spp. mycotoxins such as ochratoxin A were not detected, and aflatoxins were found in only a few samples at very low levels. Fusariotoxins such as deoxynivalenol and zearalenone were found in 61 and 43% of imported samples, respectively, but in none of the domestic samples. Domestic corn had lower carbohydrate content compared with imported corn (85.4 vs. 86.7%), but higher crude fat (3.8 vs. 3.1%). The AME values for domestic and imported corn were 3,697 and 3,378 kcal/kg, respectively. The fatty acid profiles from both corn types were similar. Conclusion: This study found significant differences between locally-grown and imported corn, particularly in terms of crude fat, AME content, fusariotoxins, and contaminant seeds (soybeans). These findings suggest that locally-grown corn might have nutritional and toxicological advantages over corn imported from the United States.

Antecedentes: El maíz es, cuantitativamente, uno de los cultivos más importantes a nivel mundial (ocupa el segundo lugar después del trigo) y uno de los principales ingredientes en dietas para animales. Objetivo: Evaluar y comparar la calidad del maíz, su contenido de micotoxinas, composición química, y energía metabolizable aparente (AME) del maíz nacional e importado. Métodos: La calidad del grano (sistema de clasificación de la USDA) se determinó en 30 muestras de maíz producido en Colombia y 21 de maíz importado. De cada origen, 15 muestras se sometieron a análisis proximal y 10 se analizaron para determinar el perfil de ácidos grasos. El contenido de micotoxinas se determinó en 30 muestras de maíz nacional y 23 de maíz importado. Resultados: Seis de las treinta muestras nacionales analizadas para calidad de grano correspondieron a grado US1 (la mejor calidad) frente a ninguna de las importadas. En categoría "grado muestra" (la menor calidad) se encontraron 10 y 6 de las muestras de maíz importado y nacional, respectivamente; 15 de las 21 muestras de maíz importado presentaron contaminación con semillas de fríjol soya. No se encontraron micotoxinas de hongos Aspergillus spp. (ocratoxina A), y niveles muy bajos de aflatoxinas en unas pocas muestras. Fusariotoxinas tales como deoxinivalenol y zearalenona se detectaron en el 61 y 43% de las muestras de maíz importado, respectivamente, pero en ninguna muestra de maíz nacional. El maíz nacional presentó menor contenido de carbohidratos (85,4 vs. 86,7%), pero mayor contenido de grasa cruda (3,8 vs. 3,1%) en comparación con el importado, respectivamente. Los valores de AME fueron de 3.697 y 3.378 kcal/kg para el maíz nacional e importado, respectivamente. El perfil de ácidos grasos de ambas procedencias fue similar. Conclusiones: Este estudio encontró diferencias significativas entre el maíz de producción nacional y el importado, en especial en su contenido de grasa cruda y AME, fusariotoxinas, y semillas contaminates (soya). Estos hallazgos sugieren que el maíz de producción nacional puede presentar ventajas de tipo nutricional y toxicológico frente al maíz importado de los Estados Unidos de América.

Antecedentes: O milho é quantitativamente uma das culturas mais importantes em nível mundial (ocupando o segundo lugar depois do trigo), sendo um dos principais ingredientes em dietas para animais. Objetivo: Avaliar e comparar a qualidade do milho, o teor de micotoxinas, a composição química e a energia metabolizável aparente (EMA) do milho nacional e importado. Métodos: A qualidade do grão (sistema de classificação do USDA) foi determinada em 30 amostras de milho produzido na Colômbia e 21 amostras de milho importado. Quinze amostras de cada tipo de milho foram submetidas a análise proximal e dez amostras de cada milho foram analisadas para determinar o perfil de ácidos graxos. O conteúdo de micotoxinas foi determinado em 30 amostras de milho da Colômbia e em 23 amostras de milho importado. Resultados: Seis das trinta amostras colombianas analisadas para qualidade de grão corresponderam a grau US1 (melhor qualidade) frente a nenhuma das amostras importadas. Na categoria "grau amostra" (menor qualidade) foram encontradas 10 e 6 amostras de milhos importados e colombianos, respectivamente; Quinze das 21 amostras de milho importado apresentaram contaminação com sementes de feijão soja. Não foram encontradas micotoxinas de fungos Aspergillus spp. (ocratoxina A) ou apenas níveis muito baixos em poucas amostras (aflatoxinas). As fusariotoxinas, deoxinivalenol e zearalenona foram detectadas em 61 e 43% das amostras de milho importado, respectivamente, mas não foram detectadas em nenhuma amostra do milho colombiano. O milho colombiano apresentou menor conteúdo de carboidratos (85,4 vs. 86,7%) porém maior conteúdo de gordura crua (3,8 vs. 3,1%). Os valores de AME foram 3.697 e 3.378 kcal/kg para as amostras de milho colombiano e importado, respectivamente. O perfil de ácidos graxos de ambos tipos de milho foi similar. Conclusões: Os resultados do presente estudo mostram diferenças significativas entre o milho de origem colombiana e o milho importado dos Estados Unidos, em especial no conteúdo de gordura crua e AME, fusariotoxinas e sementes contaminantes (soja). Estes achados sugerem que o milho de produção colombiana pode apresentar vantagens de tipo nutricional e toxicológica frente ao milho importado dos Estados Unidos.

Comparación de la evaluación clínica y por ultrasonido de la artropatía hemofílica en pacientes pediátricos / Comparison of the clinical and ultrasound evaluation of haemophilic arthropathy in children

Resumen Antecedentes: La exploración articular por ultrasonido mediante el método HEAD-US en la detección de la artropatía temprana ha sido poco estudiada en nuestro país. Objetivo: Comparar la evaluación clínica y por ultrasonido de las articulaciones en niños con hemofilia. Métodos: Estudio longitudinal, prospectivo y descriptivo con pacientes pediátricos con hemofilia A y B valorados con la escala HJHS 2.1 y ultrasonido con transductor lineal de 8 a 12 MHz. Se evaluaron las articulaciones de codos, rodillas y tobillos de forma bilateral, con el método HEAD-US. Resultados: Se incluyeron 69 pacientes; de ellos, 48 con hemofilia A grave (peso: 40.1 kg). En la escala HJHS se observó mayor afectación en la rodilla izquierda (0.49) y menor en el tobillo derecho (0.05). Con la escala HEAD-US, la más afectada fue la rodilla derecha (0.78). Existe una relación significativa en la afectación de la rodilla derecha evaluada con la escala HEAD-US en presencia de inhibidor. Conclusiones: El peso superior al percentil 50 es un factor de riesgo independiente de complicaciones por sangrado articular, mientras que la edad y el tipo de hemofilia no parecen relacionados. El método HEAD-US es una herramienta útil y accesible para la detección temprana de artropatía y hemartrosis.

Abstract Background: Joint ultrasound examination using the HEAD-US method in the detection of early arthropathy is poorly studied in our country. Objective: To compare the clinical and ultrasound evaluation of the joints in haemophilia. Methods: Longitudinal, prospective and descriptive study with paediatric patients with haemophilia A and B evaluated with the HJHS 2.1 scale and ultrasound with a linear transducer of 8 to 12 MHz. Elbows, knees and ankles joints were evaluated bilaterally, with HEAD-US protocol. Results: 69 paediatric patients were included of which 48 with severe haemophilia A (weight: 40.1 kg). On the HJHS scale, a greater involvement was observed in the left knee (0.49), and less in the right ankle (0.05). With the HEAD-US scale, the most affected was the right knee (0.78). There is a significant relationship in the involvement of the right knee evaluated with the HEAD-US scale in the presence of inhibitor. Conclusions: Weight above the 50th percentile is an independent risk factor for joint bleeding complications, while age and type of haemophilia do not appear to be related. The HEAD-US method is a useful and accessible tool for early detection of arthropathy and hemarthrosis.

Associations between college/university campus characteristics and student body mass index

BACKGROUND@#Campus environments are associated with undergraduate weight. However, few studies have examined campus type and geographic location in relation to student weight. This article aimed to identify college/university students with elevated BMIs by campus type and region.@*METHODS@#Linear mixed effects regression models were fit to data from the American College Health Association-National College Health Assessment II. Analyses tested associations between campus type/region and student self-reported BMI.@*RESULTS@#The sample included 404,987 students from 445 schools with mean BMI 24.9 ± 5.8. Across all school types/regions, BMI confidence intervals included overweight values. Two-year and public school students had higher BMIs compared to four-year and private school students, respectively. Students in the Midwest had higher BMIs compared to students in the Northeast. In the South only, Minority Serving Institution (MSI) students had higher BMIs compared to non-MSI students.@*CONCLUSION@#Healthy weight maintenance programs should be made available to undergraduate students.

Data-mining of Adverse Drug Events Signals for Tocilizumab Based on US FAERS Database / 中国药房

OBJECTIVE：To provide reference for clinical safe and rational drug use by mining adverse drug events （ADE） signals for tocilizumab. METHODS ：Data of ADE reports related to tocilizumab in the first quarter of 2015 to second quarter of 2020 were collected from US FDA adverse event reporting system. After data standardization ，the proportional imbalance method was used for ADE signal mining. RESULTS ：A total of 163 718 ADE reports were extracted ，in which tocilizumab was primary suspected drug ，involving 26 674 patients. In 26 674 patients，the proportion of female （73.69％）was higher than that of male （19.04％），and the age was mainly 60-74 years old （21.19％）. Among the 163 718 ADE reports ，the main reporting countries were the United States （70.15％），Canada（15.95％），Japan（3.33％），Australia（3.05％）and Brazil （1.43％）；consumers （31.35％）and doctors （24.94％）were the main reporting staff. A total of 747 ADE signals for tocilizumab were obtained ， commonly rheumatoid arthritis ，joint pain and pain ；and the signals as the increase of disability assessment scale score ，the decrease of disability assessment scale score ，abnormal diastolic blood pressure and abnormal systolic blood pressure were strong. A total of 33 kinds of ADE signals were found ，which were not recorded in the instructions of tocilizumab ，and mainly abnormal laboratory indicators such as decreased oxygen saturation ，decreased blood pressure and abnormal heart rate. ADE mainly involved 27 system organs ，including musculoskeletal and connective tissue ，various reactions of systemic diseases and drug delivery site ， various examinations. CONCLUSIONS ：In addition to the ADE mentioned in the drug instructions ，when using tocilizumab in clinic，attention should also be paid close to blood oxygen saturation ，blood pressure ，blood routine indexes and other laboratory indicators，and intervention measures should be taken early when ADE occurs ，so as to ensure the safety and effectiveness of drug use.

Applications of drug interaction study in new drug development and regulartory decision-making / 中国临床药理学与治疗学

Drug-drug interactions (DDI) change dose-response relationships, and may result in low efficacy or high toxicity, which are important considerations especially in medical practice with multiple-drug therapies. Predicting clinically significant drug interactions during new drug development is an important part of benefit and risk assessment in drug development and review. This article summarizes the purpose and significance of drug interactions in new drug development, the main content and precautions of DDI studies in vivo and in vitro. Drug interaction studies on novel drug approvals for 2020 in the National Medical Products Administration (NMPA) and US Food and Drug Administration (USFDA) are examined, respectively. It aims to provide reference for DDI studies and regulatory reviews in new drug development in our country.

Climate Variability and Change in Western U.S. Rangelands

We examine variability and change components of precipitation and minimum and maximum daily temperatures, and the derived variables potential evapotranspiration (PET) and the Palmer Drought Severity Index (PDSI), over rangelands in the region 30-50N, 100- 125W. We focus on areas administered by the U.S. Bureau of Land Management (BLM) and Bureau of Indian Affairs (BIA), with a view toward understanding how future climate variations may affect ecosystems, and ultimately, grazing on these lands. Based on an analysis of the annual precipitation cycle we adopt a three-season partition for the year, classifying land areas by season of maximum precipitation; this yields a coherent subregional map. Masking with a combined BLM/BIA footprint, we find that in all subregions both tmin and tmax have increased in response to anthropogenic forcing, the rate being generally greater for tmax. Significant precipitation trends are not detected, whereas PET exhibits significant upward trends in all regions. While PET-normalized precipitation, as well as PDSI, do not exhibit significant trends individually (by variable and region), the fact that most trend downward nevertheless suggests a systematic drying. We conclude that temperature constitutes the principal detectable control on hydroclimatic changes in rangelands within the study area. Although ecosystem responses may be complex, future temperature increases are expected generally to reduce soil water availability. The unforced component of variability is investigated with respect to several key climate indices on both interannual and decadal time scales.

Carcinoma papilar difuso de tiroides: microcalcificaciones fuera del nódulo tiroideo / Diffuse Papillary Thyroid Carcinoma: Microcalcifications Outside the Thyroid Node

Resumen: Introducción: La incidencia de cáncer papilar de tiroides (PTC) ha aumentado de 1975 a 2015. Basados en criterios publicados, el ultrasonido (US) es muy efectivo para predecir el riesgo de malignidad. Todos estos criterios se enfocan en los nódulos tiroideos; sin embargo, 2% de los casos se pueden presentar como focos ecogénicos difusos sin un nódulo identificable. Caso: Mujer de 17 años con historia de 3 meses con una masa palpable en la región anterior derecha del cuello, sin otros síntomas. El US de cuello revela múltiples focos ecogénicos de distribución difusa en el parénquima tiroideo con un nódulo de 6 mm TI-RADS 5 en el lóbulo izquierdo y ganglio linfáticos con componentes sólidos y quísticos, pérdida del hilio graso y con puntos ecogénicos. Se le realizó tiroidectomía total con linfadenectomía bilateral. Discusión: Las microcalcificaciones son muy sugestivas de CPT. Los ecos puntiformes se correlacionan en patología con una forma de calcificación distrófica llamada cuerpos de Psammoma, los cuales se depositan en tejido no viable. La tiroiditis crónica también puede presentar calcificaciones distróficas. Por lo tanto, un parénquima tiroideo normal con presencia de microcalcificaciones, obliga a realizar una biopsia con aguja fina para descartar CPT. Estudios recientes sugieren que la lobectomía es una opción viable y debe ser la primera elección en CPT localizado (< 2 cm). Sin embargo, esto no se debe realizar en estos pacientes, ya que la presencia de microcalcificaciones difusas nos indica un tamaño del tumor mucho mayor y resultaría en un pronóstico desfavorable. Conclusión: Las microcalcificaciones difusas deben obligar al radiólogo a sospechar la variedad difusa del CPT como primera sospecha diagnóstica.

Abstract: Introduction: The incidence of thyroid papillary cancer (PTC) has increased from 1975 to 2015. Ultrasound is effective for predicting thyroid malignancy based on published criteria. All of these criteria focus on thyroid nodules but also 2% of the cases may appear as diffuse punctuate echogenic foci without an identifiable nodule. Case: A 17-year-old female with a 3-month history of a palpable mass on the right anterior side of the neck without any further symptoms. Neck ultrasound revealed multiple punctuate echogenic foci scattered along the thyroid parenchyma with a 6 mm nodule TI-RADS 5 on the left lobe, lymph nodes with cystic and solid components, loss of echogenic hilum and punctuate echogenic foci. The patient underwent a total thyroidectomy with bilateral lymphadenectomy. The pathology report revealed diffuse distribution of papillary cancer with a nodule on the left lobe and metastatic disease on the lymph nodes. Discussion: Microcalcifications are highly suggestive of PTC. Punctuate echogenic foci correlate in pathology with a form of dystrophic calcifications, called Psammoma bodies, which are deposited in nonviable tissue. Chronic thyroiditis may also present dystrophic calcifications. Thus, a normal thyroid parenchyma with microcalcifications should encourage the radiologist to perform a fine-needle aspiration biopsy (FNAB). Recent studies suggest that lobectomy is a viable option and should be pursued in the setting of localized PTC (<2 cm). A lobectomy should not be performed in patients with diffuse microcalcifications since it would result in an unfavorable outcome. Conclusions: Diffuse microcalcifications should immediately make the radiologist suspect diffuse PTC as a first diagnostic option.

Research on FDA Data Standards Program in the United States and Its Enlightenment to China / 中国药房

OBJECTIVE：To study FDA data standards program in the United States ，and to provide reference for constructing medicine data standards in China. METHODS ：By analyzing the governance organization and policy system of FDA data standards program in the United States ，the experience were summarized for data standards development mode and development procedure ， and relevant suggestions were put forward for medicine data standards construction in China. RESULTS & CONCLUSIONS ：The organization of FDA data standards program is led by the Chief Scientist Office of FDA ，coordinated by the Data Standards Advisory Board ，specifically responsible by the Data Standards Program Board under the center for Drug Evaluation and Research ， and participated by other regulatory centers and offices under FDA. FDA data standards program is composed of 4 subsystems as data standards strategy ，data standards program action plan ，data standards catalog and data standard communication plan. According to the federal laws and regulations of the United States ，the demand of FDA and pharmaceutical industry for data standards and the importance of data standards ，the strategic objectives of data standards development are proposed ，and the strategic objectives are refined into specific projects through the data standards program action plan. These programs strictly follow the“data standards development process ”and gradually advance quarterly ，and new data standards will be included in the Data Standards Catalog . At the same time ，FDA strengthen the cooperation and communication with internal and external stakeholders through the data standards program communication plan. It is suggested that China should learn from the experience of FDA data standards program construction ，establish a medical and health data standards program management mode ，strengthen the participation of internal and external stakeholders ，establish data standards committee ，formulate data standards catalog ，and provide clear and unified data standards for the pharmaceutical industry ，so as to promote the construction of medicine data standards in China.