Doble tormenta tiroidea y arrítmica en una gestante con múltiples taquicardias refractarias mediadas por un haz de kent intermitente ablacionado exitosamente

La tormenta tiroidea es un estado crítico y poco frecuente que condiciona la disfunción de múltiples órganos por el efecto del exceso de las hormonas tiroideas, esta disfunción endócrina tiene una elevada mortalidad y genera manifestaciones típicas como la taquicardia, fiebre, alteraciones gastrointestinales, cardiovasculares y del sistema nervioso central. El embarazo se ha asociado con un incremento en la incidencia de arritmias. Necesitan un tratamiento inmediato con drogas antiarrítmicas, cardioversión eléctrica o cesárea de urgencia. El WPW es una anormalidad cardiaca congénita que consiste en la presencia de un haz anómalo (Haz de Kent) que evita el sistema normal de conducción uniendo directamente aurículas y ventrículos. Veremos el caso de una gestante de 32 semanas que presenta un cuadro de tormenta tiroidea y múltiples episodios de taquicardia paroxística supraventricular (TPS), de tórpida y sombría evolución clínica mediada por un haz anómalo de Kent intermitente. Es evidente que la tormenta tiroidea en el contexto de la gestación produjo cambios en las propiedades electrofisiológicas del haz anómalo de Kent intermitente lo cual propició el desarrollo de múltiples taquicardias paroxísticas supraventriculares refractarias a la cardioversión eléctrica y farmacológica. Tampoco mejoró con la tiroidectomía total, solamente cedió por completo con la ablación por catéter de radiofrecuencia del haz anómalo de Kent.

Thyroid storm is a critical and infrequent state that conditions the dysfunction of multiple organs due to the effect of excess thyroid hormones. This endocrine dysfunction has a high mortality and generates typical manifestations such as tachycardia, fever, gastrointestinal, cardiovascular and heart disorders, and the central nervous system. Pregnancy has been associated with an increased incidence of arrhythmias. They need immediate treatment with antiarrhythmic drugs, electrical cardioversion, or emergency caesarean section. WPW is a congenital cardiac abnormality that consists of the presence of an abnormal bundle (Kent bundle) that prevents the normal conduction system, directly joining the atria and ventricles. We will see the case of a 32-week pregnant woman who presented symptoms of thyroid storm and multiple episodes of paroxysmal supraventricular tachycardia (PST), with a torpid clinical course mediated by an abnormal intermittent Kent bundle. It is evident that the thyroid storm in the context of pregnancy produced changes in the electrophysiological properties of the intermittent Kent bundle, which led to the development of multiple PST refractory to electrical and pharmacological cardioversion. Moreover, it also did not improve with total thyroidectomy, only resolved completely with radiofrequency catheter ablation of the Kent bundle.

Health and lifestyle parameters in peripheral artery disease at two periods of the COVID-19 pandemic: comparison between men and women

ABSTRACT Objective: This study analyzed the impact of sex on self-reported health and lifestyle parameters in peripheral artery disease patients at two periods of the COVID-19 pandemic. Methods: In this longitudinal study, 99 patients with peripheral artery disease (53 men and 46 women) were evaluated during two periods of the COVID-19 pandemic ( i.e ., at onset: May to August 2020, and on follow-up: May to August 2021). Patients were interviewed via telephone, and information regarding lifestyle and health parameters was obtained. Results: At the onset of the COVID-19 pandemic, health and habit parameters were similar between women and men, with 63.0% and 45.3% indicating frequent fatigue, 73.9% and 84.9% reporting increased sitting time, and 23.9% and 39.6% practicing physical activity, respectively. At follow-up, difficulties in physical mobility (women: from 26.1% to 73.9%, p<0.001; men: from 39.6% to 71.7%, p=0.001) and the frequency of hospitalization for reasons other than COVID-19 increased similarly in women and men (women: from 4.3% to 21.7%, p=0.013; men: from 9.4% to 24.5%, p=0.038). The other parameters were similar between the periods. Conclusion: Self-reported physical mobility difficulties and hospitalization frequency increased in women and men with peripheral artery disease.

Characterization of group Ⅰ metabotropic glutamate receptors in rat superior cervical ganglion and their changes following chronic intermittent hypoxia / 解剖学报

Objective To observe the expression and localization of group Ⅰ metabotropic glutamate receptors (mGluR1/ 5) in rat superior cervical ganglion (SCG) and the effect of chronic intermittent hypoxia (CIH) on mGluR1/ 5 protein level. Methods Twelve male SD rats were randomly divided into control group(Ctrl)and CIH group(CIH), 6 rats in each group. After 6 weeks of modeling, the effect of CIH on mGluR1/ 5 protein level was detected by Western blotting, the expression and distribution of mGluR1/ 5 in SCG were detected by immunohistochemistry and double-immunofluorescent staining. Results mGluR1/ 5 was expressed in rat SCG. mGluR1 was distributed in neurons and small intensely fluorescent (SIF) cells, but not in satellite glial cells (SGCs), nerve fibers and blood vessels, whereas mGluR5 was mainly distributed in nerve fibers and a little in neurons, but not in SGCs, SIF cells and blood vessels. CIH increased the protein levels of mGluR1/ 5 (P<0. 01) in rat SCG. Conclusion Both mGluR1 and mGluR5 are expressed in the rat SCG, but their distribution are different, and the increased protein levels of both may be involved in CIH-induced hypertension.

Intermittent Theta Burst Stimulation Attenuates Cognitive Deficits and Alzheimer's Disease-Type Pathologies via ISCA1-Mediated Mitochondrial Modulation in APP/PS1 Mice / 神经科学通报·英文版

Intermittent theta burst stimulation (iTBS), a time-saving and cost-effective repetitive transcranial magnetic stimulation regime, has been shown to improve cognition in patients with Alzheimer's disease (AD). However, the specific mechanism underlying iTBS-induced cognitive enhancement remains unknown. Previous studies suggested that mitochondrial functions are modulated by magnetic stimulation. Here, we showed that iTBS upregulates the expression of iron-sulfur cluster assembly 1 (ISCA1, an essential regulatory factor for mitochondrial respiration) in the brain of APP/PS1 mice. In vivo and in vitro studies revealed that iTBS modulates mitochondrial iron-sulfur cluster assembly to facilitate mitochondrial respiration and function, which is required for ISCA1. Moreover, iTBS rescues cognitive decline and attenuates AD-type pathologies in APP/PS1 mice. The present study uncovers a novel mechanism by which iTBS modulates mitochondrial respiration and function via ISCA1-mediated iron-sulfur cluster assembly to alleviate cognitive impairments and pathologies in AD. We provide the mechanistic target of iTBS that warrants its therapeutic potential for AD patients.

Pharmacokinetics of rifampicin, isoniazid & pyrazinamide during daily & intermittent dosing: A preliminary study

Background & objectives: The National Tuberculosis (TB) Control Programme has transitioned from thrice-weekly to daily drug treatment regimens in India. This preliminary study was conceived to compare the pharmacokinetics of rifampicin (RMP), isoniazid (INH) and pyrazinamide (PZA) in TB patients being treated with daily and thrice weekly anti-TB treatment (ATT). Methods: This prospective observational study was undertaken in 49 newly diagnosed adult TB patients receiving either daily ATT (n=22) or thrice-weekly ATT (n=27). Plasma RMP, INH and PZA were estimated by high-performance liquid chromatography. Results: The peak concentration (Cmax) of RMP was significantly higher (RMP: 8.5 ?g/ml vs. 5.5 ?g/ml; P=0.003) and Cmax of INH was significantly lower (INH: 4.8 ?g/ml vs. 10.9 ?g/ml; P<0.001) in case of daily dosing compared to thrice-weekly ATT. Cmax of drugs and doses was significantly correlated. A higher proportion of patients had subtherapeutic RMP Cmax (8.0 ?g/ml) during thrice-weekly compared to daily ATT (78% vs. 36%; P=0.004). Multiple linear regression analysis showed that Cmax of RMP was significantly influenced by the dosing rhythm, pulmonary TB and Cmax of INH and PZA by the mg/kg doses. Interpretation & conclusions: RMP concentrations were higher and INH concentrations were lower during daily ATT, suggesting that INH doses may need to be increased in case of a daily regimen. Larger studies are, however, required using higher INH doses when monitoring for adverse drug reactions and treatment outcomes.

Intermittent fasting for health care, a review / El ayuno intermitente, ¿un éxito o una desventaja para el cuidado de la salud?

The incidence of obesity and overweight in the world has been increasing in recent years due to poor diet and lack of physical activity; people suffering obesity and overweight, related with malnutrition due to excess, often resort to calorie restriction diets that are usually not very effective. In this context, intermittent fasting (IF) has become popular due to the possibilities for weight loss that it offers. This diet consists of alternating periods of fasting with unrestricted eating; however, its effectiveness and consequences are unknown to most users. This narrative review analyzes whether intermittent fasting contributes to the improvement of body and metabolic composition. The purpose of the review was to examine the available data on the contribution of intermittent fasting to the improvement of body and metabolic composition, in order to provide information and to define the parameters that condition safe achievement of its benefits. IF dieting triggers adaptive cell responses that cause a decrease in lipid oxidative stress markers in individuals with obesity and prediabetes. Metabolic alterations have been found to go hand in hand with the alteration of circadian rhythms; if IF contributes to this effect, it may assist in treating and preventing obesity and associated diseases. However, there are also disadvantages, such as the loss of lean muscle mass by wasting, and increased hypoglycemia(AU)

La incidencia de obesidad y sobrepeso en el mundo ha ido en aumento en los últimos años debido a la mala alimentación y la falta de actividad física; Las personas que padecen obesidad y sobrepeso, relacionadas con la desnutrición por exceso, suelen recurrir a dietas de restricción calórica que suelen ser poco efectivas. En este contexto, el ayuno intermitente (AI) se ha popularizado debido a las posibilidades de pérdida de peso que ofrece. Esta dieta consiste en alternar períodos de ayuno con alimentación sin restricciones; sin embargo, su eficacia y consecuencias son desconocidas para la mayoría de los usuarios. Esta revisión narrativa analiza si el ayuno intermitente contribuye a la mejora de la composición corporal y metabólica. El objetivo de la revisión fue examinar los datos disponibles sobre la contribución del ayuno intermitente a la mejora de la composición corporal y metabólica, con el fin de aportar información y definir los parámetros que condicionan la consecución segura de sus beneficios. Se ha encontrado que las alteraciones metabólicas van de la mano con la alteración de los ritmos circadianos; si AI contribuye a este efecto, puede ayudar a tratar y prevenir la obesidad y las enfermedades asociadas. Sin embargo, también existen desventajas, como la pérdida de masa muscular magra por atrofia y el aumento de la hipoglucemia(AU)

Impact of different automated peritoneal dialysis modalities on the inflammatory profile of elderly patients with chronic kidney disease / Impacto das diferentes modalidades de diálise peritoneal automatizada sobre o perfil inflamatório de idosos portadores de doença renal crônica

Abstract Introduction: Chronic kidney disease, more prevalent in the elderly, is considered a public health issue worldwide. Objective: To evaluate the impact of automated, peritoneal dialysis modalities, intermittent and continuous, on the inflammatory profile of elderly people with chronic kidney disease. Methods: Prospective, cross-sectional and analytical study carried out in a dialysis clinic in Brasília - Brazil, with 74 elderly people aged 60 years or older. The patients underwent rapid Peritoneal Equilibration Test, clinical assessment, blood collection for biochemical and cytokine assessments, interleukin 6 and transforming growth factor beta 1, and answered a quality-of-life questionnaire (KDQOL-SF36). We used a 5% significance level for data analysis, associations and correlations. Results: Patients in the continuous modality had higher serum values of transforming growth factor beta 1 than those in the intermittent modality, which had higher peritoneal transforming growth factor beta 1, age and residual renal function than those in continuous mode. Interleukin 6 dosage in the peritoneum was associated with age, while serum IL-6 was associated with IL-6 in the peritoneum, time on dialysis and age. There was no association between the modality and the presence of diabetes, blood volume or nutritional status. Both modalities enable good adaptation to the dialysis treatment. Conclusion: Inflammation in automated peritoneal dialysis is mainly associated with low residual renal function, advanced age and longer time on therapy, and not to the type of dialysis performed.

Resumo Introdução: A doença renal crônica, mais prevalente em idosos, é considerada um problema de saúde pública em todo o mundo. Objetivo: Avaliar o impacto das modalidades de diálise peritoneal automatizada, intermitente e contínua, no perfil inflamatório de idosos renais crônicos. Métodos: Estudo prospectivo, transversal e analítico realizado em uma clínica de diálise em Brasília, com 74 idosos com idade igual ou maior que 60 anos. Os pacientes foram submetidos ao Teste de Equilíbrio Peritoneal rápido, avaliação clínica, coleta de sangue para avaliações bioquímicas e de citocinas, interleucina 6 e fator de crescimento transformador beta 1, e questionário de qualidade de vida (KDQOL-SF36). Foram utilizadas para análise dos dados, associações e correlações com nível de significância de 5%. Resultados: Pacientes na modalidade contínua apresentaram valores séricos do fator de crescimento transformador beta 1 maiores do que os em modalidade intermitente. Estes apresentaram fator de crescimento transformador beta 1 no peritônio, idade e função renal residual maiores do que os em modalidade contínua. A dosagem da interleucina 6 no peritônio foi associada à idade, enquanto a IL-6 sérica foi associada à IL-6 no peritônio, ao tempo em diálise e à idade. Não houve associação entre a modalidade e a presença de diabetes, volemia ou estado nutricional. Ambas as modalidades permitem boa adequação à terapia dialítica. Conclusão: A inflamação na diálise peritoneal automatizada está associada principalmente à baixa função renal residual, à idade avançada e ao maior tempo em terapia, e não à modalidade de diálise realizada.

El ayuno intermitente y sus efectos en la salud metabólica en humanos / Intermittent fasting and human metabolic health

Intermittent fasting (IF) has gained increasing scientific and general attention. Most studied forms of IF include alternate-day fasting, modified alternate-day fasting, and time-restricted eating (TRE). Several cardiometabolic effects of IF have been described in animal models and, to a lesser extent, in humans. This review analyzes the impact of IF on weight loss, glucose metabolism, blood pressure, and lipid profile in humans. A literature search was conducted in the Pubmed/Medline, Scopus, and Google Scholar databases. Controlled observational or interventional studies in humans, published between January 2000 and June 2021, were included. Studies comparing IF versus religious fasting were not included. Most studies indicate that the different types of IF have significant benefits on body composition, inducing weight loss and reducing fat mass. Changes in cardiometabolic parameters show more divergent results. In general, a decrease in fasting glucose and insulin levels is observed, together with an improved lipid profile associated with cardiovascular risk. High heterogeneity in study designs was observed, particularly in studies with TRE, small sample sizes, and short-term interventions. Current evidence shows that IF confers a range of cardiometabolic benefits in humans. Weight loss, improvement of glucose homeostasis and lipid profile, are observed in the three types of IF protocols evaluated.

O modo PSV apresenta piores desfechos em relação ao desmame quando comparado com outros modos ventilatórios de pacientes com exacerbação aguda da doença pulmonar obstrutiva crônica: revisão sistemática / The PSV mode has worse weaning outcomes when compared to other ventilatory modes in patients with an acute exacerbation of chronic obstructive pulmonary disease: systematic review

INTRODUÇÃO: A Doença Pulmonar Obstrutiva Crônica (DPOC) é um distúrbio crônico e progressivo, que evolui com o declínio da função pulmonar. Embora sua cronicidade, são comuns períodos de agudização acompanhados de Insuficiência Respiratória Aguda hipercápnica, requisitando permanência nas Unidades de Terapia Intensiva (UTI) e Ventilação Mecânica Invasiva (VMI) para reversão da falência respiratória. O desmame na DPOC ocupa até 58% da VM, logo, se faz necessário estratégias específicas para otimização desse processo, com a utilização de modos e ajustes ventilatórios que promovam um desmame precoce e efetivo. OBJETIVO: Verificar os efeitos da Ventilação com Pressão de Suporte quando comparado com modos e estratégias distintas no desmame de pacientes com DPOC. MÉTODOS: Revisão sistemática, construída seguindo critérios do PRISMA, registrada na PROSPERO (CRD42022362228). Considerados elegíveis ensaios clínicos controlados randomizados que avaliaram o modo PSV em comparação com modos e estratégias distintas, em pacientes com diagnóstico de DPOC, em VMI, sem delimitação de ano/idioma. Foram excluídos artigos incompletos, duplicados e indisponíveis aos recursos de recuperação. Desfechos de interesse foram: duração do desmame, tempo de permanência na UTI e mortalidade. A estratégia foi aplicada nas bases: PubMed, Cochrane, SciELO, e Biblioteca Virtual em Saúde. As ferramentas Escala PEDro e RevMan Web foram utilizadas para análise da qualidade dos estudos e risco de viés, respectivamente. RESULTADOS: Incluídos 8 artigos. 6 mostraram significância estatística, apresentando menor tempo de desmame no grupo ASV (24 (20­62) h versus 72 (24­144) h PSV) (p=0,041); mais dias na UTI quando comparado com o modo PAV (p<0,001). PSV foi mais eficaz nos mesmos desfechos quando comparado com a estratégia Tubo-T. Houve diferenças quanto a taxa de mortalidade com o modo NAVA. CONCLUSÃO: Fica evidente que o modo PSV quando em relação a modos ventilatórios assistidos, tem potencial de fornecer piores desfechos associados ao processo de desmame da ventilação invasiva de pacientes com DPOC.

INTRODUCTION: Chronic Obstructive Pulmonary Disease (COPD) is a chronic and progressive disorder that evolves with the decline in lung function. Despite its chronicity, periods of exacerbation accompanied by hypercapnic Acute Respiratory Failure are common, requiring a stay in Intensive Care Units (ICU) and Invasive Mechanical Ventilation (IMV) to reverse respiratory failure. Weaning in COPD occupies up to 58% of the MV, therefore, specific strategies are needed to optimize this process, using ventilatory modes and adjustments that promote early and effective weaning. OBJECTIVE: To verify the effects of Pressure Support Ventilation when compared with different modes and strategies in weaning patients with COPD. METHODS: Systematic review, constructed following PRISMA criteria, registered at PROSPERO (CRD42022362228). Randomized controlled clinical trials that evaluated the PSV mode in comparison with different modes and strategies, in patients diagnosed with COPD, on IMV, without delimitation of year/language, were considered eligible. Incomplete, duplicate and unavailable articles were excluded. Outcomes of interest were: duration of weaning, length of stay in the ICU and mortality. The strategy was applied in the bases: PubMed, Cochrane, SciELO, and Biblioteca Virtual em Saúde. The PEDro Scale and RevMan Web tools were used to analyze study quality and risk of bias, respectively. RESULTS: Included 8 articles. 6 showed statistical significance, showing shorter weaning time in the ASV group (24 (20­62) h versus 72 (24­144) h PSV) (p=0.041), and more days in the ICU when compared to the PAV mode (p<0.001). PSV was more effective on the same outcomes when compared with the T-tube strategy. There were differences in the mortality rate with the NAVA mode. CONCLUSION: It is evident that the PSV mode, when compared to assisted ventilation modes, has the potential to provide worse outcomes associated with the process of weaning from invasive ventilation in patients with COPD.

Effects of aerobic and combined training on pain-free walking distance and health-related quality of life in patients with peripheral artery disease: a randomized clinical trial / Efeitos do treinamento aeróbico e combinado na distância percorrida sem dor e na qualidade de vida relacionada à saúde em pacientes com doença arterial periférica: um ensaio clínico randomizado

Abstract Background Decreased walking ability in patients with peripheral arterial disease is often a clinical problem and limits the quality of life and daily activities of these subjects. physical exercise is important in this scenario, as it improves both the daily walking distance and the ability to withstand intermittent claudication related to the limitations of the peripheral disease. Objectives Our aim was to compare the effects of two types of exercise training (aerobic training and aerobic training combined with resistance exercises) on pain-free walking distance (PFWD) and health-related quality of life (HRQoL) in a sample composed of patients with peripheral artery disease (PAD). Methods Twenty patients with claudication symptoms were randomized to either aerobic control (AC) N= 9, or combined training (CT) N= 8, (24 sixty-minute sessions, twice a week). The total walking distance until onset of pain due to claudication was assessed using the 6-minute walk test and HRQoL was measured using the WHOQOL-bref questionnaire (general and specific domains) at baseline and after training. We used generalized estimating equations (GEE) to assess the differences between groups for the PFWD and HRQoL domains, testing the main group and time effects and their respective interaction effects. P values < 0.05 were considered statistically significant. Results Seventeen patients (mean age 63±9 years; 53% male) completed the study. Both groups experienced improvement in claudication, as reflected by a significant increase in PFWD: AC, 149 m to 299 m (P<0.001); CT, 156 m to 253 m (P<0.001). HRQoL domains also improved similarly in both groups (physical capacity, psychological aspects, and self-reported quality of life; P=0.001, P=0.003, and P=0.011 respectively). Conclusions Both aerobic and combined training similarly improved PFWD and HRQoL in PAD patients. There are no advantages in adding strength training to conventional aerobic training. This study does not support the conclusion that combined training is a good strategy for these patients when compared with classic training.

Resumo Contexto A diminuição da capacidade de marcha em pacientes com doença arterial periférica é frequentemente um problema clínico e limita a qualidade de vida e as atividades diárias desses indivíduos. O exercício físico é importante nesse cenário, pois melhora tanto a distância caminhada diária quanto a capacidade de suportar a claudicação intermitente relacionada às limitações da doença periférica. Objetivos Comparar os efeitos do treinamento aeróbico (TA) e do treinamento aeróbico combinado com exercícios de resistência (TC) na distância percorrida livre de dor (DPLD) e na qualidade de vida relacionada à saúde (QVRS) em pacientes com doença arterial periférica (DAP). Métodos Vinte pacientes com sintomas de claudicação foram randomizados para TA ou TC. Os treinamentos foram realizados em 24 sessões, duas vezes por semana. A DPLD foi avaliada por meio do teste de caminhada de 6 minutos, e a QVRS foi medida pelo instrumento da avaliação de qualidade de vida da Organização Mundial da Saúde (WHOQOL-BREF), no início e após o treinamento. Para avaliar as diferenças entre os grupos para DPLD e os domínios da QVRS, foi utilizado o modelo de equações de estimativa generalizada, testando os efeitos principais do grupo e tempo, bem como os respectivos efeitos de interação. Valores de p < 0,05 foram considerados estatisticamente significativos. Resultados Dezessete pacientes (idade média: 63±9 anos; 53% do sexo masculino) completaram o estudo. Ambos os grupos apresentaram melhora na claudicação, refletida por um aumento significativo na DPLD: grupo controle aeróbico - de 149 m para 299 m (P < 0,001); grupo de treinamento combinado - de 156 m para 253 m (P < 0,001). Os domínios da QVRS também melhoraram de forma semelhante em ambos os grupos (capacidade física, aspectos psicológicos e qualidade de vida autorreferida; P = 0,001, P = 0,003 e P = 0,011, respectivamente). Conclusões Ambos os treinamentos melhoraram de forma semelhante a DPLD e a QVRS em pacientes com DAP. Não há vantagens em associar o treinamento de força ao treinamento aeróbico convencional. O estudo não permite concluir que o TC é uma boa estratégia para esses pacientes quando comparado ao treinamento clássico.

The role of NMDA glutamate receptors in lung injury caused by chronic long-term intermittent hypobaric hypoxia

Chronic intermittent hypoxia (CIH), a component of sleep apnea-hypopnea syndrome, is suggested to cause damage to lung tissue, and the role of glutamate is not well studied. We used a chronic long-term intermittent hypobaric hypoxia (CLTIHH) model of rats to find out if such procedure causes lung injury and the potential effect of N-methyl-D-aspartate receptors (NMDARs) by using receptor antagonist MK-801 (dizocilpine). Thirty-two rats were placed into four groups; a control and three CLTIHH groups where rats were placed into a low-pressure chamber set to 430 mmHg for 5 h/day, 5 days/week, for 5 weeks. Only one group received MK-801 (0.3 mg/kg, ip) daily. We evaluated tumor necrosis factor (TNF)-α, interleukin (IL)-6, IL-10, and nuclear factor (NF)-kB for the inflammatory process, superoxide dismutase (SOD), malondialdehyde (MDA), catalase (CAT), glutathione peroxidase (GPX), total antioxidant status (TAS), and total oxidant status (TOS) for oxidative stress, and caspase-9 levels. Blood plasma, bronchoalveolar fluid (BALF), and lung tissue extracts were evaluated. Both oxidant and inflammatory parameters were significantly increased in all the mediums of the CLTIHH groups except the group that received MK-801. Significant evidence was collected on MK-801 alleviating the effect of CLTIHH. Histological evaluations revealed lung damage and fibrotic changes in the CLTIHH groups. It was first shown that the CLTIHH procedure caused chronic lung injury, and that inflammation and oxidant stress were influential in the formation of lung injury. Secondly, NMDAR antagonist MK-801 effectively inhibited the development of lung injury and fibrosis.

Adesão ao autocuidado do paciente com disfunção neurogênica do trato urinário inferior: validação de instrumento / Adherence to self-care in patients with neurogenic lower urinary tract dysfunction: instrument validation / Adherencia al autocuidado en pacientes con disfunción neurogénica del tracto urinario inferior: validación de un instrumento

RESUMO Objetivo: construir e validar o conteúdo do instrumento de adesão ao autocuidado de pacientes com Disfunção Neurogênica do Trato Urinário Inferior que realizam o autocateterismo intermitente quanto a aparência e conteúdo. Método: Estudo metodológico de validação de conteúdo de instrumento, composto por três etapas: revisão da literatura, construção do instrumento e validação de instrumento, respectivamente. A análise foi realizada através do modelo de Agree, e pelo cálculo de índice de validação de conteúdo, entre 2020 e 2021. Resultados: O Agree II, apresentou resultado de 85,6% e 84,5% para validação dos domínios escopo e finalidade e partes interessadas. Na validação de conteúdo, o item histórico familiar foi retirado do instrumento com índice de vaidade de conteúdo de 0,77. Conclusão: O instrumento contribuirá para oferecer subsídios para a prática profissional e aos pacientes portadores da disfunção.

ABSTRACT Objective: To build and validate the content of the instrument for adherence to self-care for patients with Neurogenic Lower Urinary Tract Dysfunction who perform intermittent self-catheterization as to appearance and content. Method: Methodological study of instrument content validation, composed of three stages: literature review, instrument construction and instrument validation, respectively. The analysis was performed using the Agree model, and by calculating the content validation index, between 2020 and 2021. Results: Agree II, showed a result of 85.6% and 84.5% for validation of the scope and purpose and stakeholder domains. In content validation, the family history item was removed from the instrument with a content vanity index of 0.77. Conclusion: The instrument will contribute to offering subsidies for professional practice and to patients with the dysfunction.

RESUMEN Objetivo: construir y validar el contenido del instrumento de adición al autocuidado de pacientes con disfunción neurogénica del tracto urinario inferior que realizan el autocateterismo intermitente en cuanto a la apariencia y el contenido. Método: Estudio metodológico de validación de contenido de instrumentos, compuesto por tres etapas: revisión bibliográfica, construcción de instrumentos y validación de instrumentos, respectivamente. El análisis se realizó utilizando el modelo de Agree, y mediante el cálculo del índice de validación de contenido, entre 2020 y 2021. Resultados: El Agree II, mostró un resultado de 85,6% y 84,5% para la validación de los dominios de alcance y propósito y partes interesadas. En la validación de contenido, el ítem histórico familiar fue retirado del instrumento con un índice de vanidad de contenido de 0,77. Conclusión: El instrumento contribuirá a ofrecer subsidios para la práctica profesional y a los pacientes con disfunción.

Infección respiratoria baja en neonatos asociados a ventilación mecánica

Introducción: la infección respiratoria baja constituye una importante causa de mortalidad y morbilidad en el recién nacido. Objetivo: identificar los factores de riesgo para la infección respiratoria baja asociada a la ventilación mecánica artificial invasiva y no invasiva en los recién nacidos ingresados en la UCIN del servicio de Neonatología del Hospital General Docente Carlos Manuel de Céspedes de enero 2017 hasta diciembre del 2019. Métodos: se realizó un estudio analítico de casos y controles. Los grupos de estudio estuvieron conformados por 25 casos y 50 controles respectivamente. Resultados: las variables edad gestacional antes las 37 semanas de gestación, el bajo peso al nacer poseen dos veces o más riesgos de padecer una infección respiratoria baja asociada a la ventilación mecánica de forma significativa con una p<0,05; la estadía mayor de 3 días en ventilación mostró significancia con una p: 0,031; entre los diagnósticos que llevaron a la ventilación mecánica fue la enfermedad de la membrana hialina con una p: 0,025. Conclusiones: La edad gestacional menor de 37 semanas, el peso al nacer menor de 2 500 gramos, el tiempo ventilatorio de más de 3 días y el diagnóstico de la enfermedad de la membrana hialina fueron las variables significativas.

Introduction: lower respiratory infection is an important cause of mortality and morbidity in the newborn. Objective: to identify the risk factors for lower respiratory infection associated with invasive and non-invasive artificial mechanical ventilation in newborns admitted to the NICU of the Neonatology service of the Carlos Manuel de Céspedes Teaching General Hospital from January 2017 to December 2019. Methods: an analytical case-control study was conducted. The study groups consisted of 25 cases and 50 controls, respectively. Results: the variables gestational age before 37 weeks of gestation, low birth weight have twice or more risks of suffering a lower respiratory infection associated with mechanical ventilation significantly with a p<0.05; The stay longer than 3 days in ventilation showed significance with a p: 0.031; Among the diagnoses that led to mechanical ventilation was hyaline membrane disease with a p: 0.025. Conclusions: Gestational age less than 37 weeks, birth weight less than 2 500 grams, ventilatory time of more than 3 days and diagnosis of hyaline membrane disease were the significant variables.

Introdução: a infecção respiratória inferior é uma importante causa de mortalidade e morbidade no recém-nascido. Objetivo: identificar os fatores de risco para infecção respiratória inferior associados à ventilação mecânica artificial invasiva e não invasiva em recém-nascidos internados na UTIN do serviço de Neonatologia do Hospital Geral Universitário Carlos Manuel de Céspedes no período de janeiro de 2017 a dezembro de 2019. Métodos: foi realizado um estudo analítico caso-controle. Os grupos de estudo foram constituídos por 25 casos e 50 controles, respectivamente. Resultados: as variáveis idade gestacional antes de 37 semanas de gestação, baixo peso ao nascer apresentam duas ou mais vezes ou mais riscos de sofrer uma infecção respiratória inferior associada à ventilação mecânica significativamente com p<0,05; A permanência superior a 3 dias em ventilação mostrou significância com p: 0,031; Entre os diagnósticos que levaram à ventilação mecânica estava a doença da membrana hialina com p: 0,025. Conclusões: Idade gestacional inferior a 37 semanas, peso ao nascer inferior a 2.500 gramas, tempo ventilatório superior a 3 dias e diagnóstico de doença da membrana hialina foram as variáveis significativas.

Effect of orthokeratology lens on the postoperative binocular vision rebuilding in patients with intermittent exotropia combined with myopia / 国际眼科杂志(Guoji Yanke Zazhi)

AIM: To investigate the effect of wearing an orthokeratology lens on postoperative binocular vision rebuilding in patients with intermittent exotropia combined with myopic refractive error.METHODS: Prospective control study. A total of 60 patients(120 eyes)with intermittent exotropia and myopia who underwent surgical treatment in our hospital from June 2019 to December 2020 were selected. Patients who wore orthokeratology lenses or monofocal frame glasses after surgery were divided into a treatment group(group A)and a control group(group B)according to the wishes of patients and their families, with 30 cases(60 eyes)in each group, and they were followed-up for 6mo. The third level visual function and Titmus near stereoscopic visual function of the two groups of patients were observed before and 6mo after surgery.RESULTS: There was no statistical significance in all observation indicators between group A and group B before surgery(P&#x003E;0.05). After 6mo of surgery, patients with intermittent exotropia achieved significant improvement in binocular visual function and corrected eye position. Group A was superior to group B in terms of fusion range and near stereoscopic visual function(P&#x003C;0.05). There was no statistical significance between the two groups in terms of simultaneous vision and stereoscopic visual function(P&#x003E;0.05).CONCLUSION: The binocular visual function of patients with intermittent exotropia after surgery has significantly improved. Wearing orthokeratology lenses can effectively improve binocular visual function in patients with intermittent exotropia combined with myopia after surgery.

Characterization of metabotropic glutamate receptor 7 and 8 in rat superior cervical ganglion and their changes following chronic intermittent hypoxia / 南方医科大学学报

OBJECTIVE@#To investigate the expression and localization of metabotropic glutamate receptors 7 and 8 (mGluR7/8) in rat superior cervical ganglion (SCG) and their changes in response to chronic intermittent hypoxia (CIH).@*METHODS@#We detected the expressions of mGluR7 and mGluR8 in the SCG of 8-week-old male SD rats using immunohistochemistry and characterized their distribution with immunofluorescence staining. The expression of mGluR7 and mGluR8 in the cytoplasm and nucleus was detected using Western blotting. A 6-week CIH rat model was established by exposure to intermittent hypoxia (6% oxygen for 30 s followed by normoxia for 4 min) for 8 h daily, and the changes in systolic blood pressure, diastolic blood pressure and mean arterial pressure were measured. The effect of CIH on expression levels of mGluR7 and mGluR8 in the SCG was analyzed using Western blotting.@*RESULTS@#Positive expressions of mGluR7 and mGluR8 were detected in rat SCG. mGluR7 was distributed in the neurons and small fluorescent (SIF) cells with positive staining in both the cytoplasm and nuclei, but not expressed in satellite glial cells (SGCs), nerve fibers or blood vessels; mGluR8 was localized in the cytoplasm of neurons and SIF cells, but not expressed in SGCs, nerve fibers, or blood vessels. Western blotting of the nuclear and cytoplasmic fractions of rat SCG further confirmed that mGluR7 was expressed in both the cytoplasm and the nucleus, while mGluR8 exists only in the cytoplasm. Exposure to CIH significantly increased systolic blood pressure, diastolic blood pressure and mean arterial pressure of the rats (all P < 0.001) and augmented the protein expressions of mGluR7 and mGluR8 in the SCG (P < 0.05).@*CONCLUSION@#mGluR7 and mGluR8 are present in rat SCG but with different localization patterns. CIH increases blood pressure of rats and enhanced protein expressions of mGluR7 and mGluR8 in rat SCG.

Chr9∶52042693|52047844⁃miR⁃351⁃5p⁃Pten Is Involved in the Development and Progression of Obstructive Sleep Apnea Syndrome through a ceRNA Mechanism / 中国生物化学与分子生物学报

Intermittent hypoxia (IH) is an important pathophysiological feature of obstructive sleep apnea (OSA), but its molecular mechanism is still unclear. We aim to investigate the role of endogenous competing endogenous RNA (ceRNA) regulatory network in the development of IH in OSA rats. An intermittent hypoxic rat model of OSA was constructed by hypoxic and reoxygenation cycles. CircRNAs and mRNAs were detected in rat bronchial tissues, and 230 up-regulated and 181 down-regulated circRNAs and 1238 up-regulated and 608 down-regulated mRNAs were analyzed and screened. The results of Gene ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) enrichment analysis of the differential circRNAs and mRNAs suggested that they were mainly associated with metabolic pathways and PI3K-Akt signaling pathways. The key circRNAs (the top six circRNAs with the largest differences) were further validated by quantitative real-time polymerase chain reaction (qRT-PCR), chr9:52042693| 52047844 and chr4: 64889575|64899587 were expressed in bronchial tissues consistent with the sequencing results, which were used to further construct the ceRNA regulatory network. Four potential ceRNA regulatory networks were identified by TargetScan and miRanda database, combined with the results of differential circRNA and mRNA. The expression of molecules in the four potential ceRNA regulatory networks was detected by qRT-PCR in bronchial and lung tissues, and the results suggested that the expression of this regulatory network, chr9:52042693|52047844-miR-351-5p-Pten, was consistent with the sequencing results. The findings indicate that chr9:52042693 | 52047844-miR-351-5p-Pten may be involved in the development and progression of obstructive sleep apnea syndrome through a ceRNA mechanism.

Pyroptosis mediated renal injury caused by chronic intermittent hypoxia and the intervention effect of edaravone in rats / 中国临床药理学与治疗学

AIM: To study the protective effect of edaravone on renal injury induced by chronic intermittent hypoxia and its effect on Caspase-1 mediated pyroptosis signaling pathway in rats. METHODS: Twenty four SPF male SD rats were randomly divided into normal control group, intermittent hypoxia group, intermittent hypoxia + normal saline group and intermittent hypoxia + edaravone group, with 6 rats in each group. The four groups of rats were placed in the closed feeding chamber for modeling. The oxygen concentration in the NC group was maintained at about 21%; the IH group, IH + NS group and IH + EDA group were given regular input of pure oxygen, pure nitrogen and compressed air to form anoxic-reoxygenation cycle (60 s hypoxic period + 60 s reoxygenation period). During the hypoxic period, the oxygen concentration in the chamber was reduced to 6%-7%, and the rats in the IH + EDA group were intraperitoneally injected with edaravone at a dose of 5 mg/kg per day before modeling, while the rats in the IH + NS group were intraperitoneally injected with normal saline at the same dose per day. After 8 weeks of modeling, blood and kidney tissue samples were collected to measure the levels of Crea and Urea in each group. The pathological changes and fibrosis degree of kidney were observed under light microscope after HE and Masson staining. The content of malondialdehyde (MDA) and activity of superoxide dismutase (SOD) were determined by chemical method. The expression levels of NLRP3, Caspase-1 and IL-1β in renal tissues were determined by immunohistochemical staining. The expression levels of caspase-1 and IL-1β in renal tissues were determined by Western blot. GSDMD and IL-18 mRNA were detected by RT-PCR. RESULTS: After intermittent hypoxia exposure, serum Crea and Urea were increased significantly (P < 0.01), renal tubules were damaged by pathology, collagen fiber deposition occurred in balloon space of renal units, MDA content was increased and SOD activity was decreased (P < 0.01). Caspase-1, NLRP3, IL-1β protein expression increased (P < 0.01 or P < 0.05), GSDMD mRNA and IL-18 mRNA amplification increased (P < 0.01); After Edaravone intervention, the above indexes showed a reverse trend compared with that after intermittent hypoxia exposure, and the pathological damage of kidney was reduced (P < 0.01 or P < 0.05). CONCLUSION: Chronic intermittent hypoxia may mediate kidney injury through oxidative stress activation of caspase-1 involved in the cell pyroptosis signaling pathway, while edaravone may inhibit the activation of pyroptosis signaling pathway by scavenging oxygen free radicals and down-regulating the level of oxidative stress in the body, thus playing a protective role in kidney.

The effects of high-intensity intermittent training on metabolic or circulatory parameters and exercise time during 30s lasting exhaustive exercise / 体力科学

Present study aimed to examine the effects of high-intensity intermittent training on metabolic or circulatory parameters and exercise time during 30s-lasting exhaustive exercise. Six healthy males (22 ± 1yrs) had an intermittent training four days a week for four weeks. The intermittent training consisted of 8 or more sets of 20s exercise bout at an intensity of 170%VO2 max separated by 10-s recovery. Before and after training period, VO2 max and maximal accumulated O2 deficit (MAOD) were determined as indices of metabolic capacity. During 30s-lasting exhaustive exercise, VO2, O2 deficit, and circulatory parameters, such as heart rate, stroke volume, and cardiac output, were also determined every 10s. After the training, VO2 max and MAOD were significantly increased. During 30s-lasting exhaustive exercise, exercise time, stroke volume, and cardiac output were also significantly enhanced. However, no significant differences were observed in VO2 and O2 deficit every 10s during 30s-lasting exhaustive exercise. Therefore, these findings suggest that high-intensity intermittent training enhances exercise time during 30s-lasting exhaustive exercise and that the improvement of exercise performance is closely related to an increase in anaerobic capacity.

Stereoscopic reconstruction in adults with intermittent exotropia after surgery / 国际眼科杂志(Guoji Yanke Zazhi)

AIM: To investigate the status of stereoscopic reconstruction in adults with intermittent exotropia after surgery, and analyze related influencing factors.METHODS: A retrospective study was conducted among 196 adults with intermittent exotropia who were admitted to our hospital from January 2019 to January 2021. All patients underwent strabismus surgery, and their preoperative and postoperative data were collected.RESULTS: Near and distal stereo visual function was not found in all the included 196 patients before surgery. The reconstruction rates of near stereo visual function and distal stereo visual function were 52.6%(103/196)and 50.5%(99/196), respectively. There were significant differences in surgical age, age of onset, course of disease, and postoperative level of horizontal strabismus between patients with near stereoscopic reconstruction(103 cases)and those without reconstruction(93 cases; P<0.001). Multivariate Logistic regression analysis showed that age of onset, course of disease, and postoperative level of horizontal strabismus were factors influencing near stereo visual function reconstruction(P<0.05). The receiver operating characteristic(ROC)curve showed that the area under the curve(AUC)values of age of onset, course of disease and postoperative level of horizontal strabismus to predict near stereo visual function reconstruction were 0.757, 0.737 and 0.727, respectively(P<0.001). There were significant differences in surgical age, age of onset, course of disease, and postoperative level of horizontal strabismus between patients with distal stereoscopic reconstruction(99 cases)and those without reconstruction(97 cases; P<0.001). Multivariate Logistic regression analysis showed that age of onset and course of disease were factors influencing distal stereo visual function reconstruction(P<0.05). ROC curve showed that the AUC values of age of onset and course of disease to predict distal stereo visual function reconstruction were 0.672 and 0.821, respectively(P<0.001).CONCLUSION: Stereoscopic reconstruction in adults with intermittent exotropia after surgery is affected by many factors, such as age of onset and course of disease. The influencing factors of near stereo visual function reconstruction and distal stereo visual function reconstruction are different, which deserves attention.

Programmed Intermittent Epidural Bolus in Comparison with Continuous Epidural Infusion for the Effects of Enhanced Recovery after Cesarean Section / 中山大学学报(医学科学版)

ObjectiveTo compare the effects of programmed intermittent epidural bolus （PIEB） and continuous epidural infusion （CEI） on enhanced recovery after cesarean section. MethodsTotally 120 women scheduled to undergo elective cesarean section under combined spinal and epidural anesthesia， aged 18-45 years， with single fetus， full-term pregnancy （≥37 weeks）， ASA grade II or III， were recruited， with 60 cases in each group. At the end of the surgery， after a similar epidural loading dose， patients were randomLy assigned to receive either PIEB （6 mL·h-1 beginning 30 minutes after the loading dose） or CEI （6 mL·h-1， beginning immediately after the loading dose） for the maintenance of analgesia with 0.1% ropivacaine. At 2， 6， 12， 24 and 36 h postoperatively， VAS score was used to evaluate the composite pain， and Bromage Score was used to evaluate the degree of lower extremity motor block. The time to first flatus， time to first ambulation and the satisfaction scores were also recorded. ResultsThe VAS scores at 12， 24 and 36 h postoperatively and the lower extremity motor block scores at 6， 12 and 24 h postoperatively in the PIEB group were significantly lower than those in the CEI group （P < 0.01）. The epidural analgesic dosage was less in the PIEB group than that of the CEI group （P=0.002）. The time to first flatus and time to first ambulation were significantly shorter than those in the CEI group （P < 0.05）. The satisfaction scores were significantly higher in the PIEB group than in the CEI group （P < 0.05）. There was no significant difference in the first urination time after urinary catheter removal and the length of hospital stay between the two groups （P > 0.05）. ConclusionCompared with CEI， PIEB provides better postoperative analgesia， less motor block scores， lower epidural analgesic dosage， shorter the time to first flatus and defecation and time to first ambulation， and greater patient satisfaction， which is more consistent with the ERAS concept of analgesia.