Suggestions for Improving the Palliative Care Outpatient Department through a Review of Palliative Care Visits

Aims: To explore unmet needs and enhanced outpatient care functions of palliative care for patients with cancers, scrutinized records of outpatient visits in acute care and regional designated cancer hospital. Methods: A retrospective study was made for a total of 3136 consecutive visits from electronic records between April 2020–March 2023. Results: There were 630 unscheduled visits (20.1%) with 74.0% of them occurring during working hours; a quarter of unscheduled visits were after-hours. Of the total visits, 347 visits (11.1%) resulted in emergent admissions, and of the unscheduled visits, 305 cases (48.4%) were emergent admissions. Ambulances were called in 196 cases (56.5%) of emergent admissions. Moreover, the reasons for unscheduled visits statistically differed from reasons for non-admission cases (p<0.01). Conclusion: Patients’ illness trajectories and our results revealed that palliative care patients with cancers often experience unexpected physical and mental changes. To establish more effective outpatient care, we should construct structures to be available 365 days a year for palliative care patients and to instruct patients and their care givers in advance about warning signs for admission and how to access medical services.

Effect of Different Method of Rice Establishment and Weed Management Options on Yield and Economics of Paddy

A field experiment was conducted during rabi 2022 at Zonal Agricultural and Horticultural Research Station, Brahmavara, Udupi, Keladi Shivappa Nayaka University of Agricultural and Horticultural Sciences, Shivamogga, on sandy loam soil to study the effect of different method of rice establishment and weed management options on yield and economics of paddy. The experiment was laid out in Factorial Randomized Complete Block Design with broadcasting and drum seeder method of establishment and five treatment combinations, replicated thrice. The study revealed that, the weed free treatment maintained by hand weeding recorded highest growth parameters and rice grain yield. The sequential application of pre-emergence herbicide pendimethalin 38.7 % CS @ 750 g a.i. ha-1 at 0-3 DAS (fb) early post-emergence application of bispyribac sodium 10 % SC @ 25 g a.i ha-1 at 13-15 DAS, recorded lowest total weed density (36.92, 31.73 and 40.45 No. m-2) at 15, 30 and 45 DAS, respectively and lower weed index (7.23%) under drum seeder method of establishment . The yield and yield attributing parameters like number of tillers (291.33 m-2), panicle length (19 cm), filled grains (89.33 panicle-1), grain yield (4221 kg ha-1) and straw yield (5387 kg ha-1) were observed in sequential application of pre-emergence herbicide pendimethalin 38.7 % CS @ 750 g a.i. ha-1 at 0-3 DAS (fb) early post-emergence application of bispyribac sodium 10 % SC @ 25 g a.i ha-1 at 13-15 DAS under the drum seeder method of establishment. The highest net return (? 82586 ha-1) and B:C ratio (2.81) was also recorded in the same treatment.

Bio-Efficacy of Post Emergent Herbicides on Weeds in Direct Seeded Rice (Oryza sativa L.)

A field experiment was conducted to study the bio-efficacy of post emergent herbicides on weeds in direct seeded rice in medium black clay soil at Agricultural Research Station, Dhadesugur, University of Agricultural Sciences, Raichur, Karnataka during Kharif 2022. The experiment was laid out in Randomized complete block design with three replications. There were eight treatments consisting of five post emergent herbicides sprayed at 25 DAS, hand weeding at 20 and 40 DAS, weed free check and weedy check in direct seeded rice and the variety RNR 15048 was used in this trial. Application of cyhalofop butyl 5.1 % + penoxsulam 1.02 % OD @ 2000 ml ha-1 recorded significantly lower weed density, weed dry weight, weed index and higher weed control efficiency compared to all the other treatments. It also produced higher number of productive tillers (409.4 m-2), panicle weight (3.89 g), filled grains per panicle (243.1), lower number of unfilled grains per panicle (8.4), higher grain yield (6058 kg ha-1) and straw yield (6935 kg ha-1) in direct seeded rice. So it can be concluded that application of cyhalofop butyl 5.1 % + penoxsulam 1.02 % OD @ 2000 ml ha-1 at 25 DAS (weeds at 2-3 leaf stage) was most effective in managing the weeds with higher weed control efficiency. It also resulted in higher growth and yield components of direct seeded rice leading to higher grain yield.

Effects of Integrated Weed Management Practices on Weed Parameters and Yield of Bt Cotton (Gossypium hirsutum L.)

Aim: To know the effect of integrated weed management on weed parameters and yield of bt cotton.Study Design: Randomized complete block design.Place and Duration of Study: College of Agriculture Farm, Bheemaraynagudi between July 2021 and Feb 2022.Methodology: The field experiment was conducted during Kharif 2021 at Experimental block, College of Agriculture, Bheemarayanagudi. The soil of the experiment field was deep black clayey in texture. The experiment comprises 11 weed management practices viz., T1: Pendimethalin 38.7% CS @ 750 g a.i./ha as PE + Hand weeding @ 20-25 DAS and Intercultivation @ 55-60 DAS, T2: Pendimethalin 38.7 % CS @ 750 g a.i./ha as PE fb Pyrithiobac Sodium 10 EC @ 75g a.i./ha + Quizalofop ethyl 5 EC @ 37.5g a.i./ha as PoE @ 25 DAS and Intercultivation @ 55-60 DAS. (Tank mix), T3 : Pendimethalin 38.7 % CS @ 750 g a.i./ha as PE fb Pyrithiobac Sodium 10 EC @ 50g a.i./ha + Quizalofop ethyl 5 EC @ 25 g a.i./ha as PoE @ 25 DAS and Intercultivation @ 55-60 DAS, T4 :Pendimethalin 38.7 % CS @ 750 g a.i./ha as PE fb Pyrithiobac Sodium 10 EC @ 75g a.i./ha + Quizalofop ethyl 5 EC @ 37.5g a.i./ha as PoE @ 25 DAS and Intercultivation @ 55-60 DAS, T5 : Pendimethalin 38.7 % CS @ 750 g a.i./ha as PE fb Pyrithiobac Sodium 10 EC @ 100g a.i./ha + Quizalofop ethyl 5 EC @ 50g a.i./ha as PoE @ 25 DAS and Intercultivation @ 55-60 DAS, T6 : Pyrithiobac Sodium 10 EC @ 50g a.i./ha + Quizalofop ethyl 5 EC @ 25g a.i./ha as PoE @ 25 DAS and Intercultivation @ 55-60 DAS, T7: Pyrithiobac Sodium 10 EC @ 75g a.i./ha + Quizalofop ethyl 5 EC @ 37.5g a.i./ha as PoE @ 25 DAS and Intercultivation @ 55-60 DAS, T8: Pyrithiobac Sodium 10 EC @ 100g a.i./ha + Quizalofop ethyl 5 EC @ 50g a.i./ha as PoE @ 25 DAS and Intercultivation @ 55-60 DAS, T9: Farmers practice (Hand weeding @ 25 DAS and 2 intercultivations @ 50 and 75 DAS), T10: Weedy check, T11: Weed free check.Results: Among the treatments, application of pendimethalin 38.7 % CS @ 750 g a.i./ha as PE fb pyrithiobac sodium 10 EC @ 100 g a.i./ha + quizalofop ethyl 5 EC @ 50 g a.i./ha as PoE (combi-product) @ 25 DAS and intercultivation @ 55-60 DAS recorded significantly lower weed density and higher weed control efficiency (82.39 %), also recorded higher seed cotton yield (2495 kg ha-1) and stalk yield (4056 kg ha-1) over other treatments.Conclusion: Application of Pendimethalin 38.7 % CS @ 750 g a.i./ha as PE fb Pyrithiobac Sodium 10 EC @ 100g a.i./ha + Quizalofop ethyl 5 EC @ 50g a.i./ha as PoE @ 25 DAS and Intercultivation @ 55-60 DAS was found effective in controlling the weeds with coupled with higher seed cotton yield .

La viruela de mono. ¿Una zoonosis emergente? / Monkeypox virus. An emergent zoonosis?

Resumen La viruela de mono es una enfermedad zoonótica propia de roedores y primates no humanos que producen casos esporádicos de monopox, el cual se caracteriza por lesiones exantemáticas en la piel. La viruela del mono es endémica en países del África Central y del Oeste, especialmente en la República Democrática del Congo. En 2003 se detectó por primera vez en el occidente y en el 2022 reaparece en Estados Unidos y otros países del mundo. Aunque cualquier persona que se exponga al virus puede desarrollar la enfermedad, este brote se ha caracterizado por presentar características epidemiológicas distintas ya que los grupos de riesgo más frecuente son los de los hombres que tienen sexo con hombres. Los nuevos brotes de esta enfermedad se han caracterizado por cambios importantes en la presentación clínica ya que el exantema no se presenta generalizado. Por el contrario, ha mostrado muchas variantes como la presentación de lesiones vesiculares únicas en la región genital, lo que hace difícil su diagnóstico clínico. Por ser una enfermedad emergente y presentar cambios en su comportamiento es importante estar consultando las recomendaciones de las organizaciones competentes para el manejo, tratamiento y diagnóstico de esta enfermedad.

Abstract Human monkeypox is a rare viral zoonosis endemic to central and western Africa. It was detected for the first time in the western Hemisphere in 2003. Recently it has re-emerged in USA and has spread rapidly to many countries of the world. Even though any person could contract the disease if expose to it, the populations most vulnerable to the infection are homosexuals, bisexuals and men that have sex with men. The virus produces an exanthem in the skin, which is clinically indistinguishable from other pox-like illnesses, particularly smallpox and chickenpox. Furthermore, clinical findings in recent studies have reported single vesicular lesions in the anogenital areas making the laboratory diagnosis an essential tool to be able to differentiate it from other venereal diseases. Since Human monkeypox is an emergent disease that presents very important epidemiological and clinical features, different from past outbreaks, it is recommended to be in constant communication with the competent health organizations and be aware of changes in case definitions, treatment and diagnostic procedures.

Blasting the myth of predictive INR changes related to plasma transfusion: an academic institution's experience

Abstract Introduction Plasma transfusion is a common therapeutic strategy used to lower international normalized ratio (INR) values in the non-emergent setting. However, due to lack of evidence of its efficacy, standardized guidelines for this practice have not been well established. Methods This retrospective observational cohort study analyzed 276 inpatient encounters that involved plasma transfusions focusing on change in INR values from pre- to post-transfusion, with respect to the following predictor variables: vitamin K co-administration, number of plasma units transfused, order indication and body mass index (BMI). Results The overall average change in the INR was 1.35. Patients who received vitamin K showed an average change of 2.51, while patients that did not receive vitamin K demonstrated an average change of 0.70. Increased numbers of plasma units transfused showed benefit up to three-unit orders. Greater decreases in the INR were observed for patients requiring plasma for anticoagulation reversal or active bleeding. There was no significant difference in the change in INR based on the BMI. By multivariate and regression analyses, the stepwise addition of each successive predictor variable demonstrated an increase in the shared variance in the outcome of the post-transfusion INR: the pre-transfusion INR and vitamin K co-administration alone was not significant (p= 0.45); the additional number of plasma units transfused was significant (R² = 0.13, p < 0.001), and; the subsequent additional plasma order indications (R² = 0.19, p < 0.001) and BMI (R² = 0.18, p < 0.001) were increasingly significant. Conclusion Taking into consideration the combination of multiple predictive factors may aid in a more efficient use of plasma products.

Animal model-based simulation training for three emergent and urgent operations of penetrating thoracic injuries / 中华创伤杂志(英文版)

PURPOSE@#To develop animal models of penetrating thoracic injuries and to observe the effects of the animal model-based training on improving the trainees' performance for emergent and urgent thoracic surgeries.@*METHODS@#With a homemade machine, animal models of lung injuries and penetrating heart injuries were produced in porcine and used for training of chest tube drainage, urgent sternotomy, and emergent thoracotomy. Coefficient of variation of abbreviated injury scale and blood loss was calculated to judge the reproducibility of animal models. Five operation teams from basic-level hospitals (group A) and five operation teams from level III hospitals (group B) were included to be trained and tested. Testing standards for the operations were established after thorough literature review, and expert questionnaires were employed to evaluate the scientificity and feasibility of the testing standards. Tests were carried out after the training. Pre- and post-training performances were compared. Post-training survey using 7-point Likert scale was taken to evaluate the feelings of the trainees to these training approaches.@*RESULTS@#Animal models of the three kinds of penetrating chest injuries were successfully established and the coefficient of variation of abbreviated injury scale and blood loss were all less than 25%. After literature review, testing standards were established, and expert questionnaire results showed that the scientific score was 7.30 ± 1.49, and the feasibility score was 7.50 ± 0.89. Post-training performance was significantly higher in both group A and group B than pre-training performance. Post-training survey showed that all the trainees felt confident in applying the operations and were generally agreed that the training procedure were very helpful in improving operation skills for thoracic penetrating injury.@*CONCLUSIONS@#Animal model-based simulation training established in the current study could improve the trainees' performance for emergent and urgent thoracic surgeries, especially of the surgical teams from basic-level hospitals.

Análisis retrospectivo de un protozoo emergente en México: Blastocystis spp

Blastocystis spp. es el protista intracelular que en los últimos años ha infectado a más de mil millones de personas a nivel mundial. Sin embargo, el aumento en la prevalencia en México y su potencial patógeno son inciertos, por lo que este microorganismo aún se encuentra bajo investigación. Principalmente a nivel pediátrico, la blastocistosis es estudiada con mayor atención, debido a que destaca sobre otros agentes en diversos estudios realizados mundialmente y en México. El objetivo de este trabajo fue mediante revisión bibliográfica, evidenciar la frecuencia y su transición parasitaria como el agente más prevalente en la actualidad, pese a que no se asocia a sintomatología clínica.

Blastocystis spp. is the intracellular protist that in recent years has infected more than a billion people worldwide. However, the increase in prevalence in Mexico and its pathogenic potential are uncertain, so this microorganism is still under investigation. Mainly at the pediatric level, blastocystosis is studied with greater attention, due to the fact that it stands out over other agents in various studies carried out worldwide and in Mexico. The objective of this work was to show the frequency and its parasitic transition as the most prevalent agent today through a bibliographic review, despite the fact that it is not associated with clinical symptoms.

Perioperative Outcomes in Pregnant Women Who Underwent Surgery for Adnexal Torsion / Resultados perioperatórios em mulheres grávidas submetidas a cirurgia para torção anexial

Abstract Objective To evaluate clinical characteristics, maternal and fetal outcomes in pregnant women who underwent surgery for adnexal torsion (AT). Methods All patients, who underwent surgical operation due to AT during pregnancy at the Department of Obstetrics and Gynecology, School of Medicine, Ege University between 2005 and 2020 were retrospectively investigated. Main clinical and perioperative outcomes were evaluated. Results A total of 21 patients who underwent surgery due to AT during pregnancy were included. Of all patients, 61.9% underwent laparoscopy and the remaining 38.1% underwent laparotomy. The most common surgical procedure was adnexal detorsion in both groups (48%). Mean gestational age at the time of diagnosis, duration of surgery and hospitalization were significantly lower in the laparoscopy group, when compared with the laparotomy group (p=0.006, p=0.001, and p=0.001, respectively.) One of the patients had an infection during the postoperative period. Spontaneous abortion was only observed in one case. Conclusion It can be concluded that the surgical intervention implemented for the exact diagnosis and treatment of AT (laparotomy or laparoscopy) did not have an unfavorable effect on pregnancy outcomes such as abortion, preterm delivery, and fetal anomaly. However, laparoscopy may be superior to laparotomy in terms of advantages.

Resumo Objetivo Avaliar as características clínicas, e os desfechos maternos e fetais em gestantes submetidas à cirurgia de torção anexial. Métodos Todas as pacientes operadas por torção anexial durante a gravidez no Departamento de Obstetrícia e Ginecologia da Faculdade de Medicina da Universidade de Ege entre 2005 e 2020 foram investigadas retrospectivamente. Os principais resultados clínicos e perioperatórios foram avaliados. Resultados Foraminclusas 21 pacientes operadas por torção anexial durante a gravidez. De todos as pacientes, 61,9% foramsubmetidas à laparoscopia e as 38,1% restantes foram submetidas à laparotomia. O procedimento cirúrgico mais comum foi apenas a destorção anexialemambos os grupos (48%).Aidade gestacionalmédia nomomento do diagnóstico, a duração da operação e da hospitalização foram significativamentemenores no grupo de laparoscopia em comparação com o grupo de laparotomia (p=0,006, p=0,001 e p=0,001, respectivamente.) Uma das pacientes teve uma infecção no pós-operatório. Apenas em um caso observamos aborto espontâneo. Conclusão Pode-se concluir que a intervenção cirúrgica implementada para o diagnóstico exato e tratamento da torção anexial (laparotomia ou laparoscopia) não teve efeito desfavorável nos desfechos da gravidez, como aborto, parto prematuro e anomalia fetal. No entanto, a laparoscopia pode ser superior à laparotomia em termos de vantagens.

Clinical practice and prognosis of emergent transcatheter aortic valve replacement / 中华急诊医学杂志

Objective:To evaluate the effectiveness and prognosis of emergent transcatheter aortic valve replacement (TAVR) and to provide standardized procedural suggestion for the development of emergent TAVR in China.Methods:From January 2020 to April 2021, 12 patients who underwent emergent or salvage TAVR in the Second Affiliated Hospital Zhejiang University School of Medicine were retrospectively enrolled from the TORCH registry (Transcatheter Aortic Valve Replacement Single Center Registry in Chinese Population, a prospective cohort study; NCT02803294). Baseline, periprocedural and 30-day follow up data were collected. Post-operative data were compared with pre-operative data using Paired-Samples test.Results:Patients’ median Society of Thoracic Surgeons score (STS score) was 15.432%. There was a significant decrease of mean gradient after emergent TAVR procedure (1.69 m/s vs. 4.90 m/s, P<0.01). During the 30-day follow up, there were 1 patient (8.3%) died and 2 patients received permanent pacemaker implantation. No disabling stroke, acute kidney injury, major vascular complication occurred during the first month after emergent TAVR. Among the survival patients, there was a significant releasing of heart failure symptoms to New York Heart Association function stage Ⅰ/Ⅱ in 81.8% patients at 30-day follow up. Left ventricular ejection fraction also improved significantly from (47.4±9.5)% to 58.8±8.0% ( P= 0.026). The mean gradient were (1.57±0.30) cm 2 and no patients had a moderate or severe paravalvular leakage. Besides, a significant decrease of pro-B-type natriuretic peptide (1 089.9 pg/mL vs. 12 215.5 pg/mL , P=0.001) and troponin T (0.020 ng/mL vs. 0.337 ng/mL, P=0.003) were found at 30 days after emergent TAVR. Conclusions:For patients with severe aortic stenosis and acute cardiac decompensated, emergent TAVR is a safe and effective rescue treatment.

El desafío de las enfermedades (re)emergentes, los límites de la respuesta biomédica y el nuevo paradigma de salud global / The challenge of (re)emerging diseases, the limits of the biomedical response and the new paradigm of global health

Resumen Las "enfermedades infecciosas emergentes y reemergentes" constituyen una creciente amenaza para la hegemonía de la biomedicina, al suscitar no pocos interrogantes sobre la idoneidad de su discurso y prácticas para afrontar el desafío global que representan. Se analiza el proceso de construcción de esta nueva categoría nosológica, y se examinan ejemplos destacados del impacto de las enfermedades (re)emergentes en la salud pública, la seguridad alimentaria y el desarrollo humano a escala global. Se refiere a prácticas irresponsables de sectores de la industria farmacéutica y agropecuaria, determinantes en su desencadenamiento y diseminación; y a algunos fallos cruciales de enfoque y manejo de los tiempos en las políticas de salud global en relación al VIH/sida con desastrosas consecuencias para el África subsahariana.

Abstract "Emerging and reemerging infectious diseases" pose a growing threat to the hegemony of biomedicine, raising questions about whether its discourse and practices can handle the global challenge they represent. The construction of this new nosological category is analyzed in this article, which examines some notable examples of the impact of (re)emerging diseases on public health, food security and human development on a global scale. It discusses irresponsible practices by sectors of the pharmaceutical and agricultural industries which led to the emergence and spread of these diseases; and points to some crucial failures of approach and time management in global health policies on HIV/AIDS, with disastrous consequences for sub-Saharan Africa.

Clinical characteristics of critically ill pregnant women with different admission methods to intensive care unit: data analysis from 2006 to 2019 in the university hospital / 中华危重病急救医学

Objective:To compare the clinical characteristics of critically ill pregnant women admitted to the intensive care unit (ICU) with different admission methods, in order to make more effective and rational use of ICU resources.Methods:A retrospective study was conducted. The clinical data of critically ill pregnant women admitted to ICU of Peking University Third Hospital from January 2006 to July 2019 were analyzed. According to the admission mode to ICU, the pregnant women were divided into emergency admission group (transferred to ICU on the same day or the next day due to critical illness) and planned admission group (transferred to ICU 2 days after admitting in obstetric ward). The clinical characteristics of ICU critical pregnant women, such as the incidence, causes of admission, severity of the disease, main treatment measures, mortality, and medical expenses were collected, and a comparative analysis between the two groups was performed.Results:During the nearly 14 years, a total of 576 critical pregnant women in ICU were enrolled, accounting for 0.8% (576/71 790) of the total number of obstetric inpatients and 4.6% (576/12 412) of the total number of ICU inpatients. Seven maternal deaths accounted for 1.2% of all critically pregnant women transferred to ICU, and the overall mortality of pregnant women was 10/100 thousand. Of the 576 critically pregnant women, there were 327 patients (56.8%) in the emergency admission group and 249 patients (43.2%) in the planned admission group. Compared with the planned admission group, the proportion of elective cesarean section in the emergency admission group was significantly lower (17.7% vs. 94.0%, P < 0.01), and the proportion of emergency cesarean section was significantly higher (65.1% vs. 2.4%, P < 0.01), the acute physiology and chronic health evaluation (APACHE Ⅱ, APACHE Ⅲ) scores, simplified acute physiology score Ⅱ (SAPS Ⅱ) and Marshall score were significantly higher [APACHE Ⅱ score: 6.0 (4.0, 9.8) vs. 4.0 (3.0, 7.0), APACHE Ⅲ score: 14.0 (11.0, 20.3) vs. 12.0 (9.0, 16.0), SAPS Ⅱ score: 8 (0, 12) vs. 3 (0, 8), Marshall score: 2 (1, 4) vs. 1 (1, 3), all P < 0.01]. The length of ICU stay in the emergency admission group was significantly longer than that in the planned admission group [days: 2 (1, 5) vs. 2 (1, 3), P < 0.01], and the total length of hospital stay was significantly shorter [days: 9 (7, 13) vs. 13 (10, 18), P < 0.01]. Both in the emergency admission group and the planned admission group, obstetric factors were the main reason for admission, 60.9% (199/327) and 70.3% (175/249), respectively. The proportion of postpartum hemorrhage was the highest [35.2% (115/327) and 57.0% (142/249)], followed by preeclampsia/eclampsia [7.0% (23/327) and 7.6% (19/249)]. Only 7 of the 19 critically pregnant women with puerperal infection were planned admission. All 21 patients with acute fatty liver of pregnancy (AFLP) during pregnancy were emergency admission. Among the emergency and planned admission patients, 73 patients (22.3%) and 42 patients (16.9%) required mechanical ventilation (duration of mechanical ventilation > 24 hours), 99 patients (30.3%) and 35 patients (14.1%) needed vasoactive agents, 67 patients (20.5%) and 20 patients (8.0%) received hemodynamic monitoring, and 123 patients (37.6%) and 154 patients (61.8%) were given anticoagulation therapy, respectively. In terms of severity score of critical pregnant women, there were significant differences in APACHE Ⅱ, APACHE Ⅲ, SAPS Ⅱ and Marshall scores of pregnant women with different diseases. Among them, the APACHE Ⅲ, SAPS Ⅱ and Marshall scores of AFLP were the highest [21.0 (15.0, 32.5), 12.0 (6.0, 16.5) and 6.0 (3.5, 8.0), respectively]. The APACHE Ⅱ and APACHE Ⅲ scores of postpartum hemorrhage were the lowest [4.0 (3.0, 7.0), 12.0 (10.0, 16.0)]. The SAPS Ⅱ score of pneumonia was the lowest [2.0 (0, 14.0)]. The Marshall score for puerperal infection was the lowest [1.0 (0, 3.0)]. In terms of the total medical expenses, the cost in the emergency admission group was significantly lower than that in the planned admission group [10 thousand Yuan: 3.1 (2.0, 4.7) vs. 4.1 (2.9, 5.8), P < 0.05]. Conclusions:Compared with the critically ill pregnant women who planned to be admitted to ICU, the patients emergency admitted to ICU were more complicated and urgent, and the severity of the condition was scored higher. At present, the severity scoring system commonly used in ICU can only partly evaluate the severity of critically ill pregnant women, therefore, it is necessary to design the specific severity scoring system for critically ill pregnant women to effectively and rationally use the precious ICU resources.

Mayaro fever: A brief review on the immune profile

Mayaro virus is an emergent alphavirus that infects humans, leading to Mayaro fever. Approximately fifty percent of infected patients develop arthritis symptoms in the recovery phase, a phase that can last up to a year. The literature about Mayaro virus infection and its immune response is scarce, which may hamper the development of treatment strategies. We summarize changes in cytokines and chemokines in the acute and recovery phase in Mayaro virus infected patients, and relate this molecular characterization with the immune response. VEGF and IL-12/p70 show pronounced changes in patients in the acute phase, suggesting the development of cellular immunity and Th1 response. IL-6, IL-7, CXCL8/IL-8, IL-13, IL-17, and IFN-γ are elevated in patients with arthritis symptoms in the long-term recovery phase, which may be related to the continuous inflammatory process, a possible Th2 inhibiting and promoting Th17 process. Although few studies discuss the issue, with a small number of patients and different backgrounds, inflammatory and immune response and manifestations seem to be closely linked. This information may help to develop the appropriate treatment strategies in Mayaro virus infection. Therefore, we analyzed and summarized data available in literature.

Comparison of clinical results of decompression/fusion surgery for paralysis caused by metastatic spinal tumors of unknown versus known origin / Journal of Rural Medicine

Objective: Whether or not emergent decompression/fusion surgery for paralysis caused by metastatic spinal tumors of unknown origin improves patient neurological outcome and survival remains unclear. This study aimed to evaluate the clinical outcomes of emergent decompression/fusion surgery for paralysis caused by spinal tumors of unknown or not previously diagnosed origin.Patients and Methods: Data from the medical records of 11 patients with spinal tumors of unknown origin (study group) were compared with those of 15 patients with metastatic spinal tumors of known origin (control group). The outcome measures were postoperative performance status, motor function evaluated with the Frankel grade, and actual survival after surgery as compared with the estimated survival calculated using the Tokuhashi score. χ2 analyses were performed to evaluate differences between the groups.Results: The mean performance status was 3.6 preoperatively, which improved to 2.9 postoperatively (P<0.05), in the unknown origin group and 3.6 preoperatively, which improved to 2.7 postoperatively (P<0.05), in the control group. Seven patients (64%) in the unknown origin group showed improvement in paralysis by ≥1 Frankel grade. By contrast, only 4 patients (27%) in the control group showed improvement in paralysis. The unknown origin group tended to show better improvement (P=0.05). All the patients in the unknown origin group underwent adjuvant therapy after definitive diagnosis following surgery. The unknown origin group showed a slight tendency toward better survival than toward the estimated survival.Conclusion: Emergent decompression/fusion surgery for patients with paralysis caused by metastatic tumors of unknown origin is potentially useful for diagnosing tumor origin and improving neurological outcomes and performance status, and thus for extending survival.

Experimental Frog Virus 3 infection using Brazilian strain: amphibians susceptibility / Infecção experimental utilizando estirpe brasileira de Frog Virus 3: suceptibilidade de anfíbios

An alarming number of global warnings concerning amphibian mortality outbreaks have been released in recent years. Emerging diseases stand out as the main potential causes. Ranavirus is a worldwide-spread highly infectious disease capable of affecting even other ectothermic animals such as fish and reptiles. One major issue regarding this pathology is the lack of clinical signs before it leads up to death. Aiming at having a better understanding of anurans susceptibility, this study analyzed bullfrog (Lithobates catesbeianus) survival rate, when challenged with three doses of a Brazilian strain of Frog Virus 3 (FV3). The qPCR analysis indicated a low infectivity rate in these animals both as larvae and as adults. To elucidate the results, the following hypothesis was performed: 1) The amount of inoculum used on the frogs was insufficient to trigger an infection; 2) For the FV3 to produce clinical signs in this species, there is the need for a cofactor; 3) The animals did undergo FV3 infection but recovered in the course of the experiment, and 4) The inoculum utilized might have been low-virulence. Finally, the presence of actual clinical signs of ranavirus is discussed, with the more likely hypothesis.(AU)

Um número alarmante de notificações globais sobre surtos de mortalidade de anfíbios tem sido realizado nos últimos anos. As doenças emergentes destacam-se como as principais causas potenciais. O ranavírus é uma doença altamente infecciosa disseminada em todo o mundo, capaz de afetar até outros animais ectotérmicos como peixes e répteis. Uma questão importante em relação a essa patologia é a falta de sinais clínicos antes de levar à morte. Com o objetivo de compreender melhor a suscetibilidade dos anuros, o presente trabalho analisou a taxa de sobrevivência de rãs-touro (Lithobates catesbeianus), desafiadas com três doses de uma estirpe brasileira do Frog virus 3 (FV3). A análise de qPCR indicou baixa taxa de infectividade nesses animais, tanto como larvas quanto como adultos. Procurando esclarecer os resultados, foram formuladas as seguintes hipóteses: 1) A quantidade de inóculo aplicada nas rãs foi insuficiente para desencadear uma infecção; 2) Para que o FV3 dê sinais clínicos nesta espécie, é necessário um cofator; 3) Os animais sofreram infecção por FV3, mas se recuperaram no decorrer do experimento, e 4) O inóculo utilizado pode ter sido de baixa virulência. Finalmente, foi discutida a presença de sinais clínicos reais de ranavírus e levantada a hipótese mais provável(AU)

The Contribution of Emergent Literacy Skills for Early Reading and Writing Achievement / Contribuição das Habilidades de Letramento Emergente para as Competências Iniciais de Leitura e Escrita / Contribución de las Habilidades de Alfabetización Temprana a las Competencias Iniciales de Lectura y Escritura

Abstract Studies in the English language suggest that emergent literacy skills promote success in literacy. This longitudinal study investigated whether and which emergent literacy skills contribute to initial reading and writing performance in a sample of 34 Brazilian children from public schools. The participants underwent tests on phonological awareness, oral comprehension, vocabulary and knowledge of letters at the end of Early Childhood Education. The participants' skills in writing and reading words as well as reading comprehension were evaluated in the 1st year of elementary school. Data were analyzed using correlation and regression analysis. Results showed that emergent literacy skills presented significant positive correlations with reading and writing performance. Multiple regression analyses indicated significant and independent contributions of phonological awareness and knowledge of letters for writing, however, only phonological awareness significantly and independently contributed to reading of words and reading comprehension skills. It was concluded that emergent literacy skills related to the coding domain are the most important for literacy.

Resumo Estudos em língua inglesa sugerem que as habilidades de letramento emergente favorecem o sucesso na alfabetização. Este estudo longitudinal investigou se e quais habilidades de letramento emergente contribuem para as competências iniciais de leitura e escrita de uma amostra de 34 crianças brasileiras, alunas da rede pública de ensino. Ao final da Educação Infantil, as crianças foram submetidas a testes de consciência fonológica, compreensão oral, vocabulário e conhecimento das letras. No 1º ano do Ensino Fundamental, foram avaliadas as competências de escrita e leitura de palavras, bem como de compreensão em leitura dos participantes. Os dados foram analisados através de técnicas correlacionais e de análise de regressão. Os resultados mostraram que todas as habilidades de letramento emergente avaliadas apresentaram correlações positivas significativas com o desempenho nos testes de leitura e escrita. Contudo, análises de regressão múltipla indicaram contribuição significativa e independente apenas da consciência fonológica e do conhecimento de letras para a escrita; para as habilidades de leitura de palavras e compreensão em leitura, somente a consciência fonológica contribuiu de forma significativa e independente. Conclui-se que as habilidades de letramento emergente relacionadas ao domínio do código são as mais importantes para a alfabetização.

Resumen Los estudios en inglés sugieren que las habilidades de alfabetización temprana favorecen el éxito en la alfabetización. Este estudio longitudinal investigó si y cuáles habilidades de alfabetización temprana contribuyen a las competencias iniciales de lectura y escritura de una muestra de 34 niños brasileños, alumnos de la red pública de enseñanza. Al final de la educación preescolar, los niños fueron sometidos a pruebas de conciencia fonológica, comprensión oral, vocabulario y conocimiento de las letras. En el primer año de la Enseñanza Fundamental, se evaluaron las competencias de escritura y lectura de palabras, así como de comprensión en lectura de los participantes. Los datos fueron analizados a través de técnicas correlacionales y de análisis de regresión. Los resultados mostraron que todas las habilidades de alfabetización temprana evaluadas presentaron correlaciones positivas significativas con el rendimiento en las pruebas de lectura y escritura. Sin embargo, los análisis de regresión múltiple indicaron una contribución significativa e independiente sólo de la conciencia fonológica y del conocimiento de letras para la escritura; para las habilidades de lectura y comprensión en lectura, solamente la conciencia fonológica contribuyó de forma significativa e independiente. Se concluye que las habilidades de alfabetización temprana relacionadas con el dominio del código son las más importantes para la alfabetización.

Blunt cardiac injury: experience in 43 cases treated operatively / 中华胸心血管外科杂志

Objective@#To explore early diagnosis, surgical intervention and efficacy for blunt cardiac injury.@*Methods@#43 patients with blunt cardiac injury treated operatively were studied retrospectively in respect of sex, age, cause of injury, preoperative diagnosis, operative time from injury, surgical procedures, and therapeutic efficacy. The study lasted for 15 years between September 2003 and August 2018. The main cause of injury is road traffic accident with a rate of 48.8%(21/43); and steering wheel injury accounted for 71.4%(15/21). Preoperative diagnosis was based on computer scaning, echocardiography in 26 cases. In remaining 17, initial judgement of cardiac wound was done because of obvious cardiac tamponade, or massive hemothorax with shock; and was proved during emergent thoracotomy. Surgical intervention was started within one hour in cases of 27.9%(12/43). Main procedures included pericardial decompression, clear off hemopericardium, and cardiorrhaphy in 36 cases; relief of pericardial herniation with strangulation of the heart in 3 cases, and repair of diaphragmatic hernia involving pericardium in 4 cases. Of all 43 cases, 7 cases underwent Emergent Department Thoracotomy(EDT) with a resuscitative rate of 42.9%(3/7).@*Results@#Overall mortality rate was 32.6%(14/43); 4 cases died at EDT, 5 cases intraoperatively, and 5 cases postoperatively. The cause of deaths was directly related to BCI in 9 cases(associated with transected aorta in 1 case); and associated injuries in 5 cases including liver trauma(3 cases), brain trauma(1 case), and cervical spinal trauma(1 case). In 4 of 29 survivors, intracardiac injury was proved by echocardiography postoperatively, including mitral valve in 2 cases, tricuspid in 1 case, and ventricular septum in 1 case. Of these 4 cases 2 received valvuloplasty 2 weeks and 3 months after initial operation respectively; and other 2 restored spontaneously which were ensured by echocardiography. Postoperative complications included atelectasis in 3 and infectious endocarditis in 1 respectively. They were cured . All survivors were followed up from 6 to 36 months, with a normal cardiac function and healthy condition.@*Conclusion@#Early diagnosis and emergent thoracotomy in time are essential to improve survival rate. Preoperative massive transfusion and pericardiocentesis are not advocated. If it is necessary, EDT should be exercised decidedly.

Effects of cardiac rehabilitation combined with psychological invention on clinical efficacy in high-risk patients with acute myocardial infarction after emergent percutaneous coronary intervention / 中华行为医学与脑科学杂志

Objective@#To investigate the effects of stage I cardiac rehabilitation combined with structural psychological invention high-risk patients with acute myocardial infarction (AMI) treated by emergent percutaneous coronary intervention (PCI).@*Methods@#Totally 120 patients with AMI that received emergent PCI were randomized into experimental group(n=60) and control group(n=60). The experimental group started stage I cardiac rehabilitation combined with structural psychological invention after emergency PCI.The control group received routine treatment.Self-rating Anxiety Scale (SAS) and Self-rating depression Scale (SDS) scores were compared in both groups at before PCI and 1 week after PCI.Left ventricular ejection fraction (LVEF) and left ventricular end-diastolic diameter (LVEDD) were compared in both groups at before PCI and 1 week, 1 month and 6 months after PCI.The incidence of adverse cardiac events including cardiac death and recurrence myocardial infarction were compared between the two groups at 6 months after PCI.@*Results@#The SAS score in the experimental group (36.38±5.15) was lower than that in the control group (42.10±5.79) in 1 week after PCI (t=2.313, P<0.05). The SDS score in the experimental group(37.09±5.56) was lower than that in the control group (43.85±5.33) in 1 week after PCI (t=2.330, P<0.05). The LVEF in the experimental group( (45.08±4.41)%) was significantly higher than that in the control group ((42.81±3.83)%) in 1 week after PCI ( t=2.209, P<0.05). The LVEF in the experimental group ((48.93±4.39)%) was significantly higher than that in the control group ((44.61±4.35)%) in 1 month after PCI (t=2.224, P<0.05). The LVEDD in the experimental group ((54.74±4.01)mm) was significantly lower than that in the control group ((57.81±4.49)mm) in 1 month after PCI (t=2.413, P<0.05). The LVEDD in the experimental group ((52.21±2.82)mm) was significantly lower than that in the control group ((55.65±3.88)mm) in 6 month after PCI (t=2.297, P<0.05). And there were no significant difference between the two groups at other time point(all P>0.05). The follow-up results after 6 months showed that the experimental group (8.9%) had lower incidence of cardiac death than that in the control group (24.1%) (HR(95%CI): 0.317(0.128-0.835), P<0.05). The follow-up results after 6 months showed that the experimental group (14.2%) had lower incidence of recurrence myocardial infarction than that in the control group (42.2%) (HR(95%CI): 0.263(0.125-0.548), P<0.05).@*Conclusion@#Stage I cardiac rehabilitation improved the cardiac function in high-risk patients with AMI treated by emergent PCI and reduced the incidence of cardiac death and recurrence myocardial infarction.

Blunt cardiac injury: analysis of 348 patients / 中华急诊医学杂志

Objective@#To explore the early diagnosis, therapeutic methods and efficacy for blunt cardiac injury (BCI).@*Methods@#All BCI patients from September 2003 to August 2018 were studied retrospectively in respect of sex, age, cause of injury, diagnostic methods, therapeutic procedures, and outcome. The patients were divided into two groups: nonoperative group (n=305) and operative group (n=43). The two groups were compared and analyzed.@*Results@#Totally 348 BCI patients accounted for 18.3% of 1 903 patients with blunt thoracic injury (BTI), and the mortality rate was 10.1%. The main cause of injury was traffic accident with an incidence of 48.3%. The diagnostic methods included electrocardiogram (ECG), enzymes and troponin I, echocardiography, and CT scanning, or confirmed by emergency thoracatomy. In the nonoperative group, patients were mainly myocardial contusion, with a mortality rate of 6.9%. In the operative group, patients were mainly cardiac rupture and pericardial hernia, and the mortality was 32.6%. The incidence of negative ECG between the two groups was not significantly different (16.7% vs 11.6%, P>0.05). The incidence of shock and mortality in the operative group were significantly higher than those in the the nonoperative group (P<0.01). The number of death directly resulted from BCI in the operative group was greater than that in the nonoperative group (P<0.05).@*Conclusions@#For BTI patients, BCI must be highly suspected, and necessary examinations should be given. To manage myocardial contusion without surgery, it is necessary to protect the heart, alleviate edema of myocardium, and control arrhythmia with drugs. To deal with those patients requiring operation, early recognition and expeditious thoracotomy are essential.

Blunt cardiac injury: analysis of 348 patients / 中华急诊医学杂志

Objective To explore the early diagnosis,therapeutic methods and efficacy for blunt cardiac injury (BCI).Methods All BCI patients from September 2003 t9 August 2018 were studied retrospectively in respect of sex,age,cause of injury,diagnostic methods,therapeutic procedures,and outcome.The patients were divided into two groups:nonoperative group (n=305) and operative group (n=43).The two groups were compared and analyzed.Results Totally 348 BCI patients accounted for 18.3％ of 1 903 patients with blunt thoracic injury (BTI),and the mortality rate was 10.1％.The main cause of injury was traffic accident with an incidence of 48.3％.The diagnostic methods included electrocardiogram (ECG),enzymes and troponin I,echocardiography,and CT scanning,or confirmed by emergency thoracatomy.In the nonoperative group,patients were mainly myocardial contusion,with a mortality rate of 6.9％.In the operative group,patients were mainly cardiac rupture and pericardial hernia,and the mortality was 32.6％.The incidence of negative ECG between the two groups was not significantly different (16.7％ vs 11.6％,P＞0.05).The incidence of shock and mortality in the operative group were significantly higher than those in the the nonoperative group (P＜0.01).The number of death directly resulted from BCI in the operative group was greater than that in the nonoperative group (P＜0.05).Conclusions For BTI patients,BCI must be highly suspected,and necessary examinations should be given.To manage myocardial contusion without surgery,it is necessary to protect the heart,alleviate edema of myocardium,and control arrhythmia with drugs.To deal with those patients requiring operation,early recognition and expeditious thoracotomy are essential.