Influence of the use of a walking diary on mobility in patients in cardiac rehabilitation phase 1: a randomized clinical trial / Influência do uso do diário de caminhada na mobilidade de pacientes em reabilitação cardíaca fase 1: ensaio clínico randomizado

INTRODUCTION: Inpatient rehabilitation is extremely important for patients recovering from cardiac surgery. Although a walking diary is routinely used in clinical practice, it has yet to be adequately tested and reported in the literature. OBJECTIVES: To establish whether the use of a walking diary affects the number of steps taken following cardiac surgery and whether this is related to the patient's level of cardiac anxiety. METHODS: An open, controlled, randomized clinical trial was conducted with adult patients submitted to elective valve and/or coronary surgery, who had no motor impairment. All the participants used a pedometer to register the number of steps taken over five consecutive days in the hospital. Twenty-nine individuals were randomized to create an intervention group that used the walking diary as treatment strategy, while twenty-three were allocated to a control group. The Mann-Whitney test was used to compare the number of steps between the two groups, while Spearman's correlation coeficiente was performed to evaluate the relationship between the number of steps and the level of cardiac anxiety. Statistical significance was defined as p<0.05. RESULTS: The groups were similar regarding their demographic, clinical and surgical characteristics. There was no difference between the groups regarding the total number of steps taken: control group=1,496 (477.5 - 2992.5) vs. Intervention group=1,468.5 (494.2 - 2,678) (p=0.902). CONCLUSION: The use of the walking diary had no effect on the number of steps taken and was unassociated with the level of cardiac anxiety in inpatients following cardiac surgery.

INTRODUÇÃO: A reabilitação hospitalar é extremamente importante para pacientes em recuperação de cirurgia cardíaca. Embora o diário de caminhada seja rotineiramente utilizado na prática clínica, ele ainda não foi adequadamente testado e relatado na literatura. OBJETIVOS: Estabelecer se o uso do diário de caminhada afeta o número de passos dados após cirurgia cardíaca e se isso está relacionado ao nível de ansiedade cardíaca do paciente. MÉTODOS: Foi realizado um ensaio clínico aberto, controlado e randomizado com pacientes adultos submetidos à cirurgia eletiva de valva e/ou coronária, sem comprometimento motor. Todos os participantes usaram um pedômetro para registrar o número de passos dados ao longo de cinco dias consecutivos de internação. Vinte e nove indivíduos foram randomizados para um grupo intervenção para usar o diário de caminhada como estratégia de tratamento, enquanto vinte e três foram alocados para um grupo controle. O teste de Mann-Whitney foi utilizado para comparar o número de passos entre os dois grupos, enquanto o coeficiente de correlação de Spearman foi realizado para avaliar a relação entre o número de passos e o nível de ansiedade cardíaca. A significância estatística foi definida como p < 0,05. RESULTADOS: Os grupos foram semelhantes quanto às características demográficas, clínicas e cirúrgicas. Não houve diferença entre os grupos quanto ao número total de passos dados: grupo controle=1.496 (477,5 - 2.992,5) vs. grupo intervenção=1.468,5 (494,2 - 2.678) (p=0,902). CONCLUSÃO: O uso do diário de caminhada não teve efeito no número de passos dados e não foi associado ao nível de ansiedade cardíaca em pacientes internados após cirurgia cardíaca.

Número de células CD34+ circulantes como predictor de recolección exitosa de progenitores hematopoyéticos por aféresis en trasplante autólogo / Number of circulating CD34+ cells as a predictor of successful collection of hematopoietic progenitors by apheresis in autologous transplantation

RESUMEN Introducción. El trasplante autólogo de células progenitoras hematopoyéticas es una terapia eficaz en neoplasias malignas hematológicas. El número de células que CD34+ en sangre periférica es el mejor predictor del rendimiento de recolección de células progenitoras hematopoyéticas. Objetivo. Determinar el número de células CD34+ en sangre periférica asociado al éxito de recolección de progenitores hematopoyéticos por aféresis en trasplante autólogo. Métodos. Se evaluó retrospectivamente los datos de 236 procedimientos de aféresis de células progenitoras hematopoyéticas para el trasplante autólogo en el Hospital Edgardo Rebagliati Martins (Lima, Perú) de julio del 2020 a julio del 2023. Se utilizó la curva ROC (características operativas del receptor) para determinar el número de células CD34+ en sangre periférica necesario para lograr una recolección por aféresis ≥ 2 x 106 células CD34+/kg. Resultados. El 61% fueron hombres, con mediana de edad de 58 años, el valor de corte fue de 18,38 células CD34+/μL (sensibilidad de 94,1% y especificidad de 96,9%). Conclusión. El número de células CD34+ sangre periférica para una recolección exitosa de células progenitoras hematopoyéticas para el trasplante autólogo fue de 18,38 células CD34+/μL.

ABSTRACT Introduction. Autologous hematopoietic progenitor cell transplantation is an effective therapy in hematological malignancies, the number of CD34+ cells in peripheral blood is the best predictor of hematopoietic progenitor cell harvesting performance. Objective. To determine the number of CD34+ cells in peripheral blood associated with the successful collection of hematopoietic progenitors by apheresis in autologous transplantation. Methods. The data of 236 hematopoietic progenitor cell apheresis procedures for autologous transplantation at the Edgardo Rebagliati Martins Hospital (Lima, Peru) were retrospectively evaluated from July 2020 to July 2023. The ROC (receiver operating characteristics) curve was used to determine the number of CD34+ cells in peripheral blood necessary to achieve an collection by apheresis ≥ 2 x 106 CD34+ cells/kg. Results. 61% were men, with a median age of 58 years, the cut-off value was 18.38 CD34+ cells/μL (sensitivity of 94.1% and specificity of 96.9%). Conclusion. The number of peripheral blood CD34+cells for successful collection of hematopoietic progenitor cells for autologous transplantation was 18.38 CD34+ cells/μL.

Clinical Observation on the Thumb-tack Needling for Subcutaeous Embedding Combined with Joint Mobilization in the Treatment of Post-stroke Shoulder-Hand Syndrome / 广州中医药大学学报

Objective To observe the clinical efficacy of thumb-tack needling for subcutaeous embedding combined with joint mobilization in the treatment of post-stroke shoulder-hand syndrome.Methods A total of 80 patients with post-stroke shoulder-hand syndrome were randomly divided into a treatment group and a control group,with 40 patients in each group.Both groups were given arthrocentesis,the control group was given ordinary acupuncture on the basis of arthrocentesis,and the treatment group was combined with thumb-tack needling for subcutaeous embedding.One course of treatment was 4 weeks and a total of 4 weeks of treatment was given.After 1 month of treatment,the clinical efficacy of the two groups was evaluated.The changes of Visual Analogue Scale(VAS)of pain scores and simplified Fugl-Meyer Assessment(FMA)scores,as well as the pain-free passive forward flexion and abduction of the shoulder joint of the affected limb were observed before and after treatment.The Simple Quality of Life Scale(SF-36)scores of the patients in the two groups were compared after treatment.The safety and the occurrence of adverse reactions in the two groups were also evaluated.Results(1)The total effective rate was 95.00%(38/40)in the treatment group and 80.00%(32/40)in the control group.The efficacy of the treatment group was superior to that of the control group,and the difference was statistically significant(P＜0.05).(2)After treatment,the VAS scores and upper extremity FMA scores of the patients in the two groups were significantly improved(P＜0.05),and the treatment group was significantly superior to the control group in improving the VAS scores and upper extremity FMA scores,and the differences were statistically significant(P＜0.05).(3)After treatment,the joint mobility of patients in the two groups were significantly improved(P＜0.05),and the improvement of shoulder joint movement in the treatment group was superior to that in the control group,and the difference was statistically significant(P＜0.05).(4)After treatment,the SF-36 Quality of Life Scale scores of the treatment group were significantly superior to those of the control group in terms of physical function,psychological function,emotional health,and social function levels,and the difference was statistically significant(P＜0.05).(5)There was no significant difference in the incidence of adverse reactions between the treatment group and the control group(P＞0.05).Conclusion Thumb-tack needling for subcutaeous embedding combined with joint mobilization exert certain effect in the treatment of post-stroke shoulder-hand syndrome.It can significantly improve the pain symptoms of patients,thus improving their quality of life,and the clinical effect is remarkable.

Therapeutic efficacy of massage versus instrument-assisted soft tissue mobilization in patients with lateral epicondylitis of the humerus / 中国组织工程研究

BACKGROUND:Instrument-assisted soft tissue mobilization is often used as a noninvasive treatment for soft tissue(skeletal muscle,ligament,and fascia)injuries and postoperative recovery to improve pain and enhance strength in the range of joint motion. OBJECTIVE:To compare the clinical efficacy of instrument-assisted soft tissue mobilization and massage therapy in patients with lateral epicondylitis of the humerus. METHODS:A total of 25 athletes with lateral epicondylitis of the humerus were enrolled in this study and randomized into two groups:13 subjects receiving instrument-assisted soft tissue mobilization as the experimental group and 12 subjects receiving massage therapy as the control group.The treatment period was 4 weeks,with two sessions per week.Elbow joint visual analog scale,Mayo elbow performance index,elbow range of motion measurement,and forearm strength were measured and recorded in both groups before and after treatment. RESULTS AND CONCLUSION:Both treatments significantly reduced visual analog scale score of the elbow joint after the first and last treatments(P＜0.05),but the visual analog scale score showed no significant difference between the two groups(P＞0.05).The Mayo elbow performance index showed a significant increase in both groups after the first and last treatments(P＜0.05),but there was no significant difference between the two groups(P＞0.05).In the maximum grip strength test,the maximum grip strength of the experimental group in the vertical direction and during internal and external rotations after treatment was better than that before treatment(P＜0.05),while the control group only showed improved maximum grip strength during internal rotation(P＜0.05),with no significant improvement in maximum grip strength in other states.There was also no significant difference in the maximum grip strength in all the three states between the two groups(P＞0.05).After the last treatment,the range of motion of the elbow joint and the angle of forearm pronation and supination were significantly improved in both intervention groups(P＜0.05).The maximum angle of the elbow joint for flexion was smaller than that before treatment(P＜0.05),and there was no significant difference in each angle of motion between the two groups(P＞0.05).The range of motion of the forearm and elbow joint in both groups were significant improved after the first and last treatment(P＜0.05)and there was no significant difference in difference in the range of motion of the forearm and elbow joint between the two groups(P＞0.05).To conclude,both instrument-assisted soft tissue mobilization and massage therapy significantly reduce pain,improve elbow flexibility and increase joint range of motion in patients with lateral epicondylitis of the humerus.However,instrument-assisted soft tissue mobilization is better than massage therapy to improve the maximum grip strength.

Evidence summary of early mobilization in awake patients on extracorporeal membrane oxygenation / 中华护理杂志

Objective To retrieve,evaluate and summarize the best evidence of early mobilization in awake patients on extracorporeal membrane oxygenation,and to provide a reference for clinical practice.Methods UpToDate,BMJ Best Practice,Registered Nurses'Association of Ontario,National Guideline Clearinghouse,National Institute for Health and Care Excellence,Yimaitong,Joanna Briggs Institute Library,Cochrane Library,CINAHL,PubMed,SinoMed,CNKI,Wanfang Database,Vip Database and Extracorporeal Life Support Organization Website were researched to collect the literature,including clinical guidelines,expert consensuses,evidence summaries,systematic reviews,and well-designed original studies.The time limit for retrieval was until June 2023.The quality of literature and the level of evidence were evaluated by the evaluation criteria and evidence grading system of J BI Evidence-Based Health Care Center.Results 14 pieces of the literature were included,including 2 clinical guidelines,4 expert consensuses,5 systematic reviews,2 cohort studies and 1 case series.Totally 33 pieces of evidence were summarized,covering 7 aspects:adaptation conditions for the implementation of awake ECMO,team composition,comprehensive assessment,pre-mobilization preparation,mobilization content,prevention and control of adverse events,and effect evaluation.Conclusion The study summarizes the best evidence of early mobilization in awake patients on extracorporeal membrane oxygenation.It is suggested that medical institutions establish a professional team for the early mobilization of awake ECMO patients,apply the best evidence to standardize the early mobilization process,and formulate an individualized mobilization program.

Effect of neural mobilization based on shoulder control training on shoulder pain and upper limb function in stroke patients with hemiplegia / 中国康复理论与实践

ObjectiveTo observe the effect of neural mobilization based on shoulder control training on shoulder pain and upper limb function in stroke patients with hemiplegia. MethodsFrom January, 2020 to November, 2021, 43 patients with hemiplegia after stroke in the Second People's Hospital of Nantong were randomly divided into control group (n = 21) and treatment group (n = 22). The control group received shoulder control training, while the treatment group received neural mobilization in addition. Before and after four weeks of treatment, they were evaluated with the Numeric Rating Scale (NRS) of pain and Fugl-Meyer Assessment-Upper Extremities (FMA-UE). ResultsOne case dropped off in the control group and two cases dropped off in the treatment group. After treatment, the NRS score and FMA-UE score improved in both groups (|t| >7.898, P < 0.001), and they were better in the treatment group than in the control group (|t| >2.337, P < 0.05). ConclusionNeural mobilization based on shoulder control training can significantly alleviate shoulder pain and improve upper limb motor function in stroke patients with hemiplegia.

Rehabilitation with a Patient with Severe COVID-19 Who Presented with Acute Subdural Hematoma During Ventilator and Extracorporeal Membrane Ventilator Management：A case Report / The Japanese Journal of Rehabilitation Medicine

Introduction：Intracranial hemorrhage after severe coronavirus disease 2019 (COVID-19) is associated with increased mortality and unfavorable patient outcomes.Case：A man in his 60s with independent activities of daily living (ADL) was diagnosed with COVID-19, and placed on a ventilator on Day (D)-3 and VV-ECMO on D-5. On D-23, an emergency craniotomy was performed for a left acute subdural hematoma. The patient was weaned from VV-ECMO on D-27. On D-33, sitting was initiated. On D-36, the patient was weaned from the ventilator and began exercise therapy. The Glasgow coma score (GCS) was E2V1TM4. Basic movement as assessed by the Functional Status Score for ICU (FSS-ICU) and Barthel Index (BI), was 3 and 0 points, respectively. On D-40, wheelchair use commenced. He began standing with a long leg orthosis on D-50, and began walking on D-53.On D-67, the patient transferred to a convalescent hospital. His GCS was E4V4M6. Generalized cognitive decline and motor paralysis were noted. The right upper limb, hand, and lower limb were assessed as Brunnstrom recovery stage IV, V, and V, respectively. The patient's grip strength was 11.9 kg [right] and 18.3 kg [left]. His knee extensor strength was 0.13 kgf/kg [right] and 0.19 kgf/kg [left]. The FSS-ICU, walking speed, and BI were 21 points, 0.17 m/sec, and 40 points, respectively. The patient was discharged on D-240.Discussion：The Early Mobilization and Rehabilitation Expert Consensus reports that early mobilization and active exercise can improve ADL at discharge. Our patient was weaned from VV-ECMO as soon as possible and practiced standing and walking with a long leg orthosis, resulting in a better outcome.

Fortalecimento da Rede Nacional de Atenção Integral à Saúde do Trabalhador pela mobilização social: relato de experiência / Strengthening the National Network for Comprehensive Occupational Healthcare through social mobilization: an experience report

Resumo Introdução: a participação social é o pilar da implementação da Política Nacional de Saúde do Trabalhador e da Trabalhadora que estabelece as ações de atenção à Saúde do Trabalhador no Sistema Único de Saúde, a partir da Rede Nacional de Atenção Integral à Saúde do Trabalhador (Renast). Objetivo: descrever a parceria ensino-serviço para fortalecer a atenção à Saúde do Trabalhador em um município, em consonância com os princípios da Renast, a partir da formação e mobilização social em saúde. Métodos: trata-se de um relato do projeto de extensão desenvolvido por demanda da Comissão Intersetorial de Saúde do Trabalhador e da Trabalhadora municipal. Foram realizadas três oficinas de trabalho que utilizaram o diálogo em grupos de discussão como método para produção de conhecimento associado a estratégias de ensino-aprendizagem. Resultados: profissionais de saúde, estudantes, trabalhadores e representantes de entidades participaram das oficinas, que versavam sobre: organização da Renast; a epidemiologia e papel dos diversos atores para fortalecimento da Renast; a articulação intra e intersetorial da Renast, suas fragilidades e potencialidades; e a relevância de cada ator no sentido de mobilizá-los para mudança de suas realidades. Conclusão: as oficinas apresentaram-se como estratégia possível de formação e ponto de partida, visando à mobilização social para fortalecer a Renast.

Abstract Introduction: social participation is a cornerstone in implementing the National Policy for Occupational Heath, which establishes care actions for worker's health within the Unified Health System, based on the National Network for Comprehensive Occupational Healthcare (Renast). Objective: to describe the educational-service partnership aimed at strengthening occupational care in a municipality according to Renast principles by education and social mobilization in health. Methods: This experience report focuses on the outreach project developed to answer the demands of the municipal Intersectoral Commission on Occupational Health. Three workshops were conducted using discussion groups as a method for knowledge production associated with teaching and learning strategies. Results: health professionals, students, workers, and representatives of entities participated in the workshops, which addressed Renast organization; epidemiology and the role of various actors in strengthening Renast; Renast intra and intersectoral articulation, its weaknesses and potentialities; and the relevance of each actor in changing their realities. Conclusion: the workshops proved to be a feasible strategy for education and social mobilization aimed at strengthening Renast.

Educação popular em saúde: princípios, desafios e perspectivas na reconstrução crítica do país / Educación popular en salud: principios, desafíos y perspectivas en la reconstrucción crítica del país / Popular education in health: principles, challenges and perspectives in the critical reconstruction of the country

O texto trata da abordagem teórico-prática da Educação Popular em Saúde (EPS), apresentando reflexões sobre construções possíveis com base nos princípios dessa filosofia. Esse processo de discussão teórica transita pelos processos educativos em saúde; pela capacidade mobilizadora da participação social e promoção de encontros humanos transformadores nos serviços de saúde; e pelas possibilidades para o presente e o futuro do Sistema Único de Saúde (SUS). Tem-se, pois, a importância da participação social nos serviços de saúde, destacando a abordagem comunitária como estratégia para potencializar o trabalho na Atenção Primária à Saúde e dinamizar a promoção e a vigilância em saúde. Desse modo, com os caminhos viabilizados e orientados pela EPS, pode-se contribuir para a construção de práticas mais democráticas e emancipadoras no SUS.(AU)

El texto trata del abordaje teórico-práctico de la Educación Popular en Salud (EPS), presentando reflexiones sobre construcciones posibles con base en los principios de esa filosofía. Este proceso de discusión teórica transita por los procesos educativos en salud, por la capacidad movilizadora de la participación social y promoción de encuentros humanos transformadores en los servicios de salud y por las posibilidades para el presente y el futuro del Sistema Brasileño de Salud (SUS). Se ve, por lo tanto, la importancia de la participación social en los servicios de salud, destacando el abordaje comunitario como estrategia para potenciar el trabajo en la Atención Primaria de la Salud y dinamizar la promoción y vigilancia en salud. De ese modo, con los caminos viabilizados y orientados por la EPS es posible contribuir para la construcción de prácticas más democráticas y emancipadoras en el SUS.(AU)

The text deals with the theoretical-practical approach of Popular Education in Health (PEH), presenting reflections on possible constructions based on the principles of this philosophy. This process of theoretical discussion covers educational processes in health, the mobilizing capacity of social participation and the promotion of transformative human encounters in health services and the possibilities for the present and future of the Brazilian National Health System (SUS). This highlights the importance of social participation in health services, highlighting the community approach as a strategy to enhance work in Primary Health Care and boost health promotion and surveillance. In this way, the paths made possible and guided by the EPS can contribute to the construction of more democratic and emancipatory practices in the SUS.(AU)

O viés das mídias sociais: verdade e angústia nas políticas de engajamento / Le biais des médias sociaux: vérité et angoisse dans les politiques d'engagement / The bias of social media: Truth and anxiety in engagement policies / El sesgo de las redes sociales: verdad y angustia en las políticas de compromiso

O presente artigo explora alguns impactos políticos e sociais reconhecidos nos dez anos que sucederam as manifestações de junho de 2013, dando ênfase a um fator específico: o papel das mídias sociais no cenário político e na mobilização de grupos. Partindo desse foco, trata da possibilidade de que tais ferramentas digitais possam ser melhor exploradas por certos grupos políticos em detrimento de outros, e os motivos para tanto. Tal questão será discutida a partir de autores de estudos da tecnologia, da teoria social e da psicanálise. Não necessariamente inferindo uma diferenciação de conteúdo de ideologias políticas, propomos essa distinção considerando que os impactos subjetivos e de mobilização produzidos por tais mídias podem ser assimilados e empregados de acordo com objetivos específicos. Trata-se, assim, de um exame sobre os impactos que as mídias sociais produzem em processos de subjetivação e de agrupamento, e seus efeitos políticos.

Resumos This paper explores political and social impacts present in the ten years since June 2013 demonstrations, emphasizing an specific factor: the role of social media in the political landscape and in mobilizing groups. We take as a central question the possibility that those digital tools are better explored by some political groups to the detriment of others, and the reasons that explain this difference. This question is developed with authors from the studies of technology, social theory, and psychoanalysis. Without necessarily assuming a content differentiation among political views, we propose their distinction considering that the subjective and the mobilizing impacts produced by these media can be assimilated and employed according to specific objectives. Therefore, this study is an examination of the impacts that social media produce on subjectivation and grouping processes, and their political effects.

Cet article explore certains des impacts politiques et sociaux constatés au cours des dix années qui ont suivi les manifestations de juin 2013, en mettant l'accent sur un facteur spécifique: le rôle des médias sociaux dans le paysage politique et dans la mobilisation des groupes. À partir de là, il aborde la possibilité que ces outils numériques puissent être mieux exploités par certains groupes politiques au détriment d'autres, et les raisons de cette différence supposée. Cette question sera discutée à l'aide d'auteurs issus des études technologique, de la théorie sociale et de la psychanalyse. Sans nécessairement en déduire une différenciation dans le contenu des opinions politiques, nous proposons cette distinction en considérant que les impacts subjectifs et mobilisateurs produits par ces médias peuvent être assimilés et utilisés en fonction d'objectifs spécifiques. Il s'agit donc d'examiner les impacts que les médias sociaux produisent sur les processus de subjectivation et de regroupement, et leurs effets politiques.

Este artículo explora los impactos políticos y sociales desencadenados tras diez años de las manifestaciones de junio de 2013 enfatizando un factor específico: el papel de las redes sociales en los escenarios políticos y en la movilización de grupos. A partir de este foco, se aborda la posibilidad de que estas herramientas digitales sean mejor exploradas por unos grupos políticos que por otros, y las razones que explican esta diferencia. Para discutir esta cuestión se utiliza autores de la filosofía de la tecnología, de la teoría social y del psicoanálisis. Sin asumir necesariamente una diferenciación de contenido entre ideologías políticas, se propone esta distinción teniendo en cuenta que los impactos subjetivos y de movilización que producen estas herramientas digitales pueden ser asimilados y empleados de acuerdo con objetivos específicos. Se trata, por tanto, de un examen sobre los impactos que las redes sociales producen en los procesos de subjetivación y agrupación, y sus efectos políticos.

Lições de Justiça Reprodutiva para catalisar estratégias de incidência durante a crise do Zika no Brasil / Reproductive Justice Lessons for Catalyzing Advocacy Strategies during Zika Crisis in Brazil

Resumo Revisitaremos uma constelação de respostas para garantir justiça reprodutiva para mulheres e meninas durante a crise do Zika no Brasil. As ações relatadas foram conduzidas pela Anis - Instituto de Bioética, uma ONG feminista. Argumentamos que, durante as emergências sanitárias, é necessário o uso de lentes feministas interseccionais para construir respostas efetivas e sensíveis às questões de gênero, em favor de mulheres e meninas. Apresentamos três táticas de incidência utilizadas na luta por justiça reprodutiva durante a crise do Zika: 1) construir narrativas baseadas em histórias de vida que retratem os efeitos desproporcionais da crise em mulheres e meninas; 2) produzir dados baseados em evidências para catalisar estratégias de incidência para revisão legal e de políticas públicas; 3) promover oportunidades para o fortalecimento de alianças e movimentos, bem como o compartilhamento de poder por meio de atividades de mobilização comunitária. Reconhecemos a importância de responder às necessidades das populações em tempo real, e para isso torna-se fundamental que as evidências sobre os impactos das emergências em saúde pública sejam produzidas e compartilhadas de maneira ágil. Os esforços em incidência não são estratégias fragmentadas, pois garantir a justiça reprodutiva exige uma estrutura abrangente e transformadora, incluindo soluções que envolvam o cotidiano das pessoas comuns e suas experiências de vida.

Abstract This article aims to revisit a constellation of responses to guarantee reproductive justice for women and girls during the Zika crisis in Brazil, that were conducted by Anis - Institute of Bioethics, a Brazilian feminist NGO. We argue that intersectional feminist lenses and gender-sensitive responses are necessary to build effective efforts for women and girls during a public health emergency. As such, we present three concomitant and intersectional learned tactics we used to fight for reproductive justice during the Zika crises, but also in its aftermath: 1. To build storytelling narratives that portray the disproportional effects of the crisis on women and girls; 2. To produce evidence-based data to catalyze advocacy strategies for legal and policy review; 3. To promote movement building opportunities and sharing power through community mobilization activities. We assume the importance of providing immediate evidence and gender sensitive framings to inform real-time public health responses. Advocacy efforts should not be seen as fragmented strategies, since ensuring reproductive justice demands a comprehensive and transformative framework that include solutions for multiple aspects of real-life experiences.

Application of the ICU Mobility Scale in patients submitted to cardiac surgery / Aplicação da ICU Mobility Scale em pacientes submetidos à cirurgia cardíaca

Abstract Introduction Early mobilization is an alternative used in the Intensive Care Unit (ICU) to reduce the effects of immobility. The Intensive Care Unit Mobility Score (IMS) is applied to assess mobility status. Objective To determine the functional level of ICU patients submitted to cardiac surgery using the IMS scale. Methods This is an analytical observational study carried out with adult ICU patients submitted to cardiac surgery. Data on the use of vasoactive drugs, functional level through IMS, duration of mechanical ventilation and length of ICU stay were collected from the physiotherapy routine form and recorded on a specific instrument developed for the study. The data obtained from the IMS scale score on the postoperative days in the ICU were used to classify the patients' mobility during the hospitalization period. Descriptive statistics were used to present the data. Results A total of 69 patients were evaluated, 43% of whom were men, and all had an SMI of 0 on the first postoperative day. Classification on the scale increased over the course of hospitalization (IMS between 7 and 10), despite the use of vasoactive drugs in 54.6% of the individuals. Conclusion Patients submitted to cardiac surgery admitted to the ICU had moderate-to-high mobility levels throughout their stay and at discharge from the ICU.

Resumo Introdução A mobilização precoce é uma alternativa utilizada em Unidades de Terapia Intensiva (UTIs) na tentativa de reduzir os efeitos decorrentes do imobilis-mo. A escala de mobilidade em UTIs ou Intensive Care Unit Mobility Score (IMS) é aplicada para avaliar o nível de mobilidade. Objetivo Verificar por meio da escala IMS o nível de funcionalidade de pacientes submetidos à cirurgia cardíaca internados em uma UTI. Métodos Trata-se de um estudo observacional analítico realizado em UTI com pacientes adultos submetidos à cirurgia car-díaca. Foram coletados da ficha de rotina da fisioterapia informações quanto ao uso de drogas vasoativas, nível funcional por meio da IMS, tempo de ventilação mecânica e de internação na UTI, e registrados em instrumento específico desenvolvido para o estudo. Os dados obtidos do escore da escala IMS nos dias de pós-operatório na UTI foram utilizados para classificar a mobilidade dos pacientes durante o período de internação. Utilizou-se estatística descritiva para a apresentação dos dados. Resultados Foram avaliados 69 pacientes, 43% eram do sexo masculino e todos apresentavam IMS 0 no primeiro dia de pós-operatório. A classificação na escala aumentou com o decorrer do período de internação (IMS entre 7 e 10), apesar do uso de drogas vasoativas em 54,6%. Conclusão Os pacientes submetidos à cirurgia cardíaca internados na UTI apresentaram níveis de mobilidade de moderado a alto ao longo da internação e na alta da UTI.

Lactate dehydrogenase as a hematopoietic stem cell mobilization biomarker in autologous transplantation

ABSTRACT Introduction: Pre-apheresis peripheral blood CD34+ cell count (PBCD34+) is the most important predictor of good cell mobilization before hematopoietic stem cell transplantation, albeit flow cytometry is not always immediately available. Identification of surrogate markers can be useful. The CD34+ cells proliferate after mobilization, resulting in elevated lactate dehydrogenase (LDH) activity and correlating with the PBCD34+ count. Objective: To determine the LDH cut-off value at which adequate CD34+ cell mobilization is achieved and its diagnostic yield. Materials and methods: A total of 103 patients who received an autologous stem cell transplantation (ASCT) between January 2015 and January 2020 were included. Demographic and laboratory characteristics were obtained, including complete blood count, pre-apheresis PBCD34+ and LDH levels. Receiver operating characteristic (ROC) curves were performed to identify the optimal serum LDH activity cut-off points for ≥ 2 and ≥ 4 × 106 cells/kg post-mobilization CD34+ count and their diagnostic yield. Results: A post-mobilization serum LDH cut-off value of 462 U/L yielded a sensitivity (Se) = 86.8% (positive predictive value [PPV] = 72.7%), a pre- and post-mobilization serum LDH difference cut-off value of 387 U/L, an Se = 45.7% (PPV = 97%) and an LDH ratio of 2.46, with an Se = 47.1% (PPV = 97%) for an optimal mobilization count (CD34+ ≥ 4 × 106). Conclusion: The LDH measurement represents a fast and affordable way to predict PBCD34+ mobilization in cases where flow cytometry is not immediately available. According to the LDH diagnostic yield, it could be used as a surrogate marker in transplant centers, supporting the CD34+ count, which remains the gold standard.

Conhecimento e aplicabilidade de escalas funcionais por fisioterapeutas intensivistas / Knowledge and applicability of functional scales by intensive physiotherapists

INTRODUÇÃO: A atuação do fisioterapeuta através da mobilização precoce visa reduzir os efeitos adversos do imobilismo e melhorar a funcionalidade. Nesse sentido, o uso de escalas funcionais é crucial para avaliar a condição funcional do paciente crítico. OBJETIVO: Analisar o conhecimento de fisioterapeutas intensivistas sobre escalas funcionais, conhecer as escalas mais utilizadas e as principais barreiras para aplicabilidade na UTI, além de associar o uso das escalas funcionais com a segurança e a percepção de resultados. METODOLOGIA: Trata-se de um estudo transversal e quantitativo realizado com fisioterapeutas intensivistas na cidade de Fortaleza entre agosto de 2022 a fevereiro de 2023. A coleta de dados ocorreu via questionário online (Google Forms). Os dados foram analisados através do Software Jamovi. Utilizou-se a estatística descritiva e o teste de Qui quadrado. RESULTADOS: Participaram 75 fisioterapeutas, a maioria com tempo de experiência na unidade de terapia intensiva de 1 a 5 anos. A maior parte dos profissionais percebem benefícios na utilização das escalas funcionais e utilizam para prescrição de conduta com segurança em sua aplicabilidade, sendo a escala Intensive Care Unit Mobility Scale a mais utilizada. Quanto às barreiras que mais interferem para utilização das escalas funcionais foram relacionadas a equipe, ao paciente e a instituição. CONCLUSÃO: Percebe-se que a maioria dos fisioterapeutas conhecem os objetivos e benefícios no uso de escalas funcionais, afirmam ter segurança para aplicação em sua conduta, sendo a escala IMS a mais utilizada pelos profissionais. Evidencia-se que a interação do fisioterapeuta com a equipe foi a principal barreira para a aplicação de escalas funcionais na Unidade de Terapia Intensiva.

INTRODUCTION: The role of the physiotherapist through early mobilization aims to reduce the adverse effects of immobility and improve functionality. In this sense, the use of functional scales is crucial to assess the functional condition of critically ill patients. OBJECTIVE: To analyze the knowledge of intensive care physiotherapists about functional scales, to know the most used scales and the main barriers to applicability in the ICU, in addition to associating the use of functional scales with safety and the perception of results. MATERIALS AND METHODS: This is a cross-sectional and quantitative study carried out with intensive care physiotherapists in the city of Fortaleza between August 2022 and February 2023. Data were collected via an online questionnaire (Google Forms). The data were analyzed using the Jamovi Software. Descriptive statistics and the Chi-square test were used. RESULTS: 75 physiotherapists participated, most with 1 to 5 years of experience in the intensive care unit. Most professionals perceive benefits in the use of functional scales and use them to prescribe conduct with safety in its applicability, with the Intensive Care Unit Mobility Scale being the most used. As for the barriers that most interfere with the use of functional scales, they were related to the team, the patient and the institution. CONCLUSION: Many physiotherapists are aware of the objectives and benefits of using functional scales, they say they are confident in applying them in their practice, and the IMS scale is the one most used by professionals. The interaction between the physiotherapist and the team was the main barrier to the application of functional scales in the Intensive Care Unit.

Early mobilization after total hip or knee arthroplasty: a substudy of the POWER. 2 study

Abstract Background Early mobilization after surgery is a cornerstone of the Enhanced Recovery After Surgery (ERAS) programs in total hip arthroplasty (THA) or total knee arthroplasty (TKA). Our goal was to determine the time to mobilization after this surgery and the factors associated with early mobilization. Methods This was a predefined substudy of the POWER.2 study, a prospective cohort study conducted in patients undergoing THA and TKA at 131 Spanish hospitals. The primary outcome was the time until mobilization after surgery as well as determining those perioperative factors associated with early mobilization after surgery. Results A total of 6093 patients were included. The median time to achieve mobilization after the end of the surgery was 24 hours [16-30]. 4,222 (69.3%) patients moved in ≤ 24 hours after surgery. Local anesthesia [OR = 0.80 (95% confidence interval [CI]: 0.72-0.90); p= 0.001], surgery performed in a self-declared ERAS center [OR = 0.57 (95% CI: 0.55-0.60); p< 0.001], mean adherence to ERAS items [OR = 0.93 (95% CI: 0.92-0.93); p< 0.001], and preoperative hemoglobin [OR = 0.97 (95% CI: 0.96-0.98); p< 0.001] were associated with shorter time to mobilization. Conclusions Most THA and TKA patients mobilize in the first postoperative day, early time to mobilization was associated with the compliance with ERAS protocols, preoperative hemoglobin, and local anesthesia, and with the absence of a urinary catheter, surgical drains, epidural analgesia, and postoperative complications. The perioperative elements that are associated with early mobilization are mostly modifiable, so there is room for improvement.

Qualitative systematic review of the safety and feasibility of early mobilization in critically ill patients with femoral catheters / 中国胸心血管外科临床杂志

@#Objective    To investigate the safety and feasibility of early mobilization in critically ill patients with femoral catheters, and to provide reference for guiding clinical rehabilitation training. Methods    The literature on the safety and feasibility of early mobilization in critically ill patients with femoral catheters included in PubMed, EMbase, OVID, Springer-link, Wiley Online Library, and Web of Science up to June 2021 was searched, and relevant data were extracted for analysis. Results    Seventy-two papers were initially screened, and 12 papers that met the criteria were finally included, covering 1 056 patients, and 489 patients had femoral catheters. Patients underwent 6 495 sessions of physical therapy, and a total of 62 patients had adverse events, including 14 (2.86%, 14/489) patients with catheter-related adverse events. Conclusion    Although early mobilization in critically ill patients with femoral catheters may lead to adverse catheter-related events, the incidence is low. Therefore, the associated risks and benefits should be weighed in clinical practice, and femoral catheter is not recommended as a contraindication for early mobilization in critically ill patients.

Expression Changes of Hypoxia-Inducible Factor-1α in G-CSF Induced Hematopoietic Stem Cell Mobilization / 中国实验血液学杂志

OBJECTIVE@#To investigate the expression and its relative mechanism of hypoxia-inducible factor-1α(HIF-1α) in bone marrow(BM) of mice during G-CSF mobilization of hematopoietic stem cells (HSC) .@*METHODS@#Flow cytometry was used to detect the proportion of Lin-Sca-1+ c-kit+ (LSK) cells in peripheral blood of C57BL/6J mice before and after G-CSF mobilization. And the expression of HIF-1α and osteocalcin (OCN) mRNA and protein were detected by RQ-PCR and immunohistochemistry. The number of osteoblasts in bone marrow specimens of mice was counted under the microscope.@*RESULTS@#The proportion of LSK cells in peripheral blood began to increase at day 4 of G-CSF mobilization, and reached the peak at day 5, which was significantly higher than that of control group (P<0.05). There was no distinct difference in the expression of HIF-1α mRNA between bone marrow nucleated cells and osteoblasts of steady-state mice (P=0.073), while OCN mRNA was mainly expressed in osteoblasts, which was higher than that in bone marrow nucleated cells (P=0.034). After mobilization, the expression level of HIF-1α increased, but OCN decreased, and the number of endosteum osteoblasts decreased. The change of HIF-1α expression was later than that of OCN and was consistent with the proportion of LSK cells in peripheral blood.@*CONCLUSION@#The expression of HIF-1α in bone marrow was increased during the mobilization of HSC mediated by G-CSF, and one of the mechanisms may be related to the peripheral migration of HSC induced by osteoblasts inhibition.

Carboxylesterase 1 family knockout alters drug disposition and lipid metabolism

The mammalian carboxylesterase 1 (Ces1/CES1) family comprises several enzymes that hydrolyze many xenobiotic chemicals and endogenous lipids. To investigate the pharmacological and physiological roles of Ces1/CES1, we generated Ces1 cluster knockout (Ces1 -/- ) mice, and a hepatic human CES1 transgenic model in the Ces1 -/- background (TgCES1). Ces1 -/- mice displayed profoundly decreased conversion of the anticancer prodrug irinotecan to SN-38 in plasma and tissues. TgCES1 mice exhibited enhanced metabolism of irinotecan to SN-38 in liver and kidney. Ces1 and hCES1 activity increased irinotecan toxicity, likely by enhancing the formation of pharmacodynamically active SN-38. Ces1 -/- mice also showed markedly increased capecitabine plasma exposure, which was moderately decreased in TgCES1 mice. Ces1 -/- mice were overweight with increased adipose tissue, white adipose tissue inflammation (in males), a higher lipid load in brown adipose tissue, and impaired blood glucose tolerance (in males). These phenotypes were mostly reversed in TgCES1 mice. TgCES1 mice displayed increased triglyceride secretion from liver to plasma, together with higher triglyceride levels in the male liver. These results indicate that the carboxylesterase 1 family plays essential roles in drug and lipid metabolism and detoxification. Ces1 -/- and TgCES1 mice will provide excellent tools for further study of the in vivo functions of Ces1/CES1 enzymes.

The Awareness, Practice and Perception of InstrumentAssisted Soft Tissue Mobilization (IASTM) among Malaysian Physiotherapists

@#Introduction: Instrument-assisted soft tissue mobilization (IASTM) is a relatively recent method that has been shown to help reduce muscular tension, increase flexibility and prevent tissue adhesion. Nevertheless, there is a paucity of awareness and knowledge about the benefits of IASTM, especially following injury rehabilitation, despite its many advantages. The study aimed to investigate the awareness, practice and perception of instrument- assisted soft tissue mobilization (IASTM) among Malaysian physiotherapists (PTs). Methods: The cross-sectional study included 133 PTs who answered an online questionnaire via a google link on their awareness and perception of IASTM in their practice. The Google link was given to the participants through email and the official Malaysian Physiotherapy (MPA) social media group. Results: Majority of the respondents (73.7%) are aware of IASTM technique. Despite being aware on IASTM, 74.4% of respondents reported not practicing the technique. Furthermore, 73.7% of respondents stated that the main reason they don’t practice is because fingers have better force adjustment than IASTM. Over 80% of respondents revealed that practicing IASTM can save energy and convenient during myofascial release. Moreover, 82.7 % of respondents stated that one of the benefits of IASTM for PTs is that it helps alleviate stress on fingers and wrists during soft tissue mobilization. Beyond 55% of respondents stated that they will incorporate IASTM in practice in near future. Conclusion: According to the findings, the majority of Malaysian physiotherapists are aware of the IASTM. However, fewer than half of respondents declined to incorporate it into their future practice due to the PTs preference for feeling the patient’s muscle texture. More emphasis can be given to the IASTM techniques among the PTs as the participants have mentioned that IASTM has better force exertion and saves energy when applying soft tissue massage.

Study on the effect of early mobilization in oral cancer patients who have undergone free flap reconstruction / 中国实用护理杂志

Objective:To explore an early mobilization plan for oral cancer patients after free flap reconstruction and evaluate the application effect of the plan.Methods:This study was a prospective randomized controlled trial. A total of 173 patients undergoing free flap reconstruction surgery from December 2018 to December 2021 in the second ward of Peking University School and Hospital of Stomatology were selected. The patients were randomly divided into the control group (87 cases) and the intervention group (86 cases) by cluster randomized grouping. The control group received the routine nursing plan, that was, head immobilization for 4 days after surgery, and patients performed sat up and off-bed activity on the 5th day. The intervention group received the early mobilization plan, that was, patients sat up on the 2nd day after surgery and performed off-bed activity on the 3rd day. The incidence of vascular compromise, postoperative complications, sleep time in the first 5 days after surgery, catheter removal time, hospitalization duration and expenses were compared between the two groups.Results:The incidence of postoperative pulmonary infection, the daily sleep time in the first 5 days after surgery, the time for removing nasogastric tube, trachea cannula, and urinary catheter were 7.0%(6/86), (5.0 ± 1.0) h/d, (11.8 ± 7.3) d, (6.1 ± 3.2) d, (3.6 ± 0.6) d in the intervention group, and 13.8%(12/87), (4.4 ± 1.3) h/d, (14.2 ± 5.8) d, (7.3 ± 1.7) d, (4.0 ± 0.9) d in the control group, all differences were statistically significant ( χ2 = 3.89, t values were -3.57 - -2.44, all P<0.05). There was no significant difference in the incidence of rascular compromise, hospitalization duration and expenses between the two groups (all P>0.05). Conclusions:For patients undergoing free tissue flap reconstruction, it is safe to sit up on the 2nd day and get out of bed on the 3rd day, which can reduce the incidence of pulmonary infection, improve patient sleep, and shorten the indwelling time of nasogastric tube, trachea cannula and urinary catheter.