Validity evidence for the Family Role Overload Scale

Role overload in the family can be understood as a feeling of inability to complete duties that are the individual's responsibility, and this hardship occurs due to the accumulation of tasks in the family, which can cause discomfort. The aim of this study was to obtain valid evidence of Family Role Overload in Brazilian samples. Six hundred and forty Brazilian workers of both genders took part in the study. Confirmatory factor analyses showed that the Brazilian version remained single-factor and had six items. The multi-group analyses showed configural, metric, and scalar invariance between the groups divided in terms of gender and the existence or absence of children. The scale showed positive correlations with perceived family demands and family-work conflict and a negative correlation with perceived social support in the family. It was therefore concluded that the instrument had psychometric properties that recommend its use in future research.

A sobrecarga de papeis na família pode ser compreendida como sentimento de incapacidade em concluir obrigações que são de responsabilidade do indivíduo, e essa dificuldade acontece devido ao acúmulo de tarefas na família, que podem trazer desconforto. O presente trabalho teve por objetivo obter evidências de validade da Sobrecarga de Papéis na Família em amostras brasileiras. Participaram do estudo 640 trabalhadores brasileiros, de ambos os gêneros. As análises fatoriais confirmatórias evidenciaram que a versão brasileira se manteve unifatorial e com seis itens. As análises multigrupo atestaram a invariância configural, métrica e escalar entre os grupos divididos em termos de gênero e sobre a presença ou ausência de filhos. A escala apresentou correlações positivas com demandas percebidas da família e conflito família-trabalho e correlação negativa com suporte social percebido na família. Concluiu-se, assim, que o instrumento apresentou propriedades psicométricas que recomendam seu uso em investigações futuras.

La sobrecarga de rol en la familia puede ser entendida como un sentimiento de incapacidad para completar las obligaciones que son responsabilidad del individuo, y esta dificultad ocurre debido a la acumulación de tareas en la familia, lo que puede causar malestar. El objetivo de este estudio fue obtener evidencias de la validez de la Escala de Sobrecarga del Rol Familiar en muestras brasileñas. Participaron en el estudio 640 trabajadores brasileños de ambos sexos. Los análisis factoriales confirmatorios mostraron que la versión brasileña se mantuvo monofactorial y con seis ítems. Los análisis multigrupo mostraron invariancia configuracional, métrica y escalar entre los grupos divididos en función del género y de la presencia o ausencia de hijos. La escala mostró correlaciones positivas con las demandas familiares percibidas y el conflicto familia-trabajo y una correlación negativa con el apoyo social percibido en la familia. Por lo tanto, se concluyó que el instrumento posee propiedades psicométricas que recomiendan su uso en futuras investigaciones.

Bienestar psicológico, apoyo social y sobrecarga en los progenitores de hijos con discapacidad / Psychological well-being, social support and overload in parents of children with disabilities

Resumen: Objetivo: Establecer la relación entre el bienestar psicológico, apoyo social percibido y sobrecarga en los cuidadores de hijos con alguna condición de desarrollo o discapacidad, conociendo la influencia de algunas variables sociodemográficas en los resultados de las variables psicológicas. Método: Se efectúo un estudio cuantitativo correlacional-transversal y un muestreo aleatorio simple. La muestra fue de 83 cuidadores de niños con alguna condición de desarrollo o discapacidad, quienes cumplimentaron la Escala de Bienestar Psicológico de Ryff, la escala Multidimensional de Apoyo Social Percibido (MSPSS) y el cuestionario de Sobrecarga del Cuidador de Zarit. Resultados: Los resultados revelan una correlación positiva entre las dimensiones bienestar psicológico y apoyo social, la dimensión sobrecarga del cuidador se correlaciona negativamente con estas dos variables psicológicas. Asimismo, se identificaron cambios significativos en las variables psicológicas al incorporar factores sociodemográficos del cuidador, incluyendo el género, la situación actual y la edad, así como aspectos asociados al menor, como su edad, género, tipo de discapacidad y el tiempo transcurrido desde el diagnóstico. Conclusión: El grado de apoyo social informal que perciben los cuidadores de hijos con discapacidad permite lograr un óptimo bienestar psicológico ya que determina la existencia o no de sobrecarga. Algunas variables sociodemográficas parecen influir en la experiencia de estos cuidadores.

Abstract: Objective: To establish the relationship between psychological well-being, perceived social support and overload in caregivers of children with some developmental condition or disability, knowing the influence of some sociodemographic variables on the results of the psychological variables. Methods: A quantitative correlational-cross-sectional study and simple random sampling were carried out. The sample consisted of 83 caregivers of children with some developmental condition or disability, who completed the Ryff Psychological Well-Being Scale, the Multidimensional Scale of Perceived Social Support (MSPSS) and the Zarit Caregiver Overload questionnaire. Results: The results reveal a positive correlation between the dimensions of psychological well-being and social support; the caregiver overload dimension correlates negatively with these two psychological variables. Significant changes in the psychological variables were also identified when incorporating sociodemographic factors of the caregiver, such as gender, current situation and age, as well as aspects associated with the child, such as age, gender, type of disability and time since diagnosis. Discussions: The degree of informal social support perceived by caregivers of children with disabilities allows achieving an optimal psychological well-being since it determines the existence or not of overload. Some sociodemographic variables seem to influence the experience of these caregivers.

Descripción de necesidades sobre capacitación en una población de cuidadores de pacientes con dependencia severa en el contexto del CESFAM Madre Teresa de Calcuta

Introducción: el envejecimiento poblacional, junto al aumento de enfermedades crónicas no transmisibles han llevado a un incremento en la prevalencia de las personas en situación de dependencia severa, requiriendo que familiares, amigos o vecinos asuman roles de cuidadores. Este estudio se enfoca en identificar a la población de cuidadores de personas con dependencia severa y facilitar su adherencia en programas de capacitación para en un Centro de Salud Familiar (CESFAM) en Puente Alto, Santiago de Chile. Métodos: se detectaron 82 cuidadores de pacientes con dependencia severa, de los cuales 47 seguían siendo cuidadores activos. Se encuestó telefónicamente a 35 cuidadores de pacientes con dependencia severa. Se recopiló información sobre acceso a internet, tiempo disponible y conocimiento sobre la disponibilidad de capacitaciones. Además, se evaluó el nivel de sobrecarga en los cuidadores utilizando la escala de Zarit abreviada (EZA). Resultados: el 83% de los cuidadores encuestados tenía acceso a internet, aunque se identificaron barreras como la falta de tiempo y conocimiento sobre las capacitaciones disponibles. Se encontró que el 62,8% de los cuidadores experimentaba sobrecarga severa. Estos resultados sugieren la falta de mecanismos para el cuidado de pacientes dependientes y la necesidad de facilitar la participación en programas de capacitación. Conclusiones: el estudio ofrece una breve representación sobre los cuidadores de personas con dependencia severa en un contexto de atención primaria. Se concluye que se requieren intervenciones multidisciplinarias para acercar instancias de capacitación y optimizar el cuidado del cuidador. Como parte de estas intervenciones, se desarrolló un manual del cuidador que servirá como recurso para el equipo de salud del CESFAM Madre Teresa de Calcuta, con el fin de brindar apoyo efectivo a los cuidadores.

Introduction: Population aging and the increase in non-communicable chronic diseases have led to a rise in severe dependency, requiring that family members, friends, or neighbors take on caregiving roles. This study focuses on improving participation in training programs for caregivers of individuals with severe dependency at a Family Health Center (CESFAM) in Puente Alto, Santiago, Chile. Methods: To characterize this population and determine barriers to accessing distance training, 35 caregivers of patients with severe dependency were contacted by phone. All the information was gathered on internet access, available time, and awareness of training availability. Additionally, caregiver burden levels were evaluated using de abbreviated Zarit scale (EZA). Results: 83% of surveyed caregivers had internet access, although barriers such as lack of time and knowledge about available training were identified, and 62.8% of caregivers experienced severe burdens. These results highlight the need for interventions to facilitate participation in training programs and improve the care provided by caregivers. Conclusions: The study provides a specific insight into caregivers of individuals with severe dependency in a primary care context. Multidisciplinary interventions are required to bring training opportunities closer and optimize caregiver support. As part of these interventions, a caregiver manual was created to serve as a resource for the CESFAM Madre Teresa de Calcuta health team, aiming to provide adequate support to caregivers.

Is Iron Overload Associated with Worse Outcomes in Patients with Chronic Liver Disease Undergoing Liver Transplantation?

ABSTRACT Background: Iron overload is frequent in patients with chronic liver disease, associated with shorter survival after liver transplantation in patients with hereditary hemochromatosis. Its effect on patients without hereditary hemochromatosis is unclear. The aim of the study was to study the clinical impact of iron overload in patients who underwent liver transplantation at an academic tertiary referral center. Methods: We performed a retrospective cohort study including all patients without hereditary hemochromatosis who underwent liver transplantation from 2015 to 2017 at an academic tertiary referral center in Mexico City. Explant liver biopsies were reprocessed to obtain the histochemical hepatic iron index, considering a score ≥ 0.15 as iron overload. Baseline characteristics were compared between patients with and without iron overload. Survival was estimated using the Kaplan-Meier method, compared with the log-rank test and the Cox proportional hazards model. Results: Of 105 patients included, 45% had iron overload. Viral and metabolic etiologies, alcohol consumption, and obesity were more frequent in patients with iron overload than in those without iron overload (43% vs. 21%, 32% vs. 22%, p = 0.011; 34% vs. 9%, p = 0.001; and 32% vs. 12%, p = 0.013, respectively). Eight patients died within 90 days after liver transplantation (one with iron overload). Complication rate was higher in patients with iron overload versus those without iron overload (223 vs. 93 events/100 person-months; median time to any complication of 2 vs. 3 days, p = 0.043), without differences in complication type. Fatality rate was lower in patients with iron overload versus those without iron overload (0.7 vs. 4.5 deaths/100 person-months, p = 0.055). Conclusion: Detecting iron overload might identify patients at risk of early complications after liver transplantation. Further studies are required to understand the role of iron overload in survival.

Role of serum hepcidin as a marker of iron overload in beta thalassemia major

Background: Beta thalassemia major (BTM) is the most common hemolytic anemia. Regular blood transfusion is a basic treatment modality, recurrent blood transfusion which leads to iron overload and its complications. Hepcidin hormone is found to be a key regulator of iron homeostasis and is significantly increased in children of BTM with iron overload. The main objective of the study is to find out the role of serum hepcidin as a potential marker of iron overload in children with BTM, and to correlate the relationship between serum hepcidin and serum ferritin level in BTM children.Methods: This was a hospital based prospective observational study conducted at Indira Gandhi institute of child health for 12 months from January 2019 to December 2019. Included 100 children between age group of 2 months to 18 years diagnosed with BTM on blood transfusion and 50 age and sex matched healthy controls.Results: In the study group 70% children had >5 transfusions. The median serum hepcidin level (2.354 ng/ml) was significantly higher among those with higher number of total transfusions (>5 transfusions). In addition, hepcidin level showed good positive correlation with total number of transfusions (r=0.608, p<0.001). Also, serum hepcidin showed positive correlation with serum ferritin levels with 87% sensitivity and 88% specificity which was statistically significant (r=0.749, p<0.001).Conclusions: In the present study, BTM children who received >5 transfusions serum hepcidin level was significantly elevated and serum hepcidin showed positive correlation with serum ferritin levels. Thus, hepcidin can be considered as a potential marker of iron overload in patients with BTM.

Down-regulating GSK3β alleviates hypoxia/reoxygenation-induced injury of senescent renal tubular epithelial cells by inhibiting the function of ITPR1-GRP75-VDAC1 complex / 器官移植

<b>Objective</b> To evaluate the effect of glycogen synthase kinase 3β (GSK3β) on hypoxia/reoxygenation (H/R)-induced injury of senescent renal tubular epithelial cell (RTEC) in aged mice and its regulatory mechanism. <b>Methods</b> RTEC were divided into the Young group (young RTEC with normal growth), Old group (aged RTEC induced by Etoposide), Old+Ad-shNC+H/R group [aged RTEC induced by Etoposide and then transfected with adenovirus negative control (Ad-shNC) for H/R treatment], and Old+Ad-shGSK3β+H/R group (aged RTEC induced by Etoposide and then transfected with short-hairpin RNA-expressing adenovirus with targeted silencing GSK3β for H/R treatment), respectively. Apoptosis level and mitochondrial reactive oxygen species level were detected by flow cytometry. Calcium ion level was determined by immunofluorescence staining. The expression and phosphorylation levels of GSK3β, mitochondria-associated endoplasmic reticulum membrane (MAM)-related proteins of inositol 1,4,5-trisphosphate receptor1 (ITPR1), voltage dependent anion-selective channel 1(VDAC1) and glucose-regulated protein 75 (GRP75) were detected by Western blot. The interaction between GSK3β and MAM-related proteins was analyzed by immunoprecipitation. <b>Results</b> Compared with the Young group, the apoptosis, mitochondrial reactive oxygen species and mitochondrial calcium ion levels were higher in the Old group. Compared with the Old group, the apoptosis, mitochondrial reactive oxygen species and mitochondrial calcium ion levels were higher in the Old+Ad-shNC+H/R group. Compared with the Old+Ad-shNC+H/R group, the apoptosis, mitochondrial reactive oxygen species and mitochondrial calcium ion levels were lower in the Old+Ad-shGSK3β+H/R group, and the differences were statistically significant (all <i>P</i><0.05). Compared with the Young group, the expression levels of ITPR1, GRP75 and GSK3β proteins were up-regulated, the phosphorylation levels of ITPR1 and GRP75 were increased, whereas the total protein and phosphorylation levels of VDAC1 were decreased in the Old group. Compared with the Old group, the expression level of GSK3β protein was unchanged, the total protein and phosphorylation levels of ITPR1 and GRP75 were increased, the expression level of total VDAC1 protein remained unchanged and the phosphorylation level was increased in the Old+Ad-shNC+H/R group. Compared with the Old+Ad-shNC+H/R group, the expression level of GSK3β protein was decreased, the expression levels of total ITPR1, GRP75 and VDAC1 proteins were unchanged, whereas the phosphorylation levels were decreased in the Old+Ad-shGSK3β+H/R group. Immunoprecipitation showed that GSK3β could interact with ITPR1, GRP75 and VDAC1 proteins. <b>Conclusions</b> The expression level of GSK3β is up-regulated in senescent RTEC. Down-regulating GSK3β expression may reduce the phosphorylation level of ITPR1-GRP75-VDAC1 complex, constrain the overload of mitochondrial calcium ion, protect mitochondrial function and mitigate cell damage during reperfusion.

Research progress on the role of ferroptosis in the pathogenesis of non-alcoholic fatty liver disease / 基础医学与临床

Ferroptosis is a new type of cell death proposed in recent years,and its main characteristics are iron overload and lipid peroxidation.Ferroptosis is involved in the occurrence and development of non-alcoholic fatty liv-er disease(NAFLD).Iron overload can generate a large amount of reactive oxygen species through the Fenton reac-tion.Under the action of lipoxygenase,the unsaturated fatty acids on the liver cell membrane undergo lipid peroxi-dation,which induces liver cell death and leads to the occurrence of non-alcoholic fatty liver disease/non-alcoholic steatohepatitis.Blocking ferroptosis may provide one of the therapeutic strategies to protect liver cells.

Application value of venous excess ultrasound score (VExUS Score) in patients with sepsis complicated acute kidney injury / 中华急诊医学杂志

Objective:To evaluate the effect of venous excess ultrasound score (VExUS Score) in the acute kidney injury(AKI) in Patients with sepsis, so as to reduce the risk of disease and improve the prognosis of patients.Methods:This experiment was a single-center prospective cohort study. Include septic patients with AKI who were admitted to the Department of Emergency Intensive Care Unit of the First Affiliated Hospital of Anhui Medical University from February 2022 to February 2023, Those with inadequate window, inferior vena cava (IVC) thrombus, age<18 years and known case of cirrhosis with portal hypertension were excluded from the study. Patients underwent ultrasound examination with serial determination till AKI resolved or patient is initiated on dialysis.Results:Totally 86 patients were enrolled for the study. The mean age was (60.43±15.48) with 50 (58.1%) males. Mean sequential organ failure assessment (SOFA) score was (6.23±1.87). 38 patients (44.2%) were in AKI stage 1, while 24 patients (27.9%) were in AKI stage 2 and stage 3 each. 52 patients (60.5%) had VExUS grade Ⅲ. Resolution of AKI injury showed significant correlation with improvement in VExUS grade ( p value 0.003). Similarly, there was significant association between changes in VExUS grade and fluid balance ( p value 0.005). There was no correlation between central venous pressure (CVP), left ventricular function, and right ventricular function with change in VExUS grade. Conclusions:The study shows a significant correlation between the VExUS Score and AKI staging, With improvement in kidney function, there is decline in the VExUS grade as well. Moreover VExUS Score might reliably demonstrate venous congestion and aid in the clinical decision to perform fluid removal.

Iron overload regulates atherosclerotic activity of foam cells induced by oxLDL / 实用医学杂志

Objective To explore the roles of iron overload in pro-atherogenic activation of foam cells.Methods RAW264.7 and MOVAS cells were stimulated by oxLDL,ferrimine citrate and deferoxamine respectively.Prussian Blue and Oil Red O staining were used to detect iron deposition and foam cell.CCK-8 test,DHE probe,ELISA,RT-qPCR were performed to detect the cell death rate,reactive oxygen species(ROS)generation,lipid peroxidation molecules[glutathione peroxidase(GSH),glutathione peroxidase 4(GPX4),malondialdehyde(MDA)content]and the mRNA level of ATP binding cassette transporter A1(ABCA1),ATP binding cassette transporter G1(ABCG1),inductible nitris oxide synthase(iNOS),arginase-1(Arg-1),α-smooth muscle actin(α-SMA),smooth muscle 22 alpha(SM22a),osteopontin(OPN),Interleukin-1β(IL-1β),tumor necrosis factor-α(TNF-α).Results Iron overload could reduced reverse cholesterol transporters(ABCA1 and ABCG1),promote foam cells generation,increased cell death rate,induced the expression of lipid peroxidation molecules(GSH,GPX4,MDA),and promoted pro-inflammatory M1 marker of macrophage and synthetic marker expression of vascular smooth muscle cell(VSMC)and inflammatory cytokines(IL-1β,TNF-α).Conclusion Iron overload promotes the generation of foam cells derived from macrophages and smooth muscle cells and transform them into pro-atherosclerotic phenotype,aggravates cell lipid peroxidation and inflammatory reaction,which contributes to the progress of atherosclerosis.

The Role of TGF-β1/Smads Signaling Pathway in Anti-myocardial Fibrosis Effect of SIRT1 and Related Mechanism / 华中科技大学学报(医学版)

Objective To observe the effect of sirtuin 1(SIRT1)on rat myocardial fibrosis induced by pressure overload and the proliferation of cardiac fibroblasts induced by angiotensin Ⅱ(Ang Ⅱ),and to explore the molecular mechanisms.Methods The pressure overload-induced myocardial fibrosis was established by abdominal aorta constriction(AAC)procedure in vi-vo.After treatment with SIRT1 activator,the myocardial interstitial fibrosis and the collagen volume fraction were evaluated by Masson's trichrome staining.The protein expressions of TGF-β1/Smads were determined by immunohistochemical analy-sis.After in vitro intervention of Ang Ⅱ or Ang Ⅱ with SIRT1 activator,the fibroblasts proliferation was detected by MTT as-say.The mRNA and protein expressions of collagen Ⅰ/Ⅲ(Col1α1/3α1),SIRT1 and TGF-β1/Smads in myocardial tissue and fi-broblasts were evaluated by qRT-PCR and Western blotting.Results Compared with the sham operation group,myocardial in-terstitial fibrosis was significantly observed in the pressure overload model group,myocardial collagen volume fraction was in-creased,expressions of Col1α1/3α1 and TGF-β1/Smads were significantly increased,and SIRT1 expression was decreased.After the intervention of SRT1720,SIRT1 activator could improve the myocardial interstitial fibrosis induced by pressure overload,downregulate the expressions of Col1α1/3α1 and TGF-β1/Smads,and upregulate the expression of SIRT1.Meanwhile,correla-tion analysis showed that the protein expression of SIRT1 was negatively correlated with the expression of TGF-β1.In addition,SRT1720 also inhibited Ang Ⅱ-induced fibroblast proliferation and increased expression of Col1α1/3α1 and TGF-β1.Conclusion Activation of SIRT1 inhibits pressure overload-induced myocardial fibrosis and Ang Ⅱ-induced fibroblasts proliferation via regu-lation of the TGF-β1/Smads signaling pathway.

An insight into the mechanism of iron overload in knee osteoarthritis under the theory of blood stasis / 中国组织工程研究

BACKGROUND:Knee osteoarthritis is a common disease in middle-aged and elderly people.It is a kind of disease that seriously affects the quality of life of patients and even has the risk of disability.Therefore,the pathogenesis and treatment of knee osteoarthritis have become the focus of research.In Chinese medicine,knee osteoarthritis is often treated as"biness,"which is closely related to"biness"caused by blood stasis and blood vessels blocking collaterals in the theory of"blood stasis"in traditional Chinese medicine.Iron overload is a kind of pathological state caused by iron metabolism disorder,which highly coincides with the pathogenic characteristics and clinical manifestations of the"blood stasis"theory of traditional Chinese medicine,and is a risk factor that promotes the development of knee osteoarthritis. OBJECTIVE:Based on the"blood stasis"theory,to summarize the effects of iron overload on cartilage metabolism and subchondral bone reconstruction,to lay a new theoretical foundation for the treatment of knee osteoarthritis with traditional Chinese medicine,and to explore the therapeutic effect of traditional Chinese medicine for promoting blood circulation after interfering with bone tissue. METHODS:CNKI,WanFang database,PubMed and Web of Science databases were searched for relevant literature.The Chinese search terms were"ferroptosis,iron,iron overload,osteoarthritis,blood stasis"and the English search terms were"ferroptosis,iron,iron overload,osteoarthritis,TCM."In the end,76 articles were included for further review. RESULTS AND CONCLUSION:First of all,we explored the potential of the"blood stasis"theory in treating knee osteoarthritis,and found that"blood stasis"is a crucial part in the progress of knee osteoarthritis,indicating that the"blood stasis"theory is the key to the treatment of knee osteoarthritis in traditional Chinese medicine.Secondly,"blood stasis"and iron overload have a high degree of similarity in pathogenic factors,clinical manifestations,and pathogenic characteristics,suggesting the possibility of"blood stasis"theory in treating iron overload.This finding reminds us that iron overload may be an important mechanistic basis for the"blood stasis"theory in the treatment of knee osteoarthritis.The extracts of blood-activating drugs can relieve iron overload and treat knee osteoarthritis,but the specific mechanism is still unclear.Therefore,we believe that the relationship between"blood stasis"theory and iron overload and related mechanisms are important research directions for knee osteoarthritis in the future.The related mechanism of"blood stasis"theory to alleviate iron overload and then treat knee osteoarthritis also provides a theoretical basis for the modernization of traditional Chinese medicine,such as the development of new drugs and innovative usage,and has certain guiding significance for clinical practice.

Application of deferoxamine in bone tissue regeneration / 中国组织工程研究

BACKGROUND:Aside from iron chelating,deferoxamine is also considered as an effective hypoxia mimetic agent and hypoxia inducible factor-1α stabilizer.Deferoxamine has played a favorable effect on bone regeneration in both basic and clinical research recently.Deferoxamine solutions or deferoxamine loaded bio-scaffolds have been locally applied in bone tissue engineering,and their promotion of bone repair involves various functional properties and molecular mechanisms which have not been entirely clarified.Moreover,their advances in research of bone regeneration lack comprehensive summary as well. OBJECTIVE:To review the functional properties,relative merits and advances in basic research and clinical practice of deferoxamine applied in bone regeneration,attempting to provide references and strategies for further studies. METHODS:Relevant articles were searched with the key words of"deferoxamine OR desferrioxamine OR desferal OR DFO,""bone tissue engineering OR bone regeneration OR bone remodeling OR bone repair OR bone healing OR osteogenesis,""angiogenesis OR vascularized bone regeneration OR angiogenic-osteogenic coupling"in English and Chinese by using PubMed,WanFang and CNKI databases.Eventually,88 articles were selected for review. RESULTS AND CONCLUSION:Deferoxamine can recruit stem cells and regulate their function,activate relevant signaling pathways to advance hypoxia adaptation of the cells,exert anti-inflammatory and antioxidant properties to improve local inflammatory environment,and promote bone regeneration by coupling osteogenesis and angiogenesis as well as inhibiting bone resorption.Compared with growth factors or peptides loaded in conventional bone tissue engineering,deferoxamine has its unique advantages as a small molecule drug,while it also has toxic reactions and application limitations.Therefore,it is necessary to optimize its loading form and dosagey.The unique angiogenic-osteogenic coupling ability of deferoxamine can be used in different types of bone injuries including fractures,osteonecrosis,distraction osteogenesis,bone grafting,oral related osteogenesis,and bone defects.Due to the enhancement of angiogenesis,this ability enables deferoxamine to better adapt and solve the difficulties in bone repair caused by the complex and variable clinical situations and individual differences.However,it is also necessary to compare and optimize the application methods and safe dosage of deferoxamine to expand its application scope and enhance its clinical value.

Shear wave elastography for evaluating hepatic iron overload in children with β-thalassemia major:Correlations with MR T2* value and serum ferritin / 中国医学影像技术

Objective To observe the value of shear wave elastography(SWE)for evaluating hepatic iron overload in children with β-thalassemia major(β-TM),as well as the correlations of relative parameters with MR T2*value and serum ferritin.Methods Totally 96 children with β-TM and 100 healthy children(control group)were retrospectively enrolled.Children with β-TM were divided into hematopoietic stem cell transplantation(HSCT)group(n=41)or non-HSCT group(n=55)according to underwent HSCT or not.SWE parameters were compared among groups.Spearman correlation was performed to observe the correlations of liver shear wave velocity with MR T2*value and serum ferritin,as well as Young's modulus with MR T2*value and serum ferritin in children with β-TM.Results Liver shear wave velocity(LSWV)and Young's modulus in HSCT group and non-HSCT group were all higher than those in control group(all P＜0.001).No significant difference of LSWV nor Young's modulus was found between HSCT group and non-HSCT group(both P＞0.05).SWE parameters of children with β-TM were moderately and negatively correlated with MR T2*value(r=-0.501,P＜0.05;r=-0.514,P＜0.05),while weakly and positively correlated with serum ferritin(r=0.488,P＜0.05;r=0.470,P＜0.05).Conclusion SWE was helpful for evaluating hepatic iron overload in children with β-TM,with parameters being negatively correlated with MR T2*value and positively correlated with serum ferritin.

Down-regulating XBP1s alleviates hypoxia/reoxygenation injury of renal tubular epithelial cells by inhibiting ITPR-mediated mitochondrial dysfunction / 器官移植

Objective To evaluate the effect of spliced X-box binding protein 1 (XBP1s) on hypoxia/reoxygenation (H/R) injury of mouse renal tubular epithelial cells and unravel underlying mechanism. Methods Mouse renal tubular epithelial cells were divided into adenovirus negative control group (Ad-shNC group), targeted silencing XBP1s adenovirus group (Ad-shXBP1s group), Ad-shNC+H/R group and Ad-shXBP1s+H/R group. The apoptosis level, mitochondrial reactive oxygen activity, mitochondrial membrane potential and mitochondrial calcium ion level were detected in each group. Chromatin immunocoprecipitation followed by sequencing (ChIP-seq) was employed to analyze the binding sites of XBP1s in regulating the inositol 1,4,5-trisphosphate receptor (ITPR) family. The expression levels of XBP1s and ITPR family messenger RNA (mRNA) and protein were determined in each group. Results Compared with the Ad-shNC group, the apoptosis level was higher, mitochondrial reactive oxygen species level was increased, mitochondrial membrane potential was decreased and mitochondrial calcium ion level was elevated in the Ad-shNC+H/R group. Compared with the Ad-shNC+H/R group, the apoptosis level was lower, mitochondrial reactive oxygen species level was decreased, mitochondrial membrane potential was elevated, and mitochondrial calcium ion level was decreased in the Ad-shXBP1s+H/R group (all P<0.05). Compared with the Ad-shNC group, relative expression levels of XBP1s, ITPR1, ITPR2 and ITPR3 mRNAs and proteins were down-regulated in the Ad-shXBP1s group (all P<0.05). Compared with the Ad-shNC group, relative expression levels of XBP1s, ITPR1, ITPR2 and ITPR3 proteins were up-regulated in the Ad-shNC+H/R group. Compared with the Ad-shNC+H/R group, relative expression levels of XBP1s, ITPR1, ITPR2 and ITPR3 were down-regulated in the Ad-shXBP1s+H/R group (all P<0.05). ChIP-seq results showed that XBP1s could bind to the promoter and exon of ITPR1, the exon of ITPR2, and the exon of ITPR3. Conclusions XBP1s may affect mitochondria-associated endoplasmic reticulum membrane structure and function by directly regulating ITPR transcription and translation. Down-regulating XBP1s may inhibit ITPR expression and mitigate mitochondrial damage.

The evaluation value of serum PTX3 and CK-MB levels on volume load in patients with chronic decompensated heart failure / 中国医师杂志

Objective:To explore the evaluation value of serum levels of positive pentameric protein 3 (PTX3) and creatine kinase isoenzyme MB (CK-MB) on volume load in patients with chronic decompensated heart failure (CDHF).Methods:A total of 300 CDHF patients who visited the Xingtai Central Hospital from July 2019 to July 2022 were selected and divided into a capacity overload group ( n=182) and a non capacity overload group ( n=118) based on their capacity balance level. Two clinical data sets were compared and analyzed. The receiver operating characteristic (ROC) curve was used to analyze the evaluation value of serum PTX3 and CK-MB levels on the volume load of CDHF patients. The clinical disease characteristics of the two groups of patients were analyzed using univariate analysis, and the influencing factors of volume load of CDHF patients were analyzed using logistic regression. A column chart model was constructed and validated. Results:The body mass index (BMI), waist circumference, systolic blood pressure, diastolic blood pressure, fasting blood glucose (FBG), glycosylated hemoglobin (HbA 1c), C-reactive protein (CRP), uric acid (UA), homeostasis model assessment of insulin resistance (HOMA-IR) of patients in the capacity overload group were higher than those in the non-capacity overload group, and the differences were statistically significant (all P<0.05). The PTX3, CK-MB, pulmonary capillary wedge pressure (PCWP), and CVP levels of patients in the capacity overload group were higher than those in the non-capacity overload group, while albumin, hemoglobin, and hematocrit were lower than those in the non-capacity overload group, and the differences were statistically significant (all P<0.05). The ROC curve showed that the area under the curve (AUC) of PTX3 and CK-MB for predicting capacity overload in CDHF patients are 0.795 and 0.718, with sensitivity of 86.2% and 83.7%, specificity of 65.4% and 68.6%, respectively, indicating high predictive accuracy; The AUC of the two joint predictions is 0.817, the sensitivity was 92.5%, and the specificity was 70.6%. The prediction accuracy was higher than PTX3 ( Z=3.812, P<0.05) and CK-MB ( Z=3.365, P<0.05). PTX3, CK-MB, albumin, hemoglobin, hematocrit, PCWP, and central venous pressure (CVP) were all influencing factors of volume load status in CDHF patients (all P<0.05). The column chart risk prediction model established based on these factors had high accuracy and strong applicability in clinical treatment. Conclusions:Serum PTX3 and CK-MB levels are influencing factors for volume overload in CDHF patients. A column chart model constructed in combination with indicators such as albumin, hemoglobin, hematocrit, PCWP, and CVP has high predictive value for the volume overload status of CDHF.

Effect of heparin-binding protein on vascular permeability in patients with sepsis / 中国现代医生

@#Objective To investigate the correlation between heparin-binding protein(HBP)and vascular permeability in patients with sepsis.Methods Four hundred infected patients admitted to Affiliated Jinhua Hospital Zhejiang University School of Medicine from November 2019 to November 2022 were retrospectively selected and divided into sepsis group(n=190)and non-sepsis group(n=210)according to whether they were diagnosed with sepsis or not.HBP,the difference between hematocrit(HCT)and serum albumin(ALB)(HCT-ALB)and percentage of fluid overload were compared between two groups.Pearson method was used to analyze the correlation between HBP,HCT-ALB and percentage of liquid overload.Results HBP,HCT-ALB and percentages of fluid overload in sepsis group were significantly higher than those in non-sepsis group(P<0.05).Pearson correlation analysis showed that serum HBP level was positively correlated with HCT-ALB and percentage of fluid overload 24h after admission(P<0.05).Conclusion Increased vascular permeability in patients with sepsis may be related to the high level of HBP released by neutrophils stimulated by bacterial toxins.

Evaluación integral de la congestión en insuficiencia cardíaca / Comprehensive assessment of congestion in heart failure

Resumen La interacción compleja, heterogénea y dinámica entre los compartimentos de líquido intersticial e intra vascular es una de las principales razones que explican la amplia variabilidad en la distribución y gravedad de la congestión entre los pacientes con insuficiencia cardíaca descompensada. La "congestión hemodinámica" suele pasar desapercibida clínicamente; en oposición a la "congestión clínica", que ocurre más tarde y se evidencia por disnea y ortopnea, estertores pulmonares, edema pe riférico y distensión venosa yugular. Los signos clínicos, la radiografía de tórax, el péptido natriurético cerebral (brain natriuretic peptide o BNP) o la porción terminal N del pro BNP (NT-proBNP), la presión venosa central (PVC), el ecocardiograma, el diámetro de la vena cava inferior (VCI) y la presión de enclavamiento pulmonar son los elementos más utilizados para evaluar la congestión. Otras alternativas son el ultrasonido pulmonar y visceral (VEXUS), el CA 125 y otros marcadores y, recientemente, el sistema CardioMems.

Abstract The complex, heterogeneous, and dynamic interac tion between the interstitial and intravascular fluid compartments is one of the main reasons for the wide variability in the distribution and severity of congestion among patients with acute heart failure. The "hemody namic congestion" often goes undetected clinically; as opposed to "clinical congestion", which occurs later and is evidenced by dyspnea and orthopnea, rales, peripheral edema, and jugular venous distension. Clinical signs, chest X-ray, brain natriuretic peptide (BNP) or N-termi nal-proBNP (NT-proBNP), central venous pressure (CVP), echocardiogram, inferior vena cava (IVC) diameter, and pulmonary wedge pressure are the most commonly used elements to assess congestion. Other alternatives are pulmonary and visceral ultrasound (VEXUS), CA 125 and other markers, and recently, the CardioMems system.

Continuous renal replacement therapy during extracorporeal membrane oxygenation run: a questionary-based survey

Background: Extracorporeal membrane oxygenation is becoming a broadly available form of prolonged cardiopulmonary support. Given a higher risk of complications fluid overload and acute kidney injury with ECMO, its conjugation with renal replacement therapy is seems to be beneficial in correcting acid-base and electrolyte imbalance and fluid overload. ECMO with RRT is rarely used in Indian centers. This survey gathered expert’s opinion for routinely faced clinical questions related to ECMO run during RRT/Continuous RRT. Methods: This was a questionary-based survey wherein a structured questionnaire composed of seven questions about ECMO run during RRT/CRRT was mailed as Google form to randomly selected 23 physicians and their responses have been received within one month duration (November 2022 to December 2022). Results: Fluid overload (65.2%) and AKI (47.8%) were found to be the most common indications to put a patient on RRT while ECMO. Almost responders (36.4%) stated that 20-40% patients required RRT while on ECMO. Continuous venovenous hemodiafiltration (47.8%) was the most preferred choice of RRT while on ECMO. Hypotension (38.1%), electrolyte disturbance (14.3%), and hemolysis (23.8%) were the three most common complications in patient on CRRT with ECMO. Majority of the experts feel that introducing CRRT with ECMO circuit was moderately challenging. Conclusions: Clinicians should consider the early introduction of CRRT to address acute kidney injury and fluid overload in the ECMO population. With this survey, we would like to spread awareness among physicians about important aspect CRRT during ECMO.

Growth profile of children with beta-thalassemia major

Background: Retarded growth in thalassemic patient is complex and multi-factorial, it includes chronic hypoxia secondary to anemia when pre-transfusion haemoglobin is below 9 g/dl. Development of secondary sexual characteristics in thalassemic children is markedly delayed as compared to their non-thalassemic siblings and to the expected development criteria due to chronic hypoxia and iron overload. The main objective of the present study is to monitor the growth of these patients longitudinallyMethods: This was a observational, cross sectional field study in Pune, Maharashtra.Result: Patients with beta-thalassemia major on regular blood transfusions have growth failure, deranged liver function and hypocalcaemia in conjunction with high serum ferritin levels Conclusions: Beta thalassemia major, having the potential of leading to multisystemic complications, is a chronic disease that should be treated and followed-up by a multidisciplinary approach.

Clinico-Hematological Profile and Management of Children With Non-Transfusion Dependent Thalassemia (NTDT) at a Pediatric Center in Northern India

Objective: To study the clinico-hematological profile, complications, and management of children with non-transfusion dependent thalassemia (NTDT) in northern India. Method: We retrieved and analyzed the data of 69 children with NTDT diagnosed between January, 2006 to December, 2018, aged under 18 years from our unit’s records. Result: The participants mean (SD) age was 4.4 (3.1) years, and they presented with anemia (29%), jaundice (13%), hemolytic facies (13%), splenomegaly (87%), thromboembolism (2.9%) and pathological short stature (28.5%). The most common cause of NTDT was ?-thalassemia (45%), followed by either compound-heterozygous or homozygous for E?-thalassemia mutation. The most frequent single genotype observed was compound heterozygous for IVS1-5 (G>C) and codon 26 (G>A). The mean (SD) follow-up duration was 3.5 (2.4) years. On follow-up, 27 children (%) remained transfusion free, and 30 (%) needed occasional transfusions. 63% of patients initially presenting with pathological short stature showed improvement in growth. Amongst children older than 10 years (n=20), subclinical hypothyroidism was detected in 6 children and impaired glucose tolerance test in 1 child. Conclusion: Eß-thalassemia was the commonest cause of NTDT in this population.