Cytotoxic effects of crotoxin from Crotalus durissus terrificus snake in canine mammary tumor cell lines

Background: Mammary gland tumors are the most prevalent neoplasm in intact female dogs, and they are good natural models to study comparative oncology. Most canine mammary malignancies, as in women, are commonly refractory to conventional therapies and demand continuous new therapeutic approaches. Crotalus durissus terrificus, also called rattlesnake, has more than 60 different proteins in its venom with multiple pharmaceutical uses, such as antitumor, antiviral, and antimicrobial action. Crotoxin, a potent β-neurotoxin formed by the junction of two subunits, a basic subunit (CB-PLA2) and an acidic subunit (crotapotin), has already been reported to have anticancer properties in different types of cancers. Methods: In this work, we describe the cytotoxic potential of crotoxin and its subunits compared to doxorubicin (drug of choice) in two canine mammary carcinoma cell lines. Results: Crotoxin, CB-PLA2, crotalic venom, and doxorubicin decreased cell viability and the ability to migrate in a dose-dependent manner, and crotapotin did not present an antitumoral effect. For all compounds, the predominant cell death mechanism was apoptosis. In addition, crotoxin did not show toxicity in normal canine mammary gland cells. Conclusion: Therefore, this work showed that crotoxin and CB-PLA2 had cytotoxic activity, migration inhibition, and pro-apoptotic potential in canine mammary gland carcinoma cell lines, making their possible use in cancer research.

Comparison between the ion-specific electrode and SPADNS methods for analysis of fluoride concentration in the water supply

The maintenance of adequate fluoride (F) concentration in the public water supply is fundamental for ensuring that the community use of F can reach the maximum benefit for caries control and minimum risk for dental fluorosis. Thus, surveillance systems must use accurate and valid analytical methods to determine F concentration and, according to the literature, give preference to the ion-specific electrode (F- ISE) analysis. Aim: The objective of this study was to compare the accuracy of the ISE and SPADNS methods in the determination of the F concentration in the same water sample. Methods: Duplicate water samples were taken from 30 sampling sites in the municipality of Maringá, state of Paraná, monthly for 12 months, totaling 276 samples. An aliquot was analyzed by the FOP-UNICAMP Oral Biochemistry laboratory, using the F- ISE method, and the other one, by the SANEPAR laboratory in Maringá/PR, using the SPADNS method. Descriptive analysis and Pearson's correlation test were applied, with a significant level of p<0.05. Results: Results were expressed as ppm F (mg F/L), and a very strong positive correlation (r= 0.91; p<0.001) was detected between the two methods of analysis. Conclusion: Our findings suggest that the determination of f luoride concentration in water can be made with accuracy by the SPADNS method, a standardized analysis protocol

Modelos legislativos e sistemas de políticas esportivas:brasil e portugal em perspectiva comparada / Modelos legislativos y sistemas de política deportiva: brasil y portugal en perspectiva comparativa / Legislative models and sports policy systems: brazil and portugal in comparative perspective

Resumo Este artigo aborda as normas gerais do esporte no Brasil e Portugal a partir de uma perspectiva comparativa. Parte-se do pressuposto que o esporte deve ser foco de atenção estatal e das políticas públicas como estratégia de desenvolvimento da cidadania. O objetivo principal é analisar comparativamente a legislação esportiva de Brasil e Portugal, sobretudo os atos que estabeleceram as normas gerais para este setor em âmbito nacional. Para isso, realizou-se uma pesquisa descritivo-analítica de abordagem qualitativa e abrangência exploratória, organizada a partir de trabalho de campo e análise e tratamento do material empírico e documental. A análise de conteúdo dos documentos confirmou que no Brasil o financiamento é o tema de destaque na atuação normativa do Estado, ao passo que em Portugal o exercício regulatório é a principal preocupação. Nos dois países foi possível observar o impacto dos megaeventos na esfera legislativa, com a produção de atos excepcionais.

Resumen Este artículo aborda las reglas generales del deporte en Brasil y Portugal, desde una perspectiva comparada. Se parte del supuesto de que el deporte debe ser el foco de atención estatal y de las políticas públicas como estrategia de desarrollo de la ciudadanía. El objetivo principal es analizar comparativamente la legislación deportiva en Brasil y Portugal, especialmente las leyes que establecieron las reglas generales para este sector a nivel nacional. Para ello, se realizó una investigación descriptivo-analítica con enfoque cualitativo y alcance exploratorio, organizada a partir del trabajo de campo y el análisis y tratamiento de material empírico y documental. El análisis de contenido de los documentos confirmó que en Brasil el financiamiento es el tema principal en la acción normativa del Estado, mientras que en Portugal el ejercicio regulatorio es la principal preocupación. En ambos países se pudo observar el impacto de megaeventos en el ámbito legislativo, con la producción de actos excepcionales.

Abstract This article addresses the general rules of sport in Brazil and Portugal, from a comparative perspective. It starts from the assumption that sport should be the focus of state attention and public policies as a citizenship development strategy. The main objective is to comparatively analyze the sports legislation in Brazil and Portugal, especially the acts that established the general rules for this sector at the national level. For this, a descriptive-analytical research with a qualitative approach and exploratory scope was carried out, organized from field work and analysis and treatment of empirical and documental material. The content analysis of the documents confirmed that in Brazil financing is the main issue in the State's normative action, while in Portugal the regulatory exercise is the main concern. In both countries, it was possible to observe the impact of mega-events in the legislative sphere, with the production of exceptional acts.

A comparative analysis between Mexican and Chinese health systems / Un análisis comparativo entre los sistemas de salud de México y China

Abstract Objective: The comparative network analysis of national health macrosystems is an area whose academic development has not reached due relevance if its influence on decision-making related to the design of public health policies is considered; the establishment of comparative elements between two socially, economically and culturally distant countries, such as Mexico and China, is a complex process given the difficulty of locating equivalent evaluation indicators among some of its elements. Materials and methods: The present work reflects on the similarities and dissimilarities between the national health systems, with an impact on the care provided to the most vulnerable population segments, applying a comparative nodes and networks analysis considering social and economic factors. Results: The network analysis shows that, for practical purposes, the nodes considered in the Mexican health system is superior to those nodes identified in the Chinese health system in terms of quality, mainly in nodes such as convenience of the location, using cutting-edge technology in health institutions and the skill and competence of medical personnel; conversely, the Chinese system is superior to the Mexican in terms of efficiency, mainly involuntary co-payment insurance systems to reduce the catastrophic health expenditure of the vulnerable rural population. Conclusions: The conclusions drawn may serve for subsequent studies to identify opportunities for improvement, correlations and/or trends that could be implemented in the Mexican health system, once the pertinent feasibility studies have been carried out.

Resumen Objetivo: El análisis de redes comparativo de macrosistemas nacionales de salud es un ámbito cuyo desarrollo académico no ha alcanzado la relevancia debida si se considera su influencia en la toma de decisiones relativas al diseño de políticas de salud pública. Así, el establecimiento de elementos comparativos entre dos países social, económica y culturalmente distantes, como México y China, es un proceso complejo dada la dificultad de ubicar indicadores equivalentes de evaluación entre algunos de sus elementos. Materiales y método: El presente trabajo reflexiona sobre las similitudes y diferencias entre los mencionados sistemas nacionales de salud, con incidencia en la atención que se brinda a los segmentos poblacionales más vulnerables, aplicando un análisis comparativo de nodos y redes considerando factores sociales y económicos. Resultados: El análisis de red muestra que, para efectos prácticos, los nodos considerados en el sistema de salud mexicano son superiores a los nodos identificados en el sistema de salud chino en términos de calidad, principalmente en nodos como conveniencia de la ubicación, utilizando tecnología de punta en instituciones de salud y la habilidad y competencia del personal médico; Por el contrario, el sistema chino es superior al mexicano en términos de eficiencia, principalmente sistemas de seguro de copago involuntario para reducir el gasto catastrófico en salud de la población rural vulnerable. Conclusiones: Las conclusiones extraídas podrán servir a estudios posteriores para identificar oportunidades de mejora, correlaciones y/o tendencias que pudieran implementarse en el sistema mexicano de salud, una vez efectuados los estudios de viabilidad pertinentes.

Deep anterior lamellar keratoplasty versus penetrating keratoplasty: comparison of clinical outcomes in contralateral eyes / Ceratoplastia lamelar anterior profunda versus ceratoplastia penetrante: comparação dos resultados clínicos em olhos contralaterais

ABSTRACT Purpose: This study aimed to compare the clinical outcomes following deep anterior lamellar keratoplasty and penetrating keratoplasty in contralateral eyes of the same patients. Methods: In this retrospective, comparative case series, clinical outcome data included best-corrected visual acuity, refractive spherical equivalent, refractive astigmatism, endothelial cell density, endothelial cell loss, central corneal thickness, and intraocular pressure, which were evaluated at 6, 12, 24, and 36 months after deep anterior lamellar keratoplasty and penetrating keratoplasty. Additionally, complications were assessed. Results: Fifty-two eyes (26 patients) were included, of which 19 patients had keratoconus, 6 had stromal dystrophy, and 1 had post-laser-assisted in situ keratomileusis ectasia. The mean follow-up was 44.1 ± 10.5 months in the deep anterior lamellar keratoplasty Group and 47.9 ± 11.9 months in the penetrating keratoplasty Group. No significant differences were observed in the mean best-corrected visual acuity, refractive spherical equivalent, refractive astigmatism, and central corneal thickness between the deep anterior lamellar keratoplasty and penetrating keratoplasty Groups during follow-up. The endothelial cell density was significantly higher in the deep anterior lamellar keratoplasty Group than in the penetrating keratoplasty Group at 24 and 36 months postoperatively (p=0.022 and 0.013, respectively). Endothelial cell loss was significantly lower in the deep anterior lamellar keratoplasty Group than in the penetrating keratoplasty Group at 24 and 36 months postoperatively (p=0.025 and 0.001, respectively). Intraocular pressure was significantly lower in the deep anterior lamellar keratoplasty Group than in the penetrating keratoplasty Grroup at 6 months postoperatively (p=0.015). Microperforation occurred in 4 eyes (15%) during deep anterior lamellar keratoplasty surgery; however, penetrating keratoplasty was not required. No endothelial rejection occurred in the penetrating keratoplasty Group during follow-up. Conclusions: Over the 3-year follow-up, endothelial cell loss and intraocular pressure in the deep anterior lamellar keratoplasty Group were significantly lower than those in the penetrating keratoplasty Group, while visual and refractive results were similar.

RESUMO Objetivo: Este estudo teve como objetivo comparar os resultados clínicos após ceratoplastia lamelar anterior profunda e ceratoplastia penetrante nos olhos contralaterais dos mesmos pacientes. Métodos: Nesta série de casos comparativa e retrospectiva, avaliaram-se os seguintes dados de resultados clínicos: melhor acuidade visual corrigida, equivalente esférico refrativo, astigmatismo refrativo, densidade de células endoteliais, perda de células endoteliais, espessura central da córnea e pressão intraocular. Esses dados foram avaliados aos 6, 12, 24 e 36 meses após ceratoplastia lamelar anterior profunda e ceratoplastia penetrante. Também foram avaliadas as complicações. Resultados: Foram incluídos 52 olhos (26 pacientes), sendo que 19 pacientes apresentavam ceratocone, 6 apresentavam distrofia estromal e 1 apresentava ectasia após ceratomileuse in situ assistida por laser. O tempo médio de acompanhamento foi de 44,1 ± 10,5 meses no grupo da ceratoplastia lamelar anterior profunda e 47,9 ± 11,9 meses no grupo da ceratoplastia penetrante. Nenhuma diferença significativa foi observada nas médias da melhor acuidade visual corrigida, equivalente esférico refrativo, astigmatismo refrativo e espessura central da córnea entre os grupos da ceratoplastia lamelar anterior profunda e da ceratoplastia penetrante durante o acompanhamento. A densidade de células endoteliais foi significativamente maior no grupo da ceratoplastia lamelar anterior profunda que no grupo da ceratoplastia penetrante aos 24 e 36 meses de pós-operatório (p=0,022 e 0,013, respectivamente). A perda de células endoteliais foi significativamente menor no grupo da ceratoplastia lamelar anterior profunda que no grupo da ceratoplastia penetrante aos 24 e 36 meses de pós-operatório (p=0,025 e 0,001, respectivamente). A pressão intraocular foi significativamente menor no grupo da ceratoplastia lamelar anterior profunda que no grupo da ceratoplastia penetrante aos 6 meses de pós-operatório (p=0,015). Ocorreu microperfuração em 4 olhos (15%) durante a cirurgia de ceratoplastia lamelar anterior profunda; entretanto, a ceratoplastia penetrante não foi necessária. Não ocorreu nenhuma rejeição endotelial no grupo da ceratoplastia penetrante durante o período de acompanhamento. Conclusões: Durante o acompanhamento de 3 anos, a perda de células endoteliais e a pressão intraocular foram significativamente menores no grupo da ceratoplastia lamelar anterior profunda que no grupo da ceratoplastia penetrante, mas os resultados visuais e refrativos foram semelhantes.

Prevalencia de diabetes gestacional en Colombia: una revisión sistemática y estudio comparativo

Introducción: Las mujeres embarazadas con diabetes mellitus gestacional DMG tienen un mayor riesgo de tener resultados adversos materno-infantiles, debido a lo cual es importante estimar la prevalencia de DMG en Colombia de acuerdo con los criterios de la Asociación Internacional de Grupos de Estudio de Diabetes y Embarazo (IADPSG). Materiales y métodos: Se realizó una revisión sistemática mediante búsquedas en las bases de datos PubMed/Medline y Cochrane en inglés y español. La evaluación de la calidad se hizo mediante la metodología GRADE. Resultados: En la revisión sistemática se incluyó un total de 7 estudios con 37 795 participantes colombianas. La prevalencia de DMG en Colombia fue de 8,7 %. Conclusiones: Esta revisión sistemática se constituye en un primer estudio exploratorio en estimar la prevalencia de DMG en Colombia según criterios de la IADPSG. La estimación de la prevalencia global se sitúa cercana a la media mundial, sin embargo, estos resultados deben ser valorados con precaución por limitaciones en la opción de la guía para detección de diabetes gestacional y subregistro. WDF 15-955 Project, Barranquilla, Colombia.

Introduction: Pregnant women with GDM gestational diabetes mellitus have a higher risk of having adverse maternal-infant outcomes. Objective: To estimate the prevalence of GDM in Colombia according to the criteria of the International Association of Diabetes and Pregnancy Study Groups [IADPSG]. Materials and methods: A systematic review was carried out by searching the PubMed / Medline and Cochrane databases in English and Spanish. The quality assessment was done using the GRADE methodology. Results: A total of 7 articles with 37,795 Colombian participants were included in the systematic review. The prevalence of GDM in Colombia was 8.7 %. Conclusions: As far as we know, this systematic review is the first study to estimate the prevalence of GDM in women in Colombia according to criteria of the IADPSG. The results suggest a GDM prevalence in Colombia in the world average. Be careful with these results because there could be un-der-records.

A neglected normal anatomical structure in mammal: a study in bats and tree shrews / Una estructura anatómica normal desatendida en mamíferos: un estudio en murciélagos y musarañas arborícolas

SUMMARY: The myodural bridge is a dense connective tissue connecting muscles and ligaments to the spinal dura mater in the atlanto-occipital interspace. Some researchers believe that the myodural bridge may play a vital physiological role. It is possible, for instance, that the prevention of spinal dura mater infoldings might be involved in regulated cerebrospinal fluid circulation. For instance, it is possible to prevent spinal dura mater infoldings, regulating cerebrospinal circulation. Bats are nocturnal and the only mammals that can perform a genuine and sustained flight, whereas tree shrews are arboreal mammals that often climb to a high altitude of about 10,000 feet. Both animals have lifestyles that are different from other previously studied mammals. The study of these two animals will shed further light on the existence of the myodural bridge in mammals. Gross anatomical dissection was used to observe the connections between the deep muscles of the neck and the dura mater at the level of the atlanto-occipital interspace. The existing structures were analyzed using conventional and special histological staining techniques. The suboccipital regions in bats and tree shrews contained the rectus capitis dorsal major (RCDma), rectus capitis dorsal minor (RCDmi), oblique capitis anterior (OCA), and oblique capitis posterior (OCP). Dense connective tissue connects the RCDmi to the posterior atlanto-occipital membrane (PAOM) and the latter to the spinal dura mater. The myodural bridge in these mammals shares a similar structure to the myodural bridge in humans. Histological analyses confirmed that the connective fibers of the myodural bridge were primarily type I collagen fibers. In this study, it is supplemented by the existence of the myodural bridge in mammals. This further demonstrates that myodural bridge widely exists in the normal anatomy of mammals. This provides morphological support for a comparative anatomical study of the physiological function of the myodural bridge.

El puente miodural es un tejido conjuntivo denso que conecta los músculos y los ligamentos a la duramadre espinal en el espacio atlanto-occipital. Algunos investigadores creen que el puente miodural puede desempeñar un papel fisiológico vital. Es posible, por ejemplo, que la prevención de los pliegues de la duramadre espinal pueda estar involucrada en la circulación regulada del líquido cefalorraquídeo. En esta instancia, es posible prevenir los pliegues de la duramadre espinal, regulando la circulación cerebro espinal. Los murciélagos son animales nocturnos y los únicos mamíferos que pueden realizar un vuelo real y sostenido, mientras que las musarañas arborícolas son mamíferos arbóreos que a menudo ascienden a una gran altura de unos 10 000 pies. Ambos animales tienen estilos de vida diferentes a los de otros mamíferos previamente estudiados. El estudio de estos dos animales ofrecerá más información sobre la existencia del puente miodural en los mamíferos. Se realizó una disección anatómica macroscópica para observar las conexiones entre los músculos profundos del cuello y la duramadre a nivel del espacio atlanto-occipital. Las estructuras existentes se analizaron mediante técnicas de tinción histológica convencionales y especiales. Las regiones suboccipitales en murciélagos y musarañas arbóreas presentaban el músculo recto dorsal mayor de la cabeza (RCDma), el recto dorsal menor de la cabeza (RCDmi), el oblicuo anterior de la cabeza (OCA) y el oblicuo posterior de la cabeza (OCP). El tejido conjuntivo denso conecta el RCDmi con la membrana atlanto- occipital posterior (PAOM) y esta última con la duramadre espinal. El puente miodural en estos mamíferos comparte una estructura similar al puente miodural en humanos. Los análisis histológicos confirmaron que las fibras conectivas del puente miodural son principalmente fibras de colágeno tipo I. Esto demuestra además que el puente miodural existe ampliamente en la anatomía normal de los mamíferos. Esta investigación proporciona apoyo morfológico para un estudio anatómico comparativo de la función fisiológica del puente miodural.

Pediatric canalicular laceration repair using the Mini Monoka versus Masterka monocanalicular stent / Correção de laceração canalicular pediátrica usando os stents monocanaliculares Mini-Monoka versus Masterka

ABSTRACT Purpose: One of the most important disadvantages of using Mini Monoka stents in pediatric canalicular laceration repair is premature stent loss. In this study, we aimed to compare clinical outcomes between the use of Mini Monoka and Masterka monocanalicular stents in children and discuss the potential causes of premature stent loss. Methods: The medical records of 36 patients who underwent surgical repair of canalicular lacerations were retrospectively reviewed. Children aged <18 years who underwent canalicular laceration repair with either Mini Monoka or Masterka and had at least 6 months of follow-up after stent removal were included in the study. The patients' demographics, mechanism of injury, type of stent used, premature stent loss, and success rate were analyzed. Success was defined as stent removal without subsequent epiphora and premature stent loss. Results: Twenty-seven children fulfilled our study criteria, and their data were included in the analyses. Mini Monoka was used in 14 patients (51.9%), whereas Masterka was used in 13 patients (48.1%). The preoperative clinical features, including age, sex, and mechanism of injury, were similar between the two groups. The mean age was 8.3 ± 5.5 years in the Mini Monoka group and 7.8 ± 5.9 years in the Masterka group (p=0.61). Three patients in the Mini Monoka group (21.4%) underwent reoperation due to premature stent loss. No premature stent loss was observed in the Masterka group. As a result, the rate of success was 78.6% in the Mini Monoka group, whereas it was 100% in the Masterka group (p=0.22). Conclusions: Even though the two groups did not show any statistically significant difference in success rate, we did not observe any premature stent loss in the Masterka group. Further studies with larger and randomized series are warranted to elaborate on these findings.

RESUMO Objetivo: Uma das desvantagens mais importantes do uso de stents Mini Monoka no reparo de lacerações canaliculares pediátricas é a perda prematura do stent. Neste estudo, objetivamos comparar os resultados clínicos dos stents monocanaliculares Mini Monoka e Masterka em crianças e discutir as possíveis causas da perda prematura do stent. Métodos: Foram incluídos nesta revisão retrospectiva 36 pacientes <18 anos de idade que se submeteram ao reparo cirúrgico de uma laceração canalicular com um stent Mini Monoka ou Masterka e tiveram pelo menos 6 meses de acompanhamento após a remoção do stent. Foram analisados os dados demográficos, o mecanismo da lesão, o tipo de stent utilizado, a ocorrência de perda prematura de stent e o sucesso da intervenção. O sucesso foi definido como a ausência de epífora após a remoção do stent, sem a perda prematura deste. Resultados: Vinte e sete pacientes preencheram os critérios do presente estudo e foram incluídos nas análises. O stent Mini Monoka foi usado em 14 pacientes (51,9%), enquanto o Masterka foi usado em 13 pacientes (48,1%). As características clínicas pré-operatórias, incluindo idade, sexo e mecanismo de lesão, foram semelhantes entre os dois grupos. A média de idade foi de 8,3 ± 5,5 anos no grupo Mini Monoka e de 7,8 ± 5,9 anos no grupo Masterka (p=0,61). Três pacientes do grupo Mini-Monoka (21,4%) tiveram que ser operados novamente por perda prematura do stent. Nenhuma perda prematura do stent foi observada no grupo Masterka. Como resultado, a taxa de sucesso foi de 78,6% no grupo Mini Monoka e de 100% no grupo Masterka (p=0,22). Conclusões: Embora nenhuma diferença estatisticamente significativa tenha sido detectada entre os dois grupos em termos de taxas de sucesso, não observamos nenhuma perda prematura de stent no grupo Masterka. São necessários mais estudos, com séries maiores e randomizadas, para chegar a maiores conclusões sobre esses achados.

Research on the pathways of social responsibility of public hospitals based on qualitative comparative analysis / 中华医院管理杂志

Objective:To explore the influencing factors and pathways of social responsibility of public hospitals, and to provide a reference for public hospitals in China to further improve the social responsibility level.Methods:From 2019 to 2020, 22 tertiary public hospitals in a region were selected as study cases. The social responsibility score was used as the outcome variable, social benefit, appropriateness, quality, and efficiency were used as the conditional variables, and the qualitative comparative analysis was applied to investigate the combination of conditions affecting social responsibility evaluation of public hospitals.Results:The consistency of the social benefit, appropriateness, and quality was less than 0.9 and greater than 0.8, indicating that they were sufficient and non-necessary conditions for high social responsibility of public hospitals. The consistency of efficiency was 0.747, indicating that it was neither sufficient nor necessary condition. The configuration analysis showed that there were three paths for public hospitals to achieve high social responsibility: co-driven social benefit and appropriateness with high quality assistance, co-driven social benefit and efficiency with high quality assistance, and co-driven appropriateness and efficiency, with a coverage rate of 92.6%.Conclusions:Social benefit, appropriateness, quality, and efficiency can be combined in different ways to achieve high social responsibility in public hospitals. Public hospitals could develop targeted social responsibility improvement strategies according to the actual situation, and strengthen the synergy between the elements to improve the level of social responsibility in hospitals.

Efficacy of one-incision remoual of axillary apocrine glands in children and adult patients with axillary osmidrosis: a comparative analysis / 中华医学美学美容杂志

Objective:To evaluate the safety and efficacy of single incision apocrine gland excision in the treatment of children and adult patients with axillary osmidrosis.Methods:Medical records and follow-up results were reviewed for 164 patients who underwent surgical treatment in our department by the same surgeon from January 2013 to December 2016. There were 54 males and 110 females, aged 8-61 years. with a median age of 22 years. The patients were divided into the children group ( n=31) and the adults group ( n=133), and differences between the two groups were compared. Results:The end point of follow-up was December 2019, the cure and overall satisfaction rates in the third year after surgery were 77.6% (125/161) and 88.2% (142/161) for the total population, including 87.5% (27/31) and 93.5% (29/31) for the children, respectively. There were no significantly differences in the cure rate, scar, pigmentation and the patients' satisfaction between two groups during the follow-up. The cure rate, significantly improved rate and satisfaction rate in patients who became adult during the follow-up were 80.0% (20/25), 92.0% (23/25) and 96.0% (24/25), respectively.Conclusions:Single incision apocrine gland excision could be performed for children patients. Our procedure is safe, reliable and consistant, and worthy of clinical application.

Comparative analysis of multiple models of electronic informed consent in clinical research / 中华医学科研管理杂志

Objective:To provide decision-making support for electronic informed consent selection and promotion in clinical research, and lay a possible theoretical foundation for better protection of subjects′ rights and interests, as well as promotion of clinical research quality and efficiency.Methods:This paper summarized the relevant laws and regulations of electronic informed consent, analyzed the advantages and challenges of the application of electronic informed consent in clinical research, sorted out several common electronic informed consent modes in domestic clinical research, explored their operational processes and applications, and discussed their advantages and limitations.Results:At present, three electronic informed consent modes were mainly used in domestic clinical studies. Each had their own advantages and limitations in terms of convenience of operation, data security, privacy protection of subjects, cost input, popularization degree and so on.Conclusions:Electronic informed consent needs continuing improvement of relevant laws and regulations and the joint efforts of all stakeholders engaged in clinical research. The sponsor and the researcher should take full consideration of the cost, safety, security, feasibility, and ofters, and make the selection according to the actual needs of the research.

Comparison between endoscopic submucosal dissection and gastrectomy in clinical benefit for metachronous early gastric cancer in the remnant stomach / 中华消化内镜杂志

Objective:To compare the histopathological features and treatment efficacy of different methods for metachronous early gastric cancer (MEGC) in the remnant stomach.Methods:A total of 66 patients [38 endoscopic submucosal dissection (ESD) and 28 gastrectomy] with MEGC in the remnant stomach from January 2014 to December 2020 in Drum Tower Hospital were divided into the ESD group and the gastrectomy group. The baseline characteristics, histopathological features, treatment efficacy, and cost differences of the two groups were analyzed.Results:The MEGC in the remnant stomach mostly occurred in elderly male patients, with the mean age of 69.7±8.5 years. The mean interval of the occurrence of MEGC in the remnant stomach was 6 years. As for the tumor location, the gastric body (31.6%) was the main location in the ESD group and gastric cardia (53.6%) in the gastrectomy group with significant difference ( χ2=11.07, P=0.026). The mean operation time, hospital stay, postoperative fasting time, and total treatment cost were 80.0 min, 6.0 d, 1.5 d, ￥19 436 in the ESD group and 215.0 min, 19.0 d, 6.5 d, and ￥68 665 in the gastrectomy group, respectively, with significant differences between the two groups ( P<0.05). The overall survival rate during follow-up was 76.3% in the ESD group and 71.4% in the gastrectomy group with no significant difference between the two groups ( χ2=0.736, P=0.778). In terms of postoperative complications, the incidences of bleeding and infection were 7.9% and 5.3% in the ESD group, and those of obstruction and infection were both 14.3% in the gastrectomy group. There was significant difference in the incidences of postoperative obstruction between the two groups ( P<0.05). Conclusion:ESD is safe and effective for MEGC in the remnant stomach and is better than gastrectomy in terms of the treatment cost and operation time, but the long-term efficacy still needs to be validated by large-scale prospective studies.

The ability of different Briganti nomograms to predict lymph node metastasis in prostate cancer / 中华泌尿外科杂志

Objective:To compare the predictive efficacy of different versions of Briganti nomogram in predicting lymph node metastasis in Chinese patients with prostate cancer.Methods:From October 2012 to April 2021, 583 cases with prostate cancer who underwent radical prostatectomy and pelvic lymphadenectomy by a single surgeon were retrospectively collected. For all 583 patients, the median age was 67 (63, 72)years old, median BMI was 24.39(22.58, 26.35)kg/m 2, median PSA was 22(12, 43)ng/ml. There were 65 cases, 357 cases, 140 cases and 21 cases with clinical stage T 1, T 2, T 3 and T 4. There were 30 cases, 109 cases, 104 cases, 160 cases and 180 cases for ISUP 1 group, 2 group, 3 group, 4 group and 5 group. The median percentage of positive biopsy cores was 50%(33%-83%). The validated nomograms were Briganti's 2006, 2012 and 2017. Compared with the 2006 edition, the new variables in the 2012 edition and 2017 edition were the percentage of positive biopsy cores, the percentage of the highest grade positive biopsy cores and the percentage of the lower grade positive biopsy cores, respectively. The validation patients for the 2006, 2012 and 2017 versions of nomogram were 560, 513 and 357, respectively, which were used as the differential validation cohorts. A total of 357 patients were validated for all three versions of nomogram, which was considered as the general validation cohort. The area under the receiver operating characteristic (ROC) curve (AUC), calibration curve and clinical decision curve analysis were used to evaluate the predictive efficacy of the three versions of nomograms. Results:In the differential validation cohort, the AUC values of the 2006, 2012 and 2017 versions of the nomogram were 0.738(95% CI 0.690-0.785), 0.765(95% CI 0.717-0.814) and 0.779(95% CI 0.724-0.834), respectively. There was no significant difference in AUC values among versions ( P>0.05). In the general validation cohort, the AUC values of the three versions of the nomogram were as follows 0.744(95% CI 0.682-0.805), 0.759(95% CI 0.700-0.818) and 0.779(95% CI 0.724-0.834), respectively. There was no significant difference in AUC values among the three versions ( P>0.05). The calibration curve showed that the prediction probability of 2012 and 2017 editions was in good agreement with the actual risk within the prediction probability of 0-40%. Analysis of the clinical decision curve showed that the clinical benefit of the 2012 version was greater than that of the other two versions in the prediction threshold of 0-33%. Conclusion:Briganti nomogram is suitable for predicting pelvic lymph node metastasis in Chinese patients with prostate cancer. The 2012 and 2017 versions of the nomogram have good predictive performance, and the versions can be selected according to the predictive variables that can be provided.

Fascia lata autograft bridging repair reinforced with artificial ligament as an internal brace for arthroscopic management of irreparable massive rotator cuff tears / 中华骨科杂志

Objective:To compare the clinical and imaging outcomes of fascia lata autograft bridging repair reinforecd with an artificial ligament as the internal brace with the autograft bridging repair for the treatment of irreparable massive rotator cuff tears (IMRCTs).Methods:The data of 26 patients with IMRCT who underwent fascia lata autograft bridging repair augmented with artificial ligament as the internal brace (internal brace group) and of 24 patients with IMRCT who underwent bridging autograft repair alone (control group) were retrospectively evaluated preoperatively and at 2-year follow-up. Clinical outcomes were assessed using shoulder activity, the American Shoulder and Elbow Surgeons (ASES) Score, University of California Los Angeles (UCLA) Score, and visual analogue scale (VAS) for pain. Imaging outcomes were evaluated using acromiohumeral distance (AHD), Goutallier grade, and status of fascia lata grafts according to radiographs or magnetic resonance imaging results.Results:All 50 cases were followed up for 34.2±7.2 months (range 24-45 months). Compared to the control group, the internal brace group showed better ASES score (93.5±5.3 vs. 89.5±5.7, P<0.05), UCLA score (31.7±3.8 vs. 28.5±5.6, P<0.05), improvement in UCLA score (19.6±4.2 vs. 15.9±5.7, P<0.05), active elevation (167.3°±8.4° vs. 159.4°±13.6°, P<0.05), abduction strength (8.9±1.2 vs. 8.2±1.2, P<0.05), improvement in abduction strength (4.1±1.2 vs. 3.3± 1.0, P<0.05), AHD (7.0±1.4 mm vs. 5.9±1.0 mm, P<0.05), improvement in AHD (3.3±1.5 mm vs. 2.0±0.6 mm, P<0.05), and healing rate of fascia lata autografts (92% vs. 54%, P<0.05) at 2-year follow-up. Conclusion:Fascia lata autograft bridging repair reinforced with an artificial ligament as the internal brace improves healing rate of bridging graft and postoperatively short-term clinical outcomes of patients with IMRCT.

A prospective clinical controlled study of minimally invasive-locking block modified Krackow technique for repairing achilles tendon rupture / 中华骨科杂志

Objective:To investigate the clinical effect of minimally invasive-locking block modified Krackow (MI-LBMK) and open giftbox technique in the treatment of Achilles tendon rupture.Methods:Fifty-six patients with Achilles tendon rupture from January 2016 to December 2018 were collected, including 54 males and 2 females, aged 40.7±9.4 years (range 26 to 65 years). The MI group (30 patients) used two minimally invasive incisions without exposing the rupture site, and the LBMK technique was used to repair the Achilles tendon. The open group (26 patients) used a posteromedial longitudinal incision and the giftbox technique was used to repair the rupture tendon. The Achilles tendon was repaired with 6-strand sutures in both groups. Early rehabilitation programs were adopted for postoperative rehabilitation, and regular follow-up (6 weeks, 3, 6, 12 and 24 months after operation) was performed to record the Achilles tendon resting angle (ATRA), American Orthopaedic Foot and Ankle Society ankle-hindfoot score (AOFAS), Achilles tendon total rupture score (ATRS). The rupture gap and cross-sectional area (CSA) were measured by MRI at 6 weeks and 3 months after surgery.Results:A total of 30 patients in the MI group and 26 in the open group were enrolled. The differences between the two groups in age, body mass index, interval from injury to operation, and tendon rupture site were not statistically significant ( P>0.05). All patients were followed up to 24 months after surgery. There were no wound complications in MI group, and 2 cases of superficial infection and 1 case of wound skin necrosis occurred in open group. There was no re-rupture in both groups. The relative ATRA of MI group was -6.32°±0.99°, -3.90°±1.05°, -2.38°±0.84°, -0.25°±1.37° at 3, 6, 12 and 24 months after operation, respectively. The relative ATRA of open group was -7.88°±3.71°, -6.16°±1.10°, -4.53°±0.95°, -3.01°±0.95° at 3, 6, 12 and 24 months after operation, respectively. The differences between the two groups were statistically significant ( P<0.05). The ATRS of minimally invasive group at 6 months and 12 months were 72.70±7.41 and 92.97±3.35 respectively, and the ATRS of open group at 6 months and 12 months were 68.08±6.64 and 90.85±4.27 respectively, and the differences were statistically significant ( P<0.05). The AOFAS of minimally invasive group at 6 months and 12 months were 88.60±2.76 and 93.83±1.98 respectively, and the AOFAS of open group at 6 months and 12 months were 85.77±3.20 and 92.08±2.64 respectively, and the differences were statistically significant ( P<0.05). The difference in the gap between the tendon rupture ends measured by MRI sagittal plane T2WI between the two groups was not statistically significant ( P>0.05). The cross-sectional area of Achilles tendon in the MI group was higher than that of the open group at 12 weeks ( P<0.05). Conclusion:The MI-LBMK technique may protect the peritendon tissue and has fewer complications, and can enable the patient to return to daily life faster, with lower postoperative Achilles tendon elongation and better recovery of Achilles tendon function.

Comparative analysis of clinical diagnosis application of two intrauterine adhesion scoring criteria / 中华妇产科杂志

Objective:To explore the similarities and differences of China Society of Gynecology Endoscopy (CSGE) and American Fertility Society (AFS) intrauterine adhesion (IUA) scoring criteria on IUA grading and their predictive value of reproductive prognosis.Methods:From January 2016 to January 2019, a total of 1 249 patients were diagnosed with IUA by hysteroscopy at Beijing Obstetrics and Gynecology Hospital. Totally, 378 patients with complete clinical data were enrolled, and the results diagnosed by CSGT and AFS scoring criteria were compared and analyzed.And follow-up for 2 years, the pregnancy rate and live birth rate were statistical analysis.Results:(1) The grade of IUA according to AFS and CSGE scoring criteria was less consistent ( κ=0.295, P<0.001). Compared with AFS, the proportion of severe IUA cases diagnosed by CSGE was significantly lower [45.8% (173/378) vs 15.1% (57/378); RR=0.22, 95% CI: 0.15-0.30, P<0.01); the proportions of both mild and moderate IUA cases were significantly higher ( RR=4.16, 95% CI: 2.38-7.14; RR=2.38, 95% CI: 1.75-3.23; both P<0.01). (2) The pregnancy rates of mild, moderate and severe IUA diagnosed according to CSGE were 11/13, 64.5% (147/228), 31.8% (7/22), live birth rates were 11/13, 54.8% (125/228) and 22.7% (5/22), respectively; there were statistically significant differences between the groups (all P<0.01). The pregnancy rates of mild, moderate and severe IUA diagnosed based on AFS were 3/3, 66.9% (97/145) and 56.5% (65/115), respectively, with no statistically significant difference between the groups ( P>0.05). (3) IUA grades based on both CSGE and AFS criteria were significantly negatively correlated with pregnancy rates and live birth rates (CSGE: r=-0.210, r=-0.226; AFS: r=-0.130, r=-0.147; all P<0.05). Univariate logistic regression analysis showed that CSGE had higher OR for both pregnancy rates and live birth rates compared to AFS (3.889 vs 1.657, 3.983 vs 1.554, respectrvely). Conclusions:Compared with AFS, the IUA grade based on CSGE is better related with reproductive prognosis, suggesting that the CSGE standard might be more objective and comprehensive and has better predictive value for reproductive prognosis, thus avoiding overdiagnosis and overtreatment.

Olecranon sled fixation versus tension band wiring fixation in treatment of Mayo ⅡA olecranon fractures / 中华创伤骨科杂志

Objective:To compare the efficacy between olecranon sled fixation and tension band wiring fixation in the treatment of Mayo ⅡA olecranon fractures.Methods:A retrospective study was conducted to analyze the data of 54 patients with Mayo ⅡA olecranon fracture who had been admitted to Department of Traumatology and Orthopedics, Beijing Jishuitan Hospital from October 2018 to February 2021. There were 20 males and 34 females with an age of (45.5±17.7 years), and 36 left and 18 right sides. They were divided into 2 groups according to different methods of internal fixation. Group A (25 cases) was subjected to olecranon sled fixation and group B (29 cases) to tension band wiring fixation. Preoperative data, operation time, reoperations and complications during follow-up were recorded and compared between the 2 groups. In both groups at the last follow-up, the range of the elbow motion, the Mayo elbow performance score (MEPS) and the Disabilities of the Arm, Shoulder and Hand (DASH) score were recorded to evaluate the elbow function.Results:The 2 groups were comparable because there were no significant differences in all their preoperative demographic data ( P>0.05). There were no significant differences between the 2 groups either in follow-up time [(32.8±8.9) months for group A and (35.8±9.0) months for group B] or in operation time [60.0 (60.0, 82.5) min for group A and 60.0 (60.0, 67.5) min for group B] ( P>0.05). At the last follow-up in group A and group B, respectively, the flexion and extension of the elbow was 141.0°±8.4° and 140.0 (140.0, 150.0)°, the pronation-supination 180.0 (175.0, 180.0)° and 180.0 (175.0, 180.0)°, the MEPS score 100.0 (85.0, 100.0) and 100.0 (92.5, 100.0), and the DASH score 4.2 (1.7, 6.3) and 5.8 (1.3, 8.3), all showing no statistically significant differences between the 2 groups ( P>0.05). Olecranon skin irritation occurred in 5 patients (20.0%,5/25) in group A and in 15 patients (51.7%,15/29) in group B, and 7 patients (28.0%,7/25) in group A and 21 patients (72.4%,21/29) in group B underwent removal of internal fixation, both showing statistically significant differences between the 2 groups ( P<0.05). Conclusion:In the treatment of Mayo ⅡA olecranon fractures, compared with tension band wiring fixation, olecranon sled fixation may lead to comparable efficacy in fixation and functional recovery, but significantly reduced rates of complications and internal fixation removal.

Clinical efficacy of five-element music therapy in the treatment of bipolar disorder / 中国基层医药

Objective:To investigate the clinical efficacy of five-element music therapy in the treatment of bipolar disorder.Methods:Eighty patients with bipolar disorder admitted to Shandong Mental Health Center from January 2018 to December 2019 were included in this study. They were randomly divided into a study group and a control group ( n = 40/group). The control group was treated with conventional drug treatment. The study group was treated with five-element music therapy based on conventional drug treatment. Before, during and after treatment, mania and depression were evaluated. Symptom self-evaluation scale and the Traditional Chinese Medicine Five State Emotion Questionnaire were completed to evaluate the curative effect. Patients were followed up by telephone call. Recurrence at 3, 6 and 12 months was recorded. Results:Before treatment, there were no significant differences in the scores of the Bech-Rafaelsen Mania Rating Scale (BRMs), Hamilton Depression Rating Scale (HAMD), Traditional Chinese Medicine Five State Emotion Questionnaire, Symptom Checklist-90 (SCL-90) between the two groups (all P > 0.05). During and after treatment, BRMs, HAMD, Traditional Chinese Medicine Five State Emotion Questionnaire, and SCL-90 scores were significantly decreased in each group compared with before treatment [Control group: BRMs score during and after treatment: (11.52 ± 1.57) points, (9.43 ± 1.05) points; HAMD score during and after treatment: (16.75 ± 3.05) points, (13.61 ± 2.51) points; Traditional Chinese Medicine Five State Emotion Questionnaire: emotional vocabulary (67.25 ± 5.7) points, (56.38 ± 4.97) points, physical symptoms (29.52 ± 3.94) points, (24.19 ± 3.05) points, SCL-90 score: (100.52 ± 10.26) points, (68.85 ± 7.33) points. Study group: BRMs score during and after treatment: (9.33 ± 1.09) points, (7.85 ± 0.82) points; HAMD score: (13.74 ± 2.54) points, (10.17 ± 1.97) points; Traditional Chinese Medicine Five State Emotion Questionnaire: emotional vocabulary: (58.19 ± 5.06) points, (46.85 ± 4.06) points, physical symptoms (25.14 ± 3.54) points, (20.11 ± 2.57) points; SCL-90 scores: (90.85 ± 8.97) points, (56.87 ± 5.81) points]. During and after treatment, scores of BRMs, HAMD, Traditional Chinese Medicine Five State Emotion Questionnaire and SCL-90 in the study group were significantly lower than those in the control group ( t = 3.77, 7.01, 4.48, 6.99, 8.78, 4.89, 6.05, 4.19, 7.57, all P < 0.05). Total response rate in the study group was significantly higher than that in the control group (90.0% vs. 72.5%, χ2 = 4.02, P < 0.05). At 3, 6 and 12 months after treatment, recurrence rate in the study group was 2.5%, 15.0% and 30.0%, respectively, which were significantly lower than 17.5%, 35.0%, and 52.5% in the control group ( χ2 = 5.00, 4.26, 4.17, all P < 0.05). Conclusion:Five-element music therapy for the treatment of bipolar disorder can markedly alleviate depression and mania, restore patient's emotional state, improve clinical efficacy, and decrease recurrence rate.

Wrist-ankle acupuncture combined with rehabilitation for dysphagia caused by achalasia of cricopharyngeal muscle after stroke / 中国基层医药

Objective:To investigate the clinical efficacy of wrist-ankle acupuncture combined with rehabilitation for dysphagia caused by achalasia of the cricopharyngeal muscle after stroke.Methods:Sixty patients with dysphagia caused by achalasia of the cricopharyngeal muscle after stroke who received treatment in Wenzhou Hospital of Traditional Chinese Medicine from June 2019 to March 2020 were included in this study. They were randomly divided into a treatment group and a control group ( n = 30). All patients received routine drug treatment and swallowing rehabilitation training. The control group underwent routine acupuncture treatment. The treatment group received wrist-ankle acupuncture based on routine acupuncture treatment. Both groups were treated for 4 consecutive weeks. The clinical efficacy in the two groups was evaluated using the Video Fluoroscopic Swallowing Study (VFSS), Standardized Swallowing Assessment (SSA), and Swallow Quality-of-Life Questionnaire (SWAL-QOL). Results:Before treatment, there were no significant differences in VFSS, SSA, and SWAL-QOL scores between the two groups. After treatment, VFSS, SSA, and SWAL-QOL scores in the treatment group were (8.21 ± 0.77) points, (21.19 ± 1.42) points, (200.24 ± 11.12) points, and they were (6.01 ± 0.36) points, (23.31 ± 1.45) points, and (182.37 ± 12.06) points in the control group ( t = 3.26, 5.50, 6.31, all P < 0.05). Conclusion:Wrist-ankle acupuncture combined with rehabilitation is an effective treatment method for dysphagia caused by achalasia of the cricopharyngeal muscle after stroke. It can alleviate dysphagia and improve quality of life.

Comparative analysis of Master of Public Health education between China and the UK / 中华医学教育探索杂志

The Master of Public Health (MPH) is one of the internationally recognized ways of training professionals in the medical and health field. With the outbreak of COVID-19 pandemic, the need for talents who can serve the national public health emergency management system has accelerated. This article makes the comparison of public health education in China and the UK, starting from the reasons and advantages of medical education in two countries, selecting several universities with high rankings in public health in China and the UK as the research objects, collecting and summarizing their programme descriptions, from the enrollment mode, training objectives, cultivation mode and degree types, curriculum settings, etc., in the MPH programme descriptions in order to find the advantages of MPH education in the UK, which can be used for reference in the education and training of public health talents in China, and is of great significance for the improvement and optimization of MPH education in China.