Systematic characterization and identification of the chemical constituents of the Schisandra chinensis decoction based on a hybrid scanning technique of UHPLC/IM-QTOF-MS / 药学学报

italic>Schisandra chinensis is a traditional Chinese medicine with the functions of reinforcing deficiency, strengthening, and inducing astringency, appliable to treat the chronic cough and deficiency in breath, palpitation, and insomnia, etc. A hybrid mass spectrometry scanning strategy (high-definition data-independent/data-dependent acquisition, HDDIDDA), enabling the ion mobility separation and alternating data-independent acquisition/data-dependent acquisition, was established, which, in combination with in-house library-driven automatic peak annotation workflows facilitated by the UNIFI software, was utilized to systematically characterize the multi-classes of chemical components from S. chinensis. The use of an HSS T3 column (100 mm × 2.1 mm, 1.8 μm), 0.1% formic acid in H2O-acetonitrile as the mobile phase running at the flow rate of 0.3 mL·min-1, and column temperature at 35 ℃, could enable good separation of the S. chinensis components within 42 min. HDDIDDA scan in both the positive and negative ion modes was employed for data acquisition. Based on the automatic peak annotation, reference standards comparison, MS2 data interpretation, and literature analysis, we were able to identify or tentatively characterize 105 compounds in the S. chinensis decoction, involving 56 terpenoids, 42 lignans, five glycosides, one organic acid, and one flavonoid. HDDIDDA scanning can improve the coverage of data acquisition and improve the accuracy of identification, while CCS prediction analysis provides the possibility to distinguish isomers by the ion mobility technology. The results provide reference for the intelligent material basis research of TCM.

Research progress on valgus impacted proximal humeral fractures / 中国修复重建外科杂志

OBJECTIVE@#To review the advancement made in the understanding of valgus impacted proximal humeral fracture (PHF).@*METHODS@#The domestic and foreign literature about the valgus impacted PHF was extensively reviewed and the definition, classification, pathological features, and treatment of valgus impacted PHFs were summarized.@*RESULTS@#PHF with a neck shaft angle ≥160° is recognized as a valgus impacted PHF characterized by the preservation of the medial epiphyseal region of the humeral head, which contributes to maintenance of the medial periosteum's integrity after fracture and reduces the occurrence of avascular necrosis. Therefore, the valgus impacted PHF has a better prognosis when compared to other complex PHFs. The Neer classification designates it as a three- or four-part fracture, while the AO/Association for the Study of Internal Fixation (AO/ASIF) categorizes it as type C (C1.1). In the management of the valgus impacted PHF, the selection between conservative and surgical approaches is contingent upon the patient's age and the extent of fracture displacement. While conservative treatment offers the advantage of being non-invasive, it is accompanied by limitations such as the inability to achieve anatomical reduction and the potential for multiple complications. Surgical treatment includes open reduction combined with steel wire or locking plate and/or non-absorbable suture, transosseous suture technology, and shoulder replacement. Surgeons must adopt personalized treatment strategies for each patient with a valgus impacted PHF. Minimally invasive surgery helps to preserve blood supply to the humeral head, mitigate the likelihood of avascular necrosis, and reduce postoperative complications of bone and soft tissue. For elderly patients with severe comminuted and displaced fractures, osteoporosis, and unsuitable internal fixation, shoulder joint replacement is the best treatment option.@*CONCLUSION@#Currently, there has been some advancement in the classification, vascular supply, and management of valgus impacted PHF. Nevertheless, further research is imperative to assess the clinical safety, biomechanical stability, and indication of minimally invasive technology.

O que é autoestima para os analistas do comportamento? Uma revisão sistemática / What is self-esteem for behavioral analysts? A systematic review

A autoestima é um termo muito utilizado pelas pessoas no senso comum, mas ainda são necessários mais estudos para entendê-lo sob o ponto de vista comportamental. O objetivo deste estudo foi realizar uma revisão de textos da Análise do Comportamento a respeito de autoestima. Foi realizada uma busca em três fontes diferentes: periódicos exclusivos de Análise do Comportamento; as coleções de livros Sobre Comportamento e Cognição e Comportamento em Foco; e na Scielo. No total, 16 textos preencheram os critérios, que eram a) ter a palavra "autoestima" no título b) ser um texto da Análise do Comportamento. Foram discutidas as definições de autoestima utilizadas, os participantes dos estudos, os estímulos usados em testes de medida implícita e os principais resultados. Nenhum dos textos analisados utilizou intervenções voltadas ao aumento da autoestima. Apesar de serem textos da abordagem comportamental, muitos dos estudos utilizam apenas definições e instrumentos não comportamentais. As principais conclusões da revisão foram: 1) ainda existem poucos estudos sobre autoestima na Análise do Comportamento; 2) ainda não existe uma definição comportamental bem construída, especialmente na literatura internacional.

Self-esteem is a term that is widely used in common sense, but more studies are still needed to understand it from a behavioral point of view. The objective of this study was to carry out a review of Behavior Analysis papers regarding self-esteem. A search was conducted in three different sources: Behavior Analysis journals; the book collections Sobre Comportamento e Cognição and Comportamento em Foco; and on Scielo. In total, 16 texts met the criteria, which were a) having the word "self-esteem" in the title and b) being a Behavior Analysis text. We discuss the definitions of self-esteem used, the participants in the studies, the stimuli used in the implicit measurement tests and the main results. None of the analyzed texts used interventions aimed to increase self-esteem. Even though they are texts of the behavioral approach, many of the studies only use non-behavioral definitions and instruments. The main conclusions of the review were: 1) there are still few studies on self-esteem in Behavior Analysis; 2) there is still no well-constructed behavioral definition, especially in international literature.

Research progress on transcranial electrical stimulation for deep brain stimulation / 生物医学工程学杂志

Transcranial electric stimulation (TES) is a non-invasive, economical, and well-tolerated neuromodulation technique. However, traditional TES is a whole-brain stimulation with a small current, which cannot satisfy the need for effectively focused stimulation of deep brain areas in clinical treatment. With the deepening of the clinical application of TES, researchers have constantly investigated new methods for deeper, more intense, and more focused stimulation, especially multi-electrode stimulation represented by high-precision TES and temporal interference stimulation. This paper reviews the stimulation optimization schemes of TES in recent years and further analyzes the characteristics and limitations of existing stimulation methods, aiming to provide a reference for related clinical applications and guide the following research on TES. In addition, this paper proposes the viewpoint of the development direction of TES, especially the direction of optimizing TES for deep brain stimulation, aiming to provide new ideas for subsequent research and application.

Taxonomic and faunistic study of four almost unknown Brazilian Meloidae (Coleoptera)

ABSTRACT The Brazilian fauna of Meloidae is poorly studied, even though it includes more than 160 species. In this paper, we aimed at widening the knowledge on four species of blister beetles from this country. Specifically, we defined the uncertain range of Tetraonyx angulicollis, as extended in south-eastern Brazil rather than in Mexico, and implemented the description of the species with figures. We studied the taxonomy and distribution of three almost unknown species of Nemognatha from Brazil, São Paulo State, providing descriptions and figures of sexual characters and colour variability of N. beauregardi, to which is probably referable as a junior synonym of N. plaumanni, of N. rufoscutellaris and of N. cfr. gounellei. Moreover, we assigned these three species to the subgenus Pauronemognatha, recently recorded from South America.

Accuracy of yellow fever case definition of epidemiologic surveillance, São Paulo, 2018

ABSTRACT OBJECTIVE To evaluate the accuracy of yellow fever (YF) suspected case definitions from the Brazilian Ministry of Health (BMH) and World Health Organization (WHO), as well as propose and evaluate new definitions of suspected cases, considering confirmed and discarded cases. METHODS The retrospective study was conducted at the Instituto de Infectologia Emílio Ribas (IIER), using the Epidemiologic Surveillance Form of YF cases. From the confirmed and discarded cases of YF, a logistic regression model was developed. The independent variables were used in a proposed definition of a suspected case of YF and its accuracy was evaluated. RESULTS In total, 113 YF suspect cases were reported, with 78 confirmed (69.0%). The definitions by BMH and WHO presented low sensitivity, 59% and 53.8%, and reduced accuracy, 53.1% and 47.8%, respectively. Predictive factors for YF were thrombocytopenia, leukopenia, and elevation of transaminases greater than twice normal. The definition including individual with acute onset of fever, followed by elevation of ALT or AST greater than twice the reference value AND leukopenia OR thrombocytopenia presented high sensitivity (88.3%), specificity (62.9%), and the best accuracy (80.4%), as proposed in the model. CONCLUSION The YF suspected case definitions of the BMH and the WHO have low sensitivity. The inclusion of nonspecific laboratory tests increases the accuracy of YF definition.

Assessment of optic disk by disk damage likelihood scale staging using slit-lamp biomicroscopy and optical coherence tomography in diagnosing primary open-angle glaucoma

Purpose: The current study was aimed at assessment of optic disk by disk damage likelihood scale (DDLS) staging using slit?lamp biomicroscopy and optical coherence tomography (OCT) in diagnosing primary open?angle glaucoma (POAG) patients. Methods: This was a cross?sectional observational study of 106 POAG patients, which was conducted from April 2017 to April 2018. All patients underwent slit?lamp fundoscopy with a +78 D lens and high?definition (HD)?OCT, and the vertical cup disk ratios (VCDRs) were recorded. Disk size and neuroretinal rim assessment were done, and the disk was then staged using the recent version, which stages the optic nerve head (ONH) from 1 to 10 as read from the DDLS nomogram table. DDLS scores >5 indicate glaucomatous damage. Pearson coefficient was used to correlate the DDLS staging by slit?lamp biomicroscopy with best?corrected visual acuity (BCVA), intraocular pressure (IOP), disk size, and VCDR and VCDR, mean deviation, and DDLS staging by HD?OCT. Results: The mean age of the patients was 59.54 ± 6.61 years. The male: female ratio was 2:1. The mean IOP was 16.04 ± 1.97 mmHg, and BCVA was 0.72 ± 0.13 LogMAR units. The mean VCDR on 78 D slit?lamp biomicroscopy was 0.76 ± 0.09 (standard deviation [SD]) (range 0.1–0.77), whereas on HD?OCT, the mean VCDR was 0.81 ± 0.09 (SD) (range 0.07–0.81). The mean deviation on visual field testing in decibels was ?14.43 ± 3.31 (SD). The correlation coefficient between DDLS staging by slit?lamp biomicroscopy and DDLS staging by HD?OCT parameters was r = 0.96. Conclusion: There is a positive correlation between the DDLS system of optic disk evaluation on slit?lamp biomicroscopy and most of the HD?OCT evaluation parameters

Paradoxos do paradigma pós-moderno da autodefinição: desejo de singularidade e políticas identitárias / Paradoxes du paradigme postmoderne de l'auto-définition: désir de singularité et politique identitaire / Paradoxes of the postmodern paradigm of self-definition: desire for singularity and identity politics

O movimento woke tomou conta das universidades americanas e também das brasileiras. Com origem no pós-modernismo dos anos setenta, inspira-se na genealogia do saber de Michel Foucault e na recente evolução das ciências sociais rumo à redução do universal, do simbólico, da linguagem e da cultura a uma mera construção social. Tudo é relativo e pode ser definido contratualmente nas relações intersubjetivas ou os indivíduos podem autodefinir-se. Precisaremos de comitês de ética, como observou Miller (1996), para estabelecer a verdade, a norma, o protocolo e as convenções de acordo com os diferentes indivíduos e grupos sociais. Queremos avaliar se essa tendência pós-moderna coincide com uma radicalização da lógica feminina da sexuação, a lógica do não-todo. Qual o papel dos movimentos feministas no advento da tese de que "não há universal pois o Outro não existe!".

Le mouvement woke a également pris le contrôle des universités américaines et brésiliennes. Issu dupost-modernisme des années 70, il s'inspire de la généalogie des savoirs de Michel Foucault et de l'évolution récente des sciences sociales vers la réduction de l'universel, du symbolique, du langage et de la culture, à une simple construction sociale. Tout est relatif et peut être contractuellement défini dans des relations intersubjectives et les individus peuvent se définir eux-mêmes. Nous aurons besoin de comités d'éthique, comme le notait Miller (1996), pour établir la vérité, la norme, le protocole, les conventions selon les différents individus et groupes sociaux. Nous voulons évaluer si cette tendance postmoderne coïncide avec une radicalisation de la logique féminine de la sexuation, la logique du pas-tout. Quel est le rôle des mouvements féministes dans l'avènement de la thèse selon laquelle "il n'y a pas d'universel parce que l'Autre n'existe pas."

The woke movement took over American and Brazilian universities as well. Originating in the post-modernism of the seventies, it is inspired by the genealogy of knowledge by Michel Foucault and the recent evolution of the social sciences towards the reduction of the universal, the symbolic, language and culture, to a mere social construction. Everything is relative and can be contractually defined in intersubjective relationships or individuals can define themselves. We will need ethics committees, as Miller (1996) noted to establish the truth, the norm, the protocol, the conventions according to different individuals and social groups. We want to assess if this postmodern trend coincides with a radicalization of the feminine logic of sexuation, the logic of not-all. What is the role of feminist movements in the advent of the thesis that "there is no universal because the Other does not exist.".

2020: Renewing the paradigms for orofacial pain / 2020: renovando los paradigmas para el dolor orofacial

Abstract In 2020, two important changes were adapted by the international health community: a new definition of pain and a new classification for orofacial pain conditions. With these changes new tasks and challenges also emerged, and clinicians from several disciplines begun to adopt and reconsidered classic paradigms, and the policies derived from them. This new perspective article, examine the new definition of pain proposed by the International Association for the Study of Pain, and the new International Classification of Orofacial Pain; analyzing the positive impact and further perspectives of these.

Resumen En 2020, dos importantes cambios fueron adaptados por la comunidad internacional en salud: una nueva definición de dolor y una nueva clasificación para las condiciones de dolor orofacial. Con estos cambios, también emergieron nuevos retos y tareas, y los clínicos de diversas disciplinas empezaron adaptar y reconsiderar los paradigmas clásicos; y las políticas derivadas de estos. En este artículo de nueva perspectiva, examinaremos nueva definición de dolor propuesta por la Asociación Internacional para el Estudio del Dolor, y la nueva Clasificación Internacional de Dolor Orofacial; analizando el impacto positivo y las próximas perspectivas de estos cambios.

Treatment-resistant depression and its diagnosis and treatment / 四川精神卫生

The aim of this study is to explore the diagnostic strategies and options for treatment-resistant depression （TRD）. Despite the well-established efficacy of antidepressants， 20%~30% of depressive patients in the clinic fail to respond or respond poorly to normative treatment with antidepressants. Patients with TRD are forced to bear a heavy burden of medical costs and disease. Therefore， this article discusses the TRD in terms of the definition， prevalence， disease burden， etiological mechanism， risk factors， assessment grading， highlighting different treatment strategies and options to inform clinical practice and scientific research on TRD.

Overview of the Work Related to Regulatory Scientific Research of Combination Products / 中国医疗器械杂志

Based on the research situation of the regulatory scientific research project of combination products technical evaluation in recent years, this study introduces the relevant research on how to optimize the supervision of combination products, summarizes the research progress and research results of the project, in order to promote the development of related industries.

Review of bleeding events in clinical studies of clopidogrel / 中国临床药理学与治疗学

P2Y12 receptor antagonist is currently one of the commonly used drugs for the treatment of acute coronary syndromes. Clopidogrel is a representative drug among P2Y12 receptor antagonists. Bleeding events as the most common side effect of this drug have also been concerned. The incidence and risk of bleeding events in large-scale clinical studies of clopidogrel are analyzed and discussed to provide refer-ences for reasonable clinical prescription of clopidogrel.

Beliefs About Spiritual Pain among Palliative Care Physicians and Liaison Psychiatrists: A Nationwide Questionnaire Survey

Objectives: Spiritual pain is not formally defined. The aim of this study was to clarify the beliefs about spiritual pain among Japanese palliative care physicians and liaison psychiatrists and to compare their beliefs. Methods: A nationwide questionnaire survey was conducted by mail August, 2019 on certified palliative care physicians and liaison psychiatrists. We asked 9 questions about spiritual pain (i.e. current status, definition, and the delivery of care) using a 5-Likert scale. Result: 387 palliative care physicians (response rate, 53%) and 374 psychiatrists (45%) responded. 72% (76% of the palliative care physicians/69% of the psychiatrists) reported that spiritual pain was distinct from depression, but 69% (66/71) reported that it was not defined adequately; and 59% (59/60) perceived the risks of using the words ambiguously. Only 43% (40/47) recommended the universal definition of spiritual pain, and opinions about how spiritual pain should be defined (i.e, higher being, meaning/value, or specific terms) differed among physicians. Perception about spiritual pain of the physicians were significantly associated with their religion, while beliefs about spiritual pain were essentially similar between palliative care physicians and psychiatrists. Conclusion: Although physicians regarded the definition of spiritual pain as being inadequate, the opinions about preferable definition differed among physicians. Discussion about the value of developing a consensus of spiritual pain is needed.

A High-definition Recording Method of Electrocardiogram / 中国医疗器械杂志

In order to improve the clarity of ECG waveforms and the anti-interference ability of ECG acquisition under abnormal conditions, this study proposes a high-definition ECG recording method based on superimposed averaging algorithm. The results show that the proposed method can more clearly reflect the details of the ECG. Meanwhile, it has a significant inhibitory effect on EMG interference. As a result, the proposed method has a positive significance for improving the anti-interference ability of ECG equipment.

Dosimetric effect of Varian high-definition multi-leaf collimator leaf position error on stereotactic body radiation therapy for lung tumors / 中华放射肿瘤学杂志

Objective:To evaluate the effect of leaf position error of Varian high-definition multi-leaf collimator (HD120) on the dosimetry of stereotactic body radiation therapy (SBRT) for lung tumors.Methods:Nine SBRT plans based on HD120 for lung tumors were selected as the reference plans. The parameters of the plans were modified by the in-house program based on the Varian Eclipse 15.6 scripting application program interface to generate the simulation plans with three types of leaf position errors including the isotropic systematic error, the anisotropic systematic error and the random error, respectively. Then, the dosimetric metric deviation between each simulation plan and the corresponding reference plan was calculated and regression analysis was performed to evaluate the dosimetric effect of three types of leaf position errors of HD120 on SBRT.Results:The planning target volume (PTV) D 99%, D 2cm and V 5Gy of double lungs were decreased quadraticly with the increase of the absolute value of the isotropic systematic error. The first-order sensitivity was -0.06%/mm to -0.26%/mm, and the second-order sensitivity was -0.55%/mm 2 to -1.17%/mm 2 ( R2=0.96-0.99, P<0.01). The maximum change of PTV D 99% was -3.13%. The linear regression analysis of the effects of the anisotropic systematic error and random error showed that the sensitivity of CI was 25.16%/mm ( R2=0.98, P<0.01) and -4.84%/mm( R2=0.99, P<0.01), and the sensitivity of other dosimetric deviations with the anisotropic systematic error was 4.80%/mm to 5.12%/mm ( R2=0.96-0.98, P<0.01), whereas the sensitivity with the random error was -0.47%/mm to -1.01%/mm ( R2=0.96-0.99, P=0-0.02). Conclusions:The dosimetric deviation of SBRT plan based on HD120 for lung cancer is highly sensitive to the anisotropic systematic error of leaf position, but less sensitive to the random error. In addition, the isotropic systematic error of leaf position will lead to the decrease of target coverage to a certain extent. Consequently, it is necessary to strictly control the systematic error of HD120 leaf position in the implementation of SBRT plan in clinical work.

Definition of tumor rupture in gastrointestinal stromal tumor / 中华胃肠外科杂志

Tumor rupture is a common clinical event in the process of tumorigenesis, progression, diagnosis and treatment of gastrointestinal stromal tumor, which is closely associated with tumor recurrence, metastasis and poor prognosis. Tumor rupture may be associated with some intrinsic biological aggressiveness qualities, such as large tumor size, high mitotic count, and KIT exon 11 deletion mutations involving codons 557 and 558, and may be relatively more frequent with small intestine GIST and excellent response to imatinib neoadjuvant therapy resulting in tumor tissue rapid liquefacient and necrosis. The triggering factors involve sudden increase in abdominal pressure, external pressure, collision and improper surgical operation, etc. Tumor rupture is considered as an important risk factor of recurrence after macroscopically complete resection of tumor, and an indication for determining interval or even lifelong adjuvant therapy with imatinib according to guidelines. However, there is no consensus or universally accepted definition of tumor rupture, and, consequently, its incidence varies greatly across reported series and lacks detailed epidemiological data. Without pre-defined criteria, it is difficult to assess the clinical significance of rupture. We reviewed the relevant literature and international guidelines, and generally divided tumor rupture into spontaneous rupture and iatrogenic rupture. Based on the Oslo criteria, we proposed the following six definitions for tumor rupture: (1) tumor fracture or spillage; (2) blood-stained ascites; (3) gastrointestinal perforation at the tumor site; (4) microscopic infiltration of an adjacent organ; (5) intralesional dissection or piecemeal resection; (6) incisional biopsy. The following types of minor defects of tumor integrity should not be defined as rupture: (1) mucosal defects or spillage contained within the gastrointestinal lumen; (2) microscopic tumor penetration of the peritoneum or iatrogenic damage only to the serosa; (3) uncomplicated transperitoneal needle biopsy; (4) R1 resection. In addition, we further emphasize the importance of identifying risk factors of tumor rupture, prevention and positive intervention.

Construcción de definiciones operacionales en Metacognición / Construção de definições operacionais em metacognição / Construction of operational definitions in metacognition

Desde a década de 70 a metacognição vem sendo entendida como "conhecimento e cognição sobre fenômenos cognitivos". Sua conceituação, apesar disso, ainda se apresenta inespecífica, a maioria dos pesquisadores tende a negligenciar o estabelecimento de definições mais precisas sobre a metacognição. Assim, foi realizada uma revisão narrativa, com enviesamento intencional orientado para a produção de definições operacionais aplicáveis ao processo de aprendizagem, de modo a permitir operar as ações de descrição, discriminação entre os diferentes fenômenos metacognitivos, sua classificação e interpretação de significados. A taxonomia aqui apresentada consta de 03 domínios (Habilidade, Experiência e Conhecimento Metacognitivos), trazendo 36 definições operacionais de termos metacognitivos.

Desde la década de 70 la metacognición sigue siendo entendida como "conocimiento y cognición sobre fenómenos cognitivos". Su conceptuación, a pesar de esto, aún se presenta inespecífica, la mayor parte de los investigadores tendiendo a la negligencia el establecimiento de definiciones más precisas sobre la metacognición. Así, se realizó una revisión narrativa, con desviación intencional orientado la a producción de definiciones operacionales aplicables al proceso de aprendizaje, de modo a permitir operar as acciones de descripción, discriminación entre los distintos fenómenos metacognitivos, su clasificación e interpretación de significados. La taxonomía aquí presentada consta de 03 dominios (Habilidad, Experiencia y Conocimiento Metacognitivos), trayendo 36 definiciones operacionales de términos metacognitivos.

Since the 70s, metacognition has been understood as "knowledge and cognition about cognitive phenomena". Its conceptualization, despite this, is still unspecific, most researchers tend to neglect the establishment of more precise definitions about metacognition. Thus, a narrative review was carried out, with an intentional bias, oriented towards the production of operational definitions applicable to the learning process, in order to allow to perform the following description actions: discrimination between different metacognitive phenomena, their classification and interpretation of meanings. The taxonomy presented here consists of 03 domains (Skill, Experience and Metacognitive Knowledge), bringing 36 operational definitions of metacognitive terms.

Actualización de la bronquiolitis aguda / Acute bronchiolitis update

La bronquiolitis aguda es una condición respiratoria frecuente en los niños menores de 2 años. Representa la principal causa de hospitalización infantil y se caracteriza por la presencia de sibilancias asociada a signos de una infección respiratoria alta. El agente etiológico más común es el virus respiratorio sincicial. Existe una falta de consenso con respecto a su definición clínica; y por ello, su tratamiento varía en todo el mundo. El diagnóstico es clínico, sin necesidad de emplear laboratorio o imágenes en forma rutinaria. Diversas revisiones han demostrado que los broncodilatadores, adrenalina, corticoides y antibióticos, entre otros, carecen de eficacia por lo que no se sugiere su empleo. El tratamiento sigue siendo de soporte, mediante la administración de oxígeno y manteniendo una adecuada hidratación. Cuando no se logra disminuir el trabajo respiratorio o corregir la hipoxemia se puede utilizar la presión positiva en la vía aérea para prevenir y controlar la insuficiencia respiratoria. Este artículo desarrolla una breve revisión de las principales características clínicas, epidemiológicas, radiológicas, así como algunos de los diferentes tratamientos publicados en las últimas dos décadas.

Acute bronchiolitis is a common respiratory condition in children under 2 years old. It represents the main cause of childhood hospitalization characterized by the presence of wheezing associated with signs of an upper respiratory infection. The most common etiologic agent is respiratory syncytial virus. There is a lack of consensus regarding its clinical definition; and therefore, its treatment varies around the world. Diagnosis is clinical, without the need for routine laboratory or imaging. Various reviews have shown that bronchodilators, epinephrine, corticosteroids, and antibiotics, among others, lack efficacy, so their use is not suggested. Treatment continues to be supportive, by administering oxygen and maintaining adequate hydration. When it is not possible to reduce the work of breathing or correct the hypoxemia, positive airway pressure can be used to prevent and control respiratory failure. This article develops a brief review of the main clinical, epidemiological, and radiological characteristics, as well as some of the different treatments published in the last two decades.

SIRS o no SIRS: ¿es esa la infección? Una revisión crítica de los criterios de definición de sepsis / SIRS or not SIRS: Is that the infection? A critical review of the sepsis definition criteria

Resumen El enfoque moderno de la sepsis se ha centrado en la creación de consensos globales que utilizan distintos criterios para pesquisarla en forma precoz, con el fin de disminuir la morbimortalidad asociada a ella. Hasta la aparición del tercer y último consenso de adultos (Sepsis-3), el síndrome de respuesta inflamatoria sistémica (SIRS) fue el pilar diagnóstico utilizado por defecto en todas las edades. En Sepsis-3 se decidió retirar el SIRS, lo que generó un debate internacional sobre la oportunidad de dicho cambio. Esta revisión narrativa desarrolla la historia de las distintas definiciones de sepsis centradas en SIRS, las fortalezas, las debilidades y la pertinencia de los distintos elementos que ocasionaron el debate. Dada la ausencia de actualizaciones pediátricas en Sepsis-3, se hace especial énfasis en las implicaciones para las futuras definiciones de sepsis en esta etapa de la vida.

Abstract The modern approach to sepsis has focused on creating a global consensus with different criteria to early investigate it in order to reduce the morbidity and mortality associated with this complex entity. Until the third and last consensus of adults (Sepsis-3), the systemic inflammatory response syndrome (SIRS) was the diagnostic pillar used by default for all ages. In Sepsis-3, it was decided to withdraw the SIRS, which generated an international debate about the timing of such change. This narrative review develops the history of the different definitions of sepsis focused on SIRS, their strengths and weaknesses, and the relevance of the different elements that caused the debate. Given the absence of pediatric updates in Sepsis-3, a particular emphasis is placed on the implications for future definitions of sepsis at this stage of life

Ethics and Public Health: definition of priorities in the Mexican Health Reform / Ética y salud pública: definición de prioridades en la Reforma Sanitaria mexicana / Ética e saúde pública: definição de prioridades na Reforma Sanitária mexicana

Abstract The purpose of this paper is to discuss one of the most common ethical predicaments faced by public health practitioners: the distribution of limited resources for health. The question we address is the following: If there are limited resources to provide necessary health care, how can we reasonably establish priorities? We discuss this question using as reference a real-life situation, which was the establishment of priorities in the design of a package of high-cost interventions for Seguro Popular in Mexico, a public insurance scheme that extended social protection in health to over 50 million people between 2003 and 2018. The main conclusion of this paper is that the use of explicit ethical assumptions in the design of public policies contribute to their acceptability and eventual success.

Resumen El propósito de este artículo es discutir uno de los dilemas éticos que con mayor frecuencia enfrentan quienes se dedican a la salud pública: la distribución de recursos limitados para la salud. La pregunta a la que se pretende responder es la siguiente: si existen recursos limitados para prestar los servicios de salud necesarios, ¿cómo podemos fijar prioridades? Intentamos responder a esta pregunta haciendo referencia a una situación de la vida real que fue el establecimiento de prioridades en el diseño de un paquete de intervenciones de alto costo para el Seguro Popular de México, un seguro público que extendió la protección social en salud a más de 50 millones de personas entre 2003 y 2018. La principal conclusión de este artículo es que el uso de un marco ético explícito en el diseño de las políticas públicas incrementa su aceptabilidad y favorece su eventual éxito.

Resumo O propósito deste artigo é discutir um dos dilemas éticos que com maior frequência aqueles que se dedicam à saúde pública enfrentam: a distribuição de recursos limitados para a saúde. A pergunta que se pretende responder é a seguinte: se existem recursos limitados para prestar os serviços de saúde necessários, como podemos fixar prioridades? Tentamos responder a esta pregunta fazendo referência a uma situação de vida real que foi o estabelecimento de prioridades na concepção de um pacote de intervenções de alto custo para o Seguro Popular do México, um seguro público que estendeu a proteção social em saúde a mais de 50 milhões de pessoas entre 2003 e 2018. A principal conclusão deste artigo é que o uso de um enquadramento ético explícito na concepção das políticas públicas aumenta sua aceitação e favorece seu eventual sucesso.